Technology, Recommendation and Design: On Being a ‘Paternalistic’ Philosopher

Philosophers have talked to each other about moral issues concerning technology, but few of them have talked about issues of technology and the good life, and even fewer have talked about technology and the good life with the public in the form of recommendation. In effect, recommendations for various technologies are often left to technologists and gurus. Given the potential benefits of informing the public on their impacts on the good life, however, this is a curious state of affairs. In the present paper, I will examine why philosophers are seemingly reluctant to offer recommendations to the public. While there are many reasons for philosophers to refrain from offering recommendations, I shall focus on a specific normative reason. More specifically, it appears that, according to a particular definition, offering recommendations can be viewed as paternalistic, and therefore is prima facie wrong to do so. I will provide an argument to show that the worry about paternalism is unfounded, because a form of paternalism engendered by technology is inevitable. Given the inevitability of paternalism, I note that philosophers should accept the duty to offer recommendations to the public. I will then briefly turn to design ethics, which has reconceptualised the role of philosophers and, in my mind, fitted well with the inevitability of paternalism. Finally, I shall argue that design ethics has to be supplemented by the practice of recommendation if it is to sustain its objective.     

Women’s Understanding and Attitudes towards Down Syndrome and Other Genetic Conditions in the Context of Prenatal Screening

In order to explore the impact of potential new technologies in the area of prenatal screening, we conducted a baseline study using qualitative interviews to explore women’s attitudes and knowledge regarding current and future prenatal screening technology and methods. Three cohorts were interviewed, including healthy women without children, healthy women with healthy children, and healthy women with children who have de novo genetic disorders. This study aimed to assess the baseline understanding and attitudes of women in Western Australia. Women from each cohort demonstrated adequate knowledge of the differences between screening and diagnostic tests, but were mostly unaware of the conditions for which screening is currently available except Down syndrome. Women who had children with de novo genetic conditions were generally aware of more genetic conditions than women with or without healthy children. Most women recognised the genetic basis for the conditions mentioned. Two thirds of women understood that Down syndrome is a chromosomal condition; just one third recognised that the phenotype is variable. Most women expressed a positive attitude towards Down syndrome. Social acceptance of children with Down syndrome was commonly mentioned as a concern. While the majority of women with children supported screening for Down syndrome, they emphasised that it must be an autonomous choice. General knowledge of genetic conditions illustrated that women are exposed to diverse conditions from lived experience as well as the media.     

Newborn screening for fragile X syndrome

Newborn screening for fragile X syndrome (FXS) is technically possible, and in the relatively near future accurate and inexpensive screening technologies are likely to be available. When that happens, will America's public health system adopt newborn screening for fragile X syndrome? This article addresses this issue by first placing screening for FXS in the context of the history and current status of newborn screening policy and practice. Lack of a proven medical treatment may stand as a barrier to newborn screening, but strong arguments can be made that early intervention provides important services for identified newborns and their families. Furthermore, other arguments could be used to justify newborn screening, including informed reproductive risk, medically necessary information, and consumer demand. Fragile X syndrome is offered as a prototype for many of the issues that will face society as more genetic disorders are discovered and new technologies for screening are developed.     

Pregnant Women’s Perspectives on Expanded Carrier Screening

Expanded carrier screening (ECS) is a relatively new carrier screening option that assesses many conditions simultaneously, as opposed to traditional ethnicity-based carrier screening for a limited number of conditions. This study aimed to explore pregnant women’s perspectives on ECS, including reasons for electing or declining and anxiety associated with this decision-making. A total of 80 pregnant women were surveyed from Northwestern Medicine’s Clinical Genetics Division after presenting for aneuploidy screening. Of the 80 participants, 40 elected and 40 declined ECS. Trends regarding reasons for electing or declining ECS include ethnicity, desire for genetic risk information, lack of family history, perceived likelihood of being a carrier, and perceived impact on reproductive decisions. Individuals who declined ECS seemed to prefer ethnicity-based carrier screening and believed that ECS would increase their anxiety, whereas individuals who elected ECS seemed to prefer more screening and tended to believe that ECS would reduce their anxiety. These findings provide insight on decision-making with regard to ECS and can help guide interactions that genetic counselors and other healthcare providers have with patients, including assisting patients in the decision-making process.     

