The Future of Digital Surveillance and Healthcare: A Conversation with World Leading Philosopher Stefan Lorenz Sorgner

by Lifeboat Foundation Advisory Board member Dinorah Delfin.
 
 

Introduction

Biotechnologies are giving us the ability to create algorithms that allow us to better understand and monitor what is happening inside of the human body by means of implanted chips that measure bodily processes and generate biometric data.
 
By means of this data, we can also get warnings before a disease develops. The same chips can also be used to prevent future epidemics by spotting infected people and isolating them.
 
If we are not careful, however, the current pandemic might mark the beginning of a new form of totalitarian surveillance – one that is based on collecting biometric data to predict and manipulate human behavior.
 
Historian, philosopher, and best-selling author of “Sapiens” and “Homo Deus”, Yuval Noah Harari, warns us that "one of the biggest battles of the 21st Century is likely to be between privacy and health."
 
He says: “If you know, for example, that I clicked on a Fox News link rather than a CNN link, that can teach you something about my political views and perhaps even my personality. But if you can monitor what happens to my body temperature, blood pressure, and heart-rate as I watch the video clip, you can learn what makes me laugh, what makes me cry, and what makes me really, really, angry.”
 
Authoritarian governments might argue that citizens are not capable of doing the right thing when it comes to public health and demand that everyone is monitored with implants.
 
Harari thinks that most people will be willing to give up a very significant amount of privacy for the promise of a far better health care system that can also prevent future pandemics.
 
The permanent monitoring of human bodies by means of implanted technologies by anyone other than ourselves is incredibly frightening.
 
Is this the only option we have?
 
To have a better understanding of this situation I contacted Professor Stefan Lorenz Sorgner, a distinguished philosopher at John Cabot University in Rome, Italy.
 
Stefan, also a bioethicist, a metahumanist, and the Founder and Editor-in-Chief of the Journal of Posthuman Studies published by Penn State University Press since 2017, “counts as one of the world’s leading experts on trans- and posthumanism”, according to Wolfgang Welsch (FSU Jena).
 
For over 15 years, Stefan has focused his research on the ethical implications of human enhancement technologies. The Italian philosopher Gianni Vattimo from the University of Turin says that “In Stefan Lorenz Sorgner’s work, the profound originality is accompanied by a vast knowledge of the philosophical tradition. His exploration of the philosophical meanings of post-humanism has become a point of reference that contemporary culture cannot ignore.” We will take this recommendation seriously, and see what he has to say about the current pandemic crisis.
 
 

Interview

The following interview by Dinorah Delfin took place by email on April 2020:
 

Dinorah Delfin
DD – Even though implantable technologies present so many risks and dangers like hacking, it is a highly provocative option, why?
 
SLS – The possibilities which go along with it are enormous. The advantages clearly outweigh the challenges. Hacking and security needs to be dealt with anyway. However, the constant monitoring of one’s own body could be decisive for the readiness to combat aging-related processes. As soon as the blood sugar level, cholesterol level, or blood pressure seem to change in a problematic way, people could be digitally warned, so that the problem can be addressed as soon as it arises and not only when it is well advanced.
 
Even a predictive maintenance of human health might be possible on the basis of these technologies. Predictive maintenance is being used in the Industry 4.0 so far. Sensors within a plane can tell us that a specific part of the engine is likely to become dysfunctional within the next 6 months. We can replace this part, so that no risk for human lives in this respect has to occur. With RFID chips entering the human body, we can realize the predictive maintenance of human health.
 
Researchers of Tufts University have already developed a tooth-mounted sensor which tracks every bite someone is making. Further such sensors could make up an entire Internet of Bodily Things which can then interact with the regular Internet of Things. The possibilities associated with this type of body monitoring are enormous and are likely to be of significant relevance in combating aging-related processes.
 
Here, the aspect of human flourishing comes in. Technologies have always increased the likelihood of our flourishing, and human beings have a great variety of associated goals. Yet, there are some challenges which are troublesome for most of us, and one of these challenges is the process of aging. Two thirds of all deaths are related to aging-related processes.
 
DD – Yuval believes that there does not have to be a conflict between privacy and health, why do you disagree?
 
