Introduction * Part 1 * Part 2 * Part 3 * Part 4 * Part 5
This entry represents Part 3 of a comprehensive report on the talks I attended at the Human Enhancement Technologies and Human Rights conference presented by the Institute for Ethics and Emerging Technologies. The narrative presented here represents my own personal observations and interpretations of the event and the subject matter discussed therein, and I encourage anyone who reads this who was also in attendance to note any factual errors I may have made and to offer any criticisms of my responses that seem merited.
3:00 - 4:30 PM - Equity, Technology and State Power
This was a panel moderated by Dr. Anders Sandberg. Panel members were Fred Gifford, Ph.D. whose talk was entitled "Ethical Issues in Enhancement Research", Robert Schwartz, J.D., who discussed "The Medicalization of Body Modification and the Ethical Obligations of Health Care Providers", Laura Colleton, J.D. whose presentation explored "Health Care Access in the U.S. and the Elusive Line between Enhancement and Therapy", and a duo -- Nikki Sullivan, Ph.D. and Susan Stryker, Ph.D. -- who delivered "King's Body, Queen's Member: State Sovereignty, Transsexual Surgery, and Self-Demand Amputation".
Dr. Gifford's presentation seemed a bit rushed (he seemed to have packed more information into his PowerPoint slides than was really possible to go into depth about in the allotted timespan), but nevertheless, the talk was well-structured and I was able to get a decent understanding of the ethical issues raised. Dr. Gifford's was one of the few (that I noticed) presentations that focused on the research side of the enhancement / modification / intervention issue. Obviously, these technologies need to be tested, and Dr. Gifford described an interesting means of distinguishing "enhancement" from "therapy" in that the research protocol for enhancement may necessarily be different from the research protocol for therapy. That is, someone seeking a procedure out of curiosity or a desire to gain an ability or feature that he or she previously lacked would be a very different research subject (from ethical and motivational standpoints) than someone seeking a procedure as a means to regain health or even save his or her life.
I also learned some basic (and seemingly obvious, now that I've learned them) principles of the meaning and implications of research. Before any new medical technology is released to the public, trials must be run in order to ascertain safety and efficacy according to certain applied standards. Some sick people may indeed end up being helped during a research trial, but there is plenty of likelihood that a person might receive a placebo or an experimental treatment that ends up being ineffective. Dr. Gifford pointed out that some people who end up in research trials might make the mistake of confusing this with "treatment", and certainly, this is something to keep in mind. Research is certainly needed, but in conducting research, medical scientists and the like must take care not to, for instance, target vulnerable populations when seeking volunteers for potentially risky studies. An example of a "vulnerable population" might be a group of people who, while they participate in the trial and are paid a small sum, would never be able to actually benefit from the potentially-costly results of the research.
Dr. Gifford suggested some possible guidelines for determining the ethical justifiability of clinical research. Social value and scientific validity were suggested (though I maintain that "social value" is extremely subjective and suggests some sort of collectivist philosophy -- how many people need to think something is a good idea before it is deemed to have "social value"?). It seemed as if there might have been a hint of the "resource allocation" model of investment distribution in this presentation -- Dr. Gifford also suggested that perhaps a potential enhancement ought to be scrutinized in terms of whether it sought to extend a person's capabilities "beyond human nature", whether it would be likely to "change the self", and whether it was "merely cosmetic / aesthetic".
Whenever someone brings up notions of "human nature" or "the self" these days, I can't help but feel compelled to wonder what that person's definition is of these things -- neither is a very useful term on its own. Overall, I would say that the primary value of the "Ethical Issues in Enhancement Research" segment of the presentation was the emphasis on research protocols and research ethics. This is something that transhumanists and scientists (and transhumanist scientists especially!) should spend plenty of time considering when thinking about, or proposing, various potential modifications -- how are we going to find out if they are safe and effective?
Robert Schwartz, J.D., brought up what is definitely becoming a pervasive cultural issue: that of body modification, and the health care profession's involvement in such practices. This was a tremendously interesting presentation -- body modification is one of those things that I am slowly coming to understand, mainly in the context of it potentially being a way for someone to engage in self-directed evolution and aesthetic control.
When I think about it objectively, I can't see very much of a difference in motivation between getting a particular haircut and getting a particular piercing. In both cases, the impetus has something to do with a person wanting to make his or her outer form match some artistic, aesthetic, and / or functional ideal. However, though the impetus may be the same regardless of what modification is introduced, the degree of extremity of modification can vary considerably.
Schwartz sorted body modification into three categories:
Class I: No public health consequences, few-to-no private health consequences. This class includes such things as clothing and hairstyles. Nobody but the individual and his or her preferred retailer / stylist need be involved in these sorts of aesthetic variables.
Class II: Few health concerns (public or private) but potential for some. This class includes tattoos, piercing, branding, and scarification. Some potential for injury or infection exists, however, these procedures are performed by (usually) licensed professional body-modifiers and not by doctors. Doctors may become involved if there are complications, but these procedures are usually not considered medical in nature in the absence of complications.
Class III: Major modifications that must be performed by doctors -- breast enlargement / reduction, sex reassignment surgery, circumcision (though this is sometimes performed by religious officials), and even "foot shaping". This category of modification is perhaps of greatest concern, at least in terms of potential risk: anyone seeking to undergo such modification is putting themselves at risk of potentially severe injury, loss of prior functionality, or even death.
