The Inner History of Devices by Sherry Turkle

Author:Sherry Turkle [SPi]
Language: eng
Format: epub, pdf
ISBN: 9780262201766
Publisher: MIT Press

Before and After

The decision to receive an ICD does not fit easily into medicine’s standard categories of informed consent. ICD patients are most likely to talk about their “decision” to get an ICD as no decision at all. When they consider how their doctors framed the decision, it recalls how social theorist Slavoj Žižek describes a forced choice. Žižek’s examples of forced choice include the demands made by the United States on other countries when the United States supports elections only after an unacceptable group has fallen in popularity or has otherwise been removed from the ballot, thus granting others “the freedom to make a choice on condition that one makes the right choice.”15 Forced choice is an imperative masquerading as a choice.

Doctors present the ICD as the right choice. My informants say that their doctors present implantation in the context of an imminent threat of death. John says he chose the “obvious” when his doctor said: “Okay, you can die or you can have this thing.” Since receiving his ICD, John has become less sure that his heart attack was necessarily explained by a heart defect. The life-threatening experience that led to the ICD occurred after a particularly stressful week, and he is convinced that all but one of the ICD “firings” (his word) that he has experienced were due to mechanical defects in the defibrillator. Moreover, John is not happy that the defibrillator was presented to him as wholly benign: “They said it won’t do any harm. Obviously the guy who said that has never had one of these things fire.”

John’s choice was made without understanding what was at stake. Like other informants, he insists that it was impossible to imagine what life with an ICD would be like. The most resentful patients say that their physicians never acknowledged that the machine comes with a cost.

Linda was offered her ICD after a potentially fatal heart attack. She had been experiencing symptoms that her doctors ignored. Finally, on the day she was put on a heart monitor she went into ventricular fibrillation. She says that either this was a coincidence or “God talking.” When Linda had her medical crisis, the doctors presented the choice: this machine or your life. She told me: “When the doctors look at you, and they say, ‘Well, you know, if you didn’t have this you’d be dead,’ it’s like ‘okay, thank you.’ ” But no one ever told her what the experience of having her life repeatedly saved by a machine would be like. She has been shocked by her ICD over eighty times. She talks about it being a good thing that “they have it.” The impersonal syntax is telling. Linda believes the ICD has saved her life, but the pain and uncertainty in her life make her unable to describe the good it does in personal language. It is good that “they” have it—that it exists in the world. When it comes to her own case, however, Linda is not so sure.

Once

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