SLS – To effectively promote health, big data is needed, and the more data we get, the more reliable our correlations are, and the more informed our decisions can be. Data is also needed for innovations, scientific research, as well as policy making. All these processes are central for a society. If a society wishes to flourish, it needs to have big data based upon total surveillance. The only reliable way to get it is by making governmental access to personalized data obligatory. Yet, this does not necessarily mean that we get robbed by the state. It is merely important that we get something for our data, which is in our interest!
 
Collecting data is particularly important when it comes to the issue of health. If we as a society have to choose between health and privacy, we should choose health, because the majority of citizens identify an increased health span with a better quality of life. We have no reasons for being sad about giving up our privacy. This is because it only seems that we cherish privacy, but, in fact, we do cherish freedom. While we cannot have health and privacy, the good news is that we can have health and freedom.
 
DD – How could we put in place a global health care system without compromising our personal data?
 
SLS – We need to take one step after the other. There is not even a universal health insurance available in the U.S. so far. However, having a universal health insurance is an enormously important achievement. Firstly, we need to focus on realizing universal health care systems within states. Health is not a commodity. It is an expensive, widely desired good. Even in European countries the quality of the universal health insurances varies significantly from country to country, and even within countries. It matters a lot how much money a country spends on health. If less money is available, and there is never too much money available, different sources for realizing an efficient health insurance are needed. Data is a very promising source.
 
Developing a new drug is risky and costs a lot of money. If a pharmaceutical company has successfully developed a new drug, and has patented the inventions, they have got the exclusive right for 20 years to realize a financial gain out of their patent. They can charge whatever amount of money they want for the drug developed. This makes sense, as they took the risk and financial burden to develop the drug in the first place.
 
However, data is needed for developing new drugs. Where do they get the data from? In a political regime with a total digital surveillance system, the government stores and projects the available personalized data, and they can then pass depersonalized data on to others, e.g. a drug company. Getting access to this data is in the interest of the company, since it supports the R&D activities. In this way, certain limitations can be imposed on the developing company.
 
The pharmaceutical company can no longer charge whatever is in their interest, as the drug was developed on the basis of data provided by people. The data was made accessible on the basis of a contract with the government which limits the rights of the drug company. In this way, it can be guaranteed that newly developed drugs can be made available to the people at a financially more accessible basis, or in a way that it can be included in the universal health insurance. Hence, storing and using the data by the government is not an expropriation but a payment. We support the payment of a universal health insurance by means of our personalized data. This is what I mean by democratizing the use of collecting the data.
 
DD – How could we use implantable and wearable technologies to empower citizens?
 
SLS – In Sweden, it is already an option to have a chip being implanted to substitute for your passport. This ought to generally become a legal obligation for realizing a first step towards upgrading humans. However, any surgery implies a harm being done to a person. So the following question arises: Can a certain type of bodily harm become legally obligatory? The answer has to be a “yes”. Vaccinations are the best example. If the procedure is reliable, without significant side effects, and with great advantages, then such a procedure can be justified. Given the enormous advantages and relevance for an increased lifespan, legal obligation of vaccination is justified.
 
DD – What is the appropriate way to prevent future pandemics?
 
SLS – Upgrading human bodies by means of RFID chips is the most promising means for doing so. These devices can be used concerning different kinds of diseases. An HIV infection could be detected promptly, so that appropriate medication can be prescribed immediately to minimize the physical viral load. At the same time, this means is of relevance for the containment of epidemics that can hardly be underestimated. Those infected with the coronavirus (Sars-CoV-2) could be immediately detected, isolated and treated, if human beings upgraded by chips become the new norm.
 
We are not that far off. Widely used smartphones would only have to be integrated into our bodies, instead of just carrying them around as external devices. But even in this way, comprehensive digital surveillance can already be used efficiently in the event of an epidemic.
 
China is doing this in the case of the coronavirus pandemic. There, the implementation of smart cities is already further advanced. Citizens receive a traffic light on their smartphones that is supposed to indicate the probability of an infection. If the light is yellow, citizens are obliged to isolate themselves for 7 days; if it is red, the isolation should last 14 days. The assessment is based on the evaluation of big data. Which infected person has stayed where, when and for how long? Who was in the affected areas? Who interacted with whom, when, for how long? If one also takes into account the behavioral patterns of the digital data of those actually infected, the probability of an infection can be calculated solely on the basis of a person’s interaction pattern. The associated possibilities to contain an epidemic are numerous.
 
