Technology in Society 34 (2012) 216–226

Contents lists available at SciVerse ScienceDirect

Technology in Society
journal homepage: www.elsevier.com/locate/techsoc

Does responsible innovation presuppose design instrumentalism?

Examining the case of telecare at home in the Netherlands
Asle H. Kiran*
Department of Philosophy, Faculty of Behavioural Science, University of Twente, P.O. Box 217, NL-7500 AE Enschede, The Netherlands

a r t i c l e i n f o a b s t r a c t

Article history: This paper investigates some conceptual issues in relation to the recent trend of doing
Received 12 June 2012 responsible innovation. It argues that a reflective attitude to the design process is neces-
Received in revised form 10 July 2012 sary in order to avoid design instrumentalism. This means paying attention to the
Accepted 11 July 2012
framework in which design strategies are articulated. Ignoring conceptual questions about
how technologies attain their meaning and function can lead to a counterproductive
Keywords:
design strategy because crucial influences on how technologies are shaped within actual
Innovation
practices are ignored. Using a telecare project within the Dutch Responsible Innovation
Responsible innovation
Telecare technology initiative as my starting point, I argue for a design strategy based on methodological
Design methodology insecurity. Such a strategy aims to leave open the possibility for patients and healthcare
Midstream modulation personnel to shape the manner in which the technology is used within an actual practice,
Technology-society relationship rather than solving questions about ethics and responsibility through the means of tech-
Telemedicine nical requirements at the design end.
Healthcare Ó 2012 Elsevier Ltd. All rights reserved.
Netherlands

1. Introduction an assumption can be criticized for being naïve and coun-

What assumptions about technology use and the wider
social consequences of this use are embedded in doing
responsible innovation? What problems might be attached
to these assumptions, and how can they be avoided? How is
‘technology’ conceptualized in holding such assumptions,
and what relationship between technology and society is
presupposed? These quite general and conceptual questions
are explored in this investigation into the methodology of
projects that aim for socially responsible innovation.
In this paper, I examine what can be seen as a central
assumption of such projects, namely that specific technology
designs can have specific ethical and normative conse-
quences. That is, by being proactive and intervening
‘midstream’ in innovation, technologies can be designed in
a way that meets the aim of being socially responsible. Such
* Tel.: þ31 53 489 2308.
E-mail address: a.h.kiran@utwente.nl.
terproductive. In fact, it might first appear that the aim of
responsible innovation reinforces a type of technological
instrumentalism that I call design instrumentalism. However,
a closer look reveals that there is little wrong with the
assumption in itself; in fact, this assumption is both worth-
while and largely correct. Rather, it is how the aim of
responsible innovation is approached that is the critical
point. The ‘how’ of the approach depends on the construal of
key concepts like ‘technology’, ‘society’, and ‘the technology-
society relationship’. Consequently, it is the framework,
rather than the empirical and technical design work, that we
need to examine in assessing whether responsible innova-
tion projects reinforces design instrumentalism.
In the course of this paper, I criticize the externalist
framework for leading to design instrumentalism. This view
regards technology and society as belonging to two different
ontological ‘realms’. Separating technology and society
paves the way for an understanding of technologies as being
transparent and neutral tools that we merely use to attain
specific goals, and the accompanying thought that

0160-791X/$ – see front matter Ó 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.techsoc.2012.07.001
 A.H. Kiran / Technology in Society 34 (2012) 216–226
unwelcome consequences of technology (such as pollution,
the arms race, cybercrime, etc.) can be tamed through policy
and legislation. I will argue that designing technologies from
an externalist understanding of technology and society
disregards the situated, practice-bound construction of
technologies’ meaning and their actual, concrete effects on
the practice in which they are implemented. Furthermore,
these effects often transcend the expected effects.
Settling for the instrumental understanding of tech-
nology has a very conspicuous influence on the strategies
that are chosen in the design of the innovation processes. For
this reason, it is crucial that technology is conceived in a way
that appreciates rather than obscures the co-constructional,
co-constitutional, and co-shaping relation between tech-
nology and society. Therefore, the proactive approach needs
to be framed by an understanding of the dynamic relation-
ship between technologies as material items and the users in
the practices in which the technologies are to be used.
By criticizing externalism, I present a role for conceptual
investigations in innovation projects that aim for social
responsibility. In dealing with unknowns, which is inevi-
table when designing new and emerging technologies
(even in re-designing older technologies), many decisions
can be traced back to methodology. Explaining the implicit
ramifications of an often-implicit methodology can be
important when choosing design strategies. Thus, rather
than drawing up a specific methodology for responsible
innovation, this paper is an exploration into what it means
to do responsible innovation.
Using the project Telecare at Home – Anticipating conflicting
norms in telemonitoring technologies for chronic patients at the
University of Twente in the Netherlands as a case, I analyze
central concepts and assumptions found in ‘midstream
modulation’. This prepares the ground for a discussion of the
main question raised in this paper: Does responsible innova-
tion presuppose design instrumentalism? Arguing that this
need not be the case, I present ‘technical mediation’ as an
approach that evades design instrumentalism. I close the
paper by suggesting some practical implications of the
proposed approach on design strategies for responsible
innovation in telecare. It is envisioned that this paper will
contribute to the self-reflection of engineers/designers as well
as social scientists and philosophers by explaining the foun-
dations and consequences of the choices of design strategies.
2. Responsible innovation
2.1. Telecare at home
As the name indicates, the Telecare at Home project’s
main concern is telecare technology, more precisely the
structural changes and the possible resulting problems
telecare technologies bring about when they enter health-
care practices. The project is a part of the MVI-programme of
The Netherlands Organization for Scientific Research
(NWO),1 which funds projects that proactively contribute to
1
MVI: Maatschappelijk Verantwoord Innoveren. Ethische en maat-
schappelijke verkenning van wetenschap en technologie [Responsible
Innovation. Ethical and societal exploration of science and technology] [1].
217
“responsible innovation by increasing the scope and depth
of research into societal and ethical aspects of science and
technology” [2]. The MVI-programme requires that funded
projects are multidisciplinary; encompassing the humani-
ties, social sciences and the natural/technical science. Tele-
care at Home aims to sustain ethically sound and socially
responsible innovation in telecare by developing method-
ological tools for anticipating the effects of such technolo-
gies in the care of chronic patients.
Telecare technologies have changed the norms of care in
practices that have implemented them. These changes can
sometimes be seen as driven by the technical requirements
and choices in the design stage of the technologies. In other
words, “telehealth-care technologies are not simply
another means to deliver existing health care” [[3], p. 401],
but involve fundamental changes to the practice itself and
the identity of the two main user groups, nurses and
patients. In order to develop socially responsible telecare
technologies, it is therefore important to consider the
overall care practice, not just the functions that the tech-
nologies are meant to maintain.
