Is there a right to beauty ? Life as an aesthetical project
Joseph Schmucker-von Koch, University of Regensburg
(Opening lecture given on
organized by the President of the
German Association of Aesthetical-Plastic Surgery, Dr. Neuhann-Lorenz,
Ladies and Gentlemen,
I would like to begin my lecture with a very personal experience which results from more than 25 years of activity in the field of ethical assessment of biomedical research and developments. This kind of activity did not only deal with basic ethical principles and their relevance for scientific developments. As a bioethicist who is involved in review and consulting activities on a national level as well as within the framework of the European Commission´s scientific programs one has also to deal with the hard facts of current developments within medical science and research and has to analyze whether they are in accordance with certain sets of established ethical and legal regulations.(1) This, of course, takes place in close cooperation with the other committee members who are colleagues from the medical and life sciences and analyze also whether a project or study or parts of it are “state of the art” or not.
It was within this context of highly innovative developments in the life sciences that I often had to ask myself whether the set of norms and values many refer to in public debate is still sufficient and flexible enough to adequately assess the huge potential and impact of the various dimensions of this process.
The developments within the general framework of the life sciences will have a tremendous impact on the further development of aesthetical-plastic surgery the dimensions of which we are just beginning to realize. Wayne Morrison, the winner of the Dieffenbach medal 2002, entitled his lecture in Heidelberg on the occasion of this award “Expanding the horizon of plastic surgery – from microsurgery to tissue engineering”(2). Thus he pointed already to one of the many dimensions which aesthetical-plastic surgery will realize in order to promote its most valuable task: the beauty of human beings.
Concerning the possible expansion of the horizon of plastic surgery including aesthetical-plastic surgery I would like to make a few comments from a philosophical point of view and will discuss a few ideas and scenarios which can of course not be more than a tour d´ horizon since we are still proceeding on virgin soil - slowly but steadily so to speak.
Referring to the title of today´s lecture and its subtitle I would like to propose the following thesis: Just as ethics over thousands of years of human history tried to form the inner man while life was conceived of primarily (especially in the fundamentally religious epochs) as an ethical project, so we will now be able –within the context of the developing scientific revolutions- to consider life as an aesthetical project, i.e. form man anew and optimize him on the basis of the material elements of his nature. We for the first time in human history will be able to live life as an aesthetical project.
Within this frame of reference for the first time in human history something like a right to beauty could be constituted. Aesthetical-plastic surgery will be an important part in this overall revolutionary process.
This perspective, of course, seems quite unusual at the first glimpse and it will remain so until we haven´t described the horizon of this process more properly within which life is beginning to establish itself as an aesthetical project.
Today mankind is experiencing a scientific and technological revolution which deeply affects our understanding of man and the world he lives in. This process can only be compared to the fundamental change in historic epochs which radically changed man´s understanding of himself and the surrounding nature in general (for instance from medieval man to modern man). The coordinates of this progressing change the dimensions of which we were able to have a first look at through the worldwide debate on human embryonic stem cell research and cloning, are constituted by the rapid development of three innovation processes, namely the mutual influence and synergies of information technology, biotechnology and nanotechnology. The elements of living matter as well as those of non-living matter are more and more placed at our disposal and can be interconnected in ways never experienced before. I am not only thinking here of neurotechnological systems or interface technologies for biotechnical systems. Nanotechnology based analysis in the field of pharmacological and chemical synthesis as well as characterization of various medical substances, the element specific analysis of the local influence of a medical substance as well as procedures to reach a more exact dosing and better local targeting of a substance for instance in a patient´s tumour will be the basis for further therapeutic progress. Within this nanotechnological context there will be available in a foreseeable future synthetic biohybrid organs, repair machines and alert systems which act in the human body and will stop or eliminate pathological processes resp. processes that deviate from a programmed norm status. These systems may also –via specific signal structures- send information to a surgeon who will then take the necessary measures. The reaction of biological cells to variable nanotopographies may also be used for self organisation in bio-layers. Cells, as we know, react just like the tips of an Atomic Force Microscope. When they get close to surfaces, they test whether the docking station is of the right sort for them. If you produce defined structures and attach the right cells for the proliferation of certain functions to these surfaces, cells can for instance be installed in defined lines which is important for producing artificial skin for instance.(3)
