Vol.:(0123456789)
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AI & SOCIETY (2022) 37:467–477
https://doi.org/10.1007/s00146-021-01206-z
ORIGINAL ARTICLE
A critique ofrobotics inhealth care
ArneMaibaum1· AndreasBischof2· JannisHergesell1· BenjaminLipp3
Received: 9 April 2020 / Accepted: 25 March 2021 / Published online: 16 April 2021
© The Author(s) 2021
Abstract
When the social relevance of robotic applications is addressed today, the use of assistive technology in care settings is
almost always the first example. So-called care robots are presented as a solution to the nursing crisis, despite doubts about
their technological readiness and the lack of concrete usage scenarios in everyday nursing practice. We inquire into this
interconnection of social robotics and care. We show how both are made available for each other in three arenas: innovation
policy, care organization, and robotic engineering. First, we analyze the discursive “logics” of care robotics within European
innovation policy, second, we disclose how care robotics is encountering a historically grown conflict within health care
organization, and third we show how care scenarios are being used in robotic engineering. From this diagnosis, we derive
a threefold critique of robotics in healthcare, which calls attention to the politics, historicity, and social situatedness of care
robotics in elderly care.
Keywords Social robotics· Health care· Innovation policies· Care robots· Care crisis
1 Introduction
When the social relevance of robotic applications is
addressed today, the use of assistive technology in nursing
settings is almost always the first example (Hergesell etal.
2020). Of all conceivable applications, the image of the
humanoid robot that autonomously and unerringly fetches
a glass of water for senior citizens seems omnipresent. The
assertion that robots will help care for a growing elderly
population is never really questioned. However, despite this
future vision, there is little evidence that such robots will
exist any time soon. First, in technological terms, autono-
mous, humanoid robots are nowhere near ready for use in
care or other real-world settings involving (physical) contact
with people. Second, there is currently little demand for gen-
uine care work done by robots. Neither caregivers nor care
recipients have expressed explicit interest in robotic appli-
cations (Smarr etal. 2012; Krings etal. 2018; Pekkarinen
etal. 2020). Scenarios proposing this are usually rejected
(Sparrow 2016). Furthermore, there are many doubts about
the broader ethical (Sharkey and Sharkey 2012) and legal
(Beck 2016) issues around using robots for care.
Even though, in recent times, more projects have
sought to align their research efforts with actual care needs
(Sabanovic 2014; Riek 2017; Jeon 2020), criticize anthropo-
morphic robot ideas (Duffy 2003; Sandini and Sciutti 2018;
Weber 2005) or use participatory methods (Hornecker etal.
2020; Björling and Rose 2019; Lee etal. 2017; Lee and Riek
2018) this is still not a mandatory requirement in mainstream
robotics research. This discrepancy between the poor suita-
bility and acceptance of care robots and the massive political
and scientific investments in this field makes care robotics
an especially pertinent site for critical inquiry.
In our paper, we scrutinize this powerful interconnection
of social robotics and elderly care within three arenas: inno-
vation policy, care organizations, and robotics engineering.
* Arne Maibaum
arne.maibaum@tu-berlin.de
Andreas Bischof
andreas.bischof@informatik.tu-chemnitz.de
Jannis Hergesell
jannis.herg[email protected]
Benjamin Lipp
1 Institute forSociology, Technical University Berlin,
Fraunhoferstr. 33-36 (FH 9-1), 10587Berlin, Germany
2 Chair Media Computing, Chemnitz University
ofTechnology, Strasse der Nationen 62, 09111Chemnitz,
Germany
3 Technical University Munich, Arcisstr. 21, 80333Munich,
Germany
468 AI & SOCIETY (2022) 37:467–477
1 3
In the first section, robotics and elderly care are rendered
available for one another through claims of impending
demographic change. This connection is not self-evident but
rather enabled by a number of pervasive themes specific to
the context of (European) innovation policy. For example,
independent living constitutes a major resource for legiti-
mizing the application of robots in older people’s homes. In
the second section, we show that when robotics technolo-
gies are used in the field of care, they are not a neutral entity
intervening in an unoccupied field. Instead, we address how
the introduction of robotics interacts with ongoing conflicts
in the history of elderly care between economic and care-
related interests. In this respect, robotic care is not a solution
to the “crisis of care”, but also becomes a vehicle to turn the
conflict in one direction. In the third section, we analyze
how care is made an object of robotic engineering and show
the epistemic reasons for the development of care robotics.
From this perspective, we reconstruct how, of all possible
applications, the areas of health care and nursing fit the
requirements and conditions of robotics and human–robot
interaction (HRI).
Our analyses give tentative examples of what a multi-
dimensional critique of care robotics can offer. It calls atten-
tion to the manifold biases in the current regime of care
robotics and shows its politics, historicity, and social situat-
edness. Each of the sections can be understood as a stand-
alone analysis of the phenomenon, yet none explains the
entire phenomenon.
Overall, this critique will offer a reflexive explanation of
why care robotics has become a discursive solution to the
nursing crisis and shows that the technology development
at its current state is not a solution at any level. Instead, we
need to instigate a critical debate about the political, organi-
zational, and epistemic assumptions built into much of the
work directed at making robotics a solution in elderly care.
