Jani Koskinen

Kai Kimppa

An unclear question: who owns patient information? A Kantian take on the concept of Datenherrschaft

Keywords: Patient information, Datenherrschaft, Kant, Ownership, Regulation

Patient information systems are critical instruments in modern healthcare; thus, modern healthcare systems cannot function properly without them. While there are countless varieties of information systems used in healthcare, there is one overarching commonality among them -they all contain information about patients. Different groups involved in healthcare have an interest in patients' information for different reasons. However, in many countries, it remains unclear who exactly owns the data. This issue thus needs to be resolved. As ethics is critical in determining the justifiable owner of patient information, any legislative solution to competing interests ought to be ethically well justified. In this paper, we argue that an ethically acceptable formulation of the ownership of patient data has already been suggested and that it can be further justified also through the Kantian tradition.

Introduction

Who owns patient information, and perhaps more importantly, who should own it? This is a question that the research literature has so far failed to conclusively answer. Furthermore, the potential answers offered have mainly been derived from the field of jurisprudence (although authors tackling the issue are typically also knowledgeable about ethics and healthcare) and from the United States [START_REF] Hall | Ownership of medical information[END_REF][START_REF] Rodwin | The case for public ownership of patient data[END_REF][START_REF] Rodwin | Patient data: Property, privacy & the public interest[END_REF][START_REF] Evans | Would patient ownership of health data improve confidentiality?[END_REF]. The paucity of academic discourse is interesting because of the topicality of the issue, and there is a strong global drive towards developing healthcare information systems. Cognisant of the differences between the legal tradition of the US and that of (particularly continental) Europe, 1 we need to engage in further discourse from academics with different backgrounds in terms of traditions and fields.

It appears that the ownership of patient information2 is a target of regulation that seems to have either failed or has not been accurately or explicitly defined in many countries [START_REF] Rodwin | The case for public ownership of patient data[END_REF][START_REF] Rodwin | Patient data: Property, privacy & the public interest[END_REF], [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF]. Existing arguments or viewpoints arguably diverge in relation to how the issue of ownership should be solved or approached. The first view is that patient information should be publicly owned and regulated [START_REF] Rodwin | Patient data: Property, privacy & the public interest[END_REF]. The second view is that the patient should have mastery over his/her information [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF]. The third view holds that the propertisation of information is not a solution and actually leaves the problem unsolved [START_REF] Evans | Would patient ownership of health data improve confidentiality?[END_REF], [START_REF] Evans | Much ado about data ownership[END_REF]. Common among all these views is the recognition that ownership or property rights is not easily implemented when it comes to patient information.

There seems to exist contradictory scenarios when it comes to patient information. The (lack of) regulation of ownership mentioned above, when viewed against the protection of personal information found in European Union directives, seems to be inconsistent [START_REF] Kierkegaard | Electronic health record: Wiring Europe's healthcare[END_REF][START_REF] Di Iorio | Health research and systems' governance are at risk: Should the right to data protection override health[END_REF]. Koskinen, Kainu & Kimppa [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF] show that by approaching the issue from the perspective of ethics, rather than from that of jurisprudence, the problems of unclear regulation become visible.

Koskinen, Kainu & Kimppa [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF] propose a different approach to how the ownership of patient information is viewed. They note that the traditional view of property, or current immaterial property rights, is not a plausible solution because of the nature of patient information. The solution they propose is the use of a different definition of ownership, namely Datenherrschaft [START_REF] Kainu | Between public and personal information -not prohibited, therefore permitted[END_REF] -mastery over data -granted to patients to overcome the problem [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF]. This definition seems more appropriate in serving the aim of controlling patient information because it takes greater account of the problems of property and ownership in this context. This paper starts by analysing patient information from the viewpoint of ownership because there is an established practise as well as trends to propertise different kinds of information with immaterial property legislations. The academic discourse on what constitutes ownership has considered information about people in internet and company databases. This suggests that we are in an era in which the boundaries of our privacy and protection of personhood have been re-drawn. Patient information is at the core of this issue, or at least it should be -which is not currently the case. The legislative approach is essential because our societies are controlled through the use of legislation; thus, without clear legislation, rights become non-appealable, i.e. such rights can and will be ignored or deprecated. Of course, the approach could be other than ownershipbased, for example, in Finnish legislation, 3,4,5 the aim has been to control and restrict the use of patient information with laws and regulations, not through ownership. However, with the ownership approach in focus, the issue can be clarified by analysing and stating who in the end should control and by ascertaining how patient information is used and by whom. Property rights do have a strong and fundamental position in Western countries, and this approach suggests that it is fruitful to have a strong offset for clarifying the patient's position as well as rights that protect the patient's information.

It is notable that in different countries there can be numerous ways of controlling patient information. However, it seems that a look at the Finnish legislation on the proper use and storage of patient information can lead to complex and case-specific legislation, which could be avoided with a focus on legislation based on ownership. In this way, the detailed practices -which must respect Datenherrschaft -could be regulated with soft law and could thus cope more easily with technological developments (see also Kainu and Koskinen [10]). With this, patients can thus control how their information is used (with some limitations, which are shown later on).

It seems that Datenherrschaft is an ethically justified way to regulate patient information, at least according to the Lockean [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF] position. Nonetheless, we want to strengthen the ethical justification for Datenherrschaft with Kant's categorical imperative(s). The Kantian view is relevant here because, as Wiesing [START_REF] Wiesing | Immanuel Kant, his philosophy and medicine[END_REF] states, "In a time of rapid change, the concept of human dignity and human rights from the Kantian tradition serves at a certain level as a stabilizing anchor" 6 . The Kantian tradition respects the value of humans differently than, for example, the utilitarian position. Utilitarianism seeks the most efficient outcome of good and can thus lose sight of humanity, an aspect of critical importance in the field of healthcare.

Datenherrschaft -mastery over data and information

This paper uses the concept of Datenherssaft in the same way that Kainu and Koskinen [START_REF] Kainu | Between public and personal information -not prohibited, therefore permitted[END_REF] defined it:

[Datenherrschaft is] the legal right to decide the uses of, in a database or another compilation, collection or other container or form of data, over a entry, data point or points or any other expression or form of information that an entity has, regardless of whether they possess said information, with the assumption that sufficient access to justice is implemented for a citizen to have this power upheld in a court of law. 7Datenherrschaft differs substantially from property rights in four specific ways. First, when ownership of property can be moved from one party to another, it is not a case of Datenherrschaft. Datenherrschaft is irremovable from the individual who has it. This is similar to the aforementioned by Kainu and Koskinen [START_REF] Kainu | Between public and personal information -not prohibited, therefore permitted[END_REF]: an individual's choice to participate, or not, in a criminal act is not removable from the actor -even though the driving forces behind the act can be interpreted and argued. Datenherrschaft can only be given to the person about whom the information is. It is notable that someone cannot give up his/her Datenherrschaft, even though he/she may wish to do so, as it is an integral part of who and what he/she is. This is what makes Datenherrschaft so unique. Even if there is a contract that limits one's Datenherrschaft, it cannot be upheld in a court of law.

Second, the work done is seen as a justification for individuals to gain immaterial property rights. However, the context of healthcare differs substantially from the common creation of immaterial work. Immaterial property rights are seen as compensation to individuals for work done. However, in healthcare, income is salary based, and thus, there is no need for compensation [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF].

