If robotic limbs become superior to human ones, will people opt to upgrade through amputation? Is it ethical for a doctor to perform an amputation that isn't medically necessary? What would it take for the hosts to consider getting a robotic limb?
Male Speaker 1: Brought to you by Toyota. Let's go places. Welcome to Forward Thinking.
Jonathan: Welcome everyone to Forward Thinking. My name is Jonathan Strickland and I am joined by my wonderful cohosts who are -
Lauren: Lauren Vogelbaum.
Joe: And Joe McCormick.
Jonathan: And today we wanted to talk a little bit about robotic prostheses and sort of this idea of, when we get to a really advanced state with prostheses to the point where a robotic arm is demonstrably better than a human arm, what happens then? But before we get there, I wanted to talk a little bit about some fairly recent news. Back in 2011, a couple of different patients in Europe actually volunteered to have limbs amputated and replaced with robotic prosthesis.
Lauren: And now these weren't healthy limbs. They were injured in some critical way.
Jonathan: Yes, in fact one of these gentlemen, his arm was injured in an accident where he received an incredible electric shock. I was about to say electrocution, but that actually means that you've died.
Lauren: It means death, yes.
Jonathan: He suffered an incredible electric shock, which rendered one of his arms essentially useless. The other was in a terrible motorcycle accident and had suffered severe injury to his arm. Now, this was a controversial matter that these guys had decided to go and have elective amputation, because the arm was still there.
Lauren: Right. It was healthy, it wasn't necrotizing, it just wasn't functional.
Jonathan: Right. There was no way for them to regain the functionality without perhaps having a series of incredibly complex surgeries performed on them, and even then there was no guarantee that they would receive anything even resembling full mobility of their limb. So they, in the eyes of the patient, the choice is, "Do I undergo this series of surgeries that has no guarantee of real success, and it may be that what I end up with is not a lot better than what I have one, or do I elect to have this limb amputated and replaced with a robotic prosthesis which has a demonstrable proof that it can work and at least give me some mobility back. Either way I'm going to have to go through an intense rehabilitative process, but with the robotic one, there's more of a guarantee that I'm going to have some results.
Lauren: Right, and doctors were saying, "Are you sure? Because this is very permanent.
Jonathan: Yes, there's no going back.
Lauren: There's no going back here.
Jonathan: And in fact in 2012, a woman by the name Nicola Wilding suffered a terrible injury to one of her arms in a car accident, and she now is also looking at the possibility of having her arm amputated and replaced with a robotic prosthesis. In fact, she has a Twitter account where she talks about being a potential bionic woman, which is kind of interesting. But, this is already a controversy in the medical community. There's a lot of debate about, "Is it ethical to allow someone to have an elective amputation if there's a chance, even if it's only a small one, that they could regain some use out of an injured limb through -"
Lauren: Through future technology.
Jonathan: Well, through traditional surgeries, right?
Lauren: Well sure, or even if current surgery, I think with Nicola, the issues is that doctors don't think that any time in her lifetime we're going to advance our understanding of how nerves work and reconnect in order to be able to help her.
Jonathan: Right, so if she's in a position where there is very little confidence on the part of doctors that they're going to advance medicine to the point where they can actually help her to a great extent, then is it wrong for her to go and seek out an amputation, and it's kind of interesting because it brings up this question of, what is so special about our natural limbs that makes it an ethical question?
Joe: Well, I have to admit, it's scary to me. Obviously I haven't been in this position, but I'm just trying to imagine it, and imagine that I've had a serious injury to one of my arms, that it basically is not useful, it can't do anything, and seems unlikely that I could train it. Now, on one side of the coin, I can see how it would be advantageous to get a very functional prosthetic arm that could do more than my natural arm could, but it just seems so hard to say goodbye to this flesh that's attached to my body, which is weird, because what am I? I know that's a crazy question.
Jonathan: Joe, you're a writer for Forward Thinking.
Joe: But what am I? When I think of myself, I think of my arm as a part of me, but is it really any more part of me than the fingernails that I clip off once a week? It's proteins that have been made by my DNA, but is it really who I am? Do I have some kind of loyalty to this particular clump of flesh?
