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R D E D I T I O N
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EDITORIAL BOARD
EDITOR IN CHIEF Kenneth F. Schaffner
Stephen G. Post George Washington University
Case Western Reserve University Bonnie Steinbock
State University of New York,
Albany
EDITORIAL BOARD
Leonard J. Weber
David Barnard University of Detroit Mercy
University of Pittsburgh
Stuart J. Youngner
Dena S. Davis Case Western Reserve University
Cleveland-Marshall College
of Law
FOUNDING EDITOR
Eric T. Juengst
Case Western Reserve University Warren T. Reich
Loretta M. Kopelman
Eastern Carolina University ASSOCIATE EDITOR
Maxwell J. Mehlman Mark P. Aulisio
Case Western Reserve University Case Western Reserve University
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EDITED BY
STEPHEN G. POST
VOLUME
4
N – S
Encyclopedia of Bioethics, 3rd edition
Stephen G. Post
Editor in Chief
©2004 by Macmillan Reference USA. ALL RIGHTS RESERVED While every effort has been made to
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(cid:127)
N
NANOTECHNOLOGY matter. Little was done in response to the Feynman chal-
lenge until the publication of works by K. Eric Drexler in the
1980s and 1990s. Drexler demonstrated the feasibility of
(cid:127) (cid:127) (cid:127)
such manipulation from an engineering perspective and
Imagine a world in which manufacturing and medical provided a vision for the possible benefits of such technologies.
treatments take place solely at a molecular level, a world in
which human bodies are reengineered to include more
durable tissues or to reverse past injuries. These are some of What Could Nanotechnology Do?
the dreams motivating scientists and engineers pursuing the The list of potential uses of nanotechnology continues to
field of nanotechnology. As the name implies, nanotechnology expand. The primary focus of research at this point concerns
involves the engineering or manipulation of matter, and life, miniaturization of electronic components (Bachtold et al.;
at nanometer scale, that is, one-billionth of a meter. (Ten Hornbaker et al.), but nanoscale materials may dramatically
hydrogen atoms side by side span 1 nanometer; the DNA improve the durability of materials used in machinery and
molecule is 2.3 nanometers across). If feats such as those could result in less polluting and more efficient production
mentioned above were possible, then the structures of the methods. The U.S. military has a significant interest in
human body and the current tools of humankind could be nanotechnology and has created the Institute for Soldier
significantly altered. In recent years many governments Nanotechnologies (ISN). Among the initial aims of the ISN
around the world, including the United States with its is to create stealth garments (and coatings) that are difficult
National Nanotechnology Initiative, and scores of academic to see or detect, are highly durable, and provide increased
centers and corporations have committed increasing support protection from penetrating objects. The institute aims to
for developing nanotechnology programs (Glapa). develop devices to rapidly and accurately detect biological or
chemical weapon attacks. The ISN is also interested in using
nanotechnology to help seamlessly integrate electronic de-
The Birth of an Idea vices into the human nervous system—creating the cyborg
soldier.
The idea behind nanotechnology originated with Nobel
laureate Richard Feynman in a speech he gave to the There are many possible medical uses of microscopic,
American Physical Society in 1959. He described the devel- subcellular machines. Medical applications of nanotechnology
opment of tools for molecular engineering, whereby things include rational drug design; devices specifically targeting
would be built molecule by molecule. He proposed, as a and destroying tumor cells (McDevitt et al.) or infectious
challenge to his colleagues, the writing of the entire Encyclo- agents; in vivo devices for the manufacture and release of
pedia Britannica on the head of a pin. His startling claim was drugs and for tissue engineering or reengineering at the site
that this sort of task would not require a new understanding of need; early detection or monitoring devices; in vitro
of physics and was completely compatible with what scien- diagnostic tools amounting to a laboratory on a chip (Park,
tists already understood about the nature of force and Taton, and Mirkin); devices to clear atherosclerotic lesions
(cid:127)
1871
NANOTECHNOLOGY
(cid:127)
in coronary or cerebral arteries; and biomimetic nanostructures Accidents, Abuses, and Regulation
to repair or replace DNA or other organelles. Nanotech- The vision for medical uses of nanotechnology is exciting,
nology might be used to provide artificial replacements for and if only a portion of the proposed devices prove possible,
red blood cells and platelets (Freitas, 1996), to augment or nanotechnology may benefit many thousands of patients.
