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Open Journal of Geriatrics V1 . I2 . 2018
Introduction
This article considers how Michel Foucault’s concept
of ‘technologies of self’ can be related to understanding
aging and bio-ethics in contemporary society. We can
highlight how a Foucauldian analysis can identify
both how the identities of older people are both
facilitated and constrained by bio-technologies.
The paper assesses major works undertaken by
‘critical’ theorists of health and medicine such as
Armstrong (1983) who talks of intense surveillance
between subjects and professionals which epitomises
Foucault’s notion of ‘panoptic’ power in which
surveillance and power relations manifest in a ‘top
down’ or structuralist context (Powell, 2018). There
is a need to employ methodological insights deriving
from Foucault’s (1988) later work in order to provide
more of an holistic framework for understanding
bio-ethics and old age. In this way, we can have an
the constraining and facilitative features of bio-ethics
discourses for older people.
Nevertheless, a major theme on the health and
medical sociological research agenda, the debate
about age inequalities in health and access to medicine
confronts an essential paradox towards the year
2020. Whilst critical sociological research illuminates
biography, time and longitudinal lifecourse research
(Moody1998); the central issue remains that once a
standard of living and epidemiological foundation
has been established, other, more dispersed and
intangible factors take over as major determinants of
‘socially patterned’ disease in the global arena. Central
to these developments has been a growing interest in
‘bio-ethics’ and use of technologies of bio-medicine
(Powell, 2017). There are a number of value dilemmas
in the care and medical treatment for older people
that relate to ethical decision-making (Moody 1998).
However, it is how decisions are made and who makes
decisions, which impinge upon access to health care
and issues of inclusion and exclusion (Powell, 2017).
Moody (1998) claims a crucial ethical debate in health
and medicine is whether older people should have
their health care needs and resources curtailed simply
because of their ‘age’. Such an ethical statement and
of a social grouping based upon their chronological
‘age’ (Powell, 2018). Before, the article attempts to
rethink bio-ethics, we need to understand current
thinking on bio-ethics. The concept of ‘bio-ethics’ is
full of contestedconnotations. It is an esoteric word,
and in everyday conversation between non-specialist,
Open Journal of Geriatrics
ISSN: 2639-359X
Volume 1, Issue 2, 2018, PP: 15-22
Foucault, Aging and Bio-Ethics
Jason L. Powell
University of Chester, UK.
j.powell@chester.ac.uk
*Corresponding Author: Prof. Jason Powell, PhD, FHEA, FRSPH, FRSA, Department of Social and Political Science,
Westminster Building, The University of Chester, Parkgate Road, Chester, CH1 4BJ, UK.
Abstract
technologies of good health management; use of counselling; and bodily enhancement.
16 Open Journal of Geriatrics V1 . I2 . 2018
Foucault, Aging and Bio-Ethics
and informed participants, few would claim to know
exactly what it means. And yet the word is often used,
as if its meaning were obvious and understood by all.
Other connotations of bio-ethics are more broader
in outlook: here ‘bio-ethics’ points to a more
comprehensive medical and postmodern outlook
capable of addressing psychological, biological and
cultural dimensions of health and disease (Powell,
dimensions of older people’s experiences relate to
two distinctive narratives: ‘holistic’ and ‘alternative’.
A holistic approach to cancer suggests special
attention be paid to the older ‘patient’ as a whole. An
alternative approach suggests non-invasive diagnostic
and therapeutic procedures, techniques and bio-
technologies of health management and cure for older
people (Nettleton 1995; Powell, 2018).
Ambivalence can be seen in the tension between
parallel attitudes and relational inequalities that
behaviour; a remedy to personal distress and it’s
potential for increased quality of life (Powell, 2017).
However, the application of bio-technology can also
perp
etuate a part-view of people as ‘bodies with illn
esses
or dysfunction’s that reduces legitimate experience to
passive feedback on technological success. If we move
similar ambivalence. Sociology proposes to analyse
the ‘bio-social’ aspects of the aetiology of health and
illness (Armstrong 1983; Nettleton 1995; Powell,
discipline has been to highlight how individual lives
and illnesses which was thought to be determined
solely by biological, medical and psychological factors,
in which people live. This remains invisible to the
bio-medical approach because they stem from the
social interaction before becoming embedded and
recognisable as illness in the aging body of the patient
(Powell, 2017). For example, in the ‘sociology of
emotions’ the excursion of inquiry has proposed that
‘stress’ is not only rooted in individualistic emotional
by social norms of western culture (Freund 1988;
Powell, 2018). This type of research enables the scope
of health and illness, and the medical outlook, to be
bro
adened beyond traditional individualistic accou
nts of
the body. On this basis alone, sociology has invited us
to recognise the disease of the older patient is not only
his or her own problem but rather the symptomatic
deep manifestation of underlying relations of power
and inequality (Powell, 2017; Powell and Biggs 2000).
