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NANOTECHNOLOGY, NANOMEDICINE; ETHICAL ASPECTS Banu GÖKÇAY* and Berna ARDA** *TUBITAK, **Ankara
The Scientific and Technological Research Council of Turkey, Ankara, Turkey
University, Faculty of Medicine, Department of History of Medicine and Ethics, Ankara,
Turkey
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Abstract
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Nanotechnology is a field that we often hear of its name nowadays. Altough what we know about it is soo poor, we admire this field of technlogy, moreover some societies even argues that nanotechnology will cause second endustrial revolution. In addition, nanotechnology makes our basic scientific knowledge upside down and is soo powerfull that it is potent in nearly every scientific field. Thereby, it is imposible to say that nanotechnology; which is soo effective on human and human life; will not cause social and ethical outcomes. In general, the definition of nanotechnology is the reconfiguration of nanomaterials by human; there also are different definitions according to the history of nanotechnology and different point of views. First of all, in comparison to the other tehnology fields, what is the cause of excellence of nanotechnology, what human can do is to foresee the advantages and disadvantages of it, what are the roles of developed and developping countries for the progression of nanotechnology, what is the attitude of nanoethics and what is view of global politics to nanotechological research according to international regulations are all the focus of interests of this study. Last but not least, our apprehension capacity of nanotechnology, our style of adoption and evaluation of it and the way that how we locate nanotechnology in our lifes and ethical values are the other focus of interests.
Keywords Nanotechnology; nanomedicine; nanoethics
WHAT IS NANOTECHNOLOGY AND NANOMEDICINE? Author Manuscript
First, if we check out the answer that can be given to the question “what is nanotechnology?”, here below are the definition and research area of nanotechnology: Nanotechnology is name of the sum of more than one technologies; those can change the matter and its characteristic properties at atomic and molecular levels [1,2]. By the help of this technology, qualitative and quantitative settings of matter can be done at the scale of 1 nanometer (parts per billion of a meter) and 100 nanometers [1]. Seeing the difficulty of picturing this kind of small scale unit in mind that, it would be usefull to make some comparisons. For example, if 1 nanometer would be magnified as your nose; with the same
Corresponding author : Banu Gökçay - [email protected].
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magnifation, thickness of one hair becomes 3 or 4 kilometers or a man’s heigth becomes the heigth of 3 or 4 universes those one on the top of the other [2, 3, 4]. At nano scales, the critic role of quantum physics is the reason of qualitative and quantitative settings of matter [5]. On the other hand, the extanded surface/volume ratio at nano scale is the reason of those particles to become more reactive. A material becoming more reactive means; enlarging the surface area by keeping the mass stable; more material around can get in touch with the material under consideration that has enlarged surface area. That’s, the sensitive materials at normal scale can become super durable at nano scales by extanded surface/volume ration and also by changing characteristic properties of matter. All these mean that, the power of making adorable modifications of materials; put it differently; creating materials those have adorable properties, depends on the ability of keeping changing characteristics at nano scale [1].
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The research area of nanotechnology is the composition of different and specific research fields. Altough the list of these specific research fields differ in time or countries; generally scanning electron microscobe (SEM), nanoparticle researchs, supramoleculer chemistry, molecular modelling, quantum computation, microelectronic mechanic systems (MEMS), light-emited diodes, targeted drug delivery, molecular biotechnology, tissue engineering and more are all inclusive of the nanotechnological research fields list [1]. It should be realized that nanotechnology, or beter to say nanotechnologies is not a single research field; nanotechnological work appears in so many different research fields.
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Health is a primary and indispensable issue for every human being. Therebly, it is not suprising that nanotechnologial applications are encouraged in the field of health and medicine; so called nanomedicine [2]. According to a research of Macoubrie; 31 percent of humans consider nanomedical research success as the biggest gain of all successfull nanotechnological research. What is interesting is that 95 percent of the same people think, governments and endustrial leaders will not effectively guide the risks caused by nanomedical applications [1].
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In fact, it is not correct to say that nanotechnology and human body are unfamiliar to each other. Human body is operating by the entire nano scale mechanism and processes in our cells [6]. That’s why we can call human body as a “nano factory”. In the field of health and medicine firstly pharmacy field tries to decrease the cost of drug designing process, simplifying and speeding up the drug design methods and also enhancing drug safety and drug efficiency by nanotechnological practices. As a result of these studies, targeted drug delivery systems make it possible the transmission at certain times to certain tissues, in nano-controlled manner. Secondly, nanoparticles being used in diagnosis and imaging field are soo important while monitoring disease progression. Also nano surgery tools and techniques such as nano needles and femtosecond (10 –15 of a second) laser surgery provide us doing surgical interventions at a living cell’s dimensions. Hereafter, cell therapy, ophthalmic surgery, tissue engineering and laser-assisted IVF are thought to become nano surgical practices. For example, because biocompatibility is the main obstacle for replacing senthetic materials with damaged or lost tissues; by using nano scaled materials having unique properties, it is possible to exactly mimic the surface volume of replaced tissues by
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using. By this way, human body will accept nano materials as its own constituents, while recognizing senthetic materials as outsiders [7].
ETHICAL ISSUES RAISED BY NANOTECHNOLOGY 1- Health Issues It is for sure that there are many ethical issues raised by nanotechnology in the field of medicine. On one hand the cost of nano-devices and nano surgery tools and on the other hand the unknown technical capacity of these devices&tools makes the issue ethically speculative. Moreover, it is not easy to predict the toxicity of nanomaterials because of setting qualitative and quantitative properties of matter changes its toxicity of its macrosized condition.
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There is also a societal impact of nanotechnology in the field of medicine. The futuristic overtone of nanomedicine seems to effect the relationship between physician and patient [8]. Generally, most of the physicians are the group that just performing nanotechnological advances, not the group that generating these advances. For this reason, physicians sufficient technical knowledge is essential for applying nanotechnological applications in the right way. The improvement of technology is possible with the existence of technical knowledge. As a result of that, physicians in the filed of nano medicine are gradually becoming expertises in specific fields and using specific techniques of that fields. Today and in the near future, disease progress of a patient will not be monitored just by one pyhsician.
