Thanks to medical technology mankind is, more than ever before, in control of his own destiny. That brings with it more responsibility for life and death, also if such responsibility is delegated to equipment.
“New technologies bring with them new ranges of implications”, Dr.Felicitas Kraemer explains. “On the whole we are agreed that if, for instance, one switches off a patient’s respirator one allows them to die but that if a person’s pacemaker is stopped he has been actively killed. That is because the respirator is viewed as something external, also by the patient himself, whilst a pacemaker is viewed as a part of a person’s body. Nowadays there is also such a thing as a left ventricle assist device (lvad), a heart pump that is partly implanted but also largely carried outside the body. If you switch that off do you let someone die or do you kill them?”
The case of the lvad is an instance of a new range of ethical questions arising in therapeutic technology, one of the four categories of medical technology adhered to by the philosopher Sven Ove Hansson. “In the case of this category the questions are entirely different”, Kraemer asserts. “New technology is making health care increasingly expensive. The kind of question which then arises is whether it is financially feasible to keep old people alive regardless of the cost. Take another example: in the past it was just unfortunate if someone got a heart attack in your shop. Nowadays, though, you might be asked why you did not have a defibrillator on hand.”
The second category, pertaining to diagnostic techniques, is also a broad field. There is, for example, the increasingly popular “total body screening” method in which the whole body is systematically checked. The validity of such a test is limited because doctors do not know what they are looking for. Dutch nationals who want such a test have to go to Germany because it is forbidden here. You could query whether that is correct: can the authorities deny people access to information, even if that information is of little scientific value?
“What is morally more dubious”, Kraemer claims, “is the screening of embryos before deciding whether or not to request an abortion. Can one be sure that the result is correct? How great is the chance that the detected genetic defect or illness actually develops? How serious is the illness in question? Is there treatment for it? People think that just getting a diagnosis cannot do any harm but they often forget that knowing something brings with it heavy responsibilities.”
Improvement techniques such as plastic surgery, drug-taking or medicine abuse (e.g. like when students take the adhd drug Ritalin to improve their powers of concentration) form a third category, also sometimes referred to as “enhancement”. The individual and social complications attached to all of this can be far-reaching. Apart from anything else, the borders are continually shifting. At one time a nose correction job was once termed a “fun operation” but if the environment in which one lives places great importance on outward appearance an ugly nose can lead to psychological agony. What was once a luxury matter thus becomes a medical issue. “This is not to mention all the implications issuing from human genetic improving if that ever becomes an option”, Kraemer adds. “The aim to create super-humans could completely change human nature.”
In the fourth category “that of aids”, engineers emphatically become an extension of the doctor-patient relationship. They design all kinds of equipment from wheelchairs to artificial hips, which then dictate all the subsequent therapeutic possibilities and impossibilities. One of the questions that then arises is: who bears the responsibility if something goes wrong? By and large, equipment or devices are less intensively tested before being implemented than medication and in the case of the latter things still often go wrong.
“Generally speaking”, Kraemer concludes “there are no objectively correct answers to the questions that medical technology presents. There are, at best, plausible answers ensuing from how people experience the various technologies. In the case of the lvad, for instance, people are inclined to view the device as something external. Hence the conclusion that “allowing to die” is probably the best way to describe the consequences of switching off such a device.”