At this structural tier of analysis, sociology addresses
medicine as one of the elements of social control and
do
mination legitimated through knowledge and po
wer
of ‘experts’ (Foucault 1972, 1982; Biggs and Powell
1999; Powell and Biggs 2000; Powell, 2018). This in
part explains the reluctance of medical discourses to
adopt perspectives that would radically undermine
this role (Nettleton 1995; Powell, 2017).
Biomedicine V Sociology
Extricating from the earlier work of Foucault, David
Armstrong (1983, 1987) has warned sociological
disciplines against the seduction of a relationship
of co-operation whose terms remain dictated by
medicine itself. He further cautions sociological
disciplines against becoming ‘an emasculated,
uncritical appendage’ of biomedicine (1987: 1217), as
a result of endorsing too easily an alliance of bio-social
perspectives. This proposal, Armstrong contends,
increasing consumer dissatisfaction with medicine’s
failure to address patients as persons. Similarly, a
number of Foucauldian gerontological arguments
have developed in recent years that claim medical
power must be regarded as a ‘dangerous’ expansion
of power and surveillance which reaches into the
lives of older people (Katz 1996; Biggs and Powell
1999; Powell 1998; Powell and Biggs 2000; Powell,
biomedicine and sociology is illusory as both comply
with the aging body-as-object as the main criteria
of pathological ‘truth’. In this discursive context, the
connotation of ‘bio-ethics’ raises critical questions
about how two-thirds of deaths in the USA occur
amongst older people (Moody 1998). Access to health
care services is contingent across and through the
blurred structural fault lines of ‘race’, class, gender,
sexuality, disability and how these inter-relate
with age but also through the negotiative power of
institutional and professional practices who provide
medical and health care for older people. Can we
rethink this power relationship? The sociological
alternative is to fundamentally challenge to what is
seen as a form of ‘epistemological imperialism’ in the
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Open Journal of Geriatrics V1 . I2 . 2018
Thus, the sociological tradition juxtaposes social
that are operant in medical institutions (Powell,
2017).
Bio-ethics conveys associations of deception and self-
deception; or it conveys that older people have failed
to ‘get oneself together’ in managing health situations
(Moody 1998; Powell, 2018). Indeed, there is the
suggestion that we as human beings are ‘responsible’
(Rose 1990) for looking after our own health needs.
The important point Nikolas Rose is making is that
the problem of illness bears on the constitution of the
self as an ethical subject, the sense of what we do with
our freedom, the extent to which we acknowledge
it and with it, and the extent to which we engage
with attributions of self responsibility. As Arney and
Bergen suggest, an interpretation of modern medical
encounters should start:
‘not
ore….
Indeed the modern bookstore suggests that patients,
ex-patients and would be patients are forming
themselves into a social movement that is not unlike
a rebellion. It seems the self is asserting itself against
that make up life, and it seems that the self is calling
into question the power of the physician’ (1984: 2).
The increasing popularisation of some key terms of
subjective consciousness, and a conspicousness of
behaviour, either for health or against it (Powell,
2017). Moral action, whether it is individual or
collective, involves the self-knowing the self, a process
of self-formation as an ethical aging subject. Self-
responsibility, when passed through the metaphor of
‘health’, becomes a covert form of moral judgement
upon which decisions to supply or deny (often-
expensive) forms of bio-technology can be made. A
‘healthy old age’ no longer represents good fortune, but
is seen to be the result of prudent self-care currently,
lived a ‘moral life’ that not only has its own rewards,
otherwise, to care (Powell, 2018). By comparison,
becoming unhealthy approximates being undeserving
(Powell, 2018). One is unwell because one is unhealthy
and one is unhealthy because the proper steps of self-
care had not been taken in the past. So why should
others have to provide scarce resources to make
good this moral turpitude? Such an attitude to the
healthy body presents moral decisions on the supply
and demand for services in the ‘neutral’ language of
techno-medical science (Powell, 2017). However, the
outcome is that the prudent do not need it whilst
the imprudent do not deserve it. Any allusion here
to economic planning and to pension policy is more
than passing for in both cases it is the resource-rich
whereas the resource-poor are denied it. But under
such conditions, Foucault (1987) claims ethical
practices involves individual subjectivity to analyse
themselves and their own ‘needs’ as it involves:
‘a process by which the individual delimits that part of
himself that will form the object of his ethical practice,
follow, and decides on a certain mode of being that will
serve as his moral goal. And this requires him to act
upon himself, to monitor, test, improve and transform
himself’ (Foucault 1987: 28).
