TY - JOUR
AU - Bishop, Jeffrey, P
AB - Abstract It is commonly held that Christian ethics generally and Christian bioethics particularly is the application of Christian moral systems to novel problems engaged by contemporary culture and created by contemporary technology. On this view, Christianity adds its moral vision to a technology, baptizing it for use. In this essay, I show that modern technology is a metaphysical moral worldview that enacts its own moral vision, shaping a moral imaginary, shaping our moral perception, creating moral subjects, and shaping what we imagine as moral intentions. In fact, modern technics has its own liturgics, which is foreign to Christian Divine Liturgy. Divine Liturgy is world forming, showing us a different world than the one that comes into relief in the ersatz liturgy of modern medical technics. I. INTRODUCTION Christianity is not a moral system, nor does it possess a moral system. Christian ethics is not about applying a moral system to things that arise as moral problems. To hear some Christian thinkers, you would think that science or technology tells us about a neutral reality and that Christian morality informs how we should use that technology. Christians do not merely apply a specific thinker, say a Thomas Aquinas, or John Calvin, or Dietrich Bonhoeffer, or a specific moral theory developed out of their work, to a problem. Nor does Christianity exist in isolation from reality in a Barthian revelation versus metaphysics sort of way. Christianity reveals truths about the nature of reality through its Liturgical practices; the realities of the world are already graced by virtue of having come from the Creator. Instead of a moral system, Christianity is a set of practices that places one in right relationship with God—the Divine Other—so that one can be in right relationship to others and with all of creation, such that one can know what a thing is and what is owed to that thing. Christianity then is a different way of seeing, of knowing, and of taking up with reality. Acknowledging that Christian Liturgical practice uncovers (reveals) reality differently is not to say that Thomas Aquinas, John Calvin, or Dietrich Bonhoeffer is not a helpful companion; but Christian ethics generally and Christian bioethics specifically are not primarily about intellectual or biblical resources to be applied to specific problems that show up—in, say, a novel technology, for example—as a neutral reality. Just as moral problems are ingredient with the ontological status of things and cannot be easily separated from the way those things are engaged, it is also true that the tools developed by medical science—pills, machines, surgical interventions, psychological interventions—are not merely neutral tools; they already have a moral valence in being developed for use. All moral problems emerge within an ethos. In many instances, the technology emerges to solve a problem. It is the solution to a perceived problem, which means that we must not only act rightly in response to the problem, but we must also perceive the problem rightly. Technology tries to remedy something perceived to be evil or wrong, or perceived to be a lesser good or to be a less than optimal state of affairs. That means that technology is not morally neutral, as we often imagine it to be. It is not a neutral tool waiting to be deployed for some moral good; it is not the case that the use to which technology is put is the only moral question. Rather, technology is always imbued with morality precisely because it is aimed at solving problems, which detract from goods or from the good life. In addition, the idea that tools are merely neutral and we need just to use them to do good or to prevent ill permits a weird sort of passive stance, one that acknowledges intentionality in human action, but diminishes the role of intentionality in human perception. Certainly, we use diagnostic technology to perceive problems; that much is clear. Even the technology used to solve problems comes to shape what we imagine as a problem to be solved. The old adage, if all you have is a hammer, everything looks like a nail, is to some degree true. The tool we have to solve a problem comes to be the imagined solution to multiple different problems. Thus, technology comes to shape how and what we see, and what we imagine problems to be. Taking these three points together—(1) that Christian bioethics is not merely the application of Christian thought to a medical reality; (2) that technology is not merely a neutral tool to be deployed, the morality of which is added in by intentions of the Christian actor or the actor’s pet moral theory; and (3) that technology shapes the moral imaginary—we must reimagine what it is that Christian bioethics is. What is clear is that medicine has become virtually inseparable from medical technology, and if medical technology is not itself neutral and if it shapes what we perceive or imagine as a problem, then we need to rethink Christian ethics and Christian bioethics as much more than a simple application of a moral system onto reality. In what follows, I argue that medical technology is not morally neutral, awaiting the intentions of actors to put it to good or ill use based on a Christian moral system. Rather, drawing on the work of two philosophers—Bernard Stiegler and Peter-Paul Verbeek—I argue that technology is always already moral in its very existence, and that it comes to shape the moral imaginary—the shared imagined moral life-world of a group of people. Technological society builds morality into technology. However, technology is not merely a tool of intervention. I also argue that it contributes to our perception. Thus, following Heidegger, Stiegler, and Verbeek, technology permits and enables the world to appear to us; it shapes how we perceive reality and thus what we perceive reality to be. In fact, it constricts what appears for us, including the moral valence of what appears for us in the deployment of technology. Technology participates in creating a worldview, participating not only in creating our actions, but also in our perceiving and imagining possible worlds. Moreover, I argue that technology with its techniques and tools has its own liturgical structure, and that it thus presents an alternative way of life, an alternative way of perceiving and taking up with reality. I then conclude with the claim that Christian liturgy presents an alternative way of life that shapes what we imagine to be good and that shapes our desires; Christian liturgy shapes our moral subjectivity, what we perceive as morally relevant, and what we imagine possible solutions to be. Divine liturgy is world-forming; it is the font of our way of life. Christian liturgy helps us to see differently; it allows us to see an alternative world than the one that comes into relief when we look through the medical technological lens. II. TECHNICS AND THE NONAGENTIAL BECOMING OF TECHNOLOGY Let me begin with a couple of examples that suggest that technology is not merely a set of tools