On the technologizing and technocratic trends in bioethics

- Y. Michael Barilan MD, MA
Department of Internal Medicine B, Meir Hospital, Kfar Saba, and Department of Behavioral Sciences, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Correspondence:16 Mendele Street, 63563 Tel Aviv, Israel

Email: bentovia@shani.net

Eubios Journal of Asian and International Bioethics 12 (2002), 176-81.

Contemporary bioethics is usually notable for its focus on the uses and abuses of biomedical technology, on personal liberty and the on the formulation of ethical problems as dilemmas to be solved by utilitarian calculus within the frameworks of committees and institutional guidelines. It is argued that these developments actually reflect a technologization of medical ethics itself, which more often relies non-personal algorithms of utility.

This is explained, from a historical point of view, by the impact of technology on the concepts of nature and naturalism and by the triumphs of modern science, which obscures non-scientific modes of discourse. The article acknowledges some benefits of the technologization of ethics such as the democratization of decision-making but the discussion concentrates on five arguments against the dominance of utilitarianism in medical ethics. The common denominator of these arguments is that utilitarianism fails its own standards by undermining trust in the public domain. The loss of trust is brought about by the displacement of the phenomenological self and from fostering adversarialism in ethical discourse.

Key words: bioethics, technology, critic of; utilitarianism; trust; naturalism; self

1. Introduction

The last three decades have witnessed the consolidation of bioethics as an established and independent discipline in the affluent parts of the world in general and in the USA in particular. Most of the celebrated cases in the history of bioethics deal with the uses and abuses of medical technology. Many regard bioethics as a balancing response to biotechnology. Yet bioethics may also be problematized as a natural growth of biotechnology (Elliott 1999). This is particularly evident from non-Western and non-capitalistic points of view. Medical practice and ethical concerns are human universals. They are shared by all human societies. It is highly important therefore not to confuse particular manifestations and institunalizations of ethical reasoning with ethics as a rational disciplined exercised by people who search for the right conduct of action and valuation.

In this article I will try to contemplate the following questions. Is it possible that the discipline, which is known today as bioethics, has been somewhat entrapped by the ethos of technology and efficiency? Is bioethics involved to a certain degree in the technologization of ethical deliberation and the concept of the good itself? Is it possible that bioethics harbors an earnest attempt to solve the technologization of the medical life-world by the most powerful means at our hands, namely technology itself (1)?

Jacques Ellul (1981:48) describes a similar development of technological civilization in which "everything becomes an imitation of technology or a compensation for the impact of technology". I wish to go one step further and to suggest that the compensation itself is ironically technological. Similarly, on one hand one may point to the pluralistic and cross disciplinary nature of bioethics and bioethical committees. On the other hands, one may suspect that bioethics aspires to become a technocracy of medicine. Bioethics wears a dialectical Janus face.

Bioethics emphasizes pluralism; it seeks the voice of lay people and it actually grew up as a counterpoint to technologization, technocracy and erosion of autonomy. Nevertheless, I do wish to shed some light onto technologizing trends within bioethics and the bioethical movement. These undercurrents are probably not dominant, but I do believe they thrive within the very core of bioethics.

2. Use of the terms technology and technologization

By technologization I mean first the reduction of all relevant considerations into quantifiable variables on which algorithms are applied with the intension of finding solutions to problems of choosing a conduct of action (2). Technology also consists of preconceived rational designs, which are standardized for mass replication and which are aimed at optimizing procedures so as to achieve an outcome of higher quality or by means of faster and cheaper methods (3).

Technological solutions and products are almost always used on a large scale in order to discharge practical needs or perceived needs of individuals and society. Hence technology is strongly and irrevocably enmeshed with systems of finances and administration, which, in term, are usually also subject to technological governance. Technological mode of thinking need not be mechanical. It is applicable to areas of management and bureaucracy as well.

The technocratic ethos has its roots in Plato and Hegel who envisioned the technocrats as a class of professional and highly educated civil servants, only who know what is really good for the people. A reversal of paternalism is a key motif in the bioethical ethos. A drift into technologization and technocracy might reintroduce paternalism in through the back door of contemporary practice. There are infinitesimal short gaps between technologization in bioethics, technologizing bioethics and the technocratization of bioethics.

