When technology limits our choices

We usually think of technology in terms of freeing us from limits, increasing our freedom, opening up new possibilities. With technological advances, we can do more, enhance our comfort, treat more diseases, travel farther, access more information, access more information while we travel farther, etc.

But every new technology also limits freedoms and diminishes possibilities. When a new technology comes along and becomes accepted and widespread, the possibility of choosing not to use that technology is diminished. Think of how difficult it would be to choose to live without electricity, running water, cell phones, the internet, cell phones that can access the internet. . .

In many cases, this is not a bad thing. We are certainly much better off because water treatment and good sanitation are so ubiquitous. But there are technologies in medicine that we have a really hard time choosing not to use, yet whose benefit is questionable at best. For instance, continuous electronic fetal monitoring (EFM) is used in about 85% of live births in this country, despite the fact that in a low-risk pregnancy the potential harms vastly outweigh any potential benefits. However, for many in the medical field, laboring a patient without EFM is almost unimaginable. Or take prenatal genetic screening technology. When I first began practice, it was offered only to women at high risk of having a baby with a genetic defect. Now, it is routinely offered to all pregnant women. The American Congress of Obstetricians and Gynecologists (ACOG) has recommended that the newest such technology, cell-free fetal DNA screening, be offered only to women at high risk; but given our inability not to use a technology everywhere we can, how long will it be before it becomes the “Standard of care,” offered to all pregnant women regardless of risk? And when the test doesn’t show a perfect baby, how hard has it become to choose not to have that “therapeutic” abortion?

The list goes on and on: antibiotics for viral infections, screening tests for prostate cancer, antidepressants for everyone who is not outrageously happy, CT scans and MRIs for — well, just about anything. In fact, the difficulty of not using technology, the compulsion to use technology even when it is inappropriate, is so rampant that 41 medical specialties have joined forces to publish lists of instances when various technologies that are currently commonly employed should NOT be used.

Reflecting on some of last week’s posts on this blog that dealt with euthanasia, I begin to wonder, What if euthanasia becomes an accepted, widespread technology, the “Standard of care”? In a culture in which we warehouse the old and dying in nursing homes, in which people who require expensive treatments in a cash-strapped system might be seen as — who often see themselves as — a “burden,” will euthanasia in such cases subtly begin to be understood as an obligation? Will the option of living with an expensive, terminal illness be limited? Will the freedom to live without euthanasia be diminished?

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