Lauren: And wouldn't a prosthetic, if it was truly working with you and for you, wouldn't that be equally a part of you?
Jonathan: Yeah, would the robotic prosthetic end up not just replacing the utility of your arm, but actually that identity in the sense -
Lauren: Prosthesis, sorry.
Jonathan: Thank you, Lauren, thank you, prosthesis.
Joe: Well I'm just saying that despite, all of that is rational to me. It makes sense that I could probably do more with the prosthesis, but something internally emotionally kind of recoils at that. Not that I think it would be wrong for a person to do, at all, it just seems so scary.
Jonathan: I have a centuries old riddle for you then, Joe. You have a ship, and over time parts of the ship need to be replaced, and you replace the parts of the ship as time goes on. Let's say you name the ship The Heidi Ho. Would there every come a time after you've been replacing this, piece by piece, never huge pieces, just little pieces, would there every come a time when you would no longer call it The Heidi Ho because you realize that every single piece on that ship, at some point or another, had been replaced, and there's no original part of the ship left, or does that new ship, that's in that same shape, you haven't changed the design of the ship at all, you've just changed the individual pieces out -
Lauren: Is the spirit, is the soul of that ship the same?
Jonathan: Is it still The Heidi Ho?
Joe: Right. Well that points out that our idea of identity has something more to do than just the material constituents, because our bodies do the same thing, right? Like, you -
Lauren: Technically once every seven years we completely reinvent ourselves, right? Is that the -
Jonathan: Some of us, like Lady Gaga, do it on a weekly basis.
Joe: I've heard that seven years. I don't know if that's true, but it's definitely true that our body is in constant flux and the cells are being replaced. You're not made of the exact same stuff you were ten years ago.
Jonathan: Right, but I understand entirely that there is something about the idea of saying goodbye to part of yourself, even if you're getting something new that would give you a higher quality of life, for example.
Joe: So the question is, is the arm really more a part of yourself than the fingernails?
Jonathan: Yeah, and I think most of us would say yes. Most of us would like, "Yes, that is. I can't tell you why, but it is." Now, the question I have is that right now prostheses are all about the medical world and giving people more mobility, giving them more self-reliance, giving them a higher quality of life, and all of that is so that you can replace something that has either been lost, or damaged beyond repair.
Joe: It's catching up. You're trying to get back to normal.
Jonathan: But let's say that you get to a point where the robotic prostheses are demonstrably better than a human limb, so you've created a robotic arm, for example.
Joe: So instead of catching up, you're pulling ahead.
Jonathan: You're ahead, yes. The technology has progressed to a point where the robotic arm has more capability than a human arm. So maybe it has more points of articulation. Maybe you can rotate your wrist 360 degrees, which means you can just hold the light bulb and spin your wrist around until it's screwed into place instead of having to do that wonky screw turn screw turn screw turn.
Joe: Or as we imagined in the video episode, you know, that maybe it even coordinates with other prostheses in your body to be a more accurate athletic tool. It can shoot baskets better than your normal arm.
Lauren: As you get into sensory perception, a prostheses for those as well. When I was watching Star Trek, The Next Generation, growing up, I always wondered about Geordi's visor, because it allowed him to see most of the electromagnetic spectrum.
Jonathan: Yes, much further out than the visible spectrum that all of us are familiar with.
Lauren: And at a certain point I was like, "Well, doesn't everyone want that? I kind of want that."
Jonathan: Yeah, the ability to suddenly see in infrared or ultraviolet or even radio waves or he could look at gamma radiation or things like that. Probably not so useful on the surface of the Earth, as long as our magneto sphere is working.
Joe: That would be horrifying. You'd go to the doctor's office to get an X-ray and you can see the rays coming at you.
