The repaired man or man with extras: medical human-cyborgs

Abstract

In this article, I try to provide a definition of the term medical human-cyborg and existence, from a humanistic and posthumanistic approach to health care. I try to derive and define it exclusively on the basis of real, existing medical technical solutions. Also, in order to reflect on where health care is heading and what the dangers of technological development might be. How did medicine move from implantation to medical human-cyborgs? Has it really got there?The use of the term cyborg existence is linked to posthumanist philosophy. Donna J. Haraway's Cyborg Manifesto is one of the first posthumanist philosophical works (1). For her, cyborg is not about modifying the physical body. The cyborg, it is a metaphor for a mode of being completely permeated by technology (a society organised by technology), and its key question is the analysis of personality and identity integrated into technical networks. Haraway argues that in contemporary society it is impossible to maintain distinctions of modern origin such as human/non-human, organic/inorganic. Humanism proclaims the excellence of the human race, it is being a unique summit in nature. Posthumanism is present in almost all disciplines, and so there exists the posthumanist position in health care. Posthumanist expectations and proposals for change have been formulated mainly in nursing (2,3,4). Thus, the cyborg existence is not only an identity and a metaphor, but also a possible attitude and a way of being in health care.Posthumanism has several trends. What they have in common is that they reject the inherent, purely human excellence (essence) (5). This does not mean the immediate acceptance of the machine, but it does mean that 'there is no clear dividing line between human and non-human' (6). It is a worldview without a center, which does not mean that it breaks with the human, but all its variants deny the existence of an autonomous human subject. Others, as posthumanists, are arguing that the embeddedness of humanity in living and self-organizing matter positions the human as a factor that is neither exclusively organizing nor organized (7).There is no doubt that modern health care was conceived with humanistic goals. The right to health is clearly a humanist idea. According to posthumanists, modern health care is only ostensibly the most humanistic of social institutions, and its greatest falsehood is that it is equally accessible to all. In their article on posthumanist patient care, A.C. Laurin and P. Martin draw attention to the power asymmetry/relationship between nurse/doctor and patient, as it is also observed in other areas of society (2). In humanist health care, the unequal doctor-patient situation is now common, in which the doctor exercises control over the sick person on the basis of rational scientific results (3). Nursing and medicine are also permeated by power (medical paternalism) (8).At the same time, also the clearly humanist value of medicine is the nonacceptance of correctable defects and disabilities that the health care promotes by using ever more advanced technical means to compensate for visible disabilities, for example. Moreover, cosmetic and gender-affirming surgery has long made man malleable (9), which, by making it possible to correct a condition that is not personally acceptable, is also conceived in humanist terms.The posthumanist approach to health does not dehumanise, but integrates the human and the non-human (decentralises) (6)! Posthumanist nursing means openness to desires and ways of being beyond the walls of the clinical environment. While the hospital isolates the patient's body, posthumanist care opens up to the hybrid nature of reality (10): for example, the use of virtual reality glasses by dementia patients brings them into the reality they create (escape into cyberspace) (11). This blending (cyborg existence) and the fact that many humans are chemically, surgically, technologically modified in bodies in close contact with machines is the vision of posthumanism. A new phase of human evolution may be coming, characterised by a blurring of the boundaries between humans and non-humans. Posthumanist theory is an attempt to re-socialise and decentralise the human subject. In health care, we decentralise ourselves through the use of medical devices, but at the same time we immediately subordinate ourselves to the control of digitalisation. Even the simplest mHealth (mobile Heath) devices are already embedded in the physical self-image of many (12,13). Moreover, one should also think of nomophobia (as a disease), which is the anxiety symptom complex experienced by those who do not have or do not have a working smartphone (14). According to P. Standbrink, the non-actionable, biologically exogenous so-called commoditycyborgism (the use of artificial intelligence (AI)-powered smart devices) is also a form of cyborg-existence (15). Posthumanism in health technology, with its decentralization of the subject, understands the body as part of a complex techno-ecosystem (4), thus making the definition of the human more malleable.However, posthuman health care does not provide answers to many questions not solved by humanist, and even generates new ones. It also entails inequality: I don't see how it solves the problem of inequality in health care, and why does not even becoming a medical human-cyborg getting a matter of material resources? It may change the dominance in doctor-patient relationship, but the fundamental problem here is the issue of gain health information to the patient. The patient (e-patient) can participate -as an equal partner -in matters concerning his/her own illness (no decision about me, without me), but to do so, it is increasingly difficult to judge the truth of the source of the information he/she obtains: fake news is seriously permeating also the health care sector (16). People also lack critical thinking, source-criticism that recognises health fake-news.Generative artificial intelligence and large language models can increasingly help in obtaining health information (17), but only if used well by the e-patient -which is the privilege of few. It is also inequality itself, because a good part (majority?!) of people cannot keep up with the IT advances (either) needed to manage it (18). A cyborg is a creature that mixes