2 Innovation policy: European innovation
policy andthediscursive “logics” ofcare
robotics
Care robotics is first and foremost a political reality. The
vision of robots solving the “healthcare challenge” (Ford
2015, 145ff) has been especially successful in policymakers’
meeting rooms and documents around the globe. A promi-
nent example is Japan, where the notion that (humanoid)
robots are already caring for people due to demographic
pressures and cultural affinities is in fact still a heavily subsi-
dized political fiction (Wagner 2013). Similarly, those look-
ing for the “robot revolution” in European care homes and
hospitals will still find themselves searching in vain. Never-
theless, care robotics has become an arena of political inter-
est that is not only publicly debated (European Commission
2015a) but also heavily researched and funded (European
Commission 2016a, 2017). This is a rather recent phenom-
enon. A mere 20years ago, almost nobody talked about this
vision, let alone invested public money in it. Neither elderly
care nor robotics featured in the EU’s work programs and
policy agendas. Since then, it has gradually established itself
on the European stage as the contingent product of a range
of technological, social, and, especially, political processes
(for a more extensive sociological analysis of this, see Lipp
2019).
Hence, a critique of care robotics should not take the
link between robots and elderly care for granted but rather
investigate how it could become a political reality in the first
place. Therefore, we ask: What are the discursive logics of
care robotics and how have they shaped our idea of what
care robots are and what they are for? To answer this ques-
tion, we follow Michel Foucault’s genealogical “method”
(Foucault 1997a, b). This perspective does not enquire into
the rationality of a given phenomenon, e.g., by asking “Is
care robotics a rational response to demographic change?”
Rather, it looks at how a given discourse constructs a cer-
tain phenomenon as rational. Hence, investigating discur-
sive “logics” of care robotics means asking: Under what
conditions and given which kinds of assumptions could the
vision of robots in care become plausible. To use Foucault’s
language, how has this discourse been able to talk about it
as a matter of course?
We will do this by analyzing three prominent themes of
recent European innovation policies, which, in our view,
have rendered the vision of care robotics a political pos-
sibility: the silver economy, active and healthy ageing, and
independent living. While these phenomena are not entirely
discrete, we will take each of them as an opportunity to
enquire into the way care and robotics have been rendered
compatible.
2.1 The silver economy
In industrial societies, old age has for the most part been
framed as a problem of productivity. In this context, elderly
people fall “out of the field of capacity” (Foucault 2003,
244), because they are not deemed fit or productive enough
for industrial labor. As a result, an ageing population has
mostly been seen in deficient and alarmist terms, i.e., as “a
rapidly growing population of needy, relatively affluent per-
sons whose collective dependence is straining the economies
of Western industrialized nations” (Katz 1992, 203). These
ageist stereotypes persist with terms like the “ageing tsu-
nami” (Barusch 2013), setting the tone for how elderly peo-
ple are perceived within the present socio-economic order.
Yet more recent discourses of European innovation
policy provide a stark contrast to those “alarmist” accounts
described by Katz. European initiatives subscribe to a
469AI & SOCIETY (2022) 37:467–477
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“positive vision on ageing” (EIP on AHA 2011). Following
the World Health Organization’s concept of “Active Age-
ing,” demographic change is seen as “one of humanity’s
greatest triumphs” (WHO 2002, 6). Furthermore, the Euro-
pean Commission has urged member states to view ageing
as an opportunity to grow a “Silver Economy” (EC 2015b, 8)
instead of as a hindrance to growth. Here, health managers,
engineers, tech businesses, and policymakers imagine that
an increasing number of elderly people will create a new
“silver” market of consumers, which new industries must
cater to. Hence, according to this logic, the elderly popula-
tion should not be primarily perceived as “unproductive”
or “dependent” but rather as a new group of consumers and
users of assistive technology. Specifically, the affluent, fit,
and “young old” adults are heralded as the new archetype
of old age (Neilson 2006). In turn, this excludes old people
who do not conform to such bio-political ideals of fitness
and spending power. It also reduces ageing to needs and
experiences that can be satisfied through consumption and a
logic of care provided through market relations (Mol 2008).
In this context, robotic innovation promises “to transform
lives and work practices, raise efficiency and safety levels,
provide enhanced levels of service and create jobs” (SPARC
2013). This general promise has mainly been derived from
the application of robotics in industrial contexts (ibid., 15),
where, in the past decades, production has increasingly been
automated. What is surprising here is the transfer of this
promise to elderly care—an area that is in no way similar
to robots’ traditional domains and where robots still have
to prove that they are a viable solution at all. This is not
to say that they cannot be. However, the ease with which
this assumption is accepted is problematic. This intercon-
nection can only work because of a political rationality that
assumes that robotic innovations are a solution to demo-
graphic change, because it also fits into a certain regime of
marketization. The project of care robotics is tightly linked
to agendas of competitiveness, economic growth, and indus-
trial policy. Robotics is seen as a vital future market, one in
which Europe cannot lag behind. We must understand why
these overlapping policy agendas are crucial if we are to
grasp why robotics and care seem to fit so neatly together.
As a result, ageing has become a topic for the future to be
exploited by cunning entrepreneurs and innovative engineers
(Adam and Groves 2007: 57ff). At least within the particu-
lar context of innovation policy, old age is not tackled in
alarmist terms but rather as an occasion for establishing new
links between elderly people’s everyday lives and digital
consumerism.