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The other ethical and societal impact of nanotechnology on medicine is about the relationship between the patient and the pyhsician. The proper diagnosis and treatment are depend on the proper usage of nanotechnology. Patients sense of trust to pyhsician; that is also so important for the patients pyhsicology; and the humanitarian relationship between them is need to be conserved. Progression in the field of nanotechnology cause transformation of medical profession from being an art execution to a team and technology service. Therefore, the right way of physician and patient dialog should not be disregarded, while nano medical achievement all being ocur, since technical knowledge will not be able to introduce this way of dialog [7].
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Lastly, another important scietal impact of nanotechnology on medicine seems to be in health system. Especially the differentiation of health system services leads to the differentiation of the substructure of health system. One of the main changes of health system that nanotechnological improvement effects is the labor of the personel. By the leading of new technology, prevention of diseases, early diagnosis and improved imaging systems capable of monitoring the current state of healty condition or the disease period are all settled in our health system perception. As a result of these improvements, patient care at home come into prominence rather than patient care at hospital. In other words, medicine exited hospitals and entered laboratories. On the other hand, appropriate integration between the medical knowledge and the knowledge that nanotechnological improvements introduce us is also important to handle with health system innovations in the right way. However, the opposite side of the situation is worth to be considered. Microarrays used in laboratory tests, individualized medicine and new R&D studies are all more sophisticated methods of
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nanotechnology but at least in progression period of nanotechnology; as mentioned above it is obvious that these methods will bring us very high costs [7]. For that reason, it is a fact that the expectations from nanotechnology and it’s benefits are massive in the field of nanomedicine. However, the hesitations about it’s todays technical capacity and adequacy should not be undervalued. 2- Societal Issues Altough the effect of nanotechnology on medicine, in other words on human biology is huge; the other societal effects of it also worth to be considered. Nanotechnological improvement also effects human interactions, politics and economics.
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2a- The Effect of Nanotechnology on Developing Countries—Due to the information that nanotechnology and its application fields are capable of being very powerfull and influential; effect of this powerfull new technology on developing countries is a fact that should not be disregarded. It is easy to guess that the effect of nanotechnology will differ from people having different opportunities and life styles in different places. In 21th century developed countries having big industries consider nanotechnological power as a must-have for global competion [9].
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Firstly, the difference between the definitions of developed and developing countries should be indicated. Degree of development of a country is depended on some criteria such as gross national product, political stability and equality between the citizens [1]. According to the assessment of these criteria, devepoling countries have similar picture. Most of the citizens in these countries are generally devoid of some basic necessities such as potable water, education and health services. To be lacking that far in basic necessities; to be lacking in R&D budget for developing countries is inevitable. However, altough some developing countries such as China can afford allocating much more fund for R&D with respect to previous years; lack of experience of technology management is another handicap for these countries. On the other hand, the field called “technology” should be defined in terms of socioeconomic way, to be able to analyze the effect of nanotechnology on developing countries, in an appropriate manner. If we seperate a technology’s process cycle into phases, these steps should be as follows respectively; 1. the creation of R&D ideas and the processes accruing from these ideas, 2. manufacture, marketing and utilization of products and 3. termination of the waste products of these market [1, 10].
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The decision about which studies of R&D field in the first step said above should be done is a critical decision. A wrong decision in this first step would cause big amount of money go to waste. It is feasible for developed countries to waste some R&D expenses but the conditions are not the same for developing countries. It is possible for developing countries having limited R&D budgets facing no-returning and traumatic results, when a wrong R&D decision is taken. This is because nanotechnology is a new field and presently nanotechnological study results are unknown. That’s why, it is not suprising that developing countries are mostly staying away from nanotechnological R&D studies.
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The second step of process cycle of nanotechnology is production, marketing and consumption of nano-products. In this step there are roles for every kind of country as final product producer, raw material producer and disposer of wastes. Every role for every country should be advantegeous or disadvantageous or dangerous in other words. For example, if a country is the producer of nano-materials, it shoud gain some economic advantages but the risk of environmental pollution, undetermined employee security and unprescribed dangers resulting from nano-products are all should be disadvantages for that country. On the other hand, the raw material production and marketing these materials to technological product producer countries should be advantegeous. However, a possible change of use of the current technology would cause a change for the need of raw material kind. Thus, the raw material producer countries for the previous technology would become in a disadvanteous condition rather than a advantegous one. When saying raw materials for technological products, it is recurring to the mind the mineral deposits under the ground of developing countries border lands. Since it has been available to produce more resistant and lighter mines by nanotechnology, the need for raw material is going to be decreased. As a result of this condition, metal trade will be impeded and the gap between the developed and developing countries endustries will highly increased.
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As a general determination, nanotechnology is a good thing for developed countries. However, if developing countries will not be able to race against developed countries in the field of nanotechnology, at least they should adopt in principle their conditions not to go worser. Nanotechnology will terminate developed countries dependence on developing countries having raw material, and if this will cause developing countries go downhill, developing countries should work harder on international agreements those guarantee their benefits. Developing countries should have the responsibility that international agreements will not just stay on paper. The 15th article of Universal Declaration on Bioethics and Human Rights of UNESCO is giving the idea of this responsibility of developing countries [11]: “Benefits resulting from any scientific research and its applications should be shared with society as a whole and within the international community, in particular with developing countries.”
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2b- The Effect of Nanotechnology on Laborers—It is always possible to come up with some uncertainty in every king of R&D field, this is the core property of scientific research. Naturally, the uncertainty of scientific research results are also uncertainty for the safety of researchers. When talking about nanotechnology, the unkonwn toxicity of nanoparticles should be dangerous for researchers. In this kind of dangerous testing phases of nanotechnological research, the laborers who are contributing to these testing phases as so to say “guinea pig”. Undetermined employee security and unprescribed dangers resulting from nano-products are all should be considered as the effects of nanotechnology on laborers. 2c-The Effect of Nanotechnology on Managerial Issues—Today, there is a growing attention to nanotechnological research field. While the budget for nanotechnological research in US was 2,1 bilion dolar in 2012, 16,5 billion dolar has been spent since 2001
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(2012’s budget is included). Since 2005, nanotechnological research budget that has been spent in environmental, health and defence industry fields was 575 billion dolar and the budget spent for the research for ethical, legal and social effects of nanotechnology was more than 390 billion dolar. In 2008, European Union and Japan those noticed the importance of nanotechnology spent 1,7 billion and 950 million dolar respectively. In 2008 China, Korea and Taiwan also spent 430 million, 310 million and 110 million dolar respectively [5].
