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On Replacement Body Parts

Abstract

Technological advances are making devices that functionally replace body parts—artificial organs and limbs—more widely used, and more capable of providing patients with lives that are close to “normal.” Some of the ethical issues this is likely to raise relate to how such prostheses are conceptualized. Prostheses are ambiguous between being inanimate objects and sharing in the status of human bodies—which already have an ambiguous status, as both objects and subjects. At the same time, the possibility of replacing body parts with artificial objects puts pressure on the normative status typically accorded to human bodies, seemingly confirming that body parts are replaceable objects. The paper argues that bodies’ normative status relies on the relation of a body to a person and shows that persons could have similar relations to prostheses. This suggests that in approaching ethical issues surrounding prostheses, it is appropriate to regard them as more like body parts than like objects.

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Notes

  1. For this way of framing the problem I am greatly indebted to Sparrow and Hutchison (unpublished manuscript).

  2. I leave aside tissue-engineered structures incorporating biological material, as I am specifically interested in objects with a clear artificial status.

  3. Of course, these practical ethical issues are not entirely resolved by an argument for considering prostheses more like body parts than objects, since they involve a number of complex considerations, and there are of course practical constraints on treating prostheses “like body parts.” My argument below thus will not resolve these practical ethical issues, although it will have implications for their resolution.

  4. This points to a pre-reflective relationship between a person and their characteristics. Insofar as evaluations of characteristics are reflexive, the person must already recognize that the characteristics are their own. I leave this aside here but discuss an analogous pre-reflective sense of bodily ownership below.

  5. For detailed elaboration of these and related themes see, e.g., Merleau-Ponty 1962; Atkins 2008; Gallagher 2005.

  6. An alternative suggestion is made by De Vignemont and Farne (2010) in distinguishing between motor and perceptual embodiment (using that term with a different meaning than I am here) and suggesting that both may occur by degrees. I would further suggest that, however the difference between tools of “completion” and those of “extension” is worked out, there is a need for a more fine-grained approach to understanding what is involved in embodiment—and that our moral intuitions may be an untapped resource for the cognitive sciences in this regard.

References

  • Alpinar-Sencan, Z. 2016. Reconsidering Kantian arguments against organ selling. Medicine, Health Care and Philosophy 19(1): 21–31.

    Article  Google Scholar 

  • Atkins, K. 2008. Narrative identity and embodied continuity. In Practical identity and narrative agency, edited by C. Mackenzie and K. Atkins, 78–98. New York: Routledge.

    Chapter  Google Scholar 

  • Baker, L.R. 2000. Persons and bodies: A constitution view. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Bechara, A., and N. Naqvi. 2004. Listening to your heart: Interoceptive awareness as a gateway to feeling. Nature Neuroscience 7(2): 102–103.

    Article  CAS  PubMed  Google Scholar 

  • Björkman, B., and S.O. Hanson. 2006. Bodily rights and property rights. Journal of Medical Ethics 32(4): 209–214.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brown, B. 2013. A farewell to arms (and legs): The legal treatment of artificial limbs. Columbia Journal of Law and Social Problems 47(1): 69–102.

    Google Scholar 

  • Calder, G. 2006. Ownership rights and the body. Cambridge Quarterly of Healthcare Ethics 15(1): 89–100.

    Article  PubMed  Google Scholar 

  • Chadwick, R.F. 1989. The market for bodily parts: Kant and duties to oneself. Journal of Applied Philosophy 6(2): 129–139.

    Article  Google Scholar 

  • Cheng, D.L., P.B. Greenberg, and D.A. Borton. 2017. Advances in retinal prosthetic research: A systematic review of engineering and clinical characteristics of current prosthetic initiatives. Current Eye Research 42(3): 334–7.

    Article  PubMed  Google Scholar 

  • Cohrs, N.H., A. Petrou, M. Loepfe, et al. 2017. A soft total artificial heart—first concept evaluation on a hybrid mock circulation. Artificial Organs 41(10): 948–958.

    Article  CAS  PubMed  Google Scholar 

  • Cordella, F., A.L. Ciancio, R. Sacchetti, et al. 2016. Literature review on needs of upper limb prosthesis users. Frontiers in Neuroscience 10: 209.

    Article  PubMed  PubMed Central  Google Scholar 

  • Couto, B., A. Salles, L. Sedeno, et al. 2014. The man who feels two hearts: The different pathways of interoception. Social Cognitive and Affective Neuroscience 9(9): 1253–1260.

    Article  PubMed  Google Scholar 

  • de Preester, H., and M. Tsakiris. 2009. Body-extension versus body-incorporation: Is there a need for a body-model? Phenomenology and the Cognitive Sciences 8(3): 307–319.

    Article  Google Scholar 

  • De Vignemont, F. 2013. The mark of bodily ownership. Analysis 73(4): 643–651.

    Article  Google Scholar 

  • De Vignemont, F., and A. Farne. 2010. Widening the body to rubber hands and tools: What’s the difference? Revue de Neuropsychologie 3(2): 203–211.