Defined rather broadly, telecare technologies are infor-
mation and communication technologies (ICTs) used in
a medical or healthcare setting.2 These technologies collect
physiological data – sometimes automatically, sometimes
by way of the patient’s own actions – related to specific
illnesses and complaints, such as heart diseases, diabetes,
musculoskeletal pains, and respiratory disorders. Usually,
patients receive some kind of feedback from a PDA or
a mobile phone that is linked to the monitoring equipment.
The collected data are also transferred through mobile or
broadband networks to telemedical centers, where they are
monitored and stored as ‘biographies’ – the patients’ stories
with their illness. Healthcare personnel can then be kept
updated about the state and progress of their patients
without examining them face-to-face.
Telecare technologies have several potential advantages.
An important sales argument is that they might prove cost-
effective for the healthcare system. A study from Great
Britain shows that telecare technologies can generate
savings on healthcare expenses corresponding to five times
the investments [5]. This will undoubtedly soften the
negative effects of ever-tighter budgets and changing
demographics [6]. In 2004 in Norway, there were 4.4
persons in the age group 20–66 for every retired person,
but this number is expected to drop to 3.7 in 2020 and to
2.5 in 2050. The rest of Europe can expect a similar
demographic development [7]. Although we at the same
time should expect retired people to become increasingly
healthier, this does indicate that there will be a corre-
sponding change in the ratio between working (and tax-
paying) persons and those in need of nursing. In the not-
so-distant future, this will affect both healthcare budgets
and the number of people working in healthcare [8].
2
I follow Oudshoorn [4] in defining ‘telecare technology’ as technol-
ogies used for monitoring and diagnosis that include patients as an active
part of the communication. This is different from ‘telemedicine tech-
nology’, which are technologies used for communication between
healthcare personnel, such as the Electronic patient record.
218 A.H. Kiran / Technology in Society 34 (2012) 216–226
However, this is not to say that telecare technology is
primarily a thing for the future; there are already important
needs these technologies can meet. For instance, approxi-
mately 75 million Europeans have moderate to severe
chronic musculoskeletal pain, and European healthcare
systems cannot deal with this number through face-to-face
consultations [9]. Because of telecare technologies, more
patients can be taken into treatment at the same time. This
not only shortens the waiting time for patients to enter
treatment, but early action also reduces the danger of
musculoskeletal complaints growing into chronic pain.3
Telecare technologies might also lessen the overall
strain on patients who can abstain from traveling and
waiting in hospitals and clinics, while still having their
illness followed at least as closely as in a hospital. Also,
doctors and nurses gain from close monitoring; frequent
testing of blood pressure, EKG, muscle tension etc.
providing a richer amount of data for a patient’s illness than
what is gathered in the less frequent face-to-face exami-
nations. This might encourage more personalized treat-
ment, in the patient’s home environment, thereby
potentially improving the quality of the care [10].
However, telecare technology is no replacement for
face-to-face examination and diagnosis. For one thing, the
existing practices in healthcare are challenged because the
use of telecare technologies modifies the existing relational
structures: the roles of both professional caregivers and
patients have changed as a result of these technologies [4].
In healthcare, the predominant relational structure
between healthcare personnel and patients has been face-
to-face contact, but as the neologisms ‘remote doctors’ and
‘absent patients’ [11] imply; that is about to change. In
a telecare technology supported practice, certain aspects of
the care process are delegated from doctors and specialists
to nurses and patients. Patients, in particular, find their role
to be radically transformed; from being a passive care
receiver, they are turned into their own active caretaker, as
they are expected to handle the equipment in order to
monitor their own illness, take tests, transfer the results,
and in some cases also to be in charge of their own
restitution.
Furthermore, telecare technologies sometimes create
ambiguity with regard to the precise effect they will have
on the care process. In turn, this leads to very different
ideas on the role of the technologies in a practice. Different
users might interpret the role of the technologies in
contrary ways. Even for functionally close users this can be
the case. For example, heart-failure nurses and telenurses
at a telemedical center react quite differently to extensive
flagging of patients [[4], p. 83].4 If a heart patient gains
weight, this might indicate retention of fluid near the lungs,
a symptom of heart-failure; therefore, patients will be
3
According to the Cinderella hypothesis, certain forms of neck- and
shoulder pain stem from a less-than-average ability to relax the trapezius
muscle sufficiently after being activated. The continued activation is very
low, and not normally felt by the individuals, but might in the long run
leads to chronic pain [9,10].
4
Flagging is how the telecare system indicates that the data collected
from a patient deviates from the norm and that the patient should be
checked upon.
flagged if their weight goes up. However, patients who do
not keep strictly to their diet and gain weight will also be
flagged even though there is nothing wrong with their
hearts. This has prompted telenurses, whose task is to
monitor the collected data, to suggest changes to the set
values for flagging since the current ones lead to too many
‘false’ flags (which bogs down their workload). However,
heart-failure nurses, who are in charge of setting the
values, feel that ‘false flagging’ is a good thing, since it
works as a reminder to the patients of the importance of
sticking to the diet. Here we see two very different
understandings of a situation occurring because of the way
in which the technical equipment is designed and imple-
mented into a specific healthcare practice.
Conflicting roles and norms also result from the
confusing terms in which telecare technologies sometimes
are introduced. On the one hand, more control and
autonomy is promised to patients. However, at the same
time, there is also ease-of-use and day-to-day trans-
parency which are accomplished through automatic and
‘hidden’ processes. This encourages two very different
notions of ‘telecare’. On the one hand, ‘telecare’ appears as
enabling the patient to live through the illness less like
a hospitalized patient, with enhanced autonomy and
potential for a fuller, more contented life. On the other
hand, ‘telecare’ appears as an automated and ‘hidden’ ICT-
based procedure, where the patient is left to himself, for
the most part only dealing with technical equipment.
Emphasizing the first notion leads to a more amicable
view of the technology, as allowing enough flexibility for
the patient to construct a patient-identity with the tech-
nology as an integrated element [12]. However, empha-
sizing the second notion can lead to distrust in the
technology; where the telecare equipment appears as
intrusive or as a foreign presence in the patient-identity. In
reality, of course, the distinction will not be as clear-cut as
this, since different people react differently to the tech-
nological presence in their illness. However, the potential
for a conflict of norms is still there, in terms of how the
healthcare process should be structured. Telecare tech-
nologies can drive both extremes.
Ambiguity in relation to conflicting norms might delay
the breakthrough of telecare technology. Even with the
potential to reduce the costs and increase the quality of
healthcare, only about 25% of R&D on telecare technologies
are implemented into healthcare [13]. There are legitimate
reasons for non-use; however it is also clear that the design
stage often emphasizes the technical requirements rather
than the users’ requirements [13]. Consequently, users
(healthcare personnel and patients) find the technologies
to be ill suited to their situation and needs. If this is right,
non-use of telecare technology is partly due to a lack of
communication from the user groups to the developers of
telecare technologies regarding how the technologies
should be designed in order to meet the users’ require-
ments [14].