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For the governance of nanotechnological research in the world in terms of the ethical dimensions of science and technology evolution; UNESCO established “International Bioethics Committee” composed of 36 experts of different fields, from different places in the world. The aim of this committee is to share different ideas and experiences in the field of life sciences, to make recommendations to desicion making powers and to overbridge between those powers and public. It is also soo important to raise the general consciousness of people having different educational levels. Because nanotechnology is a rapidly progressing field, it is needed to make ethical considerations for the future. UNESCO is contantly carring out the necessary studies to detect the advantages and disadvantages before the social concerns and moral expressions about nanotechnology being formed. In consequence, UNESCO is planning on to present the general framework of the state that the governance of science by developed countries those are dependent on the resources of developing countries [12]. 3- Futuristic Issues If we try to think about the possible ethical problems of the future, it is probable to face mainly with 6 subject headings, as pointed out below [13]:
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3a-Enlarging expactations and unsubstantial estimations—The not yet settled control of the power of nanotechnology and the exaggerated expactations about the potential of nanotechnology may cause to nourish false hopes and to sepend time and money in vain. Thus, it would be more useful to think about which one of the practicable processes of nanomedicine are more realistic and more meaningful; rather than just to think about which processes of nanomedicine will be practicable.
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3b- Possible risks—In the field of nanomedicine, it is really hard to make a judgement about which values are worth to spend for the sake of human health. Today, the risks of the treatments applied at nano scales are not known certainly. On this account, even if the risks of these treatments are predictable, it is hard to decide whether these risks are worth to be taken. 3c- Clinical applications of nanotechnological processes—In order to be able to apply a method clinically, first we should be sure about the method that it is useful and it is worth to be selected among all other possible methods. Thus, only in the case of these conditions, nanomedicine should be possible in the field of clinics. 3d- The problem of confidentiality—Ethical problems about confidentiality is existing in the field of nanotechnology, as it exists in other technology fields. Protection of Rev Rom Bioet. Author manuscript; available in PMC 2017 April 17.
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confidentiality in the field of nanomedicine is an issue and a matter of choice because of the easiness of electronically storage, mobility and accessibility of databases. 3e- The problem of equality—If we think about the facilities that nanotechnology provides, are limitless and be accessable by all citizens, this would be unrealistic. So that, to whom we will give priority to benefit from these facilities is another controversial subject [14].
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3f- The problem of definition of being a human—The conditions of being a human, who we are and all we know about the necessities for our existance are the components of just a probable scenario among the ones nanotechnology provides us. In other words, nanotechnology has different answers to the question of the conditions of being a human. Will we keep the knowledge about what we have now or will we benefit from the opportunities nanomedicine provides us to search for the other possible conditions of being human [15]? From this point of view, 2 important points about the ethical aspects of nanotechnology should be underlined: first, developing the potentiality of the state of “being human” of all people on the world; second, avoiding the offensive possibility of “being human”. The potentiality of the state of “being human” lead us to the question “potential for what?”. The answer to this question depends on our perception of the concept of human or the perception we will have in the future. Furthermore, will the offensive results for the state of being a human; on behalf of developing the potential of being human; be allowed or not, also depends on the forming perception of concept of human.
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Two more subject heading could be added to these 6 headings. First, the ethical problems caused by nanotechnological processes used by defense industry and second as mentioned above, the requirement of informed public body vote to form the basis for the legal aspects of nanotechnological practices [13]. Here below the Figure 1 represents the main ethical issues raised by nanotechnology those mentioned in this article:
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Figure 1.
The Main Ethical Issues Raised By Nanotechnology
CONCLUSION
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Technology is the sum of instruments those created by mankind to keep all processes and circumstances in the world under control. Technology is etymologically derived from the words “tekhnẽ” meaning craftsmanship, craft and “logia” meaning labouring [16]. Altough the word technology is derived from the Greek word “tekhnẽ”, today the perception of technology is not the same with the one in ancient Greek times. Today, what we call technology is the field of modern technology and the field of production of high-tech products (computers, cell phones, genetic engineering…etc.); whereas the ancient technology perception is interfering in nature’s normal process to produce instruments to provide for needs of mankind. Therefore, the only resource was nature for old times’ technology but now the human being who governs nature and designes hich-technologies is the main source for modern technology. According to Heidegger, the basis of technology is “framing”. Modern technology is covering the existing as being the frame of existing. This framing makes mankind have the perception of seing objects ready for his service, in other Rev Rom Bioet. Author manuscript; available in PMC 2017 April 17.
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words framing makes him feel being the master of the world [17]. Today modern technology is not existing only for to provide for needs of human beings, but also aims to create new natures different from the one they know.
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Fundementally, technology is dualistic; that is to say it has some advantages and also disadvantages for mankind. Our capacity of apprehension of technology, our style of adoption and our wish to use it all will show our view point of its advantages and disadvantages. In consequence, whether we are optimistic or pessimistic about the new nature that technology will give us; our style of valuing it will show who we are and what we appreciate the most. Comtemporarily, every kind of information is becaming transparent for everyone in the society. This transparency is profoundly revising our capacity of apprehension of “things”, our style of adoption and our desire to place them in our lifes. This transparent environment is showing all the details of “the great technology” more explicitly. Correspondinly, our capacity of apprehension of technology, our style of adoption and valuing it will be the indicators of our way of placing technology into our lifes and value judgements. The answers of the big questions such as “What will be the effect of nanotechnology on mankind?”, “What is a good life and will nanotechnology be able to change our good life perception?”, “What kind of society do we want and how should we correlate nanotechnology and the society we want?” will all differ according to our apprehension of nanotechnology correctly or wrongly; or according to our adoptation style to it [9].
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The term of nanoethics is formed as a result of the ethical questions those are the upshot of nanotechnology comprehension [15]. In order to be able to speak about the existance of the private ethics field of nanotechnology; we should also speak about the unique ethical problems nanotechnology causes or speak about that nanotechnology causes rather common ethical problems. So that, it should come to mind that nanotechnology causes similar ethical problems as biotechnology does. However, allowing matter to gain extraordinary properties and exponential degree of development of nanotechnology make it technically more powerfull than biotechnology. Therefore, it is true to say that nanotechnology causes similar but bigger ethical problems than biotechnology does [4, 18].
