‘My Fitbit Thinks I Can Do Better!’ Do Health Promoting Wearable Technologies Support Personal Autonomy?

Abstract

This paper critically examines the extent to which health promoting wearable technologies can provide people with greater autonomy over their health. These devices are frequently presented as a means of expanding the possibilities people have for making healthier decisions and living healthier lives. We accept that by collecting, monitoring, analysing and displaying biomedical data, and by helping to underpin motivation, wearable technologies can support autonomy over health. However, we argue that their contribution in this regard is limited and that-even with respect to their 'autonomy enhancing' potential-these devices may deliver costs as well as benefits. We proceed by rehearsing the distinction that can be drawn between procedural autonomy (which refers to processes of psychological deliberation) and substantiverelational autonomy (which refers to the opportunities people have for exercising potential actions). While the information provided by wearable technologies may support deliberation and decision-making, in isolation these technologies do little to provide substantive opportunities to act and achieve better health. As a consequence, wearable technologies risk generating burdens of anxiety and stigma for their users and reproducing existing health inequalities. We then reexamine the extent to which wearable technologies actually support autonomous deliberation. We argue that wearable technologies that subject their users to biomedical and consumerist epistemologies, norms and values also risk undermining processes of genuinely autonomous deliberation.

The Limits of Empowerment: How to Reframe the Role of mHealth Tools in the Healthcare Ecosystem

“…They are used by people embedded in larger social structures (Visser et al 2016) that can considerably hinder or enhance their ability (McAuliff et al 2014) to meet the established standards. This supports Owens and Cribb's (2017) assertion that there is reason to be highly sceptical about the claims that mHealth tools offer people genuine opportunities to improve their health. Instead, they could exacerbate existing health inequalities, by creating a scenario in which backwardlooking responsibility (blame) is placed on 'bad users' for whom it would have been almost impossible to achieve the defined standards of health in the first place.…”

“…The 'Empower the Person' strategy and associated policies seem to be predicated on the assumption that, as long as people are able to look at their data self through an mHealth tool, they will be able to make a rational and reasoned decision about what to do next. This is based on a rather narrow definition of autonomy, known as procedural autonomy, and it puts all the attention on the decision rather than the action that follows the decision (Owens and Cribb 2017). In reality, for mHealth tools to be 'empowering' they have to result in some form of behaviour modification intended to improve the self (Catlaw and Sandberg 2018).…”

“…In reality, for mHealth tools to be 'empowering' they have to result in some form of behaviour modification intended to improve the self (Catlaw and Sandberg 2018). This puts the emphasis on the broader relational autonomy, which centres on action rather than decision 13 (Owens and Cribb 2017). Accounts of relational autonomy recognise that acting is more complicated than deciding (Owens and Cribb 2017), not least because it takes place within the 'health habitus', where the types of online health information that people interact with, the ways that they interpret it, and the options that they have to act on it (Lewis 2006) (Mittelstadt et al 2014) are all constrained by a variety of socio-economic factors that affect some groups more than others (de Freitas and Martin 2015).…”

“…Both Michel Foucault and Gilles Deleuze talk about how power and surveillance influence modulation but it is Deleuze's theory that applies here as he argued that in control societies, modulations happen in opaque networks that are invisible to individual citizens by making surveillance forces less overt and physical, and more abstract and numerical(Galic et al 2017). Thus, individuals become subject to a regime of numbers where the health of their digital self is constantly shifting depending on hours slept, steps taken, calories consumed etc (Owens and Cribb 2017)…”

“…. Furthermore, as the devices that generate these data that control the constant modulation of the digital self, are normally held on the individual's person, this can be seen as surveillance that colonises the user's lifeworld as defined by Jürgen Habermas(Owens and Cribb 2017).…”