10.6092/issn.2038-3460/17477
Recently, socially assistive robots (SARs) have entered care work to tackle the care deficit for ageing populations. Previous research on care robot ethics has emphasised design processes and ethical guidelines. In contrast, this paper employs an empirical ethics approach to investigate how ethics is co-constituted in care practices. Drawing on ethnographic research on an SAR’s dementia-care usability trials, the core research question is “What therapeutic gains does human-robot interaction achieve for older users?” These usability trials were underpinned by the optimistic “ageing-and-innovation discourse”, which frames how “the good” and “therapeutic gain” are perceived. Furthermore, this article contributes to science and technology studies (STS) on older users by studying user figuration as a site of “ethics by other means”. It argues that the ethics of care robots should not be contemplated only as ethical frameworks, guidelines and imperatives but, rather, as situated and relational normativities that stem from care practices.
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Joni Jaakola
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Tecnoscienza – Italian Journal of Science & Technology Studies
socially assistive robot (SAR)
Ethics by Other Means? Care Robot Trials as Ethics-in-Practice
Text.Serial.Journal
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Essays
2021-03-09
2023-06-27
2021-03-09
2023-10-16
53-71
TS
Joni Jaakola
2020
10.6092/issn.2038-3460/17477
53
University of Turku
2038-3460
2
socially assistive robot (SAR)
en
71
Ethics by Other Means? Care Robot Trials as Ethics-in-Practice
https://tecnoscienza.unibo.it/article/download/17477/16326
11
                                                                              Essay
                                                                                     53




Ethics by Other Means? Care Robot
Trials as Ethics-in-Practice
        Joni Jaakola
       University of Turku, FI



     Abstract: Recently, socially assistive robots (SARs) have entered care
     work to tackle the care deficit for ageing populations. Previous research on
     care robot ethics has emphasised design processes and ethical guidelines. In
     contrast, this paper employs an empirical ethics approach to investigate
     how ethics is co-constituted in care practices. Drawing on ethnographic re-
     search on an SAR’s dementia-care usability trials, the core research ques-
     tion is “What therapeutic gains does human-robot interaction achieve for
     older users?” These usability trials were underpinned by the optimistic ‘age-
     ing-and-innovation discourse’, which frames how ‘the good’ and ‘therapeu-
     tic gain’ are perceived. Furthermore, this article contributes to science and
     technology studies (STS) on older users by studying user figuration as a site
     of ‘ethics by other means’. It argues that the ethics of care robots should
     not be contemplated only as ethical frameworks, guidelines and imperatives
     but, rather, as situated and relational normativities that stem from care
     practices.

     Keywords: ageing-and-innovation discourse; empirical ethics; figuration;
     human-robot interaction; socially assistive robot (SAR).

     Submitted: April 28, 2020 - Accepted: October 20, 2020

     Corresponding author: Joni Jaakola, University of Turku, Faculty of
     Social Sciences, Assistentinkatu 7, 20100 Turku, Finland. Email:
     jomijaa@utu.fi




1. Introduction

    The ethics of care robots has recently become a major subject of pub-
lic and academic discussions. In Europe, the European Commission
(2019) has defined ethical guidelines for the development, deployment
and use of artificial intelligence, such in the case of automated assistive
technologies and, among them, care robots. These guidelines are summa-
rised as four ethical principles rooted in fundamental human rights: i) re-
TECNOSCIENZA
Italian Journal of Science and Technology Studies
11 (2) pp. 53-71 - ISSN 2038-3460
www.tecnoscienza.net                                2020
54                                                            Tecnoscienza - 10 (2)

