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Medicine, Apparatuses, Robots and Intimacy: A Few Ethical and Political Aspects of the Linkage with Machines

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Reflections on Medical Ethics

Part of the book series: Philosophy and Medicine ((PHME,volume 138))

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Abstract

Fortunately, far from J. Ellul and from M. Heidegger, contemporary ethics invoke no more humanism or religious convictions in order to reject technologies, as if they were hostile to man. We have learned and are always learning to live with machines on which, very often, our health and even our very life depends. The existence of men in flesh and blood and the being of machines are intermingled in such a way that it is no longer possible to discern where the one starts and where the other ends. Yet, if this linkage between men and machines is generally recognized, without being rejected, the ethical problems continue to exist as if men had theirs and machines -digital machines and « intelligent » machines- had their own ethics or raised unique ethical concerns. What is quite absurd and opens wide the door to trans-humanist and post-humanist myths that cannot escape the qualification of Schwärmerei following the appellation that Aufklärung gave to such elucubrations. Nevertheless, this is not the issue: ethical questions deal with the indefectible mixed being that any modern man, member of our cultures, makes up with machines. A certain number of political conceptions are disqualified when these linkages with machines are taken into account; we highlight the point with Rousseau’s contractualism. But it may happen that moral positions, even classical, like Kant’s moral law, do not need to be applied to human beings. At least, Kant has fancied the first of the three formulations of his moral law for beings that are not specifically human. The matter is not to substitute Kantian morals to present ethics but to highlight that the ethics we are searching has predecessors and that ethics, when human nature is not imagined to be steeped in laws, cannot avoid dealing with linked or coupled beings.

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Notes

  1. 1.

    Everyone will have recognized, in this perspective, the idea G. Hottois defended in L’Inflation du Langage dans la Philosophie Contemporaine [17].

  2. 2.

    We understand that word no longer as an exteriorization, which the Germans readily call Entäusserung , but as a process which renders us foreign to ourselves, and which is expressed in German as Entfremdung .

  3. 3.

    [26], pp. 26–30. The ‘hau’ is that strength which is in the given thing and which forces the beneficiary to give it back under one form or another. Things, themselves endowed with a spirit, oblige the beneficiary.

  4. 4.

    For a more complete analysis of intimacy, [10] pp. 139–160.

  5. 5.

    [22], p. 401. The intelligible character of the transcendental subject ‘nous est indiqué par le caractère empirique comme par son signe sensible’.

  6. 6.

    A. Philonenko insists on this in his analysis of Kant’s practical philosophy: ‘Sans cesse, dans ses textes moraux essentiels, Kant parle de l’être raisonnable et non de l’homme’ ([37], p. 25). Kant always speaks of « reasonable being » rather than « man » or « human » in his practical philosophy.

  7. 7.

    Critique of Practical Reason, B. I, Part. I, Chap. III ([21], pp. 198–211). One really does have the impression of going around in circles. It is this circle that a certain number of thinkers like Foucault, Levi-Strauss and Lacan wanted to break in the middle of the 20th century (See Lacan J., [23], pp. 369–370).

  8. 8.

    I am referring here to machines that perform acts which are normally expected of intelligence: calculation was for a long time among them. Had Plato not seen in it what constitutes our humanity, more essentially and more archaically so even than language, in Epinomis, 977c ([38], p. 439)?

  9. 9.

    In Book I of Essays, Chap. XLII, ([30], pp. 254–263).

  10. 10.

    ‘Qu’on ne se moque donc plus de ceux qui se font honorer pour des charges et des offices’ (Sellier, 567, in Pascal B., [36], p. 1135). «Let us stop scoffing at those who win honour through appointments and offices» ([35], p. 218).

  11. 11.

    And, maybe also in the logic of liaisons and déliaisons which are to be explicitly found in Pascal and – more implicitly – in his sporadic reflections on machines.

  12. 12.

