Bionic construction of the human body in the light of the slippery slope argument

Yıl 2022, Cilt: 2 Sayı: 2, 81 - 90, 24.04.2022

Şükrü Keleş

Öz

Composite tissue transplantation has gained a new dimension in line with advanced technological developments. In extremity losses, the traditionally implemented procedure is to enable the extremity to regain its functionality through replantation instead of transplantation. On the other hand, innovative studies are also carried out to sup-port and strengthen the human body and improve the problematic body functions for increasing patients’ quality of life. Studies on developing biomechatronic systems, which are related to biology, neurology, biophysics, me-chanics, biomedical and tissue engineering, electronics, and computer sciences, are in progress, which indicates that a transformation has occurred in the approaches to composite tissue transplantation. This study aims to gener-ate ideas about determining a conventional limit in the interventions towards the human body against the techno-logical and scientific developments and to perform a value analysis on such interventions. This study was designed within the framework of the methodology of medical ethics and in the light of the slippery slope argument. The process of transformation from the medical procedures that aim to protect patients’ bodily integrity to the inno-vative practices that provide an opportunity to bionically turn healthy human bodies into the half machine and half-human is investigated in the light of the slippery slope argument. This study indicated that the value-related problems regarding this issue are related to the principles of respect for autonomy, beneficence, non-maleficence, and justice. The limit to be determined for the practices that aim to protect the patients’ bodily integrity and in-crease their quality of life and that are not life-saving depends on the distinction between an ill body and a healthy body. A meticulous clinical perspective and legislative regulations that prevent the instrumentalization of humans are required so as not to roll down to undesirable places on a slope. Advanced technological developments are implemented in medicine, protecting human dignity should be adopted as a fundamental value.

