Transcript Disabled people, emerging technologies and the South

Enhancement Medicine:
The final Frontier
Gregor Wolbring
www.bioethicsanddisability.org/start.html
E-mail: [email protected]
7/17/2015
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Agenda
To give some background on
• the status of emerging and converging technologies such as
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Nanotechnology, Biotechnology, Informationtechnology and
Cognitive sciences (NBIC) as they relate to NBIC-medicine;
The impact of NBIC on the very concept of health, disease,
disability and wellbeing,
The impact of the concept of health, disease, disability and
wellbeing, on the direction of research and development of NBIC
The dynamic around medicalization and the new field of
enhancement medicine
The impact of the above dynamics on ‘health’ promotion, ‘health’
research and public ‘health’
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Fields of Medicine
• Curative Medicine
• Preventive Medicine
• Palliative Medicine
• NBIC Therapeutic Medicine
• NBIC Enhancement Medicine
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NBIC-Medicine definition
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medical intervention at the molecular scale for curing disease or repairing damaged
tissues, such as bone, muscle, or nerve. [i]
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the study of biotechnology, pharmacy and biosensors at the cellular level.[ii]
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the application of nanoscale principles to biomedical technology,
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the comprehensive monitoring, control, construction, repair, defense, and improvement
of all human biological systems, working from the molecular level, using engineered
nanodevices and nanostructures;
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the science and technology of diagnosing, treating, and preventing disease and
traumatic injury, of relieving pain, and of preserving and improving human health,
using molecular tools and molecular knowledge of the human body; [iii]
the employment of molecular machine systems to address medical problems, using
molecular knowledge to maintain and improve human health at the molecular scale.”
[iii]
•
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NBIC-Medicine Taxonomy
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NBIC-medicine Taxonomy (Canada)
Nanomedicine Taxonomy Briefing Paper, by Neil Gordon and Uri Sagman
http://www.regenerativemedicine.ca/nanomed/Nanomedicine%20Taxonomy%20(Feb%202003).PDF
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NBIC medicine
US NANOTECHNOLOGY HEALTH CARE PRODUCTS DEMAND(million dollars)
% Annual Growth
Item
2004
2009
2014
09/04
20/04
Nanotech
Health Care
Product
Demand
906
6500
27700
48
35
Pharmaceutical
406
s
3000
16600
49
39
Diagnostics
465
1100
2200
19
14
Medical
Supplies &
Devices
35
2400
8900
133
50
[i] US NANOTECHNOLOGY HEALTH CARE PRODUCT DEMAND TO REACH $6.5 BILLION IN 2009 <http://www.the-infoshop.com/press/fd29054_en.shtml>
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NBIC-Medicine/NBIC-enhancement
Bionic Implants:
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“Couples' nervous system linked by implants in limbs. 06.07.2004
http://www.nzherald.co.nz/index.cfm?ObjectID=3576668
When Kevin Warwick lifted his finger, his wife Irena felt as if a bolt of lightning ran down
her palm and into her own finger. In what they billed as the first direct link between
nervous systems, the couple had electrodes surgically implanted in their arms and
linked by radio signals to a computer. Blindfolded for the experiment, they could feel
when their spouse's finger moved
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Bionic Ear: Cochlear Implants – Applications And Developments Utillising
Nanotechnology http://www.azonano.com/details.asp?ArticleID=976
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Bionic Eyes for the Blind
http://www.seeingwithsound.com/retinal.htm; Bionic Eyes – Ceramic Microdetectors
That May Cure Blindness http://www.azom.com/details.asp?ArticleID=1544; Bionic
eye offers new window on the world, Sunday 10.10.2004, CET 04:53
http://www.swissinfo.org/sen/Swissinfo.html?siteSect=511&sid=4415302
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NBIC-Medicine/NBIC-enhancement
THE NEW BIONIC MAN
BY MIKE FILLON
Illustration by Danilo Ducak
http://popularmechanics.com/science/medicine/1999/2/new_bionic_man/print.phtml
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NBIC-Medicine/NBIC-enhancement
• Chips Coming to a Brain Near You - (Wired News – October
22, 2004)
http://www.wired.com/news/medtech/0,1286,65422,00.h
tml
In this era of high-tech memory management, next in line
to get that memory upgrade isn't your computer, it's you.
