The Use of Emergent Technologies for Enhancing Human Performance: Are We Prepared to Address the Ethical and Policy Issues? George Khushf Introduction New developments in science, technology, and medicine have brought us to a unique place in history. It’s tricky to characterize properly this place, but many people, in different areas of science and medicine, have a sense of its radical character. Here is how some express it: ▪ Self-aware evolution: Until now, the processes guiding the development of life have been blind, depending on chance happenings, which provide selective advantage in contexts of competition for limited resources. But now, through our science, we have developed the capacities to engineer directly the next stages of this process. Whether by genetically altering existing living systems or through direct creation of artificial life, we can (or will soon be able to) directly manufacture the next stage.1 2 ▪ Human/machine hybrids: Technology has already radically enhanced human capacities, so we are stronger, faster, and more agile than any other living system. But the capacities were provided by external means: rockets, cars, cell-phones, and computers. However, slowly, these technologies are getting smarter, and the humanmachine interface is getting more seamless. Now we are at the cusp of the next stage: where the technology gets directly incorporated, whether by implanted chips, neural interfaces, or simply by remote sensing capacities. With this shift, the very character of the human changes. We move from the natural organism, Humanity 1.0, to the natural/artificial hybrid, Humanity 2.0.3 4 5 ▪ Medical enhancements: Until now, medicine has largely focused upon therapy. It advanced tools that enabled the detection and mitigation of disease, or the restoration of function for those disabled. But now these tools have been refined, enabling radically new uses. Instead of simple restoration of lost function, we can enhance normal function and introduce new capacities that humans have never had before.6 7 8 Even if we wish to contest the optimistic tone, or argue with the background assumptions or “transhumanist” goals,9 all should recognize the kernel of truth in these kinds of claims. Whether we like it or not, science has brought us to a place where the radical project of re-engineering ourselves moves out of the realm of science fiction and into the realm of scientific fact. In this article, I’ll sketch how we are moving from an earlier stage of the enhancement debate, where the concerns were largely at the margins of ordinary human life, to a second stage, where these issues loom larger and are integrated into our everyday world. I’ll try to show three things: (1) that the kinds of enhancement technologies on our immediate horizon are of a different kind, and pose a depth of challenge not previously 1 seen in human history; (2) that these developments fundamentally call into question the way we have advanced ethical and policy debate on emerging technology; and (3) that we must now foster new cultural and intellectual resources for constructively engaging these issues. Put simply, we stand on the horizon of a brave new world, one we are entering at an accelerating rate, but we lack the social and intellectual tools to conceptualize appropriately and to address responsibly this new world. My goal is to have you take notice, and hopefully get you and others to start developing the tools we now lack, so that we foster these emerging capacities in an appropriate manner. Stage-One: The Old Enhancement Debate The development of enhancement technologies comes in stages. First, metaphorically speaking, there are a few trickling streams, each rather sparse, arising in isolated, lonely mountains far removed from the hustle and bustle of ordinary life. Each trickle is separate from the other, spawns its own little trenches, with its own culture and life. But then, gradually, these streams come together, speed up, grow larger, and they come down from the isolated heights and enter into the hills and valleys of ordinary life. In this initial section, I’ll consider a few select “streams,” and show how the earlier stages of the enhancement debate have been framed. Then, in the next section, I’ll consider the immediate horizon in front of us, where we start to see these streams merge, and where the enhancement debate takes on a new, more troubling and radical form. Sports Doping One of the best illustrations of the “old debate” (which is, of course, still a current debate) can be found in the area of sports doping. Most people are aware of some notorious athletes: Ben Johnson’s revoked gold medal for the 100-yard dash in the 1988 Seoul Olympics, or perhaps Mark McGuire’s steroid enhanced home run record in baseball. Perhaps some are even aware of the tragic side, of fatal blood clots associated with pharmacologically boosted red blood cell counts in bicycling, or of testosterone induced rage in weight lifters. Perhaps some are even aware of the pervasive pressure that high performance athletes face to use drugs for enhancement purposes. But all this just touches the tip of the problem in this one little tributary of the enhancement debate. High performance athletes, even at college and high school levels, train in ways that combine diet, specialized exercise routines, and continued medical attention to mitigate the ever-present problems of injury and diminished function. In a sense, all their training involves a controlled tearing down and building up of their body, and the “dietary supplements” or “medical treatments” sometimes blur the lines between therapy and enhancement. In fact, the ability to draw a line and to determine when it is crossed involves a whole industry. There are national and international commissions that attend to the issues, and the rules of diet and medical treatment are now so complex that the average athlete often must depend on experts for making the appropriate distinctions. 