Nanotechnology: Changing the Disability Paradigm
Individuals vary greatly. There are different physical, intellectual, sensory and mental capabilities that differentiate us. About 650 million people around the world differ from the species typical functioning capabilities -physical, intellectual, sensory and mental- and are considered impaired. New technologies, such as nanotechnology, have the potential to help those people to overcome these differences. Nanotechnology plays an important role among other technologies as it enables them to work at the nanoscale, that is to say, at the level of atoms and molecules. Being able to work at the nanoscale is important because at the nanoscale the properties of matter change compare to the properties that matter presents in larger scales. Considering all the features and the amount of research that is carried out in the area of nanotechnology, we could say, almost without doubt, that nanotechnology has the potential to help people seen as disabled, through better implants, prosthesis materials, therapies and so on. It might even eradicate those differences that nowadays are seen as the cause of disabilities. In this paper, I am interested in discussing how nanotechnology has the potential to challenge the current disability paradigm. On the one hand, we have the issue that in the quest for posthumanity, all those people who cannot afford to become posthuman will instead become disabled. On the other hand, even if posthumanity does not pose a threat to the 'normal' humans, it will still be worth analysing the way society confronts disabilities. It seems that through new technology many want to achieve perfection, forgetting that certain disabilities also offer us a path to understand our humanness. In this paper, I will argue that nanotechnology should be used to help people with impairments to achieve an effective participation in society, rather than focusing on eliminating impairments as such.
Nanotechnology is a nanoscale technology, in which the prefix 'nano' , indicates that the measure corresponds to a one billionth part of the unit, i.e. a nanometre (nm) is equal to one billionth of a metre. In other words, nanotechnology enables us to engineer and work at the level of atoms and molecules. Nanotechnology has the potential to help us tackle many of our current problems, for instance, to combat cancer or global warming. But it also has the potential to challenge our understanding of what it means to be human, what it means to have impairments, to differ from the norm or to be different.
Individuals vary greatly. It is our physical, intellectual, sensory and mental capabilities and features that differentiate us. About 650 million people around the world have impairments that make them differ from the species typical functioning capabilities - physical, intellectual, sensory and mental- that are seen as disabled (UN Report, 2008). Nanotechnology has the potential to help people with impairments to overcome these differences, through better implants, prosthesis materials, therapies and so on. It might even eradicate those differences that nowadays are seen as the cause of disabilities. In this paper, I am interested in discussing how nanotechnology, both the way we use it and understand it, has the potential to challenge the current disability paradigm. In this paper, by disability paradigm, I am referring to the current predominant disability model in the Western culture, in which impairments are viewed and understood, namely within the medical model of disability. On the one hand, we have the issue that in the quest for posthumanity - understood as a quest to transcend our human biological limitations- all those people who cannot afford or do not choose to become posthuman will instead become disabled. On the other hand, even if posthumanity does not pose a threat to the 'normal' humans, the way in which we confront impairments is still worth analysing and questioning. I believe that analysing and questioning our current disability paradigm is worth doing, as it seems to me that within the current paradigm, we haven't been able to include those who are different, not by their own choice, but by chance or accident. Moreover, such a model does not acknowledge that certain impairments can also offers us paths to understand our humanness.
In this paper I will argue that nanotechnology should and could help us to overcome the current disability paradigm, and embrace a model, such as the social model, that uses technology for helping people with impairments to achieve an effective participation in society, rather than focusing on eliminating impairments as such. In order to achieve this, I will outline nanotechnology's importance. Then I will introduce the way disabilities are perceived and the different models of disability, and finally I will argue how nanotechnology can challenge the current disability paradigm.