In this article, the making and the use of artefacts (usually medical tools or procedures) is an important but insufficient condition for employing the term technology (4). Hence "modern or scientific technology" is more accurate. I will first explain the exact meaning I have in mind and then simply employ the word "technology". This will save words such as techne and "primitive technology" as well as the discussion about the transition from pre-modern to modern technology and the nature of machines. "Algorithms for saving problems" (the problems at stake) is kin to Bunge's concept of technology as an applied science. The emphasis on efficiency and optimization (secondary problems) follows Ellul and Borgmann's "device paradigm". Efficiency in this context is used in a wide perspective embracing economic efficiency as well. Marx was the first to point out the crucial symbiosis between control over the means of production and human life both in the private and political spheres. Algorithmic processes may be found in the natural world as well, but they all fail the "rational design" criteria. For the sake of those who believe in the existence of a Rational Creator, I would qualify technology as a human made enterprise.

I also wish to stress that deterministic linear progress is an ethos of technology, with which history may not conform. It is also possible that such an ethos is wholly impractical as a unified concept of efficiency independent on socio-cultural factors (i.e. "technical or technocratic purity") is nonexistent.

Contra to Ellul whom we cite in the beginning of this article, and contra many others, I do not believe there is something inherently wrong about technology or biotechnology as such. Deterministic philosophies of technology stress the search for one best solution at the expense of inferior alternatives (=dilemmatism). On the other hand it is crucial to realize that technology produces diversity (Toffler, 1971) and pluralism is an essential tenet of bioethics.

The technologizing trends in medical ethics may be summarized according to a few points.

  1. Emphasis on institutionalization and bureaucratization, which is manifested in the proliferation of bioethical committees, review boards, codes of conduct etc.
  2. Dominance of technological modes of thinking such as the utilitarian calculus and "empirical ethics".
  3. Since optimization is one defining component of both technology and utilitarianism. The technologization of ethics actually predetermines medical ethics as a utilitarian enterprise (5).
  4. Consequently one finds relative neglect of other aspects of ethical discourse such as about the nature of ethics and the motivation to act morally, so to speak, "inspirational ethics".
    For example, David Miller (1999:7) lists "disadvantages and burdens" that should be justly distributed among citizens: "Military service, hard, dangerous and degrading work and care for the elderly". Does care is a disadvantage or burden? Macer (1998), for example, casts bioethics as an enterprise of love. In the domain of love all parties are beneficent and benevolent alike; there are no burdens.
  5. Collapse of the distinction between humane and scientific discourse. Medical science, medical art, medical education and medical ethics are beholden as being of the same kind of discipline, which is "evidence based", namely, modulatorily observational and statistically validated.
  6. Exaggerated and even chiliastic self-expectations are typical of both technology and bioethics.
In the following sections I will contend that two conceptual misunderstanding are responsible for the technologizing trends in bioethics. The first is the tradition of teleological naturalism within the professional code of medicine and as a worldview in general. The second is the incursion of scientific and technological modes of discourse into ethical discourse.

In the last sections of this paper I will discuss utilitarianism as an embodiment of all of the above trends, the technologization of ethics, teleological naturalism, the dominance of technological and adversarial reasoning in bioethics and medico-scientific utopianism.

3. The divergent traditions of medical ethics have been directed into a single arena in which technology is both the devourer and the savior of nature.

Until modernity, the dominant ethos in medical ethics in the academic West was that of the 'Hippocratic Good Doctor', whose professional excellence and personal charisma and decorum constituted his (not hers, obviously) ethical standing. Neither was the doctor a servant of the patient nor of worldly goods but of the Art of Medicine. The doctor treated the sick charitably. He was reciprocated by honoraria rather than by the market value of his services. He answered only to his colleagues, not to social institutions, from which he sought impunity.

