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The Ethics of Assistive Technology:
Bionic Helping Hand or Broken Crutch?
John R. Reyes
The University of Akron
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Abstract
Assistive Technology, technology used to assist individuals with disabilities succeed in
society, is generally seen as a positive. Yet, there are ethical concerns to be considered in the
implementation of these devices. Do they cause the individuals to stand out more? Is the
excessive price tag on many assistive technology devices acceptable to individuals who well may
not be able to afford it? Does providing an individual with assistive technology actually stint his
growth in that area and prevent him from achieving despite or because of his perceived
disability? This article seeks to examine the ethical implementation of of assistive technology in
order evolve its use into an inclusive part of modern society.
Keywords: ethics, assistive technology, AT, disabilities
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Picture day is a day filled with combs, clip-on ties, and barrettes. Students line up with
their packets filled out by parents who need proof for the Christmas card that their children have
grown a year older and are still as cute as ever. Most parents are worried that their students might
close their eyes but some are worried that their students will stand out even more. In a school in
North East Ohio, a set of parents make sure that the teachers of their student know to take the
headrest off his wheel chair so that when the camera snaps no one can tell their son is in a wheel
chair. These parents are worried that their student will be seen as a disabled student instead of
student with a disability. The slight change in phrasing puts the student before the classification.
In general, a wheel chair is a piece of assistive technology. H.P. Parette defines assistive
technology (AT) “as any item, device, or piece or equipment that is used to increase, maintain, or
improve the functional abilities of persons with disabilities” (1993, p. 18). Assistive technology
can include any number of things from a prosthetic or communication board to an enlarged
pencil. The optimal situation for any AT device is to allow the individual to achieve at or above
the level of someone who does not need the device. This level of achievement should blend the
individual into the general populace seamlessly. In today’s world this can be difficult even
though technology is becoming more and more like something out of a science fiction movie.
However, until prosthetics can be built like Luke Skywalker’s new hand, other considerations
may have to be made. Assistive technology needs to allow people to become functional members
of society while also bearing in mind the ethical issues of blending in, affordance, and not
creating a debilitating crutch.
Fitting in is a struggle that all people face in their lives. Some seem to effortlessly mesh
with the people they meet while others struggle endlessly and never seem to grasp the knack.
Arguments rage over the ethics of having to fit in and what the social norms should even be.
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Regardless of the answer, it is a fact that individuals who do not fit the mold of “normal” run the
severe risk of standing out. Students with disabilities, especially ones that may require assistive
technology, run this risk more than most. The first and foremost goal of AT is that it should
provide students with a way to function with their typically developing peers without making
them stand out more. Logically, the point of a communication board is to allow these students to
communicate with the people in their lives; not make the people in their lives stare wordlessly
and ignore the message being relayed through the device.
In the 1995 article Reflections on Ethics, Technology, and Learning Disabilities:
Avoiding the Consequences of Ill Considered Action the authors point out that AT is designed
“"to accomplish something that could not have been done before, or reach a specific goal that
otherwise would not have been possible" (Raskind, p. 429). In other words a non-verbal student
speaks with the use of a communication board. Richard M. Jackson agrees by saying
“technology increases independence, personal productivity, and empowerment.” (2004, p. 3). In
the communication board example, a student who may previously have been unable to place his
order at his favorite restaurant because he is unable to tell the cashier what he desires just like the
person lined up before him.
Yet the next person in line as well as the cashier will invariably notice the difference in
how these orders are place. While the idea behind AT is solid, the ethical question that arises is
whether or not AT will actually make students stand out more. In the article Technology and
People with Disabilities: ethical considerations author Leandra Bedini notes “Some use of
technological devices may actually increase the visibility of the inability” (1993, p. 4). 2. Amy
Milson’s article Creating Positive School Experiences for Students with Disabilities notes this
concern by pointing out the negative opinion of special education population by others citing
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“Recent research suggests students and teachers possess somewhat negative attitudes toward
students with disabilities, or that they view individuals with disabilities as different from and
inferior to individuals without disabilities” (2006, p. 66). If the point of AT is to allow students
to integrate, then service providers must bear these issues in mind and come up with a way to
avoid adding extra stress to their pupils' already heavy loads.