Why nanotechnology is important
Nanotechnology is important for several reasons. First, nanotechnology enables other technologies and knowledge systems, such as neuroscience, to engineer and work at the nanoscale. Second, the amount of money invested and research being carried out around the world in nanotechnology keeps increasing each year (Cientifica Report 2008; IRGC, 2006). For instance, the US National Nanotechnology Initiative spent in 2005 1,081 billion dollars, but has approve 1,527 billion for 2009. Third, it has unique power and potential, due to the fact that it allows us to work with the building blocks of living and non-living matter. Also at the nanoscale, the properties of elements and materials can change dramatically, showing different electrical, conductivity, colour, strength, elasticity, melting point and reactivity properties, than they do on a larger scale. Many of these size-dependent physical properties that exist only at the nanoscale are the result of quantum effects (Wilson et al., 2002; Ratner and Ratner, 2003). Finally, it is important because nanotechnology beyond its technical understanding, brings to the fore different social visions and understandings . Matthew Kearnes et al. (2006) in the DEMOS publication, Governing at the nanoscale: people, policies and emerging technologies, identified five different understandings of nanotechnology: (1) as an extension of the 'miniaturization imperative', (2) as 'control over the structure of matter', (3) as a ' revolution', (4) as a 'new science', and (5) as 'socially robust science'. Other social understandings of nanotechnology, and the ones that are relevant to this paper, are the ones regarding nanotechnology as science fiction and as a cyborg/posthuman technology (Milburn, 2002; Cabrera, 2007). Nanotechnology as a science fiction projection might be the result of the tendency of speculation and prognosis in some of the writings about nanotechnology (Drexler, 1986; Arnall, 2003; ESRC, 2003; Garreau, 2005; Freitas; 2007; Gordijn, 2005). This vision has motivated the understanding of nanotechnology as a cyborg/posthuman technology. Donna Haraway (1991) and Scott Bukatman (1993) suggest that science fiction technologies transfigure embodied experience, creating the appearance of a posthuman subject. Nanotechnology has the potential of blurring limits- not only limits between science and science fiction, but more importantly between us as humans and our technology, and between living and non living material- and therefore is a technology that enables the cyborg and posthuman visions (Milburn, 2002; Cabrera, 2007). All these different understandings of nanotechnology make it a special kind of technology; special in the sense that it is reconstructing our world and our understanding of it and ourselves. This reconstruction can help us to incorporate marginalized groups into the choices we make as humankind to shape our understanding about our capabilities and our differences. Nanotechnology is important, not because it might help to accomplish science fiction dreams or human desires for enhancement through technology; but more importantly, because it has the potential to relocate our priorities and bring about a more equal participation, and inclusion of those who, because they do not fit both the biological and social normative species typical features, have been left behind. In other words, nanotechnology can help us change our current disability paradigm into one that does not use technology to focus just on "fixing" impairments, but rather a disability paradigm that really enables everyone. But before I get on with this subject, I believe it is important to have a better understanding of the way disability is viewed and understood.
It is important to have a better understating of disability, because definitions have social and global implications for their content, meaning, and responses (Wolbring, 2005). The term disabled has been associated with marginalized or disadvantage groups (Wolbring, 2002; 2008). Some people associate having a disability with having an impairment. The World Health Organization (WHO) in its International Classification of Impairments, Disabilities and Handicaps (ICIDH) states that impairments are "any loss, abnormality or other significant deviation of psychological, physiological, or anatomical structure or function"; whereas disability is a "restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being" (WHO,1980) or other significant deviations from a certain generally accepted population standards, which may fluctuate over time. Unfortunately, the term disabled is predominantly used to describe a person who is perceived as having an impairment, intrinsic defect, chronic illness, or disease leading to subnormal functioning and expectation. Thus, most people do not realize that having an impairment, intrinsic defect, impairment, chronic illness or disease does not make people disabled per se. If that were the case, I believe, all of us would fit the term disabled in at least one sense. People are labelled and treated as disabled as a result of the negative social attitudes and environmental barriers towards them because of their condition (WHO, 1980; Wolbring, 2005, 2008, 2008b, 2009; Miller et al., 2004). So disability is not a description of a personal characteristic, but rather it describes how society responds to people with impairments. Hence, it can be argued that disability is the way some societies or cultures have responded to those that do not fit the norm. The term disability covers a whole range of impairments, as can be seen by the definition under the Australian Disability Discrimination Act (DDA, 1992), encompassing physical, psychological, mental, sensory and intellectual impairments. It can be total or partial loss of a part of the body, or person's bodily or mental functions; the presence of something that causes or that is capable of causing disease or illness; the malformation, malfunction or disfigurement of a part of the person's