Jonathan: Well, for you that might be horrifying, but again, this could be something that if we're talking about a prosthesis, a prosthetic eye of some sort, then presumably you would be able to engage different modes, so you wouldn't have to look at everything all of the time. First of all, you would have to train your brain on how to process that information, right? We would have to have some way of being able to bring that in. Now, if we did it the way that infrared cameras and ultraviolet detectors do, then that would just mean that we would have some sort of processor reinterpret that light into something that we could see. So we wouldn't really be seeing outside of the visible spectrum, we would be pulling that information in and converting it into something we could see. Because how do you teach the brain to do something like that? That's a good question.
Lauren: Well, this is also why we don't have Geordi's visor yet.
Joe: Yeah, would you see multiple things at once? Would you toggle? Would you have predator vision?
Jonathan: You would have predator vision, and then it would also laugh just before exploding. But no, getting back into the whole idea about the superior arm, something that has that ability, can you imagine a future where athletes or really anyone, volunteers to loose a perfectly healthy limb in order to gain this superior technology and use that instead?
Joe: So the goal is really pulling ahead. There's nothing wrong with them.
Lauren: Right, a fully functional hand that you'd go, "Yeah, I could get a better one. Let's switch it out."
Jonathan: Yeah, like to the point that, again, the robotic limb is, beyond all doubt, superior to the human limb. Can you imagine that being a world where people go in for an elective surgery to have a robotic one put in place?
Joe: Well, I think we've acknowledged that I think all three of us agree that it may be more rational to prefer a superior prosthetic to whatever's attached to you, but you have some kind of strange emotional connection to the flesh that your DNA has generated. What would it take you to get there?
Lauren: Well, I think that there's a basic mammalian, "I am alive, I need to preserve myself," kind of really intrinsic drive there, and that's why reading about this research is wonderful and terrific, but it also really squicks me out. I find myself extremely disturbed reading about these thought processes.
Jonathan: Really? Interesting. Okay, Joe, let me tell you this. If I could have a robot arm right now that could allow me to fire Nerf missiles at the two of you, I would do it in a heartbeat.
Joe: Really? You think about - I just want to ask you about the actual, your real trade-off. How good would the robotic arm, or the bionic arm, we should say, how good would it have to be and how many advantages would it have to offer before you would actually say, "Yes, I will voluntarily loose the arm that belongs to me and replace it." Does it have to be just a little bit better, or does it have to be a lot better?
Lauren: It would be a lot better for me, personally, because like I said, I'm kind of squicked by the entire idea.
Jonathan: Can you actually imagine it though, Lauren?
Lauren: I can, absolutely, and I can imagine people who are perhaps more competitive than I am jumping on board pretty early.
Jonathan: Right. Early adopters.
Lauren: Early adopters, yeah. You know, mine would need to like, make calls and coffee for me and stuff like that. It would need to wake up before I do, go crawl around and do some stuff for me, and come back and reattach. That is the kind of level.
Joe: So you wouldn't go for, say, what if your arm could be replaced with one that, they promise you that you would not be able to tell the difference. It communicates directly with your brain, you get good sensory feedback from it, you can control it exactly the same, and you can't tell the difference, except that it can't get skin infections, say.
Lauren: Yeah, until I started getting really really unpardonable rashes on my hands, I don't think that I would turn over. I don't know, it's a good question.
Jonathan: Yeah, I think the arm would need to have some significant advantages. The Nerf missile thing is a deal breaker, for me.
Joe: Oh, I see what you're saying, it has the Nerf, the missiles shoot straight out of it, like a Mega Man arm.
Jonathan: Yeah, like there's a little section in the forearm that pops up and there are Nerf missiles loaded in there. By the way, Nerf has nothing to do with this podcast.
Joe: Yeah, we're not sponsored.
Jonathan: I just really want that.
Joe: Okay, so you're saying, I understand now. You want a Mega Man arm.
Jonathan: Yeah, more or less.
Lauren: So you're on the side of weaponization, is what we're really saying.
Jonathan: I want a combination of the Nerf missile arm, and a Nintendo power glove, but it's just built into my arm. Think about it. I like this idea of being able - now granted, if we were able to bypass this and not need the cyborg arm at all, the bionic arm, in order to do this, then obviously that's the way I would go, but if we had it where my robotic arm is capable of controlling things like the various electronics in my home or, again, like you were saying, Lauren, about being able to receive or make calls, that's stuff that I would really want. Now granted, I'm just talking about my right arm. Leftie stays with me, because I'm a left-hander and I cherish that.
