Chapter 19 Normative Crossover: The Ethos of Socio-technological Systems

 

Abstract

This chapter explores the normative aspects  (what we think is right or wrong) of technologies, viewing them as socio-technological systems that encompass both technical and social elements. It emphasizes the need to clarify the relationship between epistemic (trusting the knowledge coming from these systems) and ethico-political (ethical and political) activities within these systems. The concept of "ethos of socio-technological systems" is introduced to represent the inherent value of these systems. The chapter analyzes how normative issues, recognized as either epistemic or ethico-political, are interconnected within these systems. This concept is then applied and examined through the case study of a Norwegian controversy regarding the ultrasound screening program for pregnant women.

19.1 Normative Crossover

This chapter explores how technology affects and is affected by society, drawing on ideas from Thomas Hughes and other scholars. It argues that technology should be understood not just as a collection of devices and systems, but also in terms of how it's shaped by and shapes social norms and practices.

Socio-Technological Systems: This concept describes technology as part of a "seamless web" of social and technical systems. It means that technology and society are deeply interconnected and evolve together. The way technology develops and is used is influenced by social factors like culture, politics, and human behavior.

Normative Crossover: The chapter discusses how the technical and social aspects of technology blur together, creating a challenge in separating purely technical issues from ethical and political ones. This crossover means that when we make or use technology, we're also engaging in ethical and political decisions, often without realizing it.

Ethos of Socio-Technological Systems: Drawing from Charles Taylor’s philosophical anthropology, the chapter introduces the idea of "ethos" to describe the moral character of these socio-technological systems. This ethos reflects the values and moral judgments embedded in the technology itself and in the way it's used.

Human Agency and Moral Evaluations: The chapter emphasizes that people always evaluate their actions, whether consciously or not. These evaluations can be strong or weak, and they shape how people interact with technology. Discussing the goals of technology is also a way of discussing who we are and what we value as a society.

Case Study - Obstetric Ultrasound in Norway: To illustrate these concepts, the chapter references a controversy in Norway regarding the use of obstetric ultrasound for pregnant women. This case study highlights how the ethos of a socio-technological system (in this case, medical technology) affects and is affected by human moral judgments and social practices.

In summary, the chapter argues that technology is deeply intertwined with social values and practices, and that understanding this relationship is crucial for addressing the ethical and political dimensions of technological development and use.

19.2 The Ethos of an Ultrasound Screening Programme

In Norway, since the mid-1980s, every pregnant woman has been offered an ultrasound test at 18 weeks of pregnancy, which most have accepted. However, the use of ultrasound for fetal diagnosis has been controversial from the beginning. A national consensus conference in 1995 highlighted this controversy. Despite finding little or no medical benefit from the screening program, the conference recommended its continuation because it was valued by women.

This situation exemplifies the challenges in balancing medical and social goals. The consensus conference was a response to these challenges, aiming to define what the ethos, or guiding values, of the program should be. The ethos of the program was not singular but a spectrum of various evaluative judgments, reflecting both medical objectives and the experiences of end-users, such as the comfort and reassurance the screenings provided to expectant parents.

The chapter indicates that the worth of the screening program is multifaceted, influenced by medical, economic, industrial, scientific, and political interests. The ethos of the program, being historical and evolving, wasn't fully articulated or deliberated, partly due to the complexities in representing all stakeholders and the challenges in expressing the values guiding our responses to changing socio-technological systems.

The 1995 consensus might have been appropriate at the time, but as technology and practices evolve, tensions can arise between the current practice and the reasons it was initially considered good. The chapter suggests that such destabilizing elements led to a heated public controversy over a specific ultrasound research project in Norway.

19.3 The Controversy

This controversy in Norway revolved around a research project at the Norwegian National Competence Centre for Ultrasound Research at NTNU. The researchers were evaluating new diagnostic tools for early pregnancy, particularly measuring "nuchal translucency thickness" in fetuses between 11 to 14 weeks, which showed correlation with disorders like Down’s syndrome.

This research potentially threatened to transform the existing ultrasound screening program, raising concerns about eugenics and the medicalization of pregnancy. The new tools required conducting ultrasounds around the 12th week of pregnancy, coinciding with Norway's legal abortion limit, heightening eugenic implications.

