Treating Patients who have Substance Abuse Disorders and Chronic Pain

As a primary care physician, I see many patients who complain of chronic pain and who want me to prescribe pain medication. Many of these patients also have a history of substance abuse, however, and when I test them for active substance abuse by obtaining urine drug screens, the urine screens often come back positive for cocaine, methadone, fentanyl, marijuana, benzodiazepines, and other street drugs. So I must tell these patients I can't prescribe any opioid medication for their pain, because they're taking street drugs and need to stop taking dangerous, habit-forming drugs.
      Although my initial impulse may sometimes be to feel a little angry or disappointed that patients have tried to deceive me by lying to me about their substance abuse or by asking me for prescriptions for opioids when they knew they already had opioids and other illicit substances in their bloodstream, I think that denial, dissemblance, and concealment of active substance abuse may also be part of the substance abuse disorders that many patients suffer from. 
      I don't think the most caring or tactful way to tell patients I can't prescribe opioids for their pain is to say bluntly, "I can't prescribe opioids for you, because you're a substance abuser." This kind of response is likely to anger them, and seems rather callous, uncaring, and condescending.
      Some of the possible reasons why people might not want to be seen or described as substance abusers are that
      (1) It may hurt their sense of pride.
      (2) It may violate their sense of selfhood and individuality (they may feel they're being seen as just like everyone else who takes street drugs, and that everyone who takes street drugs is being seen as the same by the person who describes them as a substance abuser).
      (3) It may make them feel that the person who sees them as a substance abuser feels that he or she is better than them, and that they are being seen as somehow less worthy of respect (it may make them feel marginalized and disrespected, and it may violate their sense of equal worth and personal dignity).
      (4) They may in fact be in a state of denial that they are habitual substance abusers, and that their habit is in some ways dysfunctional.
      (5) They may be wary of losing various legal and welfare rights to which they are entitled and which they may be in danger of being denied if they're seen merely as substance abusers.
      (6) They may resent being labeled or dismissed as something they don't see themselves as (they may resent being assigned the label of "substance abuser" without their consent).
      (7) It  may make them feel they're being stereotyped, and that the uniqueness of their own life story, personal history, and social situation is being denied.
      (8) It may make them feel they're being told that whatever distress of misfortune they're suffering from is their own fault (they may feel that being told they're substance abusers is an example of "blaming the victim").
      (9) It may seem like an attempt to make them feel guilty about something they may or may not feel guilty about.
      (10) It may seem like an intrusion on their personal or social space (they may not welcome a wake-up call about their substance abuse disorder).
      (11) They may feel they're simply "self-medicating" (a term I think is often mistaken and misplaced. For someone to say "I was self-medicating" may often be a convenient way for them to try to disregard, deny, or justify their substance abuse disorder).

      So physicians must respond compassionately to patients who suffer from substance abuse and chronic pain, not by allowing themselves to be misled into prescribing drugs that such patients will abuse, and not by treating such patients as if they were any less worthy of respect than other patients, but by approaching them as individuals and developing treatment plans with them that will recognize and respond to their personal health care needs.

      The Maryland Board of Physicians guidelines for opioid prescribing include that before opioid prescribing, physicians should consider non-opioid therapies. Physicians should evaluate and inform patients of the risks and benefits of opioid use. They should establish a treatment plan and only continue prescribing opioids if the pain and functionality improvement outweigh the risks. They should screen for substance use disorders. They should consider red flags regarding potential abuse, misuse, and diversion of opioids. They should check the Prescription Drug Monitoring Program (PDMP) to review patient medical history of Controlled Dangerous Substances prescriptions. They should perform patient urine screening to confirm presence of prescribed medication and for undisclosed prescription drug or illicit substance use. And they should schedule a patient follow-up appointment 1-4 weeks after initial prescribing.¹
     The Maryland guidelines also include, regarding dosages and duration of opioids, that physicians should start low and go slow by prescribing the lowest effective dosages for the shortest possible duration. Physicians should avoid prescribing opioids and benzodiazepines concurrently. They should calculate the morphine milligram equivalent (MME) dosages, and if prescribing > 50 MME per day should increase appointment follow-up frequency and offer naloxone for overdose risk, should avoid prescribing > 90 MME per day if possible, carefully consider and justify such doses, and consider referring patients to a pain management specialist.²
     The Maryland guidelines also include, regarding continued treatment with opioids, that physicians should reassess treatment goals and determine if opioids continue to be the best option. Physicians should reassess no less frequently than every three months. They should consider whether there are clinically meaningful improvements in pain and function that outweigh the risks or harms of opioid prescribing. They should consider whether any new red flags of substance abuse disorder or diversion are present. They should perform periodic urine toxicology screenings. If over-sedation or increased overdose risk is present, they should taper opioid prescribing while considering patient psychosocial support. If tapering opioids, they should monitor for withdrawal symptoms.³
      The Maryland guidelines also include that for patients with substance abuse disorders, physicians should refer them for substance abuse treatment, should consider referring them to a pain management specialist, should consider medication-assisted treatment (MAT) such as buprenorphine, methadone, and naltrexone in combination with behavioral therapies, and should consider offering naloxone for those patients with high risk of overdose.⁴

      A complete statement of the Maryland Board of Physicians guidelines can be found at the Maryland.gov website.



