Student Spotlight: Jared Howes

Hailing from Montana, Jared Howes, received an M.Sc. in Bioethics from KU Leuven (2020), an M.A. in Bioethics from Loyola Marymount University (2019), and a B.A. in Theology from Carroll College (2015). He is currently a doctoral student at the Centre for Biomedical Ethics and Law at KU Leuven in Belgium. His research focuses on the ethics of electronic tracking devices in dementia care.

Highlight of Post LMU Academic Life:

These three academic experiences form points where my interest in technology solidified around specific topics—society, the human person, and clinical care—but throughout the program I had insightful conversations with the entire Bioethics Institute faculty. With Dr. Brown, in particular, I recall conversations on human enhancement and justice within healthcare. Leading me to take a step back and really examine the context technology arises within. Throughout my entire time at LMU, Dr. McMillan was a constant source of inspiration and reflection. I would often find myself in her office trying to tie together seemingly disparate elements to form my own opinion on topics. Dr. McMillan would push me to view issues from different perspectives, not only from a scholarly standpoint, but also from the standpoint of imagination. How can we envision novel solutions to existing problems? I mention all of these examples not merely to reminisce about my time at LMU, but to try and articulate how important this community was to the formation of my interests.

 

Knowing these past experiences, I think it comes as no surprise that my current academic interests center broadly on technology within healthcare, and more specifically on emerging technologies used in dementia care. My current PhD project focuses on the ethics of electronic tracking devices in dementia care. Electronic tracking devices (ETDs) are technological tools that allow for a range of real-time monitoring, tracking, or locating capabilities. There are different technologies that form the substructure of various ETDs. For example, global positioning systems [GPS] can be found in smartphones, watches, pendants, and bracelets. Another example is radio-frequency identification [RFID], which can show up in tags that are sewn into clothes, put into a wrist bracelet or piece of jewelry. These devices are being used to help manage wandering in dementia patients. Wandering is a behavioral symptom of dementia that involves a person with dementia eloping from their home or institutional care facility, subsequently being placed into situations with a high risk for injury or death. The hope is that a wandering person with dementia will be quickly located if they wear or use an ETD.

 

Understandably, the ability for ETDs to track and record a person’s temporal-location raises serious ethical questions in regard to their use on a vulnerable population. How do we protect a person with dementia’s privacy? Do they even have a right to privacy? What should we do with the data form these devices? Who owns it and who should have access to it? Ethical questions also extend to the physical design of devices. Should ETDs be removable, or should they be lockable? Only able to be removed by a special key that a caretaker or family member possesses. There are also questions stemming from clinical ethics. For instance, do persons with dementia need to give their informed consent to the use of these devices? What about continued consent? These are some of the issues that are brought up in both the qualitative and normative literature. My interest is in taking a step back and recognizing that many of these questions arise within the context of product design. A clear example of this is the question about whether these devices should be removable or not. This is only answerable when a device is being designed. The ultimate goal of my research, therefore, is to work towards a framework that can guide the design, development, and use of tracking devices.

 

How your interest evolved or how it prepared you for your current academic work?

To describe my current interests and academic work in bioethics, I first need to highlight some experiences from my time as a master’s student at the Bioethics Institute that I view as fundamental to my academic trajectory and where I am today. At LMU I was given the space and support to really explore and dive deeply into the way technology impacts various areas of humanity.

 

I think here of the opportunity afforded by the O’Malley chair to work with and learn from Dr. James Giordano of Georgetown. His 2018 course, Neuroethics: Issues at the intersection of brain science and society, not only introduced me to ethical issues at the forefront of neuroscience, but also opened my eyes to the wider impact that emerging technology could have on society if ethical questions are left unaddressed during their development and initial use. For example, how the introduction of brain implants could lead to widening inequality between those who can and cannot afford such devices—particularly when implants could give a cognitive edge in academic, business, and other lucrative endeavors. In a similar fashion, the following year I was able to dedicate two final papers towards technology. First, in my course with Dr. Dell’Oro, I studied artificial reproductive technologies in light of human anthropology, in what I view as a study on technology’s impact on the human person. Second, during bioethics at the end of life with Dr. Raho, I turned towards technology and clinical ethics by examining how artificial intelligence programs used to predict in-patient outcomes could possibly be integrated into end-of-life care.

 

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What are some differences you have noticed between American and European bioethics?

Well, I think bioethics in general is becoming very globalized. It is becoming more and more clear that certain issues transcend borders, oceans, and continents. For example, the discussions stemming from Crispr-cas9 recognized that what happens in one place, perhaps lack of regulations, can have unintended effects on the rest of the world. Another example is that developing nations do and will experience a larger burden from climate change than developed nations, despite developed nations playing a larger role in causing the climate to change. In this way, there is a lot of overlap between the two.

The differences are found in the particular context in which many bioethical questions arise. For one, the system of medicine is obviously very different. In Western Europe most nations

have some form of publicly funded healthcare that guarantees access to adequate care. So bioethical questions can often return to issues of public health, public expenditure, etc. For example, when discussing expansion of private genetic testing, an important factor to consider is that a “boomerang” effect can occur. When an individual receives their genetic results from a private company, if health questions emerge that person will return to the public health care system for answers. Thus, questions of regulating private DNA testing must be cognizant of this potential burden on the health care system. In the U.S., this might not be as important of an issue given the more privatized healthcare system.

Another example would be the ethos, virtue, or values of the culture. In the U.S., obviously individual autonomy and liberty is an incredibly important value. So much so, that debates in bioethics often become reduced to the principle of autonomy. Debate on healthcare systems is likewise reduced to the language of rights, obligations, and duties. My experience in Belgium, and I think to a larger extent Western Europe, is that while individual autonomy is likewise highly valued (look at euthanasia laws for one example), the principle of solidarity comes into play more often. The same questions about healthcare systems are framed in terms of solidarity more often than rights. Of course, these observations are generalizations, but I think they do bear some truth. Thus, while global bioethics is becoming more prominent, it isn’t that there is “one” bioethics. For example, bioethics in Europe is not merely an import of American bioethics, but rather that in each place a unique bioethical tradition emerges as part of a dialogue.

Jared's Current Work:

TOPIC:

The Use of Tracking Devices in Dementia Care: A systematic review of argument-based ethics literature.

 

Abstract

Background: Wandering is a behavioral symptom of dementia that often results in dementia patients eloping from homes and care facilities, leading to situations of high risk for their injury or death. Caregivers have turned to the use of electronic tracking devices for management of wandering. The capability of these devices to track, record, and monitor daily life raises profound ethical questions related to their use on a vulnerable population. The objective of this review was to identify the ethical arguments and concepts used in the normative literature focusing on electronic tracking devices in dementia care.

Methods: We conducted a systematic literature review for normative literature focusing on electronic tracking devices in dementia care. Twenty-two publications met the requirements for inclusion.

 

Results: An analysis of normative arguments and concepts described in included literature revealed that the majority of publications utilize a principlist approach. Accordingly, arguments concerning electronic tracking devices largely fall under the four principles of biomedical ethics: autonomy, non-maleficence, beneficence, and justice. A particular emphasis is given to privacy and informed consent. The normative literature recognizes that electronic tracking devices have a dual effect, being capable of either bolstering or eroding the values connected to each principle.

Conclusions: The number publications using principlism indicate a need to pursue new ethical approaches and expand upon the few non-principlist approaches already in use. In addition, many of the ethical issues raised concerning the use of electronic tracking devices involve value questions present during the design of these devices. Therefore, future ethical orientations or frameworks should account for ethical questions that exist on the continuum of design to use of electronic tracking devices.

 

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