specting human autonomy (i.e. ensuring human self-determination and
freedom); ii) preventing harm (i.e. protecting human dignity, as well as
mental and physical integrity); iii) fairness (i.e. equally distributing bene-
fits and costs); and iv) explicability (i.e. using transparency as the basis for
building trust). Universal human rights, such as autonomy, are evident in
both the guidelines presented by the European Commission and the ex-
tant literature on care robot ethics. This literature stresses that designing
assistive technologies for older adults should account for ethical princi-
ples, such as protecting privacy, ensuring dignity, preserving autonomy
and respecting the values of independence, enablement, safety and social
connectedness (Burmeister 2016; Diaz-Orueta et al. 2020; Sharkey 2014;
Sorell and Draper 2014). The same values are evident in more critical as-
sessments, in the fear that care robot implementation may lead to a reduc-
tion in human contact and a loss of privacy and freedom, as well as poten-
tial deception (Bennett et al. 2017; de Graaf 2016; Sharkey and Sharkey
2012; Sparrow and Sparrow 2006). In technology development and de-
sign, ethical frameworks are usually grounded as moral rules that should
be accounted for in the process of “value-sensitive design” (van
Wynsberghe 2013).
     Previous studies on care robot ethics (Bennett et al. 2017; Burmeister
2016; de Graaf 2016; Diaz-Orueta et al. 2020; Sharkey 2014; Sharkey and
Sharkey 2012; Sorell and Draper 2014; Sparrow and Sparrow 2006; van
Wynsberghe 2013) have heavily relied on deontological moral theory, that
is, on the need to set ethical guidelines as moral imperatives to be fol-
lowed in technology design, implementation and use. However, this ap-
proach leaves open the question of whether the complexities of care in
practice contribute towards the constitution of an ethics of care robot us-
age in any way. A deontological framework cannot fully grasp the ethical
complexities actualised in care practices. Although deontology is not rep-
resented, in the extant literature, as the only way to “do ethics”, it seems
to be the most dominant moral theory in debates on care robots. Ad-
dressing this limitation, this article strives to rethink care robot ethics not
from the viewpoint of universal human rights-centred deontology but, ra-
ther, through an empirical ethics approach (Mol 2008; Pols 2015; 2017).
This approach regards “normativity”, that is, the different forms of “the
good”, as the outcome of situated practices. In contrast to deontological
ethics, whose interest lies in whether or not moral imperatives are fol-
lowed in design and beyond, the empirical ethics or “ethics-in-practice”
approach stresses the availability of multiple ways to achieve ‘the good’
and emphasises that good care is co-constituted in practices where peo-
ple, technology and discourses meet.
     By adopting this approach, the article draws on ethnographic material
collected during usability trials for a socially assistive robot (SAR) in a
dementia care unit in Finland. The term “SAR” refers to interactive ro-
bots that provide assistance and companionship while assisting in conva-
lescence, rehabilitation and learning in cognitive, affective and physiolo-
Jaakola                                                                      55
cal therapy (Abdi et al. 2018; Feil-Seifer and Mataric, 2005). In this case,
the idea of a care robot is linked not to a type of artificial intelligence but,
rather, to the “ageing-and-innovation discourse” (Neven and Peine,
2017). This discourse frames ageing as a crisis for societies that struggle
with insufficient healthcare resources and rising costs. Within this dis-
course, innovative technology is offered as a solution to this crisis, and
when technology is implemented, it is said to have only positive out-
comes, identifying a “triple win” for individuals, societies and economies.
According to this discourse, the aged individual wins as they receive bet-
ter-quality care. Society - that is, governments, municipalities and tax-
payers - wins as healthcare costs are reduced. Finally, economies win as
marketable and exportable technologies are produced, resulting in new
jobs and economic growth. Of course, these three “levels” are interlinked.
Nevertheless, various actors involved in national and global healthcare
policy and the welfare technology industry sector tend to refer primarily
to these three winners and to use this rhetoric as a tool to galvanize the
development of new technologies (Neven and Peine, 2017). The ageing-
and-innovation discourse strongly affects the development of care robots,
and these effects are evident in the context of SAR trials.
    In this case, the ageing-and-innovation discourse offers a background
against which to examine why and how robots are trialled in dementia
care. In these trials, the discourse is mainly performed by two stakehold-
ers: the testing group, which represents an innovation company that de-
velops digital solutions for future ‘smart cities’, and the administration
and employees of the care unit, which rehearses the future of ageing
through technology pilots. The usability trials studied in this article ex-
emplify the promises of the discourse in three ways. Firstly, the SAR was
trialled as a therapeutic device that increases older users’ wellbeing. Sec-
ondly, robot technology emerges as a way to lighten the caregivers’ work-
load and, thus, as a means of tackling the demographic “care deficit” that
ageing populations bring (see also Abdi et al. 2018; Kriegel et al. 2019).
Thirdly, the trials were part of a multinational series of pilots conducted
to induce the creation of a start-up enterprise in the European Union
and, thus, new jobs. Because the ageing-and-innovation discourse pre-
sents three different “goods” that care technology can achieve, it is inher-
ently normative in nature.
    By applying an ethnographic approach, this article examines how the
ageing-and-innovation discourse is performed in usability trials. In line
with user research, I am interested in what “good” care robots achieve for
older users. Because SARs offer cognitive, affective, and physiological
‘therapy’ for the elderly, I term the individual good a “therapeutic gain”.
My research questions are as follows: what kind of ethics is enacted dur-
ing the trials? What ‘therapeutic gain’ does human-robot interaction
achieve for older users? I argue that care robot ethics should not be
framed solely by deontological claims that emphasise design processes,
but also by the ethics-in-practice perspective. In the SAR trials, this per-
56                                                           Tecnoscienza - 10 (2)

spective does not affirm such ‘universal’ values as autonomy but, rather,
the emergent ethics of care, which stresses the normativity of multilateral
interdependencies (Puig de la Bellacasa 2017; Sevenhuijsen 1998; Tronto
1993).
     I will begin by presenting the theoretical framework and my contribu-
tion to science and technology studies (STS). I will then present the
methodological principles and the context of the case study in more de-
tail. In the analysis section, I discuss the figuration of different users and
ethics. Before concluding, I discuss how the trials were deemed a success
by the stakeholders involved, in spite of evident problems, contradictions
and ambiguities.


