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Current Issues: The Ethics of Using Cybernetics and Cyborg Technologies: What Every Rehabilitation Nurse Should Know
Prosthetics and implantable devices are commonplace for rehabilitation practice. Rehabilitation nurses routinely provide care for clients who experience enhanced quality of life because of biotechnological advances. Pacemakers and prosthetic joint replacements are two of the many types of biotechnological developments that enable individuals to participate in everyday activities. These technologies assist individuals with physical limitations and promote a sense of normalcy in their lives—a vital goal for most individuals living with chronic conditions and disabilities (Asbring & Narvanen, 2002; Strauss et al., 1984).
One of the lesser-known areas within the biotechnology field is cybernetics (Hook, 2002). Cybernetics refers to a scientific field of study in which the “combining of computer technology with the neurological capacities of the human brain and nervous system” is studied (Simmons, 2001, p. 404). The term cyborg has emerged from cybernetics literature and literally refers to the merging of humans with technological devices. Although cyborg conjures images of science fiction creations from Hollywood, most of us actually are cyborgs to some degree. The use of contact lenses, eyeglasses, hearing aids, or dentures represents technological augmentation of human functioning. As cyborg technologies increase in number and sophistication, rehabilitation nurses will provide care more frequently to individuals with more serious physical limitations whose human functioning is merged with and dependent upon technological advancements.
Despite their promise in promoting human functioning, cybernetics and cyborg technologies are raising many questions regarding the ethical implications of some of these new and proposed developments. Because rehabilitation nurses work daily with individuals whose lives are affected by such technological advances, understanding the ethical concerns that arise from these technologies is important. This article provides a brief historical perspective on cybernetics, cyborg technologies, and cutting-edge developments; addresses several ethical concerns regarding emerging technologies; and discusses implications for rehabilitation nurses.
Historical Perspective and Discoveries
The term cybernetics was coined in 1948 by Norbert Weiner, a professor of mathematics who published a book that focused on this new branch of science he had founded. Weiner believed that machines and living organisms could be combined to create a superior creature. In 1960, Manfred Clynes and Nathan Kline, two scientists working for the U.S. National Aeronautics and Space Administration [NASA], extended Weiner’s ideas in an article, “Cyborgs and Space.” In it, they described a human being who is technologically complemented by external or internal devices as a cyborg or cybernetic organism. In other words, a cyborg constitutes both machine and human systems (Manoj & Azariah, 2001).
Over the past century, cyborg technologies have advanced rapidly. As early as the 1900s, bone plates were used to stabilize bone fractures and to accelerate the healing process. Artificial replacements for blood vessels, hip joints, and heart valves first were used in the 1950s and 1960s (Blanchard, 2000). During the 1970s and 1980s, significant progress in bionics engineering, along with the discovery of electrical signals in nerve impulses, made it possible to introduce motor-controlled body parts that served as prosthetics. This combination was called a myoelectric process. Through this process, amputees could subtly move a body part to create an electric pulse that, in turn, caused a prosthetic device to create full body movements (Manoj & Azariah).
Current work in cybernetics may offer hope for patients with paralysis, vision loss, and other physical limitations. Although there remains no cure for paralysis, the merging of brain-computer interfaces with neuroprosthetics could provide some individuals with the means to a more normal life. Researchers at Case Western Reserve University in Cleveland, OH, are working on a “thought translation” system that uses brain waves to move paralyzed limbs (Chase, 2000). Other research to restore vision currently is underway. For example, microelectronic retinal implants designed to replace a defect or missing link in the visual pathway are being developed to help people with degenerative diseases of the retina (Peachey & Chow, 1999). Still other work is even more ambitious; researchers from the University of Southern California are attempting to build a computer chip that will reestablish cognitive abilities. This technology could be used to restore lost memory in individuals suffering from the effects of Alzheimer’s disease or stroke (Huang, 2003). Although these new advances may hold promise for individuals with disabilities and chronic conditions, ethical issues inherent in many of these developments must be considered.
Several ethical concerns have arisen with regard to general biotechnological advancements, while other concerns are being leveled specifically at cybernetics and cyborg developments. One overriding concern voiced by some ethicists centers on the shift in society’s cultural climate toward biotechnology. Callahan, a leading ethicist, suggests that times have changed how society views biotechnology (2001). During the 1960s and 1970s, there was a strong antitechnology sentiment. In intellectual circles of that time, a wariness of science and technology was considered quite appropriate. Much of this sentiment most likely stemmed from a general societal skepticism that emerged during this tumultous time in world history. In addition, some criticism of technology may have been the direct result of the horrific experiments done in the name of advancing science and technology that were uncovered during the Nuremburg trial of Nazi war criminals. These events left such a mark on history that well into the 1990s, many Germans remained skeptical of advancements in technology (Callahan, 2001).
