The core of the article are these four questions, which represent a cause for reflection about a typical Bioethical subject, which is the relathionship between man, science and technology and the consequences of the power of manipolation of things and life which enabled mankind to cross some limits that - since now - have been thought as fixed by Nature once for all:
a) when a prosthesis exceeds health care limits becoming a human enhancement operation? Always.
b) where is the boundary which separates a socially acceptable artificial device from a "dangerous" or "immoral" one? Nowhere.
c) which features define a "human being"? (Currently) mutations.
d) is it time to re-define the current idea of "human being"? Not for now.
a) When a prosthesis exceeds health care limits becoming a human enhancement operation? Always. In order to explain this provocative answer, it could be helpful to present some introductory observations.
The word "prosthesis" comes from the ancient Greek word πρόσθεσις (prósthesis, “addition”), from προστίθημι (prostíthēmi, “I add”), from πρός (prós, “towards”) plus τίθημι (títhēmi, “I place”), from Proto-Indo-European *próti, *préti plus *dʰédʰeh- (“to be putting, to be placing”). Following the etymology of the word, the main conveyed idea is that something is added to something else which - it can be inferred - should not have necessarily missing or damaged parts.
Oddly enough, in the current agreed definition of the word "prosthesis", the ancient idea of "addition" has been replaced with the idea of "restoring, replacing" the usual but disturbed state of affairs, as it can be seen from this definition: "a prosthesis is an artificial device that replaces, restores, in full or in part, the original functionality of a missing body part, which may be lost through trauma, disease, or congenital conditions".
Following this definition, it is possible to include in the set of prosthesis artificial devices and products like drugs, artificial arms, legs, exoskeletons, artificial organs, artificial implants like cochlear ones or brain and heart pacemakers, even ART (Assisted reproductive technology), since they all are artificial devices or procedures or products used to restore the original functionality of a healthy human body. Later it will be discussed the concept of "healthy human body", which is not as clear as it could seem at first glance.
On the contrary, the idea of "addition" is conveyed through the politically incorrect couple of word "human enhancement" whose definition according to the American institute for ethics and emerging technologies is "any attempt to temporarily or permanently overcome the current limitations of the human body through natural or artificial means. It is the use of technological means to select or alter human characteristics and capacities, whether or not the alteration results in characteristics and capacities that lie beyond the existing human range".
The fact that the alteration could or could not result in "characteristics and capacities that lie beyond the existing human range", represents an essential specification which enables us to include the artficial device known as prosthesis in the wider set of artificial means used to overcome the current limitations of the human body, so that even a prosthesis represents a sort of "human enhancement".
Having said that, the answer to the question "when a prosthesis exceeds health care limits becoming a human enhancement operation" cannot be different from "always" and the infamous "human enhancement" artifical devices suddenly lose their aura of "immorality", moving the problem from the device in itself to the social acceptance of the device, which - as it has been showed - is only in part related to the device tout-court or to its usefulness.
b) Which leads us directly to the next question: where is the boundary which separates a socially acceptable artificial device from a "dangerous" or "immoral" one? Nowhere.
To explain this answer, it is useful to start with an example showing how much weight the social acceptance of an artificial device has on the development of the device itself. The example is taken from the history of the bancomat (ATM), as told by C. Flamigni, 2014.
(note: C. Flamigni, M. Mori, La fecondazione assistita dopo dieci anni di legge 40. Meglio ricominciare da capo!, Ananke, 2014, pag. 14. The full article written by C. Colombo on the Italian newspaper "Corriere della sera" can be read online at this link: http://archiviostorico.corriere.it/2003/giugno/17/Immorale_prendere_soldi_primo_Bancomat_co_0_030617037.shtml?refresh_ce-cp - last visited in 2015).
When the first "Bankmatic automated teller machine" was invented by Luther George Simjian in 1939 and used by the Citycorp Bank of New York, many people complained about the fact that the device was only used by "those people like prostitutes and gambling den users who do not want to show their faces in front of a bank cashier". So the device was removed and the invention had to wait 30 years before it could be accepted later in the 60s. Was the ATM "immoral" or "dangerous" in itself? Why people reacted that way to it?
As Luther George Simjian said in his diary, it is necessity which pushes inventors to develop new technologies and devices. Maybe in the 30s there was not yet the necessity for ATMs, but nowadays that money exchange has to be fast-paced and trackable these devices are everywhere and the idea of "immorality" and "dangerousness" related to an ATM makes us smile. But it is society who establish what is "necessary" and what is not.
