Using Technology to Deepen Democracy, Using Democracy to Ensure Technology Benefits Us All

Thursday, September 23, 2004

Enhancement Medicine and Social Questions

Who Benefits When? Medical Enhancement and the Question of Fairness

We confront the prospect of the near-term arrival of medical techniques that could modify definitive physical and cognitive capacities, radically alter the norms of functional morphology, and extend at least some people’s lives well beyond the bounds even the luckiest among us have enjoyed till now. It is a moment of profound quandary and hopefulness. I share some of the concerns registered in this column written by the technoprogressive Annalee Newitz, that successful life-extension could put unsustainable strains on society, and that longevity for the rich but not the poor will likely exacerbate contemporary forms of unfairness. Newitz is a bit more pessimistic about these worries than I am -- and probably more realistic.

Newitz worries on the one hand that only the Bill Gates/Donald Trump-types of the world will afford enhancement medicine and, on the other hand, worries that enhanced humans in whatever numbers might burden the planet’s resources beyond its capacities. If there seems an initial whiff of paradox about a simultaneous concern that both too few and too many might enjoy enhancement sublimes away under scrutiny. Both the bastard bazillionairs argument and the unsustainability argument are variants of an appeal to fairness. In fact, they are complementary: one worries that benefits will be distributed unfairly, the other worries that costs/risks will be shouldered unfairly.

And because of her expectations about unfairness she can't endorse what she otherwise admits herself is awfully appealing. (I mean, if we actually agreed to deal fairly and seriously with the deep environmental and social problems that freight the prospects of longevity and enhancement medicine we would be talking about more life here, more health, and more choices for all –- what’s not to like?)

Now, to the extent that her worries might inspire Newitz to advocate a Bill Joy kind of relinquishment of longevity medicine and research I would have to strongly disapprove of that, inasmuch as any ban would likely simply displace research and development into unscrupulous and unregulated hands and so exacerbate the kinds of legitimate worries that would inspire the ban in the first place, all the while inevitably chilling less controversial kinds of medical research devoted to securing everybody normative health and lifespan as well. But I don’t really agree with Newitz’s detractors that she advocates anything like that. Honestly, I think she is just saying, sensibly enough -- don't let your fascination with superlative emerging technologies distract you from social repercussions that are unappealing.

I notice that despite her worries and reservations, Newitz pretty much suggests that if a longevity "pill" were available today she would be sorely tempted to take it. It’s hard not to sympathize with her. Honestly, in some ways her column seemed to me like an anticipatory spasm of liberal guilt at the fact that she would possibly undergo life extension despite her recognition that society as it is currently instituted would probably become less sustainable and less fair as a consequence.

Newitz writes: "Life is good, but only if everybody has equal access to it." It's a strong statement, but I concur with it. I think probably nothing short of inculcating this kind of norm will save a humanity flirting for the first time with radical prosthetic practices from itself.

Who Benefits When, Part Two: Trickle Down or Open Access?

One benefit of a limited initial participation in radical new technologies is that it has useful sequestration effects. Early adopters (whether they are particularly adventuresome or just happen to be able to afford high initial costs) serve as the lab rats in the high stakes world of technological development. If this initial select group suffers unexpected harm, at least it is confined in its effects. An early more general distribution of cutting-edge tech could shift a high-risk choice for which the appropriate standard is informed consent, into a potential existential risk for which very stringent applications of the precautionary principle might be appropriate instead. Early adopters aren't just beneficiaries, but often benefactors.

That said, I think the dilemmas of equality and diversity introduced by radical technological development are sometimes more complicated than a “trickle-down” sensibility allows for. Not all inequalities are created equal. Surely it is sensible to insist that modifications that confer strictly positional advantages that represent larger social costs should be discouraged, for example.

Part of the story of technological development looks like the accumulation of a toy-pile, and for this part of the story the rather reductive economic analyses of market-enthusiasts really do usually seem more or less adequate.

It certainly doesn't seem unduly burdensome to most Americans, for example, that rich people get to acquire better gadgets and gewgaws sooner than the rest of us. And it is true that these innocent inequalities tend to be an engine that gets better gadgets to more people as soon as may be (globalizing this tale makes it much more difficult to stay cheerful about its presumptions, but I'll just register that and not dwell on it for now).

Americans, for example, in general seem to have no problem with the fact that very talented or innovative people, or even randomly entertaining and lucky people sometimes live lavishly more pampered lives than the rest of us do. But most of us are considerably less content at the thought that the rich would have access to life-saving treatments that are not available to the less well-off, or that anybody should go hungry in the midst of our culture's great wealth. Market platitudes suddenly seem like anemic things indeed in the face of certain forms that inequality is prone to take in the world.

I suspect that confronted by the quandaries of radical technological development we will need both the hopeful and emancipatory sensibilties of progressives as well as the cautious, more respectful sensibilities of conservatives to help us through.