2. Empirical Ethics and User Research

    This article contributes to user-oriented STS in two ways. Firstly, eth-
ics has been overlooked in recent research on technologies for older us-
ers, which has, instead, highlighted older persons’ agency in the face of
ageist, paternalistic and stereotypical technology designs and design pro-
cesses (Compagna and Kohlbacher 2015; Cozza et al. 2020; Frennert
2016; Hyysalo 2004; 2006; Neven 2010; 2015; Peine et al. 2014; Östlund
et al. 2015). Secondly, usability trials have not been examined as a site of
ethics-in-practice. I argue that usability trials are not solely concerned
with configuring technology or users, or how the designer’s image of the
user shapes and constrains possible users (Woolgar 1991), but also with
ethics. In trials, possible ways of achieving ‘the good’ for older users are
assessed. Thus, SAR trials offer a gateway via which to examine the ethics
of care robots.
    To understand the benefits of the empirical ethics approach, I will
briefly locate its genealogy in STS. The empirical ethics approach relates
to both the material semiotic tradition and the ethics of care discussions
(Thygesen and Moser 2010). In material semiotic user studies, the con-
cept of a “script” has been important. Scripts concern the anticipations
based upon which users act when facing a technology, and they are in-
scribed in a technology’s materiality and design (Akrich 1992). Script
analysis stresses the dynamic co-configuration of technology and users
(Van Oost et al. 2009). Concerning older users, “age scripts” - the ideas
and discourses of old age - have been shown to lead to stereotypical im-
ages of the aged population (Neven 2010). However, scripts do not de-
termine the user (Pols and Moser 2009). Although the “processes of con-
figuring and scripting are expressions of power and may cause dynamics
of exclusion or marginalisations” (Cozza et al. 2020, 273), the semiotic
approach has been criticised for emphasising the designer’s role and as-
sumed intentions (Mackay et al. 2000; Oudshoorn and Pinch 2008).
    The material semiotic approach addresses ethics by emphasising pre-
scriptions. For example, Latour (1992) has described how the imperative
Jaakola                                                                  57
for car drivers to slow down is inscribed into speed bumps. Thus, police
officers’ responsibilities are delegated to material artefacts. In contrast,
Verbeek (2006; 2011) has incorporated script analysis more explicitly into
normative ethics by studying how engineers do “ethics by other means”
by “materialising morality” into technology. Both Latour and Verbeek
highlight that the outcomes of relationships with technology are not pre-
determined. However, in this body of research, ethics easily becomes
“top-to-bottom” rules inscribed by the human designer into technology.
This view reinforces the idea of ethics as deontological imperatives. How-
ever, it is not only designers who do “ethics by other means”. The consti-
tution of ethics in everyday use of technology is just as important as the
ethical prescriptions inscribed in its design. Also, as Ludwig Wittgenstein
(1958) has shown, a prescription or rule does not include unambiguous
instructions for applying that rule. Thus, although morality is inscribed in
technology, there is no one correct way to “follow the script”. For this
reason, I turn to studies on empirical ethics that build on the material se-
miotic tradition and Wittgenstein’s later philosophy (see Pols, 2017).
    Studies in empirical ethics have examined how normativity is per-
formed in practice (Pols 2017; Pols et al. 2018). In consensus with the
ethics of care discussions in feminist theory (e.g., Puig de la Bellacasa
2017; Sevenhuijsen 1998; Tronto 1993), the empirical ethics approach
stresses situated interdependencies and dynamic relations. Rather than
emphasising norms and values as prescriptions in technology, normativity
is seen as the outcome of interactions between humans, technologies and
discourses. A focus on empirical ethics does not imply that ethical guide-
lines do not matter. Rather, it suggests that an ethics is not determined by
design and engineering but is, instead, an ongoing process. Caring prac-
tices have been a major site for adapting the empirical ethics approach
because they deal with how to accomplish good care in its various forms
(Lydahl and Löfstrand 2020; Mol 2008; Pols et al. 2018; Thygesen and
Moser 2010; Willems and Pols 2010). This approach emphasises situat-
edness, practices, relationality, and thus the importance of ethnographic
research, which is well-suited to grasping these aspects of care. Following
this line of thought, this article examines how users and ethics are co-
constituted in dynamic relationships between humans, technology and
discourses. In this view, robots are not expected to enact any moral rules,
such as respecting autonomy. Instead, they are seen as co-constituting the
local, practical and multiple ways of achieving the good.
    According to this theoretical framework, I use the concept of “figura-
tion” as a theoretical-methodological tool with which to contextualise the
usability trials into the broader politics of contemporary healthcare. Here,
figuration is an umbrella concept that links user configuration, ethics-as-
practice and the ageing-and-innovation discourse. It has two advantages
when contrasted with “configuration”, which is a much-used concept in
semiotic user studies (e.g., Neven 2010; Mackay et al. 2000; van Oost et
al. 2009; Woolgar 1991). Firstly, figuration does not only illustrate the
58                                                           Tecnoscienza - 10 (2)

configuration of users, nor does it only emphasise the ethical intentions of
designers; rather, it focuses on the co-constitution of users and ethics in
usability trials. Thus, figuration refers both to the various user “figures”
and the normativities enacted in human-robot interaction. Secondly, fig-
uration identifies users as embedded and embodied subjects, as “material
and semiotic signposts for specific geo-political and historical locations”
(Braidotti 2019, 34) - in this case, in the Nordic welfare state of Finland -
as well as the promises of technology evident in the ageing-and-
innovation discourse. Before putting this framework into action, I will
discuss the context of the trials and methodology.


