The Human Element of Advanced Technology
Human beings are endowed with the power and desire to reason, organize, and manipulate the world around them. These distinctly human abilities have given rise to acquisition of knowledge throughout the ages, and the rapid growth of this knowledge base has led to an overwhelming expansion of applied science and technology.1
The word technology is derived from the Greek term techne, referring to the knowledge and application of principles involved in the production of objects or the accomplishment of specific ends. Aristotle agrees that techne is a term that relates to the productive sciences - applied science.2 Today, the word technology might refer to the theoretical notion of knowledge transformed into a tangible end or product.
From a historical perspective, the drive to use information to create something seemingly greater than its creator is a basic human trait that transcends the ages of humankind. People are driven to control the human condition - ie, the inherent tragedies of life. Yet, from their inception, technological creations have the potential to lead to tragic ends. Some contend this is because of the ever-present human element within the products of advanced technology.
Case Studies
Driven by knowledge and technological imperative, our culture is deeply challenged and subsequently threatened by numerous discoveries and inventions. For example, the discovery of the atom was one of the greatest achievements of the twentieth century, but the explosion of the first atomic bombs in 1945 in Hiroshima and Nagasaki reminded us of the frightening potential of human knowledge and its tangible products. This tragedy clearly demonstrated the dilemma human beings face: maintaining the delicate balance among modern science, advanced technology, and the human elements pertaining to these achievements.
Several ethically laden cases have recently been tried in the popular media and have become topics for discussions for a number of reasons - primarily because they serve as examples of our greatest achievements gone wrong. Few citizens globally or within the US will ever forget the moment the Columbia tragedy was announced. To many people, the space program symbolizes excellence, confidence, and security. The overwhelming sense of human power and control over the forces of nature is comforting. Although the events of February 1, 2003 are devastating on many fronts, in this context the tragedy reminds many Americans of our vulnerability. Our sense of control is fragile and easily threatened. Early reports suggest that in this case, destruction of a human accomplishment was due in part to the human element - that is, human error.
From the healthcare community perspective, consider Jessica Santillan, the 17-year-old, critically ill patient who required the technology of transplantation to survive a heart and lung deformity that was sure to lead to her untimely death. On February 7, 2003, she received what was thought to be replacement organs that would provide her with hope for a relatively normal lifestyle once she recovered. Much to everyone's shock and disappointment, the procedure took a tragic turn, resulting in an unforeseen rejection of the transplanted organs and subsequent patient death.3
Transplantation technology, like all technology designed to reduce, eliminate, or prevent human suffering, is still subject to the human element of error and adverse consequences. Whether the adverse consequence is intentional, as in the atomic bomb, or unintentional, as in the case of Jessica Santillan, tragedy related to the human element occurred.
Controlling the human condition is often what drives advancements. Yet these advances often raise ethical questions, especially in the context of managing health and illness. Although modern medicine has tools to control pain and suffering in many instances, do such advances or discoveries pose a challenge to our moral fiber? What do some of these advances mean to the morality and ethics of our common, collective life? Do they enhance human happiness and welfare? What risks and benefits does the human element pose? What is the responsibility of healthcare professionals in the face of patient care and advanced technology, and how are we to interpret technology and the human experience?
Naisbitt
In Megatrends,4 Naisbitt introduces the concept high touch in the face of advanced technology. His more recent book, High Tech/High Touch: Technology and Our Accelerated Search for Meaning,5 focuses on the human element as a counterbalance to the accelerating rate of technological change. Naisbitt recognizes the need to view our interaction with technology through human lenses, helping us make the most of available technology while minimizing its detrimental effect.6
Introduction of new technology has always resulted in social change. Naisbitt suggests that conflict arises within individuals and throughout society when we are partly stuck in the pattern of the old world while simultaneously beginning to follow rules of the new world.7 In other words, while technology has accelerated rapidly, social change has not. He also reminds readers that technology and spirituality or technology and social change should be in balance, and they are not in balance today. This generates the human response to regain equilibrium. In healthcare, as a result, consumers and providers feel overwhelmed, disoriented, and alienated. Science and technology cannot tell us what life means, so it is likely that patients will seek and examine the nature of humanity through family, community, or through the people Naisbitt believes can provide the "high touch side."5
The implication for healthcare clinicians is that when high-tech patient care is provided, patients will need to feel that "high touch side" in order to regain equilibrium. This is certainly complex and can be provided in a number of different ways. In this context, respect for personhood is one method. From an ethical point of view, respect for personal autonomy, respect for personhood, informed consent, and mutual decision-making offers strategies to weave the human element into issues of advanced technology.
