What’s so bad about making humans better (Part 2)

In my previous blog, I raised the question of why it should be considered wrong to improve the human condition.  After all, we turn to technology to improve our health.  Why not expand technology to make humans better?  In my first response, I argued that by eliminating all human defects, we run the risk of dehumanization.  That is, we remove the characteristics that define us as humans i.e., our relational, volitional, spiritual, rational, moral, and creative capacities.  Transhumanism does not actually enhance, but rather cheapens the significance of humans by reducing human nature to mere information.

In addition, the rise of transhumans will inevitably leave some humans behind.  Political writer Francis Fukuyama believes that the separation between “Naturals” and the “Enhanced” will be so deep that it will make all other divisions based on religion or race seem insignificant in comparison.  Indeed, he thinks that it would result in a “full-scale class war” (Radical Evolution).  One could question whether there is any track record of long term civility in the history of humankind to indicate that we will avoid life-threatening conflict between radically divergent species.  As Bertrand Russell once observed, “Science has not given men more self-control, more kindliness, or more power of discounting their passions…Men’s collective passions are mainly for evil; far the strongest of them are hatred and rivalry directed toward other groups.”

My conclusion then is that, transhumanism is fueled by technological hubris.  It is a story with striking similarities to the account of the tower of Babel.

Then they said, “Come, let us build ourselves a city, with a tower that reaches to the heavens, so that we may make a name for ourselves and not be scattered over the face of the whole earth.” But the LORD came down to see the city and the tower that the men were building.  The LORD said, “If as one people speaking the same language they have begun to do this, then nothing they plan to do will be impossible for them.  Come, let us go down and confuse their language so they will not understand each other.”  So the LORD scattered them from there over all the earth, and they stopped building the city. That is why it was called Babel—because there the LORD confused the language of the whole world. From there the LORD scattered them over the face of the whole earth (Genesis 11: 3ff, NIV).

In both cases, we find 1) humans driven by a desire to accomplish a feat that would otherwise seem impossible i.e., build a tower that could reach heaven, build a machine into which a human could be downloaded to achieve immortality, and 2) make a name for themselves, to be able to say that human effort can realize a god-like task.  Brent Waters observes that, “The history of the world [is] not an account of creation being drawn mysteriously to a destiny assigned by its creator, but an unfolding tale of human potential and capability” (From Human to Posthuman).  But what precautions are taken into consideration with advancing technologies?  As scientist Martin Rees warns, “Humans should not create something new unless they are reasonably certain something awful will not result” (Radical Evolution).  Indeed, humans do not have a very good track record of taking care of themselves.  I am inclined to agree with Bill Joy that we are more likely to instigate the “Hell Scenario” where unimaginably horrific events begin to unfold.  Thankfully, the Christian worldview affirms the sovereign God who is not threatened by human technology, and who promises believers that there will come a day when a true and everlasting transformation will occur.

Going Viral on Anti-virus Treatment

A research group at MIT reported in PLoS One (see here for the MIT article) initial proof-of-concept experiments for an antiviral drug treatment that can combat viral infections as a robust, generally applicable fashion, much like antibiotics for bacterial infections. As of now, the current treatments for viral infections include:

1) Drugs designed to inhibit particular viral attachment to a specific target

2) Vaccines that are designed to combat a specific virus

3) “Interferons and other pro- or anti-inflammatories” – drugs that activate the cell’s system to respond to pathogens

All three of the current treatments have two major issues 1) they require a specific design for the particular virus and 2) they have unknown or adverse side effects.  First, the problem with requiring a specific design for every virus is that “specific design” means hours of research on pharmaceuticals that target whatever cell type or viral genome a particular virus attacks. The process is time-consuming and expensive and the end product is only good for one type of virus. As the MIT article points out:

“There are a handful of drugs that combat specific viruses, such as the protease inhibitors used to control HIV infection, but these are relatively few in number and susceptible to viral resistance. “ (MIT report).

Viruses undergo rapid mutation, so even after a treatment is developed, viruses may eventually develop resistance to it. While for some viruses (such as HIV) scientists have developed “cocktails” of 3 or more drugs that attack different factors of the virus to prevent resistance, this requires time and is still only efficacious against a particular virus, not viruses in general.