Answering this worry is not a simple process and there are many issues for service
providers to consider. Earlier the science fiction example from Star Wars where Luke Skywalker
receives a new hand was mentioned. His new hand serves the same function as the old and looks
like a real hand. In a chronologically earlier Star Wars movie, his father also gains a new hand
but the technology is not up to snuff and the red and gold wires expose the hand for what it is. He
therefore wears a glove to cover this nonconformity. This decision mirrors what students,
parents, teachers and tech specialists must consider in today’s technological age.
While the perfect technological solution has not yet been invented and in fact this might
include its own ethical issues, what is important is that students, parent, teaches and tech
specialists input is all included. An article called Selection of Appropriate Technology for
Children with Disabilities states “the teacher and other team members must consider the child's
preferences for certain types of technology” (Parette, 1993, p. 20).This illustrates that the first
and foremost decider in AT decisions should be the person getting the AT. Parette goes on to
give the example that “a girl may be uncomfortable using an augmentative communication
system that employs a male adult voice” (1993, p. 20). While this example is a little dated as
there are now a multitude of voice choices, it could also be stated that perhaps the child does not
want to sound robotic. Depending on the child’s mental ability she may feel she has more of an
identity using sign language.
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Another example of student preference comes from my own classroom. I had a student a
few years ago who received an assistive communication device at the start of her time with me.
Apparently a lot of time and effort was put into getting her this device in the year or years
preceding her moving up to my class. Yet, I never had any trouble understanding the child’s
wants and desires and while her vocal ability was limited it could be argued that the sound of the
automated voice was no more or less different than the sounds produced by her own vocal cords
though somewhat more understandable to someone unpracticed. As a result of not having any
personal communication issues and the extra time it took to use the device it was rarely used
within my classroom.
This student’s strength and perseverance lead into another consideration to be made in
choosing technology while considering the persons being affected. The AT needs to build off
their existing strengths. Raskind states that AT optimally offers ways to "circumvent weaknesses
while capitalizing on strengths" (1995, p. 429). An example of this, once again from my own
experience, is a student with multiple disabilities. This student was wheel chair bound and had
semi-functional use of one hand. While he had limited use of that arm his strength was he did
have the ability to use it. In order to be more independent a spoon was purchased for him that
swiveled. The swiveling end of the spoon was the assist needed in order to avoid spilling food
out of the spoon on the way to its destination (his mouth).
Another consideration that will help these students blend in is that they need to be given
chances to use the device in the world so that it becomes common place and they become
confident. Even a person with a cell phone does not blend in if he must constantly ask someone
how to use it. Matthew Sableski did a small study (Augmentative Communication Devices in the
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Classroom and Community) with students using communication devices. When one of his
students went to a hamburger restaurant and used his device the following interaction occurred:
When the waitress came over to get David's order, he pushed the correct series of buttons
and the DeltaTalker announced, "Hamburger french fries." The waitress acknowledged
David's order and then asked, "What would you like to drink?" Ms. Garrison looked at
David and repeated the question. Right away, David pushed the buttons and the
DeltaTalker said, "Mountain Dew." "We don't have Mountain Dew," the waitress said as
she looked at the adults. Immediately, and without being prompted, David punched in a
series of keys and the DeltaTalker announced "Coke! (2000, p. 5).
He follows up the example by stating “The more these devices are used by people with
disabilities, the more people without disabilities will come to accept them as functioning
members of society” (2000, p. 5). While modern technology cannot yet create an invisible device
or bioengineered solution to David’s difficulty he can become a much more seamless member of
society by being proficient with his technology and being visual in his community.
Money can be seen as a great equalizer. Perhaps the greatest ethical barrier to students
who need AT is their ability or inability to afford the technology they need in order to achieve
any of the above successes. The issue of price is not always considered in science fiction movies,
such as heroes gaining seamless prosthetics, but this issue is very real on Earth.