These sorts of modifications raise the issue of the worthiness of psychological and identity factors in justifying what amounts to major surgery -- though I am sure that most people who undergo such procedures do not do so lightly (particularly in the case of sex reassignment).
Mr. Schwartz then went on to list some of the specific motivations different people might have for undergoing body modification of various kinds. The most "acceptable" reason, from a cultural standpoint, would be a therapeutic one -- I would interpret this as being things like repairing a cleft palate that is interfering with one's ability to eat and breathe, or breast reduction surgery to ease the strain on one's back. Next might come that of financial gain -- certain modifications, such as those chosen by Cat Man and Lizard Man, offer one the chance at a rather lucrative career in entertaining and performance art. Some (perhaps most commonly, especially in the case of Class I and II modifications) use aesthetics as a means to communicate such things as internally-perceived identity, membership in a club, gang, or other social grouping, or simple rebellion. And still others poke, prod, pull, scar, and implant as a means of expressing or experiencing states that they deem spiritual or religious.
Whatever the reason, any modification that has the potential to (or necessity of) involving medical professionals may need to be regulated for the sake of protecting would-be modifiers and providing them with needed health services. However, there is a lingering unanswered (and probably hotly disputed) question as to how much modification one's insurance ought to cover.
While few would argue that some potential modifications (such as the example given of "foot shaping" -- with the motivation of wanting one's feet to look better in designer shoes) linger at or near the "superfluous" or "luxury" category, regulation of body modification needs to be well thought out and justified according to real (economic, medical) criteria rather than simple prejudice.
For another entry in the "horrible things I didn't know about before" category, Mr. Schwartz noted that until 30 - 40 years ago (presumably in the United States), some regions actually harbored and enforced what were known as "Ugly Laws". These laws stated that, for the sake of maintaining a certain degree of public "beauty", people who were "maimed or otherwise unsightly" were restricted from appearing in some public places at certain times (or possibly all the time).
This was a very telling thing to learn in terms of what I've recently come to understand about disability rights: the notion that people who look a certain way, for whatever reason, aren't fit to be seen as part of the visible human community. In a sense, modifiers and enhancers could be the natural allies of those "born different": in the sense that the more aesthetic variations permitted to form the visible spectrum of human diversity, the more exposure people will end up having to the unexpected -- eventually, the more typical folks will have to acknowledge the existence of people that hover outside statistical norms.
Laura Colleton, J.D.'s presentation addressed the "enhancement or therapy?" issue from the standpoint of legal and insurance definitions and regulations. Ms. Colleton astutely pointed out something that science-fixated transhumanst and tech progressive types (myself included) ought to remain cogent of: while scientists may not draw a clear line between therapies and enhancement, insurance companies most certainly do.
Ms. Colleton used two examples of conditions that fall along a symptomological spectrum: one "physical" (chronic pain) and one "mental" (depression). Both conditions are often very difficult to assess, in terms of severity and need for treatment, by anyone who does not happen to be the particular individual complaining of either or both of these. The concept of a "range around the average" was suggested as a guideline for determining need for services and possible coverage of services.
Despite realizing that insurance companies do need a means to determine how to offer coverage, how much coverage to offer, and to whom it ought to be offered, I tend toward thinking that a "benefit of the doubt" philosophy should be employed in favor of the patient.
Next came the tag-team presentation by Nikki Sullivan, Ph.D., and Susan Stryker, Ph.D. -- this was definitely a very academic piece, one which activated some very old English and History class neurons in my brain. For several hours after this presentation I admittedly had difficulty figuring out what point these ladies were trying to make, but then it occurred to me that they hadn't been arguing against or in favor of any particular thing; this was one of the more "consciousness raising" talks, one designed to prompt the listener to think carefully and question certain cultural constraints that might seem transparent to the uninformed.
I admit that I expected something quite a bit more, well, graphic upon learning of a talk with the phrase "self-demand amputation" in the title. But this was so definitely not a plea to allow people to cut off various limbs with reckless abandon -- it was more of a call for people to consider why such an idea might be disturbing in the first place.
It's certainly an intriguing thought exercise. Drs. Sullivan and Stryker put forth some intriguing historical examples in which bodily "wholeness" was certainly shown to be quite an arbitrary idea, and one potentially influenced by the state-perceived economic and social usefulness of a person possessing certain "equipment". For instance, at certain points in the past, it was a capital offence for a man of soldier age to cut off the fingers of his sword hand (people could actually be beheaded for cutting off their own fingers, which strikes me as terribly bizarre!). However, the same man could cut off his own genitals without penalty. This example clearly indicates that penalties for certain amputations were less rooted in some sort of inherent and visceral notion of bodily integrity, but in a perception of which parts a man needed in order to be a useful tool of the state (no pun intended).
Drs. Sullivan and Stryker discussed transsexual surgery, and how this is becoming more and more culturally acceptable as time goes on and notions of gender and wholeness adapt to fit an ever-evolving society. Perhaps transsexuals were initially persecuted not because of what they were doing, physically, to their bodies, but because of a sense that changing from male to female, or female to male, upsets some aspect of gender binaries and the social order. I definitely appreciated being made to think about what the potential sources of people's "gut reactions" might be.
Thus ends Part 3 of my report on the IEET conference. Stay tuned for Part 4 (and possibly a Part 5, depending on how long Part 4 ends up being) coming later this week.