    Article  Google Scholar 

  • Finch, J.L., G.H. Heath-, A.R. David, and J. Kulkarni. 2012. Biomechanical assessment of two artificial big toe restorations from Ancient Egypt and their significance to the history of prosthetics. JPO Journal of Prosthetics and Orthotics 24(4): 181–191.

    Article  Google Scholar 

  • Food and Drug Administration (FDA). No date. Summary of Safety and Effectiveness Data (CardioWest Total Artificial Heart). https://www.accessdata.fda.gov/cdrh_docs/pdf3/P030011b.pdf. Accessed December 11, 2017a.

  • ———. 2014. FDA-approved Cochlear Implants. https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/CochlearImplants/ucm062882.htm. Accessed December 11, 2017.

  • ———. 2017. The 670G system—P160017. http://wayback.archive-it.org/7993/20170111141252/http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-ApprovedDevices/ucm522764.htm. Accessed December 11, 2017.

  • Gallagher, S. 2005. How the body shapes the mind. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Garreau, J. 2007. Cold reality of an artificial heart. Seattle Times, August 19. https://www.seattletimes.com/seattle-news/health/cold-reality-of-an-artificial-heart/. Accessed December 11, 2017.

  • Gerrand, N. 1999. The misuse of Kant in the debate about a market for human body parts. Journal of Applied Philosophy 16(1): 59–67.

    Article  CAS  PubMed  Google Scholar 

  • Glynn, J., H. Song, B. Hull, et al. 2017. The Oregon heart total artificial heart: Design and performance on a mock circulatory loop. Artificial Organs 41(10): 904–910.

  • Hampton T. 2014. Fully automated artificial pancreas finally within reach. JAMA 311(22): 2260–2261.

    Article  CAS  PubMed  Google Scholar 

  • Heyes, C.J. 2007. Self-transformations: Foucault, ethics, and normalized bodies. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Hume, D. 1969. A treatise of human nature. Edited by E.C. Mossner. London: Penguin.

  • Hutchison, K., and R. Sparrow. 2016. What pacemakers can teach us about the ethics of maintaining artificial organs. Hastings Center Report 46(6): 14–24.

    Article  PubMed  Google Scholar 

  • Hutchison, K., and R. Sparrow. 2017. Ethics and the cardiac pacemaker: More than just end of life issues. Europace 20(5): 739–746.

    Article  Google Scholar 

  • International Medical Device Regulators Forum (IMDRF). 2014. Software as a medical device (SaMD): Possible framework for risk categorisation and corresponding considerations. http://www.imdrf.org/workitems/wi-samd.asp. Accessed December 11, 2017.

  • Joung, Y-H. 2013. Development of implantable medical devices: From an engineering perspective. International Neurourology Journal 17(3): 98–106.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kant, I. 1997. Lectures on Ethics. Edited by P. Heath and J.B. Schneewind. Translated by P. Heath. Cambridge: Cambridge University Press.

  • Kay, S., and D. Wilks. 2015. Bionic hand transplantation: Linking the cortex to the hand. Lancet 385: 2120–2122.

    Article  Google Scholar 

  • Knight, S.R., R. Aujla, and S.P. Biswas. 2011. Total hip arthroplasty—over 100 years of operative history. Orthopedic Reviews 3(2): e16.

    Article  PubMed  PubMed Central  Google Scholar 

  • Locke, J. 1975. An essay concerning human understanding. Edited by P.H. Nidditch. Oxford: Oxford University Press.

  • Lundberg, M., K. Hagberg, and J. Bullington. 2011. My prosthesis is a part of me: A qualitative analysis of living with an osseointegrated prosthetic limb. Prosthetics and Orthotics International 35(2): 207–214.

    Article  PubMed  Google Scholar 

  • Mackenzie, C. 2009. Personal identity, narrative integration, and embodiment. In Embodiment and Agency, edited by S. Campbell, L. Meynell, and S. Sherwin, 100–125. University Park, PA: Penn State University Press.

  • ———. 2010. Conceptions of autonomy and conceptions of the body in bioethics. In Feminist Bioethics: At the Centre, on the Margins, edited by J. Leach Scully, L.E. Baldwin-Ragaven, and P. Fitzpatrick, 71–90. Baltimore: John Hopkins University Press.

  • ———. 2014. Embodied agents, narrative selves. Philosophical Explorations 17(2): 154–171.

  • Martin, R. 1998. Self-Concern: An experiential approach to what matters in survival. Cambridge: Cambridge University Press.

    Google Scholar 

  • McDonnell, P.M., R.N. Scott, J. Dickison, R.A. Theriault, B. Wood. 1989. Do artificial limbs become part of the user? New evidence. Journal of Rehabilitation Research and Development 26(2): 17–24.

  • MedGadget. 2016. Retina Implant’s higher resolution alpha AMS visual implant cleared in EU. MedGadget, April 1. https://www.medgadget.com/2016/04/retina-implants-higher-resolution-alpha-ams-visual-implant-cleared-in-eu.html. Accessed December 11, 2017.

  • Merleau-Ponty, M. 1962. Phenomenology of perception. Abingdon: Routledge.