awaiting a moral calculus to tell us whether and how to deploy that technology. First, however, let me define a few terms. In the common usage, the term “technology” typically means the machines that we use to achieve our ends. We often think of it in terms of a product of scientific investigation. However, I employ the term technics in this article to refer to a much broader if interrelated set of machines, practices, and policies that attempt to produce certain kinds of outcomes. Technics then refers to technologies, techniques, and tools. Technics need not be large machines but can be small technical enterprises, even bureaucracies aimed to bring about certain kinds of outcomes. Now, I give two examples of small technical enterprises where there is a symbiosis between human activity and technological evolution and usage. These two serve to show that technics already has a moral valence that is not fully under human control. The first example illustrates technology’s relationship with innovation, economics, and law, as well as with the habits that it instills in those using technology. The second example illustrates the relationship between innovation, the creation of a new market, and the formation of desires of a society. E. Haavi Morreim published a book in 2001, Holding Health Care Accountable (Morreim, 2001). Morreim’s book mostly focuses on tort law and how, with the rise of technology, physicians (at first) did not embrace the novel technologies because they believed them to be of marginal benefit in relation to the risk or cost of using the technology. However, when bad outcomes arose—as they often do in patients needing advanced technology—patients began to sue doctors. When the courts found out that there was a novel technology that might have led to an earlier diagnosis, or might have led to a better therapy, doctors began to lose those lawsuits. These doctors were found to be at fault for not having used the novel technology. Of course, these rulings against doctors resulted in increased demand for more novel technology, which then led to an increased demand that the technology be used in order to avoid lawsuits. Thus, an imperative arose with the force of tort law behind it, prompting deployment of more technology. No one knew if the novel tools were actually better than the usual diagnostic or therapeutic interventions, but because the innovative technology was there, it demanded usage, and the legal and economic system supported that usage, even when physicians did not think the use of the novel technology was medically warranted. Take as another example the novel use of sildenafil, which was designed for the purposes of treating pulmonary hypertension in neonates. One of the unintended effects of sildenafil is that it causes erections in those who take it. This unintended tendency of a novel technology then becomes marketed as a treatment for what was—at the time of the development of sildenafil—called impotence. However, with this novel drug, marketers realized that it could have uses beyond those intended by the manufacturers. The marketers who realized the drug could be marketed for other uses were merely responding to a youth-minded, sex-crazed society that does not imagine that it would grow old or be denied any pleasures of the body. The developers of novel technologies note that they are merely responding to market forces and the desires of the populace. Nevertheless, the public never asked for, or knew it could ask for, a drug that might make the impotent potent once again. So, where does human agency sit? There can be little doubt that human agency participates in the technological system, but the directionality of that agency is not entirely that which we have always imagined: from human desire to human intention to problem-solving to technological solution. It sometimes flows from technological innovation to retroactive problem-creating, such that a problem can be found for which the technological innovation can be put into service. Bernard Stiegler offers a nice theoretical way of thinking about the way in which technics—technologies, techniques, and tools—has a kind of intentionality; he calls them tendencies. Human beings do not have direct control over the tendencies of technics. Next, I unpack Stiegler in some detail because he will help me to make my case. Stiegler is a French philosopher of technology. His work sits in the Derridean strand of French phenomenology and his book, Technics and Time, Volume 1, attempts to argue that human beings have always coevolved with technology. The work is also a critical engagement with Martin Heidegger’s Being and Time, where Heidegger in part suggests that the being of Dasein—Heidegger’s novel word for human being—is inherited from a history not of its own making and is projected into an unknown future, culminating in its own death. It is by making one’s phenomenological time real and active in the present moment that one lives authentically. Stiegler argues that human beings only have access via technics to that historical inheritance, which includes techniques for knowledge production. Technics serve as memory supports for that history. Thus, this technical inheritance participates in the constitution of the being of Dasein. Moreover, because of the drive of permanent innovation in contemporary technics, Dasein will never have time to catch up culturally. With modern technics, there is no end of time when technics is permanent innovation. Thus, living authentically creates a kind of alienation and disorientation. The problem is that there is no time for culture to catch up with technics. Technics outruns ethnics, the latter of which designates the social and cultural form of being, as Stiegler puts it (Stiegler, 1998, 25). Technics is constitutive of the temporal horizon of modern human being. In short, the technical, inorganic, and organized beings of technology contain their own tendencies, their own dynamics that operate at some distance from human agency, and to some extent participate in the creation of a life-world or a worldview for the culture; human beings are to some degree products of that temporal horizon. Increasingly, with modern technics, we participate less in the imaginative engagement in the temporal horizon. In modern technics, Stiegler claims, human evolution cannot keep up with technical evolution. Stiegler draws on the work of the French historian of technology, Bertrand Gille (1986), in order to show the way in which technology seems to evolve almost independently of human agency. A cursory intuitive example may shed light on this idea. There is a way in which the machines of an assembly line operate autonomously to build things, and the human being is on call to intervene only if there is a problem with the running of the machine. So rather than the machine being at the service of the human being, the human being is now in service to the machine. Stiegler, through the work of Gille, sees this same phenomenon at work on a much grander scale. For example, each assembly line has a whole host of other technical supports that must be in place. The machines used to build cars, for example, will have other machines that build the car-building machines. The whole apparatus of the machines used to build machines has a whole host of supporting systems—scientific systems certainly, but also political, legal, and economic systems—that must be in place to support the work of the machines building the machines. Gille shows how technical systems are dependent on other systems, including political, social, scientific, and economic systems, each serving as symbiotic supports for the technical system. There is an intricate interrelatedness of the various systems, as can be seen when the technical system is blocked (Gille, 1986, 380–439), when, for example, one country’s technology seems to stall. Stiegler describes the way in which tariffs on English iron resulted in limits on the French engineering efforts, stalling France’s ability to create better and more sturdy rails that could support larger and more powerful train engines (Stiegler, 1998, 29–33). Drawing on Gille, Stiegler notes that for technological progress to be maintained, there have to be certain economic and political arrangements within a country and between countries that are in commerce (Stiegler, 1998, 31–32; Gille, 1986, 49–66). Invention leads to innovation on the back of scientific progress. Invention and innovation result in economic growth. Economic growth leads to more investment and thus more technological progress (Gille, 1986, 60). Thus, countries interested in economic growth work carefully to keep stability of the political, economic, and trade arrangements in order to keep the technical system stable (Stiegler, 1998, 37–39). Human activity in economics and politics seems to be dictated by the activity of technics. The result then is a technical system that, through a process of trial and error, eventually equilibrates into a stable platform for which the technical system as a whole operates in a particular locale. Stiegler drawing on Gille claims that “A technical system constitutes a temporal unity. It is a stabilization of technical evolution around a point of equilibrium concretized by a particular technology” (Stiegler, 1998, 31). Stiegler’s point is that much like an organism’s evolution, technology evolves. Innovation, like a novel mutation, permits the technology to evolve and change, in relation to its environment. Eventually, an equilibrium is reached, where the technology is able to sustain itself for its tasks, as long as that task is useful and supported by other systems, including economic, political, and scientific systems. If the economic, political, or scientific systems change, the technical system becomes destabilized, and the technical system will produce different technologies in response.1 While Stiegler goes on to make a much larger claim about how technics shapes the very being of human beings, several conclusions pertinent to medicine and biotechnology emerge for the Christian bioethicist. On Stiegler’s account, technology evolves on its own, especially in the late modern West, where all the scientific and technological knowledge in the world cannot possibly be held in the mind of a single individual, and where certain machine forms of intelligence and decision-making are almost autonomous. While I am not willing to go as far as Stiegler in relativizing human agency, there seems to be a great deal of truth here. After all, technology still needs human agency, even if it is on call to support technological failures. Technology succeeds based on the desires of people to have it and to use it. However, it seems also to be true that human desires to have technology and to use it are, in part, shaped by the presence of technology to begin with. After all, technology has its own tendencies, moving into arenas that designers had not even imagined possible, as the example of sildenafil shows.2 Still, it seems obvious that the tendencies of technological innovation are not fully driven by human agency, especially in the late modern period, where technology seems to have outpaced the human being, especially with the development of artificial intelligence (AI). Technology has its own tendencies, and with the support of other systems tends to move in a certain direction, toward which no single human agent is fully in control. The two above examples—tort law’s development in light of technology and the development of sildenafil—show the way that the scientific system, combined with the legal and the economic system, come to shape both the practices of practitioners as well as the desires of consumers. I show how, for our purposes in Christian bioethics, this becomes important, but first, I must turn to the work of Peter-Paul Verbeek and his idea of moralizing technology. III. BUILDING MORALITY INTO OUR TECHNICS It is worthwhile to give a couple of examples in medicine, where there seems to be a reciprocal relationship between technics in medicine on the one hand and the creation of moral perception and moral subjectivity on the other. The first example illustrates the way in which the electronic health record (EHR) shapes moral subjectivity by increasing physician awareness of preventative medicine. The second example illustrates how the usage of a novel Quality Improvement instrument shapes the moral subjectivity of clinical ethics practitioners. The EHR is meant to create a single repository of patient information that makes certain that all of a patient’s information is accessible by any physician, at any time, and in any place. If patients have multiple doctors, they should be in better communication with one another. If a patient is traveling and runs into a health problem, the doctors in another city or state will have access to the patient’s information (Bell et al., 2010; Kern et al., 2012; Rand et al., 2014; Manca, 2015). The EHR can alert physicians to preventative measures that should be offered to the patient, given the patient’s age and health status, which also improves quality of care (Bell et al., 2010; Kern et al., 2012). These records alert the physician to think more frequently about preventative care, such that the physician has to decide whether or not to initiate the preventative screening measures. These alerts are like rubrics that must be followed, or, if not followed, a rationale must be given for not following the rubrics. While the EHR has a certain morality—promotion of the good of preventing disease before it becomes a problem—the physician must judge whether or not the preventative measure is for the good of this particular patient whom she is seeing in this moment. Thus, the act of judging the EHR’s intention to prevent disease in part shapes the moral subjectivity of the physician. Thus, the physician’s moral subjectivity is shaped through the standardization, or rather the ritualization, of the EHR. In an essay published in 2010, some colleagues and I examined an empirical study of a new Quality Improvement