Educational Trends for Expanding Women's Occupational Lives

Institutional changes are described which would facilitate the expansion of women's occupational lives. Part I reviews educational trends in schools, focusing on legislation and other activities to eliminate sex discrimination in federally supported educational institutions. Part II discusses current trends to interface education and work, and proposes a transitional work group model which incorporates feminist values and legitimizes the work place as a place for learning. Part III discusses trends towards participatory democracy and asserts that the training of women to use new technologies in communications and computers will increase their power to shape public policy. The conclusion points to the necessity for compensatory and anticipatory measures to ensure the representation of all groups of women in decision-making environments.     

The Mediated Breast: Technology,Agency, and Breast Cancer

Women intimately interact with various medical technologies and prosthetic artifacts in the context of breast cancer. While extensive work has been done on the agency of technological artifacts and how they affect users’ perceptions and experiences, the agency of users is largely taken for granted hitherto. In this article, we explore the agency of four women who engage with breast cancer technologies and artifacts by analyzing their narrative accounts of such engagements. This empirical discussion is framed within the tradition of science and technology studies, philosophy of technological mediation and phenomenology of embodied agency as ‘I can/not’. This approach leads to the conclusions that women’s technologically mediated agencies range from being restricted to extended, take place on different bodily levels, within complex temporal structures, and are determined by certain socio-cultural contexts. Furthermore, it reveals that such agency shaping does not imply a one-way conditioning relationship between technologies and users, but rather involves a reciprocal relationship in which both subject and object are co-constituted. We therefore suggest that the ‘material turn’ in philosophy of technology also needs to take into account technologically mediated, material human beings in order to gain a better understanding of human existence.     

“Testing Times,Challenging Choices”: An Australian Study of Prenatal Genetic Counseling

In many countries pregnant women deemed to be at increased risk for fetal anomaly following a screening test may attend a genetic counseling session to receive information and support in decision-making about subsequent diagnostic testing. This paper presents findings from an Australian study that explored 21 prenatal genetic counseling sessions conducted by five different genetic counselors. All were attended by pregnant women who had received an increased risk result from a maternal serum screening (MSS) test and who were offered a diagnostic test. Qualitative methods were used to analyze the content and structure of sessions and explore the counseling interactions. Findings from this cohort demonstrate that, within these prenatal genetic counseling sessions, counselor dialogue predominated. Overall the sessions were characterized by: a) an emphasis on information-giving b) a lack of dialogue about relevant sensitive topics such as disability and abortion. Arguably, this resulted in missed opportunities for client deliberation and informed decision-making. These findings have implications for the training and practice of genetic counselors and all healthcare professionals who communicate with women about prenatal testing.     

A Pilot Study of Fragile X Syndrome Screening in Pregnant Women and Women Planning Pregnancy: Implementation,Acceptance, Awareness,and Geographic Factors

We report herein results of a study performed in the Balearic Islands which had the following goals: 1) Determine the proportion of pregnant or non-pregnant women planning pregnancy, who would choose to undergo a screening test for Fragile X Syndrome (FXS), if it is accompanied by the appropriate information; 2) Assess satisfaction and any increase in stress among women who participate in screening; 3) Collect epidemiological information about the incidence of the disease in our population; and 4) Collect demographic and health history data and assess participants’ awareness of the disease. Screening was performed on 3,731 pregnant and non-pregnant women of childbearing age and the results indicate: a very high voluntary rate of participation; a high level of self-reported satisfaction and low levels of stress because of the test; a very high incidence of premutation (1/106) in our population; and a low level of awareness about the existence of FXS (25 %). Additional findings indicate no significant correlation between self-reported health history and premutation detection, and the high premutation incidence does not seem to be specific to the indigenous Balearic population. Based on these results, we discuss the pros and cons of an implementation of preconception and pregnant women screening for FXS within a public health screening program.     

The role of information technology in building public administration theory

Information technology, that assortment of technology that enables the conversion of data into information, has had an enormous impact on the field of public administration and its theoretical foundation. This article explores five of them. It begins with a discussion of one of the primary impacts of information technology on public administration theory: the development of systems theory and its descendants including the study of complex systems, chaos, and complexity theory. The importance of information technology in decision-making is explored next. Does information technology free us from the limits of bounded rationality or are we simply overwhelmed by the volume of information available via new sources, such as the Internet and the World Wide Web? The third role examined is the use of information technology as a research tool to make previously intractable problems solvable. Computer capability has enormously advanced the theoretical underpinnings of public administration. Fourth, the significance of information technology as a change agent that calls for revision of other theoretical postulates is investigated. As information technology has diffused into public organizations, how has it called into question what we previously thought about the foundation of bureaucracy? Finally, learning by doing and the manner through which practice informs theory is considered.     

