the question of ethics
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OPINION
The question of ethics | Donald Bruce
Nanotechnologies offer great promise for medicine,
although much of it is still a long way off. But even
at this early stage, the recent experience of
genetically modified (GM) food and the ongoing
debate over stem cells is focusing attention on the
question of ethics. The scientific community is
aware that it is dealing with a more skeptical public
than a generation ago. Therefore, when the
European Commission’s European Network of
Excellence on nanobiotechnology, Nano2Life, was
formed, a board was set up to ensure that the
ethical, social, and legal implications keep pace with
emerging scientific developments. This article is
drawn from some of its initial work1. Focused ethical
programs like NanoBioRAISE2 are also starting up.
We can forget gray goo, but already there are signs
that some challenging ethical issues could be raised.
Some touch on issues familiar in bioethics. Some are
more particular. But before considering these, some
basic contextual questions should be considered.
What drivesnanotechnology? One problem is that the gap between research and
rhetoric makes nanotechnologies vulnerable to
exaggerated claims, both about potential benefits
and potential harms. The use of the word ‘will’ about
unknowable future outcomes expresses an ‘article of
faith’ about science, generating a false impression of
inevitability. Equally, there is a need to be careful
about placing premature weight on speculative
concerns about nanotechnologies raised ahead of
evidence. Beware of false prophets, either way.
Secondly, it is a common misconception that
technology is neutral. On the contrary, a technology
reflects the values and goals of the society within
which it emerges and, in turn, it may alter the values
and aspirations of that society. In the somewhat
skeptical climate of public opinion, more sensitive
areas of technology might be seen as a social
contract3. A technology would be welcomed if the
values and goals of the inventor are close to those
of the wider society, and if the invention correctly
anticipates what society wishes (as with the cell
phone, for example). On the other hand, if the
inventor is remote, if the aims do not correlate with
the values and goals of the society, or if the
invention is unfamiliar or risky, there can be a
disjunction (for example, the importing of unlabeled
GM soya and maize products into the UK).
Whose values will nanomedicine express? Are its
novel ideas a product of widely shared values, or
only of a powerful elite? Here
are some values, ideologies,
and beliefs that may influence
or drive nanomedicine:
• Free, curiosity-driven
research;
• Economic growth, jobs, and
competitiveness;
• Quality of life (variously
defined, e.g. personal
affluence, consumer choice,
environmental goals, social
justice, global health and poverty, spiritual goals);
• Compassion (motivated by the desire to alleviate
human suffering);
• Medical ‘success’ (seeking a technical solution to
any condition, as an obligation);
• Different religious belief systems;
• Transhumanism (driving human evolution by
physically changing humans).
Two critical areas about which such world views
make implicit or explicit assumptions are the notion
of progress and the concept of the human being.
In nanomedicine, what dowe mean by progress? A common view in scientific and political circles is a
belief in ‘progress’ through technology to improve
the human condition in its widest sense. This belief
is confident of human skill and ingenuity to
overcome any problem. The current dominant
economic model frames nanotechnologies in terms
of their capacity for wealth generation. But another
widely held view sees intervention explicitly
balanced by care for our fellow human beings and
attention to the impacts of our innovations on the
environment. Interventions are made that respect
certain limits defined by the human condition and
our finite environment.
Technology is not the sole
engine of progress but a tool
that remains at the service of
humanity, not vice versa.
Lastly, there are those for
whom progress is entirely
personal and not for the state
to dictate.
At this stage, nanomedicine is
driven by a ‘technology push’,
which has a social dimension.
Functions and properties, which can be measured or
manipulated, tend to steer the applications that are
promoted. It is argued that laboratory prototypes
already coproduce ethics with the artifact4. So there
may already be implicit ethics in practice in the
research community. What are the needs that
nanobiotechnology is assumed to meet? Who
should define these as needs, or judge if the expense
of research is better spent on other objectives? This
is especially relevant to high-tech medicine in the
global context of health needs that often require
simpler solutions. How can such judgements be
FEBRUARY 2006 | VOLUME 1 | NUMBER 16
Donald Bruce | Society, Religion and Technology Project, Church of Scotland, UK |
srtp@srtp.org.uk
Mapping the uncharted ethical and social topographyof nanotechnologies is posing many questions forscientists, clinicians, and the public to debate
Use of the word ‘will’about unknowablefuture outcomesexpresses an ‘articleof faith’ aboutscience, generatinga false impression ofinevitability
OPINION
made democratically accountable at a meaningful
stage of development? Forecasting very uncertain
technologies is notoriously difficult, and bears the
risk that early public engagement may promote
either public assurance or public panic over the
wrong issues.
Nanomedicine and thenature of the human beingMany conceptual models of the human being exist.
Depending on the context, we might be a bag of
genes, a conscious mind, a spiritual and bodily being,
a set of capacities restrained by natural form, and so
on. The convergence of nanotechnologies with info-,
bio-, and cognitive technologies provokes a possible
conflict between holistic and functional views, and
between what is considered fixed and what is
changeable. Traditional presuppositions hold that
there are moral or societal bounds that restrain
what may be technically feasible in intervening in
the human condition. These limits are drawn from
insights into our religious and cultural traditions,
philosophy and theology, the arts and humanities,
and the social sciences. These
are challenged by the
transhumanist belief that
humans are destined to go
beyond current limitations. Is
nanomedicine to make humans
better, or should we use it to
make ‘better’ humans, by
manipulating our capacities
beyond medical conditions?