FOOTNOTES

¹Maryland.gov Maryland Board of Physicians, "Board Guidance," at https://www.mbp.state.md.us/resource_information/res_con/resource_consumer_od_board_guidance.aspx
²Ibid.
³Ibid.
4Ibid.

Linda Zagzebski's Exemplarist Moral Theory

Linda Zagzebski’s Exemplarist Moral Theory (2017) is a very cogent and persuasive attempt to construct a comprehensive moral theory by directly referring to moral exemplars, of whom she identifies three types: heroes, saints, and sages. Moral exemplars, according to Zagzebski, are people we regard as admirable and may therefore attempt to emulate, because they embody moral virtues, such as love, compassion, wisdom, and courage. Exemplars of non-moral qualities, such as athletically gifted or artistically talented persons, may also be admirable, but they may not be imitable in the same way or to the same extent that we can imitate moral exemplars, unless they have developed their gifts or talents through other qualities that we can imitate, such as determination and hard work. 

      Zagzebski observes that we may sometimes be mistaken in our admiration of people, and we may sometimes envy or resent, rather than admire people for their admirable qualities. We may also disagree about what exactly we admire in some person(s). However, an advantage of exemplarist moral theory is that we may often be more certain that some people, like Confucius, the Dalai Lama, and the Buddha are admirable than we are of what exactly is admirable about them.¹ 

      Zagzebski also notes that we may not always be able to fully imitate the admirable qualities of moral exemplars, unless we completely refocus our lives, which may be very difficult for many of us. Even though such saintly figures as St. Francis of Assisi, St Catherine of Siena, and Mother Theresa may be very admirable for their self-sacrifice and love for strangers, we may not have the moral resources to be able to emulate them in every respect. We may also not always regard moral saintliness as something desirable or something we want to completely devote ourselves to trying to emulate. We may admire some things (such as lives of asceticism and self-sacrifice) without truly desiring them, and we may desire some things (such as lives of comfort and financial security) without truly admiring them. 

      Another point Zagzebski makes is that although the emotion of admiration is assigned a primary function in her moral theory, this fact in no way implies that admiration is necessarily a more trustworthy emotion than other emotions or that we should not attend to moral judgments justified by other emotions.² Admiration shares with other emotions the features of (1) having an intentional object, (2) having an affective component, and (3) having a potentially motivating aspect. However, there may be at least two kinds of admiration: admiration for inborn talent, and admiration for acquired excellence. The latter kind is the more important one for exemplarist theory. 

      Three possible responses to an admirable person may be (1) to feel positively about her, leading to a desire to emulate her, (2) to feel negatively about, or benignly envious of her, but still leading to a desire to emulate her, and (3) to feel negatively about, or malignantly envious toward her, leading to a desire to deprive her of her admirable qualities.³ The third kind of response (malignant or spiteful envy) may arise from a kind of resentment, in which the envious person sees her own lack of, or inability to acquire, the admired good, and thus tries to deprive the admired person of that good, rather than try to acquire it herself.⁴ 

      We may admire some people more than others if they are more consistently admirable or seem to have a deeper disposition to be admirable in a wider range of situations. We may also admire some people more than others if they are admirable in a greater variety of respects (for example, if they are tactful as well as honest, temperate as well as courageous). Moral examplars, according to Zagzebski, tend to be admirable in all or most of their acquired traits, although they don’t have be admirable to the highest degree in all their acquired traits (such a feat would be very difficult or impossible). 

      Zagzebski identifies Leopold Socha (1909-1946), a Polish sewage inspector who at great personal risk sheltered Jews from the Nazis during World War II, as an example of a hero. She identifies Jean Vanier (1928- ), a Canadian philosopher and theologian who founded L’Arche, an international federation of communities for the care of the mentally disabled, as an example of a saint. And she identifies Confucius (551-479 BCE) as an example of a sage. 

      Some of the distinctive qualities possessed by sages include wisdom, insight, understanding, reflectiveness, equanimity, open-mindedness, intellectual humility, fairness, self-discipline, and creativity in problem-solving.⁵ 

      Among the advantages of exemplarist moral theory, according to Zagzebski, are that it may serve as a map, rather than a supposed manual for moral decision-making. 