3. Materials and Methods

    This paper is based on an ethnographic project that examined the us-
ability trials of a SAR prototype in dementia care in Finland. The care
unit provided in-patient care which consists of long-term residency, spe-
cialised staff and constant supervision, with social and medical services,
meals and accommodation provided (Kriegel et al. 2019). The research
material was gathered over three weeks in 2019. The material is com-
prised of field notes from participant observations and a number of in-
formal engagements with the testing group and the staff of the unit which
equated to roughly five ethnographic interviews. Through these, infor-
mation on the robot’s design and purpose was gathered. The field notes
consist of observations and verbatim notes on the users’, testing team’s,
and robot’s spoken interactions. The care unit was also observed during
the daytime. The interviews were informal, and they were not recorded.
Instead, notes were taken during the interviews. An ethnographical ap-
proach allows to ask “how technologies are embedded, evolving, and im-
pactful in our personal and social lives, and how these tie into issues of
social control” (Van den Scott et al. 2017, 509). In this case, ethnography
is an invaluable way to see how SAR technology affects dementia patients’
lives and how usability trials act as part of the optimistic technological de-
terminism implied by the ageing-and-innovation discourse. The ethno-
graphic approach also reveals ethical complexities that do not resolve into
concerns about guidelines, imperatives, prescriptions or design.
    The robot in question (Fig.1) is a socially assistive and autonomous
robot, Sanbot Elf, developed by “Qihan Technology Co. Ltd.” and modi-
fied with applications and automated navigation. Figure 1 illustrates the
robot’s appearance. The SAR has humanlike features, and it stands at ap-
proximately 145 centimetres tall. The SAR’s graceful white body bends
forwards slightly, evoking a user who sits in a wheelchair. A touchscreen
on the chest serves as the main tool with which to control the robot’s
functions. The robot has a soft pre-recorded voice (the voice of one of the
testing team). The SAR can engage in short discussions in Finnish. This
Jaakola                                                                           59
ability helps with the robot’s interactions and in achieving the goals of
robot therapy (Abdi et al. 2018; Tuisku et al. 2019). Lacking “intuitive,
reflective, and/or critical thinking skills” (Huschilt and Clune 2012, 17),
however, the robot is unable to respond dialogically or become sociable
in any authentic sense (Jones 2017). “Let’s do something fun together!”
the robot suggests. It also asks questions, such as: “Do you have any
pains?” and “Have you taken your medicine?”. It often replies to the us-
er’s (presumed) answer with an uplifting “right!” These prefigured lines
suggest that everything is going well - the robot’s answer is always the
same, whether or not the user has taken their medicine.




           Figure 1. The socially assistive robot (SAR) prototype “Sanbot Elf”.

    Four different applications were tested: short stories, a memory game,
a “musical journey” and physical exercise. The minutes-long stories were
about Finnish presidents, a nearby pond and a folk poem. The SAR nar-
rated them while showing accompanying pictures on its screen. In the
memory game, the touchscreen with the robot’s ‘ears’ and ‘arms’ changed
colour, and the robot urged the user to answer, asking with an uncanny
voice, “What colour is this?”. In this application, the warm human voice
changed to a non-gendered and monotone “robot voice”, which was un-
settling for the trials’ participants and spectators. In the “musical jour-
ney”, the SAR played popular music based on the birth year of the user.
The music was introduced along with pictures and stories about urbanisa-
60                                                         Tecnoscienza - 10 (2)