2 There are also complex strategies that have been developed for detecting violations of doping rules, and equally complex games played by athletes and their trainers for navigating these rules. In some areas of sport, organizers have capitulated to the evolving drug culture, and they make distinctions between doped and non-doped leagues (perhaps a new way of addressing the eroding distinction between an amateur and professional athlete, if only people could find ways to determine who is really playing by the nondoping rule). High performance athletics is still at the fringes of ordinary life. Though pervasive in our entertainment worlds, the problems such athletes face seems distant and surreal to most of the population. But within this small world, the problem of doping has moved from a relatively small, peripheral role to a pervasive one, and all such athletes confront it and the complex rules spun by it on a daily basis.10 11 12 (Later I will show that this development can be taken as a microcosm of larger developments that will soon influence all of society). Cosmetic Surgery Athletes dope for strength or speed. But entertainers pursue a different kind of enhancement: the face lift, boob job, or tummy tuck. At first, there was a similarly distant, surreal aura to such technological or surgical fixes. They were for the rich and famous, who had nothing better to do with their vast cash holding, and who were so vain and image-focused that they were willing to submit their bodies to neurotoxins and the surgical knife. But in this area, the widening of the stream has touched the ordinary person, although we still find relatively few who take this path. One of the more interesting developments in this area also concerns the kinds of enhancements that are emerging, and the ways they are integrated into social discourse. At first, there were few options. But now, in addition to the conventional nose job (rhinoplasty) or botulism-mediated tightening of a wrinkled face, we see enhancements of voice (for those who want a smooth sounding voice on the telephone) and even the prospect of a complete face transplant. We also find the technology integrated into alternate visions of human excellence. Thus, for example, there are popular shows like “extreme makeover,” where a somewhat homely, out-of-shape and poorly dressed housewife gets transformed into a vibrant, in-shape beauty by the appropriate combination of exercise, a new wardrobe, and the surgeon’s knife. The key thing to notice with this development is the shifting appraisal provided by society; namely, how we move from a fringe practice for the rich and famous to a readily available strategy for morphing the ordinary person into a vibrant, extraordinary one.13 14 15 Smart Drugs Although each of these enhancement streams affect people of all kinds, our public images and stereotypes link them to specific groups. Thus the sports doping problems are linked 3 to men, and the enhancements reinforce stereotypes of brute, mindless strength. Cosmetic surgery is linked to women, with stereotypes of an equally mindless concern for appearance and external beauty. These two strands are quite visible in the public eye. But there is another one, which again affects all, but which now takes unique form among youth, especially the smart, academically oriented kind. “Mindless” is not quite the right word for this kind of enhancement. Among academically oriented youth in colleges, there is an extensive interest in pharmacological means for enhancing intelligence. This goes beyond an interest in new energy boosting drinks or the caffeine and glucose shot in a Starbucks latte. Students are interested in the prescription variety—whether Ritalin or newer memory enhancing drugs originally developed for age-related dementia or Alzheimer’s. And here we don’t simply have a new iteration on the older problems of recreational drug use among youth. Even those students who normally would not experiment with drugs like marijuana now seriously struggle with questions about whether to use the “smart drugs.”16 17 18 Common Features of the First Stage of the Enhancement Debate Although these three areas of enhancement are generally isolated from one another, and we usually don’t see the same person pursuing more than one kind, they still share common features. I’ll focus on five of these shared attributes: (1) The enhancements are medical and require a physician to prescribe legally the treatment. Generally, the technologies are developed in a context of treatment, addressing the deformation or debilitation that attends illness or trauma. Since they are medical, they are regulated, and access depends on a gatekeeper, whether to prescribe the drug or provide the surgery. While this gate keeping can be, and increasingly is sidestepped on a black market, we