Abstract
So far, the very meaning of health and therefore, treatment and rehabilitation is benchmarked to the normal or species-typical body. We expect certain abilities in members of a species; we expect humans to walk but not to fly, but a bird we expect to fly. However, increasingly therapeutic interventions have the potential to give recipients beyond species-typical body related abilities (therapeutic enhancements, TE). We believe that the perfect storm of TE, the shift in ability expectations toward beyond species-typical body abilities, and the increasing desire of health consumers to shape the health system will increasingly influence various aspects of health care practice, policy, and scholarship. We employed qualitative and quantitative methods to investigate among others how human enhancement, neuro/cognitive enhancement, brain machine interfaces, and social robot discourses cover (a) healthcare, healthcare policy, and healthcare ethics, (b) disability and (c) health consumers and how visible various assessment fields are within Neuro/Cogno/Human enhancement and within the BMI and social robotics discourse. We found that health care, as such, is little discussed, as are health care policy and ethics; that the term consumers (but not health consumers) is used; that technology, impact and needs assessment is absent; and that the imagery of disabled people is primarily a medical one. We submit that now, at this early stage, is the time to gain a good understanding of what drives the push for the enhancement agenda and enhancement-enabling devices, and the dynamics around acceptance and diffusion of therapeutic enhancements.
Highlights
Health and health care technologies have constantly impacted health and health care and are seen in need of policies to govern them [1,2,3,4,5,6,7,8,9]
The following ethical issues with health policy implications around Brain Machine Interface (BMI) are raised in the literature: there is currently no legislation put in place to “safeguard the informed consent of the patients before a BMI is used in therapy” resulting in issues around the protection of patient privacy [128]; x concerns are raised with regards informed consent from minors and incompetent individuals—who should be making the decision to provide or not provide consent for TE? [127]; x the need for protocols with implementing BMI application for humans “in terms of acceptable risk to subject” [127]; x research reliability comes into question with small effect size
We submit that all the science and technology products and discourses covered in this paper will impact the delivery of healthcare and the quality indicators of health, healthcare and health systems such as the ones used in Canada [148,149]
Summary
Health and health care technologies have constantly impacted health and health care and are seen in need of policies to govern them [1,2,3,4,5,6,7,8,9]. We submit real TEs are enabling a paradigm shift as to the meaning of health and body ability expectations [24] where we see the move toward a sentiment that links being healthy to having obtained more than species-typical abilities, abolishing, as a consequence, the species-typical framework of reference evident in medicine up to today [9,25,26] Another consequence already evident is the appearance of an enhancement form of ableism (ability one sees as essential) that expects beyond species-typical abilities of humans [27]. Mostly non-therapeutic performance enhancements are debated by policy makers, scientists and laypeople with various ethicists arguing for the legalization of various forms of enhancements [27] Therapeutic enhancements as such are rarely questioned and their impact is rarely discussed [27].
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