Third, immaterial property rights are commonly passed on to other parties who have not done the actual intellectual work. This in itself is very problematic because, in many cases, there is no real possibility of possessing a right when another individual produces the intellectual work. This is so because of a weak negotiating position when rights are negotiated between parties. Instead, Datenherrschaft is non-transferable; it is a part of the patient in a similar sense as the criminal deed is bound to the person who commits the crime, as Kainu and Koskinen [START_REF] Kainu | Between public and personal information -not prohibited, therefore permitted[END_REF] show.

The last and arguably most fundamental difference is that whilst immaterial property rights are based on creative or artistic processes, work done by an individual in a healthcare situation differs substantially. Healthcare is based on evidence-based medicine -or at least it should be, or we are talking about snake oil or the art of performance. Healthcare professionals rely on science and knowledge of medicine and not on their artistic or creative ideas; therefore, property rights cannot be justified here.

The consent approach is arguably more plausible than Datenherrschaft as it has one major advantage -it is part of the prevailing legislation in many countries. However, Datenherrschaft reaches further than the consent approach. It changes the paradigm between the patient and healthcare -the patient is no longer the object of healthcare; 8 rather, he/she has control over his/her information, and he/she interacts with healthcare for some purpose. The consent regime aims to provide sufficient information to patients to make decisions regarding the medical issue at hand. The Datenherrschaft approach focuses on serving the need of the patient when he/she observes him/herself in a medical sense and, more broadly, in his/her life as a whole. Only patients can judge what are the relevant issues for them even if they may -and most probably do -need medical professionals to help them to gain an understanding of their patient information. Deber et al. [START_REF] Deber | Do people want to be autonomous patients? Preferred roles in treatment decision-making in several patient populations[END_REF] suggest that autonomous patients could be seen to mean people who wish to understand their disease and their possibilities even though they usually do not want to play the self-provider role in healthcare. The self-judging approach and the patient view of one's own life plan is critical when we think of the problem of controlling patient information. Lee and Lin [START_REF] Lee | Do patient autonomy preferences matter? Linking patient-centered care to patient-physician relationships and health outcomes[END_REF] show that the impact of patient centeredness -which should include respect for the patient's goals and desires -in health outcomes is elusive. However, even if we find no indisputable evidence for health outcomes for patients from patient centeredness, it is not a sufficient reason to disclaim it. The health outcome is not only a relevant issue for the patient and perhaps not even the most important. Knowledge of one's own situation is a core factor in gaining an understanding not only of the situation but also of the possibilities for one's life. If we must rely on the judgement of healthcare professionals regarding what information is needed by us, it is not clear that we would necessarily be treated as ends in ourselves; rather, we could end up as mere means in the system. After all, we would be expected to accept doctors' viewpoint like everyone should. This cannot be accepted if we wanted to be ends in ourselves and not reducible to mere means. To have a proper understanding of patient information for patients, there is a need for new patient information systems that would serve primarily the layman's needs and not only those of professionals. Here, the aim of Datenherrschaft would be misplaced because the information may not be understandable or even accessible to patients.

The main practical contribution of Datenherrschaft is this paradigm shift -which it also supports from a legislative standpoint -and its strong support for patients' sensemaking of their health and life [START_REF] Lahtiranta | Sensemaking in the personal health space[END_REF]. This is crucial in healthcare where healthcare professionals and especially doctors, rather than patients, have maintained control of the medical path and information [START_REF] Koskinen | Information technology -The unredeemed opportunity to reduce cultural and social capital gap between citizens and professionals in healthcare[END_REF].

Datenherrschaft would thus seem to be an appropriate solution by which to overcome the baggage associated with the term 'property' in general and especially with its economically weighted use in intellectual property rights. Datenherrschaft emphasises the right of the patient to be free from paternalistic control and speaks for the patient's right to choose how his/her information is used and by whom.

Understandably, this mastery cannot be absolute and can be overridden if it conflicts with the fundamental (which are not property rights of any sort) rights of others, such as the right to life or health. Situations in which the patient's rights are justifiably overruled would occur, for example, during lethal epidemics where others are in direct and grave danger [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF].

However, the patient's mastery can only be overruled temporarily and only with justifiable reason to protect the idea of Herrschaft. Information about overriding Datenherrschaft must be clearly reported to the patient [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF]. Another critical issue to note is the use of patient information for research purposes. There are justified reasons -for example, the duty to preserve all of mankind -for collecting anonymised patient information for research purposes, but only that anonymised data can be accessed and not the original data [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF]. However, this data should be collected within some common database(s) to which free access for research purposes would be available. This way, both the rights of individuals and their duty towards mankind would be served.

Health information technology is changing, and there is a need to analyse the idea of informed consent in the healthcare context [START_REF] Goldstein | Health information technology and the idea of informed consent[END_REF]. Traditionally, paternalism has been justified due to the doctor knowing more than the patient about various medical conditions. This is no longer always the case, and patients are more capable of taking responsibility for their own condition/s. If, in this situation, the patient continues to be treated as a target for paternalistic handling, he/she is not considered an end but rather a means for the healthcare professional. Any use of power over another needs to be justified, and in the current situation, paternalism is no longer typically justifiable as in the traditional sense.

Kantian autonomy and rational agents: prerequisites for patient centeredness and empowerment

Patient centeredness and empowerment are seen as important factors in today's healthcare systems and thus need to be taken into account [START_REF] Mead | Patient-centredness: A conceptual framework and review of the empirical literature[END_REF][START_REF] Donnelly | Viewpoint: Patient-centered medical care requires a patient-centered medical record[END_REF][START_REF] Hiscock | Patient centred leadership in practice[END_REF][START_REF] Holmström | The relation between patient-centeredness and patient empowerment: A discussion on concepts[END_REF]. Empowerment is a multilevel construct whereby people, organisations and communities gain mastery in matters that concern them by having rights and needed resources [START_REF] Rappaport | Terms of empowerment/exemplars of prevention: Toward a theory for community psychology[END_REF][START_REF] Zimmerman | Psychological empowerment: Issues and illustrations[END_REF]. To be empowered, citizens require information while patient centeredness supports respect for patients and ensures that citizens' needs are fulfilled. Without information, one obviously cannot have credible mastery or gain an understanding of one's own health or treatment. This is where Datenherrschaft makes a difference in healthcare practice as it respects the autonomy of the patient and enforces the patient's right to decide how his/her information is used by granting him/her mastery (compare this to empowerment as defined above) over his/her own information, thus reducing the possibility of healthcare professionals exercising paternalism over him/her. Nevertheless, Sjöstrand et al. [START_REF] Sjöstrand | Paternalism in the name of autonomy[END_REF] show that there can be an acceptable level of paternalism if it enhances patient autonomy. Autonomy is constructed from at least three parts. First, there must be competence held by the individual who is exercising autonomy. Second, there should be the ability to make decisions aimed at realising desires, goals etc. Third, desires should be authentic, meaning that they should not be based on, for example, self-deception or coercion. The level of authenticity in desires varies; some desires are more authentic than others [START_REF] Sjöstrand | Paternalism in the name of autonomy[END_REF]. However, there can be situations in which paternalism is acceptable -for example, in cases of nervous breakdown and shock -but paternalism itself cannot be held as a universal law.

