|
A
peer-reviewed electronic journal published by the Institute for
Ethics and ISSN
1541-0099 22(1)
– June 2012 |
Baby Steps to Superintelligence:
Neuroprosthetics and Children
Matthew
S. Lucas
Journal of Evolution and Technology - Vol. 22 Issue 1 – June 2012 - pgs 132-145
Abstract
Children
surviving neural injuries face challenges not seen by their adult counterparts,
namely that they experience neural injury before reaching neurodevelopmental
maturity. Neural prostheses offer one possible path to recovery, along with the
potential for functional outcomes that could exceed expectations. Although the
first cochlear implant was placed more than fifty years ago, the field of
neuroprosthetics is still relatively young. Several types of neural prostheses
are in development stages ranging from animal models to (adult) human trials. In
this paper, I discuss how neural prostheses may assist recovery for children
surviving neural injury. I argue that approaching the use of neural prosthetics
in children with considerations derived from transhumanism alongside traditional
bioethics can provide an opportunity to reframe adult-focused ethics toward a
child/family focus and to strip away the prejudicial metaphor of cyborgization.
In literature and
film, neural prostheses often receive a negative image, entangled in ideas of cyborgization
and the creation of a monstrosity. They may exist as enhancements in a dystopian
future, as in William Gibson’s Neuromancer
(1984). In Stephenson and George’s Interface ([1995] 2005), a neural prosthesis initially appears to be used to regain
function after a stroke, but is in fact used to control an individual in order
to sway politics. A recent film of Richard Condon’s novel The Manchurian Candidate (Demme 2004)
follows a similar overall premise (an
earlier movie version, Frankenheimer 1962, incorporates brainwashing rather
than neural prostheses). However, a more positive take on neural
prostheses was presented in the television series The Six Million Dollar Man and The
Bionic Woman, in which amazing increases in physical capabilities were put
to use to save humankind and defeat evil.
All these cases are
fiction, but neural prostheses are real. Over the past fifty years they have
moved from possibility to reality for hundreds of thousands of individuals
(cochlear implants). As technology improves, they will become applicable for
ever more uses, including, for example, the restoration of hippocampal function
via a biomimetic device (Berger et al. 2012).
Children surviving
neural injuries have deficits in cognitive functioning (Gerrard-Morris et al. 2010) that vary based upon the anatomical
location of injury, the child’s age at the time of injury, and the intensity of
the injury. Current rehabilitation efforts offer only modest compensation (Galvin and Mandalis 2009), perhaps because the
assembly of cognitive processes through human development is not yet
well-identified (Horton et al. 2010; Luna 2009;
Luna et al. 2010) and the extent of neuroplasticity in childhood and
adolescence, especially after neural injury, is unknown (Stiles 2000; Stiles et al. 2005). In this paper, I will first
briefly review neural prostheses as they exist now, identify developmental
areas that provide challenges, and discuss applications for children with
neural injury. I will then introduce transhumanism and show how transhumanism
and traditional bioethics might be applied together to benefit children after neural
injury. I argue here in favor of the use of neural prostheses in general, and
particularly for children who have sustained neural injury. The union of transhumanism
and bioethics can reframe this discussion by removing the metaphor of
cyborgization and refocusing bioethics in this population from the adult
to the child/family.
Neural
prostheses
Neural prostheses
include a variety of central nervous system implants that either provide
mechanical stabilization and anchor for biological transplants or engage in
electrical communication (recording, providing input, or both) for cognitive or
other functional effects. Like other medical devices, they experience
incremental design advances and are subject to regulation which begins with
testing in animal models. Regulation generally disfavors testing in pediatric
populations except for child-specific medical conditions or when no approved
treatments are available.
Types
of neural prostheses
There are several
categories of neural prostheses, with some overlap. One goal for neural
interface systems is to provide a link to the outside world (Hatsopoulos and Donoghue 2009), which was
accomplished with the first successfully attempted neural prosthesis more than
fifty years ago, a cochlear implant (Djourno et
al. 1957). Thus far, most published work regarding neural prostheses
concerns cochlear implants, and, as of December 2010, more than 219,000 had
been implanted into adults and children around the world (National Institute on Deafness and Other
Communication Disorders 2011). A successful implant is made possible only
by high-quality hardware and software, together with the ability for neuroplasticity
evident in human brains (Fallon et al. 2009).
