The Embedded Philosopher
a tale of failed attempts
Asle H. Kiran • 27.11.2012
telecare technology
• heart- and lung diseases, diabetes, musculoskeletal pains, etc.
• patients can stay at home, but have their condition monitored
→ promises: reduce expenditure; improve healthcare; empower patients
• “designers emphasise technical requirements, not sufficiently recognising
user requirements” (Vollenbroek-Hutten & Hermens, 2010)
• communication gap between designers and users: low implementation ratio
the telecare at home project
• telecare technologies restructure healthcare in unpredictable ways; promote
divergent norms of care (Oudshoorn 2011)
• on the one side: aims to increase the responsibility of patients and nurses for
monitoring diseases - brings more control and autonomy
• on the other: ICTs are expected to replace people and take over the responsibilities
and control for monitoring diseases
• patient reluctance: lose control and autonomy, do not trust ICTs
• professional care reluctance: care is not about discrete functions, but is a
continuous process of personal follow- up and contact that builds relations
• main research question: how can telemonitoring technologies be developed to achieve a
careful balance between surveillance by technological devices and the control and autonomy of
patients and nurses?
the telecare at home project
• two parts:
- investigate design and use practices in current telecare projects (embedded)
- develop methodological tools that support designers and technicians in finding a
balance between the conflicting norms (ethical constructive technology assessment)
• goals:
- work close to designers, technicians and engineers
- investigate various perspectives: technical, social, philosophical
- broaden multidisciplinary understanding, and deepen theories/perspectives
within the respective fields
- in philosophy: how technologies influence:
a) the shaping of ethical thinking - how ethical choice and action are both
enabled and constrained by technologies
b) the shaping of subjectivity – how people understand themselves in relation
to the technologies that surrounds us
four telecare failures
• MYOTEL. chronic neck- and shoulder-pain
- monitoring and exercises
- Roessingh + UTwente & unis from Germany, Belgium and Sweden
→ too late
• COPDdotCOM
- disease management program: detects and assists in case of emergencies,
and “promotes an active, healthy lifestyle”
- Roessingh + Utwente; continued as Conditie Coach (CoCo)
→ too dutch (I made a questionnaire, though, in english)
• IS_active (Norwegian Centre for Integrated Care and Telemedicine)
→ too overlapping (having a project-member in both projects didn’t help)
• Danish Ph.D-project on COPD briefcase (‘kolkofferten’)
→ only receiving interview data, too narrow focus
so, what to do?
“not being able to investigate an innovation project empirically, the embedded philosopher returns to
his armchair…”
• … in order to contribute methodologically:
- some articles dealing with the relation between design and use context are
published; based on literature studies rather than empirical studies:
→ what does ‘responsible innovation’ mean; design instrumentalism?
- two articles still underway (on ‘eCTA’ and ‘subjectivcation’)
• second part of the project – to develop methodological tools for designers and
technicians – is attended to, but, without the “proper” integrated approach
• however, the question is still topical: how to be embedded?
• and, for us: how to do empirical philosophy of technology without being (yet
another) STS-scholar?
philosopher on the lab floor
• empirical philosophy of technology and STS both deal with ‘soft impacts’
of innovation: how technologies have social and ethical effects that transcend
their functional properties (“technologies are no mere instruments”)
• common interest: technologically “driven” re-configuration of practices/society
• methodologically similar (usually), but differs in focus (our project):
- ethical issues
- issues of subjectivation
• more specifically how technologies challenge “the autonomous human”:
- ethics: the mere availability of technologies forces us into ethical dilemmas
and constrains our ethical choices by assigning specific roles
- subjectivation: our self-perceived possibilities (“here and now” and “in life”)
are reflections of technical possibilities (and not just scripted ones)
philosopher on the lab floor
• but how to create “methodological tools for anticipation” of such soft impacts?
how to “feed back” sociological and philosophical issues to innovation projects?
• the telecare at home project was/is committed to an ethical constructive technology
assessment; now, what does that mean?
• CTA, i.e. stakeholder workshops, with an eye for normative dimensions
• framed by an internalist view on human-technology relationship (subjectivation)
•
van der Burg (2009): ‘positive
heuristic’ rather than a ‘negative heuristic’: “form an ethical
language … which expresses advises about what to do that help form a future
technology in a way that contributes to human well-being”
philosopher on the lab floor
• “controlled imaginative endeavour”: “to start with the future scenarios that technology researchers
themselves aim to realize [‘technical scenarios’] … show that these are primarily concerned with the
technological change … an ethicist can assist in enlarging the imaginative scope that directs
technology research to also include the ways in which a new technology is able to change the medical
practice in which it will be used, in better and in worse ways for human well-being … this provides
material that helps to reflect more responsibly about what to pay attention to during the phase of
implementation in the future”
•
Kiran (2011, 2012): one
such strategy (for telecare) could be to encourage specific
design strategies that “leave room” for users to co-shape the manners in which
the medical technologies become part of their overall daily life
→ anticipating the social and ethical impact of innovation is not a matter of translating user
requirements to technical requirements; ‘methodological insecurity’
• what specific norms and values technologies should reinforce or discourage is
impossible to say outside a given practice, maybe even outside a specific patient