By contrast, Callahan suggests that questioning of technology is generally considered unacceptable in the United States today. Technological innovations encounter very little intellectual resistance and as a result, a carte blanche acceptance of biotechnology often occurs. Such recent successes in biotechnology as the mapping of the human genome may have accelerated this societal acceptance, particularly as scientists suggest that cures for such devastating illnesses as Parkinson’s disease and Alzheimer’s disease are within reach. Callahan emphasizes that there is no “more powerful antidote” to skepticism than such claims of possible clinical and scientific benefits; however, he warns that the “new romance with technology...and the obsession with scientific progress generally...are nothing to be proud of” (Callahan, p. 570). Similarly, Sas states, “while technology can be attractive, its long-term effects can be hidden by its initial benefits. Its charms need to be scrutinized...” (2002, p. 83). Such comments highlight a concern that though many biotechnological advancements are appropriate and beneficial, society must not assume automatically that all biotechnological developments will be beneficial. Instead, scrutiny of all such advancements must occur, and the ethical implications of such new developments must be considered carefully.
Another ethical concern is the timing of biotechnological developments in relation to ethical discussions. Technological developments often precede discussion regarding their ethical implications. Consequently, full consideration of ethical principles, such as beneficence, nonmaleficence, and autonomy, may not occur. For example, although the Jarvik-7 artificial heart functioned well as a machine, it created life-threatening problems, such as severe neurological complications; Barney Clark, its first recipient, fell into a coma because of this complication. Because Mr. Clark’s healthcare providers were unprepared for an outcome in which the recipient was unable to make an autonomous decision and communicate his wishes, decisions about continued use of the artificial heart had to be determined by others. During the development of the artificial heart, the potential human outcomes and the ethical issues embedded in these outcomes had not been explored fully (Simmons, 2001).
Most ethicists today believe that, to the greatest degree possible, all outcomes and the ethical issues inherent in those outcomes must be considered carefully before the development and use of technology (Pellegrino, 2003). Kilner, Hook, and Uustal (2002) suggest that rather than be surprised by the effects of new technologies and performing ethical analyses after the fact, ethicists must prospectively examine emerging technologies and propose and implement safeguards before those technologies are put into use. Such an ethical analysis is especially important in light of what it called the technological imperative—a belief held by many in the scientific community that once a technology has been created, it must be used (Grabowski, 1998).
Claims of the clinical benefits of technology may be difficult for healthcare team members to ignore, especially when conventional therapies are lacking. In their efforts to achieve positive client outcomes, healthcare providers may feel compelled to consider new technology even though its long-term benefits and drawbacks are not yet completely clear. This compulsion is especially evident in the fertility field, where healthcare providers increasingly have used cutting-edge technology without giving due consideration to the host of ethical questions such technology raises.
Discrimination, an issue that centers on the ethical principle of distributive justice, may evolve with new biotechnological developments and is another concern cited by many ethicists. New devices generally are expensive, introduced only at research centers, and receive limited or no insurance coverage. For example, newly developed prosthetic legs that are controlled by embedded microchips paired with sophisticated sensors permit very active amputees to participate in sports and other extreme physical challenges. Artificial arms and hands equipped with such microchips also are being developed to make fine manipulation possible. Unfortunately, such new developments, which are being implemented at such medical centers as those affiliated with Duke University and Oregon State University, come with price tags ranging from $20,000 to $40,000 (Ratliff, 2001). These factors highlight the fact that when new technologies are introduced, individuals with the greatest financial means rather than those with the greatest need may receive their benefits.
A final ethical concern that arises from cybernetic and cyborg technologies stems from the differing philosophical worldviews regarding what it means to be human. Many proponents of cybernetics and cyborg technologies subscribe to transhumanism philosophy. According to this view, humans will someday be reengineered to such an extent that a posthuman species will emerge. This species will be superior to homo sapiens. Transhumanists view being human, biological creatures as a temporary state or stepping stone to the emergence of a more superior being (Hook, 2004). One strong proponent of transhumanism is Kevin Warwick, a professor from the University of Reading in England, who exemplifies this philosophical perspective: “I was born human. But this was an accident of fate, a condition merely of time and place. I believe it’s something we have the power to change” (2000, p. 145). Scientists who agree with the transhumanist worldview see cybernetic technologies and cyborg developments as one means by which humans may change from biological creatures into a posthuman species. Therefore, scholars holding this worldview believe cybernetic and cyborg endeavors should proceed unfettered by ethical concerns.
Scholars harboring different philosophical views are more guarded in their acceptance of cybernetics and cyborg technologies. Simmons notes, “We now rely on bioengineered parts for breathing, cardiovascular, and renal functions, and substitute joints and extremities. The great irony is that technology is also changing our humanity. People are becoming more cyborg-like, more dependent upon their extensions and less able to live as self-contained beings” (2001, p. 405). Simmons suggests that the 21st century will see an increasingly blurred boundary between the artificial and the natural.
Ethicists and scientists specifically grounded in the Judeo-Christian perspective hold a foundational belief that humans are created in the image of God. According to this view, humans should not seek to become more perfect creations by their own invention. These ethicists voice concerns that cybernetics and cyborg technologies may be used to enhance persons, making them more “perfect” or superhuman (Hook, 2004). While ethicists and scholars holding this worldview generally applaud cyborg technologies that assist persons with disabilities or physical limitations to function at normal levels, new and proposed technologies that have the potential to enable functioning at a superhuman level generally are rejected (Hook, 2002, 2004; Pellegrino, 2003). These scholars caution all members of society to scrutinize new cybernetic and cyborg technologies carefully.
