Prosthetic Ethics James J. Hughes Ph.D. Executive Director, Institute for Ethics and Emerging Technologies Public Policy Studies, Trinity College, Hartford CT Committee on Ethical and Societal Issues in National Security Applications of Emerging Technologies November 2-3, 2011 Beckman Center, National Academy of Sciences Irvine, CA

Non-Problems & Old Problems Some ethical issues are false problems, at least from an Enlightenment POV Others are old problems, like ensuring safety and access A few are novel because of the efficacy of neuroprosthetics Institute for Ethics and Emerging Technologies 2011

Non-Problems Supersoldiers Sports enhancement Disappearing disabled cultures Authenticity Institute for Ethics and Emerging Technologies 2011

SuperSoldiers Ethics of military force, or of military applications Do prosthetics change likelihood of exploiting soldiers as guinea pigs or in the field ability to exercise judgment in field, reduce collateral damage (drones) likelihood of engaging in conflicts Institute for Ethics and Emerging Technologies 2011

Sports Enhancement Oscar Pistorius Sports is a rule- governed game If athletes with prosthetics want to compete they can start their own leagues Not relevant to society Institute for Ethics and Emerging Technologies 2011

Disappearing Disabilities 99% of disabled happy to give up their disabilities Only children forced to use Last century: dramatic decline in veteran and civilian amputees 1000 amputees from Iraq/Afghan vets surgeons in Civil War, 60,000+ amputees Changes cost-benefit analysis for social priority-setting (Loeb) Difficulty in commercializing the direct neural control prosthethics developed by DARPA or others Institute for Ethics and Emerging Technologies 2011

“Authenticity” Not human, not me But Body image is malleable Prosthetics easily incorporated, even made a valued aesthetic feature Institute for Ethics and Emerging Technologies 2011

Aestheticizing Prosthetics Aimee Mullins Institute for Ethics and Emerging Technologies 2011 Smartphone dock installed in prosthetic

Anyway We Are All Cyborgs Since literacy we have become dependent on brain prosthetics on paper Shoes, clothing, tools The idea of prosthetic enhancement is ancient: Icarus Central to the Enlightenment project Institute for Ethics and Emerging Technologies 2011

Old Problems Safety of devices Moving line between disability/normal/enhanced Unequal access Ownership & intellectual property Privacy & cybersecurity Institute for Ethics and Emerging Technologies 2011

Safety Federal Food, Drug, and Cosmetic Act covers all implants and other devices "intended to affect the structure or any function of the body of man or other animals“ But FDA’s 510k (similar to prior approval) loophole Center for Devices and Radiological Health underfunded to handle scope and pace of innovation Authority inadequate to gather clinical trial information or compel reporting of post-approval adverse events Institute for Ethics and Emerging Technologies 2011 Are military IRBs’ reviews adequate to protect soldiers from experimental technologies

Defining Disabled/Enhanced When Medicare changed its definition for coverable cochlear implants from deafness to severe hearing loss it expanded coverage for millions of seniors 25 million people in the U.S. have hearing loss Of those, 2.4 million have severe to profound deafness 25% of those aged 65 to 74 have hearing impairments 40% over age 75 have hearing impairments Institute for Ethics and Emerging Technologies 2011

Superhuman Abilities Tuneable cochlear and visual nerve implants, or prosthetics with greater than human strength Turning point: when people want to replace limb, eyes or organs with prosthetics Institute for Ethics and Emerging Technologies 2011

Unequal Access In every other industrialized country the debate is what should be in or out of the plan Here it is up to 1500 private and 60 or so public insurance plans Critical: Speed of innovation of cheap versions Institute for Ethics and Emerging Technologies 2011

Ownership & Property Devices given to wounded warriors that have restricted civilian uses (akin to allowing them to take home weapons) Repossession of a device for lack of payment (RepoMen) Restricted travel to countries that are on a proscribed export list Violating IP by allowing someone to examine, sharing details about device Institute for Ethics and Emerging Technologies 2011

Privacy and Cybersecurity Already issue with mobile technology and RFID Privacy of biometric information - controversy in 2002 over the VeriChip patient ID and tracking system Implanted medical records, e- cash, telecom Wireless hacking of prosthetics (Jay Radcliffe: insulin pump hacking) Self-hacking to control drug administration Required registration of high- power prosthetics Institute for Ethics and Emerging Technologies 2011 National security secrecy and corporate IP inhibit open source innovation, translation to application See: 2005 EU Report “Ethical Aspects of ICT Implants in the Human Body”

Newer Problems Timing of implants and upgradeability Brain-machine interfaces Structural unemployment Remote behavior control Mood control Blurred culpability Institute for Ethics and Emerging Technologies 2011

Timing of Implants Accelerating pace of innovation Especially rapid advances in biocompatible materials Cochlear implants Critical language window Destruction of cochlear tissue Institute for Ethics and Emerging Technologies 2011

Artificial Pancreas Diabetes growing rapidly Realtime blood sugar monitoring Automated release of insulin Implanted

Brain-Machine Interfaces Prosthetic bodies & human brains (Robocop) versus robot brains in human bodies (Terminator) All neural prosthetic research from peripheral nerves to cerebral on the Kurzweilian trajectory to nanoneural BCIs Institute for Ethics and Emerging Technologies 2011

Nathan Kline and Manfred Clynes “Cyborgs and Space,” Astronautics, Sept. Monitoring and controlling the body/brain of the astronaut from ground control

Institute for Ethics and Emerging Technologies 2011 Implants for Depression & OCD Depression Obsessive-compulsive disorder

Institute for Ethics and Emerging Technologies 2011 Brain-Computer Interfaces

Institute for Ethics and Emerging Technologies 2011 NanoNeural Network Self-replicating Two-way communication with trillions of neurons Networked inside and out Perfect virtual reality, mind back-up, upload

Structural Unemployment Prior cases: literate/numerate workers smartphones Competing not only against automation and globalization, but also against brain-machine enhanced workers (vets?) AugCog Institute for Ethics and Emerging Technologies 2011

Autonomy & Addiction Remote behavior control of criminals, soldiers, astronauts Wireheading: mood control Blurred culpability: developer, software, user Institute for Ethics and Emerging Technologies 2011

For more information Institute for Ethics and Emerging Technologies ieet.org Me: These slides: