Posthuman Pedagogy
Background
This week I attended the annual Cardiology Symposium where presentations were made on the developments and aspirations for the management of a variety of cardiac conditions. Without harping on too much about the medical I will try to provide some background to my pedagogy.
I have a particular interest in the management of patients that survive a sudden cardiac death. These are seemingly fit and well individuals who, without warning, suffer a cardiac arrest. The group that I see are the fortunate one’s who happened to be in the right place at the right time and therefore received CPR, defibrillation (shock) and immediate hospital treatment. Among a variety of tests to attempt to diagnosis a predisposition/explanation for this event they usually receive an implantable defibrillator (battery box attached to wires into the heart that provides a shock) should the event happen again.
What I learnt at the symposium is that these development of the devices for heart failure patients is going in the direction of a a device that resembles a rod, that sits in the heart and has capacity to wirelessly transmit data (such as heart rhythm and function) to a system that enables the physician to monitor the patients and remotely alter the function of the device to increase functioning of the heart.
This reduces the need for hospital appointments to interrogate the device for rhythm abnormalities or device malfunctions. I can foresee the future developments of this smaller device having defibrillation capability. This is exciting stuff in my world!
The adaption of the heart; with the heart being the symbolic essence of human life has made me question whether fabrication between “hybrid of machine and organism” (Haraway, 2001) has made the patient a cyborg.
The ability for the physician to learn about the heart function from the device is a post human pedagogy in itself but I would like to take this concept a step further…
My Pedagogy
A major concern I have with this patient group is the psychological trauma experienced by these patients and how to educate them about the condition. The technological advances of the device will inevitably result in less human contact between patient and physician…leaving a void in the psychological and educational support these patient require. I am neither an inventor nor a programmer but with knowledge in this field can see a future that uses a programme to assist in a patient’s recovery, adjustment and future with a cardiac device. I propose the development of a system resembling (if not exactly like) an app that provides an educational programme incorporating a programme of cognitive behavioural therapy (recommended in European guidelines for this patient group), access to peer support forums that are mediated by professionals and integration of the wireless data transmitted from the device to make support and treatment plans individualised to the patient. I envisage it being accessible via mobile phones, tablets and computers and will incorporate the most up-to-date multimedia that will appeal to the age ranges targeted.
This pedagogy resembles an amalgamation of; an online (bank-like) account, virtual community/networking sites and educational support systems such as WebCT but enters unchartered territory in terms of existing within a health care system – an environment that does not have an ‘undo’ or ‘erase’ feature should something go wrong. In discussing this with peers and colleagues I have had mix reviews as to whether this is progress or merely making the best out of a bad situation. It is commonly believed that ideally, these patients would have access to structured in-hospital support and educational programmes. To that I argue that making a person attend regular hospital appointments is costly to both them and the facility. As the devices are technologically becoming posthuman so too must the pedagogy used to integrate and support them.
November 28th, 2011 at 10:56 am
This sort of think makes me queasy, but I think you have a great idea about providing support resources and education to assist people in using such devices and handling the psychological aspects of being dependent on such a device.
November 28th, 2011 at 2:52 pm
This is great stuff Steph, and I really like the way you are playing with the relationship between body, implant and device here – really clever. I think you would like Annemarie Mol’s work on technology and medicine and her actor-network theory influenced ways of viewing them. If you had time to get hold of ‘The body multiple: ontology in medical practice’ (2002) I think you would get something from it.
Great pedagogy anyway – thanks!
November 28th, 2011 at 3:41 pm
This is a fascinating technology Steph, and one that definitely questions the boundaries of the individual. It seems that, in allowing ‘the physician to monitor the patients and remotely alter the function of the device to increase functioning of the heart’, control of the body (previously allocated to the individuals brain stem?) is being ‘outsourced’ to a system that includes the device, and the frontal lobe of a brain in another human body…
Your example also seems to emphasise the informational aspects of posthumanism, where the body-as-information is integrated into the programme of education. I like how the ‘course’ information changes in response to the corporeal data…who says knowledge can be disembodied?
November 28th, 2011 at 5:50 pm
Interesting stuff Steph. It would be very reassuring for the person to know that their doctor is able to remotely monitor the device and make any alterations s(h)e sees fit. I know I’d find it comforting. Great idea about the apps and after-care treatment too. Do you think though that these technologies are accessible to all?
I think there are probably a lot of ‘cyborgs’ around – may be the word needs redefined.
I think my daughter would find your blog interesting so I’m going to post her the link. She’s training to be a consultant anaesthetist.
December 7th, 2011 at 9:30 pm
Very interesting. I’d like to play devil’s advocate for a moment and ask about the fail-safes built into the system. If a physician can log in and “remotely alter the function of the device to increase functioning of the heart,” couldn’t they also do nefarious damage to it? Can the system be hacked?
Is it difficult to imagine the maintenance of all of the patients becoming a burden on the physician’s time, therefore the task is outsourced to a (perhaps) less educated technician who simply looks for patterns. Once this happens, why not use a computer program to do it, since computers are more efficient at monitoring patterns? But then, what if the computer decides your particular pattern doesn’t match, and therefore tries to correct it through (unneeded) defibrillations?
If the patient has less and less contact with the physician, and starts relying on the technology through an app, are we putting too much faith in the machine? Cost cutting aside, are you ready to turn over remote control of your heart to someone else, without structured support?
December 12th, 2011 at 12:06 am
Thank you all for your comments. They have certainly helped develop my understanding and spurred on some critical thinking that I hope to carry over into the assignment.
Firstly, Sian – great book recommendation! It is even written in a way that complements the way in which I think…or at least the way I think, that I think.
Kevin – your comments are very welcome and spot on. They are very really concerns that I have been grappling with when exploring this topic. Such concerns occur with increasing frequency as we encounter posthumanism powering into healthcare. However, in a similar fashion as the laser may be used to create utopia or dystopia (referenced in my block 1 posts re: Robert Winston ‘Bads Idea’s’) potential opportunities to improve patient care should not missed by fear of ‘what if’s’ but instead a beneficent approach need be adopted. One point to answer ‘what if the computer decides the patterns don’t match…tries to correct through (unneeded) defibrillations’ is that, this is already occurring. Though not a computer as some devices can malfunction or be set over/under sensitive thus delivering an inappropriate impulse. Many occasional occurrences are rarely catastrophic (sometimes a completely asymptomatic event). The wireless technology enables the physician to be aware of these ‘warnings’ and adjust the settings before a catastrophic event occurs. Perhaps the ‘fail-safe’ within my pedagogy is that the physician (as human) retains ultimate responsibility for the patients’ wellbeing and can choose to ‘revert’ to human interaction if deemed necessary…expediting a f2f meeting early than a routine appointment if the reprogramming is complex and high risk. Utilising the posthuman facilitates monitoring and potential treatment to be delivered over and above what is achievable by human means alone. You raised an interesting concern regarding hackability. This certainly could be catastrophic in terms of patient safety but also in terms of leaking confidential patient data that has an effect on a patient’s social, professional and financial wellbeing. The technical prowess required to address this is far beyond my capabilities. However, I do appreciate that this needs significant consideration and action to prevent such an event…perhaps regarded as a post-posthuman action.