2.2 Active andhealthy ageing
The theme of “active and healthy ageing” within Euro-
pean framework programs has been crucial in enabling the
interconnection of robotics and elderly care. Partly, this is
due to how the European Commission re-organized its fund-
ing policies a decade ago. Especially, the fifth framework
program (FP5) introduced a “[n]ew integrated problem-
solving approach” that replaced the former science-based
approach (European Commission 2016b). This means that
the funding agenda is not organized according to specific
disciplines anymore but is instead differentiated by key
actions “integrating the entire spectrum of activities and
disciplines” needed to solve a given societal problem (ibid.).
This means that research and development agendas in areas
like robotics are increasingly concerned with and shaped by
political expectations of usefulness. In this context, the topic
of robotics has become intimately connected to the concern
of an ageing society.
In the beginning of the 2010s, “active and healthy ageing”
(AHA) emerged as an overarching theme further integrat-
ing formerly separated work programs on health, ageing,
and digital technology. As pointed out above, these devel-
opments have been underpinned by a new understanding of
ageing. Particularly, active ageing expands what “health”
means and broadens the disciplinary scope from a purely
(bio)medical point of view to various forms of (social)
health sciences. In this context, “active ageing” not only
means being physically or mentally well but also being
socially included in society. This opens up a new playing
field for robotics to assist the elderly in their everyday lives.
This is evidenced by the fact that the EU began to view
the challenge of advancing AHA “with … [s]ervice robot-
ics within assisted living environments” (EC 2015c, 29) as
increasingly urgent. Hence, the biomedical gaze on elderly
care and ageing is now being complemented—if not at times
displaced—by technical disciplines, such as engineering,
computer science, and robotics. Here, the “cross-thematic
approach” of active and healthy ageing serves as a new logic
that links robotics and elderly care, which can be witnessed
in the emergence of further initiatives such as the “Ambient
Assisted Living” program.
At the same time, elderly care is an appealing area to test
the new paradigm of robotics. Here, the focus on robotic
assistance marks an epistemic and technological shift within
the discipline. While industrial robotics usually operate in
closed factory cages, assistive robots are explicitly intended
for lay user interaction. This gives rise to a range of new
requirements for robots and, incidentally, new ways of doing
robotics, which are often subsumed under terms like “new
robotics” (Schaal 2007). This is due to the fact that a setting
such as a household is a much less controlled one than a fac-
tory production line and, hence, a more chaotic environment.
This makes a difference for robot development, because to
interact with humans, roboticists must engineer robots as
“independent entities that monitor themselves and improve
their own behaviors based on learning outcomes in practice”
470 AI & SOCIETY (2022) 37:467–477
1 3
(Matsuzaki and Lindemann 2016, 501). This affords new
kinds of technical capabilities, for which the uncontrolled
environment of the (care) home provides an appealing—i.e.,
challenging—testbed.
2.3 Independent living
The demarcation of daily assistance and the interconnection
with assistive robotics highlights the value of independent
living, which is a prominent feature of care robotics pro-
jects. Similar to what we have described in the context of
AHA, independent living defines good ageing as “the ability
to perform functions related to daily living” (WHO 2002,
13). This not only focuses on the elderly person’s lifeworld
and lifestyle (as opposed to their medicalization) but also is
embedded within a wider imaginary of how to (re-)organ-
ize European healthcare systems. Within the context of EU
innovation policy, independent living is positioned as a way
of relieving European healthcare systems of their burdens as
such systems are increasingly under pressure due to demo-
graphic change, limited public funding, and a lack of skilled
personnel. Here, the idea is that robots will help by prevent-
ing “avoidable/unnecessary hospitalisation” (EIP on AHA
2011, 4), i.e., by assisting elderly people in their home and
thus allowing them to live independently for longer. Here,
independence is reframed as relative autonomy from and
lower utilization of institutionalized care.
The theme of independent living renders care and robot-
ics compatible in two ways: it re-defines care as (de-hospi-
talized, personalized, temporary) assistance and, at the same
time, casts robots as a (de-institutionalizing, disburdening)
response. The idea of using robots as an alternative to insti-
tutional care dates back to the very beginning of service
robotics. As early as the 1980s, robotics pioneer Joseph
Engelberger imagined robots “aiding the handicapped and
the elderly” (Engelberger 1989, 210). Interestingly, in his
book on service robotics, he positioned the use of assistive
robots in care vis-à-vis institutionalized forms of care, at a
time when the actual application of such machines was still
considered a far-off vision.
Here, being assisted by robots in a “robotised private
abode” (ibid., 217) is described as a more desirable alterna-
tive to the—in his eyes—disastrous conditions in nursing
facilities. While Engelberger does not extend his account
of institutionalized care, he discusses how robots could be
useful to the elderly and how they might even be preferable
to human caregivers. This relates to particular tasks, such
as “food preparation” or “social interaction”, certain robotic
capabilities, such as “dialog” or “grasp”, and more general
characteristics of robots that render them desirable, such as
the fact that robots do not need “personal time” (ibid., 215)
or could sustain the elderly’s “unrelenting loquacity” (ibid.,
216). Apart from the condescending tone, these quotes show
that the discursive logic of assistive robotics converges with
the political rationale of “de-hospitalizing” European health-
care systems. Robotics functions here as a “private” care
technology, which renders publicly organized care obsolete.
