Philosophy and Technology: A Perspective from Health Care and Law

Philosophy and Technology

The philosophical understanding of technology historically presents a pendular characteristic, swinging between enthusiasm and fear. The control of nature, the creation of artifacts that substitute what is naturally given, and the liberating while subjugating power of technology all give rise to enchantment and apprehension, which impact the philosophical horizon. Philosophizing about technology leads either to its praise or its rejection.

It is then necessary to extend this philosophical understanding beyond questions of value and morality. Following its own systematization, all contemporary philosophy can be read through three general lenses: (1) liberal, institutional, and positivist; (2) existential and non-positivist; and (3) critical.⁽¹⁾

I propose that contemporary philosophy of technology can also be thought of using these same three broad categories, each of them associating distinct thinkers that, nevertheless, maintain some relative cohesion.

Following the first group, the philosophy of technology reveals a double rationale concerning technical activity. The immediate knowledge involving technological operationalization is employed here with an archetypal logical character: the technique is taken as sovereign. Its respective philosophy hence attempts to obtain its internal logic, mechanisms, and results. The method employed in a positivist philosophy of technology is analytic (that is, decomposing, isolating, segmenting, clustering, gathering, establishing links and sums). In the health sciences, from Louis Pasteur in the nineteenth century to Daniel Dennett in the twenty-first-century philosophy of mind, positivist philosophy provides the foundation for the immediate relation between technical knowledge and its respective intervention.⁽²⁾ From a first diagnosis to a cure, there is a technological apparatus that goes beyond any belief or chance. By using statistics, inference methods, and expertise, all sicknesses are typified, their causes determined, and their treatment announced.

The non-liberal or non-positivist philosophies of technology bring broader implications. They investigate the technological phenomenon not only inside its practice, but also from its intimate and consequential relation with existentiality. Martin Heidegger in the twentieth century is their greatest figure. In Being and Time and The Question Concerning Technology, Heidegger presents technology as the eminent form of the inauthentic, since it is repetitive, utilitarian, banal, and unconcerned with its meaning or ends.⁽³⁾ In the already canonic Heideggerian postulation, once faced with the inauthenticity of technology, the authenticity of art and radical life arises. Artistic activity by a physician—with their experience, intuition, and hands—is the authentic, in contrast with the plain diagnosis of blood sample ratios assessed by a computer.

The third category is critical. Its most important thinkers are Georges Canguilhem, Michel Foucault, and Louis Althusser.⁽⁴⁾ These authors developed refined propositions about technology and its relation to historicity and historical modes of social relations. The critical perspective is uninterested in the logical character and functionality of technology. Nor is it about giving up due to the uncertainties of technology’s authenticity, as in the view of anti-technophiles. What is necessary is to discover the specifics of technology and its rationale within a society that is built on labor exploitation and commodity production. Only in this way can the knowledge about technology start being investigated from its own internality, in direct relation to the structured whole of social reproduction. Technology, abstract labor, and relative surplus value have an immediate relation, following a logic that reflects the indifference of the use value of every object or being.⁽⁵⁾ Technology and commodity production are, combined, the atom of capitalism. Accumulation and know-how accountability summarize the relation between technology and the valorization of value.

The most advanced philosophical debate concerning science and technology in the critical category occurred in the twentieth century with the work of Gaston Bachelard, but also with Canguilhem, Foucault, and Althusser.⁽⁶⁾ The debate insists on the historicity of technological knowledge, which is neither cumulative nor follows any finalism—with science, there is no guarantee that we will know more or better, that technologies are managed in the most efficient or accurate way, or that the results of a given technology are necessarily beneficial to society and its individuals. Scientific knowledge operates through epistemological breaks, pervaded by contradictions and concealments. In the same theoretical context and dealing with the problematics of the development of technological knowledge, Gilbert Simondon represents one of the most important frontiers of the philosophy of technology. His body of work in the second half of the twentieth century has been a constant focus of studies up until today. In books like Du mode d’existence des objets techniques, Simondon discusses the individuation of each technical object, its presence in face of all other material elements and living beings.⁽⁷⁾ Given that the technological object individuates, gaining ontological presence, the subjects can only be affirmed in relation to an environment where the technology is a reference point. Therefore, technology is not a simple gadget or something posterior. It is dissociated neither from how social relations are constituted nor from subjectivity. The subjective constitution historically occurs through technological objects.