The prices of AT can provide an impassible barrier for students with special needs. The
first question is why is assistive technology so expensive? Leandra Bedini points out a number of
things including liability insurance, products not being produced in large quantities, and having
to be custom made. Furthermore she points out that “according to PL101-336, The Americans
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with Disabilities Act of 1990, section 2 (a) (6), census data and polls have identified people with
disabilities as a group that is inferior and disadvantaged economically.” (1993, p. 5). A personal
example from my own classroom incudes parents with several foster children. The last few
months of the 2012/13 school year were spent writing and re-writing a request for an I-pad for
one of their children. They also have had several fundraisers to purchase another automatic
wheel chair for another of their foster children.
As the above examples illustrate, this process of procuring funding takes time. Raskind
points out that “even when the tab is picked up the maze through the bureaucratic funding
process may take considerable time and effort“(1995, p. 432). Another issue is that the
technology may already be obsolete by the time funding is raised. The earlier example of my
student with the communication device illustrates this. By the time she gained access to her
communication device she was already able to make her wants and desires known.
This problem does not yet have a good enough answer. The ethics behind students who
need a device but are unable to get it because they lack the funding are ones severely in question.
However, there are efforts being made such as those mentioned by Raskind who points out
“legislation (i.e. ADA Individuals with Disabilities Education Act of 1990 [IDEA],
Rehabilitation Act of 1973, Technology-Related Assistance Act of 9988) has attempted to
provide some initial mechanisms for distributing the financial burden across the educational
system, the government, manufactures, and employers (depending on the situation)” (1995, p.
432). However, more needs to be done to make sure that not only are assistive tech affordable
but that the means by which it is possible to gain access to it are speedy.
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Assuming AT is purchased, it also needs to enable the individual to achieve, not stint the
abilities they may already possess. The earlier examples of David using his communication
device and my former student's swivel spoon point to using student strengths as a way to make
sure this occurs. Richard M. Jackson’s article, Technologies Supporting Curriculum Access for
Students with Disabilities, summarizes this by stating “technology should not be isolating; rather
technology should be inclusive and liberating” (2004, p. 13). In the article Special Education,
Technology, and Teacher Education; author Sylvia S. Martin goes so far as to state “The
appropriate and successful integration of technology into learning environments has the potential
to benefit all students” (2006, p. 1). The example illustrates Universal Design principles
(assistive changes they meld into society and benefit all) such as lowered curbs that not only help
individuals in wheel chairs but bicycle riders, the elderly, and anyone walking.
The potential ethical problem is illustrated in Reflections on Ethics, Technology, and
Learning Disabilities: Avoiding the Consequences of Ill Considered Action where the authors
point out a number of ethical dilemmas concerning AT being more debilitating than facilitating.
For example if "introduced too early, either before an adequate number of instructional/ remedial
methods have been attempted or before a particular approach has had time to take effect, then
perhaps we are robbing the individual of the opportunity to improve his or her skill deficits"
(Raskind, 1995, p. 429). It then goes on to point out the potential issue of erring on the opposite
end of the spectrum: “But by same token critical learning periods during the early years might
also be lost" if we delay implementation” (p. 429).This conundrum may cause an IEP team to
freeze and hesitate to make such a decision.
Furthermore, the article by Bedini points out that sometimes it is assumed that either one
is correct when “some individuals with disabilities may find dignity and identify within their
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disability” (1993, p. 4). These students may prefer to work with their disability and find their
own ways to cope. The deaf community, for example, uses sign language to communicate and
take pride and create a personal identity. Many, if not most from this community, would see
using something like a communication device as an insult.
Despite this it is still possible to make positive strides, sometimes with little effort.
“Something as simple as encouraging students to word process all assignments can have a
dramatic impact on a student with poor motor-coordination which often makes his or her
handwriting disorganized and difficult to read” (Grover,1994, p. 1). This example points out that
students can use AT to make strides forward. In the case of a word processor, this is generally
the way most people in society write down works, especially anything of length. It is therefore
easy to blend this adaptation in without anyone even noticing that there was an issue in the first
place.
Once again, it remains important to include the individual in the decision making process.
In this technological world it is sometimes forgotten that the tech does not need to do everything.
