‘Obligatory Technologies’ and the Autonomy of Patients in Biomedical Ethics

Abstract

Autonomy is a central principle in modern biomedical ethics and medical law. 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. Drawing on the debate over ‘the technological imperative’ 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 patients ‘an offer they cannot refuse’. These mechanisms include competition, adaptation and dependency, as well as the ‘normalisation’ and ‘moralisation’ of the use of technology. The law plays a role in the normalisation and moralisation of technology use by reflecting societal norms about reasonable behaviour 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.