Ethical and Practical Concerns of Heart Rate Monitoring: Enabling Communication for Patients with Severe Communication Difficulties

BackgroundMonitoring technologies to aid communication in long-term patient care may enhance safety and well-being but may also infringe on privacy. While autonomy is a primary value in medical ethics, definitions of autonomy often take for granted a minimum level of communicative ability. For the ethical debate on autonomy to be extended to people with severe communication difficulties who cannot explicitly approve or disapprove of the use of monitoring technologies, we need to consider the ethical implications of using or not using such technologies for this patient group specifically. Main text This paper explores how contemporary philosophical arguments on monitoring physiological responses can be made applicable to people with severe communication difficulties. It further discusses autonomy concerning the ethical principles of beneficence and nonmaleficence when evaluating the use of heart rate monitoring for this patient group. While monitoring someone without their consent is ethically problematic, providing heart rate monitoring may be morally imperative as a necessary means of interaction, as this patient group is effectively isolated without much possibility to interact with their caregivers. Conclusion Although heart rate monitoring of people with severe communication difficulty can be considered a privacy infringement and a violation of the principle of respect for a person’s autonomy, it can also be autonomy-enabling and of potential beneficence. Balancing the principles and interests of a person with severe communication difficulties is challenging and demands careful and critical ethical reflection.