Ambient Intelligence Highlights Familiar Obstacles to Pre-Deployment Testing of Healthcare Innovations

Ambient intelligence systems are designed to sense, process, adapt to, and act on information in their environment: motion, light, sound, and other data. In their target article, "A Justice First Approach to Ambient Intelligence in Healthcare", Herington and Cho argue that the ethical implementation of ambient intelligence systems cannot rely on autonomy-focused, individualized clinical or research ethics frameworks. Because ambient intelligence surveillance can passively record and report information beyond its most narrow intended purpose, ambient intelligence systems implicate various groups of people (with potentially conflicting interests). To address these conditions, Herington and Cho propose a justice-first approach grounded in principles of fairness, transparent governance, and accounting for historical, societal, and structural injustice. We agree that the application of traditional bioethics approaches would be inadequate and that this situation requires thinking beyond the clinician-patient or researcher-participant dyad. We extend their argument in two ways: first, by noting that these challenges are not unique to ambient intelligence systems but arise in many health system advances; and second, by operationalizing their call for systematic research to evaluate ethicality before widespread deployment.