The persons with disabilities can often do more than people give them credit for. Bedini points
this out when she notes that “individuals with disabling conditions might opt to solve their own
problems without adaptations” (1993, p. 2). T.S. West, in the book In the Mind's Eye, goes so far
as to say that disabilities can even be strengths. "The complex of traits referred to as "learning
difficulties" or "dyslexia" may be in part the outward manifestation of the relative strength of a
different mode of thought... Too often, the gift is not recognized and is regarded only as a
problem” (1991, p. 19).It can be possible for an individual to learn to take ownership of that
which once plagued him or her. For example, a student with ADHD may learn to channel that
energy into the task or tasks placed in front of them and finish each one with zeal.
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If he or she does desire the equipment, it is important that it plays to his or her strengths.
“An assistive device that appears excellent on paper but remains unused because the child is
uncomfortable with it is the equivalent of no assistance at all (Parette, 1993, p. 19). If the child
is not properly included in the process then the technology provided can become classroom
wallpaper. If the student is unable to articulate his wants, then it may well be prudent to get the
AT device on a temporary basis in order to do a trial run. If this option is chosen make sure, if
possible, that the device can be obtained quickly if the student uses the device successfully.
Getting the individual started and then having a four month waiting period to gain access to the
technology permanently will set the student back considerably.
In order to add balance to the individual’s opinion or if the youth is very young the IEP
team all needs to make sure this decision is made carefully. Martin’s article, Special Education,
Technology, and Teacher Education, illustrates this:
To be a technologically competent special educator, teachers have the skills to select
developmentally appropriate software, to understand and delineate the related benefits of
the software, and to align software skills with curriculum. Teachers must understand how
software may provide opportunities for the student with disabilities to control
environments, to stimulate imagination, to interact with others, and to use open-ended
exploration to facilitate development of higher order skills. (2006, p. 2)
In other words, special education teachers need to become experts in whatever technology may
best help their student in question. If this means finding something they did not previously have
experience with, then they need to find someone who is proficient and become proficient
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themselves. Otherwise the student may receive something less suited to his needs simply because
the provider is more familiar with that device.
Parents need to be included as well; “by involving parents, caregivers, and professionals
in the assessment process, it is anticipated that the need for a reevaluation or appeal process is
lessened” (Sableski, 2000, p. 2). This is optimal because this technology should be something
that not only helps the child at school but in life in general. If the AT is something that meets that
criterion, then the parents need to be involved so they can help successfully integrate the AT at
home and in the community. Sableski concurs with this by stating “The child should be given
opportunities to use the device both in and out of the classroom and be encouraged to practice
using the device whenever possible” (2000, p. 3). Just like any other ability, the more a skill is
practiced the more ones proficiency improves.
In order to further assist making sure this transition goes smoothly it is important to make
sure everyone who is working with the child as well as the child himself is trained is also
important. This allows the child to have support using his device no matter where he is.
“Training on assistive devices increases the student's general knowledge level and provides the
necessary skills to family members, teachers, and other professionals who will implement the
devices in the classroom and home environment” (Sableski, 2000, p. 2). In other words,
everyone who works with this student needs to understand the AT that is being put in place in
order to be better able to guide the student in using the device to its fullest extent. The more
smoothly the student is able to demonstrate success with any device the more seamlessly the
device becomes a part of who the student is and thus becomes less of a distraction and more a
part of the person.
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All in all, the aforementioned steps need to be implemented in order to ensure the AT is
able "to accomplish something that could not have been done before, or reach a specific goal that
otherwise would not have been possible" (Raskind, 1995, p. 429). Students should become so
good with their AT that the use of it becomes like cell phones or computers: it is simply accepted
as the norm.
Blending in, cost, and avoiding exacerbating the disability are three main ethical issues in
the choosing and implementation of an assistive technological device and in order to conduct this
process ethically it is imperative that it be student centered, unrushed, and well used. The point
of AT is to include people with disabilities in today’s modern society. Since this modern world
does not yet have the ability to alter people the way they do in science fiction movies such as
Star Wars; the next best solution is for AT to be used correctly and frequently so that it becomes
a part of the norm. Optimally, something such as a communication board should be seen as no
different from a cell phone. It is simply a way to communicate.
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References
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from
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