While one leading US report was enthusiastic at the
prospect, a European group of experts has urged the
submission of enhancement goals to wider social
scrutiny if humanity is not to be redefined by a
‘techno-logic’, driven primarily by technical and
economic feasibility5,6. So where do we draw the line
to limit some technological possibilities or promote
others? The notion of functional enhancements begs
a question. Do we know what is an enhancement,
both amid the complexity and interdependences of
the human body, and the social and cultural
variability? Notions of ‘improvement’ are likely to
be socially divisive, with benefits for a wealthy few,
and carry the attendant danger of notions of ideal or
master humans that stigmatize the disabled or
anything that is now perceived as defective. To me,
this discourse misses the point about our humanity.
Beyond a certain basic point of physical survival and
necessity, what matters most to humans are not
functional and material things but the relational,
aesthetic, and creative. Our deepest problems reside
less in physical limitations than our moral, relational,
or spiritual failings.
Nonmedical contexts Procedures developed in an acceptable medical
context may pose ethical questions if applied
nonmedically. For example, nanotechnology may
assist the repair of sensory organs or provide
intimate control from the brain to prosthetic limbs
for accident victims or the disabled. Should these
devices be adapted to extend sight into the infrared
for better night vision when driving or to make the
able-bodied super-able? Should cell repair nano-
interventions seek to extend
human life span?
A useful distinction exists
between medical and
nonmedical interventions in
the human person. The
European Convention for
Human Rights and
Biomedicine, for example,
opposes sex selection for social
reasons but allows it to avoid serious sex-related
hereditary diseases. A related issue concerns
surveillance and military uses. Nanotechnology
devices implanted in the body to monitor and adjust
blood sugar levels in diabetics are more
problematical if used for the surveillance of citizens
or military applications. Inevitably, there are gray
areas, but mechanisms are needed to identify
potential crossovers at an early stage and to ensure
that nanotechnologies devised in a strict medical
context are not applied to nonmedical contexts
without restriction.
Special issues aboutnanomedicine The ability to monitor and intervene at a cellular or
molecular level may fall foul of the complexity of
the system. Nanomedicine may enable rapid
readouts of our whole genome or of our body’s
levels of everything imaginable, but what does all
that information mean? What is a ‘well’ person
when we have so much unsuspected data about our
bodies? This raises familiar issues about genetic
information, who accesses it, and how it is handled.
Lab-on-a-chip analysis may mean that my routine
visit to the doctor as a result of a cough may also
tell me that I have a susceptibility to colon cancer
with little prospect of cure. Knowing all the
information that nanomedicine could provide is not
necessarily a good thing.
The powerful targeted therapeutic possibilities for
nanomedicine can also create the potential for
powerful harm, if the precision becomes wrongly
applied or if it has more than just the desired effect.
Bottom-up construction from the molecular level,
based either on mimicking biology or on
incorporating components from living systems,
raises issues about hybrid devices that interface
human and machine, and also about priorities.
What should we choose to build? A building-block
mentality should not assume the right to tinker
around at this reduced level. We cannot know how
the changed pieces fit together if we lose sight of
the whole human. Health risks arise in the use of
nanoparticles in biological systems. How
precautionary should we be over uncertain risks that
may take a long time to assess?
This brief survey has mapped some of the ethical
and social topography of the uncharted lands that
nanotechnologies may offer to medicine, and posed
many questions for debate. How, as societies, we
seek answers as these technologies emerge will be
of crucial importance. Scientists and clinicians in
nanomedicine owe it to themselves and to the wider
society to reflect on them, so that the right benefits
may be achieved with justice, while retaining our
humanity in all its rich diversity.
FEBRUARY 2006 | VOLUME 1 | NUMBER 1 7
Early publicengagement maypromote eitherpublic assurance orpublic panic over thewrong issues
REFERENCES
1. Bruce, D. M., Nano2Life Ethics: A Scoping Paper on Ethical and Social Issues in
Nanobiotechnologies. In Nano-Bio-Ethics: Ethical Dimensions of Nano-
biotechnology, Ach, J. S., and Siep, L., (eds.), Lit Verlag, Münster, Germany (2006)
2. NanoBioRAISE – Nanobiotechnology: Responsible Action on Issues in Society and
Ethics, a Co-ordination Action in the Science and Society category of the
European Commission’s Sixth Framework Programme, FP6
3. Bruce, D. M., J. Agric. Environ. Ethics (2002) 15, 279
4. Rip, A., Second Order Ethics, A note to Nano2Life Ethics Board, 2 September 2004
5. Roco, M. C., and Bainbridge, W. S., (eds.) Converging Technologies for Improving
Human Performances, US National Science Foundation report, (2002)
6. Nordmann, A., (ed.) Converging Technologies and the Natural, Social and
Cultural World, report of a European Commission expert group, (2004)
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