If we agree on this idea, technologies that society considers necessary have more chances to be welcomed and implemented. For example, if society considers desirable and necessary increasing life expectancy and its quality, many resources will be allocated to researches aimed at this purpose. Once again, if society considers necessary the development of an artificial heart in order to save the life of a human being with an "original" but damaged heart, probably a lot of resources will be invested on the development of such technology.
(note: these kinds of researches are being implemented by the CARMAT company, which is working on a "biocompatible, auto-regulated total artificial heart including right and left ventricles designed to be as close as possible to the human heart". (http://www.carmatsa.com/ - last visited in 2015)
Turning back to prosthesis, an artificial device is more likely to be considered necessary and therefore accepted by society if it is supposed to overcome a "disease" or "illness". But there arouses another problem related to the definition of "healty human body". To a certain degree what is considered as "disease" or "illness" is culturally and socially constructed too, and it cannot be solved simply by defining health as the "full expression of species-typical function," because this concept is variable. This phenomenon is known as the so-called "medicine nosological elasticity" (note: nosology is a branch of medicine that deals with classification of diseases).
(note: see Juengst, Eric and Moseley, Daniel, "Human Enhancement", The Stanford Encyclopedia of Philosophy (Summer 2015 Edition), Edward N. Zalta (ed.), URL = <http://plato.stanford.edu/archives/sum2015/entries/enhancement/> and Erik Parens, Enhancing human Traits: Ethical and Social Implications, Georgetown University Press, 1998)
Actually, what society considers as a typical function of the human species has been changed throughout the centuries: living with permanently damaged lungs could have been impossible in the 15th century, but nowadays living and executing some "species-typical functions" with permanently damaged lungs is possible thanks to artificial lungs.
In order to give another example, it could be useful talking about some bioethical problems related to the use of ART, Assisted reproductive technology. Nowadays many scientists, researchers, academics, politicians, etc., are concerned with the ethical questions that arise from the use of some assisted human reproduction techniques. One of the most controversial issue was the development of an artificial womb (for a story about the changes in human reproduction see Aarathi Prasad, Like a Virgin: How Science Is Redesigning The Rules Of Sex, Oneworld Publications, 2012).
It is written was because the project has been so stigmatized by the society and by the media that scientists who were working on it preferred not to carry on with the researches and replacing their attention to bioengineering uterine tissue to repair a damaged or malformed uterus.
(note: http://www.theatlantic.com/health/archive/2015/01/the-high-tech-future-of-the-uterus/383232/ - last visited in 2015).
Why the idea of repairing damaged or malformed but already exiting wombs is considered desirable and supported by the society while the idea of a totally artificial womb is seen as "immoral and horrific"? Maybe because the popular imagination fears the creation of a sort of "human being factory" full of incubators where children are "cultivated" rather than "brought up"?
But supposing scientists implemented a perfectly working artificial womb and implanted it in a woman just as a "socially acceptable and welcomed" artificial lung, would the artificial womb be considered a "socially acceptable" prosthesis, being it "an artificial device that replaces, restores, in full or in part, the original functionality of a missing body part, which may be lost through trauma, disease, or congenital conditions"? Or would the artifcial womb be still considered an "immoral" or "dangerous" way to permit unhealthy women to enhance herselves giving birth thanks to technology? On the other hand, why a woman with an unhealthy lung should have more chanches to be assisted than a woman with an unhealthy womb? Maybe because a woman can live without a womb or with a damaged womb but cannot live with a damaged lung. But is this the problem?
At this point, many new questions arise which would be very interesting to analyze in another article, maybe paying attention to the biopolitical issues related to it: do we have to concentrate our efforts only on life-saving treatments and not on life quality-enhancing ones? Is really this what society desires? Is society aware of the consequences of its desires? Are these needs real or induced? And who or what induced that desires? And how can we establish what a real need is? To what extent these desires and needs are safe and morally acceptable and should be supported or limited?
Definitely, bioethicists have still a lot of job to carry on, provided that their job is to make questions and stimulate a wide debat on these issues which should not be confined within academic lecture halls, but should be spread across society, at any level.
In conclusion, as showed, the answer to the question "where is the boundary which separates a socially acceptable artificial device from a "dangerous" or "immoral" one?" is "nowhere" because that boundary is as floating as society's (real or induced, conscious or inconscious) desires and needs.
c) We do not have to forget that society is composed by human beings, whose main characteristic is (currently) to transform, as it will be discussed when answering the third question: which features define a "human being"? Mutations. If humans mutate, society mutates and so its needs and desires.