With one of the main aims being to develop a method-
ology that can anticipate conflicting norms, the Telecare-at-
Home project has a potential for bridging this communi-
cation gap. Through a social, ethical and philosophical
investigation into how patients and healthcare personnel
 A.H. Kiran / Technology in Society 34 (2012) 216–226
meet, experience and react to the presence of telecare
technologies, and through a close cooperation with engi-
neers and technical scientists, the possibilities to better
combine the technical perspective and the user perspective
could become evident. However, this should not be taken to
imply that the project primarily aims to develop ‘better’
methodological tools for the translation of user require-
ments into technical requirements. On the contrary, the
project serves as a reminder that not all user requirements
can be translated into technical requirements. Given this,
a different type of methodology is needed to tackle the
communication gap; a methodology that does not regard
norms and values as something that can be reinforces
through design, but as something that arises from an
interplay of situated social, personal and material factors
[15]. The design strategy can then be to encourage
a personalized appropriation of the technology rather than
fixing specific ways in which the technology can be user-
friendly.
2.2. Being proactive
According to the literature, engineers already take
responsibility in preventing undesired technological and
economic consequences of innovation and should expand
this responsibility to include undesired consequences
regarding “the morally relevant social roles of technolo-
gies” [[16], p. 159] as well. The morally relevant conse-
quences of innovation are sometimes discussed as ‘soft’
impacts. Soft impacts are consequences of innovation that
are not easily quantifiable, but relate to “social practices
and routines, and the moral norms underlying such prac-
tices” [17]. It is important to note that for these authors the
concept of soft impacts not only concern ethical and moral
aspects of specific technologies within a practice, but also
how norms and ethical opinions and concepts might
change in the longer run due to innovation [cf. [18,19]]. This
type of social change is necessarily difficult to predict, but if
these studies are correct about the relationship between
innovation and long term moral change, such difficulties do
not make it any less important to attempt to anticipate
possible soft impacts.
As the MVI-programme shows, there is a readiness to
invest in innovation that acknowledges and attempts to
deal with soft impacts. Innovation has come to be
recognized as being embedded in social networks that not
only are affected, but also can themselves affect innova-
tion. In order to be ‘ethically sound’ and ‘socially
responsible’, though, innovation requires a broad meth-
odological platform, incorporating different styles of
social and ethical perspectives. In practice, as in the MVI-
programme, this means that technological projects
combine forces with researchers from the humanities and
social sciences. After all, philosophers, say, are more
trained in ethical issues than technical scientists, and
sociologists know more about social dynamics than
engineers usually do.
After initially revolving around reactive ethical ques-
tions (“who or what was responsible for a specific tech-
nological accident”), the field of engineering ethics has
taken steps towards a more proactive, or preventive,
219
approach [20,21]. Several kindred concepts for proactive
research have emerged, all expressing the attitude that
ethics should be done “on the laboratory floor”,5 i.e., that
ethicists (and social scientists) should stay close to where
the actual innovation is done. “The idea behind this type of
research is that ethical investigations are carried out
parallel to, and in close cooperation with, a specific tech-
nological R&D project” [[22], p. 225]. In ethical parallel
research [22–24], ethicists monitor innovation in order to
identify ethical issues that might emerge from it. This
approach is usually focused on such ethical issues as risks
and uncertainties connected to the innovation, the
acceptability of these risks, and identifying the role of
actors and organizations, especially in locating the
responsibility for addressing and countering risk issues. As
such, ethical parallel research mainly addresses if not
‘hard’, then ‘harder’ impacts, such as pollution, accidents,
etc., than the ethical issues mentioned above as soft
impacts.
Furthermore, although there is some contact, ethical
parallel research remains a separate project from the
technological project [24]. Embedded ethical research
[25,26],6 on the other hand, strives for closer contact with
engineers and designers. In fact, this contact should be so
close that the ethics project can be said to be a part of the
innovation project [[24], p. 32]. According to Van der Burg,
getting to know each other and engaging in regular
conversations are important, especially for the ethicist,
because an evaluation of a technology’s possible impact
“can only take place in close connection to concrete
information about that technology, and the ways it can be
known and developed, which the engineers provide”
[[25], p. 311]. Furthermore, embedded ethical research
more explicitly addresses soft impacts, such as how
technologies “can be expected to influence how people
understand the good life [or other value laden concepts],
and whether and how they are able to realize it in a world
with technology” [[25], p. 303]. In order to grasp such
impacts, the embedded ethicist should have more contact
with the user groups affected by the technology under
development than what is usual for ethical parallel
researcher [cf. [26]].
Both ethical parallel research and embedded ethics are
approaches that emerged in the Netherlands. Internation-
ally, the concept midstream modulation is better known
[27,28]. The metaphor ‘stream’ here refers to the innovation
process, with ‘downstream’ being the moment when
a technology is introduced to its designated practice (or
marketplace) and upstream being where an innovation
process is initiated. First-generation Technology Assess-
ment (TA), starting up in the 1960s, was primarily
a downstream approach, geared to figure out possible
negative consequences that already had come from
5
“Ethics on the Laboratory Floor” was the name of a workshop held at
the University of Twente in 2010.
6
Although she speaks of an ‘embedded ethicist’, Simone van der Burg,
the main proponent of this line of research, does not use the concept
embedded ethical research, but regards her work as a variation of ethical
parallel research. However, van Gorp and van der Molen [24] singles out
her work as an independent approach.
220 A.H. Kiran / Technology in Society 34 (2012) 216–226
technological projects, and then develop measures of
political control to avoid or lessen these effects [[29], p.
544]. This knowledge could also be used upstream; to
prevent funding of future projects that might have the
same trajectory in terms of negative consequences [27].
Upstream and downstream approaches are basically
outside innovation, not influencing the developmental
process as such. Midstream modulation, on the other hand,
means entering innovation while technical choices and
implemental strategies are still being discussed. More
precisely, the concept “denotes the alteration of R&D
activities and processes in accordance both with existing
constraints and dynamics but also with broader societal
goals, consideration, or influences” [[27], p. 492]. Like
ethical parallel research and embedded ethics, midstream
modulation is explicit in terms of the necessity of ‘getting
to know’ the “nested processes, structures, interactions,
and interdependencies, both immediate and more
removed, within which they operate” [[27], p. 492, cf. [28]].
However, rather than taking an active part of the design
work, the ethicists work is mainly to invite and initiate the
self-reflection of engineers and designers.