find the regulatory mechanisms providing a social constraint on the way enhancements are accessed. Also, the background medical ethical norms provide guidance, whether in sports medicine for drug use, pharmaceuticals for attention, memory or mood, or surgery for improving form or figure.19 (2) The enhancements are discrete. We can usually neatly isolate the specific intervention at issue, and then consider its effect. This discreteness simplifies analysis, and it enables us to distinguish the “medical enhancement” from other kinds of enhancements associated with diet, exercise, or study. (3) The enhancements usually serve a narrow, specific purpose. They might help mood or memory, or build muscle, or improve figure. (4) The enhancements have harms that can be studied and quantified in the same way, and by the same tools we use to study benefits and harms in other areas of medicine. Although there has been relatively little study of the overall utility of these discrete medical enhancements, it is not difficult to see how such study might be 4 conducted. As a result, we can generally consider the weight of benefit against the harms. (5) While the enhancements do have clear, documented effects (although many are not well-studied), they are, in the end, relatively modest effects. An athlete using steroids might have a significant boost in strength or speed, but he will not gain radically new, superhuman powers. The student on Ritalin might gain 100 points on an SAT entrance exam, but he or she will not instantly become a genius or know things she would not have been able to know before. On the basis of these shared attributes, broader ethical and social analysis of the enhancements can take the form of an assessment of the risks and benefits of such enhancements. Many people believe that the questions of usage should be left up to each individual, since they are in the best position to assess the risks and benefits. Since the public generally sees the benefits as modest and the risks as significant, few have felt threatened by those who take the riskier path. The one exception has been in the area of sports, and this context is instructive. We need to ask: Why has the otherwise marginal practice become so significant in the area of sports? Here three factors are important. The first concerns the level of specialization in sport. For most people, it would be very difficult to isolate specific functions or abilities that could be directly enhanced by current medical technologies, and, once enhanced, could provide significant benefit in realizing life goals. Our goals are generally too diffuse, or when specific, we couldn’t better attain them by some specific technological enhancement of some designated ability. The second factor concerns the level of commitment found in a high performing athlete. One of the things we value most about athletes is the strength of will, the courage, and the persistence in a demanding activity, even when many obstacles arise. In most sports, this includes a significant risk of injury and harm, which the athlete willingly accepts in the pursuit of excellence. This virtue—with the attendant risk-taking and singleness of purpose—makes the athlete willing to accept a gamble that others would normally not accept. The third factor is, perhaps, the most significant, and it provides the key to the ethics of sports doping. Put simply, sports assume a competitive context, and they require a “fair” game. The meaning of such fairness is not easy to specify, and it ultimately depends on background notions of human flourishing and the kind of excellences manifest in sport. Consider one of the simplest and purest examples: runners in a race; a dash, like the 100yard dash. What do we value in the athlete? It is surely not just the final time. Many animals can easily best the fastest human, and a “human + machine” could easily best the fastest animal. The time doesn’t matter. Instead, we consider the somewhat nebulous combination of natural ability, intense training, diet, and so on. Now, with this as our context, we need to ask: What would sports doping add to the sport? What excellence does it enhance? And here is the rub: While the drug might lead to a better final time, it doesn’t offer anything else. It “enhances” the final time, but it does not enhance any 5 excellence we value in the sport. Yet it brings risks, and most runners would prefer to avoid these. When we couple the risks with the competitive context, we now see the full problem. Most athletes would prefer not to use the drugs, since they bring risks, but don’t add in any way to the excellence of the sport. But the margin in sport is small, and if some avail themselves of the pharmaceutical enhancement, then all must follow if they want to remain competitive. Thus, if some are allowed to use them, all will be compelled to use them. This would introduce an accelerating risk, but add nothing to the beauty of the sport itself. Thus doping is banned. And if an athlete secretly dopes, this is just cheating, and that is something antithetical to human excellence. Now we need to ask: What would happen if enhancement technologies would provide the ordinary person advantages in ordinary life comparable to the kinds of advantages doping provides in sport? What if these move from the margin to the center of life? And most significantly, what would happen if the kinds of enhancements