Wednesday, September 19, 2007

Remote Health Monitoring Is Already Here

I wrote the first draft of early portions of Stewards of the Flame many years ago. When I came to revise it and write the rest of the story, I discovered to my surprise that some of what I'd imagined isn't science fiction anymore. In fact, in a few cases reality had surpassed my original imagination and I had to add things (such as the high-tech toilets that transmit health data, which are now on the market in Japan). I'd had no idea of the extent to which remote health monitoring is already being developed, or that monitors now merely wearable will be implantable very soon. Probably the least credible premise in the novel is that in a time when we have starships, these won't be used just as much on Earth as in a colony that carries medical control to excess.

There are many legitimate uses for such monitoring. It will be invaluable for people who live in remote locations, or are too ill to visit medical offices easily, or lack transportation -- in fact, it may eventually be less costly than office visits even for people physically able to make them. And enabling the elderly to stay in their own homes instead of nursing homes is an indisputably desirable goal.

So the coming widespread availability of this technology raises troubling questions. People with chronic illnesses will want it. Ironically, I have recently developed a heart rhythm problem that makes me feel I might benefit from remote monitoring myself. Most certainly I don't want to end up in a nursing home in the future. Yet it's likely that once remote monitoring becomes common, people who are healthy will want to be monitored just in case some illness should develop later. And that would be a large step toward the kind of society portrayed in the story; it's all too easy to imagine the voters deciding that everyone ought to be monitored "for their own good," just as they've passed laws forcing everyone to wear seatbelts.

Furthermore, once a person chooses to be monitored for a specific medical problem, where does it end? I don't want well-meaning healthcare professionals checking up on how my body functions and how I live my life; I want treatment only for conditions I have personally decided that I can't put up with. Most of the discussion about privacy in connection with medical technology centers on whether the data can be made secure against unauthorized dissemination. But I want privacy from doctors, too, except with respect to problems for which I've intentionally sought help.

This issue is particularly serious in the case of very old, or very ill, people who prefer to die naturally rather than on life support in a hospital. In the novel Jesse remarks that such people often refrain from doing anything about terminal illness: "That’s how my great-granddad went, and nobody questioned it, and what he didn’t tell the doctors was left unsaid." But if such people are monitored earlier when they do want treatment, will there be any way to stop? Or will the ambulance automatically come for them, just as in the story? We are a lot closer to that situation right now than even I used to think.

For more links and a video dealing with the increasing use of remote health monitoring, visit stewardsoftheflame.com and click through to the background information.

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