IEEE Technology and Society Magazine - June 2015 - 48

Recent work in science and technology studies (STS)
and the philosophy of technology challenges technological neutrality. STS demonstrates that designers can
intentionally embed moral norms into artifacts to achieve
certain ends. Such is the case with grocery cart wheels
that lock up when taken too far from a store [1], with
bridges designed with low clearances to prevent lowincome "bus riders" from accessing upscale beaches
in New York state [2], and with cars designed to sound
annoying alarms when drivers forget to buckle their

Designers can intentionally
embed moral norms into
artifacts to achieve certain ends.

seat belts [3]. Such cases demonstrate how artifacts can
provide "material answers to moral questions" [4]. A
shopping cart with locking wheels answers the question
How far from the store should a shopper be allowed
to take this cart? A low clearance bridge answers the
question Who ought to be encouraged to visit these
beaches? Seat belt alarms answer the question Should
the driver be wearing a seatbelt? In other cases, artifacts
can unexpectedly give rise to new moral possibilities
and questions while eliminating others [4]. For example,
the introduction of ultrasound imaging into obstetrics
imposes deeply moral questions on pregnant women that
did not previously exist: Should I agree to an ultrasound
exam? And What ought I to do if the exam turns up
abnormalities [4]? In all of these cases it can be considered reasonable to describe some of the moral work as
being done by the artifacts, not just by the people surrounding them [2]-[4]. But even if we maintain a heavy
degree of technological neutrality in our analysis, at the
very least one can say that the examples above demonstrate that designers are able to both raise and answer
moral questions by embedding moral norms into technological artifacts, and that those norms can impact users'
moral lives, often profoundly.
One result of these challenges to technological neutrality is that by demonstrating how designers embed
moral norms into technology and how those norms
impact users, we can begin to draw attention to the
complex moral relationship that exists between designers, artifacts and users [1]-[4]. Analyzing aspects of the
relationship allows us to more clearly articulate how
some choices that are made during the design of a

48

technology shape a user's moral landscape. As such,
we can question the appropriateness of certain design
choices from within the context of a moral relationship.
This article argues that in cases where technological
artifacts provide material answers to moral questions
that arise in the use context, the artifacts can and should
be characterized as moral proxies acting on behalf of a
person. Because of this, we can accurately characterize
the moral link between designers, artifacts and users as
a relationship of a particularly moral kind. Moral proxies of the human kind have been a topic of analysis in
healthcare and bioethics, making them a good starting
point for thinking about moral proxies of the artifactual
kind. I draw from bioethics and STS literatures to build
an analogy between human moral proxies in healthcare
and artifactual moral proxies. I then turn my attention to
design ethics considerations. If we accept that artifacts
can function as moral proxies, it becomes important to
recognize that designers can subject users to paternalistic relationships that are ethically problematic. I argue
that there are situations in which engineers should adopt
design practices that avoid paternalism while bolstering
informed consent and user autonomy.

Moral Proxies in Healthcare
In healthcare, the ideal patient qua decision-maker is
the fully rational adult capable of understanding healthcare information as it is presented to her, weighing that
information in the context of her personal life, and communicating her preferences and decisions to others.
However, patients often find themselves in imperfect
healthcare circumstances.
It is often necessary to turn to a moral proxy for
decision-making (also referred to as a proxy decisionmaker, or substitute decision-maker). A moral proxy is
a person responsible for making healthcare decisions
on behalf of another, which is necessary when a patient
is deemed incapable of making, or communicating,
his own healthcare decisions. Incapacity of this sort
can be age related - a young child cannot make her
own decisions regarding care - or can result from a
medical condition - a patient might be unconscious,
or unresponsive, or generally unable to comprehend the
nature of his condition. If a patient is unable either to
comprehend the medical information being provided by
healthcare professionals, or is unable to communicate
his wishes, he cannot give informed consent to medical interventions. A proxy decision-maker is required in
such circumstances.
Generally speaking, spouses, family members, or
next-of-kin are considered the most appropriate moral
proxies given their presumed intimate knowledge of
the patient's life and medical preferences [5]. But this
was not always the case. The rise of modern medicine

IEEE Technology and Society Magazine

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june 2015



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