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As every kind of technology, nanotechnology will also induce changes in our life styles. For all you know, the biggest difference of nanotechnology will be the rate of changes it causes are the much more faster. The rate of life style changes depend on the exponential process rate of nanotechnological information. According to Ray Kurzweil, historically the process rate of technological information is exponential rather than linear [16]. While the process rate of nanotechnological information accelerates, the time period allowed for us to comprehend and adopt it decreases. In such a case, we would rather adopt nanotechnological “blessings” without understanding or we would spend more time to be able to adopt or understand. In both cases, it is so probable to overlook the consideration of the social process [19]. For example, the social themes of nanotechnology such as “the question of prior or not prior”, “the question of who will benefit from nanotechnological advantages”, “the question of responsibility of the developing countries to the developed ones those
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produced nanotechnological products” all generally leaved out. In order to prevent by heart society perception without the consideration of social themes mentioned above, delegates from the society should take part in the ethical and legal discussions of nanotechnology [14]. If not, taking only commercial market into consideration, the results will not always fit with the correct one for humanity [13].
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Currently, there are more than 800 products in our daily life, those produced by the use of nano-dimentional materials. Baseballs, tenis rackets, suitcases, tyres, eyeglasses, nanodimentioned thin film layers on computer and camera monitors, sunscreens, shampoos, creams, cosmetics…etc. are some of the examples of these producs [4, 5]. These products are produced of nano-materials some are light but strong, some are water-repellent, some are capable of self-renewal and some are antimicrobial. The fact that ordinary materials gaining extraordinary and desired properties when working at nano scales, provides so many successes in many industrial areas. But when the area of health and medine are being taken into consideration, though there are so many possible things done by nanotechnological processes, it is not easy and fast to achieve successes as done in the other industrial areas. The biggest obstacle for this is the increasing toxicity as dimentions of the material decreases into nano-scales. Also another obstacle for nanotechnological improvement in medicine field is the changing relationships between the individuals in health system. Unpredictible and high tecnological changes makes these individuals a bit concerned about the applications of nano-medicine tools.
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As mentioned before, nanotechnology is the name of the ability of understanding and keeping under control the qualitative and quantitative settings of matter at the scale of 1 nanometer and 100 nanometers [20]. Certainly, while considering the possible effects of this ability on human lifes, we should also bear in mind the complicacy and uncertainty of nanotechnology, as well as the exponential degree of development of nanotechnology. Complicacy is the state between order and chaos which is created by more than one interdependent factors. The characteristics of complex systems are the nonstability, uncertainty and the resistance to be kept under control. Correspondinly, modelling, estimating the consequences and keeping under control of nanotechnology is as difficult as a complex system. For this reason, exponential degree of development and complicacy of nanotechnology confront us its uncertainity. Here uncertainity means “what we know and what we do not know about nanotechnology”. Where we talk about the existance of uncertainity, there it gets difficult to detect, guess or keep under control the inputs and outputs of nanotechnological process; or simply it gets difficult to be aware of.
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On the other hand, according to the survey conducted in developing countries, most of the people have a optimistic pose about the results of nanotechnological developments. The reason for this situation is that those people’s lack knowledge about the risks of nanotechology or the satisfaction of happiness that nanotechnological products bring to their lifes. As a result of that, these people may probable become unable to distinguish between the possible applications of nanotechnology and science fiction [21]. The state of being optimistic about nanotechnology will be inevitable when people become unable to distinguish between the possible things and science fiction. In this instance, the knowledge and power gap between public and governments or between public and large companies
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grow unnoticed [22]. A similar problem had been taken into account during building the Human Genome Project and %3–5 of the project budget had been allocated for the ethical, legal and social aspests to be analysed. This budget is mainly used for two important issues. Firstly, to create an early awereness about the potential problems of the project and secondly, to reduce the potential for risk of this technology. By resolving the lack of information about the new technology, it will be enlightened the circumstances under which the satisfaction of happiness will be meaningful [13].
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Consequently, as long as the uncertainties about the potentials and the controllability of nanotechnology exists, ethical discussions will go on. We are witnessing the rapid scientific developments in the current era. During these scientific developments, it is so necessary to take care of handling the scientific strength and to take responsibilities about results of the new technologies. The underlined sense of responsibility should provide to take care about developing nanotechnology for the aims to be useful to humanity and to practice nanotechnological processes just in case of the results can be predicted. The main core of nanomedicine should be “treatment of diseases to protect the natural human form” rather than “developing the natural human form”. Last but not least, the formation of global negotiations should be created to illuminate the ethical and legal aspects of nanomedicine.
References
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1. Allhoff, F., Lin, P., Moor, J. Nanoethics: The Ethical and Social Implications of Nanotechnology. Allhoff, F., editor. N.J: John Wiley; 2007. p. 3p. 91p. 147p. 291 2. Bennet-Woods, D. Nanotechnology: Ethics and Society. Hornyak, G., editor. Taylor-Francis Group CRC Pres; 2008. p. 7-18.p. 179-183. 3. Ebbesen M. Nanomedicine: Techniques, Potentials, and Ethical Implications. Journal of Biomedicine and Biotechnology. 2006; 2006:1–11. 4. Allhoff F, Lin P. What’s So Special About Nanotechnology and Nanoethics? International Journal of Applied Philosophy. 2006; 20:179–190. 5. Nanotechnology 101. [cited 2012 April 21]. Available from: http://www.nano.gov/html 6. Kuiken, T. Nanomedicine and Ethics: Is There Anything New or Unique?. [cited 2011 August 25]. Available from: www.wiley.com/wires/nanomed 7. Kadıoğlu F. The Changing Face Of The Patient-Physician Relationship: A Journey from Trephine to Carbon Nanotube Microsensors. 2. Symposium on Medical Ethics and Medical Law. 2006:403–407. (In Turkish). 8. Poel I. How Should We Do Nanoethics? A Network Approach for Discerning Ethical Issues in Nanotechnology. NanoEthics. 2008; 2:25–38. 9. Ebbesen M, Andersen S, Besenbacher F. Ethics in Nanotechnology: Starting From Scratch? Bulletin of Science, Technology&Society. 2006; 26:451–462. 10. Sparrow R. The Social Impacts of Nanotechnology, an Ethical and Political Analysis. Bioethical Inquiry. 2009; 6:13–23. 11. Unesco. Universal Declaration on Bioethics and Human Rights. 2005. p. 7 12. Unesco. The Ethics and Politics of Nanotechnology. 2006. p. 13 13. Cameron N. Nanotechnology, Medicine and The Human Condition: A Perspective from U.S. European Commission: Group on Ethics in Science and New Technologies. Ethical Aspects of Nanomedicine. 2006:31–37. 14. Hogle L. Science, Ethics and the “Problems” of Governing Nanotechnologies. Journal of Law, Medicine&Ethics. 2009:749–758. 15. Nurock V. Ethics For, From, or With Nanotechnologies? International Journal of Philosopy of Chemistry. 2010; 16:31–42.