instrument (which they called their “QI tool”) created by Swiderski et al. (Bishop, Fanning, and Bliton, 2010; Swiderski et al., 2010). Swiderski et al. hoped to define quality clinical ethics consultation and, at the same time, to create a tool that would detect the presence or absence of quality in an ethics consult. To establish the conceptual definition of quality ethics consultation, Swiderski et al. asked a panel of experts to help them to create their definition of quality ethics consultation, but they note that no consensus definition emerged. Even though the panel of experts that Swiderski et al. had convened could not agree on what quality ethics consultation was, they went ahead and created an operationalized definition and created their QI tool.3 As evidence of the “success” of the QI Tool, Swiderski et al. point to how the QI tool began to be used. One of the subjects that used the tool to assess her own consults was a senior ethics consultant that had strenuously objected to the operationalized definition deployed in the instrument. At the exit interview, this senior consultant noted that her practice had changed because the QI tool had reminded her to include certain information in her notes and helped her to better organize her notes. Another senior consultant noted that the tool changed what she had been putting in her consultation notes. A junior consultant in the experiment group began changing his own consultation practice, because he found it provided a checklist of things for him to do. A large group of consultants that participated in Swiderski et al.’s study began to use the tool to create a standardized note that each consultant should place in the patient chart (Swiderski, 2010, 71). Swiderski et al. came to the conclusion that evidence for the usefulness of the tool was that it was used (Bishop, Fanning, and Bliton, 2010, 82). The tool was used to shape the behavior of the consultants, getting them to behave in a way that those who had designed the tool thought they should behave. Peter-Paul Verbeek, in his book Moralizing Technology: Understanding and Designing the Morality of Things, gives us a nice theoretical framework for thinking about the way that technics come to first shape moral subjectivity, and then comes to shape moral perception. Verbeek’s claim goes against the grain of our typical ways of thinking about technology as a neutral tool that can be used for good or ill. The idea of machine neutrality reigns supreme in the typical assessments of technological development. The logic of contemporary technological assessment goes something like this: human beings develop machines to carry out certain tasks; human beings then decide whether to deploy the technology using a utilitarian calculus; if there is a net positive outcome, use the technology, and if not, do not use it. However, Verbeek, following Stiegler, believes that technics are not merely inert beings, but that technics—technologies, techniques, and tools—have their tendencies built into them. Machines are always moralized. However, odd Verbeek’s idea sounds, it makes intuitive sense. After all, we build our machines to bring about imagined goods and we build into them certain tendencies and automaticities. We even build safety rules into the machines—for example, a gun safety—to create limits on the machine’s danger. Verbeek’s way of thinking about technology, while influenced by Stiegler, is much more optimistic about human control over technology, while at the same time holding with Stiegler that human subjectivity is partially created by the uses of technology. Technology certainly shapes the way we act in the world, but it also shapes the way we experience the world (Verbeek, 2011, 1–20). Technology mediates morality both because it shapes our perception, and because it shapes our imagined responses to the problems we face and how we imagine those problems to exist in the world. “Technologies have come to mediate human practices and experience in a myriad of ways” (Verbeek, 2011, 21). The development of the ultrasound permits the fetus to become more person-like to the mother; but it also permits the fetus to become a patient before the doctor’s gaze and the doctor’s interventions; it also shapes the relationship of parents to the unborn child (Verbeek, 2011, 23–27). Prior to the ultrasound, the fetus was imagined in very different ways than after the introduction of this technology. Thus, in changing the way we perceive the fetus, it changes how we imagine the moral status of the fetus, sometimes for the better and sometimes for the worse. With the extension of our perception and imagined ways of intervening, Verbeek claims that technology mediates morality. Moreover, Verbeek states that since we have not been very conscious of the fact that we build morality into our tools, we inadvertently have built bad moralities into some tools. Verbeek gives the example of the way roads were built out of New York City. The overpasses under which the roads traveled were not sufficiently tall enough to permit city buses to travel to the beaches, preventing poor people from being able to go to the beach, while permitting wealthier people with cars to travel to the beaches without trouble (Verbeek, 2011, 43–44). Thus, Verbeek makes the case that we need to be more attuned not only to the way that we shape morality, but also to the way that the machines we have built recursively come to shape our own moral subjectivity; technology shapes us as subjects and how we imagine the morality of the extended perception enabled by technology. Now there is no doubt that human agents act to build machines and that the intentions for building machines act toward the ends for which they are built. These tendencies, to use Stiegler’s term, extend both perception and agency, including moral perception and moral agency. Thus, according to Verbeek, the typical way that we think about the morality of technology is too crude. The idea that technological tools are merely instruments awaiting a human agent to do the utilitarian moral calculus—or to deploy some other moral system—and then to decide whether or not to use a machine is just too simplistic a view. Contrary to Stiegler, Verbeek thinks that human beings are not merely passive. Yet, in congruence with Stiegler, Verbeek thinks that technology has its own moral tendencies and thus, to a small extent, its own agency, as we saw in the EHR. Verbeek argues for a third way, which he calls moral mediation. He concludes that “technological mediation concerns action and perception rather than cognition; and moral mediation is not only about the mediated character of moral ideas but mostly about the technological mediation of actions, and of perceptions and interpretations on the basis of which we make moral decisions” (Verbeek, 2011, 54). Technologies can be morally active in that they help human beings interpret their world and they create a situation for human beings to make choices and to deal with the repercussions of those choices (Verbeek, 2011, 