Ethical Implications of Nanomedicine: Implications of Imagining New Futures for Medicine

Abstract

This chapter considers ethical and social issues arising from applying advances in nanotechnologies to medicine, and more briefly to enhancing the human body. While these are usually enabling technologies, they already embody values and imply trajectories for future medicine which raise important questions. In enabling a move to pre-symptomatic medicine, nano-diagnostics may revolutionise some treatments, but also pose problems. Do we want advanced warning of an untreatable disease? How early in life should we begin to take preventative medication if the onset of a treatable condition is only a probability? Are we all already ‘ill’? Handling, interpreting and counselling the increased information will be important. Nanoscale remote monitoring devices present many practical advantages to the elderly and chronically sick but at the cost of a degree of intrusion by a third party, and a shift of responsibility to the patient and the carer, which may not always be welcome. Targeted drug delivery offers many improvements but also with uncertainties about nanoparticles, side effects and patient variability. Theranostic devices which combine monitoring and therapeutic action still need human controls. In regenerative medicine, nano-scaffolds could enable tissue repair and simple replacements, but major organ constructs, if ever feasible, would need careful ethical assessment. Should nano-enabled interventions in the body become the norm, or used only for particular conditions? There may also be pressure to use devices for other than medical reasons. Human values are needed to modulate engineering logic. Faced with risk and uncertainties, how do we decide when to proceed with a nanomedical intervention, or to exercise precaution? The use of nanotechnologies to enhance the human body are discussed briefly. Important questions include how far we regard the body as ‘given’ or alterable; can we distinguish between medical interventions and enhancements; risks; worsening the rich-poor divide; whether such functional ‘improvements’ really enhance human life when viewed holistically, or when set against more pressing problems facing societies.