body; malfunction or disorder that results in the person learning differently from a person without the malfunction or disorder; a disorder, disease or illness that affects a person's thought processes, emotions, perception of reality or judgment or that results in disturbed behaviour; presently existing, previously existed but no longer exists, may exist in the future or is imputed to a person (DDA, 1992). Considering that the impairment condition(s) of the people labelled as disabled can: come and go, be multiple, be invisible to the rest or more severe than others (Miller et al., 2004), the idea of an 'average' disabled person fails, having just in common "the barriers and prejudice they face" (Miller et al., 2004:26). Moreover, people with impairments have a diverse range of identities and opinions about themselves. Some identify themselves as having an impairment/s, others do not, others some of the time; some accept the fact that they are different, others do not; some want to be brought back to the normative species typical features, others left as they are and others even want to be "fix" beyond species typical features. After having analysed the complexities and misunderstandings surrounding the disability discourse, I believe we have important grounds to include it even more in the public agenda, more than we have been doing in the past: firstly, because there are an estimated 650 million persons living with impairments that are classified as disabilities according to the UN report (2008), in the world today, which is around 10 per cent of the global population (UN report 2008); secondly, because people with the kind of impairments that are seen as disabilities are a growing group (Miller et al., 2004), not only as a result of the demographic shift towards an ageing population that is taking place, meaning that more and more people fit into the DDA 'disability' definition; but more importantly, because nanotechnology, among other technologies, is blurring normative boundaries concerning the body and mind's species typical functions, abilities and performance. Evidence of this is some of the new generation of prosthesis for athletes (Delander, 2007).
To further differentiate within the disability discourse there are different views and understanding of how to deal with the kind of impairments that are considered as disabilities. In this paper I refer to those views and understanding as a paradigm, but in the literature, it is more common to find those views and understandings referred as models on disability.
The model of disability that we hold influences the way we see and treat people with impairments, the actions we take regarding those impairments, and the usage of our technologies. In other words it defines a paradigm, in this case a disability paradigm. Having an overview on the main models of disability allows us to identify which is the current predominant disability paradigm, and some of the possible options we have if we intend to use nanotechnology for shifting to a disability paradigm that really enables people.
This is the current predominant model, at least within modern Western culture. Thus, we can say it is our current disability paradigm. Within this model, as soon as one is regarded as medically ill or exhibiting functions or structures that depart from the accepted norm, one is identified as disabled. Gregor Wolbring, research scientist at the University of Calgary, sees the medical model linked to a form of ableism "which favour species typical normative abilities (seen as the healthy state) leading to a negative perception of being 'less able' than what is species typical (the disease, defect, disorder state)" (Wolbring, 2008, p.33). Here and after I am using the term ableism following Wolbring's definition of ableism as a set of practices, beliefs, and processes that produces, based on the favouritism for certain abilities that are projected as essential, a particular kind of understanding of one's body, oneself and one's relationship with others (humans, other species and the environment) (Wolbring 2002, 2003, 2005, 2008, 2008b, 2009). As a result of this, it is plausible to say, that within this model, disability is used interchangeably with terms such as disease, impairment, illness, defect, a problem inherent to the person, anomaly, chronic disease or any other form of deviation from certain norms. Consequently, people labelled as disabled under this model are seen as patients. Hence, the aim within this model is to cure, prevent or adapt the person's impairment(s), in order to fit the norm established by the species-typical functioning (Daniels, 1985). Moreover, the use of technologies, such as nanotechnology, within this model is focusing on offering a medical or technological fix towards the norm (Wolbring, 2003). Consequently, nanotechnology under this model would be used to create therapies, new prostheses or other technical devices that allow the 'patient' to fit the norm, for instance, a cochlear implant for a hearing-impaired person. However, I believe that the assumption of us knowing what normal is, and as a consequence focusing on bringing impaired people to normal, either body structures or capabilities, only devalues and objectifies impaired people, seeing them as essentially costly and deficient. Moreover, it ignores the significant contribution people with impairments "can make as part of a diverse society" (Miller, 2004:26). Therefore, I do not think 'normal' should be equated with the species typical features, narrowing our understanding of normal as having certain body features or performing certain activities in a particular way. As it seems to me, that what we consider as normal is shaped greatly by society not by biology. Furthermore, I believe the previous reasons, make questionable this paradigm's ability to challenge the barriers imposed by society and culture. For that reason, I argue that by using nanotechnology with a different focus, we could and should bring about a shift of paradigm.
