One of the things that Havi Carel says in her excellent book Illness is that in serious illness one experiences a kind of alienation from one’s body. Suddenly you recognize that things are going on, going on in you, that you were totally unaware of, that you can’t control, that may cause you serious harm, and that may even kill you! I recall when I was first diagnosed with essential thrombocythemia. It was nineteen years ago now; I was in my late 30s and living in South Africa. For over a month I’d had a bad case of the runs. The doctors where trying to figure out what was going on with my gastro-intestinal tract. And in the course of doing so, they did routine blood work. The results didn’t help in figuring out what was affecting my gut, but they showed that my platelet count was way out of whack, about five times higher than normal.
Suddenly, I had other problems to worry about. I was told to take it easy. They didn’t want me keeling over due to a “thrombotic event”—think heart attack or stroke. I was told to make an appointment with a hematologist as soon as possible. Something was up with my bone marrow. Most likely a myeloproliferative neoplasam, a group of diseases including a kind of leukemia, in which one or more of the three main kinds of blood cells proliferate. The immediate thing to do was to check for leukemia, which can be done by a bone marrow biopsy—my first of many groan inducing, eye moistening experiences of being put under the corkscrew. (Those who want more detail on what that’s like should read my posts “Patience, Dear Patient” and “First Thoughts and Second Opinions.”) Leukemia is ruled out if no abnormality is found on chromosome 22, called the Philadelphia chromosome because it was first discovered by researchers at the Fox Chase Cancer Center and U Penn Medical School in the City of Brotherly Love. After several nervous days of waiting, I received the negative result.
With other possibilities ruled out, essential thrombocythemia was the diagnosis of exclusion. Life with a chronic disease was the new normal for me. The good news, most people diagnosed with the disease have normal longevity. The bad news is that most people diagnosed are in their 60s and 70s. Being in my late 30s, I would have decades to live with increased risk of acute myelogenous leukemia or myelofibrosis. (The latter tailed me on two subsequent intercontinental moves, and finally caught up with me in Germany last year.) Meanwhile the diarrhea had not abated. At one point the docs had me carrying around bucket to gather a 24 hour sample. Imagine my pleasure! I recall distinctly feeling back then that as a relatively young man my body seemed to be betraying me. “Wait a minute, I thought we had an agreement—ok, a tacit one maybe—but an agreement nonetheless! I don’t abuse you too much, and you keep ticking along for several decades.” Suddenly my whole system seemed to be in mutiny.
In time the gastro problems were abated by an enzyme treatment, and I settled into the routine of taking the platelet reducing meds that were then new on the market. Most medications are approved after trial testing that does not last very long. Being among the first post-trial users of the medication, I had the satisfaction and worry of knowing that I was contributing to science by helping to discover what the long term effects were. A couple of decades, passed without me obsessing about my illness…much.
After my myelofibrosis was diagnosed I had to go undergo several standard physical examinations in preparation for the stem cell transplant. A thorough dental examination revealed an abscessed front tooth. Dental infections and chemotherapy induced dead immune systems are a bad mix. So, a week before entering the hospital my lower front tooth was pulled and I was given a temporary fakie. When I wear it, it is hardly noticeable, when I don’t I look straight outta Breaking Bad. In my case there was also some concern about possible hemorrhoids, which could be aggravated by chemotherapy induced diarrhea. (A shockingly recurring theme in this piece!) So, the docs ordered my digestive tract to be scoped. The whole thing, all 8 ½ meters of it.
When I went into the examination room, they asked me if I consented to having polyps removed if any were found. “Sure, might as well find out if I have colon cancer too!” Then, unexpectedly, they asked if I wanted to be put under a general anesthetic or to be awake to watch it all on their high definition screen. It would be uncomfortable, they said, but not terribly painful. My curiosity got the better of me and I chose to stay awake. Just to be clear, I had been given plenty of very effective purging medication; so things were promised to be pretty empty inside.
During the exam there was more than one moment when, feeling the probe push from the inside of my intestinal lining, it seemed like the creature from the movie Alien was going to pop out my gut. Uncomfortable to be sure. But the high definition view made the price of admission more than worth it. It was as if I were watching out the window of a submarine. My insides turned out to be an alien underwater wilderness, undulating like a mass of mollusks in the waves. How weird to look at all that watery flesh and to think, that’s me. But how could it be? It’s me and it’s another world! I’ve never been there before; I know nothing about it. Problems could arise down there, betrayals festering into carcinogenic polyps, and I’d be none the wiser for quite a while, perhaps even for too long.
My gut is as foreign to me as the bottom of the ocean. It is its own ecosystem, teaming with microbial life, all of which I am totaling unaware of most of the time, and only bluntly aware of when something goes wrong. I don’t direct the undulations to do my bidding. I don’t intend the flesh to carry out its digestive tasks. But I am certainly more directly dependent on that region than I am the ocean’s depths. And I can’t go on very well without it doing its business. If I could have my bone marrow scoped, I would probably have a similar reaction. It’s not so much that illness alienates us from our bodies, as it is that in illness we come to appreciate that we already are alienated from many parts of our bodies. And we could not live unless we were. We could not possibly direct it all, set it to work serving our purpose. Bodily alienation makes our conscious experience possible.
Alienation from my body is bound up with my limitations. If I could control it all, I would certainly sing better, play the guitar better, and have made it into Rock n’ Roll Hall of Fame. My talent-set would be unlimited. My physical decline would be more ordered and graceful, and perhaps even cease to exist. I could stop any nascent malignancy in its tracks by sending my immune system SWAT force out to get it. And then, with unlimited time, choices would lose their poignancy. I wouldn’t have to decide between being a philosopher and a rock star. I could take 40 years to get good at one thing and 40 more to get good at another. Then move on to something completely different. Comedy, perhaps.