tion and wartime, when “gramophones changed to vinyl records” and
movies “turned from silent to talkies”. In the exercise app, the user could
execute either an arm or leg exercise while sitting down. When the user
chose an option, a video began playing featuring a physiotherapist who
showed the moves and explained how to do them. The SAR’s role as
“therapists, companions, and educators” (Huschilt and Clune 2012, 15)
to people with dementia prevailed in the test applications. The exercise
application was a form of physical therapy, and the memory game and
stories offered cognitive stimulation. The applications were chosen during
project meetings and interviews with the facility’s staff. This process
shows that the developers and providers of the robot were more interest-
ed in care employees’ evaluations and how they imagined the user than in
actual users’ genuine participation (Compagna and Kohlbacher 2015;
Cozza et al. 2020).
    The trial’s participants were residents of a public care home for de-
mentia patients in Finland that is accustomed to technology pilots. The
trials were conducted as part of the unit’s everyday routines. During the
trials, 75 interactions with 18 residents (seven male and eleven female)
were conducted. Consent was required for participation. I observed 26
sessions, which lasted approximately 20 minutes each. In addition to the
residents, the robot and myself, two representatives of the testing group -
one of whom controlled the robot’s movements - were present during the
interactions. The nurses seldom oversaw the sessions, which started with
the testing group presenting the potential activities. The trial team’s in-
tention was to test all of the applications, and the team’s “sales pitches”
sometimes had a major impact on a resident ultimately agreeing to use the
robot, even when they were initially hesitant. After the sessions, the teams
asked the users questions about the robot’s appearance and usability. I
did not participate in planning the interaction setting. Although I partici-
pated in some of the unit’s routines, which I discuss in the analysis below,
during the sessions my role was mostly that of a spectator. My ethno-
graphic approach was aligned with the principles of the empirical ethics
approach. This kind of methodology can be called “uncontrolled field
studies” (Pols 2012), in which the object of the study is approached with-
out preconfigured frames of analysis. This approach resulted in my seeing
the interaction itself not as dyadic but as multilateral - as a “crossroads”
in which people, technology and discourses meet - and such relationships
cannot be predetermined.
    The trials faced many challenges. The robot and its functions con-
stantly changed because of updates, added content and malfunctions. The
musical journey application, for example, was added to the robot during
the trials. The changes caused delays, and because of these, it sometimes
became unclear what was actually being tested. For example, the photo
show was a preliminary application, but it was only tested from a laptop,
instead of the robot itself. Somehow, the results were deemed applicable
to the robot by the testing team. The robot was also expected to distri-
Jaakola                                                                      61
bute medicine, but this task ultimately proved too difficult. However, to
stay true to the research design and, more importantly, to please the fi-
nanciers, the robot was used very briefly as a transport trolley for medi-
cine. Also, although a great deal of effort was invested by the team into
the robot’s automated navigation properties, they were not used in the
trials.
    The SAR usability trials exemplify how care technologies aspire to-
ward “the good” for individuals, economies and societies. Below, I will
examine how various user figures and forms of “the good” for the older
users were co-constituted in the trials.


4. The Figuration of Users and Ethics
    I have identified four different figurations that emerged during the
Sanbot Elf trials. The figurations refer both to user types, the “figures” of
enabled, disabled, dismissed and subversive users, and the related norma-
tivities. I discuss these figurations along with short ethnographic stories.
Because the SAR offers cognitive, affective and physiological therapy, I
refer to the aspiration toward good as a “therapeutic gain”. What this
‘gain’ turns out to be, however, depends on the situated human-robot in-
teraction. Figuration calls into question any stereotypical or one-
dimensional images of older users. None of the residents in the trials,
however, enacted only one figure. Different contexts could enact differ-
ent kinds of users between and during sessions. Thus, my focus is not on
fixed states but on continuums. I argue that the usability trials illustrate
not a set of universal moral values to be accounted for in design processes
or otherwise but, rather, normativities that are situated in the relational
outcomes of human-robot interaction.

4.1 The enabled figure

    The enabled figure exemplifies how the promises of the ageing-and-
innovation discourse were affirmed. A spontaneous session with Maria, a
resident during the Sanbot Elf trials, illustrated this process. Before the
session, Maria had repeatedly mistaken me for her son, who is “also tall”,
showing signs of trouble with recognition. Though my judgement is not
that of an expert, I believe that dementia could also be seen in her actions
when she was unable to recall that her clothes were her own and attempt-
ed to return them to the staff. Such behaviour is not unusual to the facili-
ty’s employees who, on another similar occasion, had been reluctant to
“call the police” and report the alleged “theft” of another resident’s
clothes as the resident had requested. Maria also needs assistance when
moving. Once, she asked me to walk her to the nearby couch, which I
gladly - albeit cautiously - did. Despite these ‘frailties’, Maria is one of the
more active residents, engaging in discussions with others in the shared
62                                                            Tecnoscienza - 10 (2)

facilities.
    Although Maria needs the care that the unit provides, this session with
her illustrates how interactions with the robot can affirm and expand the
residents’ abilities. The session started when Maria was drawn to the test-
ing place by the robot’s presence. She was not part of the day’s schedule,
but it was “okay” with the testing group if she wanted to listen to some
music. The ‘musical journey’ application was then tested. Maria sat down
and touched the screen. A classic Finnish waltz from the 1950s began
playing. Maria felt like dancing and swayed to the music. She commented
on the pictures shown onscreen. A moment of applause and many thanks
from Maria ended the songs, of which she seemingly never tired. When
the scheduled resident arrived, Maria stayed and listened to the tunes.
However, she soon fell asleep.
    Like Maria, most of the residents found the robot and its applications
favourable. These residents perceived the robot to be safe, calling it “be-
nevolent” and “beautiful”. In addition to “dancing”, the musical journeys
induced physical “exercise” and abilities, such as stamping one’s feet to
the rhythm and singing along with the songs. Although the musical jour-
neys were especially successful, the short stories also earned positive ap-
praisals. The short stories aroused memories and associations of past ex-
periences, which seemed appropriate (that is, “positive”) in the context of
the applications, evoking responses in the user which seemed happy, joy-
ful and excited. In addition, residents recognised the historical contexts
of the short stories and musical journeys. Stimulating nonverbal and ver-
bal communication, promoting positive emotions and evoking past expe-
riences are some of the desired aspects of “robot therapy” (Huschilt and
Clune, 2012, p. 16). Based on these positive reactions, the testing team
and the unit’s staff considered the robot a success.
    The ethical framework established by Sorell and Draper (2014) and
discussed in the introduction outlines enablement, independence, auton-
omy, social connectedness, safety and privacy as important values. The
enabled figure exemplifies how these values can be achieved in some ses-
sions. The enabled figure likes applications that arouse memories, satis-
faction and discussion, offering a chance to enforce independence, au-
tonomy and social connectedness. When the SAR is not perceived as
frightening, the value of safety is evoked among the residents. When the
user could use the robot without assistance, privacy was enforced. How
this kind of therapeutic gain aligns with the optimism of the ageing-and-
innovation discourse is important. Here, the robot works as a therapeutic
companion to the user. It achieves a normativity of enablement that re-
spects the aforementioned values. Still, other figurations were present
during the Sanbot Elf trials. In addition to enablement, disabilities were
also enacted. Thus, such usability trials become (us)ability trials, in which,
instead of the usability of the technology, the abilities of the user are test-
ed.
Jaakola                                                                    63
4.2       The disabled figure