This leads us back to the question of how exactly care is
understood in this discourse. Assistive robotics defines care
indirectly in terms of particular assistive tasks or robotic
capabilities specialized to perform such tasks. This is not
only true for early examples of service robotics but in fact
constitutes a central design philosophy in care robotics. To
render itself relevant in elderly care, robotics identifies dis-
tinct everyday “problems that older people face” (Robinson
etal. 2014, 577), which can then supposedly be met using
specialized robotic capabilities. Hence, when the innovation
policy discourse talks about care in connection with service
robots, it is presupposing a particular logic of care (Mol
2008). This is a more or less fixed set of dissectible tasks,
which can be carried out at the point of need without the
institutionalized infrastructure of hospitals and care homes.
3 Care organization: care robots
asasolution toahistoric conflict
ininpatient elderly care
Despite being a largely political, we can show that the dis-
cursive success of the care robot has had real consequences
for health care organization. When robotics technology
enters the field of elderly care, it does not occur in a vacuum.
We address a historic conflict in elderly care organization
and show how the introduction of care robots has changed
the constellation in this conflict. We argue here that care
robots are successful not because they offer practicable solu-
tions in everyday care practice, but because they resolve a
historic conflict between economic and professional–ethi-
cal interests that has existed since the emergence of elderly
care (Hergesell 2019). In the second section of our critique
of care robots, we look at the organizational structures of
elderly care as well as the enforcement of partial interests in
the context of care robotics. We draw on empirical (Herge-
sell and Maibaum 2018) and historical (Hergesell 2019) data
about care in Germany.
Today the need for care is observably increasing just as
working-age populations are shrinking, which is resulting
in a decline in nursing staff, less care by family members,
and fewer contributors to social security systems, which
are all expected to accelerate in the future. This phenom-
enon—described as the “nursing crisis”—threatens afford-
able, skilled care provision. Despite various attempts to avert
this crisis, such as reforms of care insurance or recruitment
campaigns, the most discursively prominent solution is tech-
nology. Technology promises to relieve and support caregiv-
ers, optimize work organization, and increase the efficiency
471AI & SOCIETY (2022) 37:467–477
1 3
of care work (Hülsken-Giesler and Krings 2015). In short,
promoted by political actors, healthcare technologies, and
prominently robotics claim the capacity to address all the
current problems of nursing care and provide a promising
solution for the future of the elderly.
However, as pointed out, neither the demand for care
robots nor the current technological possibilities are in line
with this notion. The question arises of why robotics is cur-
rently perceived as an effective and reasonable solution
strategy for the problems of nursing care. We argue that it
is not only the novelty of the technology but an underlying
historical conflict that is being litigated via the deployment
of this new technology.
We will show that since the emergence of geriatric care,
there has been a fundamental conflict between economic,
professional, and ethical care concepts and that this care
conflict shapes the phenomenon of care robots. By consid-
ering this conflict, we become more aware of the current
effects of care technologies and their potential consequences
for the “historically grown” (Weber 2002) structures of
elderly care than when considering them through a purely
present day, often techno-euphemistic analysis.
3.1 The historical care constellation
andthestructural conflict
To illustrate this conflict, we take a brief look at the socio-
genesis of nursing care. In the late nineteenth century, old
age was increasingly perceived as a phenomenon of the wel-
fare state, which had to be regulated based on economic
conditions and bureaucratic administration (Kondratowitz
1990). At the same time, a differentiation of the inpatient
facilities responsible for the care of elderly people began.
The numerous new retirement homes required a new type
of staff. The traditional “warders” were gradually replaced
by mostly female staff, who were entrusted with activities
specific to elderly care, thus starting the professional devel-
opment of inpatient geriatric care (Irmak 2002). In this
period, a structural conflict emerged that still dominates the
discourse of the health sector in modern welfare states today:
while caregivers increasingly developed their own profes-
sional and ethical care concepts, political and administrative
actors with an interest in a rational-efficient administrative
logic and more cost-effective care influenced nursing care.
This structural conflict has led to today’s demand for care
technologies.
A shift from care concepts limited to basic care or “keep-
ing safe” towards more positive, solidarity-based guiding
principles did not occur until the 1960s (Kondratowitz
1990). “Old age” developed into an economically secure
and meaningful phase of life. As a result, there was an up-
skilling process for the caregivers, who were increasingly
allowed to carry out care work independently and were
required to implement the socially desired concepts of old
age and care on their own. The focus was on psychosocial
care, which included the maintenance of autonomy, sup-
ported by professional caregivers (Heumer and Kühn 2010).
Thus, the formerly dominant instrumental–economic logics
of political actors lost their interpretive authority. The pro-
fessionalized caregivers were increasingly able to prioritize
their concepts of professional care, which focused on care
recipients’ quality of life. Political and administrative actors
could, therefore, no longer play the dominant role in the
structural conflict in elderly care.
From the 2000s onwards, it became more urgent to find a
solution to the structural conflict underlying the nursing cri-
sis. As shown in the first section, political actors were under
increasing pressure to present solutions to the problems of
elderly care. However, conventional attempts to overcome
this problem—for example, by reforming nursing legislation
or recruiting foreign workers—were largely unsuccessful.