Despite a huge upsurge in the label of ‘Foucauldian’
attached to medical sociological research, this has
tended to draw upon Foucault’s (1967, 1972 and
1977) earlier work (Armstrong 1983, 1987). Whilst
there is a small but growing body of gerontological
knowledge which draws from Foucault’s (1988) later
work in Canada and USA (Frank 1998) in examining
‘t
echnologies of self ’, this remains quite invisible in t
he
criti
cal gerontological literature in the United Kin
gdom
despite some exceptions (Rose 1990; Powell, 2017).
The rest of the paper seeks to understand and inter-
connect the theoretical perspective of ‘technologies of
self’ and relate to old age and aging that is relevant to
the discourses and practices of bio-ethics.
Foucault, Technologies of Self and Aging
‘It may be that the problem about the self does not
have to do with discovering what it is, but maybe has
to do with discovering that the self is nothing more
than a correlate of technology built into our history’
(Foucault 1993: 222).
Foucault’s formulation presumes the notion that
– that in order to function socially individuals must
so
mehow work on themselves to turn themselve
s into
subjects (Powell, 2018). The notion of ‘technologies’
Foucault, Aging and Bio-Ethics
18 Open Journal of Geriatrics V1 . I2 . 2018
Foucault, Aging and Bio-Ethics
subject are brought about (Powell, 2018). Objectifying
technologies of control are for example those invented
in conformity with the facets of self-understanding
provided by criminality, sexuality, medicine and
psychiatry investigated by Foucault (Powell, 2018).
These are deployed within concrete institutional
the objects they contain. For example, the possibilities
of self-experience on the part of the subject are in
the authority to decide that they are ‘truly’ ill such as a
‘doctor’ of medicine (Armstrong 1983). ‘Subjectifying’
technologies of self-control are those through which
individuals:
a certain number of operations on their own bodies
and souls, thoughts, conduct and way of being, so as
to transform themselves in order to attain a certain
state of happiness, purity, wisdom, perfection or
immortality’ (Foucault 1988: 18).
These important issues are associated to ‘truthful’
formulations of the task or the problem that certain
domains of experience and activity pose, in this case
for older people themselves. The boundaries of self-
experience change with every acquisition, on the part
of older individuals, of a possibility, or a right, or an
obligation, to state a certain ‘truth’ about themselves
(Powell, 2018). For example, bio-technology can tell
a ‘truth’ of selling a dream of unspoken desire of ‘not
growing old’ to older people. However, it is the self-
experience of aging subjects that can refute, deny and
accept the ‘truth’ claims of bio-technology. In the case
of aging lifestyles, the active adoption of particular
consumer practices, such as uses of bio-technology
contributes to a narrative that is both compensatory
and ‘ageless’ in its construction of self. Thus, the
recourse to the notion of technologies of self is capable
of accommodating the complexity of the ‘subject’
(Powell, 2017). Although Foucault maintained the
distinction between the technologies of power/
domination and the technologies of self, these should
no
t be regarded as acting in opposition to or in isolation
to one another. Indeed, Foucault frequently spoke o
f the
importance of considering the contingence of both in
their interaction and interdependence, by identifying
of domination of individuals over one another have
recourse to processes by which the individual acts
upon himself and, conversely, the points where the
technologies of the self are integrated into structures
of coercion’ (Foucault 1993: 203). The distinction
should therefore be considered as a heuristic device
Indeed, it is mythical to suggest that Foucaults early
and late works are apposite: they are complementary
in understanding social relations (Powell, 2018).
If we relate Foucault’s main aims mapped out to the
‘aging body’ and disease – all disease that pertains to
the aging body in its concrete objectivity is beyond
the foundation of relevance as the expression of a
subjectivity evidences a relation between the ethical
subject and truth. That is what changes, what is newly
problematized, in modern bio-ethical discourse.
the paper is to highlight some of the conditions of how
bio-ethics as a form of problematization, poses as a
que
stion of illness treatment and bodily enhance
ment.