The proactive approach from engineering ethics, then, is
mainly geared towards the interaction between developers
and ethicists. A different approach to feed the anticipation
of technologies’ impact is to invite assumed stakeholders
into the deliberations that go into the design process.
Participatory design [30] and constructive technology
assessment (CTA) [31], to name but two approaches that do
this, attempt to map the social impact of a technology by
involving inputs from those social groups whose jobs and
lives will be affected by innovation.7 One strategy in CTA is
to develop different future scenarios of possible impacts,
soft and hard, of innovation. Scenarios are narratives that
envision different ways the technology under development
unfolds in its designated context of use, thereby invoking
a very tangible illustration of the shaping impact of the
technology. The stakeholder reactions to these scenarios
then, ideally, help inform the technical and other design-
related choices.
Scenarios are also an integral part of the related NEST-
ethics approach [[19], cf. [17,18]]. NEST (New & Emerging
Science and Technology)-ethics scenarios (also called
techno-moral scenarios), however, are especially devel-
oped to anticipate how innovation affects soft impacts, not
just in terms of moral and ethical issues within the prac-
tices that will be affected by NEST, but also in terms of how
innovation might result in changes to our existing moral
concepts. Highlighting the latter kind of impact is impor-
tant because it directs us to the fact that being proactive
means to assess, so to speak, tomorrow’s technologies with
today’s standards. Scenarios, and other proactive strategies,
should therefore take into account that anticipation of how
a technology is received within a practice might be
7
In [22] CTA and other participatory TAs are labeled second generation
TA, while parallel ethical research and midstream modulation are called
third-generation TA. In terms of chronology of ideas that might be
correct, but the second generation should not for that reason be regarded
as less advanced than the third, but as having a different emphasis on
how to inform the anticipation of possible social impacts of innovation.
outdated once the technology is implemented. It also
constitutes a foundation for evaluating whether these
kinds of moral changes are desirable.
Regardless of similarities and differences of the above
approaches, being proactive is a response to the well-
known Collingridge dilemma: “The social consequences
of a technology cannot be predicated early in the life of the
technology. By the time undesirable consequences are
discovered, however, the technology is often so much part
of the whole economics and social fabric that its control is
extremely difficult” [[32], p. 11]. For the most part, proac-
tive approaches recognize the last part of the dilemma.
However, it is too late for interventions into the develop-
ment process. Furthermore, these interventions might not
be able to shape the technology and its social effects in
a desired way. At the same time, proactive approaches
attempt to overcome the first part of the dilemma, and
thereby dissolving it, by bringing in multidisciplinary
perspectives midstream (an unfamiliar strategy when
Collingridge formulated the dilemma). The thought being,
that a multidisciplinary group, sometimes supported by
stakeholder participation, will be better equipped to
anticipate what social impact a particular technology might
have than a group merely consisting of technical scientists
and engineers.
However, approaches that aim to be socially respon-
sible and ethically sound should not appropriate the
understanding of the technology–society relation
implied in the Collingridge dilemma. The Collingridge
dilemma appears from the view that technology has
a (semi-) autonomous trajectory and therefore, unpre-
dictable social effects at an early stage and irreversible
social effects at a later stage. Because technologies are
considered to be (semi-) autonomous they should be
controlled from the outset. This seems to be the
normative attitude that feeds the dilemma. The impli-
cation here is that the relationship between the social
and technological is external; as defined and constituted
separately, according to distinct, and often opposing,
logic [12]. Consequently, socio-technological develop-
ment as portrayed through the Collingridge dilemma
(and other externalist views) involves a tension between
technology and the social. The result of this tension is
that the relationship between the ‘social’ and ‘tech-
nology’ is characterized as being that of a power struggle:
what controls what. In other words, is the social the
stronger party, or is technology; what is the driving force
in socio-technological development?
Does the aim of doing socially responsible and ethically
sound innovation imply that proactive approaches involve
an attempt to control technology – a technology that, if not
controlled, takes on a course that is at odds with social
responsibility? The literature described above demon-
strates that being proactive means having a certain desire
to shape technology and its social and moral consequences.
However, the claim in this analysis is that this desire should
not be about controlling technology. Importantly, proactive
approaches do not reinforce the externalist view of the
technology-society relationship by assuming a design
instrumentalist approach. As I shall demonstrate below, the
externalist view comes through when technologies are
 A.H. Kiran / Technology in Society 34 (2012) 216–226
treated as neutral instruments or as mere means to fulfill
a certain pre-set goal.8
In order to be able to instead reach the goal of being
proactive, it is necessary to reject the view that the social
and technology are two opposing forces that pull in
different directions. In its place, society and technology
should be regarded as interdependent or as mutually
shaping, mutually defining, and mutually constituting.
Using the interdependent view as a methodological and
conceptual foundation we will generate a design strategy
that recognizes that the norms and values we want a tech-
nology to reinforce cannot simply be ‘built into’ the tech-
nology at the design end. Being proactive does not imply
being controlling. Only putting in the effort at the design
end of a process (and thereby regard the technology as
‘domesticated’ and ‘controlled’) is as short sighted as only
putting in the effort, in the form of policies and regulations,
downstream. The differences between the external and
interdependent views are not merely of conceptual interest.
Instead, seeing the relationship between technology and
society as interdependent requires a different methodology
for doing responsible innovation. It involves different
strategies for how we design and implement technologies
into a given context, and it involves an altogether different
emphasis on how we gain trust in the technologies that
guide us through our everyday lives. For the chronic patient
depending as much on the telecare technology as on his
nurse and doctor, the innovation methodology becomes of
utmost, although indirect, importance.
3. A central assumption
3.1. Design instrumentalism?
The emergence of the many proactive approaches to
responsible innovation demonstrate the currency of the idea
that normative considerations should run in parallel to or as
part of the design process. Technologies are no longer seen as
mere shapeable instruments whose use can be defined
independently from their material reality and wider effects.
In this regard, does intervening at the design stage in order to
induce some influence over their moral effects still treat
technologies as mere instruments, albeit of a somewhat
different kind? Don Ihde argues the assumption that certain
predefined problems can be countered through a specific
technological design is a form of technological instrumen-
talism. This is the view that technologies are means to reach
a pre-set goal [33]. This view, Ihde points out, is flawed since
technologies always transcend their intended meanings and
functions, and their social effects always go beyond their
intended effect. Technologies are multistable [33,34].
When technologies are regarded as shaping instru-
ments, Ihde calls this the designer fallacy. This fallacy
8
I am not implying that any of the mentioned proactive approaches
operate within an externalist framework. In fact, none of them aims for
control over the consequences of innovation. My concern in this paper is
a methodological discussion of a) why a proactive approach should avoid
the externalist framework, and b) how it can avoid it, both aspects in
a conceptual manner, not assessing whether the methodology of any
existing approaches are external or not.
