Bioethics Forum Essay
Continuous Health Monitoring: Greater Self-Knowledge or TMI?
For millions of health-conscious Americans, digital technology has been a boon, providing increasingly sophisticated fitness trackers that measure steps, heart rate, and calories burned. They are every dieter’s dream (or nightmare), delivering honest appraisals of behavior and activity. Researchers speak excitedly about a new frontier of “continuous health monitoring,” with the potential to detect diseases and aliments, perhaps even cancer, in their incipient stages, and understand our bodies in unprecedented fashion and intimacy. It also raises a host of disturbing questions about health surveillance. Will these devices really empower us? Will they compromise us as autonomous individuals? Will they simply drive us mad?
The pandemic has hastened the development of health monitoring devices. The Oura Ring can detect slight variations in body temperature and, therefore, might reveal early Covid symptoms and catch incipient outbreaks. This potential persuaded the National Basketball Association to outfit each of its players with an Oura Ring. The U.S. Olympic surfing team is also using the device. Unsurprisingly, all this star attention means that Oura sales are booming.
Health surveillance is increasingly stylish. The Oura ring is available in titanium or gold or encrusted in diamonds, and it is popular with celebrities. The sleek Air Pods can monitor your blood oxygen levels. New patents from Apple point to next-generation Air Pods having EKG (electrocardiogram) and ICG (impedance cardiogram) capabilities, the first line of defense against heart failure. The Apple Watch already sports an EKG feature, a heart rate monitor, and fall detection. It can measure your rate of respiration and alert you to sleep apnea. Soon the Apple Watch will include a thermometer to help with fertility planning.
Amazon’s Halo wristband can record your voice, analyze its tone, and report on your moods. New York Times columnist Kara Swisher writes of her experience wearing a Halo: “That first day a vexed emoji told me I was ‘stern’ or ‘discouraged’ for 16 percent of the day. ‘You had one phrase that sounded restrained and sad’ for 1.6 seconds at 12:30 p.m., it reported, although I have no idea what that phrase could have been. But 8 percent of the day, including for 14.4 seconds at exactly 11:41:41 a.m., I was ‘satisfied,’ with ‘two phrases that sounded satisfied, delightful or appreciative.’ Later, for 1.2 seconds at 7:18:30 p.m., I was ‘afraid, panicked or overwhelmed.’” What is the health value of this? Well, you can reflect on your various and varying emotional states, and understand what prompted them. You may subsequently decide to avoid certain encounters or experiences—or people—and reduce your stress level.
Household furniture and appliances are also part of the health surveillance network. Smart beds can monitor us at night, record our tossing and turning, and produce detailed sleep reports, which we can study over our coffee. They can detect if we are snoring, and nudge us to stop. There are also smart forks to keep track of how much and how quickly we eat.
In the works are smart toilets, being developed by Japanese manufacturer Toto. “The Wellness Toilet, which the company hopes to roll out in a few years, will scrutinize people’s daily waste output to look for various disease markers,” states an article in an Asian business publication. Stanford researchers are also working on smart toilet technology in hopes that it can aid in “precision health.”
Philosophers have long advised self-knowledge as the essential prerequisite to a life of virtue and happiness. If you don’t know yourself, your true nature, your talents, and your shortcomings, Seneca said, you simply cannot understand what fulfills you, and how you can best contribute to society and the world at large. Thus, the Stoics argued, philosophy starts in frank self-assessment and appraisal. It is a lifelong discipline, requiring patience, frankness, diligence, and commitment.
What do the many devices reporting on our mental and physical state provide for self-knowledge? What will we learn about ourselves? More importantly, what will we become?
I’m afraid we might drown in all the data. Might we also drown it out? How will we know what information is essential and what to ignore? By contrast, if we obsess over every detail, will we become hypochondriacs or narcissists of the highest order?
From a moral standpoint, these devices may make us highly insular. Poring over the constant stream of health data, will we have time or energy or incentive to wonder about other people, how they are doing or feeling? Will we care?
Surveillance scholar Shoshana Zuboff speaks of practitioners of data analysis as “high priests” versed in an esoteric and opaque science, which gives them unprecedented insight into our lives. It is chilling to ponder what data analysts will do with the embarrassment of riches gathered by our health monitoring devices. It gives them even deeper insight into our tastes and predilections—and needs—which they can then manipulate. Marketers will be happy to know if we are dieting, or struggling with our weight, or managing diabetes, cancer, or mental illness.
Despite these concerns, I suspect constant health monitoring will soon be widespread. In the United States, cost savings in health care will drive this movement. Our ailments will be less expensive to treat if they are caught early, which health surveillance enables. But it is worrisome to contemplate this new world.
Will we principally understand and know ourselves as a collection of data points? As a host of markers and figures that can be manipulated at will, much like the temperature on my thermostat? This is imprecise self-knowledge. In surveying myself, I may miss much of what is me, and what makes me—my friends, my family, my environment, all of which play a significant role in forging and sustaining my mental and physical health. What’s more, an ideal of perfection is oppressive. I am not surprised that constant health monitoring is insinuating itself into our hyper-competitive, hyper-individualistic society. But it probably won’t make living in it any more enjoyable.
Firmin DeBrabander, PhD (@Firdebrabander), is a professor of philosophy at the Maryland Institute College of Art. His most recent book is Life After Privacy.