These examples should show the wide range of perspectives plastic surgery as well as aesthetical-plastic surgery will be part of in the context of the mutual influence and synergies of nanotechnology, biotechnology and information technology. I would like to state very clearly here that there are no limits in sight for this endeavour, or I should better say: only limits that we will overcome step by step in the future as science always did since its beginning in the 17th century. Just to give you another example. If I , as a philosopher, would have told somebody 30 years ago that we should start thinking about the ethical implications of cloning human embryos I would have been attributed a lively phantasy or in a more friendly way some kind of influence of science fiction literature would have been stated. But what would have been attributed to the realm of phantasy 30 years ago has now become hard facts of the concrete scientific progress and one of the most important topics of the international scientific and public debate ! I would like to conclude that aesthetical-plastic surgery is continuously “expanding its horizon”(Wayne Morrison) due to revolutionary scientific and technological developments which continuously expand the whole range of possible applications. From new biomaterials based on nanotechnological inventions to the complex initiating and steering of anti-aging-bioprocesses there will be in this context of synergies of biotechnology, nanotechnology and information technology a whole new range of applications which will allow for the beauty of a human being in toto to be envisaged as an object of concrete technological measures. Why should we be afraid of this ? For the first time in human history our physical appearance will not be a matter of fate anymore which we have to accept and which perhaps can be optimized with cosmetic measures. It can now be optimized beginning with its structural elements.
A new kind of freedom, the freedom to beauty is on the horizon, the freedom to have the physical appearance an individual wishes to have.
Accompanied by intensive communication between patient and doctor including psychological consultation the new work, or rather art of freedom can be performed which is the achievement of beauty in accordance with the freely declared and informed will of the patient. It is only within this context where the up to now limited potential of anti-aging strategies will have become a common medical practice, that a self-evident demand for a then self-evident medical practice can establish itself. Only within this context where on the horizon of the mutual influence and synergies of bio-, nano- and information technologies a plethora of various resources is available to realize life as an aesthetical project, for the first time in history the concept of a right to beauty can be outlined on a reasonable basis. Rights originate from sociocultural contexts, and they can change with the change of these contexts or even disappear as these contexts disappear. In medical contexts rights have very much to do with the common availability of a treatment and the resources necessary for it. The new scientific-technological revolution will create a plethora of resources hitherto unknown which aesthetical-plastic surgery can make use of. Today, in this phase of transgression and new developments we still have to literally reckon with limited resources and limited possibilities.
Therefore, under present circumstances, the concept of a right to beauty appears to be something phantastic and far from any availability ever. The promise contained in this concept seems to be locked up for us and a matter of unrealistic hopes. But when there are biomaterials available that can reproduce themselves ( we have already started with that ), inexhaustible resources of vitalisation things look quite different. Who then will not want to delay for as long as possible the several forms of infirmity connected with old age ? Who then will not want to have fitness and physical beauty at one´s disposal for as long as possible ? Who will not want to enjoy one´s vitality to the fullest ? This then has nothing to do with a pathological illusion of juvenileness or a psychological inability to accept getting older.
Why should we accept constraints and restrictions which we had to accept up to now if there is no necessity anymore to accept them ? It will be as difficult for anyone to give a rationale for such restrictions just as it would be for a short-sighted person that is unable to read , but constantly refuses to wear glasses or contact lenses in order to eliminate this deficiency. Where is it written in the book of life that there is anything in our physical appearance that we have to accept just as it is ? There were times in human history where most of the features of human life had to be accepted because it was not possible to influence or change them. Most of human history is characterized by such a necessity. Those times have made it their business to morally over- interpret the scarcity of resources with twisty arguments and such make a virtue of necessity: the virtue of humbly and submissively accepting what could not be changed anyway.