Although Kant did not take a stand on medicine, his influence has been strong in the medical field, especially in relation to autonomy and human rights [START_REF] Wiesing | Immanuel Kant, his philosophy and medicine[END_REF]. Autonomy and the free will of actors are preconditions for duty, which is an essential part of Kant's moral philosophy. Duty is something that can only be performed by rational agents, and actions can only be moral when conducted by rational agents on the basis of free will [START_REF] Sjöstrand | Paternalism in the name of autonomy[END_REF]. Forced 'good' actions cannot be moral because morality comes from people's will, and the actions they undertake are just consequences of that will. The outcome is secondary or even irrelevant to the will and its goodness. Nevertheless, the will is a necessary but not sufficient condition. If the actor has not understood his/her duty, he/she can still act wilfully, but that action can be a bad action. Therefore, the universality of moral acts and taking each person into account as an end are also preconditions for moral action and essential parts of Kant's moral philosophy, which becomes concrete in the three categorical imperatives that are, according to Kant, all modifications of the same moral law, just presented differently [START_REF] Kant | Grundlegung zur Metaphysic der Sitten [Several translations used; main translation: Liddel B. Kant on the foundation of morality -a modern version of the Grundlegung[END_REF].

Datenherrschaft in light of the categorical imperative(s)

There are three different forms of categorical imperatives identified in Kant's Grounding for the Metaphysics of Morals, and there are also different translations from German to English, not forgetting other languages. Nevertheless Kant's three categorical imperatives can be translated into English as [START_REF] Feldman | Introductory ethics[END_REF]:

CI1: Act as if the maxim of your action were to become through your will a universal law of nature.

CI2:

Act in such a way that you always treat humanity, whether in your own person or in the person of any other, never simply as a means, but always at the same time as an end.

CI3: An act is morally right if and only if the agent, in performing it, follows the law autonomously.

In what follows, the third categorical imperative is examined through the first and second formulations; it is visible throughout the paper and is, as Kant points out, directly connected to the other two.

Categorical Imperative 1

The first categorical imperative, 'Act as if the maxim of your action were to become through your will a universal law of nature', demands that the Datenherrschaft of patient information be formulated and legislated in such a way that it satisfies the requirements of being a universal law. Taylor [START_REF] Taylor | A Kantian defense of self-ownership[END_REF] has analysed the paternalistic maxim and came to the conclusion that it is not acceptable for people to be treated in a paternalistic way. If a world in which the maxim of paternalism as a universal law is imagined, there would be situations in which people would not be able to truly exhibit self-control. The paternalistic maxim converts rational agents into less autonomous beings and diminishes their capacity for self-control, which is a precondition for the potential to effectively will any action. Thus, by willing the paternalistic maxim as a universal law, one takes away this capacity and leaves that will to face a collision with itself. Therefore, paternalism cannot be held as a universal law [START_REF] Taylor | A Kantian defense of self-ownership[END_REF].

Koskinen, Kainu & Kimppa [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF] argue that the patient should be held as the possessor of Datenherrschaft whereby the solution to the problem of paternalism is reached by giving the patient control over his/her information. However, the patient's Datenherrschaft cannot be absolute without violating the first formulation of the categorical imperatives. There are occasions when healthcare professionals or other authorities must have access to patient information, for example, in situations concerning disease epidemics or when access to patient information is crucial for some other individual. It appears likely that European Union legislation will increase the problem of using information for the purposes of healthcare if amendments to the Data Protection Directive (DPD) are implemented as written whereby privacy will have greater value over health [START_REF] Di Iorio | Health research and systems' governance are at risk: Should the right to data protection override health[END_REF]. In some situations, information is a premise for securing the lives of others, and so, withholding that information -as the DPD would -cannot be seen as an act of universal law. Likewise, the aforementioned anonymised patient information used for research purposes seems fitting as a universal law as it makes possible the curing or saving of people in the future. In addition, the literature (though limited) indicates that patients consider the use of their information for research and public health proposes to be legitimate (see e.g. Spriggs et al. [START_REF] Spriggs | Ethical questions must be considered for electronic health records[END_REF]).

Thus, our suggestion for a universal CI1 is: Patients should have mastery over their information, thus granting them as widely inalienable a mastery of their patient information as possible, but not exclusive control of use, thus granting the possibility of using the data in exceptional situations, such as in cases of pandemic or when information is crucial to save the lives of others or to secure their health from serious danger. Likewise, access is permitted for research purposes when properly anonymised.

The first categorical imperative clearly brings out the advantages of Datenherrschaft because it avoids the flaws inherent in paternalism compared to a situation in which citizens are without mastery of their own patient information. However, the limitations and use of anonymised information for research purposes seem to be exceptions that should be catered for. Thus, Datenherrschaft fulfils the first formulation of the categorical imperatives if those restrictions are added, as proposed by Koskinen, Kainu & Kimppa [START_REF] Koskinen | The concept of Datenherrschaft of patient information from a Lockean perspective[END_REF].

Categorical Imperative 2

The second formulation of Kant's categorical imperative states: 'Act in such a way that you always treat humanity, whether in your own person or in the person of any other, never simply as a means, but always at the same time as an end'. Thus, people should always be treated with respect by virtue of their humanity and not in an arbitrary manner. Each person should be honoured because he/she is a human being and not only because he/she is something that serves some personal end or goal [START_REF] Kant | Grundlegung zur Metaphysic der Sitten [Several translations used; main translation: Liddel B. Kant on the foundation of morality -a modern version of the Grundlegung[END_REF]. Therefore, citizens cannot be bypassed in deliberations on patient information. The contrary suggests that people are treated only as means. Kant places greater emphasis on the motivation -good will -behind actions than on the outcome. Thus, following Kant's deontological approach, a situation in which the outcome would be good is unacceptable if the moral codes are neglected or given less weight on utilitarian grounds. This makes a position in which people's liberty or other personal rights are limited by others very problematic. Thus, through the paternalistic actions of some other party, we can lose the autonomy of patients, which is seen as one of the core values of medical ethics [START_REF] Gillon | Ethics needs principles -four can encompass the rest -and respect for autonomy should be 'first among equals[END_REF][START_REF] Beauchamp | Principles of biomedical ethics[END_REF]. Hence, paternalism violates the second categorical imperative. It is obvious that solely restoring a citizen's health or curing his/her disease does not sufficiently fulfil the second Kantian formulation, thus nullifying it as a basis of how people are treated in a healthcare system. In that case, people would be treated merely as objects by the healthcare system as well as by healthcare professionals carrying out their care or medical treatments, and that would be unacceptable.

This point of objectification needs to be noted in situations a holder of Datenherrschaft over patient information is proposed to be some party other than the patient. If some party other than the citizen is granted Datenherrschaft, the patient, as a human being, is not honoured as an end in him/herself. Accordingly, if the patient is set from other Datenherrschaft candidates -who have their own goals (even though these goals be similar to those of citizens) -we do not respect people's autonomy and liberty when we choose how their information (which is an extension of themselves) is used or not used. Even though the goals might be similar to those of citizens, the outcome is not the point; the main point is the moral motive which satisfies respect for the patient as an end in him/herself.

Even though many (probably most) healthcare professionals do consider the patient as an end, not all of them necessarily do. Thus, as we cannot be sure of this, we must design systems that at least ensure that the system supports treating the patient as an end. Manson [START_REF] Manson | Why do patients want information if not to take part in decision making[END_REF] shows that even though patients seem in many cases to be unwilling to participate in decision-making, they can have different requirements for information. By according mastery to patients, we ensure that they have all the necessary information when they want or need it, and we do not rely on the hope that healthcare professionals will treat patients as ends in and of themselves.