Operative
neuromodulation is the use of an implanted device to produce an altered
electrical or chemical signal transmission in the nervous system in order to
achieve a therapeutic effect (Sakas et al. 2007).
Prostheses that take advantage of operative neuromodulation include deep brain
stimulation (DBS; currently approved in the United States for Parkinson’s
disease and other movement disorders, major depressive disorders, and seizure
disorders, and for some chronic pain sufferers), sensory prosthetics (e.g.,
cochlear implants, retinal implants currently in clinical trials), functional
electrical stimulation (primarily to restore function from paralysis), and
others (e.g., stimulation of occipital and supraorbital nerves for the abatement
of cluster headaches).
Cognitive neural
prostheses are implanted devices that are intended to restore function to any
cognitive process, including those processes that could control a functional
prosthetic limb (Andersen et al. 2010).
Operationally, these can be considered part of a brain-computer interface in
which the prosthesis allows communication between the individual’s brain and an
exterior device that compensates for lost function. This external device can be
attached to the person or be a separate piece of equipment, such as a robotic
arm or computer. At least one company has established such a system with humans
(Simeral et al. 2011; BrainGate 2012),
although development of functionally innervated systems that can control
neuromotor prostheses is in its infancy (Serruya
and Kahana 2008).
Developmental
challenges for neural prostheses
Neural prostheses are limited by the current state
of technology and neurophysiological understanding. Suboptimal design of materials
limits interaction with neural tissue and often leads to fibrotic capsule
formation (Poole-Warren et al. 2010).
Even without capsule formation, it is difficult to maintain high-signal
fidelity of the electrode-tissue interface over long periods (Konrad and Shanks 2010). As interface systems
improve, increased device efficacy will result in improved functional recovery (Wang et al. 2010).
Suggestions for improved brain-implant interfaces
include seeding the prosthesis with neural progenitor cells (Azemi et al. 2010). Kim and colleagues (2010) have created non-invasive, silk-based
(and dissolvable) platforms for use with ultrathin electronics that conform to
neural surfaces. A three-dimensional electrical interface that allows
regenerating axons to grow through and around microchannels has also been
created (Benmerah et al. 2009). The
combination of cognitive- and motor-based approaches within one system may lead
to greater benefits for individuals (Pesaran et
al. 2006) as, ultimately, the therapeutic goals of neural prostheses
include restoring cognitive functions and/or augmenting what is present after
injury or disease (Serruya and Kahana 2008).
While several challenges remain, advances have been made with adult trial
participants.
Children surviving neural
injury
Children surviving neural injury include those with
traumatic brain injury, brain tumors (benign and malignant), and other
non-traumatic injury (e.g., hypoxia, infection, stroke, substance abuse,
seizure disorders). Neural injury at younger ages has a more devastating effect
upon the development of cognitive control (Anderson
et al. 2010), and those surviving brain tumors in childhood are at
significant risk for neurocognitive deficits in adulthood (Ellenberg et al. 2009).
Assuming no life-limiting sequelae, children post-neural
injury have a potentially much longer period of time than do brain-injured
adults in which to experience decreased function, increased dependence,
potentially decreased quality of life, and impediments to participation in
society. Furthermore, these children have brains that have been injured before
reaching neurodevelopmental maturity. Neural prostheses for directed
therapeutic compensation of deficits have the potential to mitigate, or even
restore, lost cognitive, sensory, and/or motor function in children after
neural injury. This restoration then will allow that individual to personally
and independently engage with her environment and society on her own terms.
Without intervention, the demands of providing care
for these children can last decades, and this burden of care provision (at
least in the United States) falls primarily on parents/families. The child’s
restored ability to attempt a “normalized” development also frees the family
members to pursue their own life ambitions, rather than focusing on providing
care to a dependent child for the rest of their lives.