Theodore W. Berger, director of the Center for Neural
Engineering at the University of Southern California, is
creating a silicon chip implant that mimics the
hippocampus, an area of the brain known for creating
memories. If successful, the artificial brain prosthesis could
replace its biological counterpart, enabling people who
suffer from memory disorders to regain the ability to store
new memories. And it's no longer a question of "if" but
"when." …
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NBIC-Medicine/NBIC-enhancement
http://www.3sat.de/3sat.php?http://www.3sat.de/nano/bstuecke/64605
/
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NBIC-Medicine/NBIC-enhancement
http://www.amputeecoalition.org/communicator/vol2no3pg4.html
The process termed "osseoperception"
refers to the adjustment of the mind to an
osseointegrated prosthesis. The
implication is that bone-integrated
prosthetic fixtures "communicate" with
the mind, via numerous neural pathways,
to promote near-normal function of the
prosthetic limb and improved
psychological acceptance. Beethoven, who
held a pencil between his teeth and
touched the pencil to the piano keys to
help him "hear" the music, illustrates a
primitive form of this concept. Similarly,
patients can perceive their environment
through their osseointegrated prosthetic
device. A self-reported incident even
describes a patient sensing, through his
artificial leg, what type of subfloor was
beneath a carpet.
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NBIC-Medicine/NBIC-enhancement
Berkeley robotic laboratory http://www.me.berkeley.edu/hel/bleex.htm
http://www.me.berkeley.edu/hel/bleex.htm
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Where do we go from here?
• How to deal most effectively with the needs of the
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marginalized?
How to define the problem of ‘ill health’ and the
solutions to the problem?
Can one draw a line between therapy and enhancement?
Can one draw a line between therapeutic and non
therapeutic enhancement?
How to decide on R&D priorities?
How to govern science and technology?
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Where do we go from here?
• Responses to surveys indicate that 'health is what matter most' to a
large proportion of the world's population.
• 'The enjoyment of the highest attainable standard of health is one of the
fundamental rights of every human being without distinction of race,
religion, political belief, economic or social condition‘
Constitution of the World Health Organization, 1946
• The Universal Declaration of Human Rights Article 25-1 states: “Everyone
has the right to a standard of living adequate for the health and well-being
of himself.
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Where do we go from here?
Health-related human rights treaties
• WHO Constitution (WHO, 1946)
• Universal Declaration of Human Rights (1948)
• International Covenant on Economic, Social and Cultural Rights
(ICESCR, 1966)
• International Convention on the Elimination of All Forms of Racial
Discrimination (ICERD, 1963)
• Convention on the Elimination of All Forms of Discrimination Against
Women (Women’s Convention, 1979)
• Convention against Torture and Other Cruel, Inhuman or Degrading
Treatment or Punishment (Torture Convention or CAT)
• Convention on the Rights of the Child (CRC, 1989)
• International Convention on the Protection of the Rights of All Migrant
Workers and Family Members (MWC, 1990).
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Universal
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Declaration on the rights of people with Disabilities
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The Road to Enhancement Medicine
The concept of health/Relationship between health and wellbeing:
Two contradictory models exist concerning the relationship between "health" and "wellbeing".
• The first, the WHO model considers different domains of well-being as determinants of the
umbrella term “health” which is reflected in the WHO definition of health, wherein health is
defined as "a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity”. In this model the term “health” through the different
wellbeing determinants combines the areas of “medical health” and “social health” under the
term “health”.
• Many do not adhere to the WHO definition of health and do not treat wellbeing as a
determinant of health They follow a second the non-WHO model of health and wellbeing
that sets "wellbeing" as the umbrella term, and defines health as "the absence of disease and
illness". This model limits the term “health” to mean “medical health”/”medical illness”.
“Health” is used to cover the domain of "medical" determinant of "wellbeing." “Social health”
is not covered anymore under the term “health.” The “social determinants of wellbeing” are
covered by other determinants and indicators.
• Which hierarchy one uses -- a)Well-being as a determinant of health (WHO scenario), b)
Medical health as a determinant of well being (Non WHO scenario)
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The Road to Enhancement Medicine
Model of health and disease
• Within the medical model of health and disease, health is limited to cover
“medical health” and is characterized as the normative functioning of
biological systems based on the homo sapiens species-typical, normative
frameworks whereas disease/ illness is defined as the sub-normative
functioning of biological systems.
Locating the cause of and solution for “ill medical health” comes in two flavours.
• Medical determinants of medical health place the cause of sub-normative
functioning within the individual’s biological system leading to medical
interventions towards the species typical norm on the level of the individuals
(medical, individualistic cures).