221
involves a different, more active form of instrumentalism
than the usual, passive one where technologies are seen as
shapeable instruments [[35,36], p. 177, [37], p. 1]. To
distinguish these two forms of instrumentalism, we can call
the passive form use instrumentalism, whereas the active
one, criticized by Ihde, can be labeled design instrumen-
talism. The question from the previous paragraph can now
be rephrased: Do proactive approaches to responsible
innovation presuppose design instrumentalism?
However, before investigating this question, we need to
find out what is involved in posing such a question. Why
should proactive approaches to responsible innovation
presuppose design instrumentalism? From what we have
seen, these approaches do aim to implement or reinforce
a specific, desired normative understanding of a techno-
logical practice. Or, perhaps more precisely, this approach
prevents the norms and values in a given domain from
going in an undesired direction due to innovation [17]. The
idea here is that positive and negative soft impacts can be
mapped through considering possible use-patterns in
relation to a technology, and that these then can inform the
design and development process in a proactively respon-
sible way. As such, technologies (through how they are
designed) do seem to be treated like measures for shaping
not just use, but also society in a given, predefined direc-
tion. In this idea, we can discern a specific assumption
about the relation between the design stage and the use
stage. However, this assumption is indirect, and involves
two steps, so before asking whether it amounts to design
instrumentalism, let us first examine the assumption.
The first step is to assume that by doing specific designs
the use setting is affected in specific ways. On the face of it,
this seems straightforward, and sits well, I suspect, with
a common sense understanding of the relationship
between design and use. In fact, it can be said to be pre-
supposed in all design. Otherwise, if designers do not
expect people to use and behave with a technology in given
ways, why design at all? However (although the first step
might not be so uncomplicated after all), the second step is
less straightforward. By ‘using’ design to shape the use
setting, a proactive approach potentially also shapes norms
and values surrounding a given use setting in a responsible
direction. The thought here being that norms and values
can only be shaped so far through policies, regulations and
ethical debate after-the-fact. Soft impacts primarily change
as a result of changing practices, not because of philo-
sophical debate [38].9 Consequently, and this is the crux of
proactive approaches, the shaping of norms and values
must happen through shaping practices, which means that
the active ingredient from the design perspective is the
technology under development.
3.2. The positivist problem
Anders Albrechtslund presents a criticism of such an
assumption when he finds Value-Sensitive Design (VSD),
a methodology for ethical and socially responsible design
9
Of course, such change is not necessarily the purpose of philosophical
ethics.
222 A.H. Kiran / Technology in Society 34 (2012) 216–226
that also can be said to be proactive, to contain a positivist
problem [39]. Without going into Albrechtslund’s assess-
ment of VSD, which can be criticized for being unjustly
conflating, however, the concept of a positivist problem is
useful as an analysis of proactive approaches in general. As
such, an approach to proactive design is ‘positivist’ when it
takes for granted a direct correspondence, symmetry,
between the design and user ends. This, however, is
a ‘problem’ because the shortcomings of this assumption is
that for many, perhaps most, cases of technologies this
correspondence cannot be found. However, examples of
technologies that take on a different meaning and devel-
opmental trajectory than originally intended are certainly
easy to come by. Albrechtslund himself mentions the
telephone, which was designed to aid the hearing-
impaired. Having other potentialities, its further develop-
ment took a surprising direction. Another example is Via-
gra, which was developed to combat high blood pressure,
and in addition to its now most common usage, it has
shown promise as a contributing factor in reducing pros-
tate cancer tumors [40]. Ihde claims, quite strongly, not to
be able to think of any examples where the meaning of
a technology in a practice conforms strictly to its designed
meaning [33].
Albrechtslund argues further, that not recognizing the
positivist problem severs proactive approaches from actu-
ally having profound control over the ethical and socially
responsible uses and the technologies’ subsequent effects
since the outside design influences on use is under-
estimated. This is unfortunate because it “might give users,
legislators, and others the impression that technology
developed under certain guidelines are somehow certified
‘foolproof’ with regards to future ethical problems and
dilemmas” [[39], p. 71]. Therefore, it is important that work
under the umbrella of responsible innovation observe
Albrechtslund’s warning. In order to exert an actual
shaping influence over the soft impacts of technology use –
the very aim of responsible innovation – one should not
limit one’s effort strictly to the design end and merely focus
on the use, i.e. the technical requirements, of the
technologies.
Instead, additional and supplemental measures to map
and shape norms and values that are affected by the
implementation of a technology into a practice need to be
worked out. Albrechtslund does not provide any specific
advice in that direction, but he points out that any practice
involving technology always involves surprising aspects
that shape the meaning and use of technology in a different
direction than intended. Like Ihde, then, Albrechtslund
points to the actual or potential multistability of technology
as explaining why a technology’s designed meaning fails to
translate to its meaning in an actual situation in-use.
However, as I have argued previously, merely pointing to
multistability is insufficient, both on a practical and on
a conceptual level, since we need to know more about the
dynamics behind the diverging stable meanings [15].
3.3. A question of framework
Does the positivist problem necessarily follow from
holding the central proactive assumption? The positivist
problem results from presupposing that design and user
ends are symmetrical. What goes in at the design end
comes out more or less unaffected at the user end. In
relation to proactive approaches, the symmetry must be
assumed both in terms of intended function and meaning
and in terms of social and normative consequences of use if
adequately mapped and factored in during the design
stage. Having addressed this issue, we can now pose the
question from Section 3.1: ‘Does being proactive presup-
pose design instrumentalism?’ This is the key question
addressed in this paper through an analysis of the Telecare-
at-Home project. In more specific terms: Is such symmetry
assumed in proactive approaches to responsible
innovation?
The rather vague answer to this question is ‘not neces-
sarily’. The reason for the vagueness is that what design
strategies are chosen (or, for midstream ethicists, encour-
aged), to a large degree depend on how one understands
the given practice, the users involved, the relationship
between the users, and how one understands the rela-
tionship between technological and social pulls and influ-
ences in practice. Additionally, it depends on more
generally, how the dynamics in socio-technological devel-
opment are conceptualized. In other words, the conceptual
framework in which one approaches the aim of being
proactive is very important for the consideration of design
strategies. How these aspects are understood is not always
explicit. In order to avoid choosing a design strategy that
reinforces design instrumentalism, one therefore needs to
be reflective and conscious about how technology and its
relation to the practices it is a part is conceptualization.
