Conference Agenda

Telemedicine and telehealth are positioned as intimate technologies in the sense that they introduce a geographical renewal of care. Indeed, information and communication technologies enable the provision of remote health services, creating a new spatialization of healthcare. This involves new relationships of proximity and, consequently, a potential destabilization of intimacy. The spatial units associated with healthcare are thus reconfigured: the relationship to oneself and one’s body, the medical relationship, care spaces, and the healthcare system as a whole, now ordered according to a new “geography of responsibilities” (Akrich, 2010).

Despite the significant respatializations facilitated by technology—which should be ethically framed to maximize conditions for intimacy—we contend that a prevailing assumption endures: the notion of the “despatialization of care” (Mitchell, 1995). This concept, promoted within the health innovation literature, supports the idea of “placeless care” (Oldenhof et al, 2016; Ivanova, 2020), which is conceived as the capacity to overcome spatial limitations.

The arguments presented in this proposal comprise two main components: first, we assert that spatiality is a crucial and enduring component of care; second, we contend that where care takes place is fundamental to the ethical success of technologies. To demonstrate this, we will examine teleconsultation booths—spaces equipped with connected tools (e.g., thermometer, blood pressure monitor, stethoscope, and scales) that enable medical consultations between patients and healthcare professionals —. These booths materially embody the promise (Joly, 2015) of placeless care: the geographical distance between the patient and healthcare provider is effectively eliminated, implying that spatial considerations in care are no longer relevant.

Nevertheless, we argue that the spatialization of care remains a critical issue, sparking significant debate. For instance, is it ethically acceptable to place such booths in supermarkets? Could this practice contravene the public health code, which stipulates that “medicine must not be practiced as a trade” (Ordre des Médecins, 2021)? What locations and environmental conditions are necessary to ensure a high-quality teleconsultation?

In summary, the main question guiding our study is to define, through the lens of teleconsultation, what constitutes an ethical space for remote care. While the French National Authority for Health, for example, has provided recommendations regarding lighting, calmness, and booth isolation (HAS, 2024), their lack of legal enforceability allows for the emergence of heterogeneous and potentially problematic practices.

In conclusion, it is essential to address the ethical regulation of the spatialization of remote care to ensure that these emerging medical practices adhere to a framework that upholds patient dignity, intimacy, and the core principles of medical ethics.

As our relationship with technology becomes increasingly intimate, we become increasingly vulnerable to its effects. Simultaneously, a growing moral distance separates those who develop and deploy the technology from those affected by it. The development of intimate technologies like recommender systems, brain-machine interfaces, and therapy chatbots often involve the diffuse contributions of hundreds of people. This vast scale not only renders these individuals systemically invulnerable to the users’ indignation—due their lack of proximity—but also prevents them from standing in the right relation to the harms their technology may proliferate, given their diffuse nature of their contributions. Consequently, the users’ vulnerability is neither mutual nor reciprocal; it stems from a dynamic of systemic invulnerability on the part of the developers. This asymmetric relationship of vulnerability creates what Vallor and Vierkant (2024) term a 'vulnerability gap' between the creators of these technologies and their users. In this paper, I apply the concept of vulnerability gaps to the intimate technological revolution. I identify that as intimate technologies mature, the sociotechnical system that gives rise to them simultaneously breaks down the moral practices that enable more redress between their developers and users.

First, I develop an account of how intimate and often invasive technology makes us materially and emotionally vulnerable to them, arguing that our increasing dependence on these systems creates unprecedented forms of exposure to harm.

Second, drawing on Weber (1978) and Arendt's (2007; 2016; 2022) analysis of bureaucratic rationalisation, as well as instrumentalist accounts of moral responsibility from McGeer (2015) and Vargas (2013), I demonstrate how technological intimacy emerges through processes that reducing aspects of human life to technical-logistical problems. These processes dehumanise users and distance developers from moral redress through institutional structures, responsibility diffusion, and recourse to economic incentives.

Third, I show how this combination—increasing technological intimacy and decreasing moral feedback—creates a particularly dangerous moment in technological development and in the sustainability of our moral ecology. This erosion of traditional moral practices occurs precisely as these technologies gain unprecedented access to and influence over lives.

I conclude by examining how we might preserve and extend spaces for moral engagement within technological development. Drawing on analyses of bureaucratic rationalisation, I propose specific practices and institutional arrangements that could enable developers to encounter the human implications of their work directly, rather than solely through technical metrics. This includes maintaining existing channels of moral feedback where they function well, while creating new opportunities for affected users to meaningfully shape development processes. These proposals aim to balance the technical rationality necessary for development with spaces where genuine moral engagement and judgment can occur, allowing our moral practices to evolve alongside our technological capabilities.

References

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Arendt, H. (2016). On Violence. In: Blaug, R. and Schwarzmantel, J. (Eds). Democracy: A Reader. Columbia University Press. pp.566–574. [Online]. Available at: doi:10.7312/blau17412-117 [Accessed 14 January 2025].

Arendt, H. (2022). Eichmann in Jerusalem: a report on the banality of evil, Modern classics. London: Penguin Books.

McGeer, V. (2015). Building a better theory of responsibility. Philosophical Studies, 172 (10), pp.2635–2649. [Online]. Available at: doi:10.1007/s11098-015-0478-1.

Vallor, S. and Vierkant, T. (2024). Find the Gap: AI, Responsible Agency and Vulnerability. Minds and Machines, 34 (3), p.20. [Online]. Available at: doi:10.1007/s11023-024-09674-0.

Vargas, M. (2013). Building Better Beings: A Theory of Moral Responsibility. OUP Oxford.

Weber, M. (1978). Economy and Society: An Outline of Interpretive Sociology. Univ of California Press.