This model can be seen as a response to the lack of attention to the social determinants in the aforementioned model. Within this model, 'disabled' people are not seen as intrinsically impaired. On the contrary, people with impairments are given "the chance to realize that they personally are not the problem" (Miller et al., 2004:22). Accordingly, disability is seen as a socially created problem, by the attitudinal and environmental barriers, that does not allow people with different abilities and biological realities to participate and integrate as full members of society (Wolbring, 2005, 2008, 2009; Miller et al., 2004). Regarding this model, Wolbring states, "the biological reality of disabled people is seen as a variation of being, not in need of fixing, but in need of having the physical environment, the interaction with the physical environment, and the societal climate changed to accommodate their biological reality"(Wolbring, 2005:18). Consequently, under this model, social action is required instead of medical intervention. The social model does not negate that impaired have a certain biological reality that makes them different (Wolbring, 2005), but it does not aim at eliminating the difference, rather to explore ways of integrating those difference given the person the chance to develop his or her own potentials. Considering that most impaired people do not perceive themselves as subnormal but rather they describe their conditions as givens of their lives, the kit that was given to them as part of the natural lottery to meet the world, this model could truly enable them. Thus, in contrast with the medical model, nanotechnology will not be used to help impaired people to fit a norm, but rather to accommodate his or her differences in society, for example by creating environments, i.e. using smart materials, that allow blind people to navigate more easily through them.
In the last decades the transhumanist movement has gained strength around the world, permeating even the way we understand disability. The transhumanist movement emerged from the borders of cyberculture in the late 1980s. However the term "transhumanism" seems to have been first used by Julian Huxley, a distinguish biologist and Aldous Huxley's brother, as "man remaining man, but transcending himself, by realizing new possibilities of and for his human nature"(Huxley, 1957). Later on, the term started to be used, beyond what Huxley had imagined, as the short form of transitional human, someone who, due to the use of technology, his cultural values and lifestyle, constitutes an evolutionary link to a stage in which humans have transcended their human limitations. Consequently, the term is commonly used in the posthuman discourse. Transhumanism through the transhumanization of ableism has shaped a different model of disability, namely the transhumanist model. The transhumanized version of ableism, is a form of ableism based on the favouritism of those abilities that are beyond Homo sapiens typical boundaries (Wolbring, 2008, 2009). The result of this favouritism of abilities is a transhumanist model of disability in which impaired people are not the only ones seen as subnormal, but rather, all human bodies are seen as impaired and in need of improvement. This model leads to the view that humans that have not been improved beyond species typical boundaries are seen as disabled. This model, as Wolbring argues, can be understood as the transhumanized version of the medical model, as it also aims at 'fixing' or improving people's condition, with the difference that it is not only the 'fixing' of those who present sub species typical functioning, but everyone that is not performing beyond species typical functioning. Thus it is plausible to say that transhumanism is not only shaping disability or ableism, but even concepts like disease, health and the goals of medicine. As a result of these new understandings, the transhumanist model would support any technology, such as nanotechnology, that offers to improve the human body above the norm (Wolbring, 2005, 2003, 2008, 2008b). So within this model, nanotechnology use would be focus on achieving the transhumanist kind of improvements, namely making our bodies and minds longer-lasting, stronger, and smarter. The three main objections I see in this model are. First, the medicalization phenomena accelerate. Second, the ability divide increases, as many people will not be able to afford or even want to improve themselves to the transhumanist aspirations of a 'healthy/abled human'. And finally that it seems to be claiming that our human biological reality is in itself an impairment.
