1. Leiden University, Academiegebouw 10 February, 2010 luciano.floridi@philosophy.ox.ac.uk www.philosophyofinformation.net Luciano Floridi Research Chair in Philosophy of Information, UNESCO Chair in Information and Computer Ethics Research Group in Philosophy of Information, University of Hertfordshire Information Ethics Group, OUCL & Philosophy, University of Oxford Bodies of Information – e-Health and its Philosophical Implications Public NIAS-Lorentz Center Lecture Bodies of Information – e-Health and its Philosophical Implications Public NIAS-Lorentz Center Lecture

2. OutlineOutline Introduction The First Three Revolutions The Fourth Revolution The Transparent Body The Shared Body The Democratisation of Health Information The Socialisation of Health Conditions E-Mental Health The Future of e-Mental Health Back to the Fourth Revolution Conclusion: A New E-nvironmentalism

3. Introduction: The General Framework Knowledge, Science, Technology have two fundamental ways of changing our understanding: Extrovert or about the world. Introvert or about ourselves.

4. Three revolutions that changed our self-understanding: Nicolaus Copernicus (1473 – 1543) Heliocentric cosmology displaces the Earth from the centre of the universe. Charles Darwin (1809 – 1882) All species of life have evolved over time from common ancestors through natural selection. Sigmund Freud (1856 – 1939) The mind is also unconscious and subject to the defence mechanism of repression. The Classic Analysis of the Three Revolutions

5. The Information Revolution as the 4 th Revolution Turing and the Fourth Revolution. The information revolution is deeply affecting our understanding of ourselves as agents. Information is our environment (infosphere). We are not becoming sci-fi cyborgs but re- appropriating ourselves as connected, informational organisms, inforgs. Radical change brought about by the fourth (information) revolution: the disclosure of human agents as interconnected, informational organisms among other informational organisms and agents, sharing an informational environment, the infosphere.

6. 1.Digital ICTs radically changing the very nature of (and hence what we mean by) the infosphere. 2.Transformations in the infosphere affect the nature of the inforgs inhabiting it and hence their related behaviours. 3.(1) and (2) sources of some of the most profound transformations and challenging problems in the close future, as far as technology is concerned. 4.Examples of (3): privacy and surveillance; security and secrecy; accuracy, safety, reliability and trustworthiness; intellectual property and ownership; digital divide; freedom of expression and censorship; de-legittimization. 5.Issues in (4) well known and not unique. 6.Conceptual framework. Inforgs and their Health

7. Two Concepts and Two Trends The transparent body The shared body The democratisation of health information The socialisation of health conditions

8. The Transparent Body ICT as computational tools. Causes (the 3Ms) Measuring and representing. Monitoring, computing and dynamic modeling. Managing (preventing, treating intervening). Effects More visibility and explorability. Increased interactivity from without and from within (e.g. nanotechnology). Making the boundaries between body and environment porous (e.g. fMRI). From black to gray to white box.

9. The Shared Body ICT as communication tools Causes (the 3As) Availability, user-generated contents. Accessibility and education. Acceptability and medical innovation. Effects Lower entry-level “My” body as a “type” of body, from “my health conditions” to “health conditions I share with others”. Understanding (making sense and come to terms) the real problem.

10. The Democratisation of Health information ICT as computational tools. Causes Not availability and accessibility. Google search vs. Google Health or 23andMe. From being the source of information to owning the information about oneself (23andMe and genotype). Effects Empowering the patient (my life my HD). Part of the hyper conscious trend (cf. Flickr 365 project). Whose information? Erasing individual boundaries.

11. The Socialisation of Health Conditions ICT as communication tools Causes Delocalisation of information sharing. Multimedia tools (depression on youtube). Effects Advantages: less loneliness, more hope, spreading of best practices. Risk: normality in numbers, from medicalisation to socialisation of unhealthy habits; the “everybody does it” factor.

12. Health 2.0 and e-Mental Health Computation Communication Diaphanisation Sharing Democratization Socialization

13. “Contrary to expectations, levels of stigma were higher in urban areas and among people with higher levels of education.” e-Mental Health: from machine to interface “In emergencies, the number of people with mental disorders is estimated to increase by 6 to 11%. Beyond mental disorders, people in emergency situations also often experience psychosocial problems that cannot be quantified.” Inverse proportion between occurrence and tolerance. Problem: wrong phil. anthrop. From the body as a machine to the body as an interface. It is not always the hardware. Tablets can be the beginning, but hardly ever the end of a solution. Bodies of information: read, write, execute.

