Medical technology is being used to optimise health in humans – but how can we steer an ethical course? CLAIRE O'CONNELLreports
YOU CAN’T miss them – the surgically sculpted models of perfection that beam out from the pages of magazines, TV programmes and films – testaments to the powers of cosmetic enhancement techniques, which have boomed in recent times.
Twenty years ago, getting invasive surgery such as liposuction to improve your looks was considered fringe behaviour, but now skipping off to have a minor cosmetic procedure in your lunchbreak or getting a boob job for Christmas barely raises a Botox-smoothed eyebrow.
Meanwhile, we can take drugs to optimise physical and cognitive prowess and as our understanding of genetics improves it could allow us to select and modify ever more desirable traits even before birth.
Medical technology to optimise humans beyond health is on the rise, but as we develop the techniques to enhance physical and cognitive abilities, how do we ensure they are not doing more harm than good?
While we shouldn’t fear the technology, we need to look at the ethical dimension and steer a desirable course, says Bert Gordijn, professor of ethics at Dublin City University, who gave his inaugural lecture earlier this month.
“For thousands of years, since the beginning of medicine really, the most dominant idea or regulative ideal has been the reinstatement of the integrity or the wholeness of the patient, curing disease, restoring the normal situation of the organism,” says Gordijn.
“What you now see is another regulatory ideal entering the medical limelight which is that of changing a patient so as to conform with some ideal, to optimise the traits of a perfectly healthy individual, which is another focus.”
The seeds of such optimisation were sown as long ago as the 17th century, when philosophers such as Decartes and Bacon wrote about the potential of medicine to increase life span and human traits. But it took technology time to catch up, notes Gordijn.
“In the 17th century I think the main thing a physician could do was console the patient because medicine was not really powerful in terms of curative powers,” he says. “Instead that started in the 19th century with new operation techniques and antiseptic approaches and then antibiotics in the 20th century. And what we see now is that medicine is very powerful and is starting to optimise perfectly healthy individuals in many areas like cosmetic surgery and cosmetic dentistry – look at the Hollywood stars.”
It’s not just down to the scalpel either, notes Gordijn. “In psychopharmacology, some of the drugs are being used beyond therapy – Ritalin is being used by American kids to boost their concentration levels during exams, while Prozac is being used beyond therapy as a mood booster,” he says.
“Endocrinology is also being used, using growth hormones just to make kids taller without any medical necessity.”
Meanwhile, doping with performance-enhancing drugs has long been an issue in sport, and advances in gene therapy could muddy the waters further, says Gordijn.
“Gene therapy is still in the early stages, but this capability will most probably be developed,” he notes. “And it’s difficult to test athletes and see if they have been genetically modified.”
Interventions such as tissue engineering to resonstruct lost or damaged body parts could eventually be harnessed for cosmetic enhancement too, says Gordijn. “There are projects focusing on using fat stem cells for breast enhancement purposes, you could also think of having different skin or a more beautiful nose or ears.”
Melding electronics with humans could also boost future performance beyond the norm, through the use of cochlear, retinal and even brain implants, he adds.
And as medical procedures become a more normal form of cosmetic enhancement, Gordijn argues that people may perceive them as less of a risk. Meanwhile the demand for procedures is very much there.
“It’s not a black and white issue, and I don’t condemn these practices,” he says. “But it happens because it’s a market, and you can earn a lot of money by offering cosmetic interventions nowadays.”
For individuals, there’s the potential to see such interventions as a quick fix while ignoring other forms of self-improvement, according to Gordijn. And already it’s difficult to square the spend on cosmetic enhancement of healthy individuals in the developed world when other regions lack even the basic structures of healthcare, he adds.
The emerging field of using personalised genetics to estimate the risk of developing a disease also throws up ethical quagmires. To add to the confusion, policy makers don’t always have a uniform view of the issues, says Gordijn. “Many do not have a well-founded view on enhancement technologies – they have a paternalistic and restrictive view when it comes to sport, but are liberal when it comes to cosmetic interventions.
“They say it’s the free market and the choice of the individual and let them at it – if they want to have Botox, they can have it,” he says. “So there is no consistent view on this phenomenon, and it’s a phenomenon that needs to be tackled from the one perspective.”
To regulate, you have to speculate, he adds. “It’s important to anticipate trends in technology and look at them from an ethical perspective. That’s the only way to enable regulation that might steer these technologies.”
We need to put more ethical frameworks in place at national, professional and institutional levels to stimulate debate and greater awareness, says Gordijn. “I think what is important now in Ireland but also generally is to establish certain structures that facilitate ethical reflection,” he says, adding that the structures need to embed within organisations such as hospitals where situations arise.
“They have insight into all the relevant facts and a responsibility to optimise ethical decision making. It might improve the ethical behaviour of our institutions and organisations.”