In order to target a large range of viruses with one drug or technique, one must target whatever viruses have in common. This particular group at MIT, developed a technique that targets cells with double-strand RNA (dsRNA), something only viruses produce. They based their model on the body’s own defense system. By targeting this type of RNA, their technique was able to kill infected cells, while leaving healthy cells alone, and important factor in decreasing the deleterious side effects often caused by antiviral drugs. This detection method is not sequence or virus specific, but looks for one of the fundamental products of any type of viral infection. Furthermore, not only is this detection system modeled after the body’s natural defenses against viral attack, but the research team made sure that once the cells were detected, they would then undergo apoptosis (cell death) another naturally occurring process in the body.

Preliminary tests show that this technique has been able to target and kill cells infected with various types of viruses including cold viruses and H1N1. The authors report that they still need to refine and improve their technique, but are ready to begin trials in mice.

As always, I think pharmaceuticals are an important aspect of medical ethics. Several reports have already come out touting this technique as being as revolutionary as penicillin was. While their initial reports do show promise, I am always wary about claims that [technique of the time] will be the next panacea. Adult stem cells, for example, have shown great promise for healing a number of cellular conditions, however, they are not the cure-all that some would claim. They can’t cure viral infections, for example. The research paper reports some interesting finding, but the researchers themselves report needing to refine their technique. Also, the paper seems to indicate that there is a window of time when this antiviral treatment can be done. This will need to be explored since viruses are known to spread rapidly.

Machines on the Maternity Ward

I’m going to dovetail on Joe’s post once again.  Today, my girlfriend and I visited the hospital to see her friend’s new baby boy.  The floor was quiet as we got off the elevator.  We must have looked confused because the custodian set his mop down for a second and said, “You have to use the phone.”  Sure enough, next to a set of large double-doors was a red phone.  We picked up the phone.  “Yes, we’d like to see so-and-so.  She is here with her new baby.”  The unseen operator responded with a buzz, and magically the big doors swung open.  The big doors were there for security reasons, and I suppose they work for less than the watchman or the receptionist.  After we surrendered our IDs in exchange for “Visitor” stickers, we found the hum that was the room of the mom and her new son.  Friends and family stirred around taking turns holding the bundle of joy.  There was mom watching on, sitting up in her hospital bed.  And there was the machine–tall, flickering, and looming over the bed.  You see, she was not just the mother here; she was the patient.  I was thankful for the armoire of dark wood in the corner that lent a little softness to the room with its tiny, soft inhabitant.  After a while, the nurse entered and began to rummage around the hospital bed.  Yes!  Hurrah!  She began to untether mom from the IV bag.  Mom said, “Sure is good to get all that stuff off of me.”  Yes, I thought, maybe now she can hold her baby.

 

Of Machines and Men (Part II)

 

I observed last week that machines are increasingly shaping the nature of medicine; rather than medicine using its machines, its machines are starting to “use” medicine, to shape and direct the nature of medicine and adapt medical practice to the nature and methods of the machine. In this process, human activity absorbs the ethos and rhythms of the machine. Machines are all about efficiency, standardization, precision, data, and automation. Is this not becoming characteristic of the practice of medicine?

In medicine, “Efficiency” appears to be the watchword and underlying criterion for more and more decisions. The term “industry,” which previously one never would have used in the same sentence as the word “medical,” has become an accurate representation. Interactions between “medical consumers” and “providers” are increasingly mediated through machines. Leaders in medicine strive for standardization, automation, the effacement of individual practice variations, and centralization. Specialization is ever-increasing, and specialists with more techniques and machines to offer are valued more highly (and reimbursed more handsomely) than generalists who are the masters of less technology. Health care workers have reached the point where they can not practice without their gadgets. Practice quality is measured only by what is quantifiable; data, information, seems to have become the primary distinguishing characteristic of medicine, over and above relationship. Medical ethics is being reduced to machine-like process; content has become almost irrelevant. Technology is used more and more in an attempt to eradicate all ambiguity, imprecision, and uncertainty. Technology is used more and more simply because the technology exists. Both physicians and patients feel the increasingly machine-like nature of medical practice, even if they can not express it as such: patients complain of the impersonalization, sterilization, and dehumanization of medicine, while doctors feel more and more like cogs in a machine.