57). Some technologies begin with certain intentions built into them and then end up being used in ways different from their original intended design (sildenafil, for example), because they have tendencies to act beyond their own intended design. Thus, technological intentionality is always a hybrid affair between the intentions of the original designer and the imagined tendencies to which it can be put to use. Once it is out there on its own, that novel technology might be redirected for other sorts of intentions, based on its tendencies. Thus, technology has a modified form of moral agency. The same is true for freedom; it too is a hybrid affair. “On the one hand, technologies help to constitute freedom by providing the material environment in which human existence takes place and takes its form. And on the other hand, technologies can form associations with human beings, which become the places where freedom is to be located” (Verbeek, 2011, 61). For example, gun safety mechanisms are intended to prevent accidental deaths from guns firing without human intention; thus, a form of moral agency built into the gun acts to prevent accidents. Yet, the gun safety mechanisms also circumscribe freedom by making the gun harder to fire, say in a situation where rapid action is warranted—for example, in the case of a soldier. Nevertheless, it also requires the soldier to have a well-formed intention because to turn the safety off requires the actor to decide deliberately, willfully, and freely to fire the weapon. Thus, it is clear that we do, in fact, build our technologies with intended goods; we build rules into the technology that circumscribe how it is that the technologies go about achieving their intended goods. Human agency, intentionality, and freedom accompany the technological mediations. However, it is also clear that the goods intended by the technology, and the rules created to keep the technology within certain boundaries, also come to shape the moral subjectivity of the person. As we have seen, there is something of Verbeek’s technological mediation at work in the EHR, with the morality of prevention built into the technology, which, in turn, shapes the practitioner’s moral vision and moral action. It also shapes moral subjectivity, in that the physician must decide whether to deploy the prevention measures, or whether she should, for good reasons, not deploy them in the case of a particular patient. Verbeek would call this technological tendency a moral mediation. For our purposes, it should be clear that both the EHR and the QI tool were designed and intended to bring about goods—the good of health in the case of the EHR and the good of quality ethics consultation in the case of the QI tool. Also, it should be clear that in part the tools came to shape the moral subjectivity of those practitioners that had to decide about the implementation of prevention. The QI tool most explicitly shaped the moral subjectivity of the consultants, not only junior consultants but also senior consultants. The QI tool shaped the clinical ethics consultants to be more in line with the way Swiderski et al. had imagined their own work. My colleagues and I concluded that, while no consultant imagines him- or herself as fully giving up his or her agency, they nonetheless began to change their own practice in cooperation with the imagined goods of the instrument itself (Bishop, Fanning, and Bliton, 2010, 82–83). Thus, we can say that the EHR had moral elements designed into it—designed elements that then shaped the practitioners’ own moral subjectivity. The same goes for Swiderski et al.’s QI tool. These examples show us what Verbeek has in mind with technological mediation. We design morality into our technologies, techniques, and tools, only to have those technologies, techniques, and tools shape the moral imaginary of the users of those technologies, techniques, and tools. IV. TECHNICS AND LITURGICS Now that I have shown that technics shapes our moral perception, our moral action, and our moral subjectivity by drawing on Stiegler’s and Verbeek’s work in the philosophy of technology, it is clear that the neutrality thesis of technology—the idea that technology is merely neutral, taking on the moral purposes of its users—is false. It should be clear that technology is not just a morally neutral tool. Technologies, techniques, and tools are not merely an efficient mechanism to be used for good or ill, depending on the intentions and utilitarian calculations of those using the tools. In fact, technics to some degree is world-forming in that it shapes how the world is imagined. Whether one accepts the stronger thesis of Stiegler—namely, that human agency is almost completely marginalized in the human-technology co-evolutionary process—or whether one accepts Verbeek’s more moderate thesis—namely, that human actors and technology co-constitute human activity—it is clear that to some degree technologies, techniques, and tools have tendencies informed by the morality of those who design, fund, demand, and create them. Thus, they are not fully under human control. Also, it is clear that technics recursively come to form the moral subjectivity of those that create and deploy them. I find Verbeek more compelling on the small-scale, at the level of a specific tool being deployed; and I find Stiegler convincing on the larger-scale, grand scheme of technological development in relation to globalization and human activity. Human beings build technology with certain intentions, aimed at certain goods and bounded by certain limitations on the activity of the technology. Technology will have tendencies that are not fully under the control of any particular human being, creating possibilities that the designers had not imagined. Technics shape the moral imaginaries of the actors; these technologies, techniques, and tools shape what comes into relief for us and what we imagine as possible through the intervention of the technologies, techniques, and tools. These technological mediations are both standardized or ritualized in the tools, but also are enacted by agents. The agents act through technics and are recursively acted upon in deploying the technologies, techniques, and tools. In other words, the subject does not merely act upon the technological object in order to affect the world, but in deploying the technologies, techniques, and tools, the user’s perceptions, intentions, and moral subjectivity are formed. I refer to these activities as the liturgics of technics. Now I make a distinction between Divine Liturgy and liturgy, where Divine Liturgy is the work of worship done in Christian communities. Divine Liturgy mediates the relationship between the worshipping subject and God, which then conditions the relationship between the worshipping subject and others in and beyond the community, and between the worshipping subject and all of created reality. However, there are other liturgies. In some sense, all liturgies are ersatz liturgies in relation to Divine Liturgy. Thus, when I say the