Demand for a significant increase in personnel and indi-
vidual nursing concepts were limited by economics. The
result was a stalemate between the conflicting care concepts
(Hergesell 2019, 234–239, 297f).
The discursive success of care robots must be under-
stood against the background of this conflict. Today, elderly
care finds itself in a situation in which all interests must be
considered when developing (technological) solutions. The
prominence of robotic care applications is thus not primar-
ily due to their actual use in everyday care but rather relates
to the discursive integration of the historically grown con-
flict between professional care and instrumental economic
interests. Care robots promise to enhance the quality of care
and ensure professional standards, as well as to enable more
efficient care organization and reduced costs.
3.2 Care robots asameans ofconflict resolution
inelderly care
This situation means that robotics-centered projects are not
coming in a “vacuum” in which only the functional fea-
tures and performance of the care robots are relevant. The
technology is not neutral. This is especially true when care
robots—whether strategically intended or not—intervene in
the historically grown conflict. Developers must understand
that their technology will constitute a tool for the conflict-
ing logics.
In contrast to the promise of the care robot, we observed
that robotic technology has not led to an integration of inter-
ests; instead, the involvement of engineers and technology
developers and their understanding of care have led to a shift
in the historically grown conflict. We illustrate this with an
example of the conflicts and misunderstandings that occur
during participatory technological development.
472 AI & SOCIETY (2022) 37:467–477
1 3
At the beginning of the process, a needs analysis is car-
ried out, which aims to match the interests and problems of
caregivers with those of administrative actors and technology
developers. The needs analysis indicates that, from the car-
egiver’s perspective, everyday care should be designed to meet
the individual needs of the care recipients. The care provided
is supposed to exceed mere basic care—it should guarantee
quality of life and respect the dignity and autonomy of the care
recipients. To fulfil these objectives, highly qualified nurses
should be deployed and work should be organized to provide
sufficient time.
In contrast, the administrative actors and funders’ perspec-
tive focuses on the financial feasibility and legal aspects; these
include the clawback of costs or compliance with legal stand-
ards and effective work organization. Their focus is less on
individual cases but on the handling of economic resources.
They want to achieve these goals by increasing efficiency,
which means using resources efficiently and reducing costs
by avoiding care work deemed unnecessary.
During a needs analysis for care robots, the demands of
both groups may seem to match: The caregivers expect tech-
nology to free them from noncore care tasks such as filing
or repetitive control chores and thus allow them to focus on
giving care and preserving recipients’ autonomy. The funders
see the demand for autonomy as the least disruptive interven-
tion from the caregivers in the lives of the care recipients:
Autonomy can be guaranteed, especially in outpatient care,
by monitoring the care recipient’s physical safety, which sub-
stitutes for the physical presence of caregivers. So, even if the
groups lexically use the same notion of autonomy, they never-
theless aspire to very different objectives. Although the same
vocabulary is used, the relevant actors are referring to fun-
damentally different meanings. In the current situation, both
groups are not equal in their capacity to impose their logic on
the other. Because funding, development, and implementation
are controlled by the technology developers and administrative
actors, their economic–instrumental interpretation of care is
inscribed into the technology (Hergesell and Maibaum 2018).
Hence, a sociohistorical analysis helps to understand that
development processes for care robots and the complex inter-
ests, care concepts, and power relations involved. In this set-
ting, robotics technology cannot expect to be a neutral tool
that will develop to meet everyone’s needs. Even if this is not
always a conscious intention, the demand for care robots is
also an efficient strategy for political and administrative actors
to assert their interests.
4 Robotic engineering: theepistemology
ofbuilding robots andits implications
forcare scenarios
We have shown how the idea and goal of care robotics
can become a catalyst both on the discursive level for
innovation policies and on the organizational level for the
field of care. The desirability of care robots is fed by a
third strand, the epistemic conditions of robot develop-
ment. When constructing robots for applications outside of
laboratories, their developers are subject to specific socio-
technical conditions that form a subsequent context for
care robots in both discursive and manifest ways (Bischof
and Maibaum 2020). To understand how robotics can care,
one must first understand the challenge of building robots
for everyday worlds. For the theoretical, methodological,
and technical instruments of robotics, everyday worlds—
like care scenarios—are on the absolute outer limits of
workability (Bischof and Maibaum 2020). The designers’
understandings of the social situation become the core
of the epistemic practices of social robotics (see Bischof
2017, 213 ff). Both the attractions and the problems of care
delivered by robots thus lie in the fact that robot-delivered
care goes beyond the previous limits and possibilities of
robotics: If care robotics were to be understood primarily
as a technical enterprise, the extent to which its epistemic
conditions configured the addressed users and the situ-
ation of use would remain invisible (cf. Woolgar 1990;
Oudshoorn etal. 2004).