Efficiency is the end-all and be-all of machine medicine;  eliminating inefficient means becomes part of the grand project. And who in our time quibbles with eliminating inefficiency? The problem is compounded when the efficiency value system is applied not just to medicine, but to the humans it was meant to serve, when those patients who are considered “less efficient” are eliminated as blithely as last year’s smartphone. It happens now in the unborn, with prenatal genetic diagnosis identifying those “less efficient” humans who are then prevented from being born; it happens in the older and disabled, with euthanasia and physician-assisted suicide removing those who are too sick or old to be of use to themselves or others. Where will it be applied next?

To remain a human profession, medicine must regain and retain its human ethos . . . which, is why ethics is so central to its practice. In a future post I will consider some ways to resist the usurping of the essence of medicine by the efficient principle of the machine.

 

Doing Drugs for Science

 

There is a place in Chicago where you can be paid to take mind-altering drugs.

In the Human Behavioral Pharmacology Laboratory at the University of Chicago, psychiatry professor Harriet de Wit studies various licit and illicit mind-altering drugs, from caffeine to Ecstasy, by testing their effects on human volunteers. The purpose of the research is to find out how different people react to different drugs, in order to answer the central question of drug abuse research: Why do some people become addicted to drugs when most people who try them do not?

Study subjects must be between the ages of 18 and 35 and have no history of drug abuse, except those volunteers participating in the studies of Ecstasy, who must already have tried the drug.  After the studies are completed, there is no long-term follow-up of volunteers.

The story in which I first read of these studies was on the front page of the August 7th Sunday Chicago Tribune. The studies are approved by two review boards and the national advisory council of the National Institute on Drug Abuse; yet, reading about the research, I felt a bit uneasy. I believe that research done on human subjects is supposed to have at least a potential benefit to the subjects under study. Will the knowledge gained in these studies really have enough of a potential benefit to the subjects to outweigh the risk? According to the story, “studies have shown that experiments like these do not make subjects more likely to use illicit drugs.” But that does not rule out the possibility that someone who takes part in these studies could thus become exposed and addicted to an illegal drug they might otherwise never have encountered. I vividly recall patients describing to me the stories of how they became addicts the first time they took a drug (cocaine and meth are the two I remember in particular), and I can easily imagine that happening in a study such as those described; in fact the story tells of one subject who was given methamphetamine and liked the feeling of the drug: “I felt extra happy . . . I was cheerful and peppy.”

Am I overly cautious?  Am I too obstructionist?  Is the knowledge gained from these studies worth the chance that even one person might, through participation in the study, become addicted to an illegal drug?  In other words, is this ethical human-subject research?

 

Euthanasia, mercy, and the Good Samaritan

Lately I’ve been discussing infant euthanasia with some of my online students.  They are impacted very strongly by the argument from mercy.  When they consider an infant who appears to have “hopeless and unbearable suffering” as referred to in the Groningen protocol used in the Netherlands they are convinced that nonvoluntary euthanasia should be allowed if not required.  Mercy includes a desire to relieve suffering and the argument for euthanasia says that suffering should be relieved even if that means killing the sufferer.

One of the clearest expressions of mercy in the Bible is Jesus’ parable of the Good Samaritan.  In answering a question about how to love your neighbor Jesus tells a story about a man who would be rejected by those who were listening.  He finds a man who is beaten and half dead and who has been abandoned by his countrymen.  If he were a dog or a horse it would have been appropriate to put him out of his misery, but instead the man cares for his wounds and takes him to where he can receive further care.  The man who cared for the other’s wounds is identified as one who showed mercy.

The mercy that Jesus described in the story and provided for others involved hands on care for the needs of those who were injured or ill.  It sometimes involved bringing people back to life, but it never involved ending those lives.  Paul Ramsey captured Jesus’ attitude well in his ethic of “(only) caring for the dying,” and those who followed in his footsteps expressed it as “always to care, never to kill” (see First Things, Feb 1992

When we can see the importance of affirming the inherent value of every human life and search for the way to care for those who are suffering including optimal palliative care without violating the inherent dignity of that person we can be like the Samaritan that Jesus identified as a loving neighbor.