• Social determinants of medical health identify external factors as the cause of
the “ill medical health” the sub-normative functioning of the individual. This
includes, for example, contaminated water that leads to bacterial or parasitic
infections, or job insecurity that contributes to stress and heart disease.
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The Road to Enhancement Medicine
Social models of health and disease
Unfortunately, this version of the medical model is often misleadingly referred
to as the "social model of health" or as the "social determinants of health".
It is misleading because the model addresses social factors contributing to
“ill medical health”/"medical illness".
If one follows the WHO definition of Health, a real social model of health
would not just cover social determinants of medical health but would also
cover "social determinants" relating to the social wellbeing the “social
health” of a person who is not medically ill. One can be in bad social health
without having to be in bad medical health.
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The Road to Enhancement Medicine
The new kid on the block: the transhumanist/enhancement model of health
– a model in which human performance enhancement beyond species typical boundaries
is part of the concept of health characterizing health no longer as normative
functioning of biological systems but optimum functioning. Within the
transhumanist/enhancement model of health, 7 the concept of health no longer has
the endpoint that someone is “healthy” if the biological systems function within
species-typical, normative frameworks. Within the transhumanist/enhancement
model the human body – no matter how conventionally “medically healthy” – is
defined as limited and defective in need of constant improvement made possible by
new technologies appearing on the horizon (a little bit like the constant software
upgrades we do on our computers). Good health in this model is the concept of
having obtained maximum (at any given time) enhancement (improvement) of one’s
abilities, functioning and body structure.
Disease, in this case, is identified in accordance with a negative self-perception (confined
to the ‘normal’ human body) of ones non-enhanced body. Medical and technological
interventions on the level of the individual that add new abilities to the human body
or improve on existing abilities are seen as necessary remedies.Enhancement
medicine is the new field providing the remedy through surgery, pharmaceuticals,
implants and other means.
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The Road to Enhancement Medicine
“A Word on the concept of disability/impairment”
In general people use the term "disability" interchangeable with terms such as "impairment",
"disease", "illness", "chronic disease" and "defect".
However I and others perceive the meaning of the term disability as being different from the
meaning of the terms impairment, defect, illness and chronic disease.
The WHO International Classification of Functioning ( ICF) for example: states “Disability is
characterized as the outcome or result of a complex relationship between an individual’s
health condition and personal factors, and of the external factors that represent the
circumstances in which the individual lives.”13 and " Impairments are defined as "problems
in body function or structure such as a significant deviation or loss."13
Interestingly the ICF definition of ‘Disability’ achieves different meanings depending on how one
defines the term ‘health condition’ in that definition.
I also see terms such as ‘differently able’ being a replacement for the term ‘impairment’ not for
the term ‘disability’.
I perceive ‘Disability’ to mean: “People’s societal experience related to their impairment, defect,
illness and chronic disease”(medical,transhumanist/enhancement model) or “People’s societal
experience due to their as subnormative perceived non normative functioning (social model)
Within a human rights framework language one could say:” Disability means “People who are
‘discriminated against’ due to their impairment, defect, illness, chronic disease ( medical,
transhumanist/enhancement model) or People who are ’discriminated against’ due to their as
subnormative perceived non normative functioning (social model)
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The Road to Enhancement Medicine
Transhumanist/enhancement of “disability/impairment”
The transhumanist model of health and disease sees every human
body as defective and in need of improvement (above speciestypical boundaries) leading to the transhumanist model of
“disability/impairment” where every unenhanced human being
is, by definition, “disabled” in the impairment /patient sense.
The only way out of the impairment/patient label is to enhance
oneself beyond species typical boundaries. Everyone who
can’t afford the enhancement of their body will be labeled as
impaired.
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The Road to Enhancement Medicine
Enhancement Step 1 Make people feel bad about themselves
“The number of people with at least one of four major medical conditions
has increased dramatically in the past decade because of changes in the
definitions of disease." The new definitions ultimately label 75 percent of
the adult U.S. population as diseased [i] Suddenly sick A special report by Susan Kelleher and Duff
Wilson · June 26 - June 30, 2005 <http://seattletimes.nwsource.com/news/health/suddenlysick/
The annual report on Americans' health found that just over 44 percent
of all Americans take at least one prescription drug, and 16.5 percent
take at least three.