    L’irréversible et la Nostalgie, [20], p. 337: ‘L’avoir-été, qui nous apparaissait en creux ou à l’envers comme une inconsistance, va nous apparaître en relief ou à l’endroit comme un acquis inaliénable et un gage de permanence: car si l’irrévocable de l’avoir-fait est relativement irréversible puisqu’on ne peut le revivre ni même le refaire, l’irréversible de l’avoir été est à son tour relativement irrévocable puisqu’il ne peut plus être nihilisé. La positivité négative de l’avoir été, tout comme la dissymétrie de notre demi-pouvoir, atteste l’intermédiarité de la condition humaine, et elle est une assurance contre le néant. Nous parlions du caractère, sinon indestructible, du moins inexterminable du fait-d’avoir-eu lieu en général’. And, later: ‘Entre le non-être et n’être-plus il y a toute la distance infinie de l’avoir été; et rien au monde ne peut plus désormais faire que celui qui a été puisse ne pas avoir été: désormais ce fait mystérieux et profondément obscur d’avoir vécu est son viatique pour l’éternité’ ([20], p. 339).

  13. 13.

    One knows that the Nazis wanted not only to commit their crime against the Jews, but that they even wanted to delete their crime itself. Hence the necessity to elaborate an ethics of the engraving into being.

  14. 14.

    We are referring here to Schumann who, in Humoreske of Klavierwerke IV, staged and asked us to listen to an innere Stimme, an intermediary voice, between two melodic lines which are really played on the piano, and directly audible.

  15. 15.

    If the Lemme IV of the Second part states that, ‘if, from a body or individual, compounded of several bodies, certain bodies be separated, and if, at the same time, an equal number of other bodies of the same nature take their place, the individual will preserve its nature as before, without any change in its actuality’, one at once understands that those replacements could change the individual by increasing or decreasing his powers. This is how, since ‘all the modes, in which any given body is affected, follow from the nature of the body affected, and also from the nature of the affecting body’, wherefore ‘their idea also necessarily involves the nature of both bodies’, and ‘therefore the idea of every mode, in which the human body is affected by external bodies, involves the nature of the human body and of the external body’ (demonstration of Prop. 16). The Ethics (ethica ordine geometrico demonstrata), [47], pp. 51–52.

  16. 16.

    This Foucaldian “anti-humanism” is particularly sensible at the end of Les Mots et les Choses, in the very last paragraph of Chapter X about human sciences: “Une chose, en tout cas, est certaine: c’est que l’homme n’est pas le plus vieux problème ni le plus constant qui se soit posé au savoir humain. En prenant une chronologie relativement courte et un découpage géographique restreint – la culture européenne depuis le XVIe siècle – on peut être sûr que l’homme y est une invention récente. […] L’homme est une invention dont l’archéologie de notre pensée montre aisément la date récente. Et peut-être la fin prochaine” ([13], p. 398). Those who, with the strongest certainty that there exists a man, talked about dealing with human nature or investigating it, knew its frailty very well. Did Hume not say that, if one harmed the principle of causality, one harmed at the same time human nature itself? Behind the appearances of a description, Hume in reality defends human nature [19]. One century before Hume, Descartes hesitated to speak of nature, as he thought that the idea of law was enough, and did not need to be supported thus by that of nature [12]. As to Boyle, the text that he wrote on nature, A Free Enquiry into the Vulgarly Received Notion of Nature, (1686) [8], aimed to show that the idea was dangerous, and that it would be quite possible to do without it without any damage. The fear Pascal underlined as to the natural feeling of paternity may be extended to whatever can be held to be natural: as soon as man acts towards what is natural, to support it, he admits that he does not really believe in that naturality.

  17. 17.

    In his first seminars, Lacan showed a high interest in this type of machines, which he did not oppose to the ‘human being ’, but which, on the contrary, he showed to be commensurable with him.

  18. 18.

    In Medical Robotics, it is written, about robots, that ‘pour un bon nombre d’applications de chirurgie, il est pertinent d’intégrer les mobilités et les capteurs à l’intérieur du corps plutôt qu’à l’extérieur. En d’autres termes, plutôt que de manipuler avec un robot extra-corporel un instrument rigide multimillénaire (comme des ciseaux ou des pinces, par exemple, l’idée est de développer une robotique intra-corporelle, offrant au minimum les mêmes performances de qualité de mouvement, de sécurité, d’interaction avec le praticien. Le sujet n’est pas nouveau, puisque les premiers travaux datent des années 1990, mais il est loin d’être épuisé’ ([27], p. 394). And, later, ([27], p. 409), ‘La robotique chirurgicale évolue vers des solutions déliées, miniaturisées et dotées d’une certaine autonomie. Les capsules ingérables par voie buccale en sont un bon exemple. On peut s’attendre à des développements équivalents avec des dispositifs de taille millimétrique pour amener un médicament ou un capteur sur une cible donnée.’