For example, people are not necessarily treated as ends if healthcare professionals have mastery over their patient information and thus have a paternalistic hold over them. In a paternalistic relationship, healthcare professionals can decide how information is used and what is best for the citizen without knowing the personal needs of the patient [START_REF] Manson | Why do patients want information if not to take part in decision making[END_REF]. The problem is that the biomedical worldview focuses on medical consequences; this collision of worldviews (deontological vs. consequentialist) is problematic and can generate conflicts if not taken into account. Thus, the citizen's humanity as a person with his/her own will and opinions about his/her life can be lost through someone else's power over this citizen. Even though the intentions are good, the paternalistic approach itself can easily lead to loss of a person's control over his/her own life. If the possessor of information is an institution (such as the state, a healthcare organisation or a company), the problem is actually worse since institutions can and usually do treat citizens as only part of a bureaucratic process, without a trace of humanity (see, e.g. Wiesing [START_REF] Wiesing | Immanuel Kant, his philosophy and medicine[END_REF] for the view that the Kantian tradition functions as a stable anchor for humanity).

Conclusions

The clear regulation of patient information seems to be missing in several legal systems or traditions of jurisprudence. While patient information obviously plays an essential part in modern healthcare, there must be a wider discourse on the issue than there is at present. The proposal that patient information should be regulated in such a way that it gives patients the strongest possible rights over their information is ethically justified from a Kantian perspective. Other viewpoints from different perspectives and traditions are needed to elaborate Datenherrschaft in such a way that it fulfils the ensuing transdisciplinary demands.

This proposal also has the advantage of being free from the baggage of previous legal solutions. It responds to the problems of current views on property and respects the privacy and autonomy of patients. Likewise, the proposals note the right of public healthcare authorities to access and use patient information in situations deemed necessary to protect the life and health of others, for example, in the case of epidemics. Future research should evaluate what kinds of changes are needed in information systems and healthcare practices if Datenherrschaft is implemented.

There are of course other traditions, but the authors want to underline the differences between the United States and (particularly continental) Europe, which have been the main traditions of relevance to this topic.

We use the term patient information (system) to avoid the problem of different terms being used, for example, electronic health record (ERH) or electronic medical record (EMR) etc. What is important is that the patient information system, or whichever term is used, stores information about the patient.

Laki potilaan asemasta ja oikeuksista 785/1992

Laki sosiaali-ja terveydenhuollon asiakastietojen sähköisestä käsittelystä 2007/159

Sosiaali-ja terveysministeriön asetus potilasasiakirjoista 298/2009

[11 p229]

[9 p54]

The author notes that in healthcare, patients are not treated as objects in the sense that they do not have rights; they are 'objects' for healthcare in the sense that healthcare contains information designed for healthcare professionals about patients, and by mixing this information and professional work, healthcare executes the medical tasks appointed to it.


Donatella Padua
email: donatella.padua@unistrapg.it

From Caravaggio to Braque: Digital Technology and the Illusion of Augmented Responsibility

Keywords: Multidimensionality, Digital technology ecosystem, Augmented responsibility, Choice-sets, Situational Context Theory (SIT), Cubism, Digital Technology

According to the Situational Context Theory, the recent accelerated evolution of digital technology (IoT, Microchips) reinforces the trend of progressive reduction of the physical distances between an 'Augmented individual' (technology-empowered subjects playing their daily life decision-making processes based on multidimensional choice-sets) and technology. Technology becomes further more competent than the subject in dialoguing with the situational environment, both in the area of information building (search engines) and of location-based dialogue with the daily environment (IoT, NFC, VR). Because of reduced physical distances and the growth in competence of technology, the free-choice based subject's responsibility, which initially appeared 'augmented', in reality decreases and becomes an illusion, quite as the cubism illusionism of Braque and Picasso painting. Indeed, in this frame of work, responsibility appears to shift from the augmented individual to organisations and institutions managing technology with competence, within a frame of a digital technology Corporate Social Responsibility.

Complexity

Economics, Physics, Information Theory and Biology contribute to shed light on how the Rational Choice Theory linear approach appears to be unable to comprehend a complex system. Logic patterns operate on linear sequential steps, one related to the other by a cause-effect process. Instead, complex systems accelerated by technology are multidimensional complex ecosystems of digital-physical subsystems.

In October 2008, at a hearing at the American Congress, the former Federal Reserve Chairman Alan Greenspan admitted he had failed to anticipate the selfdestructive power of subprime mortgages causing the 2008 financial crisis [START_REF] Andrews | Greenspan Concedes Error on Regulation[END_REF]. The hearing represented an historical step towards the disruption of mainstream neoliberal thought stigmatized by the monetarist econometric models [START_REF] Bresser-Pereira | The global financial crisis, neoclassical economics, and the neoliberal years of capitalism[END_REF]. Indeed, behind the Rational Choice Theory principles [8] inspiring monetarism, mainstream rational linear models appeared to fail the task to provide explanations of the economic, social and political complex techno-system [START_REF] Magatti | La libertà immaginaria. Le illusioni del capitalismo techno-nichilista[END_REF]. If a linear model is characterized by only one dimension [START_REF] Takahashi | A Simple Method for Treating the Statistical Mechanics of One-Dimensional Substances[END_REF], a complex system is composed by a number of interconnected sub-networks characterized by many dimensions and multiple variables [START_REF] Bar-Yam | General Features of Complex Systems[END_REF]. Statistical Physics, Information Theory and non-linear dynamics study different features of complex systems as the relationships between its parts, the collective behaviors arising by its internal interactions and ultimately the feedforward and feedback relationships with its environment [START_REF] Chapouthier | Mosaic structures -a working hypothesis for the complexity of living organisms[END_REF]. Depending upon these environmental exchanges, in Thermodynamics, systems are classified as open or closed. An open system exchanges matter and energy with the environment, while a closed system exchanges energy [START_REF] Irfan | Open and Closed System-Thermodynamic Systems[END_REF]. An example of open eco-system composed of subsystems is provided by the biologist Konrad Lorenz in his book 'King Salomon's Ring'. Lorenz argues that "The aquarium is a world; for, as in a natural pond or lake, indeed as all over our whole planet, animal and vegetable beings live together in biological equilibrium" [START_REF] Lorenz | King Salomon's Ring. New light on animal ways[END_REF]: plants, animals and decomposers play different roles within the complex eco-system, interacting to make available the great cycle of life. Likewise, the sociologist Luhmann maintains that society is a complex system composed of interrelated parts: it exists within an environment with which it exchanges information or energy under different forms; it is a dynamic system, that is, it implies feedback and feedforward processes with the external environment; it is intelligent at different levels based on its ability to act and reach for a balance with the outside [START_REF] Luhmann | Social Systems[END_REF]. Society, on the web, is a multidimensional eco-system in interaction with the offline environment, acting like a human organism, dynamically selecting, creating and evolving to satisfy emerging social needs. In the organizational sector, a case in point is Topcoder [START_REF] Lakahani | Topcoder Case Study[END_REF], an online crowdsourcing community with more than 900,000 developers, designers, and data scientists. Topcoder's crowdsourcing marketplace connects designers, developers, and data scientists from around the world with major companies, including IBM, Amazon and NASA to enter challenges and earning prizes. The community-based crowdsourcing business model follows the format of an 'organic cell': it is osmotic to the environment (exchanging ideas with the environment -the community), dynamically selecting, creating and evolving via challenges (hackathons and contests) to satisfy both profit objectives and emerging social needs. This means that it embraces crea-tivity, innovation, and the next big ideaembraces creativity and innovation, rewarding and recognizing the best designers, developers and data scientists for honing and proving their skills. Topcoder is an example of a revolutionary complex business model based on exchange and collaboration.