The model of disability that we, as society, decide to adopt, will determine nanotechnology's focus towards 'disabilities'. We can focus on restricting or increasing our choices and use nanotechnology to focus on allowing our humanness to enable people, rather than opening a new trend in which even those that are currently consider as non-impaired will end up being labelled as disabled.
Promoting a shift of paradigm
Nanotechnology and impairments
Nanotechnology can help people with impairments. Some examples follow of what nanotechnology is doing or could do for people with impairments:
(1) Nanotechnology is being used to improve a broad range of prosthesis and implants (Chaudry et al., 2006; Loomis, 2008; IEEE, 2007), as it is making them stronger, biocompatible (Bullis, 2006; ESCR, 2003; Simonite, 2007), cleaner (i.e. antimicrobial coatings), to have better performance (i.e. increase speed and capacity processor by allowing a greater number of electrodes in current implants/prostheses) and more efficient (i.e. consuming less power).
(2) Nanotechnology is also overcoming some of the problems of existing materials, such as preventing the body's proteins from building up on sensors, which can lead to the prosthesis to not work properly, stop working or needing replacement (AZN, 2008).
(3) Nanotechnology is helping to create nanofibers that are being used to allow growth of tissue (Bullis, 2006; ESCR, 2003) and the nanocircuits that are being used to develop the next generation of wheelchairs. A generation of wheelchairs able to know its environment, sense where they are and where they must go (Benson and Barret, 2005).
Since nanotechnology enables us to manipulate matter at the nanometre scale, it can interact with biological material in more direct, precise and efficient ways; and gain access to areas of the body that have proven difficult to reach with current technologies (UA, 2009). As a consequence of these features, nanotechnology will help in the creation of new prosthetics, such as molecular prosthetics - nano scale components that can repair or replace defective cellular components (Nanowerk, 2007), memory implants (Radford, 2003; Graham-Rowe, 2003), or emotional social intelligence prosthesis (Lombardi, 2006). As some have argued, we might still need to design other key components before taking advantage of all these new and improved prostheses (Koch and Mathur, 2008; Matheison, 2007; Loomis, 2002), but that does not take away the fact that nanotechnology is pushing forward a new generation of prosthetics, treatment and diagnosis. Therefore, understanding the different ways in which nanotechnology can be used towards impairments, is crucial to help us challenge the current disability paradigm and shape the new one. The question still remains whether the shift of paradigm will be for better or for worst.
Posthuman: dreams or nightmares?
People with impairments are already seen by some people, like the transhumanists, as the bridge between human and the posthuman (Dvorsky, 2003), at least those who have been trying to "fix" or accommodate their impairments, and in some cases no longer feel compelled to mimic the human form. I believe that our understanding of posthumanity can influence our choice of the disability paradigm that we shift to. On the one hand, if we take posthuman, as a technological creature, a successor to what would become an obsolete biological human (Fukuyama, 2001), as the next evolutionary step in human evolution, when our non-biological added parts have become us, then it seems that the underlying assumption here is that our current species-typical biological state is deficient. Since the transhumanist model of disability seems to share the same assumption, I believe is plausible to say that the transhumanist model of disability supports this understanding of posthuman. The reason why I argued this understanding of posthumanity might turn into a 'nightmare', as a non-desired scenario, is because a disability paradigm based on the transhumanist ideals, will promote a view in which being human will be equated with 'disabled'. And as Len Barton, emeritus professor of inclusive education in the University of London, rightly, puts it "To be disabled means to be discriminated against" (Barton, 1996). Accordingly, if posthumans treat humans the way non-impaired people treat the impaired nowadays, it will just reinforce disablism: "discriminatory, oppressive or abusive behaviour arising from the belief that disabled people are inferior to others" (Miller et al, 2004:9).