liturgics of technics, I mean the ritualized practices that surround technologies, techniques, and tools. Thus, in a way, there is a liturgical structure to EHRs and to QI instruments, as described above. Practically, it seems obvious that something like the QI tool and the EHR create standardized approaches to ethics consultation and clinical practice, respectively. These standardized approaches become ritualized, technical reminders of what must be done in order to be a “good” clinical ethics consultant or medical practitioner. These rubrics are not unlike the rubrics of ritualized behaviors found in religious ceremonies. Thus, we can see how the rubrics—the techniques—for the deployment of these tools participates in the shaping of the moral subjectivity of the actor. That technics has a kind of liturgics seems to be practically true. Theoretically, I would like to reference two thinkers: Giorgio Agamben and James K. A. Smith. First, Giorgio Agamben, in his work Opus Dei: An Archaeology of Duty (Agamben, 2013), shows how the modern notion of duty emerges out of the Catholic liturgy and specifically out of the West’s theology of Eucharist. Implicit in this larger thesis, there is also a lesser point that Agamben makes: the culture of efficient control emerges out of this same theology of liturgy. Agamben claims that the theory of operativity that accompanies the Catholic theology of the Eucharistic Liturgy elevates the efficacy of the work of the priest, independent of the character and intentions of the actor. The priest, on Agamben’s reading, is merely instrumental.4 He argues that modern notions of duty emerge from late scholastic readings (I would say misreadings) of the figure of the priest whose work is efficacious, despite his own motives and character flaws. Thus, Agamben argues, the Catholic priest becomes the model for the modern ethical subject, whose own moral character and status do not matter so long as he follows the rubrics, the rules established for Eucharistic celebration, that is to say, as long as he follows his duty. In other words, the priest becomes merely an efficient cause of the work of the liturgy.5 Agamben claims that modern duty, where one does one’s duty whether one has moral disagreement with its deployment or not, emerges from this Catholic liturgical theory of operativity.6 Even if Agamben’s archaeology of duty is wrong, there is something true in the idea that the efficiency and effectiveness of the Eucharist can be assured, if one merely follows the rubrics and rules—the procedures and techniques—of the liturgy.7 The same seems to be true for the activity of technology. Goods are built into technology, including the idea that if one follows the rules of technological deployment, one will reap the goods that the designer has in mind, even if the good is not itself achieved. One is not culpable if the good is not achieved, as long as one intends to follow the rubrics for the use of the technology. Thus, we can see how Verbeek’s notion of designing of morality into machines grows out of a particular understanding (even if it is a misunderstanding) of liturgical action.8 Second, James K. A. Smith’s three-volume work on cultural liturgy explores the fact that we are desiring animals, and that our desires are educated through liturgical action. There is a bodily dimension to habit formation, and Smith argues that through various public liturgies, our worldview is molded and shaped; our desires are shaped through the mediation of secular liturgies. Thus, it seems that one could argue that Verbeek’s technological mediation is really a form of liturgical mediation. Smith refers to malls and universities as secular liturgical structures that mold and shape our cultural imaginaries, those shared assumptions that shape what it is possible for a group to think or imagine (Smith, 2009; 2013).9 Malls and stadiums are secular institutions. They seem to be neutral sites of activity; nonetheless, they are formative of the worldviews of people (Smith, 2009, 22). It is sometimes difficult to see how these ubiquitous institutions, activities, and practices that are so central to contemporary culture are liturgical in structure, precisely because they are so ubiquitous. Smith makes an even more bold claim that these secular institutions operate “on a more holistic, affective, embodied anthropology (or theory of the human person) than the Christian church tends to assume” (Smith, 2009, 24).10 Smith draws on the work of Charles Taylor’s Modern Social Imaginaries (Smith, 2003) and A Secular Age (Smith, 2007) for the way that secular liturgies shape the modern moral imaginary. Thus, there are structures and practices, liturgies and techniques that shape the content of what we desire. While liturgies as described by Agamben and Smith do not rise to the level and breadth of Divine Liturgy, these ersatz and secularized liturgies symbolically mediate how we engage with reality, and at the same time as they are enacted, they recursively shape our moral subjectivity. Given Agamben’s and Smith’s insights, it seems that the contemporary understanding of technology as primarily about the efficient control of outcomes emerges from aberrant and implicit secular practices of liturgical action that we find in technics—in technologies, techniques, and tools. It is not a huge leap to imagine that the modern technics of medicine—with its attendant technologies, techniques, and tools—has just such a liturgical structure. Just as Divine Liturgy is supposed to shape the moral perception and intentions of the Christian, secular liturgy does the same. With this liturgical structure in mind, let us revisit some of the technologies and techniques that I reviewed above.11 As noted, the EHR shapes the habits of medical practitioners. The EHR gets the practitioners to engage in a set of habits to enact the good of preventative medicine; it shapes the moral subjectivity of the health care practitioners. The same holds true for the QI tool created by Swiderski et al. As Swiderski et al. note, the QI tool itself changed the behavior of the clinical ethics practitioners. I also noted that with regard to the use of technology itself, there were legal, political, and economic mechanisms that tended to coax physicians into deploying more and more technology, even over against their own judgment that the novel technologies were not better than the older approaches. Moreover, the example of sildenafil shows how technology can even educate not only the habits of practitioners, but also the desires of patients, those toward whom the technology—in this case, the technology of a pill—is aimed. The availability of a treatment creates the desire for the treatment, transforming our understanding of aging as a normal part of the body’s life into an understanding of the body as itself a tool aimed at our own self-gratification. The technological apparatus, with its own liturgical structure, shapes our habits and our desires. I have elsewhere described the way in which a particular technical