I read a most interesting narrative of the world’s first “bionic man” assembled from prosthetic body parts and artificial organs donated by laboratories around the world. While it is interesting to note that the world’s first “bionic man” weighs in at a cost of almost $1 million to build, anyone who has taken a look at the cost of building a car of its spare parts purchased at retail knows that this amount is actually an incredible bargain, explicable only by the fact that the “bionic man” is by no means complete but represents only two-thirds of the entirety of the anatomy of living humans. Still, it does contain an artificial heart, blood, lungs, windpipe, pancreas, spleen, kidney and a circulatory system, some brain functions, and prosthetic implant parts of sensory organs. There is little doubt that the number of human “spare parts” will in time grow to approach the original asymptotically – likely in direct proportionality to geometrically rising cost. And let’s not forget that the component artificial body parts were, well, donated. It was their cost of assembly that amounted to a cool million.
After some breathless accounts of technological details, the anecdote reaches the intangible points of the experiment:
“The bionic man brings up some ethical and philosophical questions: Does creating something so humanlike threaten notions of what it means to be human? What amount of body enhancement is acceptable? And is it wrong that only some people have access to these life-extending technologies?
The access issue is especially troublesome, [Roboticist Rich Walker of Shadow Robot Co. in England] said. ‘The preservation of life and quality of life has become basically a technical question and an economic question.’”
True. But is it possible that Walker overlooked the fact that life extension has always been a technical and economic question?
We have successfully dodged a frank and candid discussion of this very obvious fact for the last 100 years, but this century was the exception, not the rule. In all of human history, there has never been serious doubt that there is a substantial economic aspect to significant prolongation of life. The global evolution of stem cell research has shown that, while we may erect temporary geographical and jurisdictional limits to the pursuit of scientific possibilities, we also cannot (or at least in reality we simply will not) stop the progression of science for the sake of equality or religious beliefs. At the same time, alternatives to embryonic stem cell research forced by faith-based political campaigns have led to important developments based upon the use of adult stem cells, just as the insistence of Jehovah’s Witnesses on the avoidance of blood transfusions has revolutionized “bloodless surgery” and greatly benefited the risk profile associated with easy availability of donor blood. It is simply not true that science is necessarily precluded from developing alternatives when faced with however irrational political or religious demands. Eppur si muove. So we might just as well have an intellectually honest and candid analysis and disclosure of the true reasons for political posturing in the resulting discussion about appropriate forms of social funding for the 99% that cannot afford to pay for latest medical advances out of their after-tax money.
At a time when population growth predicts a human population of 10 billion by 2050, it is ironic that the world’s richest country and its largest economy, instead of forcing cost efficiency, alternative therapy forms and business models or a reform of intellectual property law, is engaged in a bizarrely unyielding political struggle over basic medical care for its estimated 15% of uninsured poor – while life science and technology continue to expand vigorously the frontiers of the possible with regard to treatment and substitution of failing human body parts.
It seems to be a challenge to exit a cul-de-sac created by irrational taboos.
For the longest time, but especially in the aftermath of World War II that had revealed a new order of magnitude but by no means unprecedented disrespect for human life by the Axis powers, Western civilization has attempted to distinguish itself from egregious precedent by ignoring, suppressing and stigmatizing a candid and complete public discourse about the undeniable fact that not only the wrongful taking but also the preservation of human life is fairly measurably correlated with a monetary value and at least de facto generally accepted methods of its calculation. Without pursuing any ideological agenda, this generally accepted convention is nonetheless nothing short of hypocrisy – with harmful and far-reaching consequences for long overdue attempts to rationalize and improve the way we deal with an economic factual necessity and nexus that is officially denied to exist in a reflexive, axiomatic fashion. But social and political discourse in the 21st century needs to break free from being held hostage by the ghost of Hitler and religious dogma, because only full disclosure of conflicting interests and their balancing in a legitimate, rational and democratic process can lead to broad acceptance of solutions meeting both fairness standards and ensuring the continued expansion of scientific and technological evolution of the possible as well as of ethical standards calculated to channel but not stifle progress.
While irrefutable statistical evidence of diminishing heroic geriatric care inversely proportional to age has been reduced to a debate generally ended by mantra-like slogans on the “sanctity of life,” this has resulted in an increasingly complex bureaucracy of living wills and hospital regulations on the one hand, and well-intentioned but quantitatively ineffectual charitable medical care for the poor on the other: a Gordian knot that is frequently resolved by terminating “all medically possible means” at the earliest juncture least likely to result in discovery by a forensic pathologist. The immense and growing percentage of “care” extended to individuals in the last six weeks of their life accounts for an equally growing portion of a person’s lifetime medical expenses. This trend emerges at a time when the individual expiration date of human life in its final stages is determinable with increasing statistical accuracy.
Of course, society not only may conduct inquiries into these choices, one might indeed argue for a variety of reasons that it must. The commonwealth cannot in good conscience avoid acknowledging truth while the gap between the scientifically and technically possible on the one hand and the cost of its implementation on the other continues to widen. Nor is it intellectually honest to sidestep a broad social and political discourse by taking refuge with phrases that are obviously meaningless and factually incorrect such as “no price tag or utilitarian criteria can be placed on a human life.” It would be nice if this were true. But in reality, the only result this avoidance of confronting obvious reality is that there is no orderly and ethically acceptable process involved in choices that need to, and evidently are, made all the time.
In the old days, things were simple, with few questions asked and even fewer answered. This state of affairs no doubt contributed to the however unjustifiable status of medical professionals in the distinct neighborhood of divinity – not to mention readily apparent wealth sanctioned by acquiescence. But times have changed, as has the incidence of challenges under color of professional ethics that are rooted in social morality.
We face the intriguing observation that the superficial consensus of Western secular societies defers to purely religious, spiritual justifications for not only sidestepping but affirmatively suppressing any manifestation of a meaningful discourse on the “sanctity of life.” Even without any intent to dispute this notion, the axiom of the inviolability of human life (increasingly also extended as a theoretical aspiration to animal life) does not facilitate a formula that would resolve the consequences of the absence of acknowledgment of the financial dimension of its postulates. As a result, what should be determined and ordained by socio-political process is instead relegated to the uncertainties and fallibility of individual decisions and their implementation by third parties – or by a body politic that is not making conscious decisions because it refuses to face the coordinates and parameters of algorithms it is adopting ill-informed, ill-advised, ill-considered and ill-prepared. Analysis of the “expedited” passage of legislation such as the USA Patriot Act that reversed centuries of established jurisprudence on the very core of human rights shows the limits of deliberative representative democracy. In both chambers of Congress, the time for “deliberation” between introduction and adoption of this unusually voluminous bill had been less than 24 hours. However, this statute was but a particularly striking example of a trend that has been germinating over decades.
An elementary retrospective of exclusion suggests that the exclusion of “the ninety percent” from the potential of “the preservation of life and quality of life” on economic grounds will not coexist peacefully with the contemporary – and much less any future – pace of progress in medical technology. Failure to provide “social justice” by whatever standard acceptable to the citizen voter will predictably result in backlashes through social unrest that is bound to slow down and reverse the very progress of technology that privilege may be expected to ensure.
It appears that, paradoxically enough, a steep evolutionary path of technological progress requires socialized accessibility as a condition to its continued trajectory. It can be shown that, historically, advent of significant technological breakthroughs has almost always spurred a spread of enlightenment and information whereas its abuse or deprivation has resulted in patterns of setbacks to the broad availability of technology during periods of warfare and social violence that were only overcome by further spurts of technological advances, including improved processes in the use of existing technology.
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