On the other hand, if we understand posthuman following N. Katherine Hayles definition, as "an amalgam, a collection of heterogeneous components, a material-informational entity whose boundaries undergo continuous construction and reconstruction" (1999:3), it could become a 'dream', a desired scenario. I believe an understanding of posthuman that acknowledges that we are technological beings, but that does not stretch this view into the idea that our current biological status is deficient, could help us to achieve three main points. First, embrace morphological freedom- freedom to alter our own bodies and minds, without having to follow any normative guideline- not because we think our current status is deficient or in need of improvement, as the transhumanist model does, but rather on the grounds of accepting that our species features and capabilities can be different, either by natural endowments or by accident. Second, celebrate the differences presented by people with impairments, whose contribution to society should be appreciated and acknowledged. Finally, and most importantly, to challenge ableism, for the reason that it promotes a diminished state of being when a deviation, real or perceived, occurs from the abilities it favours.
I believe this understanding of posthuman, as a 'dream', can help us shifting to a new disability paradigm, one that is in accordance with the social model of disability, one that enables people, recognizes and treats them justly and equitably, without discrimination or stigmatization. A paradigm that does not embrace self and corporeal standards or particular ways to do things 'right', as this has resulted in the past in disablism, but rather that brings inclusion of differences, and changes in attitudes as well as the reform in services and products, needed for it. We have to create new cultures, focus on learning to use our own-given 'gear' before trying to supplant it with a technological one. We need to understand that we all face our differences and challenges in different ways; we need to learn from that variety of ways. I believe that only then can we say we have truly and really enhanced ourselves, by enhancing our humanness. Here I am using the word humanness to mean our ethical wisdom. We can use nanotechnology to help us to accommodate in a better way our differences, a way that allows people to participate and be included more fully. Using nanotechnology focusing on erasing our differences without learning from them would undermine the fact that we all have impairments-maybe not the kind that fit under the disability act of any country, but sure we all have limitations in our capabilities and abilities in a greater or lesser degree-, and that those differences and limitations make us who we are (whether we like it or not). Thus, instead of gaining more freedom by eradicating our impairments, it would seem like we are restricting our choices to the choices of others - choices of power and choices set by the ability rat race. Hence, it seems plausible to say that the more we want to fit into the norm, either the norms set by the medical model or the norms set by the transhumanist one, the more 'disabled' we become, as we are not capable or not able to accept ourselves the way we are. Yet, the hope is that we challenge the current disability paradigm by enhancing our humanness, aiming towards a new paradigm, in which our technology focuses on accommodating our differences and impairments, instead of just trying to erase them.
In this paper I have pointed out that according to the focus we have when using nanotechnology, it could help us to challenge the current disability paradigm, a paradigm that sees impaired people in need of being brought up to the norm or in need of 'fixing' their impairments. From the brief analysis on the three main models of disability, it was possible to observe that even though the medical model is now the predominant one, we can choose to shift to a different one. I have also argued that according to the understanding of posthumanity we have, it might help us to challenge the current paradigm on disability, and shifting to a more humane one, namely one based on the social model.
The new resulting paradigm on disability could allow for more inclusion, participation, acknowledgement of our human condition as beings with impairments, and recognition that technological fixes are not the solution to all human 'problems'. But more importantly, it could allow for truly improving our humanness and our understanding of what it means to be humans and find ways in which we, as individuals and as society, through our technological developments, focus on accommodating our differences instead of on eliminating them. We all need to take the time to learn to understand the multiple points of view that are relevant on how nanotechnology may improve or degrade our futures- a future in which nanotechnology enables us instead of disabled us.
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Centre for Applied Philosophy and Public Ethics (CAPPE), Australia
Charles Sturt University
Laura Cabrera is a research PhD student in ethics and emergent technologies in the Centre for Applied Philosophy and Public Ethics at Charles Sturt University. Laura received a BSc in Electrical and Communication Engineering from ITESM University in Mexico City, and a MA in Applied Ethics from Linkšping University in Sweden. Her current research is focus on nanotechnology and neurotechnology, and the ethical dimensions of emerging technologies around the issues of human enhancement, posthumanity, and transhumanism.