The barriers to using neural prostheses in children
with neural injury include the prejudicial framing of a human being with a
brain implant (cyborgization) as well as the ways in which adult-conjured and
framed traditional bioethics provides a disservice to children. I acknowledge
that one further barrier might involve reservations about neural prostheses held
by certain groups, such as many in the Deaf community who do not understand deafness
as a disability requiring medical intervention with cochlear implants, but
rather insist that deafness is normal (Swanson 1997). While this view may have
relevance to my later arguments concerning sociocultural constructions of normal,
its merits generally lie outside the scope of this paper, which concentrates on
neural injury in childhood. In the remainder of this paper, I will introduce
the transhumanist movement and suggest how transhumanism and bioethics might be
applied together to benefit children after brain injury.
Transhumanism
Transhumanism is a school of thought that has manifested
in various forms throughout history. In 1998, the World Transhumanist
Association (WTA) was organized as an international structure and developed
both a “Declaration” (2009) and an
extensive frequently asked questions (Bostrom
2003). In the latter, transhumanism
is defined as:
The intellectual and
cultural movement that affirms the possibility and desirability of
fundamentally improving the human condition through applied reason, especially
by developing and making widely available technologies to eliminate aging and
to greatly enhance human intellectual, physical, and psychological capacities.
… [It is also] The study of the ramifications, promises, and potential dangers
of technologies that will enable us to overcome fundamental human limitations,
and the related study of the ethical matters involved in developing and using
such technologies. (4)
In 2008, the WTA rebranded itself as Humanity+ (H+), also adopting the "Declaration" and the "FAQ". Transhumanism is a human ideology, as there are not
yet any significantly transformed humans, or posthumans – as opposed to humans who have imagined or begun transforming
themselves (Hopkins 2008, 3). Bostrom (2005) recounts a history of transhumanist
thought, stretching as far back as the Epic
of Gilgamesh and other quests for immortality, including those for the
fountain of youth and the alchemical search for the philosopher’s stone (1-2).
While the core of transhumanism includes the investigation of potential states
of existence for humans in the future, it also includes recognition and
reduction of the potential for risks with technological development; a moral
vision that focuses on reducing suffering, preserving life and health, and
improving human wisdom;1 advocacy for the well-being of all life,
human and non-human; and sometimes arguments for equitable access to advancing
technology (or at least the option to choose such technology) and for allowing individuals
to have a personal choice over how this technology directly enables their lives
(WTA 2009).
Both within and outside of the “Declaration” and
“FAQ,” there is much transhumanist discourse relating to all these. Sometimes
there is a focus on transhumanist thought as a sort of utopian vision of a more
humane form of existence (Bostrom 2008).
Sorgner (2009) and More (2010) both discuss similarities between transhumanism
and aspects of Nietzsche’s philosophy; their approaches display libertarian
features not acknowledged as significant by Bostrom. Other transhumanist
thinkers advocate caution, suggesting that the advancing technology that offers
extensive enhancement may be closer than we think and that the relationship
between becoming posthuman and upholding individual rights is more complicated
than one might imagine. This is particularly because of vexed issues of
identity that might affect the individual, other individuals, and the process
of changing a self (Walker 2008). Schneider
(2009) discusses the metaphysical problem of personal identity, especially
regarding enhancements, and suggests that transhumanism needs to establish a
clearer and more defensible conception of personhood.
This, however, is quite a task in the absence of any
uncontroversial understanding of what identity
or personhood might really amount to.
A good starting place for this discussion might be Glenn’s (2003) exploration
of how biotechnology is contributing to changes in the traditional (religious,
philosophical, and legal) notions of identity/personhood and suggests a
balancing approach that places personhood on a continuum.
Transhumanism does attempt to identify possible
harms or risks associated with advancing technologies, including the concept of
an existential risk, which is “an adverse outcome [that] would either
annihilate Earth-originating intelligent life or permanently and drastically
curtail its potential” (Bostrom 2002, 4).
Such risks include nuclear weaponry (especially its proliferation) and many
technologies that do not yet exist but are foreseen (e.g., misused
nanotechnology, ill-programmed or flawed superintelligence, engineered
bioagents), as well as possibilities that are not specifically foreseen (5-13).
Bostrom concludes that caution must be exercised as new technologies are
investigated and current ones are manipulated.