repair interaction between neurons in the brain, to improve
Any device that can operate on the subcellular level, how-
biocompatibility and the interface between brain tissue and
ever, can just as easily be designed to destroy as to repair or
cybernetic devices, and to develop more durable prosthetic
heal. In fact, it will be far easier to develop devices that kill.
devices or implants (Drexler, 1986; Drexler and Peterson;
One of the first applications of medical nanotechnology
Freitas, 1999; Crandell; BECON). Such tools have also
involves a device that can target and destroy cancer cells.
been envisioned to provide new means of cosmetic enhance-
Despite the arguments over the feasibility of creating assem-
ment, such as controlling weight, changing hair or skin
blers, it is not a far stretch to envision nanoscale weapons
color, removing unwanted hair, or producing new hair
that could be borne on the winds or delivered through the
simulations (Crawford). Also, some of the potential thera-
water or food supply. Even if not self-replicating, such
peutic uses previously listed would lead to more effective
devices, with appropriate targeting or with the ability to
treatment of life’s greatest killers, such as cancer, infectious
synthesize toxic substances once inside the host could prove
disease, and vascular disease, leading in turn to greatly
to be quite lethal or disabling. If assemblers were ever
enhanced human lifespans.
created, with the ability to self-replicate like bacteria, then
One other possible project to arise from nanotechnology the level of personal or environmental harm could be
has become the focus of a rigorous debate among members substantial.
of the nanocognoscenti. This controversial device is the self-
Concern over the potential military or terrorist use of
replicating assembler, which was first envisioned by Drexler
such technology, which could ultimately be fairly cheap to
in 1986. The assembler is in essence a form of artificial life,
produce, and thus impossible to sufficiently regulate once in
for not only would it manipulate its environment on a
existence, has led some (even within the technology commu-
molecular or atomic level, as other nanomachines would,
nity) to contend that the only safe way to proceed is
but it would also be coded and designed to replicate itself,
to choose not to develop the tools and methods of
potentially making endless copies of itself. Alternatively,
nanotechnology at all (Joy). In this view, the only way to
nanomachines could be designed to function more as viruses,
prevent the potential devastating harms of a technology, or
using the mechanisms in other living cells to help duplicate
the consequences of malicious use of knowledge and tech-
constituent parts and assemble them into a new machine.
nology, is to not develop the technology, or acquire the
While it is beyond the scope of this entry to detail the
knowledge, in the first place. Arguments of this type,
elements of the debate between those who contend such
however, assume the burden of proving:
devices can and will be developed and those who adamantly
claim that Drexlerian assemblers are a physical impossibility, 1. that the projected abilities of the device in question
the assembler is an excellent starting point for the discussion are possible to achieve;
of the ethical aspects of nanotechnology. 2. that the feared harms cannot be prevented,
controlled, or mitigated to an acceptable degree;
3. that it is feasible to achieve universal consensus that
Ethical Issues the area of technology and/or knowledge in question
The ethical issues of nanotechnology can be grouped into should not be pursued; and
five categories: 4. that such a prohibition can be sufficiently policed.
1. the challenges of prospective technology assessment In the case of the first issue, it seems very likely that
and regulation; biological nanodevices will be developed, most likely using a
2. environmental impact of nanotechnologies; so-called bottom-up approach. That is, existing biological
3. issues of justice and access to the goods and services molecules and organelles will be used as models for creating
that might accrue from nanotechnology; tools to achieve the desired function, or these “natural”
4. the ethical and social implications of increased materials will be used in new ways. An example of this is a
longevity that might result from medical project that involved the conversion of the ATPase mole-
nanotechnology; and cule, ubiquitous in living cells, into a molecular motor
5. the issues of augmentation or enhancement of (Soong et al.). Therefore, because the development of func-
human attributes and function. tioning biomechanical nanodevices is highly probable, it is
1872 ENCYCLOPEDIA OF BIOETHICS 3rd Edition
NANOTECHNOLOGY
(cid:127)
morally imperative to prospectively evaluate the possible health, lifespan, productivity, and so on. Even if consensus
impact of these technologies as they are being developed, so could be achieved, policing such restrictions will be essen-
that appropriate safeguards can be implemented to protect tially impossible. The force of curiosity, as well as the
against accidents, unanticipated consequences, or inappro- stubborn human heart’s universal propensity to rebel against
priate uses of the technology. restriction, will ensure that the research will indeed take
place, just not as rapidly as it might have otherwise. Rather it
While many disagree with Joy’s conclusions, his con-
is wiser to direct the development of the technology in such a
cerns for the potential harms that autonomous technology
way as to prepare defenses concurrently along with the
could produce are legitimate. It is his response to the second
devices themselves. It is only in this way that humankind
issue, the likely ability or inability to control or protect
and individual societies can be prepared to meet the threats
against foreseeable or unforeseeable harms, that has led to
of terrorism, accidents, and other calamities resulting from
the most dissent. Concerns have been raised that autono-
the creation and/or abuse of a particular technology.