    The outcomes of care technology implementation often differ from poli-
ticians’ and designers’ hopes (Pols 2017), which in this case means the ex-
pectation that robots can act as helpers and therapeutic devices. The disa-
bled figure stands in contrast to the promises laid out by the ageing-and-
innovation discourse. A story involving Helena, an always-smiling female
resident, best exemplifies how disabilities were co-constituted in interac-
tions with the robot. In her session, Helena tested the physical exercise ap-
plication. When starting the app, the SAR invited Helena to keep herself fit
by saying, “Let’s do some exercise!” Helena chose the upper-body exercise.
When the video started, the onscreen instructions seemed difficult to fol-
low. Helena sat quietly, attempting to understand the video. To assist the
robot, a member of the testing group performed the moves. At first, this in-
tervention did not help either, but finally, with a human example, Helena
accomplished “hugging herself”, which was part of the exercise. Neverthe-
less, doing both parts of the exercise was problematic, requiring Helena
both to hug and to let go. Her arms were left behind her back, which
seemed uncomfortable. After the video, Helena felt “tired” and wanted to
stop the session for the day.
    During the trials, it became clear to the testing team, the users, and me
that the exercise was difficult to follow. None of the users were able to do
the moves “until exhaustion”, as suggested by the robot, with or without
human assistance. Sensory disabilities were further enacted when hearing,
watching and touching the robot. It was sometimes difficult to see and un-
derstand the onscreen symbols. For example, one resident, Veikko, could
not choose between the green and red options offered because he was col-
our-blind. Disabilities are not merely ‘essential’ qualities of a user which
technology passively reveals. Instead, technology co-constitutes disability as
the outcome of the user’s interactions with it (Moser 2000; Moser and Law
1999). Thus, colour blindness is co-constituted in human-robot interaction
as a deficiency when only red and green options are provided. In addition,
the touchscreen was extremely difficult to use. Only a few residents could
use the screen by themselves; for others, the testing team controlled the ro-
bot. The more any expectations inscribed in the applications were nullified
by the actual users, the more improvisation was needed to achieve smooth-
er, albeit still awkward, interaction. This effect meant that the idea of the
robot as a therapeutic helper did not hold. Instead, the robot itself con-
stantly needed help.
    In comparing Maria and Helena’s stories, it is interesting that interac-
tions with the same technology can both affirm and deny ability in different
situations. When disabilities were affirmed, help from the testing team was
needed for residents to use the robot, as was the case with Helena. This
need for help can result in a human example of “doing an exercise” or as-
sistance with the touchscreen. In this kind of normativity, vulnerabilities
lead to interdependencies. In terms of therapeutic gain, robots that co-
64                                                             Tecnoscienza - 10 (2)

constitute disabilities instead of affirming abilities are probably not desira-
ble. However, the disabled figure does not necessarily contradict ethical
guidelines that highlight the affirmation of abilities. Vulnerabilities call for
social connectedness. In this way, the possibilities of belonging, being ac-
counted for and being cared for remain. Thus, enacting disabilities is less
an ethical disaster and more a chance to re-examine the trials’ complexities.
Although enablement has been stated as an important imperative for de-
signing care robots (e.g., Sorell and Draper 2014), the disabled figure partly
questions this assertion. Vulnerabilities, not enablement, are the precondi-
tion for residents receiving care in the first place. Next, I discuss further the
situations in which the issue of interdependencies arises.

