Meet Dr. Emily Largent, Lead of the Ethics & Policy Core at PennAITech. By day, she serves as the Emanuel and Robert Hart Assistant Professor of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine. She's also a Senior Fellow at the Leonard Davis Institute of Health Economics. Dr. Largent's research is a blend of legal and ethical considerations, focusing on improving the patient and caregiver experience across the spectrum of cognitive decline. She is the Principal Investigator of an NIA-funded R01 project aimed at developing a supported decision-making toolkit for persons with mild cognitive impairment and their care partners. A member of the Greenwall Faculty Scholars Program Class of 2023 and the 2023 recipient of the Baruch A. Brody Award & Lecture in Bioethics, her work has been published in leading bioethics and biomedical journals. Follow along as we delve into the ethical dimensions of AI in aging, the potential of digital biomarkers, and the importance of considering the social implications of emerging technologies.
My research focuses on understanding and improving the patient and caregiver experience across the trajectory of cognitive decline—from subjective cognitive complaints, to mild cognitive impairment (MCI), to a dementia level of impairment. Here’s one example: persons with neurodegenerative diseases desire interventions to buttress self-determination. One promising intervention is supported decision making, in which a person with marginal capacity seeks decision-making assistance from a trusted other or others. Supported decision making is gaining traction across the United States—nearly half of states have or are considering legislation to formally recognize supported decision making—and abroad. In my own work, I blend legal and ethical arguments for the importance of supported decision making and advocate to raise awareness of supported decision making among patients, families, clinicians, and other stakeholders like judges and lawyers. Additionally, I am Principal Investigator of an NIA-funded R01 to develop and evaluate a supported decision-making toolkit for use by persons with MCI and their care partners.
As I noted above, I'm interested in understanding and improving the experiences of patient-caregiver dyads. It's exciting that there are a number of new and developing digital health tools that can aid in healthy aging and also help those with neurodegenerative diseases like Alzheimer's. But -- while these tools have enormous promise -- they aren't always designed with ethical and regulatory challenges in mind. And those challenges can be compounded when we're working with dyads, one member of which is experiencing cognitive and functional impairment. Working at the intersection of tech and aging offered a chance to help make sure products are designed in a way that maximizes the benefits and minimizes the risks of tech for older adults.
There is a known problem with missed and delayed diagnosis of cognitive impairment. That makes me very interested in the use of digital biomarkers to help identify people who are at increased risk of cognitive impairment or who are exhibiting early signs of cognitive impairment. For example, how can we use the GPS in your car, the phone in your pocket, or even your smart appliances to learn about cognitive health? My hope is that digital biomarkers can help people monitor and understand their own risks and take positive steps, such as seeing a doctor for diagnosis and treatment or engaging in life planning.
There is incredible enthusiasm for using AI and other technologies for aging to promote the wellbeing of older adults and their caregivers. This is very exciting! However, it’s important to pause and consider the ethical, legal, and social implications of these technologies as they are being developed, before they are widely implemented, and as they spread. Failure to consider these implications can lead to problems with the Institutional Review Board (which oversees ethical and regulatory aspects of human subjects research) and reduce consumer and clinician uptake, among other consequences. Moreover, if we don’t design with an eye to alleviating health disparities, we risk perpetuating or even exacerbating existing disparities.
I am a huge fan of photography and lug my camera almost everywhere with me. Although this is about AI and tech, I think I can safely admit that I set aside my digital camera earlier this year and have started shooting with 35mm film. I love the way film slows the creative process down and makes taking pictures more deliberate. It's also teaching me some patience to wait for scans rather than to get the instant feedback of digital.