The aging body culturally represents the best hiding
place, a hiding place of internal illnesses that remains
inconspicuous until the advent of bio-ethics. We
possibilities for the constitution and transformation
of the self as a subject. In other words, what are the
zation given its conditions
of possibility? Subjective relations to the self will be
people with the proposition that this subjective truth
– the truth of their relation to themselves and to
others – may be revealed by their ‘aging bodies’. If this
is legitimate, we may anticipate through ‘biology and
culture’ (Morris 1998) the problematic of illnesses
associated with aging rejoins the sphere of bio-ethics,
in modernity, through the back door. ‘Illness’ as
problematized by bio-ethics will again belong to the
st
rategic margin that older people embodies as subje
cts
of purposeful action (Powell, 2018). While confronting
an illness this involves a deliberate practice of self-
transformation and such tranformativity must pass
through learning about the self from the truth told by
narratives of illness (Frank 1996, 1998; Powell, 2018).
This is what we can glean as a hypothesis, by building
abstractly on contemporary arguments that chart the
development of a privileged relationship between the
aging self and its truth. The rest of the paper examines
of possibility organise the actual propositions of bio-
ethical discourse. The paper analyses in particular
19
Open Journal of Geriatrics V1 . I2 . 2018
how technologies of the self can be applied to three
in counselling; and bodily enhancement.
Aging and Illness
With the rise of modernity, the ‘hospital’ became
a specialised therapeutic place and supporting
population as ‘patients’ (Katz 1996; Powell, 2018).
The rise of western rationality made it possible to
medicalise hospitals: this is how the production of
medical knowledge was spatio-temporally aligned
with the medical treatment of many elderly patients.
The relevance of this institutional process to the
development of bio-ethics can be appreciated via a
Biggs 2000; Powell, 2017). Within the analytical
economy of assistance, the notions of the ‘sick’ and
the ‘ill’ patient have appeared as newly distinctive
modern categories (Katz 1996). The new knowledge
spoke of forms of pathology relating to the capacity
to will, to act, to make decisions and ultimately to
be free to choose medicines to meet ill needs. The
development in the U.K of a universal National Health
Service (NHS) seemed to reiterate and sanction this
knowledge problematic. Universal access to medical
and health care was a key discursive touchstone of the
state’s reconstruction of society after world war two
(Alcock 1996; Powell, 2018). However, older people
were portrayed as a stoical and heroic survivor in
the immediate post-war period in Britain, this image
was contingent upon an absence of demand upon the
rest of society. This ambivalence was reinforced by
of progress and investment for the future that
of production, work and usefulness to capitalist
production. Old age then took on a problem focus. These
narratives held dominant ideas that helped shape
and legitimise policies of retirement and subsequent
inequality (Powell, 2017). Indeed, ‘old age’ throughout
the twentieth century has been seen as a social and
medical problem and this predominant perspective is
evident through the language used by policy makers.
Similarly, at the turn of the new millennium, access
to health care has become fragmented and limited,
contingent upon regional variations of ‘waiting lists’
and medical priorities. Such a fragmentation of access
to health care impacts upon unequal social relations
between social groupings across the lifecourse and
subsequent claims for access to health care.
The shift from universalism to fragmentation has
is symptomatic of postmodernity (Featherstone and
Wernick 1995; Carter 1998; Powell, 2018)). Within
a Postmodern analysis, Blaikie (1999) deconstructs
reconstructs the cultural implications of population
aging. Blaikie looks to the increased leisure
opportunities associated with old age and claims
consumer culture is breaking down dominant rigid
stereotypes of marginalisation and medicalisation.
Within such a state of condition, Blaikie (1999) claims
there are spaces for self-regulation which allow for
better understanding of ourselves and our health
needs. Similarly, the paper appropriates the usefulness
of ‘technologies of self’ as applied to more healthy
aging practices. Indeed, technologies for the healthy
of existing good health (Baltes and Carstensen 1996;
Powell, 2017). This would include the growing
market for healthy eating and exercise from midlife
onwards; second, there is an increase in the use of
counselling, and most notably narrative therapies in
later life (Knight 1996; Biggs 1999); third, there is the
use of ‘bio’ and other forms of technology to modify
and in some cases enhance bodily performance
(Shilling 1993; Featherstone and Wernick 1995).