4.3    The dismissed figure

    When the robot’s overly optimistic “attitude” and “negative” associa-
tions clash, the user is figured as “dismissed”, with hardly any therapeutic
gain from the encounter. A session with Liisa provides an example of the
dismissed figure. Before her musical journey, Liisa told us about a close
relative who “died while cycling”. It is difficult to say whether the robot
aroused these associations. It certainly seemed to have. The SAR intro-
duced the next song, an evergreen melancholic love song from the 1940’s.
This choice differed from Liisa’s wishes. She would have liked classical
music; someone close to her had worked in the opera. While the music
played, Liisa again spoke about the person who died. During the next
song, Liisa recounted how someone “started drinking”. The melancholy
post-war songs being played were sad, and I too was beginning to feel
blue.
    The music application does not include classical music, which is
Liisa’s preference. Instead, for the robot, melancholy pop tunes seem to
suit everyone. However, Liisa does not fit this kind of image of the user
and, thus, was dismissed; her personal history of opera lovers and dead
family members was not responded to. Providing stressful information
about death, alcoholism and loss is not new to SAR implementation (Sa-
belli et al. 2011), and of course, therapeutic interventions often involve
facing traumatic memories. However, it is difficult to consider Liisa’s sto-
ry as a form of robot therapy when it is contrasted with the idea of ‘every-
thing going well’, which is inscribed in the robot.
    A session with Pentti clarifies this tension. Before the session could
begin, the SAR needed to be restarted. Pentti uses a wheelchair and has
many concerns. He began a discussion by explaining that he had hurt his
fingers. I could see that they had turned black. Although he seemed spry,
Pentti talked about his problems with insomnia. In his opinion, the mela-
tonin the doctor had given him was a dosage “for little children”. He also
felt hesitant to talk to the nurses, who “do not speak Finnish well”. When
the SAR rebooted and started asking questions, Pentti answered that he
had taken his medicine but still had pains. Today “is not a good day”, he
Jaakola                                                                     65
said. “Right!” the robot replied, ending the small talk.
    The dismissed figure produces ethical ruptures. The anxiety that sick-
ness and injuries bring arouses critiques of the nurses’ and doctors’ capa-
bilities. Pentti was critical of his dosage of melatonin, which in his opin-
ion, did not help. Furthermore, he was unsure whether the nurses with
immigrant backgrounds could understand and respond to his worries.
The SAR, however, dismissed all these anxieties. As with Liisa, the ro-
bot’s overly optimistic and preconfigured “attitude” clashed with the as-
sociations that were raised during Pentti’s session. This is problematic.
The way the SAR functions nullifies any call for responsiveness - users
like Liisa and Pentti are left alone with their worries and troubles. In con-
trast, the unit’s nurses stressed the importance of always answering the
residents, no matter how repetitive they are.
    It was also clear that the care provided in the unit was, in addition to
responsiveness, about empathy. The need to ground care in an empathet-
ic relationship is evidenced by the critique articulated by Pentti: he spoke
it not for the robot to hear, but for us - the trial’s spectators - in the hope
of recognition and response. As Tuula, who tested the robot in many ses-
sions, put it: “It would be nice if it were human.” Discussions with people
were preferred to discussions with the robot. If the enabled figure illus-
trates how technology can be a joyful companion, relationships that pro-
duce dismissal, in contrast, enact the distinction between “cold” technol-
ogies and “warm”, human-centred care (Pols and Moser 2009). An un-
empathetic robot is a cold companion. The SAR’s empathy ends with its
inability to run people over, an aspect the testing group stressed when a
resident was unsure whether the robot could be trusted not to run over
her feet. However, the normativity of responsiveness and empathy cannot
be dismissed in care practices. Because the robot was unable to answer or
act empathetically - that is, to care - this responsibility was distributed to
the trials’ spectators. When one resident asked, during a session, if her
husband was dead, the testing team and I had to answer without knowing
the right answer (the robot certainly did not have the answer) or knowing
the right way to answer; we had to improvise. In these situations, the roles
changed: suddenly, we were being tested as to whether we knew how to
care.
    It became clear that the robot’s users were constantly assisted, which
calls the idea of independence into question. When a user’s independence
is removed, interdependencies are put into action. Interdependencies are
linked not to moral contracts to be executed but to the situated practical
“tinkering” that is caring (Mol et al. 2015). Empathy and responsiveness
are not universal moral values or imperatives; rather, they are situated and
relational ‘goods’ that emphasise neither idealised images of love and
recognition nor the ideal of ‘everything going well’ but, instead, a trou-
bling awkwardness and improvisation. In contrast to the enabled and dis-
abled figures, the dismissed figure illustrates how the possibility of thera-
peutic gain in these trials gradually disappeared. The session with Pentti
66                                                            Tecnoscienza - 10 (2)

already showed the criticism the robot could elicit. However, the user was
also figured as subversive in many other ways, which I will discuss below.