mous, self-replicating assemblers could escape control, and/or
mutate, in such a way as to destroy life and the environment
on a massive, cataclysmic scale. This is Drexler’s (1986) so-
The Nano-Improved Human
called “gray goo scenario.” In a 2000 article, however,
Robert A. Freitas Jr. calculated that this nightmarish sce- As mentioned above, medical nanotechnology may provide
nario is unlikely because of the ability to detect the activity of exciting tools for healing injured tissue, repairing DNA, and
such biovorous devices early on and to neutralize them. In treating neoplastic and infectious diseases, as well as for
the early days of recombinant DNA research, there were cosmetic applications. It is conceivable that some nanodevices
many concerns about releasing lethal plagues into the envi- may also be used to strengthen normal tissue; to manipulate
ronment, quite similar to a number of the concerns being certain DNA strands to alter traits; or to augment mental
voiced about nanotechnology. Yet the scientific community function, either via enhanced electronic interfaces at the
responded strongly and wisely to the challenges of DNA cellular level or by direct stimulation of certain neural
research, establishing procedural safeguards that remain in pathways. These latter possibilities immediately bring up
use (Krimsky; Fredrickson) and that serve as a model for difficult questions.
developing and containing potentially harmful technologies.
Should such uses of bionanotechnology be permitted?
Pursuing a similar course of prospective risk assessment If they should, should the medical profession be involved
and guideline development, the Foresight Institute pub- with nonhealing, elective augmentation, and if not, then
lished the “Foresight Guidelines on Molecular Nanotech- who should? Should people be allowed to use health insur-
nology” in 2000. The guidelines remain voluntary recom- ance to cover the cost of such interventions? How can just
mendations, but they could be used as a framework for access be ensured otherwise? Such augmentations, if success-
formal regulation and licensing of biologically active ful, would create significant differentials in performance in
nanodevices. Some of the recommended design principles the workplace, physical abilities, and so on. Consequently,
include: (1) dependence on a single fuel source or cofactor the wealthy would get stronger and wealthier, further in-
that does not exist in the natural environment; (2) requiring creasing their advantage over those who might not be able to
constant signaling from an external source for the device to afford the technology in question.
continue functioning; and/or (3) programming termination
In his 1999 book Nanomedicine, Freitas suggested that
times (similar to apoptosis in living cells). While it is hopeful
nanotechnology, and by implication other potentially aug-
that all responsible researchers and engineers would embrace
menting technologies, requires a new concept of disease that
suggestions such as these, there will need to be formal
transcends the classic model of disordered function. He calls
regulation with serious economic, licensure, and punitive
this new model the volitional normative model of disease,
penalties for failure to comply. Additionally, the granting of
and he described it as follows:
licenses to perform research in nonlaboratory settings or to
market nanodevices, as well as the awarding of patents, Disease is characterized not just as the failure of
should be contingent upon proof of the ability to detect and “optimal” functioning, but rather as the failure of
destroy the devices in both in vitro and in vivo settings. either (a) “optimal” functioning or (b) “desired”
functioning. Thus disease may result from:
The idea that humankind could reach universal agree-
ment to limit or forbid certain areas of research is naive, and 1. failure to correctly specify desired bod-
very unlikely to happen, particularly when the field of ily function (specification error by the
knowledge in question may lead to vast improvements in patient),
ENCYCLOPEDIA OF BIOETHICS 3rd Edition 1873
NANOTECHNOLOGY
(cid:127)
2. flawed biological program design that BIBLIOGRAPHY
doesn’t meet the specifications (program- Antón, Philip S.; Silberglitt, Richard; and Schneider, James.
ming design error), 2001. The Global Technology Revolution: Bio/Nano/Materials
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4. external interference by disease agents with
2001. “Logic Circuits with Carbon Nanotube Transistors.”
the design or execution of the biological
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program (exogenous error), or
Crandell, B. C., ed. 1996. Nanotechnology: Molecular Speculations
5. traumatic injury or accident (structural
on Global Abundance. Cambridge, MA: MIT Press.