provided are more radical, perhaps even leading to abilities people never had before? Stage-Two: Enhancements on the Horizon We are just at the stage where the new kinds of enhancements are taking form, and it is still difficult to characterize them clearly. They seem to hover in a strange world between real and make-believe, science and fiction. But they are not just future and speculative. Real scientists are conducting the research, influential companies funding it, and national agencies promoting their development. These enhancements are of an unprecedented kind. To illustrate this new stage of the enhancement debate, I’ll consider a representative policy initiative called “NBIC Convergence,” and then address some of the ethical and policy issues that arise from this. NBIC Convergence “NBIC Convergence” grew out of a December 3-4, 2001 workshop jointly sponsored by the National Science Foundation (NSF) and the U.S. Department of Commerce (DOC). It included leaders in government like former Congressman and Speaker of the House Newt Gingrich,20 and the Undersecretary of Commerce, Philip Bond.21 22 Many leaders in industry played an organizing role, including technological powerhouses like IBM and Hewlett-Packard. And it was lead by some of the most influential people in our national science agencies, including Mihail Roco, perhaps the most influential architect of U.S. funding policy in nanotechnology, and William Sims Bainbridge, a current director of NSF initiatives in information technology. The initial report of this workshop, published as a government volume and later by Kluwer Academic Publishers, was edited by Roco and Bainbridge, and has the title: Converging Technologies for Improving Human Performance. Nanotechnology, Biotechnology, Information Technology and Cognitive Science. (Thus, the N, B, I and C).23 6 The kinds of enhancements of human performance contemplated in the report are radical. They include advanced human/machine interfaces, significant extension of the human life span, genetic engineering, and the complete transformation of formal educational systems. The overview of the workshop states that with a concerted effort, any of a list of 20 enhancements could be realized within the next few years. To give a sense of the tone of the document, I’ll list the first six of these 20: ▪ Fast, broadband interfaces directly between the human brain and machines will transform work in factories, control automobiles, ensure military superiority, and enable new sports, art forms and modes of interaction between people. ▪ Comfortable, wearable sensors and computers will enhance every person’s awareness of his or her health condition, environment, chemical pollutants, potential hazards, and information of interest about local businesses, natural resources, and the like. ▪ Robots and software agents will be far more useful to human beings, because they will operate on principles compatible with human goals, awareness, and personality. ▪ People from all backgrounds and of all ranges of ability will learn valuable new knowledge and skills more reliably and quickly, whether in school, on the job, or at home. ▪ Individuals and teams will be able to communicate and cooperate profitably across traditional barriers of culture, language, distance, and professional specialization, thus greatly increasing the effectiveness of groups, organizations, and multinational partnerships. ▪ The human body will be more durable, healthy, energetic, easier to repair, and resistant to many kinds of stress, biological threats, and the aging process.24 After providing the list, Roco and Bainbridge summarize: If we make the correct decisions and investments today, any of these visions could be achieved within twenty years’ time. Moving forward simultaneously along many of these paths could achieve a golden age that would be a turning point for human productivity and quality of life. Technological convergence could become the framework for human convergence.… The twenty-first century could end in world peace, universal prosperity, and evolution to a higher level of compassion and accomplishment. It is hard to find the right metaphor to see a century into the future, but it may be that humanity would become like a single, distributed and interconnected ‘brain’ based in new core pathways of society. This will be an enhancement to the productivity and independence of individuals, giving them greater opportunities to achieve personal goals.25 7 There are several things that are remarkable about this list, and about the optimistic conclusion. Perhaps most striking is the radical character of the enhancements that are contemplated. Consider the first item on their list. When they speak of “fast, broadband interfaces directly between the human brain and machines,” they don’t just mean a better Road Runner connection for your home computer. They are speaking of direct neural/digital interface. The kind of linkage they have in mind can be seen in the work of one of the conference speakers, Miguel Nicolelis, a researcher at Duke University Medical Center.26 27 28 He implanted electrodes into the sensormotor-cortex of monkeys, and utilized a computer algorithm to translate the signals, so a robotic arm could directly mimic the monkey’s own arm. After the algorithm was worked out for translating the brains signals, the monkey was rewarded with fruit juice when it