The notion of the good as the perfection of one's kind is part and parcel of the Aristotelian and Thomist doctrines of natural law and of the good as the natural consummation (telos) of every natural kind. Doctors aim at becoming good doctors and people strive to become good people. Illness diverts the sick from the good. Doctors, being members of elite, can reach the good without assistance from outside of medicine, while the sick need professional help in order to rid them of disease and to direct them toward the good. Medical paternalism compensated for patients' helplessness at finding the good. Therefore, every physician strives towards the ideal of the Good Doctor (6), who, in turn, applies his skills to assist people in their somatic, existential and moral quest of getting closer to the ideal of The Good Human Being who is complete and balanced in body and spirit. The triumphs of medical science lured many to believe that the medical gaze is capable of objective and quantifiable elucidation of human nature and its moral precepts (for example, Brandt, 1987). The American Medical Association declared in 1936,

Medical ethics had always rested fundamentally on medical economics

Ethics has become an integral part of the practice of medicine. Anything that aides in the fight on disease is "good'. Whatever delays recovery or injures health is "bad'

This development and treatment of medical ethics gains much greater significance when compared with the development of ethics in a society as a whole (cited by Rothman, 1990: 104).

The message is that medical ethics, being part of the medical corpus of knowledge, is objective, scientific and - most importantly - separate from the hazy and controversial realms of "metaphysical or philosophical controversies".

Adversarialism becomes the spirit of "survival of the fittest" which belongs to the ideology of the free market and evolutionism. Spencer defines ethics as "An ideal code of conduct formulating the behavior of the completely adapted man in the completely evolved society" (Adams, 1998: 174). His contention is that there is one pathway of adaptation and evolution; that this pathway is naturalistic, ideal and complete. Therefore any moral problem can be regarded, from a naturalistic point of view as a moral dilemma comprising of opposing solutions, only one of which should prevail.

Ecology, technology and the distribution of goods are political issues and not limited to the field of medicine. It is no wonder that the appearance of these concerns in the modern era contributed to the democratization of medical ethics. The advent of clinical trials and "evidence based medicine" are responsible for the democratization and the technologization of bedside clinical practice. Matthews (1995:145) observes,

When the issue of medical decision-making moved from the cloistered confines of professional medical expertise, into the arena of open political debate (thrust there by highly potent, industrially produced drugs) could the advocates of statistical procedural objectivity gain the upper hand.

The bureaucratic technology of large clinical trials has partitioned between the medical sciences and bedside medicine (Vandenbroucke, 1998; Matthews 1995: 141-9; Porter, 1992; Rothman 2000). Technology has solved practical problems through the transformation of the natural and social environment.

The industrial revolution and the technological revolutions have shaken up the world in such radical ways so as to threaten the very stability of the natural environment in which the good can be realized. This way, technology undermines the scientific confidence that nourishes it. Technology evaporates moral conviction in the combustion of natural goods.

Medical technology assists medicine in its strife for the good of humankind and it catalyses democratization of discourse. On the other hand it threatens the very foundations of the good in virtue of the transformation of nature so as to undermine the concept of the good, and the natural and unmediated setting for pursuing it. The transformation of the world, especially when perceived as degradation of nature, is taken for the degeneration of ethics as well. When mathematics rules, discourse is significantly freed from subjugation to privileged ideologies or classes. But, on the other hand, the moral self also looses his or her special role in the phenomenology of ethics and in the discharge of private and public life. Democratization is only partial (Barilan 2002).

Wuthnow observes (1987:69-79) that every ethical discourse is dependent on acknowledged boundaries between the possible and the inevitable, thus delineating accountability, responsibility and prudence. The ethos of modern science and technology is charged with an unrelenting drive to reach beyond such boundaries. Therefore, we tend to commit a nihilistic version of the natural fallacy, namely, if everything might be technologically possible, ethics is no longer possible, unless in the form of technologised ethics.

Camus observes (1955: 77), "What distinguishes modern sensibility from classical sensibility is that the latter thrives on moral problems and the former on metaphysical problems" (7).

Camus discusses Kirilov, the engineer, who contemplates suicide. Camus finds a direct link between the technological dissolution of perceived limits and the absurd desire for death, which is perceived as the last and only means of self-affirmation. Dostoyevsky and Camus seem to have anticipated the kernel of bioethical fire: a confrontation between autonomy and biotechnology in the induction (techniques of reproduction) and quench of life (abortion and euthanasia).