  19. 19.

    It was thematized in its principle by Leibniz, when he distinguished clear, distinct, adequate symbolical and intuitive ideas [25]. It is obvious that for him symbolical ideas – which do not imitate their object and do not require its presence – are much more productive than clear, distinct or adequate ones. The more a language severs itself from a strong link with the imagination, the more chance it has of being powerful in its thinking and practice on a reality it does not imitate.

  20. 20.

    Echoing that unfortunate corporeity, Professor Didier Sicard wrote, in a book which is quite remarkable for its prudence and the information it contains, ([45], pp. 163–164): ‘Ce corps, déjà mis à distance par l’imagerie diagnostique, va désormais ‘être envoyé’ sur les écrans de la télé-médecine. Numérisée, archivée, fixée, transmise à l’autre bout du monde, cette image d’un moment malheureux du corps devient une information organique. Le statut de l’autonomie de cette image est un des problèmes du futur. Pourra-t-on retravailler cette image, la virtualiser? ou n’envoyer que des images définitivement fixées? On imagine les problèmes éthiques que pose l’intervention médicale sur une image … qui pourrait ainsi être rendue artificiellement pathologique ou normalisée… La télé-médecine pose comme problème majeur celui de l’autonomie du patient face à la médecine.’

  21. 21.

    In the article he wrote on Merleau-Ponty upon his death , Lacan, showing his difference with to latter, wrote that ‘si le signifiant est exigé comme syntaxe d’avant le sujet pour l’avénement de ce sujet, non pas seulement en tant qu’il parle, mais en ce qu’il dit, des effets sont possibles de métaphore et de métonymie non seulement sans ce sujet, mais sa présence même s’y constituant du signifiant plus que du corps, comme après tout on pourrait dire qu’elle fait dans le discours de Maurice Merleau-Ponty lui-même, et littéralement.’ Lacan however, performed a generous reading of his friend who died prematurely. It seems that it is rather, and most often, in opposition to the phenomonology of the body [28, 29] that Lacan asserted that ‘le corps dont il s’agit en psychanalyse est le corps d’un être qui parle et de ce fait même, voit son fonctionnement organique profondément altéré et transformé par cette incidence du langage.’ The body is changed by the fact that it is engaged ‘dans la dialectique signifiante’.

  22. 22.

    We know the statements: ‘I would rather live until the age of seventy or eighty than live for two hundred or three hundred years,’ ‘What would our relationship with others become if we lived that old?’, and ‘Would we not be an unbearable weight for society?’ Or perhaps is it a very odd debate, particular to some French ideologists!

  23. 23.

    Which may imply that there must be speaking beings to build machines.

  24. 24.

    This sentence is echoed in a passage of the Conference delivered by Lacan on 22nd June 1955 ([23], p. 350): ‘On sait bien qu’elle ne pense pas cette machine. C’est nous qui l’avons faite, et elle pense ce qu’on lui a dit de penser’. Lacan however does not say this to take a Cartesian path, for he at once adds that ‘si la machine ne pense pas, il est clair que nous ne pensons pas non plus au moment où nous faisons une opération. Nous suivons exactement les mêmes mécanismes que la machine’.

  25. 25.

    ‘For I observe, that men are everywhere concerned about what may happen after their death, provided it regard this world; and that they are few to whom their name, their family, their friends, and their country are in any period of time entirely indifferent.’ ([19], p. 79).

  26. 26.

    One can, therefore, when one is in Paris, wonder what time it is on a given point of the sun or of some other star: this question is at the same time unavoidable and absurd. It is due to a lack of control of the limits of language.

  27. 27.