activated the robotic arm without moving its own arm. Eventually, the robot arm was moved miles away to another university, and the monkey was trained to manipulate the arm simply by looking at a computer image on the screen. The monkey could use the robot arm to pick up items and move them around – all this, without moving its own arms, and by means of a direct interface between its own brain and the computer/robotic arm/remote communication complex. At the NBIC Convergence workshop, Nicolelis reflected on the implications of his research: The full potential of the ‘digital revolution’ has been hindered by its reliance on low-bandwidth and relatively slow user-machine interfaces (e.g., keyboard, mice, etc.). Indeed, because these usermachine interfaces are far removed from the way one’s brain normally interacts with the surrounding environment, the classical Von Neuman design of digital computers is destined to be perceived by the operator just as another external tool, one that needs to be manipulated as an independent extension of one’s body in order to achieve the desired goal. In other words, the reach of such a tool is limited by its inherent inability to be assimilated by the brain’s multiple internal representations as a continuous extension of our body appendices or sensory organs. This is a significant point, because in theory, if such devices could be incorporated into ‘neural space’ as extensions of our muscles or senses, they could lead to unprecedented (and currently unattainable) augmentation in human sensory, motor, and cognitive performance.29 At a subsequent NBIC workshop in 2004, another researcher, Rodolfo Llinas, from the New York University School of Medicine, considered how the electrodes utilized in the brain machine interface might be introduced in a new manner. He began his talk in an almost joking manner, telling how his friends at the medical school informed him that it’s usually not a good idea to drill holes in peoples head and then insert foreign objects. (A reference to the implanting of electrodes associated with Nicolelis-like research). He thus came up with the idea of using “nanowires”—wires so small they could be inserted by a catheter into the blood lines that feed the appropriate region of the brain, enabling a 8 remote brain/machine interface to accomplish the kinds of things Nicolelis did with his implanted electrodes. Llinas then showed research results on how, in a Petri dish, the wire can trigger a neuron, and the neuron, when fired, can trigger the wire. He provided a Functional Magnetic Resonance Image or fMRI showing how, in a mouse, the wires cross the blood/brain barrier and snuggle up next to the neurons. These are just two of the many examples that could be provided on current research related to brain/machine interfaces. Some of this research is already in the human testing stage, enabling paraplegics to control “smart rooms” or blind people to detect objects through video glasses that completely bypass the natural eyes with electrodes that feed directly into the brain. And while the initial stages of human subjects’ research will largely focus on medical treatments, many of the most prominent researchers have broader interests, seeking what Nicolelis has called “a major paradigm shift in the way normal healthy subjects can interact with their environment” with “unprecedented ability to augment perception and performance in almost all human activities.” 30 Some researchers are also engaging in self-experiment; for example, Kevin Warwick at the University of Reading in the UK, has implanted microchips within his body in order to advance cybernetic research on the interface with “smart environments” (viz., his laboratory). This research—just a glimpse at the first item in their list of 20—already illustrates the kinds of enhancements that now lie on the horizon. Such “second stage enhancements” have the following features: (1) The enhancements provide radically new capacities. While many of these enhancements are initially developed for medical applications, the researchers involved immediately see their radical enhancement potential, and they openly explore ways to augment human ability. Even when the focus is on medical applications, treatment no longer just concerns the fixing of a broken machine. The very line between cure and enhancement blurs. Once a paraplegic has an interface with a smart room or a robotic prosthetic, it is a simple matter to upgrade the hardware to give superhuman strength or a new environmental awareness. A blind person with neural/video interface can as easily see in the infrared or ultraviolet range, as he could light of the visible spectrum. (2) The enhancements are multi-functional, and alter how we approach disability. In older disabilities research, there was an interest in restoring typical human function, and mimicking normality by means of prosthetics. Recently, there has been a shift to maximizing function, even if this involves completely new ways of developing prostheses. Thus, for example, a lost leg might be replaced with a strange looking prosthetic that might actually improve speed relative to the normal person. (There is now debate about whether individuals with such prostheses should be allowed to compete in normal races, since they now seem to have an advantage). It is also being discovered that the technological linkages might introduce