Great article yet very long winded.
These reflections on ethical aspects of nanomedicine are followed by excerpts from R.A. Freitas' opus magnum with short comments.
On ethical aspects of nanotechnology see:
- The Nanoethics Group
- European Group on Ethics and New Technologies to the European Commission
- Bibliography and Links
- Springer Journal on NanoEthics
Introduction
According to Freitas nanomedicine is
“ […] (1) the comprehensive monitoring, control, construction, repair, defense, and improvement of all human biological systems, working from the molecular level, using engineered nanodevices and nanostructures; (2) the science and technology of diagnosing, treating, and preventing disease and traumatic injury, of relieving pain, and of preserving and improving human health, using molecular tools and molecular knowledge of the human body; (3) the employment of molecular machine systems to address medical problems, using molecular knowledge to maintain and improve human health at the molecular scale.” (R. A. Freitas: Nanomedicine, Vol. I: Basic Capabilities, Georgetown (Texas) 1999, p. 418)
Following this vision, nanomedicine will change in a short, middle, and long term perspective the life of individuals and societies in many regards. These changes are of major ethical relevance as far as they concern human self awareness, as well as the respect, responsibility, and care we owe to each other and to the environment. Similar challenges that have been predicted of information technology, genetics and brain research have to be grasped in their convergence. Nanomedicine should be ethically located, as Freitas does, within a healing vision without excluding the question of enhancement.
Ethical Aspects of Nanomedicine on a short, middle, and long term perspective
The ethics of nanomedicine can be conceived as prospective responsibility on a short, middle, and long term perspective (5, 10, 20 years). But obviously this kind of predictions are subject to unexpected breakthroughs.
On a short term perspective nanomedicine faces ethical questions that arise mainly from the knowledge gaps concerning the risks of interventions using:
Nanomedical products
Nanocosmetic products
Nanodelivery vehicles / systems / implants
Nanodiagnostic tests
In general, due to the present lack of knowledge the precautionary principle, i.e., the responsibility to take preventive action to avoid harm to human health or the environment in a situation where knowledge gaps prevail, should be applied particularly in case of the invasive use of nanotechnology in the human body. There are knowledge gaps with regard to the toxicity of nanoparticles and nanomaterials not only for the human body but also for the environment.
The dangers of affecting the human brain with nanotechnology are among the most controversial ethical aspects particularly if such interventions are beyond a healing perspective. The preservation of human identity should be respected in all such interventions as well as in research projects dealing with them.
On a middle term perspective nanodevices and nanomedical products will be used in all medical fields. This rises ethical questions of responsibility at a local and global level. Particularly questions of data protection and privacy arise as in the case of genetic testing. Nanodiagnostic tests will rise the question of healing expectations that in many cases will not be fulfilled. The gap between diagnostic and healing possibilities will affect the relation between the physician and the patient concerning informed consent as well as the right of the patient not to know. Nanomedical implants, drugs and treatments will rise the question of justice and fairness in the health care system as well as between rich and poor societies (nano divide) in case such drugs and treatments do not happen to be better and cheaper as the ones used today which is one of the promises of nanomedicine so far.
There is also the question of patents in this field, i.e., the question whether artificial configurations of chemical elements can be considered as inventions.
On a long term perspective nanotechnology envisages not only the creation of autonomous nanomachines to be used inside the human body but the enhancement and even transformation of the human body and human identity particularly in case they were used to modify the human brain.
The use of nanomachines in the human body implies the risk that due to a damage in the onboard computer this could not be appropriately steered. The threat of nanomachines (fighting nanorobots) will become real not only in war situations but also in case they were produced and used by terrorists in everyday life. This could also lead to new forms of ubiquitous surveillance and monitoring becoming a new threat to privacy and autonomy.
From an ethical viewpoint it is not desirable to create autonomous nanomachines as far as they could become not only out of control but even able of acting in an own initiative (automated decision-making) eventually against their human designers. This so called black goo scenario is at present purely science fiction but it shows ad limine not only undesirable but also unacceptable effects of what sometimes is being called a transhumanist vision. This vision becomes a nightmare in case the human race is conceived as something capable of being superseded on the basis of nanotechnological self annihilation. The reverse is a healing vision in which nanomedicine is viewed at the heart of a human- and life-centered scenario. This vision is affirmative towards technology in general and nanotechnology in particular as far as any technology means a transcendence of what is naturally given by creating something artificial. In other words, technology belongs to human self understanding. The ethical limits of self-manipulation arise at the moment when such changes become a threat to human self awareness based on a radical transformation of the human body. But this limit leaves a broad field of possible applications that will concern the enhancement of human capabilities which are not per se a threat to human dignity but might lead to a better life through an improvement of healing methods, new materials improving the quality of life etc. It is difficult to foresee now such positive and negative effects including the gray goo scenario, i.e., the impact of self-replicating nanomachines in the ecosphere.
Conclusion
The view of the human body from a nano perspective is basically reductionist similar for instance to the view of the human brain as a computer, now a nano-computer. This reductionist view can give rise to the naturalistic fallacy, i.e., to the idea that human phenomena can be changed or influenced at the nano level without telling the manipulator what changes are more or less desirable. It enforces the misleading belief that all human diseases could eventually be treated and eliminated by advanced nanotechnology. The potential benefits of nanomedicine are wrongly extrapolated into a view of the human being as a mere composition of atoms and molecules. It is hard to believe that on the basis of manipulations at the nano level the condition humaine between birth and death can be changed.
The utopian idea of a longer life of, say, two or three hundred years on the basis of nano-manipulation looks at least from the perspective of today’s political and economic situation more like a nightmare than a utopia. It can be considered also a cynical perspective in view of what should and could be done with the help of nanomedicine in order to alleviate real human pain. Such utopian visions are misleading not only with regard to the expectations of patients but also of the public opinion and of politicians responsible for public funds for research projects envisaging such perspectives.
ANNEX
Freitas' on Ethics of Nanomedicine with Short Comments
Freitas' outstanding book on Nanomedicine is quoted from: http://www.nanomedicine.com/NMI.htm
1) 21st Century Medicine
http://www.nanomedicine.com/NMI/1.2.1.13.htm
"The very earliest nanotechnology-based biomedical systems may be used to help resolve many difficult scientific questions that remain. They may also be employed to assist in the brute-force analysis of the most difficult three-dimensional structures among the 100,000-odd proteins of which the human body is comprised, or to help ascertain the precise function of each such protein. But much of this effort should be complete within the next 20-30 years because the reference human body has a finite parts list, and these parts are already being sequenced, geometered and archived at an ever-increasing pace. Once these parts are known, then the reference human being as a biological system is at least physically specified to completeness at the molecular level. Thereafter, nanotechnology-based discovery will consist principally of examining a particular sick or injured patient to determine how he or she deviates from molecular reference structures, with the physician then interpreting these deviations in light of their possible contribution to, or detraction from, the general health and the explicit preferences of the patient. In brief, nanomedicine will employ molecular machine systems to address medical problems, and will use molecular knowledge to maintain human health at the molecular scale.".
Full article > http://www.capurro.de/nanoethics.html