    See Shapin S., ([44], pp. 30–35). The book the article refers to was published by Cambridge University Press, 2014. P.-E. Dauzat translated it into French with the subtitle: Une brève histoire de l’avenir in 2017. S. Shapin’s article, translated by D. Veaudor had already been published in the London Review of Books on 13th July 2017.

  28. 28.

    It is quite strange to note that the inventions and techniques presented by the god Theuth are among the main functions expected of present-day computers: games, learning languages , mathematics, calculation, and memorization, which is at the core of Phaedrus.

  29. 29.

    The Social Contract, II, VI: ‘Les lois ne sont proprement que les conditions de l’association civile.’ ([40], p. 380).

  30. 30.

    ‘Les actes du souverain ne peuvent être que des actes de volonté générale, des lois’ ([42], p. 842). There is an identification of the general will and the law: in a note to Book II of The Social Contract, Ch. VI, defining what he calls a republic, Rousseau says that it is told ‘en général, (de) tout gouvernement guidé par la volonté générale, qui est la loi.’ ([40], p. 380). <in general, any government directed by the general will, which is the law (trans. J. Bennett, earlymoderntexts.com/assets/pdfs/rousseau1762.pdf)>.

  31. 31.

    The point is made in a remarkable passage in The Social Contract, B. III, Ch. IV: ‘Voilà pourquoi un auteur célèbre a donné la vertu pour principe de la République; car toutes ces conditions ne sauraient subsister sans la vertu: mais faute d’avoir fait les distinctions nécessaires, ce beau génie a manqué souvent de justesse, quelquefois de clarté, et n’a pas vu que l’autorité souveraine étant partout la même, le même principe doit avoir lieu dans tout État bien constitué, plus ou moins, il est vrai, selon la forme du gouvernement.’ ([40], p. 405). <That is why a famous writer – Montesquieu – has made virtue the driving force of a republic; for none of the conditions could exist without virtue. But that great thinker did not make all the needed distinctions, and that lead it often to be inexact and sometimes to be obscure; he did not see that because the foreign authority is everywhere the same, the same driving force should be at work in every well-considered state -more or less, it is true, depending of the form of the government (trans. J. Bennett, earlymoderntexts.com/assets/pdfs/rousseau1762.pdf)>. [41]

  32. 32.

    The Social Contract, II, VI: ‘Quand tout le peuple statue sur tout le peuple, il ne considère que lui-même, et s’il se forme alors un rapport, c’est de l’objet entier sous un point de vue à l’objet entier sous un autre point de vue, sans aucune division du tout. Alors la matière sur laquelle on statue est générale comme la volonté qui statue. C’est cet acte que l’on appelle une loi.’ ([40], p. 379). The Geneva manuscript went as far as saying (II, IV): ‘La matière et la forme des lois sont ce qui constitue leur nature; la forme est dans l’autorité qui statue, la matière est dans la chose statuée’ (Pléiade, p. 1461). <When the whole people decrees for the whole people, it is considering only itself; and if a relation is then formed, it is between two aspects of the entire object, without there being any division of the whole. In that case, the matter about which the decree is made is, like the decreeing will, general. This is what I call a law. (Trans. J. Bennett, earlymoderntexts.com/assets/pdfs/rousseau1762.pdf)>. [41]

  33. 33.

    It is interesting, in this respect, to see that that notion of folding also works for authors as diverse as Spinoza (involvere in latin), Jaspers (das Umgreifendes in German) and Deleuze, who all reject the concept of foundation.

  34. 34.

    As is the case, for example, of Pascal. ([34], p. 1135), ([35], pp. 217–8).

  35. 35.