additional functionalities that might complement the restored kinds. Each of the 20 enhancements contemplated in the NBIC report concern a broad cluster of abilities, which are jointly enhanced by 9 the new technology. The brain/machine interface, for example, might initially focus on some specific disability (like lost sight), but the technology itself is like a cell phone: once it is introduced, many other functions are enabled. The technology thus can provide a broad range of opportunities for the person who receives it, and by means of the new enhancements, people can explore new modalities of human existence. Thus research on a disability like paraplegia might be the avenue for exploring new forms of human life. The “treatment” becomes an early experiment in how to transform human existence. (Many of the researchers on the cutting edge view this research in such a way, and we find strange combinations; e.g., military funding and medical research). (3) The lines between diverse enhancements blur, and they involve the convergence of multiple kinds of technology. In the earlier stages, we had isolated streams, and the enhancement applications were usually associated with a specific function. Problems were localized in specific enhancement cultures. Now we find the streams starting to converge. In fact, a careful reading of the 20 NBIC items (or even the six highlighted earlier in this article) will show that there is considerable overlap between them. Thus, for example, developments in robotics, smart environments, and information technology turn out to be of central importance for brain/machine interfaces, and, likewise, advancements in the brain/machine interface will significantly accelerate and alter research in these other areas. The very name selected for the NBIC initiative is telling: there is a concern with a “convergence” of multiple streams of research, with an attendant recognition that each area complements the other. (4) The enhancements develop at an accelerating rate. A central theme in the initial NBIC workshop concerned how best to catalyze the enhancement research. It was recognized that initially some investment of effort and resources is needed to bring together the diverse streams of research, but once this linkage is made, there is an explosion of development. The enhancements thus advance at an accelerating rate, and, as they enable new capacities, these feed back upon the research process, making possible forms of advancement that cannot even be imagined at this stage. An example of such exponential advancement in capacity can be found in the Human Genome Project. When the project was first initiated, available technology for sequencing the genome would have required a century for completion. Planners recognized that enabling technology emerges and accelerates development. In fact, such development took place even faster than originally anticipated, so that the project was completed ahead of schedule. (5) The enhancements will provide significant advantages to those who obtain them. In competitive contexts of education, business, and the military, the pressure to use these enhancements will grow, and the problems raised by this will become prominent and pervasive in the everyday of life of all people. 10 Ethical and Social Issues Integral to Stage-Two Enhancement Technologies The more radical enhancements (the stage-two kind) are still a decade or two in the future, and it is tempting to say that we should not worry too much about them until they take a more concrete and specific form. At this stage, can we do much more than speculate? Such a “wait and see” attitude would, in fact, represent the ways we normally address the ethics and policy of emergent technology. Initially, we have researchers who push the envelope in science and technology, and industries, which find ways to link these emergent developments with human needs. As new technology takes form, we have different levels of ethical and social analysis. Thus, for example, a new pharmaceutical slowly percolates upward from the initial science and lab work to animal tests and ultimately to diverse phases of human subjects research, with their drug trials. As the drug comes on the market it is then further regulated by the medical norms which govern their prescription and use. If downstream some start to use these drugs for enhancement purposes, we simply take this as a new topic, and work through the ethical and policy issues at that stage Shouldn’t we do the same thing with stage-two enhancements? For several reasons, I think this traditional two step model (first R&D, then ethics and policy) is no longer appropriate. In fact, such assumptions are deeply problematic, because they don’t sufficiently account for the radical character, accelerating rate, or transformative potential of stage-two enhancements. While we are still a decade or two away from the full introduction of stage-two enhancements, the research that determines the character of these enhancements is already well underway, and vast resources by industry and government are being invested in their development. We are already witnessing the initial stages of human experimentation, not just in medical arenas, but also in industry and the military. When these technologies are mature, they will not just be like a new gadget, even a highly influential one like computers or cell phones. They make possible