Abstract:
Partial Truth Telling in the Introduction of New Technologies: Ethical Obligations and Experimental Subjects
In this paper I will discuss how patients are performed as experimental subjects during the introductory phases of technology adoption. In presenting the case of an imaging technology used in the delivery of Radiotherapy treatment, I consider what happens when information on risks or usage of new technologies is not disclosed? Through using the philosophical frame of ‘truth telling’, I explore the risky practices embedded and enacted during the use of new technological systems and how these might lead to contradicting views of involvement.
X-ray volumetric imaging (XVI), the focus of a number of fund raising campaigns in the mid 2000’s, was introduced accompanied by a fanfare of newness and discourses of ‘hope’, ‘inspiring clinical confidence’ and ‘accuracy’. The XVI, and the possibilities it affords, were incorporated into strategic planning priorities across the UK based on a rationale of self-evidence and despite the absence of heath technology assessment.
This paper draws on ethnographic work in one hospital during this period. I reflect on interviews with staff members who, prior to the introduction of the XVI technology in one department, discussed a lack of evidence, absence of proof, a lack of compatibility with existing systems in use, the politics of the decision making process and perturbing doubts. Placing this alongside observations of staff and patients during the ‘experimental’ stage of use with the XVI, I consider how staff views were at odds with discussions and practices that occurred with and on patients once the technological system was in place.
Despite the lack of knowledge about the increased radiation dose, once the system was in place, risk was classified as inevitable or someone else’s responsibility. The actions of the patients were influenced by their interpretation of the information they were provided with. Yet, the patient capacity for action was located within the confines of the knowledge they received from staff and other sources. As such, patients’ own values and actions were shaped by the level of understanding they obtained and practitioners were able to direct the actions of the patients through maintaining these partial levels of understanding. Such partial truth telling created order and justification for practitioners’ own practices. By not correcting what aspects of ‘new’ treatment they were getting, practitioners ensured the patients remained engaged whilst being protected from any suggestion that what they are doing was questionable.
In this paper I will show how both patients’ and practitioners’ partial understanding about the risks and benefits of the XVI system created incommensurable ideas regarding the use of the system and what the patients’ role was during these introductory stages. As such I problematize ‘truth telling’ in these contexts and consider how patients’ experiences of ‘new’ treatment can be at odds with ‘experimental’ practices.
Biography:
Lisa Wood is a Lecturer in Social Sciences at Lancaster Medical School. Her research focusses on technologically mediated practices with a specific interest in how organisations and practitioners generate knowledge, more recently looking at practices ‘on the move’. This feeds into interests in knowledge production, accountability, responsibility and autonomy in practice. She’s on Twitter @DrLisaWood
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