Unpredictability

Sociology and Economics indicate that the loss of order originated by the complexity of the Internet eco-system brings a disruption of power and control systems leading to uncertainty and risk. Individuals have more freedom, less control and more responsibility on their subjective decision-taking processes.

In the Internet multidimensional complex system, predictability appears not to be viable any more. Zygmunt Bauman argues that postmodern global society, because of the processes of fragmentation and individualization, has produced a 'new global disorder' 1 . In pre-modernity, order entailed the idea of predictability, allowing persons to safely predict the consequences of their actions. In the Modern Age, the rational linear patterns of the Rational Choice Theory interpreted reality under the theoretical approach of a perfect information and social order. In a complex digital social environment, instead, there is an absence of comprehension, in the Latin meaning of cum-prehendere, that is, to embrace all aspects, grasping all rational and irrational sides of subjective action. This view reflects into the concept of a society of uncertainty as predicted by Bauman [START_REF] Bauman | Paura liquida[END_REF] or, in economics, as predicted by Galbraith [START_REF] Galbraith | La morte definitiva (e la prossima vita) di Keynes[END_REF]. Related to the concept of uncertainty, the father of the theory of risk Ulrich Beck [START_REF] Beck | World Risk Society[END_REF] maintains that society itself founds on risk.

In this general condition of disorder and uncertainty, individuals do not act in accordance with the requirements of social roles and have to be responsible for their own actions. In fact, they are not protected nor controlled any longer by the traditional model of community of the Pre-Industrial Age [START_REF] Tönnies | Comunità e società[END_REF]. Indeed, pre-established patterns of social relationship appear to have dissolved (decline of church, political parties and associations, leading to a decline in identity, loss of social civicness, and a general decline in power by institutions [START_REF] Putnam | Bowling Alone. The Collapse and Revival of American Community[END_REF]), shifting to an Internet-Age model of society, characterized by multidimensionality, more freedom, less control, but more responsibility for one's self decision-making process. This phenomenon reflects into the need of protagonism on the web as a tendency to biographic narrations -as the proliferation of blogs or personal diaries on social networks-and an obsessive search for original performances and contents [START_REF] Castells | Information Age: Economy, Society, and Culture[END_REF], [START_REF] Beck | World Risk Society[END_REF], [START_REF] Ehrenberg | La fatica di essere se stessi[END_REF]. Under an organizational and business perspective, unpredictability translates into a general disruption of the mainstream make-or-buy models and increasing difficulties in vision-building, including the loss of meaning of long term planning given the fast pace of environmental change; uncertainty also leads to risks in reputation, given the viral connectivity of the web-, higher volatility in investments and a strong need to focus on customers' needs, reflecting in a general shift of power from the brand to the stakeholder [START_REF] Padua | Trust, Social Relations and Engagement. Understanding Customer Behaviour on the Web[END_REF].

Finally, unpredictability within the relationship between humans and technology is mainly based on the sense of risk (issues of security and privacy) and a lack of trust in technology which may occur when technology fails [START_REF] Cofta | Trust, Complexity and Control. Confidence in a Convergent World[END_REF].

Connectivity

Thermodynamics, Neurology, Physics, Network Analysis contribute to illustrate how in the Internet the speed of change follows a viral non-linear pattern. Virality develops on networks of connected knots, where space and time are the coordinates of multiple directions. Connectivity and virality appear to be the multidimensional paradigm governing change.

In Thermodynamics, chaotic systems are an extreme example of instable systems, as trajectories of initial conditions diverge over time following an exponential and non-linear ratio2 . Correspondingly, scientists adopt the 'Hockey stick model' to describe the exponential growth of Internet users along time.

In Neurology [START_REF] Gupta | Space-time network connectivity and cortical activations preceding spike wave discharges in human absence epilepsy: a MEG study[END_REF] as in Quantum Physics [START_REF] Vidal | Entanglement in quantum critical phenomena[END_REF], space and time are the two variables governing the phenomenon of connectivity. Likewise, in Network Analysis, the connection between nodes defines a portion of space and it occurs in a determined lapse of time, generating a relationship between speed and space. In the Internet, the speed of change by growing at geometric progression follows a non-linear viral pattern: one bank collapses, then other fifty follow; a computer is attacked by a virus, the speed of contagion is impressive; a virus infects a person, the contamination spreads all over the world. Virality appears to be the multidimensional paradigm governing the evolution of the change. Malcolm Gladwell evidences how epidemiology explains the three agents of virality3 : a. first, contagion. A contagious behavior transmits to other persons in similar contexts. The web space is made of interactions, so contacts are possible among a huge number of persons and contagious behavior spreads. b.

Second, small changes have big effects. Contagion starts from a small amount of infected units. c.

Third, speed: change happens not gradually but suddenly.

These three aspects shed light on the issue to govern information given the speed of change, following viral not linear, multidimensional patterns. This pattern may be related to chaos theory [START_REF] Gleick | Chaos: Making a New science[END_REF], where early weak signals, almost indistinguishable, may become suddenly uncontrollable tsunamis at global level. A case in point is company governance and reputation crises sparkled within the digital environment [START_REF] Hiles | Reputation Management. Building and protecting your company's profile in a digital world[END_REF] or a video suddenly going viral on YouTube social network.

Multidimensionality

In painting, as in in multiple domains of human expression we can observe a shift from the monodimensionality and unity of the Modern age to the multidimensionality of the Internet Age.

Thermodynamics defines systems as open or closed in relation to the interaction with the external environment. This classification sheds light on the key role of the context or 'environment' to the comprehension of eco-systems dynamics.

In 1914 Gertrude Stein was walking along Boulevard Raspail with her friend Pablo Picasso. When they saw for the first time a military convoy of mimetic tanks passing by, Picasso uttered: 'We created this. This is cubism!'. It was the beginning of a different way of looking to life, of perceiving reality, it was a multidimensional cubist vision [START_REF] Ramo | Il secolo imprevedibile [Or. Ed.The Age of Unthinkable. Why the New World Disorder Constantly Surprises Us and What We Can Do about It[END_REF].

Cubist painting is a high expression of multidimensionality and an ideal ground to analyse the shift from mono to multidimensionality occurred from Modernity to Postmodernity.

Fig. 1. Caravaggio and Braque Comparative Analysis

If we analyse by comparison the well-known 1600 Caravaggio's picture 'Basket of fruit' with an assimilable subject of the early twentieth century, authored by Braque, several differences emerge (Figure 1). Caravaggio's paint is an exact, meticulous reproduction; reality is represented with absolute fidelity; it is definitely static; it is three dimensions; it requires an exterior analysis from the viewer; it is an extremely objective definition of reality: anyone sees the picture in the same way given its definition. It is monodimensional, in this sense. As opposite, Braque's fruit dish appears almost undistinguishable, as any viewer may subjectively give his or her own interpretation, focusing on one element or on another; reality appears in a subjective way; the object is dynamic, many planes intersect one with the other in multiple dimen-Caravaggio 'Basket of fruit', 1599 ('Canestra di frutta')

Braque 'Fruit Dish', 1908 ('Plat de fruits') sions allowing different visions; it is a deconstruction of reality, allowing the spectator to re-construct it in a personal way; Braque's cubist approach asks for a deep analysis, a process of research to provide a personal interpretation to a complex representation of an object. Finally, in the Caravaggio's picture the focus is in the picture itself: Caravaggio wants the spectator to look at the basket as the painter wishes. In Braque's fruit basket, instead, the focus is within the subject standing in front of the painting, that is, outside the picture. In other words, there is an exchange between the external environment (the viewer and his or her context) and the inside (the painting), to reach for a balance of comprehension, a negotiation of meanings. The viewer is free to assign a meaning to the picture. This example aims to explain how, in painting, the representation of a fragmented, chaotic, and complex reality need to evolve from an objective to a subjective, multidimensional pattern. The same process has taken place in many other artistic expressions like Frank Gehry or Daniel Libeskind's architecture, called 'liquid architecture'.

