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Doing Away with the Agential Bias: Agency and Patiency in Health Monitoring Applications

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Abstract

Mobile health devices pose novel questions at the intersection of philosophy and technology. Many such applications not only collect sensitive data, but also aim at persuading users to change their lifestyle for the better. A major concern is that persuasion is paternalistic as it intentionally aims at changing the agent’s actions, chipping away at their autonomy. This worry roots in the philosophical conviction that perhaps the most salient feature of living autonomous lives is displayed via agency as opposed to patiency—our lives go well in virtue of what we do, rather than what happens to us. Being persuaded by a device telling us how to conduct our lives seemingly renders the agent passive, an inert recipient of technological commands. This agential bias, however, has led to a marginalization of patiential characteristics that are just as much part of our lives as are agential characteristics. To appreciate the inherent interlocking of acting and being acted upon, it is vital to acknowledge that agency and patiency are correlates, not mutually exclusive opposites. Furthermore, it is unclear whether an action can only count as agential so long as its causes are internal. Drawing on the extended mind and extended will framework, I argue that mHealth applications merely serve as volitional aids to the agent’s internal cognition. Autonomously set goals can be achieved more effectively via technology. To be persuaded by an mHealth device does not mainly—let alone exclusively—emphasize patiency; on the contrary, it can be an effective tool for technologically enhancing agency.

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Notes

  1. https://techcrunch.com/2015/06/02/6-1b-smartphone-users-globally-by-2020-overtaking-basic-fixed-phone-subscriptions/ (retrieved May 2017).

  2. http://www.gfk.com/global-studies/global-studies-fitness-tracking/ (retrieved June 2017).

  3. Whenever I talk about “doing” in the context of persuasion and autonomy, I take “omitting” to be implied. For brevity’s sake, I hereafter omit “omitting.”

  4. Davis et al. ’ (2015) scoping review surveys health-related behavior change theories as they are put forward in the social sciences.

  5. This reading is suggested by many other accounts of paternalism. Michael Cholbi (2017), to name just one example, has recently put forward a version of rational will that ranks the wrongfulness of paternalistic interventions in terms of the extent to which such acts replace the paternalizee’s practical rationality with the paternalizer’s and the degree of mistrust in the paternalizee’s rational agency displayed by the paternalistic intervention.

  6. This question requires a separate treatment, but is not of central importance for my purposes.

  7. The issue as to whether one can, in principle, interfere with one’s own autonomy or whether this necessarily requires another agent is interesting, but a detailed analysis thereof must remain a task for another day. At first blush, it looks as though actively deciding to renounce one’s autonomy is itself an act of autonomy.

  8. There is much to be said about the interplay between acting and being acted upon. Mikael M. Karlsson (2002), for example, cashes out the distinction between things we do and things that happen to us in an Aristotelian attempt of “self-movement.” Richard Taylor (1982) questions the metaphysical distinctiveness of action and suggests a more practical approach, claiming that we decide whether something is an action or someone an agent when we encounter them; as we go along, so to speak.

  9. An anonymous referee pressed the point that the interpretation of predicates like “suffering” seems very generous here. What is meant to be shown by emphasizing things like suffering (and similar patiential expressions) is the idea that in every instance of human action, there is always simultaneously an aspect in which things passively happen either to someone else involved in that action or to that very agent initiating the action (this is why I have earlier described agency and patiency as correlates). The reviewer further says, and rightly so, that it would be more intuitive to say that agents sometimes also “overcome,” for example, some “resistance” but that this does not make them patients. This might be so, but I think there is still reason to resist this intuitive appeal and instead hold on to the conceptual conviction that agents are in some relevant sense always also passive with regard to their actions. “Overcoming” some resistance, in this example, suggests that the agent actively does so overcome, when in fact they might just passively “endure” something that happens to them, something that is an integral part of the action but that the agent has nonetheless no influence or control over and is thus patiential with regard to the action.

  10. Thanks to an anonymous referee for drawing my attention to this.

  11. I owe this point to an anonymous referee.

  12. I am grateful to an anonymous referee for pointing me in that direction.

  13. Thanks to an anonymous referee for pointing this out.

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Acknowledgements

Special thanks to the audience and the referees of the 20th Conference of the Society for Philosophy and Technology (SPT) in Darmstadt for their helpful comments on earlier versions of this paper. Thanks also to the referees of Philosophy and Technology for their valuable feedback.

Funding

I am grateful to the German Federal Ministry of Education and Research (BMBF) for their generous financial support.

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  1. Department of Philosophy, University of Duisburg-Essen, Room: LE 329, Forsthausweg 2, 47057, Duisburg, Germany

    Nils-Frederic Wagner

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Wagner, NF. Doing Away with the Agential Bias: Agency and Patiency in Health Monitoring Applications. Philos. Technol. 32, 135–154 (2019). https://doi.org/10.1007/s13347-018-0313-7

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