failure). (Freitas, 1999, p. 20)
Crawford, Richard. 1996. “Cosmetic Nanosurgery.” In Nano-
While encompassing traditional understandings of disease, technology: Molecular Speculations on Global Abundance, ed.
this model additionally takes disease out of the context of an B. C. Crandell. Cambridge, MA: MIT Press.
objective pathophysiological assessment and turns disease Drexler, K. Eric. 1986. Engines of Creation. New York: Anchor.
into whatever the patient defines it to be. Any limitation or Drexler, K. Eric. 1992. Nanosystems: Molecular Machinery, Manu-
undesired trait may now be declared disease. Though osten- facturing, and Computation. New York: Wiley.
sibly continuing the contemporary trend of patient self- Drexler, K. Eric, and Peterson, Christine. 1991. Unbounding the
determination to a new level, this approach is fraught with Future: The Nanotechnology Revolution. New York: Morrow.
both danger and injustice. To declare that a condition is Fredrickson, Donald S. 2001. The Recombinant DNA Contro-
disease imposes a moral claim that services ought to be versy: A Memoir. Washington, D.C.: ASM Press.
rendered for its modification, elimination, or amelioration. Freitas, Robert A., Jr. 1999. Nanomedicine, vol. 1: Basic Capabili-
The balance between beneficence (the obligation to do ties. Austin, TX: Landes Bioscience.
good) and nonmaleficence (the obligation to prevent harm) Grethlein, Christian E., ed. 2002. “DoD Researchers Provide a
may be inappropriately tipped to what the patient desires, Look Inside Nanotechnology.” Special issue of AMPTIAC
rather than needs. Physicians would be reduced to agents of Quarterly 6(1).
wish fulfillment and to technicians, rather than remaining Hornbaker, D. J.; Kahng, S.-J.; Misra, S., et al. 2002. “Mapping
healers. These issues already exist to some degree in the area the One-Dimensional Electronic States of Nanotube Peapod
Structures.” Science 295: 828–831.
of cosmetic surgery but will expand to involve most other
areas of medicine as well. Further, claims to “treatment” Joy, Bill. 2000. “Why the Future Doesn’t Need Us.” Wired,
April, pp. 238–262.
would unjustly deplete healthcare resources and funds,
potentially depriving those in real need of legitimate healing. Krimsky, Sheldon. 1982. Genetic Alchemy: The Social History of
the Recombinant DNA Controversy. Cambridge, MA: MIT
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Conclusion McDevitt, Michael R.; Ma, Dangshe; Lai, Lawrence T.; et al.
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Nanotechnology offers exciting new tools for materials Science 294: 1537–1540.
processing, more powerful and integrated electronic devices,
Mulhall, Douglas. 2002. Our Molecular Future: How Nanotech-
and new medical therapies. Nanodevices, however, may also nology, Robotics, Genetics, and Artificial Intelligence Will Trans-
become instruments of harm, and they require prospective form Our World. Amherst, NY: Prometheus.
regulation and engineering to prevent both foreseeable and Park, So-Jung; Taton, T. Andrew; and Mirkin, Chad A. 2002.
unforeseeable negative consequences. Nanodevices join a “Array-Based Electrical Detection of DNA with Nanoparticle
number of other developing technologies that offer the Probes.” Science 295: 1503–1506.
potential to alter or augment the human body. A prospec- Roco, Mihail, and Bainbridge, William Sims, eds. 2001. Societal
tive, widespread discussion of the implications of these Implications of Nanoscience and Nanotechnology. Arlington,
VA: National Science Foundation.
technologies for the human species, the profession of medi-
cine, and the world’s communities should occur as soon as Soong, Ricky; Bachand, George; Neves, Hercules; et al. 2000.
“Powering an Inorganic Nanodevice with a Biomolecular
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Motor.” Science 290: 1555–1558.
C. CHRISTOPHER HOOK
INTERNET RESOURCES
BECON (NIH Bioengineering Consortium). 2000. “Nanoscience
SEE ALSO: Biomedical Engineering; Cybernetics; Enhance- and Nanotechnology: Shaping Biomedical Technology: Sym-
ment Uses of Medical Technology; Human Dignity; posium Report, June 2000.” Available from <http://www.
Transhumanism and Posthumanism becon.nih.gov/poster_abstracts_exhibits.pdf>.