This kind of unworthy humility will be a thing of the past – if the nanotechnological, biotechnological and IT (information technology) transformation of reality can go forward unimpeded.
What is called “augmented reality” in the realm of IT optimisation of real object perception , i.e. the integration of real object perception und virtual reality which reaches out into interface-techniques of bio-technical systems, can beyond this specific application be conceived of as the key concept and program for human nature in general. From the present scientific and technological developments we can conclude that humankind is on its way to “augmented reality”. Human nature is deficient and not perfect. And which serious argument could be brought up against the endeavour to eliminate such deficiencies wherever we can do so with the help of scientific and technological innovations ? I would like to recommend here a 400 page document containing the report on a workshop organized by the U.S. National Science Foundation in December 2001. US technology experts from the government, from science and the industry were discussing the potential of innovations which is to be expected from the mutual influence and the synergies of nanotechnology, biotechnology, information technology and cognitive science. The report is entitled: “Converging technologies for improving human performance. Nanotechnology, biotechnology, information technology and cognitive science”.(4) There you also find a discussion about nanoinformational biofeedback-mechanisms which can produce small, highly specific biological changes in the human body.
A broad public debate on all of these perspectives of paramount importance is still a desideratum. And there is a danger that things are going the same way again as they went concerning the discussion on human stem cell research or cloning. First many cannot imagine such possibilities, they deny –among those even scientist- that something like that could ever happen, and all of a sudden the results are there and become hard facts of science. Then people don´t know how to integrate the whole development into their own every day concept of life. The consequence is that out of complete surprise and fear massive restrictive measures are declared due to the pressure exerted by a shocked public – restrictions that due to the rapid progress of science are already outdated when they are imposed.
The process of interconnection of biotechnology, nanotechnology and information technology will allow an optimization of the human body which can now start with the elementary material structures. We are still at the beginning, and therefore this perspective also sounds quite unusual and for many hard to grasp. And, of course, there will be setbacks in the course of these developments, suffering that cannot be foreseen and which biomedical progress cannot exclude a priori. I only remind here of the first bone marrow transplantations performed with great hope in children suffering from leukemia. But some children died and so quite a few scientists and an alerted public demanded at that time that these experiments should be stopped since they would have no ethical justification anymore. Today bone marrow transplantation is a favourite therapy option for children suffering from leukemia, and the responder rate is quite significant.
There is a rising willingness among the general public, especially
among young people, to optimize the
physical appearance of the body. We have some very informative statistics in
According to a poll by the Allensbach research institute one year before the FORSA poll the self-assuredness of 72 percent of the female population and also of 44 percent of the male population depends on whether they feel they were looking good.
An estimated 300 000 – 800 000 times a year measures by
aesthetical-plastic surgery are taken in
The surgeon in this context is both: scientist as well as artist. The beauty of the patient is his work and he reaches this goal when the new features , the change he performed in human nature look like being “natural”. The “natural look”, an appearance that reflects the individuality of the patient and makes him look like he would always have been looking that good, is the visible sign of the surgeon´s success.
Interdisciplinary research of engineers, cell scientists, biologists, chemists, scientists in the field of materials research and clinical professionals will open up hitherto undreamed-of possibilities. Let me explain this in a more philosophical and abstract way: The border lines, caused by our imperfect knowledge and abilities, between our imperfect reality and the perfection which we up to now can only admire outside ourselves with deep aspiration in the great works of art, are beginning to fade at the same pace our scientific knowledge and abilities broaden extensively. Imperfection in controlling and shaping the human and non-human nature will gradually cease. Speaking symbolically: More and more we are being handed over into our own hands. Medical thinking and practice which meets the requirements of a more than 2500 year old ethical tradition, namely to foster health and to alleviate pain and suffering, will guarantee that these are good hands which are taking care of us. They will be able, on the basis of the ongoing scientific and technological progress, to perform with us what in the previous history of mankind we only could admire outside ourselves with deep aspiration in the great works of art. Let me cut a long story short and say it in a more provocative way: the lively human being as a lively work of art is getting closer to the realm of possibility.