These technologies of self very much epitomise the
earlier discourse derived from Nettleton (1995) as
alternative therapeutic procedures, techniques and
bio-technologies of health management and cure for
older people (Powell, 2018).
that whereas in previous eras, the control of the body
had been enhanced by external constraining virtue of
the corset, contemporary shaping has involved active
working, through exercise and diet. The multiplication
of magazine articles, self-help manuals, diet and
exercise clubs, extending through midlife and beyond
also bear witness to the popularity of attempts to
work on the self in this way. Baltes and Carstenson
(1996) and Powell (2017) have indicated that a closer
attention to the maintenance of bodily and mental
capacity is typical of later life.
Foucault, Aging and Bio-Ethics
20 Open Journal of Geriatrics V1 . I2 . 2018
Foucault, Aging and Bio-Ethics
related to later adulthood, is closely related to the
growth of leisure and a lifestyle approach to the
creation of late life identities. It therefore resonates
beyond the simple fuelling and repair of the bodily
machine to include a continual re-creation of the self
within a particular social discourse. This discourse
closely associates the construction of a healthy lifestyle
with positive self-identity (Powell, 2018).
Perhaps the most notable increase in the use of
technologies of the self can be seen in the use and
promotion of counselling and psychotherapy for
older adults. Having for many years been actively
discouraged, lifecourse counselling, and most notably
narrative counselling is currently undergoing a
gerontological renaissance (Knight 1996; Biggs
1999). The focus here has been on ‘re-storying’ or re-
inventing oneself in line with current life-priorities.
to the personal past than that adopted by traditional
psychotherapy. Whereas the past had previously been
seen as a repository of experiences that determined
choices in the present, the narrative approach sees
personal memory as a sort of ‘rag-bag’ of vignettes
and experiences that can be recombined to tell
(Powell, 2017). McAdams (1993), perhaps the best
known narrative therapist and one with a particular
interest in midlife identity, links the popularity of
narrative techniques with wider social trends toward
a blurred lifecourse. ‘Because’ he states ‘our world can
no longer tell us who we are and how we should live,
35). This technology and discourse has been invented
which promotes self-care. This time the focus is on the
psyche: a healthy mind is associated with the capacity
to re-author oneself and keep that narrative going
(Powell, 2018).
The third example of a technique of self refers to a
direct use of new technology to either modify the
appearance or performance of identity. To paraphrase
Morris (1998) technologies here hold out the promise
of ‘utopian bodies’. Indeed, Haraway’s (1991)
original reference to cyborgic fusion of biological and
machine entities has been enthusiastically taken up
by postmodern gerontology (Powell, 2018). The list
of technologies available extends beyond traditional
prosthesis to include virtual identities created by and
management. Thus Featherstone and Wernick (1995:
3) trill that it is now possible to’ Re-code the body
itself ‘as biomedical and information technologies
make available’ the capacity to alter not just the
meaning, but the very material infrastructure of the
body. Bodies can be re-shaped, remade, fused with
machines, empowered through technological devices
and extensions’.
In each case, a technology has been employed in
order to re-shape the aging self in later life, in order
to overcome or destabilise existing discourses on the
aging self. The ethics of such re-invention have been
explored in terms of the economic costs and personal
at the beginning of this article (Powell, 2017). The
bio-ethics of using such technology to deny the force
of aging as a human experience have been subject
to less scrutiny (Powell, 2018). Indeed it is perhaps
emblematic of contemporary western culture that each
of escape from, rather than a deepened understanding
of aging identity (Powell, 2017).
Conclusion
The purpose of this paper has been to critically
in terms of how we rethink health and medicine and
associated issues of illness and access to health and
medical technologies (Powell, 2017). Whilst some
of work of Foucault in raising critical questions of the
medical ‘gaze’ of aging (Powell and Biggs 2000; Powell,
2018) this article has sought to complement such an
approach through how subjectivity can be delineated
as a core concept in understanding aging and bio-
ethics. Indeed, the discourse of bio-ethics shifts
the question of health from an ontology of disease
dominated by professional discourses (Armstrong
1993, 1987) to an elaborate analysis of ‘technologies
of self’ (Foucault 1988) and how this analytical
metaphor bears reality on some social practices
of bio-technology which impinges upon a social
reconstruction of the ethical aging subject. Through
the use of a Foucauldian narrative, we have explored
three areas of: the maintenance of good health; use
of counselling narratives; and bodily enhancement
(Powell, 2018. These three technologies have been
self has been re-shaped and will continually be re-
21
Open Journal of Geriatrics V1 . I2 . 2018
shaped by the self’s own consciousness (technologies
of self ) and by others (technologies for self) (Powell,
2017). The self is caught between an ontological battle
of learning about the self and health needs and having
their ‘needs’ decided by others (Powell, 2018).
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