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English review - The Dark Side of Health Technology | Lecture by ethicist Tamar Sharon

Nowadays, technology seems to be indispensable when it comes to our health. We track our sleep, calories and steps with the help of apps on our smartphones or wearables; doctors can be consulted via video-conference; and we talk about our feelings on Twitter and Facebook. While technology promises many benefits such as improved health, easy access, and lower costs, the vast amount of data being collected and processed raises concerns – especially about privacy.  In this online event organized by Radboud Reflects, speaker Tamar Sharon – professor of philosophy, digitalisation, and society at Radboud University – took a critical standpoint towards health technology. Sharon specialises in how digitalisation influences public norms and values, and how these can be protected. In a first part, Sharon addressed how technology changes the way we think about health, as well as the benefits of health technology. In a second part, she highlighted the social and ethical concerns about health technology, focusing on the values of autonomy, inclusivity, and solidarity. The subsequent discussion was moderated by philosopher Cees Lijenhorst.

How Technology Changed Our Thinking About Health

The reconceptualization of health through technology has happened in three shifts. Whereas health used to refer to the absence of disease or disability, Sharon argued that it is now ‘a holistic, dynamic, and continuous project that is geared towards prevention and prediction.’

First,  the integration of non-medical data such as sleep patterns, which – due to technological developments – became quantifiable, measurable, and comparable, and therefore relevant for medical research. A broader conception of what counts as health related activities, and which data can be drawn upon led to a holistic conception of health.

Second, health with the help of technology extended into the homes of people. Technologies such as telemedicine, and smart homes detecting when a person falls or what they eat made health an ongoing, ‘continuous’ process that was not limited anymore to episodical check-up appointments.

Third, a shift occurred from treating people when they already showed symptoms of disease (reactive approach), to treating people when they do not show symptoms but merely early signs of disease, that an algorithm predicts could turn into a disease (predictive and preventive approach).

The Dark Side: Social and Ethical Consequences

What are the social and ethical consequences of health technology? Tamar Sharon discussed the influence on three fundamental values: autonomy, inclusivity, and solidarity. First of all, her concerns about autonomy were not limited to the constant medical surveillance that proceeds health technology, but also included that medical data can easily be shared and sold. This is especially problematic – Sharon explained – because ‘privacy is the breathing room we need to engage in the process of self-development’ which is crucial to autonomy but undermined by constant data collection and  sharing.

Second, inclusivity is undermined because ‘technologies can reproduce systemic forms of discrimination based on race, gender, and social status’ – for example the data sets that AI is trained with can contain biases which are then reproduced in practice. Furthermore, she highlighted that ‘inclusive healthcare requires optimizing for increased access, not for cost reduction.’ Although it might be tempting to completely automate health care in favour of cost efficiency, Sharon pointed out that humans need to be kept in or on the loop in order to not automate away important aspects of health care such as empathy and understanding.

Lastly, ‘solidarity,’ she explained, ‘is a strong moral value,’ that is important for our health care system, but that is being undermined by health technology. Health technology makes health the responsibility of individuals, instead of focusing on structural causes of disease. Thus, people loose a sense of mutual obligation, and questions arise such as whether people that choose to not get vaccinated should receive treatment or not.  However, Sharon pointed out that despite the control we can have over our lifestyle, we cannot choose ethnicity, gender, or our socio-economic status, which also play a role in getting ill. Consequently, health cannot be the responsibility of individuals only. Yet, when solidarity is undermined, people turn against and blame each other. As tempting as this might be, Tamar Sharon questioned this practice and argued that people cannot be held accountable for getting ill, since although lifestyle choices might play a role, there are other factors involved as well that people do not have control over.

Technology Is Not Bad In Itself

‘Technology is never the sole agent,’ explained Tamar Sharon. ‘What we see is societal and political trends that are given a boost by technology.’ The point is that technology itself is not the problem. It does, however, strengthen biases, the undermining of autonomy and solidarity, but also the preventive character of healthcare. ‘Technology is neither good nor bad; nor is it neutral,’ Sharon quoted M. Kranzberg. It does, however, transform how we understand our fundamental values such as autonomy, inclusivity, and solidarity. ‘If we cherish these values and principles […] it is crucial to look around us at how these are also being impacted by technological drifts in health and medicine, lest we lose these for better health and lower costs.’

Luisa Koch, Research Master student Philosophy