What’s so bad about making humans better? (Part 1)

In the previous two blogs, I’ve made transhumanism my focal point.  I concluded that transhumanism correctly highlights human imperfections, but incorrectly assumes that the essence of human nature is information.

Still, it may be fitting to question why it should be considered necessarily wrong to improve the human condition.  It is a fair question to raise; after all, Christians should not naïvely presume that all human enhancements are inherently evil.  Moreover, Christians must admit that Scripture does not specifically address the issues of human enhancement or transhumanism.   Thus, even if altering human nature is against God’s intentions for humans, it may not be possible to make a conclusive case from Scripture against it.  Furthermore, even if one could present a biblical case against transhumanism, transhumanists generally do not accept Scripture as an authority.

I continue my critical response with what I believe to be some of the negative consequences of transhumanism. Transhumanism, the philosophy that drives it, and its actual fulfillment, will negatively impact humanity in at least two areas:  1) the dehumanization of humans, and 2) the unavoidable but dangerous distinction between the “Naturals” and the “Enhanced.

First, a strong case can be made that, by forfeiting the negative traits that make us human (in our current form), we lose the potential positive qualities that result from difficult life experiences.  In the book Radical Evolution by Joel Garreau, one chapter underscores the negative impact of transhumanistic assumptions.  Political writer Francis Fukuyama observes that, “Human nature exists, is a meaningful concept, and has provided a stable continuity to our experience as species.”  It is, “with religion, what defines our most basic values.”  But in the transhumanist world, we “no longer struggle, aspire, love, feel pain, make difficult moral choices, have families, or do any of the things that we traditionally associate with being human.”  Consequently, we “no longer have the characteristics that give us human dignity.”  He continues:

“Even something like the elimination of pain and suffering… There’s something about the experience of pain and longing and anxiety and all of these things that our therapeutic society is trying to get rid of.  It is somehow necessary to our self-understanding of what we are as human beings.  I mean, you can’t have courage without risk.  You can’t have real compassion or sympathy with the personal experience of pain.

Human nature provides us with a sense of morality as well as the ability to make moral, social and creative choices.  It allows humans to dialog with each other about issues pertaining to justice, autonomy, human rights, politics and, ironically, whether transhumanism is a good idea.  Brent Waters continues this sentiment by summarizing Leon Kass’ perspective, “It is in coming to terms with their finite limits, and the inherent pain and suffering entailed in those limits, that humans embody the nobility of spirit that is supremely expressed in procreation.”

British neuroscientist Susan Greenfield adds that, in the end, humans will lose their individuality and personal identity.  They will lose the will to achieve because achievement will be built into the technology.  Perhaps the worst facet of the transhumanist scenario is that, if the successful transfer to machines occurs, then humans won’t know that they are dehumanized, nor with they care to know it.

In next week’s blog, I will discuss a second potential downside to transhumanism – a new form of class war!

In Response to “Of Machines and Men”

I think Joe hit the nail on the head.  One of the reasons I’ve focused on personhood during my short bioethics career is that American physicians are increasingly unable to distinguish between the human being and the biological system.  Some deny altogether the existence of anything beyond the physical body, but others only consider the spirit or the soul to be some sort of esoteric thing about which one might philosophize.  As a result most physicians believe that if they know the medical information, perform the procedure correctly, and achieve a good outcome then they have practiced good medicine.  Tips they can gain from Abraham Verghese about interacting with the patient are icing on the cake.  An inspirational insight from Atul Gawande allows them to be reflective in their spare time.   But really, those kinds of things are for humanities professors or hospital social workers.  In the medical curriculum, we see this value system in ethics teaching that amounts to not much more than instruction on managing emotional responses.   “Use this phrase when talking to a patient about cancer so they will feel this way.”  “When you enter the exam room, perceive the patient’s disposition by examining facial cues and posture.”  If the physician uses a stimulus-response framework for patient interaction, then he has fallen back into the same problem all over again.  That’s why mentorship is so important in medicine: a student “lives life” with the attending physician so as to acquire his way of looking at the world, not just his skills.  That’s why the oaths—Hippocrates, Maimonides, or others—are so important: they emphasize that medicine is a covenant between two people before it’s anything else.  And, most notably, that’s why a medical practice most consistent with Jesus’s healing ministry is one which would still have something to offer if the machine and the lab report were not even there.