      Among the purposes of such a theory are (1) to create a comprehensive ethical theory that serves the same purposes as deontological, consequentialist, and virtue theories, (2) to have practical application by structuring moral theory around a motivating emotion—the emotion of admiration, (3) to explain and justify a genealogy of morals, and to track moral development, (4) to link theoretical ethics with empirical research in psychology and neuroscience, and (5) to meet the needs of different communities, and to frame the discussion of moral theory in cross-cultural discourse, by allowing different communities to identify distinct but overlapping sets of moral exemplars.⁶


FOOTNOTES 

¹Linda Trinkaus Zagzebski, Exemplarist Moral Theory (Oxford: Oxford University Press, 2017), p. 10. 

²Ibid., p. 28. 

³Ibid., p. 53. 

⁴Ibid., pp. 55-56. 

⁵Ibid., p. 95. 

⁶Ibid., pp. 3-4.

Some Equivalence Relations in Hegel's Phenomenology that may Provide a Key to its Understanding

Spirit = Reality (spirit is reality, and reality is spirit)

Reason = (all) Reality [reason is (all) reality, and (all) reality is reason]

Reason = the conscious certainty of being all reality¹ (or the certainty of consciousness that it is all reality²)

Reason = Spirit that knows itself in its truth, as the conscious certainty of being all reality³

Reason = Self-consciousness⁴ (which exists both in itself and for itself, because the self as an object of self-consciousness is both an object in itself and for itself)

Independent self-consciousness = self-consciousness that is purely for itself and not for another (not determined by another)

Dependent self-consciousness = self-consciousness that is determined by another

The relation between independent and dependent self-consciousness = in a metaphorical sense, the relation between lordship and bondage or between master and slave

The “unhappy consciousness” = divided self-consciousness = the consciousness that is conscious of itself as divided and unable to reconcile itself with another

Consciousness (including self-consciousness) = the simple substance of Spirit

Self-consciousness as reason = all reality

Idealism = the Notion that reason is the conscious certainty of being all reality

Consciousness, insofar as it has Reason = Spirit⁵ = Reality⁶

The moments (or stages) of consciousness = sense-certainty, perception, and understanding

Pure being = the essence of sense-certainty⁷

The entire system of consciousness = the entire realm of the truth of Spirit⁸

Spirit in its truth = the living ethical world⁹ = the individual form of Spirit that proceeds from and returns to the self of Spirit¹⁰ 

Spirit = Reason = concrete ethical actuality

Religion = the consciousness of absolute being¹¹ = the fulfillment of the life of Spirit

The Three Forms of Religion = Natural Religion, Religion in the Form of Art, and Revealed Religion

Natural Religion = Religion in which Spirit knows itself as its object in a “natural” or immediate shape¹²

Religion in the form of art = Religion in which the shape that Spirit takes is a form of self through the creative activity of consciousness¹³

Revealed Religion = Religion in which Spirit is presented in and for itself as a unity of its actual shape and true form of self¹⁴

Absolute being = the self-consciousness of Spirit¹⁵

Spirit as absolute being, which knows itself as all reality = all truth

Essence = that which has being in itself¹⁶ = the spiritual alone = the actual

The true alone = the actual

Spirit = self-supporting, absolute, real being¹⁷  

Absolute Being = Spirit that is in-and-for-itself, insofar as it is simple eternal substance¹⁸

Science = the Spirit that knows itself as Spirit¹⁹

The way to science = the science of the experience of consciousness²⁰

The description of the coming-to-be of Science as such = the phenomenology of Spirit²¹

(See also my review of the Phenomenology here.)


FOOTNOTES

¹Hegel’s Phenomenology of Spirit, translated by A.V. Miller (Oxford: Oxford University Press, 1977), p. 142.
²Ibid., p. 140.
³Ibid., p. 263.
⁴Ibid., p. 139.
⁵Ibid., p. 265.
⁶Ibid., p. 217.
⁷Ibid., p. 59.
⁸Ibid., p. 56.
⁹Ibid., p. 265.
¹⁰Ibid., p. 265.
¹¹Ibid., p. 410.
¹²Ibid., p. 416
¹³Ibid., p. 416.
¹⁴Ibid., p. 416.
¹⁵Ibid., p. 410.
¹⁶Ibid., p. 14.
¹⁷Ibid., p. 264.
¹⁸Ibid., p. 325.
¹⁹Ibid., p. 12.
²⁰Ibid., p. 56.
²¹Ibid., p. 15.

Chronology of the Life of Pauli Murray (1910-1985)

Nov. 20, 1910 – Anna Pauline Murray (she called herself “Pauli” from about the age of 20 onward¹) was born in Baltimore, the fourth of six children. Her mother, Agnes Fitzgerald Murray, who had been trained as a nurse at the Hampton Training School for Nurses, died of a cerebral hemorrhage in March 1914, in the fourth month of her seventh pregnancy, when Pauli was 3 years old. Her father, William Henry Murray, a graduate of Howard University, was a schoolteacher. However, in 1905, he became ill with typhoid fever complicated by encephalitis, and he was never mentally the same afterward.² In 1917, he had to be committed to the local mental hospital, and a year later was transferred to Crownsville State Hospital, where in 1923 he was murdered by a white guard, who beat him to death with a baseball bat.³ The guard was convicted of manslaughter, and was sent to prison for ten years.⁴

1914 – Pauli went to live with her aunt, Pauline Fitzgerald Dame, in Durham, North Carolina.