When seeking to describe and explain this epistemic
context of robot development for care robotics, the main
challenge is to show what roboticists actually do—that is,
how they try to fix social phenomena such as care techni-
cally and scientifically. For this purpose, we will briefly
describe typical patterns of robot development for care
scenarios. These two cases show how the addressed users
are configured by the development practices (Woolgar
1990; Oudshoorn etal. 2004) and how the social institu-
tionalization of care practices facilitates the development
and implementation of robotics scenarios. Finally, we will
observe that the actual implementation work in care robot-
ics—“making the robot work”—rarely follows the needs of
the users, but rather the epistemic and technical conditions
of robot development: The assumed “users” of care robots
appear in very narrowly defined roles, as the persons to be
treated, who are integrated within rationalized routines.
To understand how the epistemic conditions of health-
care robotics affect research and development practice, we
conducted ethnographic fieldwork and interviews in five
robotics in health projects in Europe and the United States
(Bischof 2017). At first glance, care robotics projects look
very similar: Robots are used in care environments and
473AI & SOCIETY (2022) 37:467–477
1 3
the results are measured. The characteristic difference that
we will show in two examples is how care is operational-
ized as a project goal—either as a successfully measur-
able intervention in a field of practice or as a technical
challenge. The mode of incorporating empirically existing
care situations into the development diverges accordingly:
is the goal to make robots function for a certain existing
situation or rather to abstract from it to create a transfer-
able—universal—solution? Both types imply modes of
decontextualization from care practices, as the cases will
show.
4.1 Constructing asakey epistemic mode
By the paradigm of constructing, we mean practices that
aim to make a functioning robot technically feasible. When
this epistemic mode is applied in a care context, it leads to
an understanding of care as a “task” to be completed by the
robot. Therefore, subsets of practices, i.e., serving a glass of
water, are transformed into a cascade of actions, for which
applicable rules need to be disclosed. The technical mem-
bers of a project team need concrete specifications against
which they can test and measure the system. Supposedly
meaningful tasks can also be made up or staged for this pur-
pose—for example, if no such real-life operational situation
is accessible. The “home assistance” case that was assessed
by Bischof (2017, 202 ff.) via participant observations and
subsequent expert interviews illustrates this.
For the first user tests in this EU-funded project, two con-
crete tasks were operationalized, which are now being car-
ried out with older people as test persons for the first time.
This is being done in a “living lab”, which is designed like a
living room, including a kitchenette with refrigerator. Dur-
ing the test, the seniors sit on the sofa and are supposed to
maneuver a butler-like robot with a tablet computer through
the tasks assigned to them. One task is for the robot to take
a water bottle out of the refrigerator. Since this is the first
user test, many problems are expected to occur. The test
leader, who sits on the sofa next to the test subjects, often
has to moderate during breaks caused by non-functioning or
explain again what the task is. The biggest problem, how-
ever, is that the robot cannot open the refrigerator door itself
due to technical difficulties in controlling the gripper. For
this reason, the test persons have to get up themselves dur-
ing the water fetch task, walk to the refrigerator about three
meters away, place the bottle on a kind of tray for the robot
and sit down again so that the bottle can be brought to them.
Getting up is tedious for some test persons (some with a
walking stick, one even with a walker). At the refrigerator
and on the way back, there are repeated coordination prob-
lems between the robot and the test persons when they pass
the invisible laser scanner and the machine stops for safety
reasons.
It would contradict the idea of a test to expect it to work
smoothly on the first occasion. Indeed, user tests are carried
out to identify problems. The coordination between spatial
conditions, different hardware components, operating soft-
ware on the tablet computer and, last but not least, the test
manager, the engineers, and the test subjects is complicated
and time-consuming. However, the specific decontextualiza-
tion of the actual care practices that results from the decom-
position of human–robot interaction into tasks becomes
evident.
The decomposition of human–robot interaction into tasks
that are modeled as technical problems creates a reality of
its own. The researchers see themselves as objective observ-
ers who want to observe “natural” human–robot interaction
(Woolgar 1990, 84f.). At the same time, a number of coinci-
dences and accidents occur in the test that makes their inter-
vention necessary. Instead of the tasks showing “natural”
user behavior, it is evident that many practices of technical
and social debugging are necessary to fulfill the intended
task. Second, the contexts and meaning of assistance in the
household must be subordinated to the developmental logic
and suspended over many project steps. In this case, this may
mean that the tested interaction no longer produces a mean-
ingful equivalent in the intended use context. The observed
test, however, serves to maintain this well-formed (technical)
problem—which is just not solvable at the moment of test-
ing. In such “tasks,” the user becomes a system component
that also determines the execution of the task and must be
configured accordingly with the help of test runs, operat-
ing instructions, and moderated use. Overall, this example
from the constructing type shows a typical time sequence,
in which conditions and knowledge from concrete assistance
or care scenarios are obtained at the very beginning of the
project and then technically narrowed down. Subsequently,
the majority of the available resources are invested in techni-
cally resolving the defined problem. Concrete living environ-
ments or notified user groups are only created at the end of
the project or at the beginning of the project.
4.2 Applying robots asakey epistemic mode
Projects with the goal of applying care robots aim to prac-
tically implement human–robot interaction in a concrete
setting. This typology is often characterized by the partici-
pation of nontechnical experts—for example, from gerontol-
ogy, nursing science, or medicine. Care robotics of this kind
is understood as pioneering research that prepares and tests
the use of robots in care and tends to generalize from the
specific application scenario they design for.