4.4    The subversive figure

    In the ageing-and-innovation discourse, old age is viewed in the nega-
tive, as a problem and a lack (Neven and Peine 2017). This results in
identifying special ‘needs’ for the aged that the young and healthy do not
have. Problems with memory call for memory stimulation and rehabilita-
tion, for instance. Thus, short stories, ‘musical journeys’ and a memory
game were installed in the robot, as mentioned above. However, some of
the older users were reluctant to position themselves as old and frail or,
indeed, to accept the relationship between old age and the ageist inscrip-
tions in technology (Neven 2010). During the trials, verbal, nonverbal
and silent opposition emerged. The best example of verbal opposition in
the Sanbot Elf trials was a session with Tauno, a man born in the 1920s
who followed and understood the applications easily. He commented on
them with indelicate remarks, clearly unsatisfied. After the memory game,
in which he deemed the colour red to be the “colour of a commie”, the
observing group member declared Tauno the “winner”. The man asked
in response, “What was there to win in that?” As a concluding remark for
the session, Tauno stated that the robot “needs a hell of a lot of im-
provement”. He said he “is not going to stay here looking at this kind of
toy” and further insisted on “getting rid of that computer”, which is “not
much good at bullshitting”.
    Opposition was not always this striking; sarcasm is one example of
this. In one session, when the robot asked Helena’s gender, the ironic re-
ply was, “Guess.” Another example came when testing the memory game:
the user stated that the colour was “mostly blue”, emphasising “mostly”.
At times, in the Sanbot Elf trials, the robot was a source of humour for
participants, something to laugh at. Such was the case with the memory
game, especially. Even the testing team deemed it “horrible”, too simplis-
tic, easy and non-activating. At other times, the users were cooperative
but seemingly chose not to answer the robot’s questions or follow the
testing team’s instructions. In earlier user studies, reluctance and incapa-
bility to enact the expectations laid on the user have been conceptualised
as “re-configuration” (Mackay et al. 2000), “non-use” (see Oudshoorn
and Pinch 2008) and “innosumerism” (Peine et al. 2014), for example.
However, these concepts frame older users too narrowly within the per-
spective of active and critical consumerism (see also Compagna and
Kohlbacher 2015). Silence and refusal offer slender opportunities for fu-
ture innovations and reconfigurations. For this subversive figure, no ther-
apeutic gain can be achieved in terms of the ageing-and-innovation dis-
course. Instead, the subversive figure illustrates that the individual good
is missing. What is present, however, is criticism that calls for alternatives.
    So why did the stakeholders deem these trials a success in spite of the
Jaakola                                                                   67
ambiguities and the subversive users discussed above? I claim that this is
because the trials were performed under the logic of the ageing-and-
innovation discourse. Future-orientation and promises of high-tech inno-
vations are important facets of this discourse (see also Crabu 2014; van
Lente and Rip 1998). Thus, criticism in the present might be offset by the
hope and optimism placed in future improvements. Indeed, the testing
team highlighted a future-orientation: the robot was introduced as a tool
to gather data for improvements. Although the inactivity and opposition
that the subversive figure illustrates could be seen as negative effects of
interacting with a currently underdeveloped robot, these kinds of “fail-
ures” can always be framed as desirable, and thus justified, regardless of
whether they result in any actual improvements. Some of the nurses, too,
were happy when the robot had any activating impact on users. This
“everything goes” rationality echoes the pervasive ageing-and-innovation
discourse, in which technology’s mere presence is more important than
how well a technology executes its tasks (Neven and Peine 2017). Alt-
hough care robots are designed according to moral imperatives and “uni-
versal” values, they are implemented in care practices under the rationali-
ty of ‘everything goes’ which questions the idea of ethics as guiding prin-
ciples.


5. Conclusion
    This article has presented care robot trials as a site of ethics-in-
practice. Instead of a deontological ethics approach, which is the norm in
ethical discussions of care robots, an empirical ethics approach informed
by the concept of figuration was conducted. This approach resulted in
identifying four different user figurations: the enabled, disabled, dis-
missed and subversive. In turn, all of these figures have illustrated what
kinds of therapeutic gains are (or are not) accomplished for older users in
human-robot interactions. In the trials, normativity in action meant a
clash between abilities and disabilities, dismissal and responsiveness, and
independence and interdependencies. When disabilities, responsiveness,
and interdependencies were enacted, an ethics of care came to the fore.
This kind of ethics is based on care practices that stress improvisation and
tinkering. This formulation of ethics is not usually included in ethical dis-
cussions on SARs or the present state of the robot, because the discussion
is too firmly focused on deontological ethics and design processes.
    The article’s findings question the idea that “universal” moral val-
ues, such as autonomy, enablement and independence, should be central
in ethical assessments of care robots. The trials do not resolve into the
normativity of enablement which stems from the ageing-and-innovation
discourse. Indeed, only the enabled figure enacted these values and fully
realised the optimism of the “triple win” rhetoric. Because the SAR en-
acts the interdependencies of care, rather than the independence of the
68                                                             Tecnoscienza - 10 (2)

care receiver, its role as the liberator of the workforce and saviour of a
demographic is questionable. The contradiction between the ideal of an
autonomous, independent user and the actual and dependent residents
connects to neoliberal healthcare reforms that, in the care unit discussed,
had been introduced, for example, in the form of an imperative to refer to
residents as ‘customers’ in order to respect their autonomy and freedom
of choice. The need to address dementia patients as ‘customers’, and the
independence expected from them as users, exemplifies the kind of user
that is imagined as desirable and ethically justified in contemporary care
practices, that is, a ‘customer’ who is in need of cognitive and physical
therapy but is nevertheless active, autonomous and able (see also Fren-
nert 2016). In practice, though, “the logic of care” (Mol 2008), function-
ing not on the independence of the customer but rather on interdepend-
ent relationships, came to the fore in these trials.


Acknowledgements
This research was supported by grants from the Ella and Georg Ehrnrooth Foun-
dation, the Oskar Öflund Foundation, and the Turku University Foundation.


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