With each aesthetical-plastic restitution of a hand the fingers of which were cut off by an accident, with each aesthetical-plastic harmonization of a deformed face, with each successful facelift we already can see this work of art become reality.
Though in single cases such practice will find global acceptance the general process of scientific and
technological developments in this field will demand some reasonable
corrections of some patterns of self
understanding and everyday orientation. Traditional patterns of
self understanding which humankind got used to over thousands of years will have to be
relativized if not abolished in certain cases in
favour of a growing freedom of
creatively modelling the material processes of man´s
nature. We are witnessing a breathtaking development that unveils to us with
every scientific success more and more of man´ s ability to model the basic
processes of life even up to the human spirit (brain research). Yet there is
still a big step to be taken by humankind to adjust to these developments,
perhaps at times in contrast to its rich spiritual tradition which up to now
formed the main frame of reference for self orientiation.
On the occasion of the 50 th anniversary of the
discovery of the DNS double-helix-structure by Crick and Watson Christian Schwaegerl
of the “Frankfurter Allgemeine Zeitung”(
However, in spite of the great advantages of the ongoing scientific and technological progress we should not loose out of sight what Johann Wolfgang von Goethe had been a prominent example of and what he said in a conversation with Eckermann on March 11, 1828 about the characteristics of a man of genius: “If entelechia (an inner tendency) is strong enough as we find in men of genius it will not only have through its vitalizing potential a strengthening and sublimating impact on the organisation of the body but will also try continuously to assert its privilege of eternal youth due to its spiritual superiority. Hence we find in very talented persons even in old age still fresh epochs of great productivity; it seems like they time and again would experience a temporary rejuvenescence.”(5)
The growing scientific and technological abilities which allow us to contribute to visible beauty of a human being, must be complemented –and that´s what we can learn from Goethe here- by an endeavour from within, by a strong will to model the inner self, a continuous fostering of positive attitudes and values, a positive and creative way of thinking that allows us to experience life as something beautiful and act accordingly for our fellow citizens. They will in turn experience our existence as a positive contribution to their lives which can give them the feeling -so important nowadays- that life is beautiful in itself.
1) see “Basic Bioethical Guidelines” on my homepage: http://www.schmucker-von-koch.de
2) see program of the German “Vereinigung der Deutschen Plastischen
Chirurgen/ Vereinigung der Deutschen Aesthetisch-Plastischen Chirurgen (September 18-
21, 2002, Heidelberg. URL: http://www.vdpc-2002.de/Programm-vdpc-2002.pdf)
(3)vgl. Robert F. Service: Biotechnology: Designer Tissues Take Hold. In: Science (1995) (vol.270, 13.10.95), 230ff; a continuously updated survey of current research and developments can be found on the website of the „Materials Research Society“: http://www.mrs.org. There you also find the MRS-Bulletin. Quite helpful: the website of the National Science Foundation: http://www.nsf.gov. Concerning nanotechnological developments and their ethical implications see: Anisa Mnyusiwalla, Abdallah S. Daar, Peter A. Singer: ‘Mind the gap’: Science and Ethics in Nanotechnology. In: Nanotechnology 14 (March 2003) R9–R13 (http://www.iop.org/EJ/S/UNREG/journal/0957-4484)
(4) see http://www.wtec.org/ConvergingTechnologies/Report/nbic-complete-screen.pdf. The respective homepage can be found under the URL: http://www.wtec.org/ConvergingTechnologies/
(5) Johann Peter Eckermann: Gespraeche mit Goethe in den letzten Jahren seines Lebens (Conversation with Goethe during the last years of his life), 11. Maerz 1828. The text has been published as part of the Gutenberg-project under the URL http://gutenberg.spiegel.de/eckerman/gesprche/gsp3069.htm
University of Regensburg
Institute of Philosophy