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16. Kurzweil, R. The Age of Spiritual Machines. In: Kurzweil, R., editor. Technology: Evolution by Other Means. Penguin Books; 2000. p. 14-17. 17. Martin Heidegger. [cited 2013 June 7]. Available from: http://en.wikipedia.org/wiki/ Martin_Heidegger 18. The Ethical Implications of Nanotechnology. [cited 2011 August 20]. Available from: http:// www.nanoethics.org/ 19. Yücel, D. Nanotechnology: Promised Miracles. Cumhuriyet Bilim Teknik [Internet]. 2010. [cited 2011 November 2] (In Turkish). Available from: http://www.cumhuriyet.com.tr/?hn=186470 20. Kuzma J. What’s Nanotechnology, Why Does It Matter? From Science to Ethics. Bioethical Inquiry. 2011; 8:209–211. 21. Tevfik H. Snow White and The Quadrillions Dwarfs. Hayykitap. 2005:23–24. 33–34. (In Turkish). 22. Petersen A. Introduction: The Ethical Challenges of Nanotechnologies. Bioethical Inquiry. 2009; 6:9–12.
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Rev Rom Bioet. Author manuscript; available in PMC 2017 April 17. Published in final edited form as: Rev Rom Bioet. 2015 ; 13(3): .
NANOTECHNOLOGY, NANOMEDICINE; ETHICAL ASPECTS Banu GÖKÇAY* and Berna ARDA** *TUBITAK, **Ankara
The Scientific and Technological Research Council of Turkey, Ankara, Turkey
University, Faculty of Medicine, Department of History of Medicine and Ethics, Ankara,
Turkey
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Abstract
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Nanotechnology is a field that we often hear of its name nowadays. Altough what we know about it is soo poor, we admire this field of technlogy, moreover some societies even argues that nanotechnology will cause second endustrial revolution. In addition, nanotechnology makes our basic scientific knowledge upside down and is soo powerfull that it is potent in nearly every scientific field. Thereby, it is imposible to say that nanotechnology; which is soo effective on human and human life; will not cause social and ethical outcomes. In general, the definition of nanotechnology is the reconfiguration of nanomaterials by human; there also are different definitions according to the history of nanotechnology and different point of views. First of all, in comparison to the other tehnology fields, what is the cause of excellence of nanotechnology, what human can do is to foresee the advantages and disadvantages of it, what are the roles of developed and developping countries for the progression of nanotechnology, what is the attitude of nanoethics and what is view of global politics to nanotechological research according to international regulations are all the focus of interests of this study. Last but not least, our apprehension capacity of nanotechnology, our style of adoption and evaluation of it and the way that how we locate nanotechnology in our lifes and ethical values are the other focus of interests.
Keywords Nanotechnology; nanomedicine; nanoethics
WHAT IS NANOTECHNOLOGY AND NANOMEDICINE? Author Manuscript
First, if we check out the answer that can be given to the question “what is nanotechnology?”, here below are the definition and research area of nanotechnology: Nanotechnology is name of the sum of more than one technologies; those can change the matter and its characteristic properties at atomic and molecular levels [1,2]. By the help of this technology, qualitative and quantitative settings of matter can be done at the scale of 1 nanometer (parts per billion of a meter) and 100 nanometers [1]. Seeing the difficulty of picturing this kind of small scale unit in mind that, it would be usefull to make some comparisons. For example, if 1 nanometer would be magnified as your nose; with the same
Corresponding author : Banu Gökçay - [email protected].
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magnifation, thickness of one hair becomes 3 or 4 kilometers or a man’s heigth becomes the heigth of 3 or 4 universes those one on the top of the other [2, 3, 4]. At nano scales, the critic role of quantum physics is the reason of qualitative and quantitative settings of matter [5]. On the other hand, the extanded surface/volume ratio at nano scale is the reason of those particles to become more reactive. A material becoming more reactive means; enlarging the surface area by keeping the mass stable; more material around can get in touch with the material under consideration that has enlarged surface area. That’s, the sensitive materials at normal scale can become super durable at nano scales by extanded surface/volume ration and also by changing characteristic properties of matter. All these mean that, the power of making adorable modifications of materials; put it differently; creating materials those have adorable properties, depends on the ability of keeping changing characteristics at nano scale [1].
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The research area of nanotechnology is the composition of different and specific research fields. Altough the list of these specific research fields differ in time or countries; generally scanning electron microscobe (SEM), nanoparticle researchs, supramoleculer chemistry, molecular modelling, quantum computation, microelectronic mechanic systems (MEMS), light-emited diodes, targeted drug delivery, molecular biotechnology, tissue engineering and more are all inclusive of the nanotechnological research fields list [1]. It should be realized that nanotechnology, or beter to say nanotechnologies is not a single research field; nanotechnological work appears in so many different research fields.
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Health is a primary and indispensable issue for every human being. Therebly, it is not suprising that nanotechnologial applications are encouraged in the field of health and medicine; so called nanomedicine [2]. According to a research of Macoubrie; 31 percent of humans consider nanomedical research success as the biggest gain of all successfull nanotechnological research. What is interesting is that 95 percent of the same people think, governments and endustrial leaders will not effectively guide the risks caused by nanomedical applications [1].
