The Embedded Philosopher a tale of failed attempts

1. The Embedded Philosophera tale of failed attempts Asle H. Kiran • 27.11.2012

2. 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 recognisinguser requirements” (Vollenbroek-Hutten & Hermens, 2010) • communication gap between designers and users: low implementation ratio

3. 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?

4. 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 technologiesb) the shaping of subjectivity – how people understand themselves in relation to the technologies that surrounds us

5. 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

6. 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?

7. 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)

8. 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”

9. 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