Technological development differentially distributes capacities to effect ends and this includes the capacity to exploit others. Over the longer term, there is a real worry that a sufficiently uneven distribution of longevity and morphological modification, or intelligence augmentation, or non-open-source access to nanotechnological powers, could re-write inequality in the image of a kind of pernicious speciation.

And one just needs to have a look how humans treat other species now to be reminded why such an outcome looks worrying. The proof is ubiquitous that the relatively more powerful are prone to abuse and exploit the relatively less powerful unless restrained by law, and this is cause enough to worry. Fears that "posthuman" radical modifications and augmentations would provoke especially catastrophic applications of this general tendency of course has no proof, because the pace and scope of modification we are talking about hasn't happened yet.

I say, let's regulate development to ensure better standards of safety, openness, and overview, to legitimate and fund encouraging avenues of development, and to police recklessness and abuse. This is a way to encourage development, not frustrate it. I say, let's be sure to distribute the risks, costs, and benefits fairly among all the stakeholders to development. This is a way to make development fairer, not to impose conformity or choke off innovation.

I Want More Life, Fucker! Enhancement and Upheaval

I agree with Newitz: I don't think the world can stably survive a state of affairs in which Bill Gates can cheerfully expect to live 300 years, while other millions expect to live to 30.

Contrary to some of our market libertarian technophiliacs, I don't think the word "envy" is big enough to encompass the stomach-knotting outrage such a prospect arouses in me.

I think that without an explicit and conspicuous commitment to fairness the distribution of radical medical benefits will exacerbate injustice and that this will in turn exacerbate dangerous social instabilities. Some market-fundamentalist types seem to consider these claims to somehow constitute a form of name-calling.

It's true, I also happen to consider the health, nutrition, and hygiene crises in much of the developing world right now to be an almost unspeakably obscene calamity, one already contributing to global terror and insecurity and an unconscionably stupid waste of human creative potential. Again, some liber-techians want to suggest that the public registration of ethical priorities like these with which they disagree amounts to some kind of hypocritical sanctimony and nothing more.

Market libertarian technophiles often seem to protest that any concern with questions of fairness is the squeal of envious losers for the earnings of worthy winners. They argue that the concern for fairness would clot the developmental flow of technology, so that none would enjoy its fruits. Fairness, they say, really means either everyone gets everything or nobody gets anything.

Of course, whenever one converses on the internet, I suppose, one risks this uncanny moment when everybody drops off the world’s edge into a comic book. Suddenly everybody has been clothed in flaming ideological drag on a bleak battlefield, libertopians arrayed against absolute egalitarians....

But, look, really, now, life-extension wouldn't be like other things. An unequal distribution of lifespan isn't like an unequal distribution of Jaguars vis-à-vis Saturns. Human lives aren't the same thing as cell-phones and laptops.

It's apparently easy for some to be suave in their contemplation of the prospect of being in the lucky minority that benefits early from an unfair distribution of life-extension treatments. But I hope my market-libertarian friends are really right when they imagine themselves snug exemplars of this Cyborg Elect. How especially brutal to find one doesn't make the cut after all, after dedicating oneself so devotedly and long to the proposition of a special life-worthiness in the moneyed elites!

You see, I just don't agree that only "envy" could explain the distaste with which some of us contemplate the proposed spectacle of rich people getting to live when less rich people don't. Too much about the acquisition and maintenance of wealth involves dumb luck and disavowed dependencies on the work of others for me to complacently accept as fair that poverty would (and does) impose on less lucky people the cost of avoidable illness or premature death. Red in tooth and claw may "nature" be, but civilization can do better than that.

Now, I notice that the very thought that a demand for fairness might slow the pace of development enough that its benefits might then elude them fills liber-techians with rage. But what if that demand for fairness has the consequence that a majority would receive these treatments quicker than the trickle-down beneficence of that feudal-aristocratic model? Why does their plebeian rage at exclusion appall the free-marketeers when their own does not? What's the difference? Lives are lives are lives.

Digression: Metaphors We Live (and Live and Live and Live) By

Part of the problem here, I think, is that people keep talking metaphorically about a "pill" that some but not others will be able to afford, and imaginging the effect of taking this pill will be the arrival of this new state called "longevity." To the already absurd oversimplications of exclusively market-oriented social analysis this adds two more layers of hopeless oversimplication to the way we are talking about these issues -- first, about the kind of interventions we're talking about and second, about the effect these interventions will produce.

Of course, instead of "a pill" what we will get will be roughly continuous with contemporary medicine, a vast messy proliferation of treatments for pathological conditions and kinds of damage, developing at different paces, the ultimate effects of individual treatments and their crazily complex interactions with one another unknowable for years upon years to come.

Second, instead of "anti-aging-ness" the effect of these interventions will simply be "health". Health, I expect, will be considerably more edifying than what passes for health these days, but health it will remain. For immortality and other comparable mystifications, good folks will continue to have to darken the doors of their local churches and poetry readings and brothels and bars just as they do at present.

