'Obligatory Technologies' and the Autonomy of Patients in Biomedical Ethics

Abstract

Drawing on the debate over ʻthe technological imperativeʼ in the sociology and philosophy of technology, the article suggests several concrete mechanisms that produce the appearance that the use of technology is obligatory – essentially giving individuals ʻan offer they cannot refuseʼ. These mechanisms include competition, adaptation and dependency, as well as the ʻnormalisationʼ and ʻmoralisationʼ of the use of technology. The law plays a role in the normalization and moralization of technology use by reflecting societal norms about reasonable behavior in relation to technology use and in enforcing moral judgements that a technology ought to be used. Given the highly technological nature of modern medicine, it is important to pay attention to how these mechanisms play out in the medical context.

The standard approach to autonomy in biomedical ethics focuses mainly on limits on cognitive ability and knowledge or explicit pressure from third parties as the main sources of problematic constraints on autonomy. Relational autonomy theorists argue that this is too limited, pointing to the effect of the social and economic environment on the actual scope of autonomy of many patients. This article extends the relational autonomy critique of the standard model of the independent and autonomous patient by exploring how technology may also operate to constrain the autonomy of medical decision-making - with a particular focus on subtler forms of legal coercion.

Keywords: autonomy, law, norms, biomedical ethics, bioethics, autonomy of technology, technological imperative