    In B. II, Chap. II of The Spirit of the Laws, Montesquieu says, startling a reader familiar with Rousseau, that ‘la brigue n’est pas dangereuse dans le peuple, dont la nature est d’agir par passion. (…) Le malheur d’une république, c’est lorsqu’il n’y a plus de brigues; et cela arrive lorsqu’on a corrompu le peuple à prix d’argent (…)’ ([31], p. 244). <Intrigue is dangerous in a senate; it is dangerous in a body of nobles; it is not dangerous in the people, whose nature is to act from passion. (…) The misfortune of a republic is to be without intrigue, and this happens when the people have been corrupted by silver> ([32], p. 14); <Intriguing [though dangerous in a senate, and also in a body of nobles] is not dangerous in the people, whose nature is to act through passion. (…) The misfortune of a republic is, when intrigues are at an end; what happens when the people are gained by bribery and corruption. (trans. in The Complete Works of M. de Montesquieu, London, T. Evans, 1777, 4 vol., vol. 1, all.libertyfund.org/totles/montesquieu-complete-works-vol-1-the-sprit-of-laws [32]). On the contrary, Rousseau condemned plots without exception in The Social Contract, B. II, Chap. III: ‘Mais quand il se fait des brigues, des associations partielles aux dépends de la grande, la volonté de chacune de ces associations devient générale par rapport à ses membres, et particulière par rapport à l’État; on peut dire alors qu’il n’y a plus autant de votants que d’hommes, mais seulement autant que d’associations. Les différences deviennent moins nombreuses et donnent un résultat moins général’. ([40], pp. 371–2). <But when plots and deals lead to the formation of partial associations at the expense of the big association, the will of each of these associations – the general will of its members – is still a particular will so far as the state is concerned; so that it can then be said that as many votes as there as men is replaced by as many votes as there are associations. The particular wills become less numerous and give a less general result. And when one of these associations is so great as to prevail over the rest, the result is no longer a sum of small wills but a single particular will; and then there is no longer a general will, and the opinion that prevails is purely particular. (Trans. J. Bennett, earlymoderntexts.com/assets/pdfs/rousseau1762.pdf)>. [41]

  36. 36.

    The matter of the laws being deduced, in a way, from their form.

  37. 37.

    It has often been said that one can recognize a democracy not but by how the law of the majority is respected, but by looking at the fate of the minorities.

  38. 38.

    Bentham identified it as an essential political passion in Rationale of Judicial Evidence, ([1], I, p. 422): ‘Shame may be considered as operating in the character of a security for trustworthiness in testimony, in so far as, on the occasion of a man’s delivering testimony, the contempt or ill-will of any person or persons is understood to attach, or apprehended as being about to attach, upon a deviation, on his part, from the line of the truth.’

  39. 39.

    Nicholas Carr shows this [9] when he distinguishes at least two types of strategies in the programming of computers: that which aims at exhausting all the possible solutions of a given situation, and that which rather follows the choices of human intelligence and seems to support it. Carr cleverly shows that it is not necessarily the second type that is the most efficient. Deep Blue , the computer that defeated Kasparov in 1997, followed the first strategy. In a way, this is an old story that has existed in mathematical strategies themselves. The history of probability calculus shows it, as Fermat’s complete enumerations, the more selective trees of Pascal, which calculates the expectations of players, are opposed. A century later, Bayes, in order to solve his famous game problem, played on the reflection of who speculates rather than on an objective enumeration of all the possible solutions of a given situation. It is by following a Fermatian scheme that, for example, the theorem of the four colours could be formulated: ‘en explorant de façon systématique toute une multitude de combinaisons qu’il eût été fastidieux d’énumérer à la main’ ([14], p. 58).

  40. 40.

    [46], p. 238: ‘La pensée philosophique doit accomplir réellement la synthèse et elle doit construire la culture, coextensive à l’aboutissement de toute la pensée technique et de toute la pensée religieuse. (…) La culture doit réunir réellement toute la pensée technique et toute la pensée religieuse. (…) La pensée philosophique saisit et traduit la portée de cet intervalle; elle le considère comme positivement significatif, non comme un domaine statiquement libre, mais comme la direction définie par la divergence de deux modes de pensée; (…) la pensée philosophique prend naissance au long du devenir divergent pour le faire reconverger’.

  41. 41.

    La Bible, [6], Les Proverbes, XXX, 18–19, Tome II, p. 1439. [7], p. 599.

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Cléro, JP. (2021). Medicine, Apparatuses, Robots and Intimacy: A Few Ethical and Political Aspects of the Linkage with Machines. In: Reflections on Medical Ethics. Philosophy and Medicine, vol 138. Springer, Cham. https://doi.org/10.1007/978-3-030-65233-3_6

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