1926 – When Pauli was 16, she graduated from Hillside High School in Durham, and then moved to New York City to stay with her cousin Maude. In order to meet the entrance and residency requirements for Hunter College, which at that time was a women’s college that offered free tuition to city residents, she spent a year at Richmond Hills High School, graduating in 1927.

1930 – She married William Roy Wynn, but soon realized the marriage was a mistake, and they permanently separated. The marriage was finally annulled in 1949.

1933 – She graduated from Hunter College, one of four black women in a class of 247 women.

1937 – After the decline of a close relationship between her and Margaret (Peggie) Holmes, whom she had met in 1934, she suffered an emotional breakdown. She struggled with her transgender identity—she identified as a man in a woman’s body who was attracted to women.⁵ She was never able to publicly disclose or discuss her gender identity.

1938 – After she recovered, she applied to graduate school in sociology at the University of North Carolina, where her white great-great-grandfather had been a trustee,⁶ but she received a rejection letter that said explicitly, “members of your race are not admitted to the University.”⁷

1940 – Pauli and her friend Adelene McBean were arrested and jailed in Petersburg, Virginia for refusing to move to the back of a bus, thus violating state segregation laws.

1941 – Pauli enrolled at Howard University Law School, graduating in 1944 as the only woman and the top-ranked student in her class.

1943-1944 – She participated with other Howard Law School students in a series of cafeteria sit-ins, protesting racial segregation in local cafeterias and restaurants.

1944 – She applied for a post-graduate fellowship at Harvard University Law School, but received a rejection letter that said explicitly “you are not of the sex entitled to be admitted to Harvard Law School.”⁸ (Harvard Law School did not admit women as students until 1950.)

1945 – She earned a master’s degree in law from the University of California, Berkeley. After passing the state bar exam in 1945, she became California's first black deputy attorney general in January 1946.

1950 – She published States’ Laws on Race and Color, an extensive compilation of the laws of every state regarding racial segregation and discrimination. The book provided a valuable resource for the NAACP in its struggle against racial discrimination, and Thurgood Marshall, who was at that time NAACP Chief Counsel, described the book as the “bible” of the civil rights movement.⁹

1956 – Her biography of her family, Proud Shoes: The Story of an American Family, was published.

1956-1960 – She worked as an associate attorney for the New York law firm of Paul, Weiss, Rifkind, Wharton & Garrison, where she met Irene (Renee) Barlow, office manager, who became her close friend and companion.

1960-1961 – She taught at the University of Ghana School of Law, in Accra. She later coauthored with Leslie Rubin a work entitled The Constitution and Government of Ghana (1964).

1961 – She was appointed by President Kennedy to the President’s Commission on the Status of Women, serving from 1961-1963.

1963 – On Nov. 14^th, she delivered an address entitled “The Negro Woman in the Quest for Equality” to the National Council of Negro Women, in Washington, D.C., in which she criticized civil rights leaders for having failed to invite any women to deliver speeches at the March on Washington or to be a part of the delegation of leaders that met with President Kennedy at the White House afterward. She used the term “Jane Crow” for the twofold kind of discrimination that women of color are confronted with—discrimination not only on the basis of race (Jim Crow), but also on the basis of gender (Jane Crow).

1965 – She coauthored with Mary O. Eastwood an article in the George Washington Law Review entitled “Jane Crow and the Law: Sex Discrimination and Title VII.”¹⁰

1965 - She became the first African American to earn a doctoral degree from Yale University Law School. Her doctoral thesis was entitled “Roots of the Racial Crisis: Prologue to Policy.”

1966 – She was a cofounder of the National Organization for Women.

1967-1968 – She served as Vice-President of Benedict College in Columbia, South Carolina.

1970 – She published a collection of her poetry, entitled Dark Testament and Other Poems.

1971 – Ruth Bader Ginsburg, who wrote the plaintiff’s brief in the U.S. Supreme Court case Reed v. Reed, named Pauli Murray and Dorothy Kenyon as coauthors, in recognition of their influential work on gender discrimination. Reed V. Reed was the first case in which the U.S. Supreme Court ruled that the Equal Protection Clause of the Fourteenth Amendment prohibits gender discrimination.

1968-1973 – Pauli taught at Brandeis University, where she eventually received tenure as full professor in American Studies.

1973 – Irene Barlow, her longtime friend and companion, died of a brain tumor. Pauli decided to resign her professorship at Brandeis in order to enter General Theological Seminary in New York and study for the ministry.