As I have mentioned elsewhere, I think the word "aging" will largely be relegated to the status of a folk-term like the word "instinct" is now. The seven kinds of damage on which Cambridge biogerontologist Aubrey de Grey focuses his attention, for example, are conditions into which we might intervene to live healthy lives longer than has hitherto been possible or even imaginable. But who knows what new conditions and diseases may emerge in the aftermath of even the most resounding success for de Grey's SENS program of research? Death isn't a black be-robed skeleton with a scythe. It isn't a thing to vanquish with a pill.

Just like now there will be healthcare to provide through various therapeutic pathways to sprawling swarming diverse populations of worthy citizens, rich and poor. Healthcare inequity is already shaping up as a force for social instability and an inspiration for radical social reform. These issues are already globalizing in ways that are difficult to get a handle on. The kinds of medical breakthroughs radical techno-ethicians, technocultural critics, and progressive technology advocates speculate about are going to exacerbate this turmoil. Surely even liber-techians can grasp this as a practical possibility, however much it otherwise offends their sleekly calculating predatory sensibilties?

I Want More Life, Fucker! Enhancement and Upheaval, Continued

We are talking about entering the threshold era in which we develop for the first time medical techniques to enable greater-than-hitherto normative healthy lifespans and the enhancement of individual capacities. This will be an era with special problems and promises.

In the long term, to paraphrase Keynes, many who might otherwise live may be dead. Does anybody really expect people to complacently accept their lot on this issue as the mostly arbitrary prosperity sweepstakes has disposed of things? Even those who are satisfied (as certainly I am not) to pathologize as "envious" those who rankle at the unfairness of money buying, not just second cars or hot hookers, but literally years and years of healthy life, surely even they can see the sense of taking steps to ameliorate the social instability that will likely arise in such a developmental era?

I expect the Methuselah Mouse is going to be a mouse that roars.

I think the demand for access to more-than-normatively healthy-lifespan extending medicine is going to incubate a second occasion for genuinely revolutionary upheaval. I say this as one of those boring lefties who finds revolutions profoundly unappealing prospects: I strongly prefer versions of radical left politics involving nice matronly social workers with clipboards to the ones in which pumped up teenaged boys in revolutionary vanguards wave guns around.

All that aside, I honestly don't see any reason to accept the apparent premise of the market-firsters that an institutional concern with fairness would frustrate or slow development in the first place. Why wouldn't it incubate wider participation in experimental trials, enlist a wider investment in terms of time, lives, and resources, a wider quicker more flexible sharing of information, and hence accelerate development for everybody?

The costs of medical research are likely too high to inspire a direct or easy analogy to free-software models, but the current drumbeat of market-fundamentalist deregulation siphoning off money into Big Pharma marketing departments advertising libido enhancement to thousands in the developed world while millions in the developing world are dying from diarrhea scarcely seems like a plausibly prolongable model either.

It seems to me likely, for both good and ill, that the North Atlantic democracies, and much of the rest of the world, are now busy re-inventing themselves in the image of medical industrial complexes. Bioremediated states can be expected to derive their legitimacy differently than military-industrial-infotainment states -- by selling their citizens more than daydreams of security, but by enlisting them in civilization-wide projects of longevity and enhancement medicine figured as freedom.

Diffuse fears of global terror pale in the face of the existential terror of mortality, and it is hard to imagine states not wanting to get in on that action. Once medicine intervenes in the normative bound of three-score and ten, the prevention of premature death with no stable denotation becomes part of what states do in establishing justice and ensuring domestic tranquility.

Citizens are becoming not only legal but also experimental subjects, exchanging much of what presently passes for privacy for their public participation in the most extensive medical research programs imaginable. Although there is little sign that the experimental subjects have noticed it yet, they embody valuable data-points in exchange for which they might demand entitlements otherwise under social seige at present. As the benefits of increasingly ubiquitous automation have served to concentrate rather than democratize prosperity, more or more people are threatened with dispensibility around the world. In the brutal world of market rationality, the only thing worse than exploitation is irrelevance. As bodies on the net, individuals may rediscover their indispensibility. Otherwise, the legitimate discontent of the disappeared is more likely to express itself in murderous ways.

The strain on planetary resources introduced by universal participation in enhancement medicine is hard to fathom. Children must be incomparably rarer in a world where youth lingers incomparably longer. The shift into renewable and sustainable infrastructural architectures and utilities would be, if such a thing is imaginable, more urgent than ever. Perhaps people who expect to live longer might likewise become more rational, imagining themselves actual inhabitants of the futures into which their reckless and thoughtless conduct and consumption reverberates with consequence.

Every option on the game-board is transforming in its assumptions and consequences under pressure of ongoing and upcoming technological developments: the emergence of enhancement medicine, ubiquitous automation, insanely destructive devices...

In her "Manifesto for Cyborgs," Donna Haraway tossed off as an aside a comment that has haunted me for years: "Foucault's biopolitics is a flaccid premonition of cyborg politics, a very open field." For legal and experimental subjects in the prosthetic democracies that are aborning now, amidst terror and strife and unbearable strain, the potentials for both abuse and for empowerment boggle the mind. There is more, much more, to come.

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