YOICHIRO MURAKAMI

Professor, International Christian University

Everything has advantages and disadvantages

First of all, it is not only biological monitoring using wearable computer, but everything has both positive and negative sides. Taking a personal matter as an example, I do have extra contraction, what is called irregular pulse. An electrocardiogram in hospital would not show the symptom, but by monitoring with a 24-hour wearable device the abnormality would be easily found. Thus, one advantage of biological monitoring is that it enables us to obtain information which we can not have in the conventional methods, and to treat the symptom effectively.

On the other hand, a doctor I know who specializes in circulatory organs says ¡ÈIf you can cope with daily life without trouble, you shouldn¡Çt worry about it too much. The more you feel nervous about it, the more it will get worse as a heart is an organ that can be influenced by the one¡Çs mental state. If its condition is really serious, there are suitable treatments for it.¡É Even if it is non-invasive, monitoring the condition round-the-clock might give a patient the same stress as they have in intensive care unit, and there is a possibility that one become too sensitive about it and feel anxious.

This is a common example, but the point I¡Çm trying to make is a positive side always has a negative side behind it. Not only with biological information but also engineering approach has started to contribute to human body in various ways. However, perhaps engineers who experiment new things develop radical approaches without paying enough attention to the negative side. Moreover, what makes this issue more difficult is that in medical field, there are always a certain amount of demands for the plus side.

Difficulty with demands

The most straightforward example to show the high demand in new positive developments is the demand of infertility treatment. Advanced technology could meet the demand of an infertile couple by using even cloning technology. However, the whole society would put a brake to cloning humans. The issue has always been controversial.

The same thing can be said to organ transplant and if there are certain technologies, there are always people who would like to benefit from it. Therefore, it is difficult to ignore those people¡Çs wish against the ethical issues discussed in society.

In fact, cloning technology might seem to be somewhat grotesque as it is a technique that enables one to reproduce asexually. But how about partial cloning (which is called therapeutic cloning in medical field)? Even in a case where a patient has no alternative to having an organ transplant, if they could clone a cell from one¡Çs own cell, they could have a pancreatic islet transplantation using the ES cell. It would be hard to say whether we should say absolutely no to clone if there were high demands in such a situation.

There are rational arguments about cloning, however, the fact is that most people tend to have feelings against and show negative reaction. I personally believe that even if we discuss the issue further, no theoretical evidences will be found to prove that cloning technology is not acceptable.

Of course, it does not imply that any technology should be allowed. But we can not blame someone for trying to manage to get out of a hard situation if their or their children¡Çs lives are threatened. Needless to say, social and ethical problems always follow, but we cannot make a quick decision to draw a line in a single sweep in the medical field, where we treat human life.

Should every demand be satisfied?

Should we recognize every demand in public and satisfy them with the technology?

The debate over committing suicide has been going on for a long time. Assume that there is someone who wants to kill themselves, and there also is another person who can help them with certain techniques. Probably not everyone would actually help the person though. Since the oath of Hippocrates ¡ÈI will not give no deadly medicine to anyone if asked, nor suggest any such counsel,¡É doctors have insisted the principle, and the society expected them to comply with it at the same time. Thus, it has been believed that even if there is a demand, we should have a limit to the technology available.

However, at present, the Netherlands has already legalized euthanasia and countries that follow the law are likely to appear. In this circumstance, helping someone with death wish cannot be judged under as ¡Èwrong¡É in the medical area. The issue of technology and people¡Çs needs is at an extremely sensitive situation.

Then, how can we prevent excessive development of technology and manage people¡Çs ever-growing demands within a reasonable limit?

I believe that when technology and people¡Çs demand have both social and ethical problems, the society should make a certain decision. Perhaps it would change over generations. We should draw a line at where all people are not completely satisfied but no one is totally unsatisfied.

However, it would be a problem if we never allowed any exceptions. Not only the cases going beyond the socially accepted line but also the cases doing the totally opposite. For example, let¡Çs say my child was involved in a traffic accident and became brain-dead. If I was asked to let my child become an organ donor and if I refused it, my will would have to be respected (even if it is lawful or not,) it is no good if someone piled pressure on me or blamed my intention only because most people wouldn¡Çt refuse.

Society must allow people to make their own decision and the individual decisions should be respected in any circumstances as long as it concerns a threatening matter. It seems that this way of thinking would be the only way to tackle this issue.

Monitoring is also controlling

Going back to the issue of biological monitoring using wearable computer, what concerns me most is the issue of safety. Just like the issue raised on the impact of cell phone on a person who rely on a pacemaker, the reliability of the data in remote censoring system and its safety are not guaranteed. Various measures on the technical side must be being taken against these problems as a matter of course, however, as long as the monitoring system treats human lives, every caution should be taken to carry the case forward. From this point of view, the level of the latest technology is not yet satisfactory to convince everyone.

Another thing that is of great concern is that being monitored is in other words to commit oneself to the controlling system. There are some people who believe it is better for health, but the others may feel that it does in fact have adverse effects. The controlling center would immediately respond if the patient¡Çs condition is abnormal, however, further research should be carried out to see how effective it would be. Of course there are exceptions, but a human body naturally balances itself as it goes through both good and bad conditions. For the patients who are in intensive care units, any minor changes in their heart rate or blood pressure could be fatal, but it remains in doubt whether it would be necessary for people who can lean an ordinary life outside hospital.

The same thing can be said to the process to obtain one¡Çs biological information. Recently, the sizes of the wearable devices are more and more minimized, but in the case of 24-hour monitoring, it wouldn¡Çt be practical if it were any sort of a burden on patients. And also, it would raise the issue of privacy if one¡Çs positional information became widely available. However, without positional information, we couldn¡Çt deal with matters in an emergency. It would be a great support for the serious cases where people have fatal diseases; therefore, making use of such technologies for the system would be necessary.

Unlike infertility treatment, monitoring by wearable device is not absolutely necessary. It is a system, which is still in a stage of suggestion. In order to familiarize this device, we need to have an agreement in the society as to decide how far the system should go.

How to accept the technology as a society

Anyhow, it will take a long time for the society to accept the results of the rapid development of the technology. At the same time, it is obvious that some people will want to go further and others will not. Therefore, the important thing is to handle the society with certain flexible rules.

To do so, information is needed more than anything in order to let everyone make one¡Çs own decision. Since criterion of judgment arise from where everyone can share common information, it is necessary to provide all the people with accurate information about present situation.

How to live one¡Çs life is a personal issue. Everyone has the right to choose the way of life and death. The basic principle is to develop an argument based on this idea.

The necessity of considering other issues

It has been said that there is an expectation on a nationwide scale for the establishment of medical care network using wearable devices. And it is thought that it could be beneficial to prevent or find diseases at early stages. As a result, we could reduce increasing medical cost.

Consequently, reasonable ground should be presented so that the public can reach their judgments. For instance, by running a practical simulation, people might have an idea about who will benefit from the system and who will not, or, even if the system does not seem beneficial to certain people, they should understand that it might reduce the medical cost.

Finally, I would like to add that medical disparity is much bigger worldwide compared to the one in Japan. Even today, the situation is such that many people die of tuberculosis, cholera, or malnutrition. 100 dollar can save a lot of people under serious conditions, but in reality, the money is poured into what is not necessary. We need to be aware of fairness in medical practice on the globe, although our issue is only discussed nationwide.

Generally speaking, technology often develops leaving social problems behind. Obviously the society makes a progress as a result of investigating radical things, however, it seems that affluent society is formed with people having consciousness about the issue and different viewpoints.