The Ethics of Doctors, Cyborgs and Amputations

When we go to the doctor we want to them to treat a persistent cough, or our earache, or our trouble with low energy levels, or even something more sinister. Imagine you were the doctor treating such patients—it seems fairly obvious that you should make no objection. What grounds could you possibly have for making a moral objection to treating a patient with an ear infection? What if a patient presented though that wanted to have an ‘antenna’ implanted into their skull, or to be cryogenically frozen? These might seem like things that we expect would only happen in the latest blockbuster sci-fi. What if too a patient presented that wanted to have a healthy limb amputated? This sounds like something out of one of the perverted Saw franchise films. However, technology has advanced far enough that these are real scenarios that some doctors must navigate. In contemporary times, medical practice is not merely about treating the common cold or resetting a broken leg, but a role that requires its practitioners to negotiate morally challenging questions. So just what is happening at the forefront of medical treatment? And are medical treatment and morality coming apart there?
 

For quite some time there have been discussions—often debates—about the moral permissibility of using certain medical technologies. At the heart of the deliberation is the question, ‘Because we have this technology available to us, does that mean we should use it?’ When we ask ourselves that question we recognise that medical treatment is not simply limited by technological considerations but moral ones too. Abortion and the use of euthanasia are two very well known examples. We have the technology to abort a foetus with a relatively low physical risk to the mother’s life, as we also have the technology to manage a patient’s death so that it is comfortable and dignified. But having these technologies does not necessarily mean we should use them—because the question of the moral permissibility of doing so must first be settled.
 

Most people, medical or not, seem to have some sort of ‘gut-feeling’ about whether, they think, people should be allowed to have an abortion or, separately, to be euthanised. The difficulty, and divisiveness, of such considerations is evident in the vastly different laws of nations and states across the world with respect to these two medical procedures. What is common to a discussion about abortion and euthanasia is the consideration of how to understand life and death—when is a foetus, for example, considered to be a living person in its own right? And does being a living person entail the right to end one’s life voluntarily, as with euthanasia? However, technological advancements are pushing medical practice beyond the realm of treatment, that is, beyond the realm of life and death.

There are now medical technologies available that are fundamentally intended for human enhancement. Also, there are existing technologies being used in new ways to enable patients to embody their felt identity. People surgically attaching ‘antennae’, people amputating healthy limbs and people opting to be cryogenically preserved for indefinite amounts of time—because we have these technologies available to us, does that mean we should use them? It is a complex question to answer for many of these medical procedures but let's look briefly at two cases.
 

Neil Harbisson describes himself as a ‘cyborg’ because of the antennae he had surgically attached to his skull over a decade ago. He claims that the antenna is intended to allow him to “hear” a wider spectrum of colours because he is naturally colourblind. The antenna works by converting light in the visible and non-visible spectrum, such as ultraviolet and infrared light, into vibrations that he receives as sound waves in his skull. The antenna also has an Internet connection through which Harbisson allows a select number of people to ‘send’ him colours. Indeed this is radical surgery. So much that a bio-ethics committee in Spain rejected his application to proceed with it—he eventually had it surgically attached by an anonymous surgeon. What constitutes the opposition to such surgery though? There are obviously security concerns with respect to the way Harbisson utilises his ‘in-built’ internet connection. For example if he were sitting the UMAT® Exam, how could we be sure he wouldn’t utilise his Internet connection to help answer the questions? Or to even communicate with someone else who could give him the answers? There are also concerns with how others might make unsolicited connections to the antenna though—you could imagine it would be highly disturbing if a hacker connected to the antenna and was able to make it vibrate constantly. I guess it would be like having tinnitus, but of the antenna rather than of the ear!

There are deeper issues too though that relate specifically to the enhancement of human persons. So much of our systems of law, morality and politics rely on a particular idea of what a human person is—and what rights they are so afforded—so when a human person acquires the ability to connect to the Internet directly through their body then does this fundamentally change their status as a human person? What can we say of their native intelligence if they have all of the information of the Internet, potentially, available to them? The actual antenna Harbisson has installed may not be as powerful as these questions suggest but the fundamental issue is the same: when is a human person no longer a human person but a cyborg? And are our social institutions capable of managing cyborgs and human persons in a meaningfully just way?
 

The Harbisson case highlights a key element of the balance between medical treatment and morality because he considers the antennae as part of himself—evident in his specific identification as a cyborg. Indeed, identity is a reason many people have surgery. Most elective surgery is, by its very nature, an expression of identity; having a ‘nose job’, getting breast implants, having liposuction, an injection of Botox in the brow, and collagen in the lips all relate to one’s understanding and expression of their own identity. In a sense they are more advanced expressions of identity then getting a tattoo or dyeing one’s hair a particular colour. So then is it the same for when a patient presents that says they do not identify with one of their healthy limbs and want to have it amputated? When I first heard about two such surgeries performed by Dr Robert Smith in Scotland I was pretty appalled. The shock though was mostly born from the fact I had never heard of anyone who felt disenfranchised with their healthy leg, so much that they’d want to amputate it. As a doctor, is there anything morally wrong with doing this for a patient who says that they want it?
 

The first objection one is likely to have regarding the patient’s well-being is their mental capacity to make such a decision. It is such a radical surgery to want to have that it would be negligible not to question the motive for having such a surgery. There are some who object to the permissibility of the surgery on the grounds that the patient would then become a liability for the public health system—it seems like a fairly insubstantial objection when we consider that there are very few people who would actually elect to have the surgery even were it widely available. The most pressing concern seems to be the irreversibility of the surgery: if you agree to amputate my leg for me because I don’t like want it today, then you can’t simply attach it again when I return to your practice tomorrow asking for it back! Given the impossibility of determining the likelihood of the patient regretting their decision it is very difficult to determine whether proceeding with the surgery is, after all, in the interest of the patient’s well-being—which is what the doctor is there to do.
 

So advancements in technology are reshaping the way medicine is practiced: doctors are no longer practitioners who can only do good but are increasingly required to make morally challenging decisions about their practice. No longer either are these matters of life and death but they are matters of human enhancement and identity that interact with our understanding of what a human person is. Thankfully, as you prepare for the UCAT, you can feel safe in knowing that in the years of study ahead you will be prepared to face the challenges of being a modern doctor—and if you do not want to amputate healthy limbs or attach antennae to people’s skulls, well there will be plenty of people needing treatment and surgery to save their life rather than their identity!