14. e-Mental Health: uncovering the anomaly They do not step into the same rivers. It is other and still other waters that are flowing. (and souls take their spirit from the waters). It is death to souls to become water Heraclitus They do not step into the same rivers. It is other and still other waters that are flowing. (and souls take their spirit from the waters). It is death to souls to become water Heraclitus We are the anomalous species, points of resistance against Being; whirlpools in the river of reality. Stretched or snapped. Mental life as balance: healthy detachment vs. unhealthy disengagem. The paradox of the others as problem and solution. Solutions not just for the individual but also for the individual’s social group.

15. Global E-Mental Health “Low-income countries have 0.05 psychiatrists and 0.16 psychiatric nurses per 100.000 people, compared to 200 times more in high- income countries.” Assumptions: recognition, technical skills, economic means. low- and middle- income countries are the ones most affected by mental disorders. ICT is not just the web. A mobile solution? E.g. Australia 2009 Semantics first. “On average about 800 000 people commit suicide every year, 86% of them in low- and middle-income countries.” “Low-income countries have 0.05 psychiatrists and 0.16 psychiatric nurses per 100.000 people, compared to 200 times more in high- income countries.” : 38m people, 18.3m own a mobile. M-PESA (2007): 7m users, paying system. Kenya: 38m people, 18.3m own a mobile. M-PESA (2007): 7m users, paying system. Murdoch Children's Research Institute and Telstra Foundation. Mobiles help track 14- to 24- year-olds suffering from depression. Successful pilot of the program monitors factors that may contribute to mental illness, interactively.

16. ESoles Inc.: prototype insoles with pressure sensors that relay their information wirelessly to a nearby mobile phone, with data on pressure in 11 different zones of each sole. “Genomic medicine”: genomic information and technologies used to determine disease risk and predisposition, diagnosis and prognosis, and the selection and prioritisation of therapeutic options. GM Humanity. E-Mental Health: Future Developments? Demography, aging population, e-Mental Health for the future not for the past. E-Mental Health: from following to leading ICT innovation. The future infosphere: anything to anything (a2a), anywhere for anytime (a4a), onlife. The next M: modification (Trojan horse for bioeng).

17. The development of e-Health and its ethical issues are part of a wide and influential fourth revolution in the long process of dislocation and reassessment of humanity’s fundamental nature and role in the universe. 1.We are not immobile, at the centre of the universe (Copernicus). 2.We are not unnaturally detached and diverse from the rest of the animal world (Darwin). 3.We are not Cartesian subjects entirely transparent to ourselves (Freud). 4.We are not disconnected entities, but rather inforgs, sharing with biological agents and engineered artefacts a global environment ultimately made of information, the infosphere (Turing). Back to the Fourth Revolution

18. Conclusion: e-Mental Health and E-nvironmentalism In an infosphere in which being an inforg is the default position, the status and accountability of both human and artificial agents become increasingly problematic. We should accept this new conceptual revolution as humbling but also exciting.

19. Conclusion: e-Mental Health and E-nvironmentalism Great opportunity: developing a synthetic e-nvironmentalism or new ecological approach to the whole of reality. How we build, shape and regulate the new infosphere ecologically is the crucial challenge brought about by the fourth revolution. Future generations will find synthetic e- nvironmentalism unproblematic. It is our task to ensure that the transition from our environment to theirs is as ethically smooth as possible.

20. Leiden University, Academiegebouw 10 February, 2010 luciano.floridi@philosophy.ox.ac.uk www.philosophyofinformation.net Luciano Floridi Research Chair in Philosophy of Information, UNESCO Chair in Information and Computer Ethics Research Group in Philosophy of Information, University of Hertfordshire Information Ethics Group, OUCL & Philosophy, University of Oxford Bodies of Information – e-Health and Its Philosophical Implication Public NIAS-Lorentz Center Lecture Bodies of Information – e-Health and Its Philosophical Implication Public NIAS-Lorentz Center Lecture ACKNOWLEDGEMENTS Many thanks to Jan van Leeuwen, the NIAS-Lorentz Center and everybody else who made the meeting possible. COPYRIGHT DISCLAIMER Texts, marks, logos, names, graphics, images, photographs, illustrations, artwork, audio clips, video clips, and software copyrighted by their respective owners are used on these slides for non-commercial, educational and personal purposes only. Use of any copyrighted material is not authorized without the written consent of the copyright holder. Every effort has been made to respect the copyrights of other parties. If you believe that your copyright has been misused, please direct your correspondence to: l.floridi@herts.ac.uk stating your position and I shall endeavour to correct any misuse as early as possible.