Wouter Mensink ‘Subject of innovation, or: how to redevelop the patient with technology’. PhD thesis, University of Leiden, The Netherlands, 2012.
Pdf of thesis on University of Leiden library site
People are shaped in many ways: as subject of scientific inquiry, as part of a political category or in relations with others. Alternatively, they shape themselves. Michel Foucault examined such ways of ‘subjectivation’: the manner in which the human ‘subject’ is formed. He is most famous for his work on the role of surveillance in society. Contemporary critics argue that the surveillance he describes was only possible in the industrial era, in which people were often confined to closed spaces: schools, factories or hospitals. With the coming of the information era, however, the surveillance model is said to be defunct. People are much more distributed, to name just one distinction.
One way of assessing the value of Foucault’s work for present-day questions is to examine how ‘subjectivation’ relates to technology. His work on neoliberalism provides a starting-point. We do need to look further though, for example at Bruno Latour’s work. He claims that technologies are to people what ‘plug-ins’ are to the internet. The web is personalised by installing different plug-ins, add-ons or apps. Similarly, our subjectivity is shape by the technologies with which we engage. Question is how this turns out in practice.
In order to take such a practical angle at these philosophical questions, this study examines the case of healthcare innovation. It articulates how patients are shaped in relation to technology. Technology is placed in a particular context when it is drawn into a discussion about innovation. The Dutch Electronic Health Record and the Personal Healthcare Budget are political designs that aim to foster innovation. Both policies started mid-1990s and were nearly abolished in 2011. What happened over the course of these one and a half decades?
Apart from these two policies, the study also covers other innovation-related developments in Dutch healthcare: the so-called Diagnosis Treatment Combinations, functional description techniques for health insurances, the Quality-Adjusted Life Years calculation and medical chat rooms.
It ends by examining the possibilities of democratising healthcare innovation, by investigating the example of ‘Living Labs’. These are local or regional platforms in which people are in some way involved in innovation processes. Just like for the different policies, the crucial question is: which role is attributed to the patient?