4. Utilitarian economics and the dominance of ethical discourse

The success of medical science, which combined basic sciences and clinical statistics, fostered a belief that bioethics and biomedicine are of one kind, and that is the apodictic discourse of utilitarian economics. Both biotechnology and utilitarian thinking are inherently driven towards optimization of specific outcomes according to which health is an optimized good (8). Health is conceived as harmony which is reflected by one's quality of life. The latter is taken as a quantative good. Medical ethics is considered as an integral part of medical science; hence it assumes the guise of utilitarian calculus (9).

"Evidence based medicine" promotes a notion of "evidence based ethics". If there is one accurate diagnosis and one optimal workup and therapeutic plan, there should be a single, calculable and demonstrable solution to an ethical challenge (10). The purported solution and the deliberations leading to it are also expected to be harmonious.

The binary paradigm of art and science has been criticized (Heidegger 1977:34; Jones and Gallison, 1998: introduction) and a continuous scheme offered instead. The problem here is much more serious since my claim here is that one pole or one end of a continuum might displace the other. Every element bears a hidden side of its own subversion. Hegemony, for example, might well be conceived as the other side of harmony. The difference lies in the mode of discourse as it reflects the ethos of medicine and our self-image as humans.

Plato recognized that human knowledge is divided into distinct realms; each has its own scope of knowledge, rules of reasoning and degrees of certainty (Philebus, 55d). Aristotle, accepted this insight, but rejected Plato's contention that Ethics, like geometry is an exact theoretical science. Aristotle (Topics, book 3; Nic Eth. 1094b, 1140ff.) describes two modes of argumentation. Theoretical science (episteme) is based on established premises and the process of deduction from premises to conclusions. Dialectic or problematic deliberation (phronesis), on the other hand, begins with accepted premises (endoxa) from which plausible inferences are drawn on the basis of similarities. Every case is unique and quantitatively inexhaustible. The parties to the deliberation pick up widely accepted ideas, which are called commonplaces or loci, and apply them to particular cases by method of inferential analogies. Analogy, as Stafford observes (1999:156ff) defies algorithmic coding to the effect that Dennett and other philosophers of the mind dismiss as "first person privileges to inner states of mind". In the next section I will further explore the significance of this dismissal. Yet, analogy is essential for tool-making as much as for hermeneutics (Sheets-Johnstone, 1990:61) (11).

The method of "principalism", which is the dominant paradigm of bioethics, (DuBose et al, 1994, part 2) was developed after David Ross and in the spirit of commonplace reasoning. The four principles are conceived as the most widely accepted commonplace values of medical ethics from which the deliberative process is picked up and taken into the more problematic niches of intimate decision-making and the grottos of idiosyncratic circumstances and personalities.

Dialectical reasoning has been the strategy of choice of moral deliberation in the West until the modern era (Flechner, 1974; Jonsen and Toulmin, 1988). The advent of "evidence based medicine" which is executed by a team of bureaucratized professionals replaced "commonplace based medicine" and "intention based medicine". The rise of utilitarianism and individualism has also affected principalism. Donneley (1994) refers to these processes as the transition from principles, to "principals", from values, which are part of the public domain to, subjects whose communal province consists solely of articulated "lived experience", wishes as well as of the positive corpus of biomedical knowledge. Richard Sennett (1974:311) describes a similar attitude to public life in the modern era

People can be sociable only when they have some protection from each other;

Without barriers, boundaries, without the mutual distance which is the essence of impersonality, people are destructive.

Sennett discusses modern urban planning, but his comment is reminiscent of contemporary trends in bioethics, which aims at the protection of individuals from society, using the impersonal tools of algorithmic and utilitarian reasoning. The insistent emphasis on the supremacy of individual autonomy in bioethics (Fox 1976; Veatch, 1984) has shifted weight from the commonplaces of the public sphere to the individuals who are locked behind veils of privacy. Autonomy is a protective device, shielding the self from society and, in the case of bioethics, from overbearing physicians. Little (1995) deplores that situation in which the only inhabitant of the public sphere is the institutionalized utilitarian algorithm, which have banished emotions and the phenomenological self from moral discourse to the confinement of the private sphere. In this light we can appreciate the appearance of "moral algorithms" to guide decisions such as the withdrawal of life-sustaining treatments (Rabeneck et al, 1997; Pellegrino, 2000).

