Technological innovations are commonplace today and usually provide great social benefits. The case of medical technology is of prime interest, for though it seems to provide primarily advantages, it may unwittingly turn over to technocrats the governance of modem society. This essay warns against the pitfalls of the age of technocracy, and calls for the maintenance of democratic controls over the development and implementation of modem technology.
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References
1.
For the confusion between science and technology see Joseph Agassi, Science in Flux, Boston Studies in the Philosophy of Science, Volume 29 (Dordrecht, D. Reidel Publishing Co., 1975), Chapter 12; for the instrumentalist view of science--science as the theoretical part of technology--see Joseph Agassi, Science and Society, Studies in the Sociology of Science, Boston Studies in the Philosophy of Science, Volume 65 (Dordrecht, D. Reidel Publishing Co., 1981), pp. 243-244.
2.
Numerous helpful references and discussions concerning induction can be found in Agassi's Science in Flux and Science and Society. A standard formulation of modem inductivist views of science is Carl G. Hempel's Aspects of Scientific Explanations (New York, The Free Press, 1965). See also Karl R. Popper's discussion in The Logic of Scientific Discovery (1934), ( New York, Harper & Row, 1968 ), Chapter 1.
3.
John Dewey, The Quest for Certainty: A Study of the Relation of Knowledge and Action (New York, Capricon Books , 1960). The relation of the quest for certainty and prophecies as well as scientific predictions is discussed in Raphael Sassower's Philosophy of Economics: A Critique of Demarcation ( Lanham, MD, University Press of America, 1985), Chapter 3.
4.
Ernest Gellner, Legitimation of Belief (Cambridge, Cambridge University Press, 1974).
5.
This is one conclusion drawn from the debate between the inductivists and non-inductivists. The origins of the debate can be traced back to David Hume .
6.
E.g., J.H. Abramson and E. Peritz, Calculator Programs for the Health Sciences (Oxford , Oxford University Press, 1983 ). The Proceedings of the Annual Symposium on Computer Application in Medical Care are helpful and updated resouces. The Cumulated Index Medicus of 1984 lists twelve pages of references under the entry 'computers,' illustrating the diversity of sub-topics concerning the use of computer technology in medicine.
7.
Karl R. Popper, The Logic of Scientific Discovery, and his Conjectures and Refutations. The Growth of Scientific Knowledge (New York, Harper & Row, 1963).
8.
A concise account is provided in Karl R. Popper, The Open Society and Its Enemies (Princeton, Princeton University Press, 1962), Chapter 3, iv, Chapter 11, ii.
9.
The case of defining 'death' in medicine is only one among many other cases in which the views of definitions have continuously changed due to technological innovations. In the case of neonatal care, what some ten years ago were considered 'lost' or 'untreatable' cases (neonates weighing, say, less than 750 grams), are being routinely treated today in ICUs.
10.
In addition to the Harvard and Minnesota criteria there are also the Japanese and Scandinavian ones. For a comprehensive overview of the controversies surrounding the competing criteria for the assessment of death, see Defining Death, A Report on the Medical. Legal and Ethical Issues in the Determination of Death, President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, July 1981.
11.
The definitions of brain death adds complications to the controversy over active and passive euthanasia.
12.
Much can be learned from recent debates concerning nuclear technology. Books, movies, lectures, and articles have allowed the public to be better educated about the issues involved in this technology. The public no longer merely stands in awe of nuclear technology--it wants to politically control it. The same should be true of medical technology. Recent establishments of Ethics Review Commitees in hospitals provide for some public participation (in addition to physicians, lawyers, and hospital administrators, there are also public representatives).
13.
The obvious source of this view (that life is sacred) is institutionalized religion. This matter, however, is extremely complex since some religions make provisions for allowing death and not requiring that any expenditure of money and energy will be exhausted in order to save the lives of individuals .
14.
Emergency cases, of course, have special provisions. Likewise, we should note the differences between private and public health care providers. George J. Annas, The Rights of Hospital Patients (New York, Avon Books, 1975), Ch. V.
15.
This solution to the problem of kidney dialysis was enacted into law by Congress (U.S. Public Law 92-603, 1972), thereby eliminating one level of decision making (everyone is entitled to this treatment). However, this solution did not resolve the problem of the criteria by which to decide who is entitled to this treatment. See R.C. Fox and J.P. Swazez, 'Kidney Dialysis and Transplantation,' Encyclopedia of Bioethics, ed. W.T. Reich (New York, The Free Press, 1978), pp. 811-816.