radically new forms of human interaction, and with this, they alter the rules of post-hoc ethical and policy reflection. This is the key component to recognize. Many of the enhancements will be of such a kind that those who control them may have capacities to manipulate directly the rules of social engagement in ways we now might consider unfair. I’m not saying this will happen, but it might, and these kinds of radical shifts in power and control should be explored in tandem with the development of the technologies. If we wait until a later stage, when the developments are apparent, we may be too late to alter the path of the technology and channel it in the most constructive directions. We also should consider the implications of the accelerating rate of development. Convergence catalyzes diverse streams of research, and the resulting explosion leads to countless specific technological innovations. This tremendous advance in productivity is a central concern of the U.S. Department of Commerce, and a reason why they have fostered such technological convergence. But the benefit has a flip side. When so many new, significant technologies emerge together, they outstrip our capacity to reflect on the ethical and policy implications. I have already seen this in the area of bioethics. When I first entered the field about two decades ago, there was a relatively small bioethics 11 community, and most had a general sense that the core ethical issues were being addressed. They were difficult new issues, for example, associated with the technological extension of life or allocation of organs for transplant. But since that time, the health care transformations and technological developments have accelerated to such an extent that only the most visible of topics are addressed. The new issues raised by any topic, for example, something like “medicine and the Internet” (a topic hardly addressed by the bioethics community) could occupy the whole bioethics community for countless years. The older model where you have an ethics and policy community that considers the results of science and industry is no longer a viable model, because the expanding ethics community remains too small, and the technological developments are too rapid and increasingly radical. Instead, we today need a deeper integration of ethical and policy reflection into the diverse streams of research and industrial development. Those who create the new stagetwo enhancements need to be actively involved in an ethical and policy discussion that considers how these capacities should be best advanced, and the larger public should be initiated into the radical, transformative projects that are now integral to our cutting-edge science and industry. This bridging poses deep challenges, both to our academic cultures of research, where there is a divide between the sciences and humanities, and to our industry and science agencies, which are vigilant against any outside intrusion into their sacrosanct domains. If we cannot move beyond the current polarizing discourse, still largely on the fringes of human life, what will happen when we fully enter the brave new world that already opens up in front of us? Conclusion While I think there are some clear things we can do to initiate a more responsible integration of research and ethical/policy reflection, I won’t even attempt to outline these here. My goal has been more limited: to sketch the kinds of enhancements that now lie on our horizon, and make apparent the depth and scope of the challenges they will pose. Until we see this, any concrete recommendations will not make sense, especially since they must involve a commitment of effort and resources to change long-standing traditions of science policy, and these traditions aren’t easily altered. But if we see the challenge, then the excitement and gravity of the questions might lead to greater resolve. After all, shouldn’t we all be interested in a project that seeks to reengineer our basic human capacities? In a sense, we are all the research subjects of this grand new experiment. Though few name it or even see it as such, many are involved in the project, and we already see some state-two enhancements taking form. Whether we like it or not, Humanity 2.0 has entered the stage of beta testing, and we all have a stake in the new product. 12 The material in this document is based upon work supported by a grant from the National Science Foundation, NSF 0304448, Nanotechnology Interdisciplinary Research Team [NIRT], PHILOSOPHICAL AND SOCIAL DIMENSIONS OF NANOSCALE RESEARCH: “From Laboratory to Society: Developing an Informed Approach to Nanoscale Science and Technology.” Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author and do not necessarily reflect the views of the National Science Foundation. References Adam, D. (2001). Gene therapy may be up to speed for cheats at 2008 Olympics. Nature 414: 569-570. Alam, M. (2001). On beauty: evolution, psychosocial considerations, and surgical enhancement. 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Employment Relations Today 30(2):1-13. 