The enclosure of the self behind protective rights within a confrontational social sphere and beyond "evidence based discourse" harbingers the displacement of the self as moral agent by utilitarianism.

5. Arguments against utilitarianism as technologization of ethics

Following Feenberg's (2000) discussions of theories of technology I think that when technology becomes value laden and autonomous, the technological method cast shadow over the ends and values of society. It is at this moment when the process of technologization becomes problematic and even dangerous, unless met with creative and resistant dialogue with the people interacting with that technology. Indeed, technology may expedite the solution of non-technical problems, but it should not become the sole or even dominant mode of deliberation and action.

The transformation of ethics into utilitarian calculus and medical ethics into another kind of medical technology promotes strife since dilemmatism which is one step short of adversarialism (Gracia, 2001) and the transformation of deliberation into a tug of war (Bohm 1996:28). Compromise, creative solution, personal sacrifice or conversion of mind and heart are not part of the process (12). Dilemmatism embraces the assumption of conflicting interests and preferences and then proceeds to provide a resolution based on give and take, while interpersonal discourse harnesses rhetoric, empathy, emotions and reason in order to undo the initial conflict or to delineate a creatively new horizon of solutions. Sincere interpersonal discourse might well be a better paradigm for ethical deliberation, since persuasion can transform the balance of preferences, gains and losses while algorithmic thinking leaves them intact. Dilemmatism ignores the utility values of compromise; persuasion or even conversion. The very nature of our ethical decision-making bears directly on the utility of our actions and, most importantly, on the utility or happiness we find in our life. All this is not reflected in dilemmatism and in the technologization of life.

Second, when deliberation is an algorithmic process and the decision is dependent on an optimal outcome, ethical committees are needed solely in order to guard against possible bias or undue influence of an interest group. Ethical committees and other forums of interpersonal exchange become superfluous to the kernel of ethical reasoning, which, theoretically could be processed by a computer (13). Pluralistic deliberation turns up as an extraneous to the crucible of moral decision-making, since a committed utilitarian must be ready to give up on democracy or even on individual human rights whenever a valid utilitarian algorithm finds more optimized solutions to practical dilemmas. Possibly, a truthful utilitarian argument can never violate such values and rights. Possibly utilitarianism may end up as an alternative pathway always leading to identical conclusions deliberative ethics arrives at (14), but the fact remains that utilitarianism cares for numerical summation and not for values, and whatever is non-calculable in human affairs. Indeed, ethics and its panoply of terms, such as rights and the moral self, serve as exterior props or trappings to utilitarian ethics, whose kernel is the collection of quantifiers and the algorithmic possessing of data and the promotion of pleasure or satisfaction. Peter Singer (1993:96), for example writes about human rights,

I am not convinced that the notion of a moral right is a helpful and meaningful one, except when it is used as a shorthand way of referring to more fundamental moral considerations

The "more fundamental way of moral consideration" is the utilitarian calculus. The "more fundamental way" is at best an alternative to ethics, as much as a sophisticated android or cyborg is an alternative to a human being. Utilitarianism may successfully mimic ethics, and it can eloquently play philosophical games of emulation such as the Chinese Room (Searle, 1980), digitalized simulacra (15) (Baudrillard, 1983) or the Turing Machine (Turing, 1950), but it is not ethics as long as we take ethics to be a phenomenological experience of decision making by behalf of a human agent exercising freedom of action and faculties of evaluation; ethics as an interpersonal discourse which deliberates all probable solutions and strives towards a prudent, fair, and right one by means of persuasion, fairness and non-coercion.

A utilitarian model can show that the best way to manage ethical issues is precisely through seemingly subscribing to moral creeds that are more accepted phenoneonoligacally such as deontology. This is what "rule utilitarianism" does. Nevertheless, this has nothing to do with a commitment to pluralistic and democratic discourse and to moral probabalism. The commitment is to optimized consequentialism. One can conceive of some form or rule utilitarianism in which prudential deliberation produces the best consequences. Such a model is reminiscent of "best of all worlds" hypothesis, in which gratification is the natural outcome of moral action (16).