It is not the central assumption in itself that is prob-
lematic; rather, the problem emerges when design instru-
mentalism is adopted as the proactive approach. That is,
when this approach regards the design of technologies as
the main method for doing responsible innovation. To
maintain the central assumption is still possible – and
necessary in order to be proactive, but this requires an
explicit rejection of the externalist framework, which is
presupposed by design instrumentalism. One should not
give up the ambition to exert proactive influence, but in
order to gain such an influence, the complex relationship
between technology and the social must be understood as
something different from that of a power struggle between
an independently defined social realm and an indepen-
dently defined technological realm. These two ‘realms’
define each other within a practice, and only as such do
they contextualize the enabling and constraining the use of
technologies. Furthermore, both realms are effective in
generating further, soft impacts. In other words, the posi-
tivist problem should not be seen as a problem with the
ambition of being proactively responsible in innovation,
but as a problem derived from adopting design
instrumentalism.
4. Technical mediation
4.1. The interrelation between subject and object
What does it mean that ‘the two realms define and
shape each other’? In order to ‘refute’ the externalist
 A.H. Kiran / Technology in Society 34 (2012) 216–226
framework from which design instrumentalism surfaces
we need to understand the non-externalist nature of
technical mediation. According to Bruno Latour [41],
assuming at the outset that objects and subjects are
essentially differentiated means that technical mediation
takes on the mere role of putting subjects and objects
together again, in which case a technological item is seen as
either neutral (technological instrumentalism) or all
encompassing (technological determinism). Both alterna-
tives are untenable, and we need to understand subjectivity
and objectivity as products of a constitutional process,
instead of conditions for such a process. Subjects and
objects should not be described as having stable, autono-
mous essences, but as being dependent on the specifics of
their relation and situatedness. There is no such thing as
a subject without an object and vice versa. The subjects
emerge as subjects through dealing with objects, and
objects are objects only in relation to a subject.
For example, the statement ‘Guns don’t kill people,
people kill people’, from National Rifle Association (NRA) is
stated to defy those who advocate stricter gun control in
the USA [[41], p. 176]. The NRA regards the gun as a strictly
neutral instrument that only brings out the latent
compulsions of a user. If the user of a gun is a peaceful
person, the use of the gun will be for peaceful purposes, but
if the user is a criminal, the gun will be used for criminal
purposes. Determinism, on the other hand, is implied in the
gun control slogan, ‘Guns Kill People’ that instigated the
NRA’s statement above. Who is right? Do humans control
guns, or do guns control humans? Neither, according to
Latour. “You are another subject because you hold the gun;
the gun is another object because it has entered into
a relationship with you. The gun is no longer the gun-in-
the-armory or the gun-in-the-drawer or the gun-in-the-
pocket, but the gun-in-your-hand, aimed at someone who
is screaming” [[41], p. 179–180].
In order to substantiate this, Latour presents four non-
instrumentalist meanings of technical mediation. First,
there is goal transformation. The goals we set, and can’t set
are transformed when we enter into relationship with
a technological device. This implies that the world appears
differently when we can see it or act on it ‘through’ tech-
nologies [cf. [15,42]]. Second, there is the composition of the
technical mediation. Because the goal of a technical medi-
ation is transformed, or becomes a new one, the mediation
can only be understood as being composed of both the
human and the technological element. A shooter, the acting
entity, is not man þ gun, but the new hybrid, man-gun.
Third, there is Latour’s well-known use of the concept of
black-boxing. Since the various acting elements are
composed in the above sense, we tend to treat technical
mediations as a totality. What an element (human, tech-
nological, sub-processes) does can only be known, or re-
flected upon, on opening up this totality.
Fourth, there is delegation. Performing an action with
the help of technology means delegating responsibilities.
This is not necessarily done consciously, but results from
the specific kind of accentuation that happens in technical
mediation. The gun accentuate specific aspects in the
human, and the human accentuates specific aspects of the
gun (another person in a different situation might have
223
used the gun as a hammer, or used the computer for
gaming). In technical mediations, duties are delegated
depending on the situated practice and the capabilities and
possibilities that both human and technological element
present to the situation. Regarding subjects (individuals,
society) and objects (technologies) as external to each
other fails to expose the constitutional aspect of technical
mediations.
Technical mediation is relevant on several levels. As
recognized by Waelbers and Swierstra, technical mediation
structures “what we believe to be the case, what we believe
to be possible, and what we believe to be desirable” [[16], p.
160, original emphasis]. In other words, the constitutional
effects of technical mediation are not only relevant for
ontology and epistemology, as outlined by Latour, but also
for our moral understanding and, hence, ethics: “For
example, our ideas on the desirable social roles of women
are co-shaped by innovations like the contraceptive pill,
condoms, the washing machine and the microwave” [[16],
p. 160]. A more developed argument on the moral signifi-
cance of technical mediation is found in Verbeek [42], who
in a lengthy case study shows how a technology like
obstetric ultrasound constitutes a) normative choices, and
b) moral subjects; the latter following on the former when
parents cannot but relate to the normative choices pre-
sented by the former. If an ultrasound examination reveals
that a fetus carries a certain risk of having Down’s
syndrome, the parents are given the choice of taking
further tests. In case it is established that the unborn child
indeed has Down’s syndrome, the parents are offered an
abortion. However, this second round of tests carries
a certain risk (1:250) of provoking a miscarriage. Still, many
parents accept the risk of losing a healthy child in order to
determine if the fetus has Down’s syndrome [[42], p. 23–
27]. This particular technology opens up and constrains
ethical choices, and it constitutes parents as ethical actors.
4.2. Methodological insecurity
Looking for methodological measures to control an
assumed autonomous technology leads to design instru-
mentalist. This, for instance, is seen in a practical, design-
related question: what or who do we blame if a tech-
nology fails to become implemented into its intended
practice? As mere neutral instruments, technologies only
act as intermediaries between the actors within the prac-
tice. In a telecare setting, this means that if a telecare device
is used ‘wrongly’ or not used at all there must be something
wrong with how it is designed; some technical mishap or
user unfriendliness, or it must be a human problem, such as
insufficient user training.10 By paying no attention to how
technologies transform and reshape a practice, for instance
by redefining the identities and internal relations within
the practice, all efforts in rectifying non-use become tar-
geted at improving or redeveloping technical aspects.
Without considering how the norms, values and the
structure of healthcare changes as a result of a technology
10
Thanks to Finn Olesen for calling attention to this particular aspect of
technological instrumentalism.
224 A.H. Kiran / Technology in Society 34 (2012) 216–226
taking over some aspects or chores within a practice, there
is no guarantee that a piece of refurbished equipment will
fare any better as long as it reinforces the same ethical and
social norms as the earlier model.
Taking this to a more general level, design instrumen-
talism means putting the entire responsibility of condition
of our world on the people and the society that produce,
regulate, and govern technology use, rather than seeing
how technologies shapes and re-shapes ‘soft’ societal
aspects by their presence. Clinging to an instrumentalist
notion of technology is to lose a valuable analytical tool,
whether one is studying history, sociology, or philosophy;
the social changes that innovation contributes to become
somewhat mystical and elusive. By acknowledging and
conceptualizing the influential role of mediating technol-
ogies, we can better grasp where to put in the effort in
order to shape and change things for the better. Or, in the
context of the framework developed in this paper; how to
be proactive in order to do responsible innovation.