For the health sciences, Simondon opens the possibility of thinking through the relation between “natural” life and technology as something that is not merely extrinsic or occasional. In this sense, it is not about understanding technology as a third party in relation to a subject, but rather as one of its necessary strategies of grasping physio-pathological conditions. Without confusing the technological with the biological, it is still important to highlight that the two fields ontologically intersect.

Health Care Technology and Philosophy

Among several possible objects that may concern the philosophy of technology, health care is one of the most important. This is not only because the medical practice is one of the most advanced manifestations of technology, but also and especially because it deals with key questions concerning life. To think philosophically about health and health care is to think about the nature of the human being, as well as about physiology, pathology, the normal, the undesired, and the supposed cure.

I propose to read the relation between philosophy and health (and health care) following two key theoretical problems. The first concerns what is health, sickness, and cure. The second concerns the limits of human beings, generating discussions about the general determinations of what is “natural” in a person and issues of bioethics and bio-rights involved in technological advances in health care.

The work developed by Canguilhem provides the most important way of thinking about these issues. In The Normal and the Pathological, Canguilhem dismisses readings that differentiate health and sickness simply based on a quantitative distinction in relation to a generalized reference metric.⁽⁸⁾ His reading points that there is a qualitative gap between health and sickness. Sickness only denominates the condition of an inferior corporal disposition compared to a previous condition, considered the baseline for healthy. The sickness is revealed as an adverse chronological succession when compared with a previous moment of greater capabilities. For the patient who suffers, the pathological condition is effectively a qualitative condition distinct from the physiological one. Thinking about health is not simply reducing the patient to quantities given by plots, indices, or statistics; health and health care is thinking from the patient’s point of view, a feeling of a qualitative loss of one’s own vital power.

If a healthy condition is a qualitative distinction based on the own patient’s life, it is not possible to treat the physiological condition starting from ideal metrics of “normal” or “abnormal,” nor from “healthy” averages among persons. One cannot compare different bodies or give functional parameters for a health condition as far as such a condition is determined individually. The core of the treatment is clinical and resides in the capability of offering a cure to the patient, which is neither a coming back to a previous state nor an achievement of idealized metrics. For the clinician, the cure is allows the patient to self-define another normative condition, desirably less disfavoring in qualitative terms if compared to a pathological condition. Somehow, Canguilhem disregards technology as an objective directive of health and sickness.

In a different way, though, Canguilhem relocates the central importance of technology in the very clinical activity and vital power itself. In texts like Knowledge of Life, he discusses life and nature, and their limits.⁽⁹⁾ Against the tradition that considers a healthy condition as a conformation to the so-called ideal—called normal or average parameters—Canguilhem insists that biological and corporeal power is neither limited nor predefined. The evolution of species does not allow for any possibility that the human being is finished. This is not about reading reality with religious eyes—the human as the masterpiece of God. It is about reading reality by looking at the potentials of life itself, and technology as something socially built by individuals. Canguilhem raises questions about a humanity that could become cyborg without necessarily saying that its nature would be consequently negated. Employing medicines or intervening medically for a cure is a form of action in nature, through the nature of the human being itself. To live is to react and to demand most of the vitality from biology and the means (including technological ones) available at a particular historical time.

Canguilhem does not consider healthy and sickly conditions as technical metrics that can be predefined, nor does he think there exists a standard physiological nature that shall be maintained or restored. His thinking opens space for a critical political position in the face of the limits and potentials of life and health. Dominique Lecourt, following Canguilhem, has become a key reference by calling for a similar critical political position toward the relation between health and technology. According to Lecourt, the “human post-human” does not know the natural limits of what has been previously given due to technological activity.⁽¹⁰⁾ For such a technological pathway to not be dominated by the political whims of the state or capital concerning bodies—which could and do generate eugenic infamies—a critique of social reproduction becomes necessary. This puts health and health care in a space broader than moral or normative juridical ethics. Health care and its technologies have the same fate as the present mode of structuring social relations, that is, the capitalist mode of production.