mechanical (cyber) and biological (organic) components. In art (movies, books, comics), they are mostly super-powered creatures with sensors, weapons, robotic limbs, even AI to help them make decisions, but the point is that they are amplified, they have superpowers. Most of us first heard the term cybernetic organism (cyborg) in the Terminator 1 movie (T-800). But the Terminator is not actually a cyborg in the current (and future) medical sense. The organic part was just the skin, some muscle, designed to blend in with the humans (cover the machine). Obviously the details weren't worked out, but it wasn't a really "human" biological tissue, just a disguise. The more advanced version of the T-800 and the one in Part 2 (now with human emotions) is a so-called biohybrid robot: it is an electronics system with human tissue -in the case of the T-models, a tissue mantle. Androids (or replicants) are not cyborgs either, because they are AI-controlled robots that do not contain human tissue, but are fully human-like.In reality, more and more people are living with some kind of device (medical device, artificial organ) in their body: pacemaker, prosthesis, etc. These people could not be called as cyborgs. Or should we? Or with how many incorporated electronics should we call them as cyborg? Or only when AI already plays a fundamental role in the electronics built in and it is able to make independent health decisions? The ICD (implantable cardioverter defibrillator) and the pacemaker also make independent decisions, but they are not AI! A medical implant is a device or tissue that is placed in or on the body. Probably most implants are prostheses (others e.g. sense bodily functions) and mainly support organs (e.g. medical devices). A prosthesis is an artificial/engineered device that replaces a limb or missing organ. A prosthesis is an artificial replacement part of the body: it replaces a part that is missing or no longer functions properly. An artificial heart -as a highly technical medical solutions -that can be used now e.g. to go to school is just a more serious implant only? (19) Or is a person with such an artificial heart living as a human-cyborg? A cyborg is therefore can also be a combination of a human and a machine: part human, part robot (this is the medical humancyborg).Many people have tried to classify medical human-cyborgs. Basically, they are classified according to the different levels of integration of artificial accessories into the body: e.g. a human with a neurological device (e.g. bionic arm) (20) or a human with a device that supplements (replaces) the nervous system (e.g. cochlear implantation). Some classifications even introduce a category in which the device also adds a new function to the nervous system, speaking of reconfigurative, even adaptive and creative (implying machine learning of the device) capabilities (21). According to P Standbrink, cyborgism in the sense of human development (machine and digital) takes seven forms, differing in intensity, extent and degree of hybridity (15). In his division of biologically embedded medical human-cyborgism, he mentions two degrees: biologically exogenous medical human-cyborgism (e.g. exoskeleton) and biologically implanted medical human-cyborgism (totally artificial heart, TAH). He also gives a category for so-called non-actionable biologically exogenous commodity cyborgisms (e.g. smartphone, interactive digital platforms). There is also a publication whose authors consider any technical or mechanical device that is connected to the body to assist human hearing, movement, vision, failing organs, and more, as examples of medical human-cyborgism (22).There is no clear definition of the human-cyborg condition. One could even decide whether one can be called a cyborg on the basis of how many artificial organs one has implanted: how much of the combination of ICD, cochlear implant, pacemaker, prosthesis is needed for medical human-cyborg existence? Or should the degree of machine-human hybridity (more machines essential to life functions and less humans) be a measure of medical human-cyborg existence? There is therefore no accepted definition of being a human-cyborg. In my opinion, with the enormous development of medicine, it seems to be necessary. The definition should declare that the cyborg concept defines exclusively physiological functional capacity, or attempt to integrate this medical definition into the philosophical, cognitive literature approach. I believe that people with implants and artificial organs are not yet medical human-cyborgs, these are great achievements of humanistic medicine. Health care currently creates repaired patient with technological, bionic and AI-based healing (machines). As long as the abilities of the person treated in this way do not differ from those of a healthy person, we can only talk about healing resulting from the technological development of health care ("Repaired Man"). A person who sees with a bionic eye does not see better or moves with a bionic arm is not stronger, as well as the person living with a TAH will not be more fit cardiacly than a healthy person.But the integration of the machine (+AI) into the human body may reach such an extent (one may say the degree of hybridity) that it will not only be a supplementary tool for the nervous system but will also be suitable for machine learning. If the technology reaches the point when the patient, with the artificial organ -received as treatment -able to do more than when healthy, in this case the "Man with Extras" is created. This development therefore no longer means that humanist health care has reached the point of the patient's dependence and intertwining with medical technologies. Rather, it means that medical science begins to actively control abilities. As long as this happens for the purpose of healing (as an advantageous side effect, just as many drugs have beneficial side effects), it may perhaps still be called humanist medicine.In my opinion, someone can only become a medical human-cyborg if he also receives cybernetic organ superpowers compared to a healthy person. Consequently, if the sick person receives a device that does not only supplements their impaired abilities, but also increases his biological abilities, then these will be born the medical human-cyborg. Perhaps this is the time when healthcare enters the posthuman state.