I suggest that design strategies in responsible innova-
tion should assume a methodological insecurity [15]. This
involves, not only concern with the design end of innova-
tion, but also to focus on supplemental contextual methods,
related to the specific practices. More precisely, the design
should enable users to take responsibility to shape their
own relationship to the technology [cf. [12]], rather than
‘locking’ us to specific ways of appropriating the technol-
ogies.11 But what does this mean for the actual design
work? The assumption that different people have different
technological needs, (which is the demonstrated in the case
of Telecare at Home), would compel designers to leave
some flexibility in how the technology can be implemented
into the care practice. Rather than dreading and attempting
to neutralize the shaping of a technology that goes on in the
designated practice, designers should anticipate how needs
and demands in practices will differ. Somewhat paradoxi-
cally, presupposing less control might mean gaining more
influence. That is, rather than countering the mentioned
communication gap (Section 2.1) through more specifically
stated technical requirements that absorb some more
finely defined user requirements (thus creating a more
rigid system with ever more rigid norms of use), it can be
tackled by an opposite strategy, allowing for a situated
construction of how the technology can be appropriated by
individual patients to meet their individual needs.
Pragmatically this makes sense. As mentioned above,
too rigidly designed technology means that fewer users
(such as patients and nurses) will find them suitable for
their needs since rigidity implies an ‘accept or reject’
rhetoric. This can in part explain the disappointingly low
implementation rate of telecare systems into healthcare,
since norms that are in conflict with some users’ set of
values has to be accepted as part of the system, leading
potential users to reject the system altogether. For instance,
some users are happy to sacrifice breach of privacy and loss
11
In [15], I argue for some other practical shortcomings of the exter-
nalist framework. For instance, it fails to frame an adequate account of
our resistance towards proactive technologies that coercively steer us
towards specific behaviors.
of autonomy for easier and smoother functionality, others
cannot accept that. If a system can be calibrated within
a practice in both directions for the two different types of
patients, half of the patient group does not need to become
non-users. Consequently, methodological insecurity might
lead to more easily adopted telecare systems and thereby
more willingness to use them among both patients and
healthcare workers.
Methodological insecurity also makes good conceptual
sense. Kiran and Verbeek argue that users most efficiently
build trust in technologies if they are allowed to define
their relationship to them, that is, if they can co-construct
the role that the technologies play in their illness and
overall life [12]. Such situated construction, allowed by
methodological insecurity, might lead to variations in use,
but with less chance of the kind of conflicting norms that
hamper beneficial and invaluable use of telecare tech-
nology in healthcare.12
Waelbers and Swierstra offer a model (not a method-
ology) for engineers and designers to distinguish morally
relevant aspects of innovation. Similar to what I have
pointed out, this model is based on the fundamental atti-
tude that we often “lack the necessary means of control to
ensure that what we intend to happen will happen” [[16], p.
164]. Still, that does not mean that we are totally in the dark
in identifying some possible ‘hard’ and ‘soft’ impacts. Their
main argument is that only by using as a starting point the
actual and possible consequences of technical mediation
(Section 4.1) can we distinguish how normative dimensions
are affected by innovation. The model offers a range of
questions (“will the technology mediate our perceptions of
the stakeholders?”, “will the technology create new rights
for certain involved stakeholders?” etc.) that can help
engineers to identify who will be affected by innovation,
the consequences that can be directly related to the tech-
nical mediation, and through that, the normative dimen-
sion of innovation.
However, this model, in addressing engineers and
designers, remains a detached one, in the sense that
stakeholders are identified, but not invited into the design
stage. The Telecare at Home project therefore wants to stay
closer to a CTA approach, but supports this approach with
an eye for the normative implications of technical media-
tion. It is still impossible, in principle, to map perfectly how
a practice is affected by innovation, but articulating a plan,
model, or prototype and presenting it to possible stake-
holders, will enable them to relate more tangibly to the
innovation, which in turn might give useful feedback on
how a given technical mediation might affect a practice.
This way, it will be easier to analyze the practice in terms of
soft impacts, and thus avoid incorporating choices that
solidify the uses and norms of the technologies under
development. For the Telecare at Home project, it is espe-
cially the choices that facilitates or constrains the control
12
Of course, certain factors must also be in place, for instance, the
technologies must work satisfactorily on a technical and functional level.
So, for the system to retain its functionality, the situated construction
must be within certain technical, functional and practice-related
constraints.
 A.H. Kiran / Technology in Society 34 (2012) 216–226
and the autonomy of patients and nurses, or choices that
might hamper adequate surveillance of the patients that
are in focus.
5. Concluding remarks
In this paper, I have presented concepts and theories
behind responsible innovation, and asked what type of
approach one should choose in order to be proactive.
Having dismissed design instrumentalism for hinging on an
externalist view of the technology-society relationship,
with its implied focus on controlling technology, I proposed
a methodological insecurity, which acknowledges the sit-
uated construction of technological practices. However, it is
important to note that methodological insecurity is not
a method. It is in itself just an approach to the less-than-
symmetrical relationship between the design end and the
user end. What method a project aiming to be proactive
embraces depends on a further understanding of tech-
nology, society, the particular practice, and the level
of insecurity. This paper has primarily provided an under-
standing of some of the shortcomings of design
instrumentalism as a framework for design strategies in
innovation.
Acknowledgments
This article was made possible by NWO, Netherlands
Organization for Scientific Research (Programme: Respon-
sible Innovation – ethical and societal exploration of science
and technology, project ‘Telecare at Home. Anticipating
conflicting norms in telemonitoring technologies for
chronic patients’). The author would like to thank Aud Sissel
Hoel, Bjørn Myskja, Nelly Oudshoorn, Peter-Paul Verbeek,
Marianne Boenink, and two anonymous reviewers for their
valuable comments on earlier versions of this article.
References
[1] http://www.nwo.nl/nwohome.nsf/pages/NWOA_73HBPY [accessed
12.06.2012].
[2] http://www.nwo.nl/nwohome.nsf/pages/NWOA_7E2EZG_Eng#docs
[accessed 12.06.2012].
[3] Oudshoorn N. Physical and digital proximity: emerging ways of
health care in face-to-face and telemonitoring of heart-failure
patients. Sociology of Health and Illness 2009;31:390–405.
[4] Oudshoorn N. Telecare technologies and the transformation of
healthcare. Basingstoke: Palgrave Macmillan; 2011.
[5] http://www.guardian.co.uk/uk/2009/jun/24/social-care-telecare
[accessed 12.06.2012].
[6] Freund D, Smeeding TM. The future costs of health care in ageing
societies: is the glass half full or half empty? In: Tuljapurkar S,
Ogawa N, Gauthier AH, editors. Ageing in advanced industrial states.