1976 – She completed the third year of her seminary training at Virginia Theological Seminary, in Alexandria, Virginia, and received a Master of Divinity degree. Her master’s thesis was later published as “Black Theology and Feminist Theology: A Comparative Review” (in the Anglican Theological Review, January 1978, pp. 3-24). She described the strengths and weaknesses of black theology and feminist theology, and suggested that neither had yet fully explored the interlocking relation between racism, sexism, and classism.

1977 – She was among the first group of women to be ordained as Episcopal priests (on January 8^th, at the Washington National Cathedral), and was the first African American woman to be ordained as an Episcopal priest. She had been raised in the Episcopal Church in Durham, North Carolina, and her aunts Pauline and Sallie had been longtime members of St. Titus’ Episcopal Church in Durham.

1977 – On June 12^th, in a sermon at the Church of the Holy Comforter in Washington, D.C., she said,

      “Jesus of Nazareth…treated women as persons of equal dignity and worth with men…When he visited the home of Mary and Martha in Bethany, he approved of Mary’s rejection of the kitchen role and permitted her to sit at his feet and listen to his teaching as if she were a male rabbinical student. And when he was teaching in the temple, he refused to condemn the woman charged with being caught in the act of adultery, saying to the man who had brought her in, “Let him who is without sin among you cast the first stone.”…

      And women responded as disciples of Jesus, following him as he went about preaching the good news of the kingdom of God and using their own means to provide for him and his company. They followed him to the cross and stood by him during those agonizing hours of crucifixion when the other disciples had run away in fear. Women discovered the resurrection on Easter morning and went to tell the eleven; and according to John’s Gospel, Mary of Magdala was the first person to whom the Risen Lord appeared…

      The message of Jesus of Nazareth was that wholeness of being lies, not in superior status or exclusiveness…but in the ministry of love and service that recognizes human worth. And many women today, responding to that message, are seeking a theology which in symbol and language will help people to understand the wholeness of God and the oneness of humankind.”¹¹

1977 – On Oct. 12^th, in a lecture at Vassar College, she said,

“My own quest for freedom of self-expression and wholeness of personality in the face of severe societal restrictions imposed upon me by poverty in my youth, by racism, and sexism have had much to do with my interest in law and theology. In my earliest youth I sought to work out intolerable frustrations through poetry. As I became more deeply involved in the civil rights movement in the 1940s, I turned to law as a means of working within the system for social change. In time, as the world crisis has deepened, I began to realize that the law by itself is inadequate to cope with fundamental moral and ethical issues of our time, and this led me to theology. I cannot pretend that I have found a synthesis, for my feminist outlook sharpens the tensions experienced in trying to come to terms with a continuous struggle for authentic selfhood...The synthesis that I strive for is one that harnesses the creative urge to a vision of a more humane society and in which I can direct whatever talents I possess toward making that vision a reality.”¹²

1978 – She served as priest in several parishes in Washington, D.C., Baltimore, and Pittsburgh, but had to retire at age 72, due to church rules regarding retirement.

1979 – On March 28^th, in a lecture at the Church of the Atonement, in Washington, D.C., she said,

“True community is based upon equality, mutuality, and reciprocity. It affirms the richness of individual diversity as well as the common human ties that bind us together. The marks of a community of faith are communion, participation, mutual trust, sharing, and fellowship. A community of faith is both social and sacramental. As Professor Letty M. Russell of Yale Divinity School defines it, “Communion is participation with Christ in his work as the representative of God’s love to others, and sharing with his community in common actions of celebration, reflection and service to the world.” This is what we do in our Lenten season in a special sense, for following our celebration of the Holy Eucharist and sharing of a common meal, we reflect together on how we can respond to world hunger for human dignity as well as physical sustenance.”¹³

1985 – She was featured in a segment of Charles Kuralt’s “On the Road” program on CBS.

1985 – On July 1, at the age of 76, she died of pancreatic cancer in Pittsburgh. She was buried under the same headstone as Irene Barlow, in Cypress Hills Cemetery, Brooklyn, New York.

1987 – Her autobiography, Song in a Weary Throat: Memoir of an American Pilgrimage was published.

FOOTNOTES

¹Rosalind Rosenberg, Jane Crow: The Life of Pauli Murray (Oxford: Oxford University Press, 2017), p. 39.

²Pauli Murray, Song in a Weary Throat: Memoir of an American Pilgrimage (New York: Liveright Publishing Corporation, 1987), p. 13.

³Ibid., p. 72.

⁴Ibid., p. 73.

⁵Rosalind Rosenberg, Jane Crow: The Life of Pauli Murray, pp. 55-60.

⁶Ibid., p. 4.

⁷Song in a Weary Throat, p. 148.

⁸Ibid., p. 310.

⁹Ibid., p. 373.

