Social relations in the "high place" of technology

• Author: Stefano Tomelleri
• Position: Human Sciences Department, University Of Bergamo, Italy
• Pages: 243-248

Page 243

1. Introduction

It is a common notion that techno- scientific medical knowledge has currently gained an unprecedented therapeutic efficacy. In the last years we have witnessed a faster and faster advancement in both pharmacologic research and the use of techno-instruments in medicine. This has greatly improved the success of therapeutic interventions, explaining the present widespread trust in expert systems as well.

In spite of the plurality of icons about such a recent development in medicine, Intensive Care Unit is the real place, which evokes, more than any other, the salvific power of new technologies [4].

2. In the Beginning of our Research

When I entered into an Intensive Care Unit for the first time - in order to carry out a qualitative research on end-of-life- decisions, on a sample of six Italian ICUs (4 North, 1 Centre, 1 South) with two colleagues of mine, a health psychologist and a philosopher - I was really surprised to see a so high presence of techno- equipment surrounding the patients' bed.

In each Intensive Care Unit, three focus groups were organized, where the participants were asked to express their personal point of view concerning end-of- life decisions related to a specific topic of discussion: the action and the impact of technology in the medical practices, the success and the failure in the end-of-life decisions, the image of ICU seen as a context of relations and interactions. Through the textual analysis of the accounts, we have tried to underline, among the single discussions, the most meaningful critical polarization of the communicative knowledge [2-5].

2.1. The "High Place" of Technology

The big light displays, the racks in pots that continuously control the parameters and thePage 244large use of any sort of high-tech made me imagine to have come to the most advanced frontier of medical science. In other words, I was in a place where medicine seemed to focus the very modern idea of therapeutic intervention: illness is a natural process that hits the body.

Crossing the threshold of Intensive Care Unit - after a careful wearing ritual to avoid any sort of outside contamination within the ICU aseptic environment - I felt I was entering the "high place" of technology.

In the last thirty years, the developments in the techno-scientific field provided new opportunities of intervention to care workers: from the replacement or support of vital functions (such as artificial breathing devices, the cardiac pump or the kidney emunctory) passing through the inhibition of consciousness by extended sedation, to the diagnose of the brain death in despite of the beating heart using well-defined neurological principles and rendering possible, this way, organ transplants [6].

2.2. The Starting Hypothesis

In the beginning of our research, I was firmly convinced that care workers engaged in ICUs were culturally influenced by a kind of magic and salvific idea of their profession.

I believed that there was no remarkable difference between common sense and medical knowledge with reference to such an issue; I believed that both of these sorts of knowledge shared an idea of technology as a powerful, omnipotent expert system able to solve even more controversial issues included those concerning end-of- life conditions.

3. The End-of-Life Decisions

The end-of-life decisions concern more precisely admissions and discharges to/from ICUs and the limitation of intensive treatments.

To be clear, the limitations of treatment deal with those cases in which the monitoring or the treatment have become inappropriate: they are heavy in excess because of the presence of irreversible case histories, the failed response to the medical treatment, or the explicit patient's revocation of a previous consent or even the achievement of a therapeutic limit that was agreed before [1].

3.1. Technical Equipments and Human Frailty

The firm belief in the resolving power of technology and protocols as in decisions about admission, discharge and limitation of intensive treatments, was perhaps also due to the sharp contrast between technical equipments and the evidence of human frailty exposed in naked bodies depending on technological devices to stay alive and often unconscious, in a coma due to ongoing clinical pathologies or to pharmacological treatments in order to satisfy therapeutic needs.

3.2. Types of Patients

Taking into account the framework we have described, we can argue that there are two types of...