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The Road to Enhancement Medicine
Enhancement Step 1 Make people feel bad about themselves
According to a 2005 report by the Canadian Institute for Health
Information[i]increased drug spending in Canada relates to the volume of
drug use and the entry of new drugs (typically introduced to the market at
higher prices) and not an increase in prize of the old drugs a conclusion
which was also reached by the Standing Senate Committee on Social
Affairs, Science and Technology which states that prescription drug
spending could be attributed to increased utilization of existing drugs
(50%), sales of new drugs in their first full year (32%) and price increases
of existing drugs (18%).[ii]
“Medicalization may help feed unhealthy obsessions with health, obscure
or mystify sociological or political explanations for health problems, and
focus undue attention on pharmacological, individualized, or privatized
solutions”.[iii]
People in America feel much less well than those in Bihar, India,
though their life expectancy is much better (p 860). [i]
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The Road to Enhancement Medicine
Enhancement Step 2 Add Enhancement to the Mix
"'I believe in transhumanism': once there are enough people who can truly say
that, the human species will be on the threshold of a new kind of existence,
as different from ours as ours is from that of Peking man. It will at last be
consciously fulfilling its real destiny."
Julian Huxley First Director-General of UNESCO [i]
The transhumanization of medicalization moves the dynamic of
medicalization one step further by adding the enhancement of body
appearance and functioning above species typical norms and boundaries
to the mix. Although many maintain that a line can be drawn between therapy and
enhancement[i] this might not be as easy as it sounds if not impossible. Many
therapies have enhancement aspects to them. Many enhancements can be
classified as therapies and many therapeutic interventions can and are used later
on for non therapeutic purposes. More variations of human body structure and
functioning are labeled as deviations as diseases (dynamic of medicalization).
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The consequences of the transhumanist/enhancement model
If one can’t prevent enhancements a few problems are imminent which
one has to deal with, However as the debate around the issues and
the governance of science and technology is structured in the
moment it is unlikely that it can deal with any of the below
problems.
a) The generation of an ability divide (trickle down concept really does
not hold true)
b) One can expect a worsening of a gap between the rich and poor
countries and within the rich and poor people of every country
c) The concept of responsibility.
d) Cost explosion
e) Enhancement Medicine
f) Disabled people drift towards the Transhumanist/enhancement model
g) Enhancements will lead to an increase of people perceived as ‘impaired’
h) Decrease in self esteem: Rat race of abilities:
i)The promotion of synthetic biology
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The consequences of the transhumanist/enhancement model
j) Change in Concept of Personhood (sentient being)
k) It might lead to the reality that basic ‘medical good’ with no performance productivity
upsite will be
deinsured/ seen as futile care and enhanced medical goods with a performance productivity
upsite will
become insured. To quote Murray the designer of the Disability Adjusted life years
“In fact, as shown above the results are quite consistent across groups that individuals
prefer, after
appropriate deliberation, to extend the life of healthy individuals rather than those in a
health state worse
than perfect health” (p.726).” [i] A bias flowing from the last quote, which one can act on
increasingly is to
favour "enhancement medicine" over "curative medicine".
l) The separation of consciousness and human body (where is the soul? Organ based
memory?
m) Who will still follow denominations which are against a working immortality?
Will the Church become the Church for the people not being able to afford immortality?
For what purpose? To fight for an equitable access to immortality?
Would the poor even be a member of the Church if they know that the Church won’t help
them gain Immortality?
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The consequences of the transhumanist/enhancement model
“When we hear the term, we usually think of biodiversity in foods or
animals. But it applies to humans as well. In some sense, the notion
of biodiversity clashes with the transhumanist paradigm. To the
degree that biodiversity defends the existence of and prolonging the
lives of all forms of sentience, it negates the doctrine of species
improvement on the grounds that it isn't always in good interests for
life itself. If becoming "better" is about streamlining and selecting
various physical and mental attributes over others, other cognizant
forms will be left behind. Respect for biodiversity thus negates the
hierarchy of "ability" so idolized by the human species. For
example, disabled persons' lack of "ability" is what defines how they
are perceived, rather than personal characteristics. One of the
critiques of transhumanism as espoused by Dr. Gregor Wolbring is
that it serves to represent disabled persons as "defective products"
on the ladder of "ability".[1]
[1]
http://www.betterhumans.com/Resources/Encyclopedia/article.aspx?
articleID=2002-06-09-1
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If you have any questions after the talk e-mail me at
[email protected]
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