# Healthcare Students' Ethical Considerations of Care Robots in The Netherlands
## 1 Introduction  
Over the past decades, a shift in healthcare needs has become evident. World population is ageing, whereas replacement fertility is dropping [1] (pp. 2-5). Life expectancy is higher than ever [2] and older adults require an increasing amount of healthcare [3, 4]. By 2040, the number of older dementia patients is estimated to be 81.1 million worldwide [5]. These people often require more specialised care [6, 7]. For example, loneliness among older adults may lead to excess morbidity and mortality [8]. The changes in the amount and specialisation of healthcare needs also increase the costs [9]. On top of severe healthcare budget-cuts in most Western countries, a shortage of educated care professionals is expected in the area of specialised care [2]. This shortage of hands together with the aftermath of a global financial crisis foreshadows a future of low-quality eldercare against high costs [10]. Progressively, the call for care technology becomes louder and care robots seem to be in the vanguard of that development [11]. Care robots come in many forms, from surgery machines (e.g., Da Vinci Surgical System) to cuddle toys (e.g., PARO). Generally, three types of care robots may be distinguished: assistive, monitoring, and companion robots [12]. Assistive robots help withhygiene chores such as washing someone's hair [13]. Monitoring robots survey matters of behaviour or health [14]. Companion robots provide entertainment and daily management, which is typical for dementia patients [15] as well as for socially isolated seniors [16]. A healthcare robot is not a conventional machine but an agency that makes (partially) independent decisions and executes specialised tasks with little assistance [17]. Healthcare robots provide support for basic activities, assisting seniors and their caretakers [18]. However, despite recent advances in robotics, care robots cannot independently tend to the needs of older adults, nor will they in the foreseeable future. Thus, robots themselves need their minders, on the work floor as well as in operational management. That is, current students of care will be working with robots as their colleagues [19]. Others will be managers and planners, dealing with teams of care personnel and robots. To prepare healthcare systems for new technology, proper training of (future) care workers is required [3]. Higher vocational students will become the care managers that coach the lower vocational students, who become the care professionals, working in mixed robot teams. The questions that arise from such observations include: How do professionals of tomorrow perceive such robot care, as useful and helpful in their jobs or threatening, expecting massive lay-offs? Does robot care clash with moral principles of \"good care?\" These and related questions are addressed in the current paper, investigating what trainee professionals think of assistive, monitoring, and companion robots in terms of morality, utility, and acceptance. In view of robot care, how do care students consider patient: (1) autonomy; (2) non-maleficence; (3) benefence; and (4) justice [20]? These basic principles of healthcare ethics are generally accepted to assess medical and care procedures, treatments, interventions, and technologies. To guarantee autonomy, patients should have full control of decisions that concern their health. They cannot be forced into treatment. Patients should be informed as completely as possible, and made aware of dangers, benefits, and success rates. Treatment is performed only under the patient's fully informed-consent. Non-maleficence states to better do nothing than something that worsens the patient's condition. Treatment should not harm the patient, their kin, environment, or society. An incision may temporarily and locally \"harm\" a patient as long as the greater benefit is ensured. Therefore, benefence entails that all acts, thoughts, and deliberations are with the good of the patient in mind.