Dordrecht: Springer; 2010. p. 173–93.
[7] http://www.ssb.no/ssp/utg/200401/01/ [accessed 12.06.2012].
[8] Esser PE, Goosens RH. A framework for the design of user-centred
teleconsulting systems. Journal of Telemedicine and Telecare
2009;15:32–9.
[9] Vollenbroek-Hutten MMR, Hermens HJ, Kadefors R, Dannels L,
Nieuwenhuis LJM, Hasenbring M. Telemedicine services: from idea
to implementation. Journal of Telemedicine and Telecare 2010;16:
291–3.
[10] Kosterink SM, Huis in ’t Veld RMHA, Cagnie B, Hasenbring M, Vol-
lenbroek-Hutten MMR. The clinical effectiveness of a myofeedback-
based teletreatment service in patients with non-specific neck and
shoulder pain: a randomized controlled trial. Journal of Telemedi-
cine and Telecare 2010;16:316–21.
225
[11] Mort M, May CR, Williams T. Remote doctors and absent patients:
acting at a distance in telemedicine? Science, Technology and
Human Values 2003;28:274–95.
[12] Kiran AH, Verbeek PP. Trusting our selves to technology. Knowl-
edge, Technology and Policy 2010;23:409–27.
[13] Vollenbroek-Hutten MMR, Hermens HJ. Remote care nearby. Jour-
nal of Telemedicine and Telecare 2010;16:294–301.
[14] Huis in ’t Veld RMHA, Widya IA, Bults RGA, Sandsjø L, Hermens HJ,
Vollenbroek-Hutten MMR. A scenario guideline for designing new
teletreatments: a multidisciplinary approach. Journal of Telemedi-
cine and Telecare 2010;16:302–7.
[15] Kiran AH. Responsible design. A conceptual look at interdependent
design-use dynamics. Philosophy and Technology 2012;25:179–98.
[16] Waelbers K, Swierstra TE. Designing a good life: a matrix for the
technological mediation of materiality. Science and Engineering
Ethics 2012;18:157–72.
[17] Boenink M, Swierstra TE, Stemerding D. Anticipating the interaction
between technology and morality: a techno-ethical scenario study
of experimenting with humans in bionanotechnology. Studies in
Ethics, Law, and Technology 2010;4:1–38.
[18] Swierstra TE, Stemerding D, Boenink M. Exploring techno-moral change:
the case of the ObesityPill. In: Sollie P, Duwell M, editors. Evaluating
new technologies, methodological problems for the ethical assessment of
technology developments. Dordrecht: Springer; 2009. p. 119–38.
[19] Swierstra T, Rip A. Nano-ethics as NEST-ethics. Patterns of moral
argumentation about new and emerging science and technology.
NanoEthics 2007;1:3–20.
[20] Lynch WT, Kline R. Engineering practice and engineering ethics.
Science, Technology and Human Values 2000;25:195–225.
[21] Swierstra T, Jelsma J. Responsibility without moralism in techno-
scientific design practice. Science, Technology and Human Values
2006;31:309–32.
[22] Doorn N, Fahlquist JN. Responsibility in engineering: toward a new
role for engineering ethicists. Bulletin of Science, Technology and
Society 2010;30:222–9.
[23] Zwart SD, van de Poel I, van Mil H, Brumsen M. A network approach
for distinguishing ethical issues in research and development.
Science and Engineering Ethics 2006;12:663–84.
[24] van Gorp A, van der Molen S. Parallel, embedded or just part of the
team: ethicists cooperating within a European security research
project. Science and Engineering Ethics 2011;17:31–43.
[25] Van der Burg S. Taking the “soft impacts” of technology into
account: broadening the discourse in research practice. Social
Epistemology 2009;23:301–16.
[26] Van der Burg S. Ethical imagination: broadening laboratory delib-
erations. In: Roeser S, editor. Emotions about risky technologies.
Dordrecht: Springer; 2006. p. 139–55.
[27] Fisher E, Mahajan RL, Mitcham C. Midstream modulation of tech-
nology: governance from within. Bulletin of Science, Technology
and Society 2006;26:485–96.
[28] Schuurbiers D. What happens in the lab: applying midstream
modulation to enhance critical reflection in the laboratory. Science
and Engineering Ethics 2011;17:769–88.
[29] Palm E, Hansson SO. The case for ethical technology assessment
(eTA). Technological Forecasting and Social Change 2006;73:543–58.
[30] Schuler D, Namioka A, editors. Participatory design: principles and
practices. Hillsdale: Lawrence Erlbaum; 1993.
[31] Rip A, Misa TJ, Schot J, editors. Managing technology in society. The
approach of constructive technology assessment. London and New
York: Pinter Publishers; 1995.
[32] Collingridge D. The social control of technology. New York: St.
Martin’s Press; 1980.
[33] Ihde D. The designer fallacy and technological imagination. In:
Vermaas PE, Kroes PA, Light A, Moore S, editors. Philosophy and
design. From engineering to architecture. Dordrecht: Springer;
2008. p. 51–9.
[34] Ihde D. Technology and the lifeworld. From garden to earth. Bloo-
mington: Indiana University Press; 1990.
[35] Heidegger M. The question concerning technology. In: Heidegger M,
editor. The question concerning technology and other essays. New
York: Harper and Row; 1977. p. 3–35.
[36] Borgmann A. Technology and the character of contemporary life.
Chicago: University of Chicago Press; 1984.
[37] Feenberg A. Questioning technology. London: Routledge; 1999.
[38] Dorrestijn S. Design your own life: over ethiek en gebruisvriendelijk
ontwerpen. In: Huijer M, Smits M, editors. Moralicide: Nieuwe morele
vocabulaires voor technologie. Kampen: Klement; 2010. p. 90–104.
[39] Albrecthslund A. Ethics and technology design. Ethics and Infor-
mation Technology 2007;9:63–72.
226 A.H. Kiran / Technology in Society 34 (2012) 216–226

[40] http://www.sciencedaily.com/releases/2010/09/100927155318.htm
[accessed 12.06.2012].
[41] Latour B. Pandora’s hope. Essays on the reality of science studies.
Cambridge, US: Harvard University Press; 1999.
[42] Verbeek PP. Moralizing technology, understanding and designing
the morality of things. Chicago: The University of Chicago Press;
2011.
Asle H. Kiran has a PhD from the Norwegian University of Science and
Technology in Trondheim in 2009. Currently he is working in the
Department of Philosophy at the University of Twente, the Netherlands, as
a post-doctoral researcher in the project Telecare at Home. He has pub-
lished articles on empirical philosophy of technology, phenomenology,
and on ethics in journals like Human Studies, Philosophy & Technology
and Knowledge, Technology and Society.