Joe: So you were joking about the Nerf gun, but you seriously would actually, you think, trade for a somewhat capable, what would you call it, an executive control electronic -
Jonathan: It would definitely need to be able to not only do everything that my current arm can do, but do it better, because otherwise I would just be like, I'm not going to lose my arm just for some convenience. I would need it to be able to perform better and I would need it also to have those extra bells and whistles.
Joe: Well, just one thing I was going to say is that I'd need, I think one thing I would need is the ability to upgrade. Now, imagine that they offer me an arm that is exactly the same as my arm now, but it can't get skin infections. Not like I get a lot of skin infections on my arm, but just some kind of basic advantage that's not very huge, but they say that software is upgradeable, and you could download aps that make the arm even better.
Jonathan: I would definitely want both software and hardware to be upgradable. Because as someone who owns a smartphone, there's something that's really frustrating about taking home the smartphone and then the next week a better smartphone comes out. Can you imagine if a better arm came out the week after you got a graft?
Lauren: Or even just, what if your arm gets viruses? What if your arm gets computer viruses?
Jonathan: Well, your arm can get viruses now.
Lauren: What if someone can - Well then, is it really an improvement over your current arm, or what if a virus gets into your arm and it goes bad?
Jonathan: So now we're going to an Idle Hands scenario. Alien hand syndrome.
Lauren: What if someone hacks your hand? That's terrible.
Joe: How many episodes are we going to have where something becomes a robot and then it gets viruses or people hack it? They hack it, and then it's dangerous. Is this the future of everything is potentially hackable? "Oh no, they hacked my coffee cup."
Jonathan: Lauren, honestly, I think if someone wants to do you harm, there are easier ways to go about it than hacking into your cyborg arm.
Lauren: I don't know, but that one has style. I would pick that over -
Jonathan: Okay, well it's good to know that Lauren would pick that. So if we see Lauren with a How to Hack Robotic Arms for Dummies book at her desk, we all know not to go with that elective surgery.
Lauren: Everyone watch out, yep.
Jonathan: Well, you know, this is an interesting hypothetical conversation. Or, this is a real conversation, but it's an interesting conversation about a hypothetical topic. It'll be interesting to see if we ever do reach a time, in our lifetimes, where such a consideration would need to be made for realsies. I mean, we've seen people elect to have their injured arms amputated. I don't know that we're ever going to get to a point within our lifetime where a healthy limb would be amputated by choice. If that does happen, it'll be huge news. And I imagine there will also be an enormous backlash in the medical community and a real debate about the ethics of such a thing. Like, who performs such a surgery, and is that ethical or not.
Lauren: Yeah, there is a condition under which people feel like limbs that they have that are healthy are not their own and they want them off.
Jonathan: Yeah, I've heard of such a thing as well, and that raises questions. Like, if you were to open this up, is that ethical if people who might have something that other folks would identify as a disorder, whether you want to call it that or not. I'm sure there are many people who would say, "That is a disorder." That's fair enough to say. Would it be fair to open up the doors for those people to go in and have those elective amputations, or would that be unethical, if the medical community said, "No, this needs to be treated as a form of psychological disorder." There are a lot of tricky questions and we don't have the answers for it, mostly because our technology is not there yet. But the reason why we have these conversations is, that technology is going to continue to advance and we will, one day, be at that point. So having the conversation early is a lot better than having it after the fact.
Lauren: Definitely. Always.
Jonathan: So guys, this is a good time to remind you, if you are interested in these sort of topics, please go to our website fwthinking.com and let us know. You can check out the video series there, you can read our blog posts, and really take part in this conversation and let us know what you are excited about as far as the future is concerned, and that way we can really concentrate on these topics and really have a great conversation about it. We look forward to hearing form you, and we will talk to you again really soon.
Male Speaker 1: For more on this topic and the future of technology, visit fwthinking.com. Brought to you by Toyota. Let's go places.
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Duration: 20 minutes