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In fact, it is not correct to say that nanotechnology and human body are unfamiliar to each other. Human body is operating by the entire nano scale mechanism and processes in our cells [6]. That’s why we can call human body as a “nano factory”. In the field of health and medicine firstly pharmacy field tries to decrease the cost of drug designing process, simplifying and speeding up the drug design methods and also enhancing drug safety and drug efficiency by nanotechnological practices. As a result of these studies, targeted drug delivery systems make it possible the transmission at certain times to certain tissues, in nano-controlled manner. Secondly, nanoparticles being used in diagnosis and imaging field are soo important while monitoring disease progression. Also nano surgery tools and techniques such as nano needles and femtosecond (10 –15 of a second) laser surgery provide us doing surgical interventions at a living cell’s dimensions. Hereafter, cell therapy, ophthalmic surgery, tissue engineering and laser-assisted IVF are thought to become nano surgical practices. For example, because biocompatibility is the main obstacle for replacing senthetic materials with damaged or lost tissues; by using nano scaled materials having unique properties, it is possible to exactly mimic the surface volume of replaced tissues by
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using. By this way, human body will accept nano materials as its own constituents, while recognizing senthetic materials as outsiders [7].
ETHICAL ISSUES RAISED BY NANOTECHNOLOGY 1- Health Issues It is for sure that there are many ethical issues raised by nanotechnology in the field of medicine. On one hand the cost of nano-devices and nano surgery tools and on the other hand the unknown technical capacity of these devices&tools makes the issue ethically speculative. Moreover, it is not easy to predict the toxicity of nanomaterials because of setting qualitative and quantitative properties of matter changes its toxicity of its macrosized condition.
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There is also a societal impact of nanotechnology in the field of medicine. The futuristic overtone of nanomedicine seems to effect the relationship between physician and patient [8]. Generally, most of the physicians are the group that just performing nanotechnological advances, not the group that generating these advances. For this reason, physicians sufficient technical knowledge is essential for applying nanotechnological applications in the right way. The improvement of technology is possible with the existence of technical knowledge. As a result of that, physicians in the filed of nano medicine are gradually becoming expertises in specific fields and using specific techniques of that fields. Today and in the near future, disease progress of a patient will not be monitored just by one pyhsician.
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The other ethical and societal impact of nanotechnology on medicine is about the relationship between the patient and the pyhsician. The proper diagnosis and treatment are depend on the proper usage of nanotechnology. Patients sense of trust to pyhsician; that is also so important for the patients pyhsicology; and the humanitarian relationship between them is need to be conserved. Progression in the field of nanotechnology cause transformation of medical profession from being an art execution to a team and technology service. Therefore, the right way of physician and patient dialog should not be disregarded, while nano medical achievement all being ocur, since technical knowledge will not be able to introduce this way of dialog [7].
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Lastly, another important scietal impact of nanotechnology on medicine seems to be in health system. Especially the differentiation of health system services leads to the differentiation of the substructure of health system. One of the main changes of health system that nanotechnological improvement effects is the labor of the personel. By the leading of new technology, prevention of diseases, early diagnosis and improved imaging systems capable of monitoring the current state of healty condition or the disease period are all settled in our health system perception. As a result of these improvements, patient care at home come into prominence rather than patient care at hospital. In other words, medicine exited hospitals and entered laboratories. On the other hand, appropriate integration between the medical knowledge and the knowledge that nanotechnological improvements introduce us is also important to handle with health system innovations in the right way. However, the opposite side of the situation is worth to be considered. Microarrays used in laboratory tests, individualized medicine and new R&D studies are all more sophisticated methods of
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nanotechnology but at least in progression period of nanotechnology; as mentioned above it is obvious that these methods will bring us very high costs [7]. For that reason, it is a fact that the expectations from nanotechnology and it’s benefits are massive in the field of nanomedicine. However, the hesitations about it’s todays technical capacity and adequacy should not be undervalued. 2- Societal Issues Altough the effect of nanotechnology on medicine, in other words on human biology is huge; the other societal effects of it also worth to be considered. Nanotechnological improvement also effects human interactions, politics and economics.
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2a- The Effect of Nanotechnology on Developing Countries—Due to the information that nanotechnology and its application fields are capable of being very powerfull and influential; effect of this powerfull new technology on developing countries is a fact that should not be disregarded. It is easy to guess that the effect of nanotechnology will differ from people having different opportunities and life styles in different places. In 21th century developed countries having big industries consider nanotechnological power as a must-have for global competion [9].
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Firstly, the difference between the definitions of developed and developing countries should be indicated. Degree of development of a country is depended on some criteria such as gross national product, political stability and equality between the citizens [1]. According to the assessment of these criteria, devepoling countries have similar picture. Most of the citizens in these countries are generally devoid of some basic necessities such as potable water, education and health services. To be lacking that far in basic necessities; to be lacking in R&D budget for developing countries is inevitable. However, altough some developing countries such as China can afford allocating much more fund for R&D with respect to previous years; lack of experience of technology management is another handicap for these countries. On the other hand, the field called “technology” should be defined in terms of socioeconomic way, to be able to analyze the effect of nanotechnology on developing countries, in an appropriate manner. If we seperate a technology’s process cycle into phases, these steps should be as follows respectively; 1. the creation of R&D ideas and the processes accruing from these ideas, 2. manufacture, marketing and utilization of products and 3. termination of the waste products of these market [1, 10].
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The decision about which studies of R&D field in the first step said above should be done is a critical decision. A wrong decision in this first step would cause big amount of money go to waste. It is feasible for developed countries to waste some R&D expenses but the conditions are not the same for developing countries. It is possible for developing countries having limited R&D budgets facing no-returning and traumatic results, when a wrong R&D decision is taken. This is because nanotechnology is a new field and presently nanotechnological study results are unknown. That’s why, it is not suprising that developing countries are mostly staying away from nanotechnological R&D studies.
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The second step of process cycle of nanotechnology is production, marketing and consumption of nano-products. In this step there are roles for every kind of country as final product producer, raw material producer and disposer of wastes. Every role for every country should be advantegeous or disadvantageous or dangerous in other words. For example, if a country is the producer of nano-materials, it shoud gain some economic advantages but the risk of environmental pollution, undetermined employee security and unprescribed dangers resulting from nano-products are all should be disadvantages for that country. On the other hand, the raw material production and marketing these materials to technological product producer countries should be advantegeous. However, a possible change of use of the current technology would cause a change for the need of raw material kind. Thus, the raw material producer countries for the previous technology would become in a disadvanteous condition rather than a advantegous one. When saying raw materials for technological products, it is recurring to the mind the mineral deposits under the ground of developing countries border lands. Since it has been available to produce more resistant and lighter mines by nanotechnology, the need for raw material is going to be decreased. As a result of this condition, metal trade will be impeded and the gap between the developed and developing countries endustries will highly increased.