¹⁰In this groundbreaking article, Murray and Eastwood explained that the typical excuses or arguments given by employers for gender discrimination—namely, (1) the argument that, supposedly, women are only temporary workers, because they will leave work to marry and raise children, (2) the argument that certain customers or clients may prefer to utilize the services of men rather than women, (3) the argument that men may be physically stronger or have more physical endurance than women, and (4) the argument that employers may have to provide separate facilities, such as dressing rooms or restrooms, for women, thus requiring additional expenses on the part of the employer—do not, according to Title VII of the 1964 Civil Rights Act, justify gender discrimination. (Pauli Murray and Mary Eastwood, “Jane Crow and the Law: Sex Discrimination and Title VII,” 34 George Washington Law Review, 1965, abridged version in Radical Feminism, edited by Anne Koedt, Ellen Levine, and Anita Rapone, Times Books, 1973, pp. 165-176.)

¹¹Pauli Murray, “Sermon, June 12, 1977,” in Pauli Murray: Selected Sermons and Writings, edited by Anthony B. Pinn (Maryknoll: Orbis Books, 2006), pp. 67-69.

¹²Pauli Murray, “Synthesis: Theology, Feminism, and the Law—The Impact upon a Creative Writer,” in Pauli Murray: Selected Sermons and Writings, pp. 206-207.

¹³Pauli Murray, “Challenge of Nurturing the Christian Community in Its Diversity,” in Pauli Murray: Selected Sermons and Writings, pp. 210-211.

What is Technophilosophy?

Technophilosophy (or technological philosophy) may be defined in a variety of ways. It may include the philosophy of technology (“tech philosophy”), the philosophy of engineering, the philosophy of computer science, and cyberphilosophy, as well as technofeminism, technocultural futurism (including Afrofuturism, Latin@futurism, and other futurisms), and other cultural or aesthetic movements embracing the philosophy of technology, the philosophy of science, and social philosophy.

      It may also be a philosophy based on, or supported by, technology. Thus, it may be a philosophy founded on, or supported by, computers.

      It may also be a philosophy aimed at promoting the use of technology (in various settings and in society as a whole).

      It may also be the philosophy of a technological society or era.

      It may also be a philosophy inspired by technology. Thus, it may be a philosophy of the technological self (e.g. the online identity, anonymity, or reality of the self) and technological others. It may also be a philosophy of the machine (e.g. regarding the ability of machines to think or to act intelligently) and machine-like beings.

      Technophilosophy may also be any philosophy disseminated by technological means (e.g. by online philosophy encyclopedias, journals, blogs, podcasts, or videos). Thus, it may be an electronic or e-philosophy, an integral component of the world of e-books, e-learning, and other online technology.

      Technophilosophy may also be a discipline analogous to technoart, technodance, technomusic, technoscience (including technobiology, technochemistry, and technophysics), and technopolitics.

      It may be conventional or unorthodox, aboveground or underground.

      Technophilosophy (and the philosophy of technology) may include the study of the ethics, aesthetics, metaphysics, epistemology, and politics of technology. Thus, technophilosophy may include technoethics, technoaesthetics, technometaphysics, technoepistemology, and technopolitics.

      Peter A. Angeles (1992) explains that in ancient Greek philosophy, techne (art, skill, or craft) referred to (1) anything deliberately created by humans, in contrast to anything not humanly created, (2) any skill in making or doing things, (3) knowledge of how to do or make things, as opposed to knowledge of why things are as they are, and (4) professional knowledge of the procedures involved in making or doing things. Such terms as “technique," “technical,” and “technology” are derived from the Greek concept of techne.¹

      Technology is pervasive in modern culture and society. Thus, the philosophy of technology may include the study of agricultural, educational, energy, and environmental technology, as well as film and video, financial, communications, medical, military, and space technology.

      Philosophers of technology include Plato (Laws), Aristotle (Physics), Francis Bacon (New Atlantis, 1627), Ernst Kapp (Grundlinien einer Philosophie der Technik, 1877), José Ortega y Gasset (Meditación de la técnica, 1939, translated as “Thoughts on Technology,” 1972), Martin Heidegger (Die Frage nach der Technik, translated as “The Question Concerning Technology,” 1977), and Lewis Mumford (Technics and Civilization, 1934). 
      Philosophers of technology also include Marshall McLuhan (Understanding Media: The Extensions of Man, 1964), Michel Foucault (Technologies of the Self, 1988), Donna Haraway (Simians, Cyborgs, and Women: The Reinvention of Nature, 1991), Avital Ronell (The Telephone Book: Technology—Schizophrenia—Electric Speech, 1989), Don Ihde (Technics and Praxis, 1979; Bodies in Technology, 2001), Jacques Ellul (The Technological Society, 1964), Carl Mitcham (Thinking through Technology: The Path between Engineering and Philosophy, 1994), Fernando Broncano (Nuevas Meditaciones sobre la Técnica, 1995; Mundos Artificiales: Filosofía del Cambio Technológico, 2000), and Shannon Vallor (Technology and the Virtues: A Philosophical Guide to a Future Worth Wanting, 2016).

