Ethics and the Limits of Science

Abstract

Sir:FigureScience, however, cannot create ends and, even less, instill them in human beings; science, at most, can supply the means by which to attain certain ends. But the ends themselves are conceived by personalities with lofty ethical ideals and—if these ends are not stillborn, but vital and vigorous—are adopted and carried forward by those many human beings who, half-unconsciously, determine the slow evolution of society. —Albert Einstein We read with great interest the article by Chuang and Chen1 entitled “The Possibility and Potential Feasibility of Putting an Extra Functioning Free Muscle Transplant onto a Normal Limb: Experimental Rat Study.” We would like to discuss the ethical implications of their scientific outcomes, and we are sincerely surprised that no one has published any comment yet. In their investigation, the authors revealed that the extra muscle transfer resulted in significant increases in size and function of the operative limb without interfering with the original biceps function and demonstrated that the transfer is safe and feasible for functional and aesthetic augmentation purposes in a normal rat limb with no functional deficit.1 That is contrary to what reconstructive surgery has been developed for: surgery to restore the form and function of the body becomes surgery to selectively improve subject physical qualities and features. Although Chuang and Chen1 suggested how an extra functioning free muscle transplant may correct cosmetic defects in particular cases such as asymmetric limbs, they concluded too easily that their outcomes should be the first step to potentially enhance the performance of athletes or heavy laborers as a form of functional augmentation. From the scientific point of view, we indeed have to congratulate the authors1 for their brilliant idea and exhaustive extraction and analysis of data. From the ethical point of view, it seems necessary to open a debate regarding the future implications of these experiments. Scientific progress should certainly be seen as a blessing more than it could represent a curse. Advancements in technology in every field represent the way through which humans satisfy their desire for discovering what is still unknown and apply it to daily life to allow it to become known and useful, and it is an admirable purpose. It is the highest purpose of science. However, are we ready to create the perfect human (either athlete or heavy laborer or soldier or whatever)? History is full of myths and legends in which the pursuit of enhancement of human phenotypic characteristics is emphasized (the Prussian king even forced tall women to marry tall soldiers so they could breed more tall boys!2). Since Mendel's discoveries on genetics, a robust number of scientists have spent their lives attempting to improve the gene pool of the entire species through genetic engineering with the questionable aim of propagating selective “positive” characteristics in humans. Although we are still very far from this achieving this in humans, and regardless of what this would be used for, the question that should be asked is, “even if we could, should we?” The work of Chuang and Chen1 testifies that we could (at least in animals); however, are we so sure that potential enhancement and/or augmentation of healthy human functions would appear more enriching than destructive? In any event, less than 500 years ago, Galileo Galilei was already convinced that it would be a great mistake not to support science and research (“I do not feel obliged to believe that the same God who has endowed us with sense, reason, and intellect has intended us to forgo their use”3), and we all have inherited his philosophy, being sons of his scientific method. However, maybe we would do better to focus on improving patients' lives than on manipulating human functions. Davide Lazzeri, M.D. Operative Unit of Plastic and Reconstructive Surgery, Hospital of Pisa, Pisa, Italy Lorenz Larcher, M.D. Section of Plastic, Aesthetic, and Reconstructive Surgery, General Hospital Linz, Linz, Austria Fabio Nicoli, M.D. Department of Plastic and Reconstructive Surgery, University of Tor Vergata, Rome, Italy Corrado Campisi, M.D. Unit of Plastic and Reconstructive Surgery and, Unit of Lymphatic Surgery and Microsurgery, RCCS University Hospital “San Martino”, Genoa, Italy Tommaso Agostini, M.D. Maxillofacial Surgery Unit, Hospital of Florence, Florence, Italy DISCLOSURE None of the authors has a financial interest to declare in relation to the content of this communication.