SCIENTIFIC CONTRIBUTION E-care as craftsmanship: virtuous work, skilled engagement, and information technology in health care Mark Coeckelbergh Ó Springer Science+Business Media Dordrecht 2013 Abstract Contemporary health care relies on electronic devices. These technologies are not ethically neutral but change the practice of care. In light of Sennett’s work and that of other thinkers (Dewey, Dreyfus, Borgmann) one worry is that ‘‘e-care’’—care by means of new information and communication technologies—does not promote skilful and careful engagement with patients and hence is neither conducive to the quality of care nor to the virtues of the care worker. Attending to the kinds of knowledge involved in care work and their moral significance, this paper explores what ‘‘craftsmanship’’ means in the context of medicine and health care and discusses whether today the care giver’s craftsmanship is eroded. It is argued that this is a real danger, especially under modern conditions and in the case of telecare, but that whether it happens, and to what extent it happens, depends on whether in a specific practice and given a specific technology e-carers can develop the know-how and skill to engage more intensely with those under their care and to cooperate with their co- workers. Keywords Health care Á Medicine Á E-care Á Ethics Á Virtue Á Knowledge Á Information technology Á Craftsmanship Á Skill Á Know-how Á Work Á Telecare Á Cybermedicine Introduction Today most work is mediated by information and com- munication technologies (ICTs) and contemporary health care is no exception: it relies on electronic devices for prevention, diagnosis, and treatment. Consider use of per- sonal computers, the use of the Internet to acquire health information, electronic prescribing, medical expert sys- tems, medical imaging technologies, chip implants, robots (care robots and robots in surgery), mobile devices that enable monitoring and sharing of health information, and electronic patient records. Some of these technologies are used for what is known as ‘‘telemedicine’’ and ‘‘telecare’’: care givers and care receivers are no longer in the same location, but communicate and exchange information via ICTs. For example, telemonitoring devices enable chroni- cally ill people or elderly to stay at home while their medical condition is monitored by nurses and other care workers at a different location. It is expected that this care at a distance will increase in the future. Some project a future in which robots will take care of the elderly. The use of these electronic technologies in medicine and health care has advantages, but also raises a number of ethical worries, for example safety and privacy issues. Is it safe for patients and care workers to interact with care robots? Do electronic patient records and mobile devices that monitor health respect the privacy of patients? How reliable is this ‘‘e-health’’ and this ‘‘cybermedicine’’, given that there can always be computer errors and that com- puters can be hacked? However, in this paper I am con- cerned with a more challenging ethical issue: the problem is not only how these devices are used, but also how they change health care practices and how they change our thinking about health care. Influenced by contemporary philosophy of technology, I start this paper with the A previous version of this paper was presented at the ‘‘Good Work’’ Sennett conference, University of Humanistic Studies, Utrecht. M. Coeckelbergh (&) Department of Philosophy, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands e-mail: m.coeckelbergh@utwente.nl 123 Med Health Care and Philos DOI 10.1007/s11019-013-9463-7