There are numerous criticisms of transhumanism.
Transhumanism already here?
One could say that humans are already in
transitioning states, especially with the changes that cosmetic plastic surgery
makes possible. Although these might seem superficial, Scott (2009) argues that the use of cosmetic plastic
surgery to “cheat
Another way to view transitioning humans is to
consider how technology is embraced when the goal is to decrease suffering or
increase quality of life or health. Insulin pumps, cardiac pacemakers,
implanted defibrillators, and many other prostheses with therapeutic value can enhance
human living. If having control over one’s physiological processes constitutes
enhancement, then an argument can be made that the use of oral contraceptives
to control ovulation is a form of enhancement (Lindsay
2010). Extending that rationale, vaccinations provide artificial
immunity to infectious agents that the body has (generally) not yet encountered,
an enhancement that prevents disease and premature death. Daniels (2000) discusses
the vaccine example as part of a treatment-enhancement distinction based on
“normal functioning” and basing “permissibility” on a social justice rationale.
But how would “normal functioning” appear after a neural injury in childhood,
especially when the individual is still in the process of physiological
neurodevelopment? This question remains unanswered. Neural prostheses are viewed
thus far as a possible therapy, though one can imagine the technology being
used for purposes of enhancement in the future, especially in an individual
whose brain is still developing intra- and inter-cortical connections.
Transitioning (enhancing?)
the human state of a child after neural injury?
The two primary aspects of transhumanism that apply
to the use of neural prostheses for children surviving neural injury include
the mitigation of suffering (via therapy) and the potential for enhancement. Many
philosophers, bioethicists, and others have debated whether a principled
distinction can be made between therapy and enhancement – and if so, where the
line might be established. Colleton (2008)
understands that there is a distinction between therapy and enhancement and
explores this issue by creating definitions of relevant terms based upon those already
in existence in state-level statutes in the United States, health insurance
company definitions, and pharmaceutical websites. Such an approach, though,
biases the discussion toward common practice. In the United States, the health
insurance companies are payers for therapy (and preventative care), but they
will generally pay only for care that is mandated by law (e.g., whatever is
deemed to be “medically necessary”), assists in returning an individual to a
previous state of health (e.g., an antibiotic regimen), or prevents the
individual from reaching a state of ill health (e.g., preventative care,
vaccinations). The term “enhancement” is used differently in different
circumstances, and the dichotomization of therapy/enhancement is difficult to
establish because the discussion relies on the concept of “health” (Bess 2010), something that is itself
controversial: what counts as health varies in many ways, depending on the individual,
the culture and relevant society, and their extent of medicalization.
It is clear, however, that children surviving neural
injury would have therapeutic opportunities with neural prostheses.
Rehabilitation or reconstruction might be individually directed and would focus
on the mitigation of suffering and the improvement in quality of life.
Enhancement with neural prostheses might be possible in the future after
certain aspects of the technology (e.g., neural interface systems) are vastly
improved and neurophysiological processes are better understood.
If a human being has a neural prosthesis, is that
person in a transformational state toward posthumanity? Is that person a
cyborg? Does an infant who receives a cochlear implant become a cyborg or
something else not-quite-human? Is the answer relative to the individual’s
conception of identity?
For a child surviving neural injury, would a neural
prosthesis only (potentially) restore lost function? In the case of those
receiving cranial radiation for brain tumors, would a prosthesis prevent a loss
of future function? Or would the prosthesis compensate beyond what that
individual’s potential would have been without neural injury? Is this an enhancement,
and how would one determine that it is an enhancement without defining a
person’s potential before it is achieved? Does the restoration/enhancement
provided by a neural prosthesis mediate (potential) future suffering? Assuming there
are no complications related to the prosthesis itself, is the resultant quality
of life improved beyond what human beings experience now, or at least beyond
what the individual patient would have experienced without injury?
