IEEE Technology and Society Magazine - June 2015 - 50

both Jane and the defibrillator, and only then can they
deliver shocks to Jane's heart. If all goes well, after
considerable time, coordination and effort, the human
actors have just successfully performed the medical
interventions the ICD is capable of performing on its
own almost instantaneously. Thus, Jane's ICD all but
eliminates the need for humans in the critical path to
the medical intervention. It continuously monitors her
heart, detects abnormal cardiac rhythms, and delivers
potentially life saving shocks before a single human
bystander has the chance to come to Jane's assistance.
ICDs are capable of accomplishing the work of several humans, a fact that Bruno Latour refers to as delegation [3]. Designers delegate the tasks of continuous
monitoring, medical assessment and intervention to
the ICD. Not only does the ICD perform those functions
but also, unlike its human counterparts who are error
prone, it performs them with the accuracy and consistency expected of a computer. ICDs also mediate
our relationship with the physical world, in this case
Jane's relationship with time and space [4]. With her
ICD working diligently in the background, Jane is free
to travel farther from medical centers with a certain
confidence that in an emergency the time and space
between her and medical experts will have less impact
on her chances of survival; the ICD promotes Jane's
freedom and independence by expanding her geographical safety zones.
In addition to the work that is delegated to the ICD,
and the mediating role it plays, answers to deeply moral
questions can be delegated to it too [4]. An answer to
that life and death question that was asked of Jane
prior to her implantation - Would you like to have
potentially life-saving electrical shocks administered in the future event that your heart goes into
an abnormal rhythm? - is implicit in the presence
of an activated ICD. Yes! Shock the heart and sustain
Jane's life! The ICD is continuously poised to answer
that deeply moral question by the mere fact that it is
in Jane, actively monitoring her heart, ready to deliver potentially life-saving electrical shocks at the first
sign of an abnormal rhythm. Her ICD instantaneously answers an important healthcare question on her
behalf when called upon to act.
The ICD, therefore, can be cast as moral proxy acting
on behalf of Jane. In the absence of an ICD, an ideal
moral proxy would be required to provide an answer
to that same life and death question in an emergency:
Would Jane agree to have potentially life-saving electrical shocks administered given that her heart has
gone into an abnormal rhythm? An activated ICD provides an answer to that question.
To further illustrate how an artifact can function
as moral proxy, consider Jane's current situation. Just

under a year ago she was diagnosed with inoperable
cancer. Her initial prognosis suggested she had four to
six months to live, and her health has deteriorated to
the point that her medical team have discussed palliative measures with her and her family. As a part of those
conversations, Jane was asked whether she would want
the medical team to attempt to resuscitate her in the
event that her heart stopped. Recalling the intense pain
she suffered when her ICD fired years ago, and recognizing the gravity of her current medical condition, she
decided that no resuscitation efforts should be made,
only that she be kept comfortable.
Of course, her "do not resuscitate" (DNR) preference,
a deeply moral end-of-life decision, would be ineffective if
the medical team failed to alert all of the medical staff by
way of adding the important DNR note to Jane's medical
chart. In that case, healthcare staff that were not a part of
the DNR conversation would have no way of knowing what
Jane's preferences were, and would likely assume proxy
decision-making powers and attempt CPR in an emergency. Her DNR preferences would be equally ineffective
if no one alerted the ICD to her preferences by deactivating it. In that case, quite unaware of the information
on her chart, in the event that Jane's heart went into an
abnormal rhythm the ICD would assume proxy decisionmaking power and deliver its pre-programmed series of
up to nine painful shocks. With the moral decision to (or
not to) attempt cardiopulmonary resuscitation delegated
to it, an ICD functions as an efficient moral proxy the
moment abnormal heart rhythms are detected, that is,
the moment the question whether or not to attempt resuscitation must be answered.
As it stands, Jane is waiting for the medical staff to
contact the ICD manufacturer to assist with the deactivation (hers is an older model that the hospital is
unequipped to deactivate). She is told the deactivation
could take several days to accomplish. Delegating to
the ICD her new end-of-life preferences involves highly
specialized equipment and some official paperwork.
Jane hopes that her last moments in life will not involve
several painful reminders of the powerful little device
within her. As a moral proxy, her ICD is proving to be
somewhat uncooperative.

An Ontological Objection
It is quite odd, one might say, to describe a technological artifact as capable of participating in any kind
of relationship. Artifacts do not have the mental stuff
required to decide anything, so it is just a mistake to
describe them as decision-makers. Thus, ICDs are incapable of moral action, they merely execute someone
else's instructions.
Two responses to this objection rescue the artifactual moral proxy. First, human moral proxies can

IEEE Technology and Society Magazine

∕

june 2015

Table of Contents for the Digital Edition of IEEE Technology and Society Magazine - June 2015