Make your own free website on Tripod.com

Is there a right to beauty ? Life as an aesthetical project

Joseph Schmucker-von Koch, University of Regensburg

 

(Opening lecture given on March 7, 2003 at the spring symposium of the Academy for Aesthetical-Plastic Surgery,

organized by the President of the German Association of Aesthetical-Plastic Surgery, Dr. Neuhann-Lorenz, Munich)

 

                                                                  I.

Dear colleagues,

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.

 

                                                                    II.

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.

 

                                                                 III.

 

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 Germany about the readiness to optimize the body at least concerning its physical appearance. 82 percent of young women under the age of 30 would be ready to undergo aesthetical-plastic surgery in order to be more satisfied with their body. This is the result of a poll published by FORSA on August 20, 2002. The market research bureau had questioned about 2000 women from age 14-60 . According to this survey only every fourth woman in Germany is satisfied with her body. Only 27 percent declared they would not change anything on their body. The contentedness with the body would increase with age, the study says. 74 percent of the 30-44 year old women would like to undergo aesthetical-plastic surgery and of the 45-59 year group it was still 60 percent that would do so. Only 38 percent of the women over 60 were ready to undergo such treatment.

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 Germany to create what mother nature had denied to an individual. We have a continuously rising tendency through the last decade. All this represents a trend which goes beyond a mere temporary fashion: the willingness not to accept oneself in the present state of nature, but to optimize it whenever it makes sense on the basis of the scientific and technological achievements available. Everybody has, of course, to decide for himself whether and which measures should be taken. The professional advice by the surgeon and his experience play an important role in this decision-making process. The decision-making process is very complex here and needs well in time before the surgery plenty of knowledge and information which is  gained from various sources such as questionnaires, laboratory analysis and computer simulation that  for instance can show what an effect a planned operation on the nose would have on the proportions of a face. Other decisions have to follow. Whether on the occasion of a facelift only a bail shaped cut from one ear to the other should be made or just 2 or 3 stitches at the hair line for the endoscope, whether only the visible skin or also the connective tissue layer below should be tightened  with the SMAS-method – which operational technique finally will  be chosen has to be decided on individually by the surgeon according to type, age  and texture of the skin.

 

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”(March 01, 2003) has pointed quite convincingly to this task yet to be mastered.

 

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

 

Address:

Prof.Dr.Dr.Joseph Schmucker-von Koch
  University of Regensburg
  Institute of Philosophy
  Universitaetsstrasse 31
  D-93040 Regensburg