Asking these questions is important before embarking
on research with neural prostheses in children with a goal of therapeutic
efficacy. One must strongly consider the risks to such a trial, as well as how
they are weighed against any foreseeable benefit – in this case restoration or
prevention of functional loss, along with potential enhancements; however, it
is debatable just what alterations amount to enhancement. In a particular case,
it might be imponderable whether a prosthesis would offer
enhancement/improvement beyond an individual’s projected developmental course (sans
neural injury). It certainly could provide improvement over the lifespan
post-injury; however, investigations in post-natal developmental biology have
not revealed how functional neural pathways mature in healthy children and
adolescents. The latter point may even suggest that it is premature to embark
on a trial of neural prostheses in children. Devices that would offer the best
therapeutic benefit should be designed in such a way as to allow for at least
an equivalent process that mimics healthy neurodevelopment, but this may not be
possible without a solid understanding of what actually constitutes healthy
neurodevelopment.
Even seemingly straightforward questions of quality
of life can be problematic. For example, many survivors of childhood brain
tumors who cannot live independently self-report their quality of life as high
when their parents and healthcare providers offer low proxy ratings (e.g.,
Carpentieri et al. 2003; Kuhlthau et al. 2012). Aside from disagreement on
quality of life, one cannot project future changes in quality of life resulting
from a medical intervention without first obtaining supportive data, and a
blinded randomized controlled trial of neural prostheses in children does not
appear feasible.
These questions are complicated especially by our
lack of neurophysiological understanding, as well as by sociocultural norms and
legal structures surrounding the ethics of research with children. Arguments
against the use of brain-interfacing prostheses often rely on the premise that
personhood is lost (e.g., change in identity) or altered (e.g., cyborgization).
These arguments make reference to traditional conceptions of bioethics. However,
principlist bioethics, especially the concept of autonomy, is too narrow to
address the questions surrounding neural prostheses in children and fails to
provide us with a nuanced assessment. Not only are these bioethical concepts
constructed from one set of sociocultural norms, but they also are constructed
from the perspectives of adults who believe that it is their role to make
decisions about who needs protection and how that protection should manifest
for individuals younger than a certain number of years. Unfortunately, this is
somewhat arbitrary. There is no magical moment that occurs, for example, at
midnight on a person’s eighteenth birthday suddenly providing her with sufficient
insight and ability to make independent decisions for herself.
Discussion
It is important, then, to address the use of neural
prostheses in children surviving neural injury with an ethical perspective that
can balance the impulsive monster view (cyborgization) with an appropriate
incorporation of a child’s and her family’s perspective. Such a task is
difficult given that ethics is typically discussed and understood from an adult
perspective, as it has been developed by adults. What element of paternalism is
appropriate when considering neural prostheses for brain-injured children is
yet to be discussed in the literature. We can, though, readily conceive that a
neural prosthesis could benefit a child who has survived neural injury. Once
the science has solidified, such that pediatric and adolescent neurodevelopment
is better understood, thereby reducing some of the involved risks, ethical arguments
might be able to justify the use of neural prostheses in brain-injured
children. At that point, schools of thought such as transhumanism, as played
out in both academic and popular media, might offer a means by which a society
might reframe the so-called cyborgization of a child. What is currently viewed
with suspicion, and perhaps as the creation of a monstrosity, might then be
seen as a process that benefits the child, her family, and the wider society.
Ethical justifications
Ethical justifications for the use of neural
prostheses in brain-injured children are not difficult to conceive should
neurophysiological knowledge of neurodevelopment catch up with technological
ability. The utilitarian view of ethics might readily accept a pediatric neural
prosthesis trial, given that the benefits could include a greater chance for
lifelong independence for the child, a family that is freed from a lifetime of
supporting a brain-injured child, and a society that would no longer need to
contribute to that child’s support and would obtain the possible benefit of her
social contributions.
One foundation for a deontological view of ethics is
Kant’s categorical imperative (Kant 1964, 402),2 which can be
practically interpreted as not making an exception of oneself (to whatever
duty/rule structure is or has been established). A deontological
view generally takes a personal or individual ethical focus – rather than a
social or group focus – and uses a duty- or rule-based structure. Compared to
the consequentialist approach employed by utilitarians, such a view might
demand a more nuanced assessment of the ethics of neural prostheses for young
patients.
