Introduction
A recent addition to technologically enabled practices in healthcare that create new ethical and legal issues is “video-algorithmic patient monitoring.” We use this term to describe an assemblage of video sensors and algorithmic software that enable nurses to make remote, non-contact clinical observations of patients in hospital environments. Terminology remains unsettled for this practice, as it often does in areas of rapid technological change. Other definitions include “artificial intelligence-enabled audio-visual surveillance and monitoring” (McDonald 2021), “vision-based patient monitoring and management” (Lloyd-Jukes et al. 2021) and “digitally assisted nursing observations” (Barrera et al. 2020). Video-algorithmic patient monitoring has been trialled in several countries on specific patient populations including on “renal patients undergoing dialysis, neonates in intensive care, adults in intensive care, and patients and staff in a high-security mental health setting” (Barrera et al. 2020). The technology is also being used by care services for older persons and persons with disabilities, including those with mental health conditions (McDonald 2021) and will be likely used in home-based care, particularly for older persons (Lange and Maruthappu 2019) if indeed this is not already occurring.
For the purposes of this commentary, we will focus on video-algorithmic patient monitoring in acute psychiatric settings, where it is at experimental stages (Barrera et al. 2020). Novel ethical and legal issues arise in the mental health context, particularly as semi-automated nursing may seek to analyse patient behaviour, such as those associated with self-harm, assault, and suicide, and not just physiological matters such as pulse and breathing rates. The behavioural component potentially shades into “surveillance,” where “surveillance” is defined as comprising a “[w]atch or guard kept over a person … ; often … supervision; less commonly, supervision for the purpose of direction or control, superintendence” (Oxford English Dictionary 2018). This is also the case where monitoring extends to surveilling against staff malpractice (see Lloyd-Jukes et al. 2021). Further, a significant proportion of inpatients in acute mental health settings are detained and treated involuntarily (over 50 per cent in some acute public mental health systems), which carry the associated and vexed questions of upholding free and informed patient consent.
Regardless of these specificities, the ethical and legal issues raised by video-algorithmic patient monitoring in psychiatric settings are relevant beyond the mental health context and concern potential futures of healthcare and human care more broadly.