The myth of technology in health care

Technology is believed to have liberated health care from dogmas, myths and speculations of earlier times. However, we are accused of using technology in an excessive, futile and even detrimental way, as if technology is compelling our actions. It appears to be like the monster threatening Dr. Frankenstein or like the socerer’s broom in the hand of the apprentice. That is, the same technology that should liberate us from myths, appears to be mythical. The objective of this article is to investigate the background for the re-entrance of the myth: How we encounter it and how we can explain it. The main point is that a myth of technology is normative: it relates ‘is’ and ‘ought’ and directs our actions. This becomes particularly clear in health care. Hence, if there is a myth of technology, it is an ethical issue, and should be taken seriously.     

Managing one's body using self-management techniques: practicing autonomy

This paper discusses some of the anthropological andphilosophical features of the use of self-managementplans by patients with a chronic disease, focusing onpatients with asthma. Characteristics of thistechnologically mediated form of self-care arecontrasted with the work of Mauss and Foucault on bodytechniques and techniques of self. The similaritiesand differences between self-management of asthma andFoucault's technologies of self highlight some of theways in which self-management contributes tomodifications in the definitions of patients andphysicians. Patients, in measuring their lungfunction, first come to rely on measurements more thanon felt disturbances, but next, felt disturbancesbecome modified by previous measurements. Physicians,on the other hand, see their role changed from expertto being a participant in a joint treatment. It isargued that the concept of agency is more appropriatefor describing the advantage of self-management forpatients than autonomy.     

What Diagnostic Devices Do: The Case of Blood Sugar Measurement

Diagnostic devices do more than just passively register facts. They intervene in the situations in which they are put to use. The question addressed here is what this general remark may imply in specific cases. To answer this question a specific case is being analysed: that of the blood sugar measurement device that people with diabetes may use to monitor their own blood sugar levels. This device not only allows the patients concerned to better approach normal blood sugar levels, but alters what counts as normal in the first place. Using the device may shift people's attention away from their physical sensations towards the numbers measured, but it may also help them to increase their own physical self-awareness. Self-monitoring finally (something that the devices have made possible) makes patients less dependent on professionals, but it requires them to engage in self-disciplining and binds them to the outcomes of their measurement activities: their own blood sugar levels.     

Sustained efficacy of dialectical behaviour therapy for borderline personality disorder

Dialectical Behaviour Therapy (DBT) is considered one of the most promising treatments for borderline personality disorder (BPD). Recently, we reported significantly positive effects of 12 months DBT on parasuicidal behaviour and impulsivity in a mixed group of female BPD patients with and without substance abuse. Fifty-eight women with BPD were randomly assigned to either 52 weeks of DBT or treatment as usual (TAU). Follow-up assessment took place at 78 weeks, i.e., 6 months after discontinuation of DBT. Participants were clinical referrals from addiction treatment and psychiatric services. Outcome measures included parasuicidal behaviour, impulsivity and substance abuse. Six months after treatment discontinuation, the benefits of DBT over TAU in terms of lower levels of parasuicidal and impulsive behaviours, and in alcohol use, sustained. No differences between the treatment conditions were found for drug abuse. In conclusion, DBT seems to have a sustained effect on some of the core symptoms of BPD and on alcohol problems in a mixed population of female borderline patients with and without substance abuse problems.     

Nanotechnology — A new field of ethical inquiry?

Parallel to the public discussion on the benefits and risks of nanotechnology, a debate on the ethics of nanotechnology has begun. It has been postulated that a new “nano-ethics” is necessary. In this debate, the — positive as well as negative — visionary and speculative innovations which are brought into connection with nanotechnology stand in the foreground. In this contribution, an attempt is made to discover new ethical aspects of nanotechnology in a more systematic manner than has been the case. It turns out that there are hardly any completely new ethical aspects raised by nanotechnology. It is much rather primarily a case of gradual shifts of emphasis and of relevance in questions which, in principle, are already known and which give reason for ethical discussions on nanotechnology. In a certain manner, structurally novel ethical aspects arise through the important role played by visions in the public discourse. New questions are also posed by the fact that previously separate lines of ethical reflection converge in the field of nanotechnology. The proposal of an independent “nano-ethics”, however, seems exaggerated.     

意象活动与自尊水平关系的研究

在当今的许多团体心理辅导和训练中,关于苹果意象的活动常常被用于测量团训参与者的自尊水平。但其科学性一直没有得到实证研究验证。该研究采用了这种意象想象技术,同时用SES量表测量其自尊程度。并通过对测量结果的统计分析,揭示了苹果意象大小与自尊水平之间的关系。     

Ethics and engineering courses at Delft University of Technology: Contents, educational setup and experiences

This article reports on the development and teaching of compulsory courses on ethics and engineering at Delft University of Technology (DUT). Attention is paid to the teaching goals, the educational setup and methods, the contents of the courses, involvement of staff from engineering schools, experiences to date, and challenges for the future. The choices made with respect to the development and teaching of the courses are placed within the European and Dutch context and are compared and contrasted with the American situation and experiences. Previous versions of this article were presented at the meeting of the SEFI Working Group on Engineering Ethics in Rzeszow, Poland, April 29–May 1, 1999 and at the SEFI Annual Conference in Zurich, Switzerland, September 1–3, 1999.     

Towards a research programme for ethics and technology

In this editorial contribution, two issues relevant to the question, what should be at the top of the research agenda for ethics and technology, are identified and discussed. Firstly: can, and do, engineers make a difference to the degree to which technology leads to morally desirable outcomes? What role does professional autonomy play here, and what are its limits? And secondly, what should be the scope of engineers' responsibility; that is to say, on which issues are they, as engineers, morally obliged to reflect? The research agendas proposed by the authors contributing to this special section, implicitly, give different answers to these questions. We suggest that an explicit discussion of these issues would greatly help in constructing a common research agenda.     

The Embodiment of Birth

This paper rejects dualism between mind and body toview the self as an embodied biological entity. Rather thanseeing the body operating by passive mechanisms as Descartesargues, it holds it actively moves in and even defines its world. Carrying this perspective to medicine presents an attempt toincorporate or work with internal processes of the body; it issensitive to how patients identify with their bodies. Thecurrent discussion over the extent to which women should try tohave natural childbirths provides a concrete example of thedifferences between mechanistic and embodied approaches tomedicine.     

Keeping Up with the Cloneses -- Issues in Human Cloning

The advent of cloning animals has created a maelstrom of social concern about the ethical issues associated with the possibility of cloning humans. When the ethical concerns are clearly examined, however, many of them turn out to be less matters of rational ethics than knee-jerk emotion, religious bias, or fear of that which is not understood. Three categories of real and spurious ethical concerns are presented and discussed: 1) that cloning is intrinsically wrong, 2) that cloning must lead to bad consequences, and 3) that cloning harms the organism generated. The need for a rational ethical framework for discussing biotechnological advances is presented and defended.