OPINION

The question of ethics | Donald Bruce

Nanotechnologies offer great promise for medicine,

although much of it is still a long way off. But even

at this early stage, the recent experience of

genetically modified (GM) food and the ongoing

debate over stem cells is focusing attention on the

question of ethics. The scientific community is

aware that it is dealing with a more skeptical public

than a generation ago. Therefore, when the

European Commission’s European Network of

Excellence on nanobiotechnology, Nano2Life, was

formed, a board was set up to ensure that the

ethical, social, and legal implications keep pace with

emerging scientific developments. This article is

drawn from some of its initial work1. Focused ethical

programs like NanoBioRAISE2 are also starting up.

We can forget gray goo, but already there are signs

that some challenging ethical issues could be raised.

Some touch on issues familiar in bioethics. Some are

more particular. But before considering these, some

basic contextual questions should be considered.

What drivesnanotechnology? One problem is that the gap between research and

rhetoric makes nanotechnologies vulnerable to

exaggerated claims, both about potential benefits

and potential harms. The use of the word ‘will’ about

unknowable future outcomes expresses an ‘article of

faith’ about science, generating a false impression of

inevitability. Equally, there is a need to be careful

about placing premature weight on speculative

concerns about nanotechnologies raised ahead of

evidence. Beware of false prophets, either way.

Secondly, it is a common misconception that

technology is neutral. On the contrary, a technology

reflects the values and goals of the society within

which it emerges and, in turn, it may alter the values

and aspirations of that society. In the somewhat

skeptical climate of public opinion, more sensitive

areas of technology might be seen as a social

contract3. A technology would be welcomed if the

values and goals of the inventor are close to those

of the wider society, and if the invention correctly

anticipates what society wishes (as with the cell

phone, for example). On the other hand, if the

inventor is remote, if the aims do not correlate with

the values and goals of the society, or if the

invention is unfamiliar or risky, there can be a

disjunction (for example, the importing of unlabeled

GM soya and maize products into the UK).

Whose values will nanomedicine express? Are its

novel ideas a product of widely shared values, or

only of a powerful elite? Here

are some values, ideologies,

and beliefs that may influence

or drive nanomedicine:

• Free, curiosity-driven

research;

• Economic growth, jobs, and

competitiveness;

• Quality of life (variously

defined, e.g. personal

affluence, consumer choice,

environmental goals, social

justice, global health and poverty, spiritual goals);

• Compassion (motivated by the desire to alleviate

human suffering);

• Medical ‘success’ (seeking a technical solution to

any condition, as an obligation);

• Different religious belief systems;

• Transhumanism (driving human evolution by

physically changing humans).

Two critical areas about which such world views

make implicit or explicit assumptions are the notion

of progress and the concept of the human being.

In nanomedicine, what dowe mean by progress? A common view in scientific and political circles is a

belief in ‘progress’ through technology to improve

the human condition in its widest sense. This belief

is confident of human skill and ingenuity to

overcome any problem. The current dominant

economic model frames nanotechnologies in terms

of their capacity for wealth generation. But another

widely held view sees intervention explicitly

balanced by care for our fellow human beings and

attention to the impacts of our innovations on the

environment. Interventions are made that respect

certain limits defined by the human condition and

our finite environment.

Technology is not the sole

engine of progress but a tool

that remains at the service of

humanity, not vice versa.

Lastly, there are those for

whom progress is entirely

personal and not for the state

to dictate.

At this stage, nanomedicine is

driven by a ‘technology push’,

which has a social dimension.

Functions and properties, which can be measured or

manipulated, tend to steer the applications that are

promoted. It is argued that laboratory prototypes

already coproduce ethics with the artifact4. So there

may already be implicit ethics in practice in the

research community. What are the needs that

nanobiotechnology is assumed to meet? Who

should define these as needs, or judge if the expense

of research is better spent on other objectives? This

is especially relevant to high-tech medicine in the

global context of health needs that often require

simpler solutions. How can such judgements be

FEBRUARY 2006 | VOLUME 1 | NUMBER 16

Donald Bruce | Society, Religion and Technology Project, Church of Scotland, UK |

srtp@srtp.org.uk

Mapping the uncharted ethical and social topographyof nanotechnologies is posing many questions forscientists, clinicians, and the public to debate

Use of the word ‘will’about unknowablefuture outcomesexpresses an ‘articleof faith’ aboutscience, generatinga false impression ofinevitability

OPINION

made democratically accountable at a meaningful

stage of development? Forecasting very uncertain

technologies is notoriously difficult, and bears the

risk that early public engagement may promote

either public assurance or public panic over the

wrong issues.

Nanomedicine and thenature of the human beingMany conceptual models of the human being exist.

Depending on the context, we might be a bag of

genes, a conscious mind, a spiritual and bodily being,

a set of capacities restrained by natural form, and so

on. The convergence of nanotechnologies with info-,

bio-, and cognitive technologies provokes a possible

conflict between holistic and functional views, and

between what is considered fixed and what is

changeable. Traditional presuppositions hold that

there are moral or societal bounds that restrain

what may be technically feasible in intervening in

the human condition. These limits are drawn from

insights into our religious and cultural traditions,

philosophy and theology, the arts and humanities,

and the social sciences. These

are challenged by the

transhumanist belief that

humans are destined to go

beyond current limitations. Is

nanomedicine to make humans

better, or should we use it to

make ‘better’ humans, by

manipulating our capacities

beyond medical conditions?

