New Lab’s quarterly event series, Existential Medicine, explores technological disruption in the medical field and its impact on the human experience. In part two, Augmented Humanity, panelists discuss sensory and cognitive augmentations, body enhancement, and the surrounding ethical and regulatory quandaries.

There are many excursions in the course of a life, but few fixed points in the timeline. We are born, with a brain and a body. We grow up, we age, and ultimately, we die. These facts of life have always been unalterable and intertwined with what it means to be human.

But what if we fixed our genetic flaws, fortified our bodies with replacement organs and robotic limbs, and enhanced our minds with technology and drugs? Is there a future human who may be unlike any of us or anyone who has ever been?

One Foot in the Door

That future seems tantalizingly near: in the past few weeks, brain-computer-interfaces (BCI) allowed three paralyzed individuals to browse the internet on a tablet with nothing but their mind, while the announcement of the birth of genetically modified babies in China took the world by fury and surprise. Rapid advances in medicine, science, and technology are starting to make it possible to surpass the limitations of the body and even rewrite our genetic code.

During the second installment of Existential Medicine: Augmented Humanity, panelists unpacked such forays into human augmentation, including the future of implants and robotics, and how we can ensure our species leverages new technology for the greater good of humanity.

We already have one foot in the door in that future, emphasized New Lab co-founder David Belt, opening the evening. We have amended our limited memory with the virtually infinite capacity of hard-drives on remote servers. We delegate pathfinding and other cognitive skills to our phones and allow AI algorithms to do some decision-making for us. These tools have become extensions of our brains. “Is there a difference if the tool is in our hand or if it is an implant in our brain?” Belt asks.

Human augmentation is in fact, not even a new idea, recounted moderator Nadja Oertelt, Massive Science CEO and co-founder. Since the dawn of humanity, we’ve used tools to extend our physical ability and turned to naturally occurring substances, such as tobacco and caffeine, for neurological effects. Even arm prosthetics and hearing aids were invented a few centuries ago.

But we are now at a tipping point — new technologies are being developed faster than ever, and they’ve taken a shift by becoming able to alter the biology of the body or interface directly with the brain. “We’re kind of reaching this really radical point,” Oertelt states. “These things are happening very rapidly and there are a lot of questions that we need to answer.”

Augmentation in the Works

Turning to the lab, Katherine Cora Ames, a neuroscientist at Columbia University, shared an overview of engineering successes and hurdles in developing robotic prosthetics. Ames studies how the two sides of the brain work together to control movements. Her research helps identify how to translate brain signals into programs that control prosthetic devices.

Brain signals are recorded by implanting microelectrodes in the motor cortex, the area governing movement. The most commonly used implant, according to Ames, is a lentil-sized set of 100 microelectrodes called a Utah array. As clinical studies test the long-term safety of brain implants for those with motor degenerative disease or who are paralyzed, patients may also participate in scientific studies of mind-controlled prosthetics.

Several studies have made progress, showing how patients can control a robotic arm to perform simple reaching and grasping, or type letters by moving a cursor with their thoughts. But the technology is still crude and slow; people outfitted with this technology can only type about 10 words per minute, Ames confirmed.

Numerous engineering problems need to be solved before we reach a point where implantable prosthetics are an everyday device for paralyzed patients. “There are a lot of different hurdles,” Ames shared. “One is the recording technology itself. Right now, state of the art is recording about 100 neurons simultaneously, and there are millions of neurons just in your motor cortex.” Figuring out what exactly those neurons are doing to give rise to a complex movement is another tricky problem.

There are also engineering challenges in terms of prosthetic interaction. When we move an arm, the brain doesn’t just command the arm to move, but also receives feedback from the arm as it moves. “For patients who don’t have that feedback, it becomes really difficult to do even simple movements because the brain is designed to work with this very complex feedback system,” explained Ames. To develop a sci-fi level prosthetic, we need to understand how to write back the right information.

Eventually, a working brain-computer interface may be developed. But then the question is, can it be also used by healthy people who wish to augment themselves?

This question is even more pressing as private companies — such as Facebook and Elon Musk’s Neuralink — have launched their own research into consumer-facing BCI and neural enhancement devices in parallel to experimentation developing in the lab. Privately-funded research has the benefit and ability to tackle engineering challenges that are typically difficult to secure funding for within academia, Ames noted. And that raises questions about who will receive access to these technologies once they are here.

Who Gets to Augment?

Do we all have a right to augment ourselves? Who should be the gatekeeper to whether or not we’re allowed to be one kind of human or another? What separates augmentation from merely treatment? It turns out, the definitions are still quite blurry.

“There’s no consensus,” shared panelist Anna Wexler, a bioethicist at the the University of Pennsylvania who studies the ethical, legal, and social issues around emerging technology and DIY medicine. Generally, for a procedure to be different from a treatment, it has to enhance the individual above the norm. “But of course, what is normal and what is baseline?” Wexler prompted.

For instance, there are cochlear implants that can be implanted at a young age and restore hearing in people who are born deaf. “But there’s been pushback from the deaf community,” Wexler cautioned. “They’re saying, ‘no, we don’t have a deficit. This is fundamentally who we are.’” They have developed a culture around sign language, deaf schools and community groups, and may want to preserve what is a core part of their identity.

These situations give rise to tricky questions. “What happens if deaf parents have a kid and they don’t want to give that child a cochlear implant? Who has the right to make that choice?” asked Wexler. “This gets back to the question of what is normal and who is to say what is normal for someone else.”

The advent of CRISPR-CAS9, a genetic technology that makes it easier than ever to edit the genome, has taken these concerns steps further. The technique has great promise for tackling flawed genes behind certain diseases. But in theory, it could go as far as enhancing a person’s genetic code. If something could make humans stronger and smarter, should we all have it?

“Would there be a world where that should be a right for everyone, just like it’s not crazy for us to think that everyone should be provided with basic internet access?” Wexler speculated. “It is an interesting question and it is not totally obvious which way things will go.”

These queries are bound to increasingly arise as science advances and tech devices and genetic techniques make their way out of the clinic and into the hands of consumers. Our current regulatory system, such as the US Food and Drug Administration (FDA), deals with technologies that have medical purposes. But with technologies used for enhancement, we enter unregulated territories, where society as a whole has to first answer some fundamental questions. It’s time for everyone to start thinking, what should the future human look like?