Despite the medical benefits, the project faced public and political scrutiny. The Norwegian Minister of Health publicly questioned the desirability of the research, sparking a debate about political intervention in scientific research. Critics initially attacked the Minister for interfering, but the debate soon shifted to focus on the broader social and ethical implications of obstetric ultrasound.

A local ethics committee reevaluated the project, and after peer review, found a high likelihood of false positives in the diagnoses. This led to a loss of support for the researchers and criticism of the project's integrity.

The controversy highlighted the interconnectedness of scientific research, ethics, politics, and public opinion. It showed how a research project, particularly in a sensitive area like prenatal care, could become a focal point for broader societal debates about technology, ethics, and the role of government in regulating scientific research.

19.4 Two Normative Concerns

This section discusses two main normative concerns raised by the Minister's intervention regarding obstetric ultrasound screening in Norway:

Eugenics Concern: The first concern relates to the potential eugenic implications of the ultrasound screening. With advanced diagnostic tools, the debate around abortion could shift from focusing on the parents' social conditions to the notion of a "well born" child, threatening the unconditional value of human life. This change could lead to situations where parents would have to decide whether to continue a pregnancy based on potential disabilities or disorders in the fetus, like Down's syndrome. Such decisions could make parents responsible for choosing which lives are worth living, posing ethical dilemmas and increasing the burden of responsibility on them.

Medicalization of Pregnancy: The second concern is the increased medicalization of pregnancy. Early diagnostics could lead to more frequent and powerful diagnostic tests, potentially turning normal pregnancies into medical conditions. While most women accept and even expect ultrasound tests as part of the pregnancy experience, this acceptance raises the question of whether women genuinely want these screenings or feel pressured to comply with medical recommendations. Accepting these tests can lead to living with uncertain diagnoses and can transform the pregnancy experience, making it more about medical surveillance than a natural process. The concern is that medicalization could affect not only the pregnancy but also the relationship between the mother and the child after birth.

Both these concerns relate to how the socio-technical system of obstetric ultrasound, with its potential changes, could influence broader social and ethical issues. The controversies reflect the complex interplay between technology, ethics, and politics in healthcare.

19.5 Ethos, Socio-technical Systems, and Normative Crossover

This section discusses how the controversy over obstetric ultrasound screening in Norway highlighted two interconnected normative concerns within the socio-technical system:

Temporal Separation of Technical and Political Activities: Initially, the controversy was seen as a conflict between the technical responsibilities of scientists and the political responsibilities of policymakers. Scientists were expected to develop and research diagnostic technologies first, with politicians later assessing the political implications. However, the debate shifted to focus on the overall value of the screening program, revealing deeper ethical and social issues.

Ethos of Socio-Technical Systems: The concept of the "ethos" of socio-technical systems is central to understanding this controversy. Ethos refers to the moral character of these systems, shaped by both technical and social factors. This ethos evolves with changes in the socio-technical system and needs to be critically examined. In this case, the ethos of the screening program was challenged by concerns about medicalization and eugenics.

Engaging with the Ethos: The controversy sparked a broader debate on the politics of obstetric research, which might have been overlooked otherwise. The research project was originally about assessing new diagnostic tools for potential inclusion in the screening program. However, the Minister’s intervention brought attention to the moral implications of these tools, particularly regarding eugenic concerns and the medicalization of pregnancy.

Temporal and Normative Aspects of Ethos: The ethos of a technology or program is historically shaped and evolves over time. It is formed through a process where socio-technical systems gain stability and public trust. In this case, the debate centered around whether the new diagnostic tool should change the established ethos of the screening program.

Normative Crossover in Scrutiny: The Minister's intervention highlighted the need for moral scrutiny that crosses the boundaries of technical and social realms. The controversy became more than a technical debate; it engaged with broader ethical and political concerns integral to the screening program's ethos.

In summary, the controversy over obstetric ultrasound in Norway illustrates how ethical, technical, and political aspects intertwine in socio-technical systems, challenging traditional boundaries and calling for a holistic approach to understanding and addressing these complex issues.