Various parts of me could be replaced, and I could carry on just fine. Better in fact. My transplant has shown that. I have heard people marvel at what an improvement their new hips are. Bit by bit this stuff is replaceable. And I’m not lost in the shuffle of the parts. That thought suggests one way that bodily alienation could be fully overcome. Over time, all of my parts, piece by piece, might be replaced by polymer membranes, fiber optic cables, and semi-conductors. And with each new part a monitoring and control device might be installed, giving rise to multiple feedback loops and full control. This post-human person would seem to enjoy several advantages. Longevity without decrepitude certainly seems appealing caeteris paribus.
But there is one problem. I doubt that the result would be me. Along the path of transition from my biological self to that post-biological, post-human person, I would disappear. The person who comes to exist, let’s assume for a moment that it is a person, in the process of shedding my body parts is someone else. Without my body (at all), I am nothing. What’s in it for me to bring that post-biological person into existence? I would seem to have no personal stake in it.
If what I am suggesting is right, it’s seems doubtful that I could exist in any way other than alienated from my body. One intuitively plausible, but I think ultimately unsatisfying, objection is that as long as the post-human person has my memories it’s me. If we could get the technology right, I could exist that way and be unalienated from my physical, post-biological, existence. In response to this, recall the character Rachael in the movie Blade Runner. She looks just like a human, an adult woman; she feels just like a human; and she even has childhood memories. But she is not biologically human. She has been constructed by the Tyrell Corporation. And she has been programmed with the memories of the daughter of the corporation’s owner, Eldon Tyrell. Although she has the daughter’s memories, she is not identical to the daughter. You might think that seems plausible but only insofar as the daughter is still alive. (In the movie we don’t know if that’s the case.) But consider that if the daughter died, Rachael would not suddenly in a flash become her. Rachael is either her all along or never. And the former seems utterly implausible. Having someone’s memories is not enough to make one that person.
My focus has been on our personal fates in of overcoming our bodily alienation. Two of the most influential philosophers of the nineteenth century, Hegel and Marx, saw alienation as a great social evil. In their own different ways they developed accounts of alienation and recommendations for how it might be overcome. What about the desirability of overcoming bodily alienation on a social scale over time? Imagine generations of people in the future undergoing a gradual transformation to post-humanism. Do we have reason to see the eventual transition of our species into post-human beings in full control of their artificial bodies as attractive? I declared that caeteris paribus longevity without decrepitude is appealing. But in this case the caeteris definitely are not paribus. For reasons roughly similar to my personal case, it’s hard to see why we would want to celebrate the extinction of our species and the creation of new artificial long-living post-humans.
Disease can be bad for all sorts of reasons—it limits our abilities, it disrupts our plans, it can be costly, and it can hurt to name just a few. We have very good reasons to want to reduce the disease burden both within our generation—where it is especially inequitable—and for future generations. That does not mean that it makes sense for me to want to transcend my biological existence, or for us to want to extinguish our species on behalf of other beings who would not experience bodily alienation. After all, what are those future post-humans to us? Utilitarians may disagree; we have a reason to desire a world with less or no physical suffering. Hence, we have a reason—perhaps an obligatory one—to seek the means, through post human transformation, to that end.
Moreover, a disease free post-human world might have an appeal beyond confirmed utilitarians. Those who take rights seriously may claim that if the outcome is better and no one’s rights are violated—imagine all the replacement of parts and organs over the generations is consensual—then we have reason to pursue it. To cast the net more widely still, throw in the additional constraint that the introduction of the technology at each step along the way is consistent with realizing equality of opportunity and a fair distribution of wealth. If we could manage the just introduction of an eternal or at least very long living post-humanity to take our place in a more egalitarian post-human society wouldn’t that seem like a compelling goal? The reduction of suffering due to disease and ill health is doubtless good. So, one might think that every step we take in that direction consistent with justice, short of extinguishing our humanity, is surely good. If that is true, then the last step—the humanity extinguishing one—must also be good.
I am not convinced that every step would be on the whole good. In each case one has to weigh the gain of disease eradication against the loss. Doubts might arise regarding whether each aspect of being human lost can be adequately compensated for by sophisticated machine performance. Some of the things that we accomplish seem especially valuable because we, not something else, are doing it. Two examples that come to mind are the beauty of the human voice in song and the pleasures of sexual intimacy.
And, I’m not confident that by the end the post-human beings could be capable of conscious experience. There would be no overall benefit by replacing mortal suffering humans with immortal, non-suffering post-biological zombies. (Not of the flesh-eating variety, of course. That would make the argument too easy for me!) Consciousness as we’ve known it thus far arises in organisms. How this happens and the relationship between consciousness and biology are not known and are the subject of much controversy among philosophers and psychologists. But we should not suppose that a bunch of sophisticated machines will be conscious. I assumed earlier for the sake of the argument that they would be persons. In fact, I think we have reason to question that assumption. And that certainly throws the worthiness of the aim of a post-human world into doubt.
Replacement of a great many human parts will probably produce gains for human well-being in the coming years. More profound alternations could conceivably come through the use of genetic technology. As the capacity for alteration becomes more powerful, it will be important to gain more clarity than we now have about what we can replace without losing more than we gain. Discussions about that seem to be running behind technological developments presently. Less urgent, but no less important, are the debates about whether the long term aim should be healthier humans or post-humans.