Visit a hospital intensive care unit. Whether you are a patient or a family member or a physician or a nurse, the view is the same. Machines are all about. Patients are tethered by monitor wires and catheter tubing. Such are only the most apparent limits of hi-tech medical life support. More subtle are the strictly drawn lines of the technology itself. Within specified confidence limits, predictable diagnostic or therapeutic results are validated. Outside these limits lies unknown risk. So a first major observation is that technology is pervasive in modem medicine.
A second major observation is that compliance, carefully shaped by the limits of technologic validation, becomes a technological imperative, for both patients and caregivers. Once the regimen is set, it shapes everything from eating, to sleeping, to working, to playing, and to the scheduling and content of the physician-patient encounter. For the most part, patient, family and physician willingly conform to the dictates of the technology which will make living safely medically predictable. Jacques Ellul has observed that "the border between technical activity and scientific activity is not at all sharply defined" ([1], p. 9). He rejects the neat theoretically constructed relationship between science and technology by which theory and hypothesis determine the development of technique. Instead, he maintains, it is not a question of minimizing the importance of scientific activity, but of recognizing that in fact scientific activity has been superseded by technical activity to such a degree that we can no longer conceive of science without its technical outcome ([ 1 ], pp. 9-10).
For Ellul technique is not machinery, technology or this or that procedure to accomplish an end. "In our technological society", he says, "technique is the totality of methods rationally arrived at and having absolute efficiency (for a given stage of development) in every field of human activity" ([1], p. xxv, italics original).
Ellul confirms my own observations. As physicians seek to practice medicine scientifically, basing their practice on theory and hypothesis, they are caught up