15 About the Author George Khushf, Ph.D. is the Humanities Director of the Center for Bioethics and Medical Humanities and an Associate Professor in the Department of Philosophy at the University of South Carolina. His research focuses upon administrative and organizational ethics in health care, the philosophy of medicine, and the ethics of emergent technologies. Research for this essay has been funded by a grant from the National Science Foundation to consider the ethical issues integral to nanotechnology. Dr. Khushf can be reached at khushfg@gwm.sc.edu. ENDNOTES 1 See Garreau, J. (2005). Radical evolution: the promise and peril of enhancing our minds, our bodies – and what it means to be human. New York, NY: Doubleday. 2 See Silver, L. (1998). Remaking Eden. London, UK: Harper Perennial. 3 Vickers, M. (2003). Cyberhumanity: the blurring boundaries between people and technology. Employment Relations Today 30(2):1-13. 4 Hughes, J. (2004). Citizen cyborg: why democratic societies must respond to the redesigned human of the future. Boulder, CO: Westview Press. 5 Elliott, C. (2003). Humanity 2.0. Wilson Quarterly, Autumn: 13-20. 6 See Stock, G. (2002). Redesigning humans: our inevitable genetic future. Boston, MA: Houghton Mifflin. 7 See Kurzweil, R. (2004). Fantastic voyage: live long enough to live forever. London, UK: Rodale Books. 8 See Bayertz, K. and Schmidt, K. (2004). Testing genes and constructing humans – ethics and genetics. In G. Khushf, ed., Handbook of Bioethics. Dordrecht, Holland: Kluwer Academic Publishers, pp. 415-438. 9 See Fukuyama, F. (2003). Our posthuman future: consequences of the biotechnology revolution. New York, NY: Picador. 10 Hoberman, J. (2002). Sport physicians and the doping crisis in elite sport. Clinical Journal of Sport Medicine 12: 203-208. 11 Mendoza, J. (2002). The war on drugs: A perspective from the front-line. Clinical Journal of Sports Medicine 12:254-258. 12 Adam, D. (2001). Gene therapy may be up to speed for cheats at 2008 Olympics. Nature 414: 569-570. 13 Alam, M. (2001). On beauty: evolution, psychosocial considerations, and surgical enhancement. Archives of Dermatology 137: 795-807. 14 Davis, K. (2000). The rhetoric of cosmetic surgery: luxury or welfare? In E. Parens (ed.), Enhancing human traits: ethical and social implications. Washington, DC: Georgetown University Press, pp. 124-134. 15 Little, M.O. (2000). Cosmetic surgery, suspect norms, and the ethics of complicity. In E. Parens (ed.), Enhancing human traits: ethical and social implications. Washington, DC: Georgetown University Press, pp. 162-176. 16 See Gardner, H. (2000). Intelligence reframed: multiple intelligences for the 21st century. New York, NY: Basic Books. 17 Gazzaniga, M. (2005). The ethical brain. Chicago, IL: Dana Press. A nice summary of his book is provided in Gazzaniga, M. (2005). Smarter on drugs. Scientific American Mind 16(2): 32-37. 18 Elliott, C. (2000). The tyranny of happiness: ethics and cosmetic psychopharmacology. In E. Parens (ed.), Enhancing human traits: ethical and social implications. Washington, DC: Georgetown University Press, pp. 177-188. 19 Miller, F., Brody, H. and Chung, K. (2000). Cosmetic surgery and the internal morality of medicine. Cambridge Quarterly of Healthcare Ethics 9: 353-364. 20 Gingrich, N. (2002). Vision for the converging technologies. In Roco, M. and Bainbridge, W., Editors (2002). Converging technologies for improving human performance: nanotechnology, biotechnology, information technology and cognitive science. Arlington, VA: National Science Foundation and U.S. Department of Commerce, pp. 31-47. Available in PDF format at www.wtec.org/ConvergingTechnologies/ (pagination is altered). 16 21 Bond, P. (2002). Converging Technologies and Competitiveness. In Roco, M. and Bainbridge, W., Editors. (2002). Converging technologies for improving human performance: nanotechnology, biotechnology, information technology and cognitive science. Arlington, VA: National Science Foundation and U.S. Department of Commerce, pp. 28-30. Available in PDF format at www.wtec.org/ConvergingTechnologies/ (pagination is altered). 22 Bond, P. (2004). Vision for converging technologies and future society. In Roco, M. and Montemagno, C., Eds. (2004). The coevolution of human potential and converging technologies. Annals of the New York Academy of Sciences 1013, pp. 17-24. 23 See Roco, M. and Bainbridge, W., Editors. (2002). Converging technologies for improving human performance: nanotechnology, biotechnology, information technology and cognitive science. Arlington, VA: National Science Foundation and U.S. Department of Commerce. The complete report is available in PDF format at www.wtec.org/ConvergingTechnologies/ (pagination is altered). 24 Cite 23, pp. 4-5. 25 Cite 23, pp. 5-6. 26 Nicolelis, M. (2002b). The amazing adventures of robot rat. Trends in Cognitive Sciences 6(11): 449450. 27 Nicolelis, M. (2003). Brain-machine interfaces to restore motor function and probe neural circuits. Nature Reviews/Neuroscience 4 (May): 417-422. 28 Nicolelis, M. and Chapin, J. (2002). Controlling robots with the mind. Scientific American, October: 4653. 29 Nicolelis, M. (2002a). Human-machine interaction: potential impact of nanotechnology on the design of neuroprosthetic devices aimed at restoring or augmenting human performance. In Roco, M. and Bainbridge, W., Editors. (2002). Converging technologies for improving human performance: nanotechnology, biotechnology, information technology and cognitive science. Arlington, VA: National Science Foundation and U.S. Department of Commerce, pp. 223-227 (citation on p. 223). Available in PDF format at www.wtec.org/ConvergingTechnologies/ (pagination is altered). 30 Cite 29, p. 224. 17