The requirements of deontological systems of ethics
are discussed primarily by and with respect to adults. Again, we must transform
an adult-centered, individual ethical perspective into a method that would be
appropriate for either the individual brain-injured child or the family unit. In
addition to the adult/individual versus child/family focus problem, another
difficulty arises in these cases. When a previously normal/healthy child
experiences an illness or injury (such as a brain tumor) that fundamentally
alters her functional ability, families often reframe how they understand the
child (Deatrick et al. 2006). This change in contextual understanding may very
well also change the values that the family considers most important, which may
then also alter the hierarchy of deontological duties/rules.
Aspects of utilitarianism, deontology, and other
ethical theories are incorporated into the now classical understanding of
bioethics: autonomy, nonmaleficence, beneficence, and justice. These
principles, as they are called, take as their standard for interpretation the
healthy adult human, or at least the adult human without any diminished
cognitive function. A child surviving brain injury is generally considered
cognitively immature, is below the legally sanctioned age for autonomous
decision-making, and has acquired cognitive deficits. Where should the line be
drawn when determining when a child can make decisions about her own future as
an adult? Why should this decision be made by adults?
Transhumanism + ethics
Transhumanism may be applied alongside more
traditional ethical guides in order to reframe how these questions are
addressed, although this might only be relevant in practice if those involved accept
the values associated with transhumanism. Not all survivors of neural injuries
in childhood wish to pursue academic study or even a career. Many are content
living a fairly solitary life with their families (though the views of the
other family members might vary greatly). Other survivors of neural injury in
childhood struggle because they do not have the functional capability to
succeed in education, the workplace, or even social environments (Ellenberg et
al. 2009). These individuals might like to have the choice to use technology that
compensates adequately for the loss of function. From the point of view of
transhumanism, this should be a choice available to the individual to make at
any time, though how parent/family input would be factored into the decision is
unclear. If efficacy and safety were not major concerns, the decision to use
the technology would probably take place within families.
Taking a step back from a future with fully
available technology, to a time closer to the present with emerging technology,
the use of transhumanist thinking alongside traditional bioethics could help
reframe the approach to research trials involving neural prostheses in children
surviving brain injury. Given informed consent and assent and the support of a
multidisciplinary team of investigators, the “possibility and desirability of
fundamentally improving the human condition through applied reason” (Bostrom
2003, 4) would unfold simultaneously with investigation for therapeutic
benefit. Transhumanism does not seek harm any more than do those seeking or
applying therapeutics. Thus investigating the use of neural prostheses in
children surviving brain injury can have goals from both transhumanism and
traditional healthcare research.
Without intervention, many children surviving neural
injury have questionable future competence and autonomy, potentially unable to
live independently because of physical or cognitive constraints. With a neural
prosthesis, however, who or what is in control? Does the patient maintain
control using the prosthesis to compensate for neurological deficits, or is the
computer interface directing her decisions, actions, thoughts, etc.? Should
this be understood as a question of identity? If so, how much input from the
family and parental view of the child’s identity should be used when decisions
are made about patient care? Or is the question of identity moot, since those
suffering neural injury “lose” self-identity (Anderson-Shaw
et al. 2010) and then struggle to regain it during recovery (Hoogerdijk et al. 2010)? An individual’s
identity develops as he or she grows older (especially from child to adult).
What may be more relevant to the discussion are questions of autonomy.
Historically, bioethical standards were created in
response to injustices that had already taken place (e.g., Nuremberg Code after
the Doctors’ Trial; Belmont Report after
Transhumanism can help address some of these
questions. One can presume that for the foreseeable future a child will not
receive a neural prosthesis unless there is some therapeutic goal associated
with the device and there is no primary enhancement purpose, per se, to
such a device. Transhumanist purposes for technology use include “improving the
human condition,” and the therapeutic purposes of neural prostheses do not
differ so greatly, though the scale of improvement might differ. While an
implant’s purpose is to allow an individual to regain lost function (e.g.,
motor control, memory formation), her condition is greatly improved beyond her
post-injury functioning. Many of the neural prostheses already in development,
however, engage with technology outside of the individual (e.g., robotic limb,
brain-computer interfacing) that can provide her with different and sometimes
greater capabilities than she possessed pre-injury. The use of neural
prostheses creates transitioning states in individuals that should not be
viewed as a cyborgization any more than others with different bodies (the
injured, ill, or disabled) should have their own conditions contextualized by a
sociocultural “normal.” By this, I refer to and agree with Lupton’s (2003) conclusion
that the metaphors we use for conditions different from the norm – especially
those that are less understood – reveal social or political anxieties that those
creating the imagery desire to categorize and control.