The aforementioned ethical concerns have significant implications for rehabilitation nurses. Rehabilitation nurses must recognize that most of the clients for whom they provide care are acculturated not to question scientific advancements. As a result, clients may fail to scrutinize biotechnological advances and the research that leads to those advances. Such blind acceptance by individuals with chronic conditions and disabilities, coupled with the vulnerability that often accompanies such conditions, may foster unquestioning participation in research protocols that offer only the potential for promising outcomes. In addition, clients may decide to have prosthetics or devices implanted simply because it increasingly is the commonplace thing to do.
As advocates, nurses must ensure that clients are fully informed about the risks and benefits of participating in biotechnological research and the risks and benefits of any device being considered for use. To advocate appropriately, nurses must have a working knowledge of current developments in the progressive field of biotechnology. Attending conferences and reading articles on biotechnology and sharing this information with colleagues should help nurses stay up-to-date.
More work must be done to ensure that ethical issues, such as those that occurred with the Jarvik-7 artificial heart, are considered before technological development. Rehabilitation nurses may contribute to this endeavor when they are asked to participate in protocols designed to develop new devices and aids. When approached by biotechnology researchers, nurses should question whether and what ethical considerations were explored before the development of the technology being tested in the current research protocol.
Nurses should ask questions regarding the proposal review process. Today, research conducted in healthcare institutions must receive institutional review board (IRB) approval before implementation of the research protocols. Embedded in the IRB review process is a careful scrutiny of the ethical issues related to the proposed research. After IRB approval has been granted, nurses can be somewhat reassured that an objective body has reviewed and supported the ethical nature of the project. Unfortunately, IRBs may not be established in some smaller clinics or agencies that offer rehabilitation services. In such settings, rehabilitation nurses must be cautious regarding participation in research protocols. If no review process is established currently for objectively evaluating research proposals, nurses should collaborate with colleagues to develop a review process in which the ethical issues of proposed research is considered.
Rehabilitation nurses must recognize that new prosthetics that may closely replicate the complex functions of a healthy limb carry a hefty price tag and may only be available to individuals with the greatest financial resources, rather than to those with the greatest need. Rehabilitation nurses can help to overcome such injustices by identifying potential community resources that may assist individuals who are less financially privileged. Such assistance may come in the form of financial support to those in need, or the devices may be purchased and then donated to those individuals.
Finally, many ethicists pose philosophical questions regarding biotechnology and its impact on humanity. Unfortunately, in our fast-paced world, few individuals spend time reflecting on personal beliefs, worldviews, and philosophical perspectives. For rehabilitation nurses who are exposed daily to the rapid technological developments in health care, understanding personal philosophical views is imperative.
For nurses beginning a philosophical journey, pondering several foundational questions may prove helpful. These philosophical questions may include the following (Moreland & Craig, 2003; Rae, 2003; Sire, 1997):
Considering these questions may assist nurses in understanding their beliefs regarding the meaning of life and the role of humanity. Such reflections also may help nurses to formulate views regarding the impact of biotechnological advances on humanity. In addition, philosophical reflections may guide nurses to construct personal views regarding whether limits should be placed on these advances.
Determining philosophical beliefs is especially important today, when many scientific developments, including cybernetics and cyborg technologies, are pushing beyond the traditional limits of science. Nurses should determine for themselves whether it is appropriate for such technologies to be developed simply because we have the ability to do so. Rehabilitation nurses, as well as other members of the healthcare team, should consider the more global philosophical issues raised by many new technologies. Not only should short-term effects of these new technologies on individuals be considered, but perhaps more importantly, the long-term effects of these technologies on all of humanity should be questioned.
Philosophical reflection can help nurses to crystallize their own views on the ethical nature of particular biotechnological research projects. Careful evaluation of personal philosophical views may provide a foundation upon which nurses can base their decisions whether to be involved in certain research protocols.
Cybernetics and cyborg technologies are rapidly developing in the field of biotechnology. Such developments have yielded a wide variety of devices and prosthetics that have promoted the quality of life for many individuals with physical limitations and generally have been applauded by society and the rehabilitation field. However, such rapid developments have given rise to multiple ethical concerns. Understanding these ethical concerns and the implications they have for rehabilitation nurses is imperative. While the potential benefits of advances in technology are great for those with disabilities and chronic conditions, ethicists suggest that skepticism must be balanced with the zeal that often accompanies cutting-edge developments. As Hook notes, “We must show not a fear of technology, but a courageous control of technology, and refuse to let technology control us” (2002, p. 67).
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Linda Weaver Moore and Linda S. Rieg are associate professors at Xavier University in Cincinnati, OH. Address correspondence to Linda Weaver Moore, Xavier University, 3800 Victory Parkway, Cincinnati, OH 45207-7351.