The relevant perspective is that the shift from monodimensionality and unity to multidimensionality takes place in multiple domains of our social life. This process indicates how the global environment has transformed into a complex multidimensional and relational system.

According to Edgar Morin, individuals organize their knowledge into four domains: cultural (humanistic and scientific), social, economic, and political 4 .

During the last decade, in these domains we have witnessed an evolutionary process following a multidimensional pattern. This course has involved many sectors of human action performing as subsystems of a unique wider global system. Domains and sub-domains such as economics, sociology, technology, welfare, politics, science, art, business appear to have followed this process. Some examples for each domain follow (see Figure 2).

In economics, besides GNP 5 , new indicators such as Social Capital or Indexes of well-being measure wealth. Economists such as Stiglitz, Sen, Fitoussi or enlightened scientists as Coleman [START_REF] Coleman | Foundations of Social Theory[END_REF] and Putnam [START_REF] Putnam | Bowling Together[END_REF] have introduced Social Capital as a global economic parameter. In addition, multidimensional indexes of well-being6 are becoming progressively accepted parameter to express the multidimensionality and relativity of the perception of wealth by a population. These evolutions in the measurement of wealth evidence the growing complexity of the set of variables required to explain an environment.

In human sciences, sociologists are moving from holistic and individualistic models towards 'relational models' able to provide an understanding of the postmodern society. Sociology of Relation [START_REF] Donati | Relational Sociology: A New Paradigm for the Social Sciences[END_REF] is a representative new branch of sociology. In welfare politics, the role of governments is moreover giving space to bottom-up forces, as forms of open-government or wikicracy [START_REF]Open Government. Collaboration, Transparency, and Participation in Practise[END_REF]. Many other examples show how e-government solutions, as participative platforms, create highly effective relationship-building programs between institutions and citizens.

In science, theoretical studies are examining the possibility that quantum mechanics may be applicable not only to subatomic particles, but also on a larger scale: this would mean that the microscopic and macroscopic realms interact, evidencing a relational pattern that upset the classical assumptions of Physics, and opening the doors to parallel universes.

In art, ideas once shared among a chosen few belonging to élites, today are constantly produced and shared among a vast public, at zero cost. Pictures, images, videos, pieces of literature are forms of art shared with the vast Internet audience (Instagram, Snapchat, Flickr, Pinterest just to mention some of them).

In the organizational sector, companies are showing how their boundaries are progressively fading, moving towards global hive-net, horizontal, knowledge-oriented structures, by processes of externalization. This shift of focus performs from the centre outward and from unity to multidimensionality. The first, subverts the traditional vertical bureaucratic organizational model; the second, refers to the richness of diversity inside the organisations.

All these elements illustrate the general shift of paradigms from unity and monodimensionality (as one-dimensional economic indicators or individualistic social models) to multidimensionality and relationships (as social capital and connectivity).

This shift affects the relationship between human choice and responsibility in a digital technology context. Below, an introduction to the next section highlights the three conceptual steps tackling this topic:

1. When the device acts as a filter between individuals and situational contexts, multidimensionality affects the subject's decision-making process by enlarging the span of choice-sets (see section 5

). An example is the process of creation of a 'wishlist' compared to a traditional offline purchasing act inside a shop (showcases are Sephora, Gucci and McDonald, focused on wishlists building7 ). 2. Multidimensionality leads to a hyper and self-centred subject, the ideal type of which appears to be a 'Homo Augmentatus' ('Augmented Individual', see section 6), willing to express herself or himself in original and unique, personalised ways and looking for personalisation. Companies have understood this social priority and respond with customized products. Cases in point are Coke's personalized bottles or the customized Fiat 500, providing customers with a product configurator to design one's own car. Personalisation is also provided by companies through the adoption of evolved business models as the Long Tail allowing an 'endless choice creating an unlimited demand' [START_REF] Anderson | The Long Tail: Why the Future of Business Is Selling Less of More, Random House Business books[END_REF]. A case in point is the iTunes personalised playlist or any mobile's set of apps, personalized according to tastes and needs. Brand marketing adapts to this change by tracking Customer Journeys on the web to understand personal behaviours and provide unique customer experiences; search engines track individuals' search behaviours to provide aligned information or to market data and information to companies indispensable to personalize processes. Offers, products, promotions are in real time aligned to the individual's tastes and experiences. 3. Importantly, the resulting higher grade of freedom of choice and opportunities of the Internet Age leads to an evolution of the concept of the subject's responsibility into an 'Augmented Responsibility' (section 7), where digital technology plays the role of 'augmentator' (enhancer) of human subjectivity. 4. However, as digital technology is showing a definitely superior grade of competency than the human in filtering environmental data and information, the critical appraisal of the augmented individual and augmented responsibility appears to be an illusion. Indeed, technology itself, and organisations behind technology, by selecting, filtering and packaging information show to be taking a great deal of the burden of responsibility. This opens the doors to a new concept of Digital Corporate Social Responsibility.

Physical Distance

The accelerated evolution of digital technology reduces the physical distances between Human and Technology. The more distance gaps reduce, the more the digital device is able to participate to the situational contexts of the individual and provides the subject with growing sets of information and of choice.

According to the Situational Context Theory (SCT) [START_REF] Malinowski | The meaning of meaning. A study of the influence of language upon thought and of the science of symbolism[END_REF] the concept of physical distance allows meanings to be exchanged in an environment where interaction takes place in a particular time and place. The 'context' is the situation within which something exists or happens, and that can help explain it [START_REF] Mechkour | Overview of Situation Theory and its application in modelling context[END_REF]. In this conceptual frame, it may be assumed that technology plays the role of interface between the subject and the situational contexts, allowing the exchange of meanings via interaction. Importantly, interaction occurs both with the device and via the device (technological medium). In this section we analyse interaction via the device, thus studying how distance plays a role between the human and the device. In section 7 we will tackle the interaction with the device.

Fig. 3. Devices-Distances-Situational Contexts graph

In Figure 3, the evolution of digital technology from PC to Laptop to Ipad to Nearables and Wearables to Implantables evidences a progressive reduction of the physical distance between the human body and the technological device (H-T Distance) and a growing interaction of the device with situational contexts, also thanks to the introduction of the Internet of things (IoT). This gap reduction relates to the following variables, which we will call 'Distance-Frequency variables':

1. Correspondence of the mobility of the device to the individual's mobility (PC is suited to work on a desktop -a cellphone concept is focused on 'mobile' 8 ); 2. Body-device physical distance and Frequency of contact: a PC lays on a desktop at about three spans distance from the body (not mobile, low frequency), while a mobile is by definition a handheld 9 (mobile, high frequency); a wearable smart device follows the rule of the wristwatch and its corresponding frequency of wearing is intended to be higher than a mobile phone [START_REF] Follett | Designing for Emerging Technologies: UX for Genomics, Robotics, and the Internet of things[END_REF]. 3. Individual-device interaction with situational contexts.