Yes, let us have a focus on caution while proceeding
toward some goal (therapeutic or enhancement), but let us do so without
stigmatization. In the past, biomedical framings of bodies that are
different from the medical norm have conceptualized those bodies with
negative metaphors. In an ideal future, biomedicine and transhumanism can frame
bodies that are different as: (a) if you are satisfied with your body,
great – if not, change is possible, and (b) the change that you choose occurs
outside of oppressive and stigmatizing discourse. Adding transhumanism to the bioethical
contextualization for children surviving neural injury will allow us to strip
away the prejudicial metaphor of cyborgization, making possible opportunities
for therapy or enhancement, as technology allows and as chosen by the
individual.
It is not practical to throw traditional conceptions
of autonomy aside only when considering children, thus establishing separate
autonomy standards based on a developmental age rubric (not to mention the new
problems of trying to decide when to switch between standards) would be
inappropriate. What may help, though, is the context that transhumanism adds to
scenarios involving potential improvements to the human condition. Despite
Beauchamp and Childress’ (2009) claim that bioethics is based on universal
morality (2-5), it primarily reflects the values of a Western, industrialized
culture (Weingarten 2011). These values inform how traditional bioethics
approaches children and include: children generally cannot make decisions for
themselves; someone who is considered a legal guardian for the child must make
the final and official decision for her; and since children are considered
vulnerable, they need added protections when being considered for experimental
situations. Reflecting traditional bioethical values, children are seen as
having limitations (e.g., cognitive, physical) when compared to adults.
Transhumanism aims to “overcome fundamental human
limitations” and, when added to bioethics, can help to inform discussions centering
on children with neural injury. These children will not only develop into
adults, but the neural injuries have established limitations in those
individuals, limitations that have the potential to be overcome. Transhumanism,
when paired with bioethics, removes the value of an adult-focus and
replaces it with overcoming limitations in an individual.
I agree that protecting the vulnerable is a good
idea, and transhumanism does not imply otherwise. Protections can and should remain
in place, reframed in the context of limitations: limited cognitive capacity,
limited ability to create long-term memories, or limited motor ability. The
standards against which these limitations are identified, though, would have to
be well-thought out. For instance, as typical human capacities are increased it
might not be reasonable to reframe previously “normal” human cognition as a
limitation requiring special protections.
Next steps
The most pressing need is more basic science
research focusing on pediatric and adolescent neurodevelopment. Without
understanding how neural circuitry develops in immature, post-natal humans, we
will not be able to develop technology targeted at exploiting these processes.
Meanwhile, more deliberation is needed regarding
children and autonomy. Is it possible to have a fully child-centric autonomy?
If not, how about a family-centric autonomy? My suggestion to remove the value
of an adult-focus and to replace it with overcoming limitations in an
individual still assumes certain values, particularly that a limitation is
negative and overcoming that limitation is positive. While I do not think it
possible to have a value-free ethics, are there more appropriate values that
could be applied? This may be best addressed by interviewing groups of children
who either have or have not participated in research or extensive clinical care.
There is no consensus on whether or not there should
be a dividing line between therapy and enhancement, though perhaps the wrong
question is being asked. Even considering a bifurcation between therapy and
enhancement brings with it qualifications laden with metaphors. Perhaps a more
appropriate approach would include abandoning normative conceptions of therapy
or enhancement and embracing bodies that are different. If all bodies
are different, neither therapy nor enhancement has a normative ground from
which to judge.
Notes
2. Pagination
refers to the Academy edition.
Acknowledgements
The author is
supported by grants from the United States National Institutes of Health
(T32NR007100; F31NR013091) and the American Cancer Society (DSCN-10-089). I
wish to thank J. A. Deatrick for her thoughtful suggestions and the generous
feedback provided by the reviewers and editors.
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