11 Reconfigurations of autonomy in digital health and the ethics of (socially) assistive technologies

In this contribution the ethical impact of socially assistive technologies is analyzed against the background of digitalized healthcare and medicine in a thoroughly “data-fied” society in general. Socially assistive technologies such as smart home sensors and carebots raise ethical issues which are continuous with other technologies in this cluster (e. g. health-related apps, telemonitoring) but their application in the context of particularly vulnerable populations such as elderly persons also appears to ex-pose the limitations of established medical ethics and technology assessment tools starkly. While some specified analytic and ethical tools have already been developed, the meaning and scope of the underlying ethical criteria and reference concepts themselves is changing further. This will be illustrated by focusing in on reconcep-tualizations of (personal) autonomy such as the shift from patient autonomy to user or consumer autonomy, the vision of empowered autonomy in participatory, democratic care and medicine, and the effects of a prospective “autonomy” of the devices themselves. A broader discussion of assistive technologies along these lines may help accommodate the often precarious internal capabilities for self-determination in the elderly and/or vulnerable, and avoid neglect of important contextual and external factors to support and promote autonomy as an ethical cornerstone also in digital health.