Not Just a Pretty Face: Legal and Ethical Issues in Regenerative Nanomedicine
This blog entry on nanomedicine and human enhancement is based upon a presentation I gave at the 2009 Human Enhancement & Nanotechnology Conference in Kalamazoo, Michigan. The title, as you may have gathered, was intentionally provocative and intended to underscore the idea that regenerative nanomedicine is not just for enhancement purposes; that within a decade, regenerative nanomedicine will be the primary methodology for medical therapies and treatments.
The National Institute of Health regards regenerative medicine as that area of medicine which includes both therapy and enhancement of biological function that has been lost due to congenital abnormalities, injury, disease, or aging. But how does one distinguish between therapy and enhancement? At first blush, the lines between seem clear cut. Therapy is for healing the sick and relieving the suffering; enhancement is meant to augment or improve the “normal” workings of the human body and psyche. Many therapeutic interventions can and are used later on for non-therapeutic purposes; for example, Sildenafil Citrate (popularly known as Viagra) may have started off as a therapy, but has quickly found a place in society as a lifestyle drug. Or Minoxidil, originally used to treat high blood pressure, now advertised as the drug of choice for thinning hair or hair loss in men and women.
Futurist and scientist Ray Kurzweil predicts within the next 25 years the union of human and machine, in which the knowledge and skills embedded in our brains, will be combined with the vastly greater capacity, speed, and knowledge-sharing ability of our own creations. He speculates that the merger between human and machine will be so complete that distinctions will be impossible or rendered meaningless.
The ethical, legal, and societal concern is that by merging with technology, we will change what it means to be ‘human’ or a ‘person’ and change basic human nature. But I would argue that these technologies –which we have created -– are reflection and extension of ourselves and our nature. The spectrum of human nature ranges from kindness to cruelty. It is an understatement to say that we are capable of inflicting tremendous harm and suffering – on ourselves, as well as other life forms and the planet itself. When we are apathetic and unaware of the interconnectedness of all living species on this earth, one needs look no further than the recent oil catastrophe in the Gulf of Mexico to see the result. At the same time, humans are capable of tremendous good – compassion, empathy, generosity and transcendence. When an earthquake struck Haiti, people from all over the world stepped in to help both the humans and animals of the disaster stricken area. Technology extends the spectrum and amplifies that nature.
Within this spectrum, one of the primary concerns is access. With a worldwide aging population, regenerative medicine will be in peak demand in the decades to come. Within the United States and Canada, health disparities are well documented in minority populations. When compared to Whites, these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes. Among the questions that need to be addressed are, for example, “is it appropriate to commit research funding, expertise, personnel, and infrastructure resources on developing and disseminating technologies with enhancement potentials when more than 50 million people are without adequate health care in the United States and hundreds of millions are without even basic health care globally? Are such technologies likely to exacerbate or reduce unjust inequalities? What rights (or obligations) do parents have with respect to adopting such technologies for their children?”
These are daunting questions, but we cannot simply turn a blind eye and pretend that the answers are of no consequence. We need to continue a proactive approach (such as this blog) with continuing dialogue and collaboration among the stakeholders; consider a set of recommendations similar to those set up at the Asilomar Conference on Recombinant DNA; come to terms with the notion that our creations can have unintended or unforeseen consequences and consider who will decide issues of regulation and liability.
Finally, we need recognize and acknowledge that our language is stuck in personhood-person dichotomy, that leads to all sorts of confusion, as boundaries between machines and beings begin to blur.
As nanotechnology progresses, and both humans and nonhumans receive therapeutic benefits and enhancements, it will be up to us, as individuals and as a society, both publicly and privately to determine what regulation is needed and how culpability and responsibilities should be allocated.
|Author :||Linda MacDonald Glenn, J.D., LL.M.
Department of Medical Education
Alden March Bioethics Institute
Albany Medical Center