Nanomedicine, Ethical Issues of

The size, interactive, multifunctional, and precision features that nanoscale science and engineering enables has the potential to redefine medical technologies in a broad array of areas, such as drug delivery, imaging, analysis of cellular functions, tissue engineering and reconstruction, biomolecule engineering, implant materials, communication, and monitoring. Medical technologies are not merely tools used by medical practitioners and healthcare organizations. Like all technologies, they structure the form of the activity in which they are involved. Medical technologies shape organizational designs, patient-physician relationships, how diagnosis and treatment is accomplished, expectations about outcomes, and conceptions of health and disease, for example. If nanomedical technologies realize the possibilities enumerated above, then they are likely to restructure these and other aspects of medical practice and healthcare in significant ways.

For example, nanomedical technologies will enable the gathering of vast amounts of personalized information. Policies, infrastructure, and expertise will be needed to collect, manage, organize, analyze, and control access to this information. Many of the challenges involved are new variations on old medical issues—i.e., ensuring privacy and efficient information management. However, from the perspective of medical practices, relationships, and institutions, it will involve new organizational arrangements, new power relationships, new points of service, new forms of medical expertise, new approaches to diagnostics, and new sets of expectations.

The same is likely to be true with respect to other forms of nanomedical diagnostics and therapeutics, since the restructuring potential is not a result of the particular features of nanomedical information technologies, but of the nature of technology's role in human activities and the prominence of technology in contemporary medical practice and healthcare systems. The reconstitution of skills, activities, organizational designs, infrastructures, expertise, expectations, training, costs, and relationships precipitated by nanomedical technologies may well be overall beneficial for patients. However, it will require substantial adaptation across all relevant areas of medicine and healthcare.

If nanomedical technologies have the medical significance commonly projected for them, as well as the broad restructuring significance described here, they will raise ethical and policy issues related to distributive justice, risk management, autonomy, community welfare, public health, procedural justice, allocations of burdens and benefits, responsibility, control, and oversight. In addition to raising a broad array of familiar issues in novel forms, some nanomedical technologies have the potential to raise less familiar issues, since they have the potential to challenge the basic evaluative framework for medicine—that is, that the goal is remediative, to restore species typical functioning, so far as possible. Many nanomedical technologies will be dual use technologies in the sense that, while developed for therapeutic purposes, they will also have human enhancement potentials—that is, they will be technologies that could be used to augment human capabilities beyond the range of functioning otherwise attainable by modifying the biological systems involved. For example, artificial or enhanced immune system function may be possible with the use of nanotechnologies with the ability to detect and trigger destruction of viruses and pathogenic bacteria. Nanoengineered surfaces and nanomaterials may enable robust brain-machine interfacing [Page 509]to directly control machines through neuronal activity. Nanomaterials may provide increased strength and durability to artificial joints and limbs, as well as advantages in tissue engineering and reconstruction, thereby helping to increase life spans. Artificial red blood cells may enhance endurance and physical ability through increased oxygen exchange.

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