object—the ventilator—ends up creating policies and technics for decision-making, such as DNR forms, Living Wills, Advance Directives, and even the Physician’s Orders for Life-Sustaining Treatment (POLST) forms (Bishop, 2019). I describe the way in which these technical liturgics shape our way of thinking. Thus, modern technics—technologies, techniques, and tools—also has a liturgics that accompanies it. I now wish to describe briefly the relationship between Christian liturgy and Christian ethics. V. CHRISTIAN LITURGICS, CHRISTIAN ETHICS I began this essay by noting that Christianity is not a moral system. Thus, the tone of this essay will have to change from a scholarly treatise to a phenomenological description. Too often Christian ethicists generally, and Christian bioethicists specifically, seem to think that all that is needed is the application of a Christian moral system—the rational ideas of Christianity—to a novel medical tool, technique, or technology to see if they can be used by a Christian. This way of thinking is beholden to the idea that technics—created by medical science, medical practice, and medical technology—are just neutral instruments awaiting some moral system—an instrumental, rational will—to put the technology, techniques, or tools to work. We find this when Christian thinkers try to deploy the systems or thought of Thomas Aquinas, or John Calvin, or Dietrich Bonhoeffer, without examining the world-forming dimension of the liturgical technics. I have argued thus far that modern-day technics already has a liturgical structure that shapes the moral subjectivity of the actors and the desires of those on whose behalf they act. They already have some notion of good and right built into them. They already shape what we take to be morally important, both in terms of moral perception and moral action. As Smith has noted, secular liturgics often have a robust anthropology at work, one that is “holistic, affective, and embodied” (Smith, 2009, 24). Thus, the modern technics of medicine seems to be natural, neutral, and in need only of a little Christian moral tweaking. After all, the technologies, techniques, and tools already have a partial morality built into their intended ends. They already have some presumed good as their end. They already have their moral rules in place. No intellectual intervention, no theory of action, no systematic theological intervention is strong enough to overcome the tendencies of the modern liturgics of technology. Thus, the typical way of doing Christian bioethics is insufficient to the morality of technics. So, what is the Christian ethicist generally, and the Christian bioethicist specifically, to do? The answer is both simple and difficult at the same time. It is simple in that we must constantly point not to particular thinkers or particular Christian moral systems, but to Divine Liturgy. This activity seems particularly important for the bioethicist, because the entirety of the life of humankind is at stake, not merely its political or economic dimensions. After all, Divine Liturgy is a total-body experience. All the senses are engaged: smell (incense), touch (the kiss of peace, the reverencing of icons), sight (icons, statuary, the smoke of the incense rising), sound (chant and music), and taste (bread and wine; body, and blood). The body changes position in the liturgy and across the seasons, varying according to local custom. From standing to kneeling to bowing to genuflecting to prostrations, the body is placed in subservience to the Divine Other as the supplicant approaches the throne of God. Fasting before receiving the Eucharist, fasting during the fasting periods, and even feasting during the feasting periods, one’s bodily perceptions and bodily will must be conformed to the Divine mind and will. The body must be comported accordingly. The bowing of the head in prayer, touching one’s head to the icon, the bowing of one’s head to receive a priestly blessing, and raising up one’s gaze to the heavens, these actions all create the conditions for the possibility of one’s lowering the intellect to the Divine, of bringing the intellect into alignment with the Divine mind, and in preparing the moral subjectivity of the worshipper, such that she can be of service to the other. It brings perception into alignment with Divine perception, such that we can see the world the way that God does. It brings our intentions of the will to act into alignment with the Divine will as God. It brings the body into alignment with the Divine purpose; that is to say, it establishes moral subjectivity. These liturgical actions are not merely rituals; they are practices and techniques very different from those encountered in the secular liturgics of technics. They are preparing us to see not only the Divine Other, but the neighbor in her otherness. We cannot know what the body is or what it is for, or the meaning of the body, until we learn to perceive all of reality through the lens of Divine Liturgy. Liturgy teaches us that our bodies are not our own but belong to the Holy One, and as possessions of the Holy One, we are called to the care of the poor and the suffering. The practices of Divine Liturgy shape our bodily and our intellectual will; they shape our desires. They help us to imagine the world differently from that of the secular liturgics of technics. Divine Liturgy is world-forming; it is the enactment of a whole life-world, a life-world that stands in stark contrast with those life-worlds of the secular liturgics of technics. In fact, Christian liturgy is even more profoundly formational and countercultural to the modern secular liturgy regnant in the intentions and tendencies of modern technologies, techniques, and tools. The Divine Liturgy itself must become the counterpoint of the modern technological liturgics, but it must also come to create new and different ways of doing medicine. Only Divine Liturgy can withstand the logic of modern technics. Divine Liturgy is the embodied practice of the Church, practices that shape perception, action, and moral subjectivity. Divine Liturgy is the practice of the Church and the formation of our moral imaginary. It tells us how to take up with the world in engagement. It is through the practice of Divine Liturgy that one’s desires are educated and are orientated rightly. Liturgy shapes what we perceive as important in that in entering into the presence of the Divine Other, we learn how to comport ourselves to the other that we meet in the streets. The worshiper is a beggar approaching the throne of God, asking for a few crumbs of the Bread of Heaven. As a beggar, she learns how to see rightly the person she encounters in the street, someone like herself in need of Holy food and drink. Divine Liturgy not only shapes what she perceives but how she acts in the world. She understands that her own prayer in Liturgy is only possible by the repeated call to prayer. “Again, and again, let us pray to the Lord.” In Liturgy, she comes to realize that her act of worship is dependent on prior