Third, when utilitarians reject other ethical doctrines, they also usurp the legitimization of ethics and its institutions and habits, thus bringing us full circle to critical theory's warning that technology and capitalism are the legitimizing hard rock of modern society. The chiliastic aura of cutting edge technology is sometimes utopian, sometimes dystopian, and it depotentiates legitimization form the daily spheres of selfhood and interpersonal discourse.

As already noted in the introduction to this essay, technological thinking does not deal with motivational, inspirational and existential aspects of human life in general and ethical life in particular. "Why ethics" is not merely a meta-question or a discourse of legitimacy. Different convictions and sets of mind directly influence the utility of experiencing phenomenological ethics. The calculus of preferences will change when we add the satisfaction or frustration of merely having the experience of doing good or bad. Therefore it appears that employing a simulacrum of ethics will fail the utility standard merely by giving up the experience of action from duty or responsibility or mission.

Blackburn writes (1998:165) "Do the principles [of rational choice theory] make it analytic that anybody can be interpreted as pursuing their own utility? Not quite, because you can forfeit eligibility."

Indeed, a hard core of mystery is nested in the human heart. Do we have a coherent and eligible account of why we want to live and love, or why those whishes are sometimes so quickly forfeited for trivial quests and even wishes for suicide and destruction? Not quite. Narrative and hermeneutic approaches step in offering an attempt at figuring out the human person and her intractable complexities, but the active participation of a moral self is mandatory of the exercise of an ethical discourse. The best of all interpretations will not do without it. This leads us to the fifth objection.

Personal preferences and subjective experiences are accepted as input into the utilitarian calculus at the price of alienating ethics from the phenomenological self. Such alienation is particularly bothersome if we pay attention to Torraine's (1995:222ff.) insight that respect for the subject within a democratic discourse is the real challenge of modernism, not technology, or threats on human rights. It is a human subject who is an acting agent irreducible to reason, consumption, instrumental action or any established sense of collective identity (p. 262).

My use of "modern" in modern technology is not committed to the degree of naturalness people experience with a certain device or action (see Mumford 1934:80). But since most people find it easier to use narrative, analogy and other forms of non-algorithmic thinking while tackling problems, an algorithmization of ethics alienates morality phenomenologically even further.

I will not repeat here the general criticism of rational choice theories on the basis of which utilitarian calculus is usually established (Bunge, 1999: ch. 4 & 5; Blackburn 1998:ch. 6), but in my sixth argument against the technologization of medical ethics will level at personal choice theories one criticism, which is particularly pertinent to medical ethics. It is notable that the classical experiments of "rational choice theories" such as the prisoners' dilemmas are artificial constructs whose outcome is almost trivial such as winning or losing a certain amount of money. We know little about the way people make choices and preferences in real and extreme life situation when life and limb are at stake. This is not a direct argument against the technologization of medical ethics, but against the unquestionable applicability of currently used rational choice models to medical situations.

Lastly, I believe that trust is the key factor behind the public concerns about medical ethics, and that trust is most shaky in the liminal zones of contemporary medicine. Seligman (1997:25) writes,

Trust is something that enters into social relations when there is role negotiability, in what may be termed the "open spaces" of roles and role expectations. Another way of saying this, is that trust enters into social interaction in the interstices of system, or at system limit, when for one reason or another, systematically defined role expectations re no longer viable.

The liminal zone in our discussion is that between the technological and non technological and between the biological and phenomenological in our life. Three of the above objections to the technologization of ethics share the displacement of the phenomenological self as the hub of ethical and social agency (2nd, 3rd and 4th). No wonder that the technologization of medical ethics undermines trust, and this is enhanced by the promotion of adversarialism. We must acknowledge the system-limit of technology and numerical thinking in order to reclaim problematic deliberation in clinical practice, clinical ethics and ethics. Medicine cannot and should not distance itself from technology. Nor a heuristic separation of the biological and the phenomenological is easy or sometimes possible in many medical settings. There is no way out of the narrow liminal zone. Consequences and utility do matter, and terribly so. It is when all calculations are finished and the results are set before our eyes that ethical deliberation begins, not ends. Evidently, this is a utopian paradigm, similar to the "clear market theory" based on the full information hypothesis in economics. Most often we need to act on partial and even skimpy knowledge and understanding of the facts and their quantifiable aspects. This is, as Aristotle already noted, one more reason why the moral agent is more central to ethics than non-personal data about a problem at hand. This point is particularly evident and felt at the bedside of patients than while deliberating an issue of public health.