  • Mudry, A., and M. Mills. 2013. The early history of the cochlear implant. JAMA Otalaryngology—Head and Neck Surgery 139(5): 446–453.

  • Munzer, S.R. 1993. An uneasy case against property rights in body parts. Canadian Journal of Law and Jurisprudence 6(2): 319–341.

    Article  Google Scholar 

  • Murray, C.D. 2004. An interpretative phenomenological analysis of the embodiment of artificial limbs. Disability and Rehabilitation 26(16): 963–973.

    Article  CAS  PubMed  Google Scholar 

  • ———. 2008. Embodiment and prosthetics. In Psychoprosthetics, edited by P. Gallagher, D. Desmond, and M. Maclachlan, 119–129. Dordrecht: Springer.

  • Nghiem, B.T., I.C. Sando, R.B. Gillespie, et al. 2015. Providing a sense of touch to prosthetic hands. Plastic Reconstructive Surgery 135(6): 1652–1663.

    Article  CAS  PubMed  Google Scholar 

  • Nolan, H., D. Wang, and J.B. Zwischenberger. 2011. Artificial lung basics: Fundamental challenges, alternative designs and future innovations. Organogenesis 7(1): 23–27.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pazzaglia, M., and M. Molinari. 2016. The embodiment of assistive devices—from wheelchair to exoskeleton. Physics of Life Reviews 16: 163–175.

    Article  PubMed  Google Scholar 

  • Resnik, D. 1998. The commodification of human reproductive materials. Journal of Medical Ethics 24(6): 388–393.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ricoeur, P. 1992. Oneself as another. Translated by K. Blamey. Chicago: University of Chicago Press.

  • Robson, D. 2014. The mind-bending effects of feeling two hearts. BBC Future, December 5. http://www.bbc.com/future/story/20141205-the-man-with-two-hearts. Accessed December 11, 2017.

  • Saal, H.P., and S.J. Bensmaia. 2015. Biomimetic approaches to bionic touch through a peripheral nerve interface. Neuropsychologia 79(B): 344–353.

    Article  PubMed  Google Scholar 

  • Schechtman, M. 1996. The constitution of selves. Ithaca: Cornell University Press.

    Google Scholar 

  • Schofield, J.S., K.R. Evans, J.P. Carey, and J.S. Herbert. 2014. Applications of sensory feedback in motorized upper extremity prosthesis: A review. Expert Review of Medical Devices 11(5): 499–511.

    Article  CAS  PubMed  Google Scholar 

  • Second Sight. 2017. Frequently asked questions. http://www.secondsight.com/frequently-asked-questions-pf-en.html. Accessed December 11, 2017.

  • Shoemaker, D. 2007. Personal identity and practical concerns. Mind 116(462): 317–357.

    Article  Google Scholar 

  • Sparrow, R. 2015. Enhancement and obsolescence: Avoiding an enhanced “rat race.” Kennedy Institute of Ethics Journal 25(3): 231–260.

    Article  PubMed  Google Scholar 

  • Svenaeus, F. 2010. What is an organ? Heidegger and the phenomenology of organ transplantation. Theoretical Medicine and Bioethics 31(3): 179–196.

    Article  PubMed  Google Scholar 

  • Tagney, J. 2010. A literature review comparing the experiences and emergent needs of adult patients with permanent pacemakers (PPMs) and implantable cardioverter defibrillators (ICDs). Journal of Clinical Nursing 19(15-16): 2081–2089.

    PubMed  Google Scholar 

  • Toombs, S.K. 2001. Reflections on bodily change: The lived experience of disability. In Handbook of Phenomenology and Medicine, edited by S.K. Toombs, 247–261. Dordrecht: Kluwer Academic Publishers.

    Chapter  Google Scholar 

  • Velleman, J.D. 1996. Self to self. The Philosophical Review 105(1): 39–76.

    Article  Google Scholar 

  • Wilkinson, S. 2000. Commodification arguments for the legal prohibition of organ sale. Health Care Analysis 8(2): 189–201.

    Article  CAS  PubMed  Google Scholar 

  • Wilson, C. 2017. Artificial lungs in a backpack may free people with lung failure. Daily News, March 21. https://www.newscientist.com/article/2125422-artificial-lungs-in-a-backpack-may-free-people-with-lung-failure/. Accessed December 11, 2017.

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Acknowledgements

This research was supported by Australian Research Council Centres of Excellence funding scheme (grant ID CE140100012). My thanks to Robert Sparrow for extensive comments on several drafts of the paper. Thanks also to other members of the ethics and policy team at the ARC Centre of Excellence for Electromaterials Science and participants at the 2017 European Society for Philosophy of Medicine and Healthcare Conference, for helpful comments and questions.

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Correspondence to Mary Jean Walker.

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Walker, M.J. On Replacement Body Parts. Bioethical Inquiry 16, 61–73 (2019). https://doi.org/10.1007/s11673-018-9889-y

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Keywords

  • Artificial organs
  • Prosthetics
  • Embodiment
  • Organ sales