Da vigilância à automação: pensando a medicina em tempos de maquinário cognitivo

Abstract

Despite the ubiquitous presence of information technologies in the organization of contemporary social life, some of their ethical and political repercussions have been overlooked by research and concerns in the health field. By bringing together key concepts in the thematic field of critical studies in cybernetics, discussing them based on the work of relevant authors, and linking them with outpatient medicine, especially with regard to the notion of health needs and the political tensions arising from their different formulations, we will investigate the ways in which new information technologies, especially AI, have contributed to the automation of cognitive tasks and reflect on the impacts of this mechanization of the clinic on medical work and on the transferential relationship. We will identify the history of recent transformations in information technologies, providing a description of the business model that has organized their dissemination through the understanding of their circuit of production and circulation of their value. In a scenario that, despite its continuities, is profoundly different from that of industrial capitalism, originally analyzed by Marx, there was nevertheless a marked homology between the machine-fixed capital axis, as articulated in the Fragment on Machines in the Grundrisse notebooks, and the technologies for automating cognitive tasks, marked by the form of intellectual property. This new era of capital – named by Zuboff “surveillance capitalism” and by Wark “vectorialism” (two diagnoses that, although they present significant similarities, diverge substantially in terms of prognosis and prescription) – is fundamentally marked by a progressive desubstantialization of the content of the commodity, which begins to assume increasingly abstract and explicitly relational qualities, differentiating itself from its “past” form encapsulated in the consumer good. The possibility of automating certain clinical tasks corresponds to the digital formulation of clinical tasks that are already algorithmic from the outset – given their protocol-based nature based on instructions such as “if x, then y”, in which the clinician’s task consists of translating the contents arising from the clinical examination into “x”, here representing certain criteria that, when met, have as a corollary a diagnostic proposition, which, in turn, corresponds to a specific range of therapeutic possibilities, “y”. The fact that these technologies increase the productivity of medical work will be considered critically in the context of the Brazilian health system, marked by the impasse in medical provision at the population level. The optimism of proponents of their dissemination is contrasted with a perspective in which the progressive digitalization of the doctor-patient interface curtails the “right to transfer” of marginalized populations.