What follows is my position piece for London’s FutureFest 2013, the website for which no longer exists.
Medicine is a very ancient practice. In fact, it is so ancient that it may have become obsolete. Medicine aims to restore the mind and body to their natural state relative to an individual’s stage in the life cycle. The idea has been to live as well as possible but also die well when the time came. The sense of what is ‘natural’ was tied to statistically normal ways of living in particular cultures. Past conceptions of health dictated future medical practice. In this respect, medical practitioners may have been wise but they certainly were not progressive.
However, this began to change in the mid-19th century when the great medical experimenter, Claude Bernard, began to champion the idea that medicine should be about the indefinite delaying, if not outright overcoming, of death. Bernard saw organisms as perpetual motion machines in an endless struggle to bring order to an environment that always threatens to consume them. That ‘order’ consists in sustaining the conditions needed to maintain an organism’s indefinite existence. Toward this end, Bernard enthusiastically used animals as living laboratories for testing his various hypotheses.
Historians identify Bernard’s sensibility with the advent of ‘modern medicine’, an increasingly high-tech and aspirational enterprise, dedicated to extending the full panoply of human capacities indefinitely. On this view, scientific training trumps practitioner experience, radically invasive and reconstructive procedures become the norm, and death on a physician’s watch is taken to be the ultimate failure. Humanity 2.0 takes this way of thinking to the next level, which involves the abolition of medicine itself. But what exactly would that mean – and what would replace it?
The short answer is bioengineering, the leading edge of which is ‘synthetic biology’. The molecular revolution in the life sciences, which began in earnest with the discovery of DNA’s function in 1953, came about when scientists trained in physics and chemistry entered biology. What is sometimes called ‘genomic medicine’ now promises to bring an engineer’s eye to improving the human condition without presuming any limits to what might count as optimal performance. In that case, ‘standards’ do not refer to some natural norm of health, but to features of an organism’s design that enable its parts to be ‘interoperable’ in service of its life processes.
In this brave new ‘post-medical’ world, there is always room for improvement and, in that sense, everyone may be seen as ‘underperforming’ if not outright disabled. The prospect suggests a series of questions for both the individual and society: (1) Which dimensions of the human condition are worth extending – and how far should we go? (2) Can we afford to allow everyone a free choice in the matter, given the likely skew of the risky decisions that people might take? (3) How shall these improvements be implemented? While bioengineering is popularly associated with nano-interventions inside the body, of course similarly targeted interventions can be made outside the body, or indeed many bodies, to produce ‘smart habitats’ that channel and reinforce desirable emergent traits and behaviours that may even leave long-term genetic traces.
However these questions are answered, it is clear that people will be encouraged, if not legally required, to learn more about how their minds and bodies work. At the same time, there will no longer be any pressure to place one’s fate in the hands of a physician, who instead will function as a paid consultant on a need-to-know and take-it-or-leave-it basis. People will take greater responsibility for the regular maintenance and upgrading of their minds and bodies – and society will learn to tolerate the diversity of human conditions that will result from this newfound sense of autonomy.
