A funny thing happened on the way to the ICU . . .

In the latter half of the last century, medical technology made huge leaps in the ability to sustain biological function. Suddenly we could replace lost kidney function and keep lungs breathing and hearts pumping for people who, but a short time before, would inevitably have died from their kidney, lung, or heart failure.

But something funny happened on the way to the ICU. These new technical means of medicine radically changed the calculus of the goals or ends of medicine. Our technical advances far outpaced our ability to think ethically about how to use our newfound abilities.

The new technological means allow us to keep bodily functions going when they would otherwise stop. For many patients, these are lifesaving and appropriate interventions. However, for others, these new treatments become treatments that treat — nothing. To put it another way, when there is some radical insult to a person’s body, the technical means to sustain vital functions such as breathing and circulation are an appropriate intervention that buys time for the body to heal in ways it obviously couldn’t if those vital function weren’t sustained, i.e., a body can’t heal if it’s dead. But there are some patients for whom death is imminent, inevitable, and no degree of healing is possible outside of a miracle. For these people, the technical means become an end in and of themselves. We sustain a person’s bodily functions, not as a means to allow any hoped-for healing to take place, but because we are able to. We may not even ask why we do it; we do it because we can. Sometimes we even think that if we can do it, we must. Thus a technical means becomes an end in and of itself.

This is one of the inevitable tendencies of technique (of which technology is a subset): the tendency to turn means into ends. If we can ethically control the expansion and use of techniques, then they can be our servants: powerful ones that we must keep a close eye upon, yet servants nonetheless. But we humans have a tendency to place faith in technology, to assume its goodness, and so to catalyze its tendency towards self-justifying expansion. To the degree that we allow this to happen, we end up serving our technology, rather than technology serving us. We end up doing things because we can: keeping the ventilator on because — well, because the patient’s on a ventilator; doing the scan or the blood test because, well, we have a patient here, and we have to do something, and we can, even if it doesn’t really serve the end of improving or preserving the health of the patient.

Of course, it is not only in the ICU that this automatic deferral to technology can occur, but in all areas of medical practice. In light of this apparent deficit of ethical reflection on and regulation of our technology, in light of the exchange of our control over technique for technique’s apparently autonomous self-propagation, I wonder whether the practitioners of the medical art are not in danger of transforming from professionals to technicians.

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Janice Benson
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Janice Benson

Dear Joe: I agree with your concerns. I think another culprit to our ‘automatic deferral to technology’ is due to the power of the anecdote when patients have a miraculous turn around after being in extremis. We all want our loved ones to be that person, too, when they are so sick. However, I think a stronger impetus is the economic stimulus to developing new bio ‘toys’ given our insurance ssystem and our economic incentives. Our whole economy is focused on buying and selling things, and making and selling high priced things, such as expensive monitor systems, new devices that… Read more »

Janice Benson
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Janice Benson

Dear Joe: I think that the pull of a large economic stimulus is too large to be avoided. Our current economies (for the last 200 years) ALWAYS invent a new big hole to dig that will put people to work and give us something to buy. We will find clever ways to market and sell new big hole pieces until we find better big holes to dig. Perhaps we can find a good way to make money by asking ‘why’ we invent things and then we will start doing so as the good capitalists and consumers that we are. (Start… Read more »