Good healthcare is in the “how”

What do we mean by good healthcare, and do machines threaten it? If good care requires expertise, then what kind of expertise is this? If good care is “human” care, does this necessarily mean “non-technological” care? If not, then what should be the precise role of machines in medicine and healthcare? This chapter argues that good care relies on expert know-how and skills that enable care givers to care-fully engage with patients. Evaluating the introduction of new technologies such as robots or expert systems then requires us to ask how the technologies impact on the “know-how” expertise of care givers, and whether they encourage a less care-full way of doing things. What role should which technologies play in which tasks and practices? Can we design and use them in such a way that they promote care-full and engaged ways of doing things with people? It is concluded that new machines require new skills to handle the technology but also and especially new knowing-how to handle people: knowing how to be care-full and caring with the technology. Good care is not about something external called “ethics” but about how things are done in medical and care practices. Machines are welcome if they contribute to this more knowledgeable, skillful, participatory, engaged, and caring way of doing things. This vision of good care enables us to evaluate new technologies and encourages care givers, care receivers, and other stakeholders to explore better ways of designing, regulating, and using them.