Ethical Considerations
The human element of advanced technology raises untold ethical questions. In the wound care clinician's context, the question is: To what extent does booming technology truly serve to improve the human condition? What are the risks and benefits certain specialty products and procedures provide? What ethical debate is necessary regarding these new technologies, and what is the role of the clinician as a provider and a human being?
In the face of unintentional harm, as with Jessica Santillan, stakeholders are making every effort to remove the human element that can lead to human error. However, wound care clinicians are faced with new technologies in hope of controlling pain and other chronic conditions among their patient base every day. Often, patients are so eager to have their conditions controlled that they fail to recognize the inherent harm in certain methods of wound care management. Wound care clinicians, as patient advocates, are morally obligated to collaborate with their patients to identify treatment modalities that control the risks and promote the benefits of a particular treatment.
In the discipline of bioethics, respect for personal autonomy is an important ethical ideal that is sometimes considered an especially important American ideal. Much of the US Constitution is based on respect for personal autonomy reflective of its culture.
The word autonomy is derived from the Greek autos meaning self and nomos meaning rule. The term originally referred to the self-rule or self-governance of independent city-states. Autonomy has since been extended to the self-rule of individuals.8 Personal autonomy is considered self-rule that is free from both controlling interference by others or limitations, such as the patient's inadequate understanding that prevents him/her from making meaningful personal decisions.9 In other words, clinicians who seek to ensure respect for personal autonomy are obligated to provide patients with both the information and the means to make choices. Informed consent is grounded in respect for personal autonomy and is especially important to making choices pertaining to advanced technologies that may hold foreseeable or unforeseen consequences.
Since the late 1940s with the Nuremberg trials, which presented appalling descriptions of medical experimentation in concentration camps, consent has been emerging as an important ethical consideration. In fact, the term informed consent did not even appear in the literature until the mid-1950s. It wasn't until the early 1970s that debate began to mount... coinciding with rapid advances in modern technology. In recent years, the focus of informed consent has changed from the researcher/clinician's obligation to disclose information to the quality of the patients' understanding and consent. The forces behind this shift of emphasis were autonomy-driven.8 With the continued expansion and advancement of technology, health-related decision-making continues to evolve.
For example, the concept of mutual decision-making is gaining widespread recognition within the medical community. Mutual decision-making refers to autonomous decision-making where the clinician is more actively involved with not only describing procedures and treatment modalities, but also with decisions made after thorough debate as to inherent risks and benefits, both foreseen and unforeseen. The patient's lifestyle, value system, emotional support, and other factors are considered in this process. Although it is not a substitute for the process of informed consent, mutual decision-making further introduces the human element into issues of advanced technology.
Conclusion
Advanced technologies have accelerated beyond opportunities to properly provide for ethical debate and appropriate plans for control. Healthcare clinicians are in a key position to understand, offer opinions, and advocate for patients in the face of technologies yet to come. The natural drive to improve the human condition by preventing pain and suffering must be balanced with an understanding of the inherent risks and benefits. The human element can be both a blessing and a curse. Human error can erode perfectly created strategies of advanced technology, just as our humanity cements trust, hope, and care into the highly technical and stark world of advanced treatment modalities. Patients and clinicians are best served when the ethical ideal of informed consent and mutual decision-making is woven into the introduction of advanced technologies in patient care.
1. Editorial. Faith, Science and Advanced Technology. Available at: http://www.ecumenicalyouth.org/science_tech.html. Accessed February 20, 2003.
2. Reese W. Dictionary of Philosophy and Religion. Atlantic Highlands, New Jersey: Humanities Press; 1996
3. Editorial. Jessica's Family Hopes for Miracle. Available at: http://www.cbsnews.com/stories/2003/02/20. Accessed February 20, 2003.
4. Naisbitt J. Megatrends: Ten New Directions Transforming Our Lives. New York, NY: Warner Books;1982
5. Naisbitt J. High Tech/High Touch: Technology and Our Accelerated Search for Meaning. New York, NY: Nicholas Braely Publishing; 2001.
6. Editorial. John Naisbitt. Available at: http://www.naisbitt.com/. Accessed February 20, 2003.
7. Naisbitt J. Worlds Between Eras. In Press.
8. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. Oxford, UK: Oxford University Press; 2001:57-90.
9. Hill TE. Autonomy and Self-Respect. Cambridge, UK: Cambridge University Press; 1991:1-4.