DD – According to Karen Sandler, executive director of the Software Freedom Conservancy, “there is one bug for every 100 lines of software… a pacemaker, for instance, has 70,000 lines of code.” Are you in favor of monitoring your own biometrics?
 
SLS – It has to become a legal obligation to let your biometrics permanently get monitored to guarantee that your central interests can be realized. For the sake of promoting health, we need to abandon privacy. I am aware that this is a challenging thought, and it terrifies me, too. Yet, if you consider the various options and implications, then it seems as the best possible feasible option. I am making these suggestions as an as-good-as-it-gets ethics. No solution will be without challenges, but all things considered this way of dealing with privacy is as good as it gets. Why do we think that we need privacy? There are two main theories that explain this, the property theory and the sanction theory, and they are not mutually exclusive.
 
According to the property theory, data is our intellectual property and therefore an extension of ourselves. If governments or anybody else take away our data, they seem to expropriate us. But is this necessarily the case? If data is our property that we can exchange for other goods in our favor, such as our health insurance, then this is not an expropriation. Having a universal health insurance is an enormously important achievement, but keeping the system alive demands huge financial inflows. Using our data to partially compensate for this service is in the interest of a society.
 
Furthermore, the sanction theory states that we fear that the data being collected, stored, and used by a government could be the grounding for sanctions against us. We fear sanctions. However, sanctions are necessary. If a murderer of an innocent child gets caught and sanctioned, this is just and widely accepted by the society. We merely do not wish to be sanctioned for acts which should not be sanctioned, neither morally, institutionally, nor legally. This is the crucial issue. The fear of such sanctions is also the reason why we fear our personal data being stored in one place. But how can these fears be dispelled?
 
First, we need to reduce the possibility of access to the data by humans, because the risk of abuse is too high. Data should primarily be granted to algorithms. Only in specialized circumstances should humans have the right to access the data. This is a significant challenge which permanently needs to be dealt with.
 
Second, we need to become much more open and pluralistic. You should only be punished for acts where direct harm is being done to another person. Currently, this is far from being the case in many parts of the world, even in the most developed democracies, such as Germany, where, for instance, incest among consenting adults is prohibited. It is merely a contract among two or more consenting adults to have sex together. The government should not have the right to have any say in this respect. By the way, incest among consenting adults is legal in Spain.
 
Third, we need to promote e-governance to make decision making processes concerning our data more transparent.
 
It is not necessary that total surveillance leads to freedom, but total surveillance can be in our interest under the circumstances I just mentioned. Total surveillance must not be expropriation, but it could be our payment for something the majority of people regards as an important determinant of the quality of life, namely our health. We pay with our data for our universal health insurance. Total surveillance does not have to lead to illegitimate sanctions either. To reduce the risk of this taking place we need to store our personalized data safely, and it ought to be primarily accessible by algorithms. Finally, we need to promote plurality much further. Each person should have the right to live in accordance with his or her idiosyncratic needs, wishes, and longings.
 
DD – Yuval believes that instead of building a surveillance regime, it is not too late to rebuild people’s trust in science, in public authorities, and in the media. Do you agree?
 
SLS – Reliance on people’s trust in science, public authorities, and media is not sufficient for generating all the data which we need. In order to make sure that we get sufficient information about rare diseases, that everyone has the possibility for increasing their individual health span, and to prevent others from getting infected, the collection of digital data by means of total surveillance is needed.
 
DD – How much of your privacy would you give up for your survival?
 
SLS – We have to give up all of our digital data, but it ought to be done in a democratic manner. If the suggestions I am making here are being considered, then we would have a proper democratic use of our data. If such a system of surveillance was embraced in Europe then we would use our data in a proper democratic way, in a way that is in tune with central achievements of the enlightenment, instead of wasting the precious resource the data is, which is currently happening in Europe. This undermines our strongest interests.
 
Other influential nations have different ways of dealing with data. In China, the data is collected by the government on the basis of values and norms which cannot be reconciled with our European standards. It is an efficient way, as the government has the capacities of realizing total surveillance, but the enlightenment norm of freedom is too important for us. We need to stick to it and fight for it.
 