The graph evidences how the more distance reduces the more the device participates to situational contexts and provides information to the user. According to the SCT assumptions, it means that the device plays the role of medium as an interface to exchange meanings with the environment, allowing exchange of information and providing the subject with multiple choice-sets in his or her decision-making process.

The concept of mobility in terms of 'user experience' (UX) is about making content available when and where users want it, as efficiently as possible [START_REF] Matsekh | The Who, What, When, Wear, and Why of Wearable Technology. UXMagazine[END_REF]. Based on the graph analysis and because of the direct relationship between information and choice-sets, we may use the syllogism according to which the more distance reduces, the more choice-sets are available to the device user.

In this explanatory mainframe, we have to exclude Desktops because of their participation to situational contexts restricted to a fixed location and Implantables because of their inability to provide information directly to the bearer, excluding any mindful involvement of the individual. 10 In fact, a basic requirement of a free and responsible choice is the subject free will and awareness key to interact rationally with the device, i.e. to retrieve information on a specific issue. A heart by-pass participates 24h to the individual's situational contexts but the subject cannot interact consciously with the implanted device. Other cases of irrational behaviours as simply looking at the device or touching it 11 are excluded, as we are focusing on technology as a mean and not as an end.

Augmented Individuals

In a Multidimensional environment where Human-Digital Technology distance reduces, 'augmented individuals' are technology-empowered subjects enabled to access multidimensional choice-sets in their daily-life.

The void of institutional power entailed by globalization has determined a crisis of the meaning of existence, the disruption of strong references safely determining identity. 12 According to sociological [START_REF] Giddens | Central problems in social theory: Action, structure, and contradiction in social analysis[END_REF], cognitive [START_REF] Bandura | Social foundations of thought and action: a social cognitive theory[END_REF], behavioural theories [START_REF] Smith | F. Skinner and behaviorism in American culture[END_REF] connecting the macro with the micro-level, multidimensionality at the macro-level of the complex internet system affects the individual in two opposite directions: the first, in terms of a lack of comprehension of the complex social environment [START_REF] Beck | World Risk Society[END_REF], [START_REF] Luhmann | La Fiducia[END_REF], [START_REF] Bauman | Voglia di Comunità[END_REF] and a perception of risk [START_REF] Bauman | Il disagio della postmodernità[END_REF], [START_REF] Beck | World Risk Society[END_REF]; the second, in terms of providing a sense of freedom, given the absence of predetermination in social action [START_REF] Hirshman | Le passioni e gli interessi[END_REF], an impressive access to information and freedom to subjectively make decisions among a growing number of choice-sets. To refer to the Caravaggio-Braque analysis, we are far from the holistic [START_REF] Durkheim | La divisione del lavoro sociale[END_REF] approach of Caravaggio's objective pattern. Along the same direction, we may say that the Internet Age individual is far from the Homo Sociologicus 13 of Dahrendorf, qualified by social roles, characterized by a pre-determined action, a limited field of experience and a lack of subjective responsibility in relation to a scarce presence of free expression 14 ; The Internet Age individual appears also to overcome the Homo Oeconomicus of Hirshman, qualified by personal interest [52] and acting along the mean-end pattern of the costs-benefits comparison (Rational Choice Theory). In fact, the Homo Oeconomicus played its role in the context of the social order of the Modern Age where social positions where distributed and coordinated. Instead, in the multidimensional Internet Age, by lacking those role expectations connected to social positions, the individual ideal type appears to be a 'Homo Augmentatus' ('Augmented Individual'). That is, a hyper-subject, self-centred in the three meanings of: a. Protagora's 'antropos metron', where the human itself is the measure for any human expression; b. under the phenomenological perspective, as opposition to objectivity, c. under the Weberian concept of space of meanings of actions [START_REF] Cesareo | La libertà responsabile[END_REF]. 12 Throughout the historical phases of pre-modernity, modernity and postmodernity the relationship between the individual and society has been characterised by a progressive disruption of the unitary principles: in Illuminism, rationality; in Idealism, spirit; in Marxism, materialist laws of reality. This process led to a progressive loss of certainty reflected in a loss of power of political authorities, of moral laws, of religious structures. Globalization, by accelerating the processes of fragmentation and de-institutionalisation, has disrupted the State-Nation-Society concurrence [START_REF] Bauman | Voglia di Comunità[END_REF][START_REF] Beck | I rischi della libertà. L'individuo nell'epoca della globalizzazione[END_REF][START_REF] Castells | Galassia Internet[END_REF][START_REF] Dahrendorf | Dopo la democrazia[END_REF][START_REF] Crouch | Postdemocrazia. Laterza[END_REF]. 13 [50] p.51 14 [51] p.139

Augmented Responsibility

The resulting higher grade of freedom of choice of the Internet Age leads to an evolution of the concept of the subject's responsibility into an 'Augmented Responsibility' or a complex-multidimensional construct, where freedom of the act of choice is exerted by hyper-subjective norms and values.

In section 6, within the definition of physical distance, technology played the role of medium, or mean of interface between the human and the environment. Instead, within the concept of the hyper-subjective Homo Augmentatus, technology is tackled under the relationship with the human. In this perspective of physical interaction with the user, digital technology plays the role of 'augmentator' (enhancer) of human subjectivity. As subjectivity emerges as a process of building the meaning of one's own life leveraging exclusively one's own resources 15 [START_REF] Giaccardi | L'io globale. Dinamiche della società contemporanea[END_REF], the intimate relationship established between the subject and the technological device [START_REF] Levy | Collective intelligence: Mankind's Emerging World in Cyberspace[END_REF] lets the device play the role of an empowerer of human cognition by increasing the individual set of resources (choice-sets). Resources provided by the IT to the connected ('always on') Augmented individual allow accessing a remarkable amount of information and choosing various alternatives of navigation to explore the web landscape (platforms, media, channels), designing constantly changing journeys.

The individual will select resources in a conscious, free-will pattern (we will see how this perception in reality is an illusion). Free-will relates to that subjective component of the person represented by reflexivity, autonomy of choosing and originality 16 . Reflexivity is a disposition of cognitive nature occurring when "what is relevant to us is the adoption of the standpoint of the first person" 17. In other words, the 'Augmented individual' experiences an 'Augmented responsibility', being the autonomy of choice a disposition of free-will enabling the person to take choices in a relatively independent way. In synthesis, 'Augmented responsibility' refers to an 'augmented individual', centred on himself or herself as a subject, conscious, in a position of wide freedom and empowered by technology to make a choice by applying hypersubjective norms and values. An example is the process of acquisition of information to purchase an item: the possibilities provided by the web are infinite, considering the opportunities provided by creating forums, or chats, or surveying, or accessing websites, social networks and communities or rankings.

The Illusion

As a paradox, in contrast with the notion of 'augmented responsibility', digital technology is progressively taking over part of the individual's decision-making processes of information selection. Being more competent than the subject in dialoguing with the situational environment, it provides focused and selected information, thus limiting choice-sets and generating bounds to the subject's free-will. This reduces the critical appraisal of the augmented individual and subjugates their responsibility making augmented responsibility an illusion. Responsibility, indeed, appears to shift from the augmented individual to organisations and institutions managing technology with competence, calling for a new concept of digital technology Corporate Social Responsibility entailing trust.

