Technological advances and digitalisation are opening up new possibilities in healthcare. Tools to support diagnosis, treatment and care are now widely used in clinical practice, including digital surveillance systems. Long used in intensive care, they are now making their way into inpatient and long-term care facilities, promising greater safety and efficiency. Alongside their potential benefits, critical ethical, medical and legal aspects must be weighed carefully.
In many circumstances, the use of digital surveillance systems has become indispensable as a complement to care and treatment. In intensive care units, for example, real-time image transmission helps to identify critical situations when no professional is present at the patient's bedside. The temporary use of digital surveillance systems, when medically indicated, can enhance patient care and is often deemed acceptable.
Also in other settings, digital surveillance systems are used, whether visual, audio or based on artificial intelligence, with the goal to improve the quality of care. They interfere with privacy to varying degrees, affecting those being monitored as well as their relatives, visitors and healthcare professionals.
Particular attention must be paid to protecting the privacy of inpatients and nursing home residents. These individuals are forced to temporarily or even permanently give up their private space due to their dependence on medical or nursing care. This applies to all areas of inpatient care – from acute hospitals and psychiatric wards to rehabilitation clinics and long-term care facilities.
Position statement by the Central Ethics Committee of the SAMS
The Central Ethics Committee (CEC) has developed a position paper outlining the opportunities and challenges associated with the use of digital surveillance systems. It also formulates key requirements for their responsible use. The position paper is aimed primarily at healthcare professionals, as well as hospitals and long-term care institutions.
Summary
Digital surveillance systems raise fundamental medical-ethical and legal questions, particularly where audio and video surveillance is used, whether continuously or «on demand» (activated when needed). The requirements formulated by the CEC illustrate the conditions under which digital surveillance systems may, in justified individual cases, be used in a medically appropriate, legally permissible and ethically responsible manner.
Among the key requirements are the protection of privacy and the principle of proportionality. Depending on their design and application, digital surveillance systems interfere to varying degrees with individuals’ privacy. Surveillance may also affect relatives, visitors and staff.
In its position paper, the CEC concludes that digital surveillance systems must never be used routinely. It also emphasizes that, despite ongoing technological advances, human care and personal attention remain indispensable components of holistic healthcare.
Restriction of freedom of movement
When assessing digital surveillance systems, it should be noted that, depending on how they are used, they can act as measures that restrict liberty. Restricting freedom of movement or personal liberty constitutes a coercive measure. Although those affected may perceive a digital measure as less invasive or restrictive than other means, such as pressure mat sensorsor one-to-one observation, the same medical-ethical and legal provisions apply as for other coercive measures in medicine. Medical-ethical guidelines on this topic are currently being revised coercive measures in medicine.