In such development processes, users such as nursing staff
or relatives, who are actually secondary and tertiary users,
become relevant for the engineers. This is because the spe-
cific application and test areas of such projects are located
474 AI & SOCIETY (2022) 37:467–477
1 3
in highly institutionalized settings such as care facilities or
hospital wards. The necessary formalization of human–robot
interaction, therefore, often occurs according to the organi-
zational and institutional conditions of care practices. An
example of this is an early case in which the Paro robot
was used in a European care facility in 2008 (cf. Bischof
2017, 198 ff). The decision to use the Paro robot was made
on the basis of its readiness for use, especially since it had
CE certification and thus met the insurance requirements.
However, on their way into the field, the researchers faced
some rejection regarding the use of the robot in specific care
facilities. Either nursing staff members were unwilling to
participate in the study or relatives did not give written con-
sent to let their senile parents or grandparents participate in
the experiment. Therefore, the research team decided to wait
until the Ministry of Health approved the research protocol.
Following this step and several presentation workshops to
demonstrate the robotics platform, six nursing homes, their
staff members, and the relatives of 80 patients participated
in the experiment.
The project did not seek to compare different robots or
robot characteristics. The motivation was rather to carry
out and test the use of a robot in inpatient care. The opera-
tionalization of the measure of effectiveness clarifies the
type of reference to the field of application: Nursing staff
members were to assess via questionnaires whether the
use of the robots (positively) influenced the nursing rou-
tine. In addition, a medical indication scale of the dementia
patients’ wellbeing was applied, which was also based on
staff assessments.
So, much of the researchers’ work consisted in establish-
ing their field access. The communication with the different
authorities, actors, and requirements in this process can be
understood as “boundary work” (Gieryn 1983). These are
social negotiation processes about the circumstances under
which the use of robots in this field of application is permis-
sible, possible, desired, and feasible. The reasons for rejec-
tion ranged from ethical concerns to problems in adapting
the duty rosters such that the 4-month test design could be
carried out in the already limited time in the morning rou-
tine. In addition to the experimental results, the real achieve-
ment of the project was, therefore, to have established an
initial fit between the intended field of application and the
proposed solution.
Thereby, this test showed how different users were con-
stituted and configured. Such tendencies were already evi-
dent in the “top down” course of stakeholder involvement:
from political organizations to economic units, from staff to
family members. In contrast, the supposed primary users,
the dementia patients, do not appear directly in the scenario
development. They are often the subject of the researchers’
efforts, for example, as legal subjects regarding consent pro-
vided by their legal proxies or as consumers with reference
to the CE mark, and also in the discursive justification of
the goal to increase the quality of life for the elderly. This
can be justified from a practical and methodological point of
view in the case of dementia patients with limited cognitive
abilities. For the developmental practice described above,
however, the fact that the dementia patients appear as the
treated persons, who are already integrated into rationalized
daily routines, is constitutive. The actual implementation
workers then followed the secondary users, i.e., the nursing
staff who ultimately implemented the test.
4.3 Care robotics’ decontextualizing epistemics
Care becomes the subject of robotics under certain epistemic
conditions. Innovation policy (see 1.) and the historic con-
flict within care organization (see 2.) are such conditions.
By highlighting typical project modes, we showed how
“care” is epistemically framed as a problem to be solved in
robotics. This leads to two modes of decontextualization of
actual existing care practices. The deconstruction of care
practice into “tasks” leads to a decontextualization context
in which the meaning of the practices is mechanized—up to
the point where the scenario completely ceases to function.
Instead, the focus is on defining a well-defined (technical)
problem. Many rather implicit aspects of care practices are
thereby hidden. But even projects that are motivated by the
goal of applying robots in “real-world” care settings exhibit
an epistemology of decontextualization. They focus mainly
on the conditions of the institutional context and not on
the needs of the primary users, who were surveyed sepa-
rately. The persons to be cared for manifest as “personas”
who are integrated in a heavily institutionalized context,
as is the case for the entire health care system. They may
not, in principle, be defenseless inmates of a total institu-
tion (although this is certainly true for advanced dementia
patients in nursing homes) (Goffman 1961), but as subjects
they are almost exclusively seen in their largely transfer-
able role as patients or persons in need in an institutional
setting that sets the rules. The fact that care facilities and
many care settings are a highly structured area of everyday
life contributes to this decontextualization. Here, there are
already complexity reductions that help roboticists to define
a technical “scenario”. The “users” appear in a very specific
role—as those to be treated—who are integrated in rational-
ized routines. Although user-centered or even participatory
methods are increasingly applied in HRI context (Hornecker
etal. 2020; Björling and Rose 2019; Lee etal. 2017; Lee
and Riek 2018), the use of such methods itself does not
protect against decontextualization of the social situation
of use. Both examples of care robotics projects presented
here understood themselves as user-centered design. Even
participatory methods configure future users in specific ways
(Bischof and Jarke 2021), critical analysis needs evaluate
475AI & SOCIETY (2022) 37:467–477
1 3
time points and involved actors and especially use of the
accumulated data for later design decisions to prevent decon-
textualization of social situations of use.
5 Conclusion andcritique
In all three arenas, we have shown that the discursive success
of autonomous humanoid care robots cannot be explained
by their abilities alone—either current or projected. Instead,
our analysis shows how the interconnection is socially con-
structed, i.e. part of a particular regime of care robotics that
narrows down the range of available challenges and solu-
tions. Acknowledging this, opens up the topic for contesta-
tion and critique by showing its constitutive contingency.
