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Department of Values, Technology and Innovation, Delft University of Technology, Delft, The Netherlands Abstract: To date, the majority of work in the fields of human–robot interaction and robot ethics take as the starting point a dyadic interaction between a human and a robot. It is clear, however, that the impacts of robots in health care (understood as ranging from embodied robots and AI to avatars and chatbots) far exceed the individual with whom the robot is interacting. One of the most critical aspects of introducing robots in health care is how such a “bot” will restructure the health care system in a variety of ways: roles of health care staff will change once “bots” are delegated tasks, certain professions may no longer exist (eg, cleaning robots may remove the need for janitorial staff), the education of health care staff will need to include “bot” training, resources will be reallocated to account for the purchasing of “bots”, and the expertise of health care staff will be called into question (eg, when an AI algorithm predicts something that the physician does not). A well-developed care system that includes “bots” of all kinds should predict and balance the ethical impact equally between not only caregivers and receivers, but for the system within which these actors function. This article proposes a model for doing just this, the human–robot–system interaction (HRSI) model that allows for the ethical assessment of “bots” as mediators between a care receiver and a health care system. The HRSI model has important implications for revealing a new set of ethical issues in the introduction of “bots” in health care and in calling for new forms of empirical research to track possible (unintended) consequences related to the rearrangement of roles and responsibilities in the health care system resulting from the integration of health care “bots”.

<p>A paradigm shift for robot ethics: from HRI to human–robot–system interaction (HRSI)</p>