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As a general determination, nanotechnology is a good thing for developed countries. However, if developing countries will not be able to race against developed countries in the field of nanotechnology, at least they should adopt in principle their conditions not to go worser. Nanotechnology will terminate developed countries dependence on developing countries having raw material, and if this will cause developing countries go downhill, developing countries should work harder on international agreements those guarantee their benefits. Developing countries should have the responsibility that international agreements will not just stay on paper. The 15th article of Universal Declaration on Bioethics and Human Rights of UNESCO is giving the idea of this responsibility of developing countries [11]: “Benefits resulting from any scientific research and its applications should be shared with society as a whole and within the international community, in particular with developing countries.”
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2b- The Effect of Nanotechnology on Laborers—It is always possible to come up with some uncertainty in every king of R&D field, this is the core property of scientific research. Naturally, the uncertainty of scientific research results are also uncertainty for the safety of researchers. When talking about nanotechnology, the unkonwn toxicity of nanoparticles should be dangerous for researchers. In this kind of dangerous testing phases of nanotechnological research, the laborers who are contributing to these testing phases as so to say “guinea pig”. Undetermined employee security and unprescribed dangers resulting from nano-products are all should be considered as the effects of nanotechnology on laborers. 2c-The Effect of Nanotechnology on Managerial Issues—Today, there is a growing attention to nanotechnological research field. While the budget for nanotechnological research in US was 2,1 bilion dolar in 2012, 16,5 billion dolar has been spent since 2001
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(2012’s budget is included). Since 2005, nanotechnological research budget that has been spent in environmental, health and defence industry fields was 575 billion dolar and the budget spent for the research for ethical, legal and social effects of nanotechnology was more than 390 billion dolar. In 2008, European Union and Japan those noticed the importance of nanotechnology spent 1,7 billion and 950 million dolar respectively. In 2008 China, Korea and Taiwan also spent 430 million, 310 million and 110 million dolar respectively [5].
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For the governance of nanotechnological research in the world in terms of the ethical dimensions of science and technology evolution; UNESCO established “International Bioethics Committee” composed of 36 experts of different fields, from different places in the world. The aim of this committee is to share different ideas and experiences in the field of life sciences, to make recommendations to desicion making powers and to overbridge between those powers and public. It is also soo important to raise the general consciousness of people having different educational levels. Because nanotechnology is a rapidly progressing field, it is needed to make ethical considerations for the future. UNESCO is contantly carring out the necessary studies to detect the advantages and disadvantages before the social concerns and moral expressions about nanotechnology being formed. In consequence, UNESCO is planning on to present the general framework of the state that the governance of science by developed countries those are dependent on the resources of developing countries [12]. 3- Futuristic Issues If we try to think about the possible ethical problems of the future, it is probable to face mainly with 6 subject headings, as pointed out below [13]:
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3a-Enlarging expactations and unsubstantial estimations—The not yet settled control of the power of nanotechnology and the exaggerated expactations about the potential of nanotechnology may cause to nourish false hopes and to sepend time and money in vain. Thus, it would be more useful to think about which one of the practicable processes of nanomedicine are more realistic and more meaningful; rather than just to think about which processes of nanomedicine will be practicable.
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3b- Possible risks—In the field of nanomedicine, it is really hard to make a judgement about which values are worth to spend for the sake of human health. Today, the risks of the treatments applied at nano scales are not known certainly. On this account, even if the risks of these treatments are predictable, it is hard to decide whether these risks are worth to be taken. 3c- Clinical applications of nanotechnological processes—In order to be able to apply a method clinically, first we should be sure about the method that it is useful and it is worth to be selected among all other possible methods. Thus, only in the case of these conditions, nanomedicine should be possible in the field of clinics. 3d- The problem of confidentiality—Ethical problems about confidentiality is existing in the field of nanotechnology, as it exists in other technology fields. Protection of Rev Rom Bioet. Author manuscript; available in PMC 2017 April 17.
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confidentiality in the field of nanomedicine is an issue and a matter of choice because of the easiness of electronically storage, mobility and accessibility of databases. 3e- The problem of equality—If we think about the facilities that nanotechnology provides, are limitless and be accessable by all citizens, this would be unrealistic. So that, to whom we will give priority to benefit from these facilities is another controversial subject [14].
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3f- The problem of definition of being a human—The conditions of being a human, who we are and all we know about the necessities for our existance are the components of just a probable scenario among the ones nanotechnology provides us. In other words, nanotechnology has different answers to the question of the conditions of being a human. Will we keep the knowledge about what we have now or will we benefit from the opportunities nanomedicine provides us to search for the other possible conditions of being human [15]? From this point of view, 2 important points about the ethical aspects of nanotechnology should be underlined: first, developing the potentiality of the state of “being human” of all people on the world; second, avoiding the offensive possibility of “being human”. The potentiality of the state of “being human” lead us to the question “potential for what?”. The answer to this question depends on our perception of the concept of human or the perception we will have in the future. Furthermore, will the offensive results for the state of being a human; on behalf of developing the potential of being human; be allowed or not, also depends on the forming perception of concept of human.
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Two more subject heading could be added to these 6 headings. First, the ethical problems caused by nanotechnological processes used by defense industry and second as mentioned above, the requirement of informed public body vote to form the basis for the legal aspects of nanotechnological practices [13]. Here below the Figure 1 represents the main ethical issues raised by nanotechnology those mentioned in this article:
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Figure 1.
The Main Ethical Issues Raised By Nanotechnology
CONCLUSION
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Technology is the sum of instruments those created by mankind to keep all processes and circumstances in the world under control. Technology is etymologically derived from the words “tekhnẽ” meaning craftsmanship, craft and “logia” meaning labouring [16]. Altough the word technology is derived from the Greek word “tekhnẽ”, today the perception of technology is not the same with the one in ancient Greek times. Today, what we call technology is the field of modern technology and the field of production of high-tech products (computers, cell phones, genetic engineering…etc.); whereas the ancient technology perception is interfering in nature’s normal process to produce instruments to provide for needs of mankind. Therefore, the only resource was nature for old times’ technology but now the human being who governs nature and designes hich-technologies is the main source for modern technology. According to Heidegger, the basis of technology is “framing”. Modern technology is covering the existing as being the frame of existing. This framing makes mankind have the perception of seing objects ready for his service, in other Rev Rom Bioet. Author manuscript; available in PMC 2017 April 17.