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NARRATIVE
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Feynman, Richard. 1959. “There’s Plenty of Room at the written, spoken, or (by extension) enacted account of occur-
Bottom.” Available from <http://www.zyvex.com/nanotech/ rences, either historical or fictional. Story, however, is used
feynman.html>.
more often, especially informally, to denote spoken and
Foresight Institute. 2000. “Foresight Guidelines on Molecular fictional accounts, while narrative emphasizes the inclusion
Nanotechnology.” Available from <http://www.foresight.org/
of nonfiction or indicates a contrast with visual or numerical
guidelines/>.
data, as in historiography or book production or computer
Freitas, Robert A., Jr. 1996. Respirocytes: A Mechanical Artificial science. Narrative tends to be used generically in literary
Red Cell: Exploratory Design in Medical Nanotechnology. Fore-
theory, perhaps following the Russian formalist and French
sight Institute. Available from <http://www.foresight.org/
structuralist distinction between story and plot, where story
Nanomedicine/Respirocytes.html>.
designates the events, and plot, the ordering of those events
Freitas, Robert A., Jr. 2000. “Some Limits to Global Ecophagy by
in the literary or historical account. Thus, the story of
Biovorous Nanoreplicators, with Public Policy Recommenda-
Oedipus begins with the prophecy his parents receive before
tions.” Foresight Institute. Available from <http://www.fore-
sight.org/NanoRev/Ecophagy.html>. his birth; the plot of Sophocles’ play begins when, years later,
he learns from the same oracle that the plague that afflicts his
Glapa, Steven. 2002. “A Critical Investor’s Guide to Nanotech-
nology.” In Realis. Available from <http://www.inrealis.com/ city is punishment for the unavenged death of the old king.
nano.htm>. Narrative refers to the whole and implies, for any particular
telling, the inseparability of plot and story.
Institute for Soldier Nanotechnologies. 2003. Available from
<http://www.aro.army.mil/soldiernano/>.
As it orders events, narrative asserts or connotes some
National Nanotechnology Initiative. 2003. Available from <http:// causal relation among those events and imputes character
www.nano.gov/>. and motives to the actors (Forster). Yet, despite this linearity,
National Science and Technology Council. 2003. “Nanotech- conclusions are never foregone. As narrative depicts events
nology: Shaping the World Atom by Atom.” Available from embedded in the lives and concerns of its protagonists,
<http://itri.loyola.edu/nano/>.
circumstances unfold through time in all their contingency
and complexity (Ricoeur). Whether it is the life story
essential to moral understanding (Burrell and Hauerwas;
MacIntyre) or the political history of a nation (White),
narrative explores the way cause and effect are entangled
with the variables of human character and motivation, with
NARRATIVE
luck and happenstance. When moral principles or political
generalizations are abstracted from events without the use of
narrative, those details are left behind as inessential, even
(cid:127) (cid:127) (cid:127)
though for those involved such particulars may represent
Human beings are a narrative species. We tell stories inces- what is most valued in a life or a history. Narrative remains
santly; we read and listen to them, watch them unfold on mired in the particulars of human experience. From its
screen and stage. In making and absorbing narrative—news, designation of certain details as relevant “facts” and certain
gossip, fiction, drama, anecdotes, and history—we spin and occurrences as “events” to the use of rhetorical strategies in
untangle explanatory accounts of the way the world works the representation and description of those facts and events,
and how we and our fellow human beings act in every narrative is concerned with the construction and interpreta-
conceivable circumstance. Memories of the past and ideas of tion of meaning.
the future are expressed in narrative accounts of how the
world was and how it will, or should, become. Individual
identities and self-conceptions are packaged in life stories, Narrative and Medical Knowledge
part (and heirs) of larger family, community, and national
Because narrative is the primary way of organizing and
stories that shape the life events and choices to become the
communicating the sense human beings make of the world,
chapters that follow. There is even evidence that narrative,
the interpretive process integral to shaping and understand-
rather than simply a creative use human beings have found
ing a story is at the heart of human knowing. Thus, the
for language, is instead the motive for its acquisition: Young
investigation of narrative forms and practices is a fruitful way
children learn to talk in order to give some account of
of understanding how knowledge is acquired and transmit-
occurrences in their daily lives (Bruner).
ted. To understand medical knowledge—whether the pa-
For the most part, the word narrative is used inter- tient’s illness, the physician’s practice, ideas of causality,
changeably with story to designate a more or less coherent issues of medical ethics, or activities of clinical research—it is
ENCYCLOPEDIA OF BIOETHICS 3rd Edition 1875