acts of worship offered by the Church throughout all history, and the Triumphant in the heavenly, eternal worship offered to God. Thus, her action in the world is only possible—indeed it is only possibly her action at all—precisely because she participates not in the intentions of technological design, but in the intention of the Divine will. All of her efforts to act in the world are now offered as acts of Divine worship. It is only once one’s world has been formed in Divine Liturgy that one can rightly judge whether modern technics should be engaged at all. It is only after one has been formed by Divine liturgy that one can see what technological liturgics cannot see. It is only after one’s desires have been rightly formed that one can tell whether the technologies, technics, and tools offered are worthy of deployment. Once one’s perceptions of reality have been shaped by the novel technology, those perceptions must be judged against the normative perceptions anchored in Divine worship. It is only then that one can judge the tendencies built into technologies, techniques, and tools, and whether they fit with the telos and the goods of Divine Liturgy. In this way, the secular liturgics of technics must be placed lower than and in service to Divine Liturgy. In practicing Divine Liturgy, she comes to desire for herself and the whole world, union with the Divine, which orients her every action on behalf of all and for all. The reality revealed in Divine Liturgy comes to shape all other intentions and engagements with creation. Footnotes 1. It is certainly true that the “invisible hand” of the market promotes and enables a lot of technological innovation. However, my analysis should not mean that I am promoting a naïve Marxist/Socialist agenda. After all, as Jacques Ellul points out in his book The Technological Society, Marx did not speak out against technological innovation, which could have resulted in workers losing their jobs. Marx himself knew that technological innovation and the production of capital were necessary. Rather, he thought the distribution of the benefits of technological innovation should be more widely distributed. “Karl Marx rehabilitated technique in the eyes of the workers. He preached that technique can be liberating. Those who exploited it enslaved the workers, but that was the fault of the masters and not technique itself” (Ellul, 1964, 54). 2. Stiegler’s point is much boarder than what I have articulated here. In fact, drawing on the work of André Leroi-Gourhan (1943, 1945, 1993), Stiegler wants to make the claim that human beings have always coevolved with technology. The human animal is small, slow, weak, and hairless; without technology, it would not have survived. In fact, the thumb and the use of tools evolved before the frontal lobes (Stiegler, 1998; Leoi-Gourhan, 1943, 1945, 1993). 3. For the philosophy and practice of social scientific research, see Babbie (2004, 119, 131–2). It should be noted that in the philosophy of social science, the first step is to establish a conceptual definition, followed by establishing an operationalized definition. There are several methodologies that one could use to establish a conceptual definition. Swiderski et al. (2010) used a method that would allow practitioners engaged in the practice to establish the conceptual definition. The second step—the creation of the operational definition—allows for social scientific researchers to find instances of the conceptual definition in the world. The fact that Swiderski et al. failed to establish a consensus definition should have dissuaded them from establishing an operational definition. However, it did not (Bishop, Fanning, and Bliton, 2010). 4. I do not have space to engage Agamben fully. However, it should be noted that in Catholic dogma, the intentions of the actor must be to intend what the Church intends in order for the sacraments to be valid. Thus, the will of the priest at the level of the priest participates in the will of the Church. Thus, Agamben is in part wrong with his assertion about the lack of intentionality on the part of the priest. The priest’s intention must participate in the Church’s intention. 5. On the subject of the metaphysics of efficient causation in medicine, see my work, The Anticipatory Corpse: Medicine, Power, and the Care of the Dying (Bishop, 2011, 20–23; 93–94; 107–108; 166–167). 6. Agamben’s theory of the origins of modern duty seem to be illustrative of the way that contemporary authors arguing against conscientious objection claim that Christian physicians must act by giving an abortifacient, even if their own moral conscience finds it morally abhorrent. In modern duty, moral subjectivity is separated from the action. 7. According to Agamben, the distinction between the immanent and the economic Trinity along with a distinction between a reading of the Epistle to the Hebrews and a reading of the Letter of St. Clement to the Corinthians, and along with the Donatist controversy, all combined together and gave rise to a separation between the work done and the subject doing the work in Liturgical action. It was this separation, he argues, that gave rise to the modern concept of duty. While I have theological quibbles on Agamben’s reading of Divine Liturgy, I still find much that Agamben has to say about the emphasis in Western liturgical theology on the activity of the priest separated from the subjectivity of the priest in effecting the work of liturgy to be an excellent illustration of the rise of instrumental reason and instrumental action, and thus giving birth to modern technological (instrumental) rationality. 8. Agamben points out the separation of the activity of Eucharistic liturgy from the human subject that does the work of liturgy is the beginning of the concept of ethical duty, where the intention of the person acting does not matter, so long as he acts rightly, and independent of any good that may (or may not) come of it. However, it stands to reason that in emphasizing the metaphysics of efficient causation in the theology of the Eucharist, Western thinkers might have ushered in the modern epochē of the enframing, as Heidegger calls it—the epochē of merely instrumental reason and merely instrumental action. 9. See also Smith’s (2017) third volume of the Cultural Liturgies project, Awaiting the King. 10. Smith is a reformed Protestant, philosophy professor at Calvin College in Grand Rapids, Michigan. I think he is certainly correct that it is true that the liturgies of Protestantism generally, and reformed Protestantism, specifically operate on an incomplete anthropology. It is less clear to me that this is true of the fully embodied anthropology of Catholic and Orthodox Christianity. I do not have space to argue this point. 11. 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TI - Technics and Liturgics
JF - Christian Bioethics
DO - 10.1093/cb/cbz016
DA - 2020-02-27
UR - https://www.deepdyve.com/lp/oxford-university-press/technics-and-liturgics-kb1s9iuUN0
SP - 12
VL - 26
IS - 1
DP - DeepDyve
ER -