Aristotle was the first philosopher introducing the concept of téchne (technology). At that age there was no separation between the two components of the concept: knowledge and know-how (téchne and praxis). Knowledge was a unitary concept, corresponding to the concept of 'art' to Romans, which included different crafts and expertise. Art implied managing knowledge and know-how. Indeed, in the digital contemporary life, it appears that technology has taken over the know-how and is progressively taking over also knowledge, in many fields as in daily-life issues.

In terms of know-how, it is a reality how much we are unaware of how simple daily-life objects work. We do not know materials and mechanics of a toaster, a cellphone, a PC, a TV. Technology, instead, has full competence in this. Being competent, knowing the 'whys' and having power and control over the know-how, it determines a subtraction of responsible free-will to the 'augmented individual'.

In terms of knowledge, reality tells us we are delegating much of our knowledge to digital technology: search engines, by leveraging their position of power are competent in filtering the Internet information, releasing it by personalised tracks of past researches. This represents a limitation of the individual's freedom to rationally and emotionally select a choice. It is a progressive reduction of choice-sets, bounding freedom and responsibility and generating a dangerous illusion on 'augmented responsibility'. If this represents a simplification of reality [START_REF] Luhmann | Potere e complessità sociale. Il saggiatore[END_REF] and a positive lift from the cognitive burden of choosing (in some cases, large choice set sizes discourage individuals from making a choice [START_REF] Iyengar | When Choice is Demotivating: Can One Desire Too Much of a Good Thing?[END_REF]), it has severe ethical consequences. In fact, this process, while providing search engines with more and more focused profiles of the Internet users to be marketed to companies, it dissolves the primitive value of the Internet: the democratic preservation and valuing of different standpoints, to favour a rich diversity [START_REF] Pariser | The Filter Bubble[END_REF].

Against a perception of an 'Augmented individual' with 'Augmented responsibility' this other side of the matter appears to be deeply de-responsabilising as it generates a bounded-information. Indeed, bounds are not created by human cognitive and information limitations as in Herbert Simon's economic theory [START_REF] Simon | A Behavioral Model of Rational Choice[END_REF]. In our analysis, search engines, via their power and control put bounds to human knowledge, ending up in a possible control of perceived reality. SEO techniques are a case in point, as search engines enjoy a unique position in ranking websites based on variables defined by them. Not questioning the modalities of how algorithms variables are identified and the fact that individuals are to decide which Google page to visit, it is undiscussed that this is a delicate position. Moreover, the fact that that an oligopoly of search engines define the boundaries of knowledge (the total number of page results related to a search term) is a complex and 'sensitive' matter. A search result indicates that an entity has selected information in place of a human, often in sensitive matters, i.e. religion issues, culture, politics, values. The single individual mostly interested in a specific information ranked as the least relevant for Pagerank, for instance, is virtually excluded to accessing that information.

This scenario of illusion of technological empowerment is moreover relevant as technology by increasing competence via progressively reducing H-T distances (section 6), collects, owns and manages information providing more and more the subject with already packaged, elaborated information and focused to the specific situational need. Examples of location-based dialogue with the daily environment are IoT-based wearables and smart devices, NFC (Near Field Communication, as beacons) and Virtual Reality devices skilled in dialoguing with the environment. IoT is highly competent in collecting information from the human-environment interaction in many sectors as health research 18 , investing, insurance. 19In synthesis, these evolved forms of digital technology transmit an idea of empowerment and improvement of human choice, of efficiency, effectiveness, security and safety. However, this disruption of human bonds, in reality, hides a deep illusion: the illusion of freedom and empowerment of a 'Homo Augmentatus' with an 'Augmented responsibility'. The increasing trend of closing the human-technology gap reinforces the illusion of a 'technology providing a perfect service', like the illusion of a 'perfect information' of the Modern Age Rational Choice Theory. In the Internet Age, instead, the human issue is a lack of comprehension of the full context given the complexity of the online-offline environment (section 1). As in the Cubist Braque's and Picasso's illusion, where abstraction and reality are in conflict, in a Multidimensional reality, the illusion of an 'Augmented Responsibility' clashes with the bounds to human freedom imposed by digital technology.

This concept opens the doors to a new opportunity for technology owners within the Digital Corporate Social Responsibility, with the aim of reaching a sustainable relationship with stakeholders. In the health sector, for example, many are the examples of technology addressing issues in research (health data collected via mobiles [START_REF] Ganesan | A Review on Challenges in Implementing Mobile Phone Based Data Collection in Developing Countries[END_REF]), or, in developing countries, in medicine distribution (via drones [START_REF] Kulwin | Meet Zipline. Recode[END_REF]), helping the community of health workers [START_REF] Kolodni | Medic Mobile[END_REF] or providing basic healthcare information in India (via search engines [START_REF] Russel | Google search is now providing access to basic healthcare[END_REF]). In this frame, Digital Corporate Social Responsibility has to stay at the core of the strategic process of technology owners to build a trustworthy relationship between humans and 'competent' technology. However, competence is only one of the five components of trust. The other four, in fact, are: Integrity, Benevolence, Transparency, Congruence of value [START_REF] Mayer | An integrative Model of Organizational Trust[END_REF]. Only if organisations behind technology address all the five concepts, a trustworthy relationship with the humans will be built, probably addressing many issues in privacy and security.

Fig. 2 .

 2 Fig. 2. The Shift of Paradigm

[START_REF] Bauman | La società individualizzata: come cambia la nostra esperienza[END_REF] p.[START_REF] Durkheim | La divisione del lavoro sociale[END_REF]

[START_REF] Prygogine | La fin des certitudes.Temps, Chaos et les lois de la nature, Editions Odile Jacob, Paris [Tr. It. La fine delle certezze. Il tempo, il caos e le leggi della natura[END_REF] p.[START_REF] Hiles | Reputation Management. Building and protecting your company's profile in a digital world[END_REF]

[START_REF] Gladwell | The Tipping Point: How Little Things Can Make a Big Difference[END_REF] p.7

[START_REF] Morin | La testa ben fatta [tr. It. La téte bien fait[END_REF] p.[START_REF] Galbraith | La morte definitiva (e la prossima vita) di Keynes[END_REF]

Gross national product (GNP) is the total market value of the final goods and services produced by a nation's economy during a specific period of time (usually a year). Available at http://www.britannica.com.

[START_REF] Andrews | Greenspan Concedes Error on Regulation[END_REF] Better Life Index by OECD, available at http://www.oecdbetterlifeindex.org.

See the following videos at: https://www.youtube.com/watch?v=PhfVFuVprMc for the Gucci showcase; https://www.youtube.com/watch?v=EsT04Uopl7o for the MacDonald showcase; https://www.youtube.com/watch?v=UfIz0PYyucw for the Sephora showcase.

[START_REF] Cesareo | La libertà responsabile[END_REF] p.[START_REF] Hiles | Reputation Management. Building and protecting your company's profile in a digital world[END_REF]

[56] p.[START_REF] Dahrendorf | Dopo la democrazia[END_REF]

[START_REF] Taylor | Radici dell'io. La costruzione dell'identità moderna[END_REF] p.171

MyHeart Counts' wristbands project collects data to be sent to health research centers via advanced gyroscopes, accelerometers, barometers and other sensors. Available at https://med.stanford.edu/myheartcounts.html.

In the Insurance industry, wearables, by tracking customers' activity, allow insurers to keep policy pay-outs down to a minimum.