Health Care Technology and the Law

The philosophical horizons of health care technologies are immediately transposed onto the field of the law through the support, limitation, and modulation of biotechnological action. I propose here that four key elements are presented: (1) juridical subjectivity, (2) commodity, (3) the state and public law, and (4) bioethics.

Health care technologies directly intersect with law in the constitution of juridical subjectivity. In capitalist societies since the nineteenth century, the juridical core comes from subjects of law, carriers of free and autonomous will, and subjective rights. The possibility of contractual binding for labor exploitation via wages and capital accumulation—which becomes private property—resides in the formal equality before the law and the freedom of the market. In this context, the law does not arise from any general social interest: the necessary form taken by capitalist social relations is that of juridical subjectivity. This makes the interest of each subject of the law as the basis of juridical action, while prioritized over transindividual interests.

The law just confirms the possibilities of health care technologies based on the autonomous will of the subjects of the law. In the private sphere, myriad health technologies are offered as a catalogue of possibilities. The subject of the law is a consumer of commodities and services. From buying drugs to using medical treatments, the space allowed for the use of health care technologies is mostly that of the relations of consumption in health care.

These are the conditions that make health care a commodity. In the words of Evgeny Pashukanis, the form of juridical subjectivity is a mirror and an immediate corollary of the commodity form.⁽¹¹⁾ The contractual freedom to consume health care and its associated technologies inevitably makes health and health care commodities. It is then necessary to think about the complex economic processes of production, distribution, funding, and advertisement of health care technologies. If juridical subjectivity constitutes the plexus of health care as a possibility for individual freedom, this is in turn directly linked to an economic machine associated with the health care industry. The available products, catalogue of treatable diseases, medicines, and medical interventions have a necessary relation to the economy of health care technologies. Profit and accumulation govern the juridical aspects of health care.

The capitalist social determination is in fact built on the valorization of value via agents of production in exploitative relations and profit, only possible because of the state. The dynamics between capitalists and workers, and sellers and consumers, necessarily create political instances separated from those very agents. In Estado e forma política, I propose that the state, as a third party in the face of other subjects of the law, is neither a neutral social form nor some entity above capitalist dynamics.⁽¹²⁾ The state is materially derived from the commodity form: its existence, range of action, and possibilities of intervention are determined by and bound up in the valorization of value. This is true even though the state preserves relative autonomy and can, in different situations, prioritize specific strategies of accumulation, classes, factions of classes, groups, companies, and individuals over others.

The nature of capitalism’s political form, derived from the commodity form, implies that the state cannot be put above the dynamics of accumulation. Concerning health care technologies and public law, its basis is far from a constant imposition on the limits of health care as a commodity. On the contrary, the state arises as constituent of the possibility of capital accumulation via health care technological goods and services. State responsibility goes from providing licenses, patents, and guarantees of industrial and intellectual property rights to the buying of medicines for public health. Moreover, the state provides tax incentives and subsidies, signs international agreements on the accessibility and regulation of drugs, materials, and services. The field of public law for the health care industry only incidentally imposes limits. Structurally, the constituent character of the state makes possible the capitalist dynamics in health and health care technologies.

Due to the state’s very nature, there is no political field that can be categorically asserted as ethical in the context of the dynamics of accumulation and the interests of particular classes, groups, companies, and individuals. To think about the ethical regulation of health care technologies is to think in the potentialities, limitations, and contradictions that pervade capitalist social reproduction in general. It is not about forgetting the relative material autonomy of the state nor the normative effectivity of juridical decisions. Nevertheless, capitalist social dynamics are necessarily focused on opportunities for accumulation. Thinking about biolaw as pervaded by conflicts, antagonisms, and contradictions is to reach the limits and possibilities of the law in all its materiality, in terms of the regulation of health care and its provision.

