Materialized Oppression in Medical Tools and Technologies

Abstract

It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems.

Keywords:

• Philosophy
• race and culture/ethnicity
• gender/sexuality
• biotechnology
• health policy
• regulatory issues

This article is referred to by:

Racism-Conscious Praxis: A Framework to Materialize Anti-Oppression in Medicine, Public Health, and Health Policy

Historicizing Technological Hegemony

Medicalized Oppression: Labels of “Violence Risk” in the Electronic Medical Record

Systems, Wrongs, and Moral Aggregation

Materialized Oppression in Inpatient Psychiatric Unit Design

How Medical Technologies Materialize Oppression

Preventing Bias in Medical Devices: Identifying Morally Significant Differences

On Racist Tools and the Bioethics Lexicon

How Materialized Oppression Contributes to Bioethics

ACKNOWLEDGMENTS

Both authors contributed equally, from conception to revision. For generous and helpful feedback on an early draft, we thank: Stephen M. Campbell, Elizabeth Lanphier, Eduardo Martinez, and Angela Sun. We are also grateful for the feedback provided by audience members of talks at the University of Michigan and Erasmus Medical Center and by this journal’s anonymous referees.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

FUNDING

The author(s) reported there is no funding associated with the work featured in this article.

Notes

1 Indeed, the racial bias built into pulse oximeters should not be that surprising, because it mirrors the biases found in other light-based devices outside of medicine, notably in photography (Dyer 1997; Roth 2009). Although it is becoming more widely known that some smartphones and digital cameras do a poor job photographing darker skin tones, it is less well known that even prior to digital photography, the chemical film emulsions and printing technologies used in still photography and in movie-making were systematically less good at depicting darker skin tones due to the usage of white reference models in the calibration processes. Both photography and light-based fingertip oximeters are examples where skin tone biases are encoded in technologies, and both can be traced to calibration decisions using whiteness as a norm. We think it is important to emphasize that oximetry manifests the same bias as many other light-based devices from everyday life that employ technically distinct underlying technologies—not only analog and digital cameras, but also automatic soap dispensers and night vision cameras—because it shows that the bias built into pulse oximeters is not intrinsic to the specific technology, but contingently congruent with oppression.

2 Whether there is anything biological about racial categories used in medicine is complicated and contested (Maglo 2010, 2011; Valles 2017). Part of this complexity is the distinction between the non-essentialized claim that race has biological reality with the essentialized claim that race has genetic reality. Racial discrimination can cause physiological changes in the body, and so the social reality of race can create biological reality of race without genetic reality—and even independent of socioeconomic status (Kaplan 2010; Roberts 2011). Our claim is that efforts to infer essentialized biological differences, such as genetic differences, from group differences in spirometry were unjustified.

3 Many of Hutchison’s examples of moral aggregation problems draw from the broader collective action problems literature, such as tragedy of the commons. There are two important differences between these two concepts as we understand them. First, moral aggregation problems are explicitly concerned with morality, while collective action problems are, at their core, concerned with decision and cooperation. Second, while moral aggregation problems share with collective action problems features of expediency and invisibility, they also explicitly include structural factors beyond agent preferences.