Currently, all humans are mutants and the (platonic, indeed) idea of a fixed human nature is no more sustainable. To explain this statement it could be useful starting from the essay by J. Habermas, The Future of Human Nature, 2003.
(note: J. Habermas, The Future of Human Nature, translated by H. Beister, M. Pensky, and W. Rehg, Cambridge: Polity, 2003)
In this book Habermas explains his reasons for viewing genetic manipulation and pre-natal screening as impermissible (except to prevent disease and serious impairment) and asks to the reader if it is morally acceptable enabling humans to "program" their genetic makeup and thus their existence through biotechnology. As it will be shown soon, the question is misleading, because it presumes a) that humans have been remaining the same since they appearance throughout the centuries; b) that a human existence is determined entirely by its genetic makeup.
In this article the assumption b) will not be discussed in details, as it weakness is clear: genetic reductionism. This critique is based on another assumption which is that the complexity of human beings cannot be reduced to genetic, because human beings are (hopefully) more than the result of their biological processes.
Regarding to the assumption a), the problem here is that human species does not have a fixed-by-nature and immutable "essence", as humans have always been "programming" themselves throughout the centuries using different methods, thus manipulating their bodies and the surrounding world in order to enhance the quality and the duration of life. We start transforming and manipulating our body and the surrounding world since the day that we were born.
This is easy to understand simply noticing the fact that thanks to its ability to manipulate the surrounding world and itself using different tools and processes, human species has improved its life expectancy during the centuries.
Now, the problem is that more sophisticated, powerful and potentially dangerous methods of manipulation are available, and so mutations should be designed more carefully than before and not forbidden a priori. According to R. Marchesini, author of Post-Human,
(note: see R. Marchesini, Post-human.Verso nuovi modelli di esistenza, (Post-human.Towards a new process ontology), Bollati Boringhieri, 2002 ),
the method used by humans to transform themselves and the surrounding world in order to enhance their capabilities is a "continuing hybridisation with animals, vegetables and now technology", a co-evolutionary process.
Marchesini criticised the obsolete definitions of human being given by humanism and trans-humanism because they assume the idea of the humans self-sufficiency, as humans were or could be totally independent and isolated from their bodies and their surrounding world. Both humanism and trans-humanism are unable to understand the essential contribution of animals, vegetables and technologies to the evolution of humankind, so they are no more sustainable.
In addiction, humans self-comprehension is related to the external world: they always make a comparison between what they currently can do and what vegetables, animals and now technological products can do, so they will always try to overcome their current limits and the mutation process probably would never stop. In order to make an example, human brain is usually compared to a computer, but there are many things that a computer can do and a human brain cannot do, so we discovered limits which we did not feel to have before the invention of the computers and it works as a stimulus to find new solutions to enhance "natural" brain potential.
If we agree on the fact that the features which define a "human being" are variable and unpredictable mutations, we should not fear the challenges we have to face now that science is our co-evolution partner and try to do our best to transform ourselves in something which could make us proud of humanity. But how can humankind be proud of itself?
Let us try to suggest a way through which humans could answer to this question, starting from a definition of "human" which would be currently widely accepted. A human being is "that particular being able to transform consciously and independently itself and the surrounding world according to an autonomously set purpose. A purpose is autonomously set when the decision is based on awareness of the facts, resulting from information and education". Knowledge and research could therefore be the key of our future mutations, associated with feelings of empathy and modesty for every creature.
The way to face this difficult challenge could be giving people methods and instruments through education (starting from schools) and awareness campaigns in order to develop their personal opinion and to make their informed decisions on what they want and do not want to be and to do, without easy sensationalisms and stigmatisations, always keeping in mind that the more powerful tools are, the greater responsibilities arise.
d) In conclusion, is it time to re-define the current idea of "human being"? Not for now.
As discussed in the former paragraph, for many centuries being "human" has been synonymous with (hopefully) consciously and independently transforming on purpose and manipulating the surrounding world and themself, and presumably this meaning will remain the same. For now, at least. In fact, as Heraclitus reminds us, "all entities move and nothing remains still" (Heraclitus quoted by Plato in Cratylus, 401d), so even humans' attitude to transformation could change in the future, or we could be asked to re-define the idea of human being because there will be other things or creatures able to manipulate their world and themselves the way humans do. Who knows?
The challenge is open.