While one leading US report was enthusiastic at the

prospect, a European group of experts has urged the

submission of enhancement goals to wider social

scrutiny if humanity is not to be redefined by a

‘techno-logic’, driven primarily by technical and

economic feasibility5,6. So where do we draw the line

to limit some technological possibilities or promote

others? The notion of functional enhancements begs

a question. Do we know what is an enhancement,

both amid the complexity and interdependences of

the human body, and the social and cultural

variability? Notions of ‘improvement’ are likely to

be socially divisive, with benefits for a wealthy few,

and carry the attendant danger of notions of ideal or

master humans that stigmatize the disabled or

anything that is now perceived as defective. To me,

this discourse misses the point about our humanity.

Beyond a certain basic point of physical survival and

necessity, what matters most to humans are not

functional and material things but the relational,

aesthetic, and creative. Our deepest problems reside

less in physical limitations than our moral, relational,

or spiritual failings.

Nonmedical contexts Procedures developed in an acceptable medical

context may pose ethical questions if applied

nonmedically. For example, nanotechnology may

assist the repair of sensory organs or provide

intimate control from the brain to prosthetic limbs

for accident victims or the disabled. Should these

devices be adapted to extend sight into the infrared

for better night vision when driving or to make the

able-bodied super-able? Should cell repair nano-

interventions seek to extend

human life span?

A useful distinction exists

between medical and

nonmedical interventions in

the human person. The

European Convention for

Human Rights and

Biomedicine, for example,

opposes sex selection for social

reasons but allows it to avoid serious sex-related

hereditary diseases. A related issue concerns

surveillance and military uses. Nanotechnology

devices implanted in the body to monitor and adjust

blood sugar levels in diabetics are more

problematical if used for the surveillance of citizens

or military applications. Inevitably, there are gray

areas, but mechanisms are needed to identify

potential crossovers at an early stage and to ensure

that nanotechnologies devised in a strict medical

context are not applied to nonmedical contexts

without restriction.

Special issues aboutnanomedicine The ability to monitor and intervene at a cellular or

molecular level may fall foul of the complexity of

the system. Nanomedicine may enable rapid

readouts of our whole genome or of our body’s

levels of everything imaginable, but what does all

that information mean? What is a ‘well’ person

when we have so much unsuspected data about our

bodies? This raises familiar issues about genetic

information, who accesses it, and how it is handled.

Lab-on-a-chip analysis may mean that my routine

visit to the doctor as a result of a cough may also

tell me that I have a susceptibility to colon cancer

with little prospect of cure. Knowing all the

information that nanomedicine could provide is not

necessarily a good thing.

The powerful targeted therapeutic possibilities for

nanomedicine can also create the potential for

powerful harm, if the precision becomes wrongly

applied or if it has more than just the desired effect.

Bottom-up construction from the molecular level,

based either on mimicking biology or on

incorporating components from living systems,

raises issues about hybrid devices that interface

human and machine, and also about priorities.

What should we choose to build? A building-block

mentality should not assume the right to tinker

around at this reduced level. We cannot know how

the changed pieces fit together if we lose sight of

the whole human. Health risks arise in the use of

nanoparticles in biological systems. How

precautionary should we be over uncertain risks that

may take a long time to assess?

This brief survey has mapped some of the ethical

and social topography of the uncharted lands that

nanotechnologies may offer to medicine, and posed

many questions for debate. How, as societies, we

seek answers as these technologies emerge will be

of crucial importance. Scientists and clinicians in

nanomedicine owe it to themselves and to the wider

society to reflect on them, so that the right benefits

may be achieved with justice, while retaining our

humanity in all its rich diversity.

FEBRUARY 2006 | VOLUME 1 | NUMBER 1 7

Early publicengagement maypromote eitherpublic assurance orpublic panic over thewrong issues

REFERENCES

1. Bruce, D. M., Nano2Life Ethics: A Scoping Paper on Ethical and Social Issues in

Nanobiotechnologies. In Nano-Bio-Ethics: Ethical Dimensions of Nano-

biotechnology, Ach, J. S., and Siep, L., (eds.), Lit Verlag, Münster, Germany (2006)

2. NanoBioRAISE – Nanobiotechnology: Responsible Action on Issues in Society and

Ethics, a Co-ordination Action in the Science and Society category of the

European Commission’s Sixth Framework Programme, FP6

3. Bruce, D. M., J. Agric. Environ. Ethics (2002) 15, 279

4. Rip, A., Second Order Ethics, A note to Nano2Life Ethics Board, 2 September 2004

5. Roco, M. C., and Bainbridge, W. S., (eds.) Converging Technologies for Improving

Human Performances, US National Science Foundation report, (2002)

6. Nordmann, A., (ed.) Converging Technologies and the Natural, Social and

Cultural World, report of a European Commission expert group, (2004)