In the U.S., the data is collected by big companies. They thereby turn into quasi-political players, who have the potential to undermine the foundations of liberal democratic societies. Another challenge which goes along with this way of dealing with data is that only specialized data is being collected. In order to collect all the relevant data, the data needs to be sold in between the companies or the companies and the government. This might also not be an efficient way for getting a comprehensive amount of data, so that hidden information can be spotted. In addition, it undermines that the users who produce the data benefit from it in the appropriate manner due to the power difference between big companies and individuals. Both the U.S. as well as the Chinese option are not appropriate for Europe, which makes it an enormous challenge to economically compete with these nations.
 
We need to find a proper democratic usage of our data. In order to do so, we need to rethink the meaning of data, and to reconsider our judgement on data collection, as we need to make a choice between health and privacy. And in making this choice, we should go for freedom.
 
DD – Ethicist and Political Theorist Harvard professor, Danielle Allen, talks about our current need to massively scale up testing and contact tracing to achieve pandemic resilience, “but that can’t mean turning toward methods that trample civil liberties and disregard justice,” she adds. 
 
Danielle talks about the need to establish non-commercial, peer-to-peer encrypted systems whereas the government or tech companies can’t have access to citizens’ biometrics. She says, “For instance, developers are working on apps that permit people to opt into GPS and Bluetooth-based data systems that will send them warnings if their phone has moved along the same path as the phone of someone else who has also opted into the system and who has reported a positive test for the coronavirus."
 
The contact tracing system Danielle proposes is inspired by a program that was established in New York to tackle HIV which was created around a culture of “Opting-In”. The data collected exists for a period of time in the user’s phone, and then it gets deleted. 
 
What are the advantages and disadvantages of this approach compared to the centralized data collection systems proposed by you?
 
SLS – There have been discussions about a similarly structured system in Europe, too. However, it rests on several problematic assumptions. You need to have an enlightened public where an enormous amount of people are willing to participate and who are willing and ready to opt-in. In particular in countries with a long standing liberal tradition, this is an enormous challenge.
 
There are many reasons why people might decide not to opt-in or why this approach is not a helpful one: lack of knowledge of being coronavirus positive, digital exclusion, a lack of understanding, a lack of trust, a fear of sanctions, laziness, joy of being a free rider, a lack of care, or an absence of a strong individual motivation.
 
In the end, there are too many people who do not know their health status, are digitally excluded, have a lack of trust, or fear the risk of having something to lose, who would not be willing to opt-in. The availability of such an app might even worsen the situation, as it also conveys a false feeling of security, which might increase the likelihood of people taking fewer precautionary measures.
 
The central issue which needs to be taken seriously is that we already have a clear empirical evidence for a lack of interest in participating in opt-in solutions, even though a specific act is seen as morally right. The case of getting registered as an organ-donor is structurally analogous to that of opting into a coronavirus app. In several countries with an opt-in option concerning organ donations, donating one’s organs is seen as the morally right thing to do, e.g. in Germany. Still, most people do not get registered for being an organ donor, even though there is an enormous shortage of organs. However, in countries with an opt-out option, where donation by default is the general principle, e.g. in Austria, hardly anyone decides to opt-out, as they regard organ donation as an ethically trivial act.
 
The system Danielle Allen suggests might sound good in theory, but the enlightened altruistic active citizen who is digitally literate and willing to actively opt-in to such a system is far removed from real life. Getting registered in a coronavirus app is structurally analogous to getting registered for being an organ donor, which is the main reason why analogous public reactions can be expected.
 
In addition, not many people are needed to undermine the system of opt-in registrations and cause an enormous amount of new infections. You just need to have a couple of asymptotic people as superspreaders, who did not opt-in, in order to bring about many more cases in a society, such as a barkeeper, an active member in a religious community, or a health care worker.
 
Furthermore, the regulation I suggested has the additional advantage that the digital data is also being used to at least partially pay for the universal health care system, which is an enormous achievement. It takes seriously the relevance of data collection for innovations, scientific research, and policy making. It is in the interest of the people as well as of a government to be able to collect and use digital data.
 
To guarantee that an enormous plurality of different lifestyles can be embraced in a society while a highly efficient universal healthcare system is available, we need a democratic usage of our digital data. My suggestions seem a promising initial step for developing appropriate social, legal, and political structures for realizing a proper democratic usage of our digital data.
 
Originally published in Immortalists Magazine Issue No. 4, Pg. 58.