Lab-grown organs, ethics, and immortality (2) …

It’s a temptation—a big temptation!  Success in growing and transplanting lab-grown organs is so revolutionary that it’s tempting to look at the immediate results without asking any of the larger questions. 

As we saw in the previous post, several individuals have already benefited from tissue engineering, receiving lab-grown bladders and in one case a wind-pipe. And it’s reasonable to expect more success in the future—though not so great nor so soon as many would hope.

Tissue engineering is only one part of the new field of regenerative medicine.  The list of revolutionary advances is already long and growing.  Recombinant DNA technology is used to make drugs to treat diabetes and to stimulate the production of red blood cells.  Fabricated hip joints, heart valves, blood vessels and cochleas have already become part of routine medical treatment.

As wonderful as these advances are, they are accompanied by a host of ethical issues.  Will embryonic stem cells be used?  Would restrictions on developing these treatments, even for ethical deliberations, subject an untold number of patients to unnecessary suffering?  Will the benefits be available to all or just to the wealthy?  Will those involved in the clinical trials be properly informed of the risks?

But there is a more fundamental question:  Is aging a disease that can be cured?  Or, a bit differently, is death a disease to be cured?  And pressing even further, should these new technologies be used to help us become posthuman?

These profound questions are the subject of Brent Waters’ important essay, “Extending Life:  To What End?”  A few excerpts from the section entitled “Waging War against Death” will provide insight into the consequences of considering aging and death as disease.

If the principal benefit of regenerative medicine is improved health, then presumably its beneficiaries will also live longer lives.  The development of superior diagnostic, therapeutic, preventative, and enhancement techniques is bound to raise the statistical norm for average life expectancy.  Yet if three-score-and-ten has become obsolete, what measure should replace it—100, 150, 5oo years, or more?  At present, science cannot offer any definite answer to what the outside limit might be. …

The prospect of living longer does not suggest that regenerative medicine is merely a high-tech version of Ponce de Leon’s vain quest for youthful immortality.  Yet extending longevity has certainly been a factor in creating public interest in investment in the fledgling biotechnology industry. … [T]here is … a growing perception, in both the industrial and medical literature that aging is akin to a disease that can be treated.  In the absence of any known outside limit, however, what constitutes effective treatment?  Without a given limit it would appear that regenerative medicine is the first step in an endless struggle against growing old.  If medical resources become increasingly developed and deployed for this purpose, however, does it not raise a rather awkward question:  is aging a disease that can be cured?  This question helps us get at the heart of the matter, because the chief benefit of regenerative medicine is its ability to cure rather than merely treat disease or injury.  It is through rejuvenating the functions of tissue and organs that longevity is extended.  Consequently, to cure aging is not to contend against the passage of time, but against the accompanying cellular degeneration and resulting morbidity.

If aging is regarded as a disease to be cured, however, does this not suggest that the advent of regenerative medicine also signals a declaration of war against the old enemy, death?  Presumably the answer must be yes, for death is the end result of degeneration and morbidity.  Yet what would victory against this old foe mean, and what would be the cost?  Total victory would be immortality, and if this ambitious goal proves elusive, greatly expanded longevity would represent a partial but nonetheless significant triumph.  The cost of winning this war would be the radical transformation of medicine as a practice and its patients.  To wage war against death requires that medicine forsake its traditional emphasis on caring in favor of curing.  The chief medical practice would no longer be providing care and comfort to patients suffering the ravages of illness and deteriorating bodies, but to eliminate the organic sources of their suffering.  The role of medicine would not be one of assisting patients to come to terms with their mortal state, but to enable them to vanquish mortality or at least keep degeneration and morbidity at bay for a more extended period of time.  Moreover, if an effective war against death is to be waged, then medicine must in turn transform its patients.  The move from care to cure entails that the line separating therapy and enhancement be blurred if not erased. … Consequently, the patient is simultaneously the beneficiary and artifact of such transformative medicine.  Medicine is no longer dedicated to relieving the human condition but is radically changing it.

If regenerative medicine is the first step in curing aging and an act of war on death, then a provocative issue is forced upon us, namely, should humans use their technology to become something other than human?  It would seem that some such aspiration is at play if the goal is to use technology to overcome or extend the mortal limits that evolution has programmed into the human biology.  Yet if these limits are overcome or greatly extended, then mortality is no longer a definitive feature of human life.  Yet in the absence of this definitive feature, what are humans aspiring to become as artifacts of their own engineering?  Or to pose the question more starkly:  should humans aspire to become posthuman?

Waters goes on to examine four possible answers.  He is careful to not “implicate regenerative medicine in some far-fetched conspiracy to create a more grotesque brave new world than that imagined by [Aldous] Huxley.”  Rather, the goal is to stimulate reflection and discussion of possible unanticipated consequences of these remarkable technologies.

The essay, “Extending Life:  To What End?” is Chapter 5 in This Mortal Flesh:  Incarnation and Bioethics (2009).  This essay was originally presented as a talk at the annual bioethics conference of The Center for Bioethics and Human Dignity at Trinity Evangelical Divinity School.  The audio is available online as “Extending Human Life to What End: Ethical Reflections on Regenerative Medicine,” Part 1 and Part 2.