      José Ortega y Gasset (1939) defines technology as the improvement brought about by us on nature for the satisfaction of our necessities.² It is also a reform of those aspects of nature that place us in need. Thus, the concept of human necessity is fundamental to our understanding of technology.³ The mission of technology consists in releasing us for the task of being ourselves.⁴

      Michel Foucault (1988) says there are four major types of techniques or technologies that we can use to understand ourselves: (1) technologies of production, which permit us to produce, transform, or manipulate things, (2) technologies of sign systems, which permit us to use signs and symbols to communicate meanings, (3) technologies of power, which determine our conduct and submit us to certain ends, and (4) technologies of the self, which permit us “to effect by [our] own means or with the help of others a certain number of operations on [our] own bodies and souls, conduct, and way[s] of being, so as to transform [ourselves] in order to attain a certain state of happiness, purity, wisdom, perfection, or immortality.”⁵

      Foucault says these four types of technologies hardly ever function separately, although each of them may imply a certain mode of training or modification, not only in the sense of our acquiring certain skills, but also in the sense of our acquiring certain attitudes.⁶

      Carl Mitcham (1994) distinguishes between the engineering philosophy of technology and the humanities philosophy of technology. The former begins with an analysis of the nature of technology itself, while the latter begins with an analysis of the relation of technology to art, literature, ethics, politics, and religion.⁷

      Thomas A.C. Reydon (2018) describes three approaches to (or ways of conceiving) the philosophy of technology: (1) as systematic clarification of the nature of technology, (2) as systematic reflection on the consequences of technology for human life, and (3) as systematic investigation of the practices of engineering, invention, designing, and making of things.⁸

      Frederick Ferré (1995) describes a number of possible questions regarding the use of current technologies, such as (1) What should be the role of technology such as robotics and automation in the workplace? (These technologies may in some cases cause workers to lose their jobs, their sense of personal autonomy, or their input regarding their job duties.) (2) What are the risks of relying completely on computers? (In addition to security and privacy concerns, there may be concerns regarding responsibility for error when computers are required to make important decisions.) (3) What limits should be set on the development of nuclear technology? (4) What kinds of technologies need to be transferred to developing countries? (5) What limits should be imposed on genetic engineering and the development of reproductive technology?⁹

      David E. Nye (2006) asks, “Do we control technology or does technology control us?” Do we shape the machines and systems that surround us or are we shaped by them? (According to social constructivists, technology is shaped by us, but according to technological determinists or constructivists, we are determined or shaped by technology.) Are we using technology to destroy the natural world or to protect it? Are we trying through technology to undermine democracy or to enhance it? Are we trying to make the world more secure or to make it more dangerous?¹⁰

      Concerns that may arise regarding the use of new or existing technologies include their ability to fulfill particular needs, their impact on quality of life, their impact on human health, their impact on social equity (who will benefit from them, and who won’t?), their expense, their cost effectiveness, their ability to support economic growth, their environmental sustainability, their use of renewable or nonrenewable natural resources, and their energy efficiency.

      The risks of technology may include the rise of a technocracy (a non-elected ruling class of technicians or a technoelite) whose decisions can, or could, in innumerable ways, impact our daily lives. In politics, a technocracy (as opposed to a democracy, but perhaps in some ways similar to an aristocracy or plutocracy) might take the form of a government ruled or dominated by a class of technological executives or corporate directors. A technocracy might also be a government based on or guided by technological principles, or a form of control of (public, social, and cultural) resources and institutions by technological executives, companies, or industries.

      Technophilosophy should therefore not be left to fall into the hands of a wealthy and powerful technoelite. Technophilosophy may be avant-garde or futuristic in its embrace of technology and its interest in finding new ways of doing philosophy, but it should not avoid the responsibility to recognize and attempt to remediate social and cultural factors that contribute to inequitable access to technology. Another responsibility of technophilosophy may be that of recognizing, questioning, and challenging the methods by which technology becomes a means of social control.

      Other risks or possible pitfalls for technophilosophy (and for philosophy of technology) include technicism and technocentrism. Technicism, as defined by Egbert Schuurman (1997), is the attitude that all problems can be solved by scientific-technological methods.¹¹ (Technicism may be analogous to scientism, the attitude that all questions can be answered, and all problems can be solved, by scientific methods.) Schuurman explains that among the risks of technicism in the field of genetic engineering are that it may result in the technicization of living organisms, resulting in the loss of genetic and bio-diversity. This may in turn lead to a possible increase in susceptibility of genetically engineered organisms to unknown diseases. If we accept the technological model for plants, animals, and human beings, says Schuurman, then we may see them merely as technological artifacts that we can manipulate, and we may neglect their dignity and integrity.¹²

      Technocentrism, as defined by to Seymour Papert (1988), is the attitude that all questions center on the uses of technology.¹³ Technocentrism may focus on technological solutions to educational, economic, social, and cultural problems, to the extent that it disregards or neglects non-technological kinds of solutions.