Assessing technology acceptance for skills development and real-world decision-making in the context of train driving

Advances in technology have improved operator performance and efficiency in transport but it is not uncommon for end users to resist technology in spite of its benefits. Operators may resist technology from genuine and legitimate concerns though it is often seen as unjustified. While beneficial, such resistance can have detrimental effects on operations and safety, and can result in the withdrawal of a technology. Theories relating to technology acceptance include elements such as perceptions about the purpose and use of the technology, personal impact, individual characteristics, peer influence, perceived equity, and organizational factors. Although considerable research into technology acceptance and resistance has been conducted in other domains, very little has been conducted in transportation. Findings from two Australian studies are reported which examined train driver attitudes to two state-of-the-art technologies aimed at enhancing skills development and real-world decision-making. The technologies were implemented in the form of in-vehicle information support and simulated learning. Analysis of interviews defined three overarching themes relating to technology resistance: task dynamics related to ways of working and safety; redundancy regarding the utility of the technology and the impact on job security; and personal impact with respect to effects on status and the drivers’ capacity to learn new skills. It is argued that domain-specific characteristics must be considered when designing and implementing new technologies to ensure that benefits of technologies are optimised. It is also argued that resistance should be seen as a positive element of the design and implementation process. This paper has high relevance for transport researchers, and practical application for rail organisations and policy makers.     

Trust in Nanotechnology? On Trust as Analytical Tool in Social Research on Emerging Technologies

Trust has become an important aspect of evaluating the relationship between lay public and technology implementation. Experiences have shown that a focus on trust provides a richer understanding of reasons for backlashes of technology in society than a mere focus of public understanding of risks and science communication. Therefore, trust is also widely used as a key concept for understanding and predicting trust or distrust in emerging technologies. But whereas trust broadens the scope for understanding established technologies with well-defined questions and controversies, it easily fails to do so with emerging technologies, where there are no shared questions, a lack of public familiarity with the technology in question, and a restricted understanding amongst social researchers as to where distrust is likely to arise and how and under which form the technology will actually be implemented. Rather contrary, ‘trust’ might sometimes even direct social research into fixed structures that makes it even more difficult for social research to provide socially robust knowledge. This article therefore suggests that if trust is to maintain its important role in evaluating emerging technologies, the approach has to be widened and initially focus not on people’s motivations for trust, but rather the object of trust it self, as to predicting how and where distrust might appear, how the object is established as an object of trust, and how it is established in relation with the public.     

Reproductive freedom, self-regulation, and the government of impairment in utero

This article critically examines the constitution of impairment in prenatal testing and screening practices and various discourses that surround these technologies. While technologies to test and screen (for impairment) prenatally are claimed to enhance women's capacity to be self-determining, make informed reproductive choices, and, in effect, wrest control of their bodies from a patriarchal medical establishment, I contend that this emerging relation between pregnant women and reproductive technologies is a new strategy of a form of power that began to emerge in the late eighteenth century. Indeed, my argument is that the constitution of prenatal impairment, by and through these practices and procedures, is a widening form of modern government that increasingly limits the field of possible conduct in response to pregnancy. Hence, the government of impairment in utero is inextricably intertwined with the government of the maternal body.     

The role of information technology in building public administration theory

Information technology, that assortment of technology that enables the conversion of data into information, has had an enormous impact on the field of public administration and its theoretical foundation. This article explores five of them. It begins with a discussion of one of the primary impacts of information technology on public administration theory: the development of systems theory and its descendants including the study of complex systems, chaos, and complexity theory. The importance of information technology in decision-making is explored next. Does information technology free us from the limits of bounded rationality or are we simply overwhelmed by the volume of information available via new sources, such as the Internet and the World Wide Web? The third role examined is the use of information technology as a research tool to make previously intractable problems solvable. Computer capability has enormously advanced the theoretical underpinnings of public administration. Fourth, the significance of information technology as a change agent that calls for revision of other theoretical postulates is investigated. As information technology has diffused into public organizations, how has it called into question what we previously thought about the foundation of bureaucracy? Finally, learning by doing and the manner through which practice informs theory is considered.     