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words framing makes him feel being the master of the world [17]. Today modern technology is not existing only for to provide for needs of human beings, but also aims to create new natures different from the one they know.
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Fundementally, technology is dualistic; that is to say it has some advantages and also disadvantages for mankind. Our capacity of apprehension of technology, our style of adoption and our wish to use it all will show our view point of its advantages and disadvantages. In consequence, whether we are optimistic or pessimistic about the new nature that technology will give us; our style of valuing it will show who we are and what we appreciate the most. Comtemporarily, every kind of information is becaming transparent for everyone in the society. This transparency is profoundly revising our capacity of apprehension of “things”, our style of adoption and our desire to place them in our lifes. This transparent environment is showing all the details of “the great technology” more explicitly. Correspondinly, our capacity of apprehension of technology, our style of adoption and valuing it will be the indicators of our way of placing technology into our lifes and value judgements. The answers of the big questions such as “What will be the effect of nanotechnology on mankind?”, “What is a good life and will nanotechnology be able to change our good life perception?”, “What kind of society do we want and how should we correlate nanotechnology and the society we want?” will all differ according to our apprehension of nanotechnology correctly or wrongly; or according to our adoptation style to it [9].
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The term of nanoethics is formed as a result of the ethical questions those are the upshot of nanotechnology comprehension [15]. In order to be able to speak about the existance of the private ethics field of nanotechnology; we should also speak about the unique ethical problems nanotechnology causes or speak about that nanotechnology causes rather common ethical problems. So that, it should come to mind that nanotechnology causes similar ethical problems as biotechnology does. However, allowing matter to gain extraordinary properties and exponential degree of development of nanotechnology make it technically more powerfull than biotechnology. Therefore, it is true to say that nanotechnology causes similar but bigger ethical problems than biotechnology does [4, 18].
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As every kind of technology, nanotechnology will also induce changes in our life styles. For all you know, the biggest difference of nanotechnology will be the rate of changes it causes are the much more faster. The rate of life style changes depend on the exponential process rate of nanotechnological information. According to Ray Kurzweil, historically the process rate of technological information is exponential rather than linear [16]. While the process rate of nanotechnological information accelerates, the time period allowed for us to comprehend and adopt it decreases. In such a case, we would rather adopt nanotechnological “blessings” without understanding or we would spend more time to be able to adopt or understand. In both cases, it is so probable to overlook the consideration of the social process [19]. For example, the social themes of nanotechnology such as “the question of prior or not prior”, “the question of who will benefit from nanotechnological advantages”, “the question of responsibility of the developing countries to the developed ones those
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produced nanotechnological products” all generally leaved out. In order to prevent by heart society perception without the consideration of social themes mentioned above, delegates from the society should take part in the ethical and legal discussions of nanotechnology [14]. If not, taking only commercial market into consideration, the results will not always fit with the correct one for humanity [13].
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Currently, there are more than 800 products in our daily life, those produced by the use of nano-dimentional materials. Baseballs, tenis rackets, suitcases, tyres, eyeglasses, nanodimentioned thin film layers on computer and camera monitors, sunscreens, shampoos, creams, cosmetics…etc. are some of the examples of these producs [4, 5]. These products are produced of nano-materials some are light but strong, some are water-repellent, some are capable of self-renewal and some are antimicrobial. The fact that ordinary materials gaining extraordinary and desired properties when working at nano scales, provides so many successes in many industrial areas. But when the area of health and medine are being taken into consideration, though there are so many possible things done by nanotechnological processes, it is not easy and fast to achieve successes as done in the other industrial areas. The biggest obstacle for this is the increasing toxicity as dimentions of the material decreases into nano-scales. Also another obstacle for nanotechnological improvement in medicine field is the changing relationships between the individuals in health system. Unpredictible and high tecnological changes makes these individuals a bit concerned about the applications of nano-medicine tools.
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As mentioned before, nanotechnology is the name of the ability of understanding and keeping under control the qualitative and quantitative settings of matter at the scale of 1 nanometer and 100 nanometers [20]. Certainly, while considering the possible effects of this ability on human lifes, we should also bear in mind the complicacy and uncertainty of nanotechnology, as well as the exponential degree of development of nanotechnology. Complicacy is the state between order and chaos which is created by more than one interdependent factors. The characteristics of complex systems are the nonstability, uncertainty and the resistance to be kept under control. Correspondinly, modelling, estimating the consequences and keeping under control of nanotechnology is as difficult as a complex system. For this reason, exponential degree of development and complicacy of nanotechnology confront us its uncertainity. Here uncertainity means “what we know and what we do not know about nanotechnology”. Where we talk about the existance of uncertainity, there it gets difficult to detect, guess or keep under control the inputs and outputs of nanotechnological process; or simply it gets difficult to be aware of.
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On the other hand, according to the survey conducted in developing countries, most of the people have a optimistic pose about the results of nanotechnological developments. The reason for this situation is that those people’s lack knowledge about the risks of nanotechology or the satisfaction of happiness that nanotechnological products bring to their lifes. As a result of that, these people may probable become unable to distinguish between the possible applications of nanotechnology and science fiction [21]. The state of being optimistic about nanotechnology will be inevitable when people become unable to distinguish between the possible things and science fiction. In this instance, the knowledge and power gap between public and governments or between public and large companies
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grow unnoticed [22]. A similar problem had been taken into account during building the Human Genome Project and %3–5 of the project budget had been allocated for the ethical, legal and social aspests to be analysed. This budget is mainly used for two important issues. Firstly, to create an early awereness about the potential problems of the project and secondly, to reduce the potential for risk of this technology. By resolving the lack of information about the new technology, it will be enlightened the circumstances under which the satisfaction of happiness will be meaningful [13].
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Consequently, as long as the uncertainties about the potentials and the controllability of nanotechnology exists, ethical discussions will go on. We are witnessing the rapid scientific developments in the current era. During these scientific developments, it is so necessary to take care of handling the scientific strength and to take responsibilities about results of the new technologies. The underlined sense of responsibility should provide to take care about developing nanotechnology for the aims to be useful to humanity and to practice nanotechnological processes just in case of the results can be predicted. The main core of nanomedicine should be “treatment of diseases to protect the natural human form” rather than “developing the natural human form”. Last but not least, the formation of global negotiations should be created to illuminate the ethical and legal aspects of nanomedicine.
References
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