We are irrevocably dependent on technology in order to realize our non-technological goals and values, namely human life and society. Technology and utilitarian calculations bring ethical problems to our door (17). They do not solve them. Humane attitudes such as optimism, goodwill, care and forgiveness are mandatory for the realization of trust (Jones, 1996) and the fulfillment of ethical life, particularly the life examined in the face of human suffering and fragility.


  1. Habermas would call this the colonization of the medical life world by the system of biotechnology. Interestingly, Habermas oeuvre almost never mentions or discusses technology.
  2. See Dennett (1995:48-60) for a comprehensive presentation of algorithmic thinking.
  3. The last remark is directed at the "strong program" of Bloor (1991).
  4. Domestication or domination, let alone "total control" (Levy 1987:161), over nature and humankind is not an essential or even central for the concept of modern technology as it is discussed here. It is notable that preservation of natural phenomena, recycling of waste etc are themselves technological challenges. Applying domination (technologies of preservation) in order to relieve nature of human domination (technologies of common industry) would be a contradiction in terms (cf. Callahan, 1973: ch. 3). Technologies may have psychological, political and symbolic ramifications, but this is true for every human action and institution. A religious taboo on pork, for example, is as powerfully influential as any agri-technological practice.
  5. Pettit (1990), for instance, finds "methodological simplicity" as the main argument for consequentialism. He specifically castigates non-consequentialists for concentrating on deliberation rather than justification, a practice that he finds "counter-productive".
  6. This is one possible reason why "political ethics" took almost center stage in pre-modern medical ethics.
  7. Similarly, Rawls (2000: 1) contrasts classical ethics, which deals with the good life with modern ethics, which is concerned with duties, rights and prohibitions. Regarding action out of dismissal of metaphysics is an even more problematic feature of utilitarianism.
  8. Which, in my view it is not, but his reaches beyond the scope of this essay.
  9. See Boyle (2000:84ff) for a survey of attempts to quantify all aspects of health, healthcare and happiness, such as the QUALY system.
  10. Admittedly, many bioethicists propound a pluralistic ethics, which is receptive to multiple, and often opposing, solutions to moral problems.
  11. Reducing reason to computation dates back to Leibnitz, Descartes and Hobbes (Haugland, 1985: ch. 1).
  12. Carol Gilligan and other advocates of "care ethics" leveled this criticism against "male mode of thinking", but I think that the issue is technological thinking (which is indeed dominated by men) not a direct gender related difference.
  13. A utilitarian will most likely uphold ruling by ethical committees, which are incongruent with utilitarian judgment and the reason for that will be the prudence of rule-utilitarianism. A wise utilitarian may always forgo what appears to be the best solution for the sake of an alternative, which ultimately will nevertheless lead to better outcome.
  14. One can conceive of some form or rule utilitarianism in which prudential deliberation produces the best consequences. Such a model is reminiscent of "best of all worlds" hypothesis, in which gratification is the natural outcome of moral action. Even if we accept this kind of ontology, one wonders if there is any distinction left between naturalism, rule-utilitarianism and deontology.
  15. Baudrillard emphasizes modularity rather than algorithmic (or any other mode of) processing or production. Nevertheless, the absence of an original bears directly on the denial of privileged self and agent.
  16. Even if we accept this kind of ontology, one wonders if there is any distinction left between naturalism, rule-utilitarianism and deontology.
  17. Same is true the other way round. Care ethics invites problems of distributive justice whose elucidation requires consequentialist assessments. Those problems would have been nonexistent in careless society. This is one more example of the ongoing exchange between technology and people and their humane values and interests (Feenberg 2000: ch. 9).

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