      Cyberphilosophy has been described as the intersection of philosophy and computing.¹⁴ Cyberphilosophy may include cyberethics (including the ethics of hacking, identity theft, violations of privacy, and so on), cyberaesthetics (including the aesthetics of computer hardware, architecture, programming, and website design), cybermetaphysics (concerning the nature of cyberspace, computer-generated worlds, and virtual reality), cyberepistemology (concerning the relation between computing and the theory of knowledge, and also concerning the kind of collective building and sharing of knowledge that’s represented by openly editable websites like Wikipedia), cyberpolitics (including cyberactivism, journalism, and blogging regarding such issues as internet censorship, access, and net neutrality), and cyberphilosophy of mind (including examination of the relation between computation and thinking or consciousness). Cyberphilosophy may also be concerned with human-computer interaction, and with cyberculture studies.

      Technofeminism, according to Judy Wajcman (2004), may examine the role that gender plays in technology and the ways in which technology is gendered. It may also investigate and interrogate the sexual politics of technology, and it may examine the relationship between woman and machine.¹⁵

      The technosphere (the technological context in which we live¹⁶) consists of all the structures we’ve built in order to help us survive on the planet.¹⁷ It includes such structures as highways, buildings, machines, tools, equipment, and computer systems. The other spheres of the Earth are the lithosphere (the solid surface layer of the Earth), the atmosphere (the layer of air that stretches above the lithosphere), the hydrosphere (the Earth’s water—on the surface, in the ground, and in the air), and the biosphere (the part of the lithosphere, hydrosphere, and atmosphere that supports life). The physical technosphere includes the urban, rural, subterranean, marine, and aerial technospheres. Components of the technosphere include artifacts that may eventually become technofossils (preserved material remains of technological artifacts, which we may find nearly everywhere).¹⁸

FOOTNOTES

¹Peter A. Angeles, The HarperCollins Dictionary of Philosophy (New York: HarperCollins Publishers, 1992), p. 308.

²José Ortega y Gasset, “Thoughts on Technology” [1939], in Philosophy and Technology: Readings in the Philosophical Problems of Technology, edited by Carl Mitcham and Robert Mackey (London:  Collier Macmillan Publishers, 1972), p. 292.

³Ibid., p. 294.

⁴Ibid., p. 300.

⁵Michel Foucault, “Technologies of the Self,” in Technologies of the Self: A Seminar with Michel Foucault, edited by Luther H. martin, Huck Gutman, and Patrick H. Hutton (London: University of Massachusetts Press, 1988, p. 18.

⁶Ibid., p. 18.

⁷Carl Mitcham, Thinking through Technology: The Path between Engineering and Philosophy (Chicago: The University of Chicago Press, 1994), p. 62.

⁸Thomas A.C. Reydon, “Philosophy of Technology,” in The Internet Encyclopedia of Philosophy, ISSN 2161-0002, https://www.iep.utm.edu/, 2018.

9Frederick Ferré, Philosophy of Technology (Athens: The University of Georgia Press, 1995).

¹⁰David E. Nye, Technology Matters: Questions to Live With (Cambridge: The MIT Press, 2006), p. x.

¹¹Egbert Schuurman, “Philosophical and Ethical Problems of Technicism and Genetic Engineering,” in Techné: Research in Philosophy and Technology, Fall 1997, Vol. 3, No. 1, online at https://scholar.lib.vt.edu/ejournals/SPT/v3n1/schuurman.html.

¹²Ibid.

¹³Seymour Papert, “A Critique of Technocentrism in Thinking About the School of the Future,” in Children in the Information Age, 1988, pp. 2-18, online at http://www.papert.org/articles/ACritiqueofTechnocentrism.html.

¹⁴James H. Moor and Terrell Ward Bynum, “Introduction to Cyberphilosophy,” in Metaphilosophy, Vol. 33, Nos. 1/2, January 2002, p. 26.

¹⁵Judy Wajcman, Technofeminsim (Malden: Polity Press, 2004).

¹⁶Ferré, Philosophy of Technology (Athens: The University of Georgia Press, 1995), p. 1.

¹⁷University of Leicester, “Earth’s ‘technosphere’ now weighs 30 trillion tons, research finds,” Nov. 30, 1016, Phys.Org, online at https://phys.org/news/2016-11-earth-technosphere-trillion-tons.html.

¹⁸Jan Zalasiewicz, et al., “Scale and Diversity of the Physical Technosphere: A Geological Perspective, “ in The Anthropocene Review, Vol. 4, Issue 1, Nov. 28, 2016, pp. 9-22.