Anahtar Kelimeler

Medical ethics, slippery slope argument, bionic construction

Kaynakça

• 1. Turkish Medical Association. (2012, June). Composit Tissue Transplantion Report. Retrieved from https://www.ttb.org.tr/haberarsiv_goster.php?Guid=66e730c4-9232-11e7-b66d-1540034f819c
• 2. Thurston AJ. Paré and prosthetics: The ear history of artificial limbs. ANZ J. Surg. 2007;77(12): 1114-9. doi: 10.1111/j.1445-2197.2007.04330.x
• 3. Zuo KJ, Olson JL. The evolution of functional hand replacement: From iron prostheses to hand transplantation. Plast Surg (Oakv). 2014;22(1): 44-51.
• 4. Hernigou P. Ambroise Paré IV: The early history of artificial limbs (from robotic to prostheses). Int Orthop. 2013;37(6), 1195-7. doi: 10.1007/s00264-013-1884-7.
• 5. Dubernard JM, Owen E, Herzberg G, Lanzetta M, Martin X, Kapila H, et al. Human hand allograft: Report on first 6 months. Lancet. 1999;353(9161):1315-20. doi: 10.1016/S0140-6736(99)02062-0.
• 6. Lanzetta M, Petruzzo P, Vitale G, Lucchina S, Owen ER, Dubernard JM, et al. Human hand transplantation: What have we learned?, Transplant Proc. 2004;36(3):664-8. doi: 10.1016/j.transproceed.2004.03.006.
• 7. Özkan Ö, Demirkan F, Özkan Ö, Dinçkan A, Hadimioglu N, Tuzuner S, et al. The first (Double) hand transplantation in Turkey, Transplant Proc. 2011;43(9):3557-60. doi: 10.1016/j.transproceed.2011.08.045.
• 8. Ministry of Health of the Republic of Turkey. Composite Tissue Centers Directive (2011, March 29). Retrieved fromhttps://www.tonv.org.tr/tr/yasal-duzenlemeler/
• 9. Akdoğan E. Bir alt disiplin olarak Biyomekatronik. In: Türkiye Otomatik Kontrol Ulusal Toplantısı (in Turkish). 2013. 176-8 p.
• 10. Aman M, Sporer ME, Gstoettner C, Prahm C, Hofer C, Mayr W, et al. Bionic hand as artificial organ: Current status and future perspectives. Artif Organs. 2019;43(2):109-18. doi: 10.1111/aor.13422.
• 11. Herr H. (2014, March 28). TED Talks. Retrieved from https://www.youtube.com/watch?v=CDsNZJTWw0w
• 12. Breton DL. L’Adieu au corps. (Translator: Aziz Ufuk Kılıç). 1st ed. İstanbul; Sel Yayınları, 2016.
• 13. Aman M, Festin C, Sporer ME, Gstoettner C, Prahm C, Bergmeister KD, et al. Bionic reconstruction: Restoration of extremity function with osseointegrated and mind-controlled prostheses. Wien Klin Wochenschr. 2019;131(23-24):599-607. doi: 10.1007/s00508-019-1518-1.
• 14. Pierrie SN, Gaston RG, Loeffler BJ. Current concepts in upper-extremity amputation. J Hand Surg Am. 2018;43(7):657-667. doi: 10.1016/j.jhsa.2018.03.053.
• 15. Dore C. Abortion, some slippery slope arguments and identity over time. Philos Stud. 1989;55(3):279-91. doi: 10.1007/BF00355326.
• 16. Hetzler PT, Nie J, Zhou A, Dugdale LS. A report of physicians’ beliefs about physician-assisted suicide: A national study. Yale J Biol Med. 2019;92(4):575-85.
• 17. Buturovic Z. Embracing slippery slope on physician-assisted suicide and euthanasia could have significant unintended consequences. J Med Ethics. 2021;47:257-8. doi: 10.1136/medethics-2020-106089.
• 18. Walton D. The slippery slope argument in the ethical debate on genetic engineering of humans. Sci Eng Ethics. 2017;23(6):1507-28. doi: 10.1007/s11948-016-9861-3.
• 19. Bruzzone P. Financial incentives for organ donation: A slippery slope toward organ commercialism? Transplant Proc. 2010;42(4):1048-9. doi: 10.1016/j.transproceed.2010.03.058.
• 20. E. Volokh, ‘The Mechanisms of the Slippery Slope’ (2003) 116 Harvard Law Review 1026–1137, 1032. Available at: https://www.mayerbrown.com/-/media /files/perspectives-events/publications/2003 /01/the-mechanisms-of-the-slippery-slope/files/slippery/fileattachment/slippery.pdf
• 21. Smith, S. (2012). Slippery slope arguments. In End-of-Life Decisions in Medical Care: Principles and Policies for Regulating the Dying Process(Cambridge Bioethics and Law, pp. 261-289). Cambridge: Cambridge University Press. doi:10.1017/CBO9780511793929.015.
• 22. Topçu E, Yalım NY. A medical ethical evaluation, using the slippery slope argument, as to whether or not preimplantation genetic diagnosis will result in eugenics and human instrumentalization. TJOB. 2015;2(3):187-201. doi: 10.5505/tjob.2015.52824.
• 23. Burg, W. The slippery slope argument. Ethics. 1991;102(1):42-65.
• 24. The Constitution of the Republic of Turkey. (1982, November 9). Retrieved from https://www.anayasa.gen.tr/1982Constitution-EYasar.htm
• 25. Official Gazette. The Law on the Harvesting, Storage, Grafting, and Transplantation of Organs and Tissues” (1979, May 25). Retrieved from https://www.resmigazete.gov.tr/arsiv/16655.pdf
• 26. Official Gazette. The Regulation on Organ and Tissue Transplantation Services (2012, February 1). Retrieved from https://www.mevzuat.gov.tr/mevzuat?MevzuatNo=15860& MevzuatTur=7&MevzuatTertip=5
• 27. Official Gazette. The Convention for the Protection of Human Rights and Human Dignity in Terms of the Implementation of Biology and Medicine: The Law on the Approval of Human Rights and Biomedicine Convention. (2017, March 14). Retrieved from https://www.resmigazete.gov.tr/eskiler/2017/04/20170403-49.htm
• 28. Cooney CM, Siotos C, Aston JW, Bello RJ, Seal SM, Cooney DS, et al. The ethics of hand transplantation: A systematic review. J Hand Surg Am. 2018;43(1):84.e1-84.e15. doi: 10.1016/j.jhsa.2017.08.004.
• 29. Chang J, Mathes DW. Ethical, financial, and policy considerations in hand transplantation. Hand Clin. 2011;27(4):553-60. doi: 10.1016/j.hcl.2011.07.006.
• 30. Oğuz NY, Tepe H, Büken NÖ, Kuçur DK. Bioethics Terms Dictionary. 1st ed. Ankara: Türkiye Felsefe Kurumu; 2005.
• 31. Turkish Bioethics Association. Statement on the Organ Transplantation and Ethics. Retrieved from https://biyoetik.org.tr/gorusler/turkiye-biyoetik-dernegi-organ-nakli-ve-etik-ilkeler-gorusu/
• 32. World Medical Association. Statement on Organ and Tissue Donation. Retrieved from https://www.wma.net/policies-post/wma-statement-on-organ-and-tissue-donation/
• 33. Keleş Ş. Does genetics threated human freedom and autonomy (in Turkish)? Turk Clin J Med Ethics. 2013;21(1):1-17.
• 34. Dickenson D, Hakim NS. Ethical issues in limb transplants. Postgrad Med J. 1999;75(887):513-5. doi: 10.1136/pgmj.75.887.513.
• 35. Salminger S, Roche AD, Sturma A, Mayer JA, Aszmann OC. Hand transplantation versus hand prosthetics: Pros and cons. Curr Surg Rep. 2016;4:8. doi: 10.1007/s40137-016-0128-3.
• 36. Brack R, Amalu EH. A review of technology, materials and R&D challenges of upper limb prosthesis for improved user suitability. J Orthop. 2020;23:88-96. doi: 10.1016/j.jor.2020.12.009.
• 37. Harris J. Is gene therapy a form of eugenics? Bioethics. 1993;7(2,3):178-87. doi: 10.1111/j.1467-8519.1993.tb00283.x.