The discussion concerning the judicialization of health care opens space for reflection on bioethics. If bioethics are considered as a moral idealization of a good or fair manipulation of health care technologies, it in fact falsifies concrete reality. What is taken as bioethical is structurally correlated to business-as-usual in capitalist society. The sanctity of private property, reparations in the case of patent violations, and respect for industrial properties are all considered as ethical as, or even more ethical than, breaching these same dictums to ensure that people have adequate, accessible health care. Often in juridical disputes, the legal security of health and health care technologies wins over aspects related to human dignity. It is not about a simple consolidation of opinions or individual values: there exists an ideological complex that sustains bioethical landmarks. Respect for the individual is coupled with subjectivity as a voluntary motor force of production and circulation. The biopower boundary indicated by Foucault is revealed as the frontier of the commodity in relation to the core elements of life.

An ideological complex related to bioethics sustains the tenets of health care technologies; however, this complex operates in an antagonistic manner. There are divergent capitalist economic forces—moral, religious, and cultural standards that are invested with strong ideological forces that eventually counterpose the power of capital; social movements, resistance, and struggles for human dignity that are promoted by some classes and groups. As a result, one cannot say that the ideological dominance of profit making in health care is uncontested. There are distinct struggles and disputes, many of them reactionary, many of them progressive.

In conclusion, a more profound thinking about existing social relations and their reproduction is necessary to understand the problem of bioethics as an intrinsic element of the capitalist social structure, which needs to be assessed and criticized. Health care technology, like all technology under capitalism, carries the contradiction of a society driven by exploitation and accumulation. Health care carries the selective condition of being accessible only through money, leaving a multitude in sickness. The regulation of capitalism’s exploitative social relations cannot be the answer to this deadlock. Our hopes and struggles need to focus on making a different, better social structure, humanity, and non-commodified engagement with nature.

Translated by Pedro Nardelli.
Pedro Nardelli is an associate professor at LUT University in Finland. He can be contacted at pedro.nardelli[at]gmail[dot]com.

Notes:

↩ Alysson L. Mascaro, Filosofia do Direito (São Paulo: Atlas, 2018).
↩ Louis Pasteur, Écrits scientifiques et médicaux (Paris: Flammarion, 2010); Daniel C. Dennett, Brainstorms: Philosophical Essays on Mind and Psychology (Cambridge, MA: MIT Press, 2017).
↩ Martin Heidegger, Being and Time: A Translation of Sein und Zeit (New York: SUNY Press, 1996); Martin Heidegger, “The Question Concerning Technology,” Technology and Values: Essential Readings 99 (1954): 113.
↩ Georges Canguilhem, Ideology and Rationality in the History of the Life Sciences (Cambridge, MA: MIT Press, 1988); Michel Foucault, The Birth of the Clinic (Abingdon: Routledge, 2002); Louis Althusser, Philosophy and the Spontaneous Philosophy of the Scientists (London: Verso, 2012).
↩ Karl Marx, Capital, vol. 1 (London: Penguin, 1990).
↩ Gaston Bachelard, The Formation of the Scientific Mind (Manchester: Clinamen, 2002).
↩ Gilbert Simondon, “On the Mode of Existence of Technical Objects,” Deleuze Studies 5, no. 3 (2011): 407–24.
↩ Georges Canguilhem, The Normal and the Pathological (New York: Zone, 1991).
↩ Georges Canguilhem, Knowledge of Life (New York: Fordham University Press, 2008).
↩ Dominique Lecourt, Humano pós-humano: A técnica e a vida (São Paulo: Edições Loyola, 2005).
↩ Evgeny Pashukanis, Law and Marxism: A General Theory (London: Ink Links, 1978).
↩ Alysson L. Mascaro, Estado e forma política (São Paulo: Boitempo, 2015); Alysson Leandro Mascaro, Estado y forma política (Buenos Aires: Prometeo, 2016).