 

Of Machines and Men (Part I)

 

As part of my job, I have the privilege of participating in the delivery of many babies.  I was at one such blessed event earlier this week.  There were several medical personnel and the father standing around the bed of the expectant mother. Due to the wonders of epidural anesthesia, she was quite comfortable, despite the fact that she was in the final stages of labor.

Suddenly I became aware of what all of us were doing — myself, my residents, the nurse, even the father: we were watching a machine. The mother was hooked up to a machine that monitored both the baby’s heart rate and her own contractions. The rest of us stood and stared at the machine. When the machine showed she was having a contraction, we would all turn towards her and encourage her to push, cheerleaders for her and the little life that she was bringing into the world.  But we kept one eye on the machine, and as soon as it indicated the contraction was over, we turned away from the mother and towards the machine again, waiting expectantly for it to tell us when the next contraction was coming.

With a sense of deja vu I realized that I had observed a similar phenomenon in the ICU: doctors, therapists, nurses, even family and visitors who had no idea what the little multi-colored squiggly lines on the monitor meant, nonetheless staring expectantly at the monitor on the wall instead of at the patient in the bed.  And in my training of resident physicians, I have watched videotaped patient encounters showing them sitting in the office with the patient, staring deeply into the computer screen instead of at the patient who has come to see them.  Similarly, in their inpatient work, the residents spend a few minutes on the hospital floor seeing their patients, and the remaining hours of the day (and night) staring into a computer screen, tending to the computerized chart — the “iPatient,” as Abraham Verghese called it here.

The practice of medicine has historically been founded on the physician-patient relationship;  on that foundation has been erected an edifice of techniques and technologies, tools for medical practitioners to use in serving their patients. However, it seems that in our time the tools are beginning to attack the foundation of medicine rather than just being used by it. For a variety of reasons, the tools and technologies increasingly become the center of the physician’s attention. Instead of medical practitioners defining how the tools are used, the tools begin to define what medicine is. We are becoming what Neil Postman called a Technoloply: our tools change and determine our practice’s purpose and meaning, our very way of knowing and thinking and relating to our patients.

 

Edmund Pellegrino once wrote, “Men have always sensed that the more they forged and the more machines they built, the more they were forced to know, to love, and to serve these devices.” (From Humanism and the Physician.)

 

Next week:  Some thoughts on what we can do about the ascendancy of the machine in medicine.

 

The limits of medicine and technology

 

In Too Much to Know, author Ann Blair notes that in our culture, which virtually deifies technology, we believe that we can find technological solutions to all problems, even those that are actually addressable only by attending to ourselves.*

Perhaps this confusion about the proper solution to a problem is part of the crisis in medicine and bioethics. The knee-jerk expectation of the public and the medical enterprise alike is that for every problem people bring before a doctor there can be found a solution, and that a technical solution will be the best. But what if that assumption is incorrect?

What if there are some patients for whom a technical solution is the worse option? Maybe there are some depressed patients for whom the best solution to their problem is not another pill, but the balm of human compassion and the encouragement to use the resources they have at hand to find comfort. Maybe there are some people with terminal diseases for whom the best solution is not every last possible intervention trying to sustain bodily function indefinitely, but rather help in strengthening faith and preparing for death.

Maybe instead of attempting to eliminate disabilities by trying to detect and eliminate fetuses that have them, we should be striving to be a people who can love and cherish those among us with worse disabilities than our own. Maybe instead of seeking absolute certainty (an illusion at best) by demanding that every technological test and scan be made available, we should be learning to live in the freedom of the inevitable uncertainty that comes with life on this planet.

Maybe there are types of human suffering that medicine was never meant to address. Maybe there are problems that we can only address by fixing not the problem, but our selves. And maybe part of the task of bioethics should be seeking the wisdom to discern between the two.

 

*This summary of Blair’s thought is from Alan Jacobs’s review in the May/June 2011 Books & Culture.