Are we ready for bionic patients

Hugh Herr, a roboticist (yes, that's a real job title) at the Massachusetts Institute of Technology, boldly asserted at a conference organized by The Economist that disability will be largely eradicated in the 21^st century. Upon revealing his bionic legs, Herr suggested that patients may soon decide to replace painful arthritic limbs with fully functional robotic ones.

Herr may have been accurate about the medical side, but important legal and ethical issues will have to be resolved before this new technology becomes commonplace. When should we allow people to amputate their limbs? How should improved medical technology change our definition of a disability? And who will pay the cost?

Patients rarely opt for voluntary amputation. Historically, prostheses were never as good as a natural limb. Herr asserts, however, that improved prosthetic technology may cause patients to consider amputation at a lower pain threshold. Philippa Oldham, head of manufacturing at the Institute of Mechanical Engineers, suggests that in the future, prostheses may be made of nanotube technology, have the same structure as a biological leg, and provide the same amount of energy.

Oscar Pistorius, a South African sprinter, gained fame when he became the first double amputee to compete in the Olympics. Pistorius, also known as "Blade Runner," ran in the 2012 Summer Olympic Games on Flex-Foot Cheetah legs.

Despite significant controversy, Pistorius was allowed to run. It was determined that he was "physiologically similar but mechanically dissimilar" to runners with natural legs. Olympic officials held that Pistorius was on equal footing (quite literally) with his competitors, despite being a double amputee.

Technology is changing the limitations on individuals with disabilities, which may also change legal definitions and rights. The European RoboLaw project is attempting to research issues such as the legal rights of a person with locked in syndrome who communicates with a brain-computer interface, and the potential need to change the definition of disability with changes in bionic and neural interface technology.

Additionally, we must consider ethical issues regarding when individuals should be allowed to opt for voluntary amputation. How severe must the condition be? If technology advances as Herr and Oldham predict, we may see individuals treating limb amputation as cosmetic surgery. Are we prepared to allow limb amputation the same way we allow nose jobs? And how does this possibility affect doctors' requirement to "do no harm?"

Another issue to consider is cost. We will have to decide when insurance companies must cover these treatments and equipment, which will be extremely expensive. Maintaining and replacing prostheses can cost millions of dollars over the course of a lifetime. Under what circumstances should these technologies be considered medically necessary?

Although this type of medical advance is tremendous and can improve the lives of many, we must remember that no human being is immortal and mixing man with machine can lead to a variety of unexpected results. Before we allow arthritic patients to replace their legs with prostheses, we must carefully consider the consequences.