While we analyzed each level separately, they are in
fact highly interdependent. The interplay between the are-
nas described above can be illustrated as a feedback effect
within a loop where assumptions in one arena travel and
shape activities the other arenas (see Fig.1).
For instance, funding priorities set in innovation policy
shape the epistemic practices of robotics projects. Here,
the expectation to “fix” demographic change by building
autonomous machines narrows the scope of such projects
to merely technical aspects and implies a linear innovation
model. This means that user needs and application sce-
narios are mostly set at the beginning of research projects
instead of being iteratively negotiated with care personnel
and older users inside the care organization, with consid-
eration for its power structures. From there, engineers tend
to deconstruct care practices irrespective of their context
while disregarding their intrinsic efficiency. This takes an
economic–instrumental interpretation of care as the basis
for its ‘optimization’. Despite emerging from a shared prob-
lem—demographic change—it becomes clear that the solu-
tion cannot be single-tracked but needs to pay attention to
and incorporate the historically grown heterogeneity of the
field of care. Otherwise, this leads to privileging certain
perspectives (e.g., care managers or entrepreneurs) that are
compatible with that economic–instrumental logic of care
while foreclosing the input by other important groups like
care personnel and older people. The loop is complete when
the former build the basis for how policymakers and funders
set the priorities for their research programs, which, in turn,
shape the setup of research projects, and so on.
Considering the feedback effects that stabilize this regime
of care robotics, we derive a threefold critique, which calls
attention to the politics, historicity, and social situatedness
of care and robotics.
The first critique refers to the political vision of apply-
ing robots in care. Here, it is clear that the problem of an
ageing society has been profoundly reconfigured in positive
and potentially negative terms. Generally, we can observe
that care robotics and elderly care have been made to fit
the current regime of marketization, rationalization, and de-
hospitalization. The current push for robotics in health care
is thus heavily implicated in the ongoing project of solv-
ing the “health care crisis” by exclusively focusing on the
market, technology, and the private sphere. In this sense,
robotics is a prime example of a political technology (Win-
ner 1980) that reproduces existing power relations instead
of helping to unsettle them. Hence, robotics is disruptive
in a problematic sense; it dismantles alternative solutions
to the demographic challenge ahead by deflecting attention
away from communal, social, and public strategies instead
of supporting them. Hence, we call for a more responsible
politics of robotics in health care, one that is able to reflect
the constraints it sets on governance (Stilgoe etal. 2013)
instead of simply heralding a technological fix.
The second critique relates to the idea that when develop-
ers and engineers enter the field of care it is not an empty
space waiting for machines. We have shown the conse-
quences of different logics in a historically grown field. To
successfully develop robots for care in the future, it will
be important not only to consider different levels of social
aggregation but to also bring together as many different
research perspectives and subjects as possible in an inten-
sive dialogue to obtain a holistic picture. This calls for an
in-depth analysis of the socio-historic setting—generally as
well as locally—to provide practice-oriented knowledge.
This goes beyond most ethical, legal, social issues (ELSI)
efforts of today. Currently, the lack of such considerations
means the deployment of robotics technology increasingly
focuses on standardization and selection into reasonable
and unreasonable care measures, whereby reasonable often
means economic and marketable. In consequence, care
robots are unintentionally produced to rely less on tradi-
tional, care-intrinsic knowledge. In the long term, this could
lead to the deprofessionalization of nursing.
Fig. 1 Interplay of the sections
476 AI & SOCIETY (2022) 37:467–477
1 3
And third, we want to heighten awareness of the epis-
temic framing of care as a problem to be solved in robotics.
As we have shown through ethnographic analysis, the epis-
temic modes of care robotics often lead to a decontextual-
ization and deconstruction of care practice into individual,
technically feasible tasks. This begets both mechanized care
ideas and robots that do not function in specific care situ-
ations. It is difficult to overcome the epistemic conditions
of a field like care robotics, but our analysis points to the
rather mundane conditions of care robotics projects that can
be improved. Corresponding to the critique on innovation
policy, the usual cycle of publicly funded robotics projects
that aim to technically solve a social problem should be
broken. Instead, project funding and organization should
consider open and iterative project structures that look at
how care practices are situationally and interactively enacted
(Hornecker etal. 2020). The essential implication, which
would have to change accordingly, is that the understanding
of robots as neutral machines and engineering practice as
value-free would have to become obsolete.
This threefold critique is but a preparatory step for
evaluating and possibly shifting the current regime of care
robotics in elderly care. It calls for an integrated view of
the manifold factors that shape and stabilizes this regime
that ultimately privileges economic–instrumental ration-
ales, grants epistemic primacy to technical disciplines, and
largely ignores the historicity and organizational situated-
ness of care practices. We argue that these biases can only
be shaken if, first of all, we manage to instigate a critical
debate about the very political, organizational, and epistemic
fundaments that have enabled this regime in the first place;
hopefully breaking its perpetual feedback loop.
Funding Open Access funding enabled and organized by Projekt
DEAL.
Open Access This article is licensed under a Creative Commons Attri-
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copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
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