Current status of newborn screening: decision-making about the conditions to include in screening programs

Newborn screening is considered a highly successful public health program that has resulted in the reduction of mortality, mental retardation, and other serious disabilities in thousands of children since the introduction of screening for phenylketonuria (PKU) in the 1960s. Programs are based in state public health departments such that each state independently reaches decisions as to which conditions should be mandated for inclusion in programs, leading to considerable variability among the states as to what is being screened. New technologies and knowledge of the genetics of many conditions have greatly expanded the number of conditions with potential for inclusion in newborn screening.     

Multistability and the Agency of Mundane Artifacts: from Speed Bumps to Subway Benches

A central question in philosophical and sociological accounts of technology is how the agency of technologies should be conceived, that is, how to understand their constitutive roles in the actions performed by assemblages of humans and artifacts. To address this question, I build on the suggestion that a helpful perspective can be gained by amalgamating “actor-network theory” and “postphenomenological” accounts. The idea is that only a combined account can confront both the nuances of human experiential relationships with technology on which postphenomenology specializes, and also the chains of interactions between numerous technologies and humans that actor-network theory can address. To perform this amalgamation, however, several technical adjustments to these theories are required. The central change I develop here is to the postphenomenological notion of “multistability,” i.e., the claim that a technology can be used for multiple purposes through different contexts. I expand the postphenomenological framework through the development of a method called “variational cross-examination,” which involves critically contrasting the various stabilities of a multistable technology for the purpose of exploring how a particular stability has come to dominate. As a guiding example, I explore the case of the everyday public bench. The agency of this “mundane artifact,” as actor-network theorist Bruno Latour would call it, cannot be accounted for by either postphenomenology or actor-network theory alone.     

Public Storylines in the British Transition from Rail to Road Transport (1896–2000): Discursive Struggles in the Multi-Level Perspective

ABSTRACT

An analysis of the transition from railways to highways as the dominant British transport system during the twentieth century shows that public storylines about competing niche and regime technologies can have a powerful influence on socio-technical transitions. These storylines are developed by supporters and opponents of the competing technologies, with each group attempting to frame their favoured technology positively. The public salience of these storylines can be evaluated by assessing how highly they score on four elements of frame resonance: empirical fit, experiential commensurability, actor credibility, and macro-cultural resonance. These storylines can be seen at play across the entirety of the transition to a road-based transport system, from the very early history of the automobile through to the turn of the millennium, when public opposition to road transport was becoming increasingly pronounced. This case study uniquely traces discursive conflict over the entire course of a multi-decade transition. While existing literature in the multi-level perspective typically emphasises the disadvantages faced by niche-innovations, this case study shows that powerful storylines, enabled by the right cultural repertoires and possibly negative storylines about existing socio-technical systems, can create powerful political support for a new technology, giving it an advantage against more established incumbents.     

Incorporation of a successful community-based mammography intervention: dissemination beyond a community trial.

Although a variety of interventions to increase breast cancer screening have been found to be effective in community-based trials, their ultimate contribution depends on the extent to which they are incorporated (i.e., adopted and adapted) by community organizations. From 1990 to 1995, the authors conducted a National Cancer Institute-funded community-based trial that increased screening mammography among women ages 40 and older living in Minneapolis public housing. This study describes the processes by which this intervention, called Friend to Friend, was successfully adopted by the American Cancer Society, Midwest Division, and adapted for use by women throughout the state. The authors offer insights from experience with this translational effort and make recommendations to facilitate collaboration between research and community organizations.     

Busy lifestyles and mammography screening: Time pressure and women’s reattendance likelihood

Time pressure is often cited as a reason for non-attendance at mammography screening, although evidence from other areas of psychology suggests that time pressure can improve performance when barriers such as time pressure provide a challenge. We predicted that time pressure would negatively predict attendance in women whose self-efficacy for overcoming time pressure is low, but positively predict attendance when self-efficacy is high. Time pressure was operationalised as the self-reported number of dependent children and others, and average number of working hours per week. Australian women were surveyed after being invited to attend second or subsequent screenings at a free public screening service, and subsequent attendance monitored until six months after screening was due. The majority (87.5%) attended screening. Women with more dependent children and higher self-efficacy showed greater attendance likelihood, and women with fewer non-child dependants and lower self-efficacy were less likely to attend. Working hours did not predict attendance. Findings provide partial support for the idea that time pressure acts as a challenge for women with high self-efficacy.