1. • Biomedicine and Technocratic Power
• Journal article by Joanne L. Finkelstein; The Hastings Center Report, Vol. 20, 1990
Biomedicine and Technocratic
Power.
by Joanne L. Finkelstein
Current developments in biomedicine promise a genetically engineered and better future.(1)
A "genetic future" would mean incorporating more high technology medicine into the habits
of everyday life. The order of the body, that is, the sense of how we should look, act, and
perform, would become the domain of conventional medicine, and we would look to medicine
to intervene in human performance, ability, and even character when we thought these were
less than they should be. Our willingness to accept medicine in this capacity would require
the deeper conviction that technological developments and scientific discoveries are proper
measures of human progress.(2)
Such attitudes are not remote from contemporary values. We live in an era in which many
personal and social problems are treated as if they were matters capable of technical
solution-the interventionist response to infertility through in vitro fertilization is an example.
Such a belief system conceals from us the probability that advanced technology will not
successfully solve the complex social problems we think it should. Moreover it grants to
advanced technology, and those who own and control it, a high social value. Indeed, so
highly valued is technical knowledge that it can supersede moral considerations and
argument in providing a base upon which therapeutic and research decisions are taken. For
example, the widespread use of amniocentesis and chorionic villus sampling, which foretell
the sex, health, parentage, and future diseases of the fetus, has the immediate appeal of
decreasing the numbers of damaged and defective newborns by indicating the "need" to
terminate a pregnancy but, simultaneously, the same technology has the latent function of
determining which human lives are more valuable, or in utilitarian terms, which individuals
are potential welfare burdens to the community in the long term.
Measuring the future capacities of a fetus is a form of human accounting that estimates the
individual's future costs or contribution to the society. As early diagnostic and screening
procedures become technically commonplace, a classification of human traits deemed
suitable for remediation is simultaneously coming into effect. In the future, as more of our
genetic abilities and characteristics are foretold by technically sophisticated probes, we would
look to medicine to intervene to ensure that our physical appearance and capacities are in
accord with current standards of normalcy.(3) In these circumstances, the practices of
biomedicine have the latent function of social engineering.
Michel Foucault has argued that this is characteristic of medicine in the West, whose
development is coterminus with an account of how social power is accumulated by an elite
profession through its increasingly esoteric technical base.(4) The rapid increase in the
medicalization of various human conditions has served to promulgate the view that medicine
can perfect human life. Many of the current well publicized developments in medicine such as
genetic testing, transgenic engineering, organ transplants, and so on, promise a perfected
human in a future bio-utopia where debilitating diseases and degeneration have been
effectively eliminated.(5) In such a future, our dependence on medicine to specify and
regulate how we should live and behave has the effect of indenturing us to the professional
ambitions of medicine. The point must be emphasized that medicine has not been greatly
successful in raising the standards of health across the community. On the contrary, history