Can People Be Ordered to Be Enhanced with Artificial Limbs

To what extent can
people be ordered to
be enhanced with
artificial limbs and
muscles?
Damyan Todorov
Law & Technology
Tilburg University
March 2017

To what extent can people be ordered to be enhanced with artificial limbs and muscles?
2
Preface and acknowledgements
The current thesis was written as a part of the LLM Law and Technology at Tilburg University
and aims to focus on the interplay between human enhancement technologies and law.
I would like to thank my supervisors Ronald Leenes and Tom Chokrevski at Tilburg University
for their commitment and critical feedback.
Last but not least, I would like to thank my beloved family, my friends and all my colleagues
at Tilburg University for their amazing support and huge positive influence throughout the
whole year of my education at Tilburg University. Special thanks to my closest peers at
Tilburg University.
Recommended citation:
Todorov, D.O., “To what extent can people be ordered to be enhanced with artificial limbs
and muscles?”,(2017)

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Table of Contents
Chapter 1: Introduction..............................................................................................................4
Chapter 2: Artificial limbs and muscles in light of human enhancement technologies ............7
2.1 Introduction.................................................................................................................7
2.2 Definition of human enhancement technologies........................................................8
2.3 Definition of artificial organs.....................................................................................10
2.4 Definition of artificial limbs .......................................................................................12
2.5 Definition of artificial muscles...................................................................................13
Chapter 3: Possible coercive enhancement of people by artificial limbs and muscles ...........15
3.1 Introduction...............................................................................................................15
3.2 Establishing a state of abundance of artificial limbs and muscle technologies........16
3.3 Consequences of abundant availability of artificial limbs and muscles....................23
3.4 Coercion as a feasible undesirable consequence......................................................27
3.5 Examples of coercive enhancement across society ..................................................28
3.6 People ordered by superior authority to be enhanced.............................................31
Chapter 4: Limitations of ordered enhancement in the terms of law.....................................35
4.1 Introduction...............................................................................................................35
4.2 The right to bodily integrity considerations ..............................................................36
Chapter 5: Conclusion ..............................................................................................................44
Bibliography..............................................................................................................................45

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Chapter 1: Introduction
Human enhancement is currently an expanding field of science that challenges our
perception of reality and human nature on a daily basis. Human enhancement technologies
vary tremendously and how they benefit humans depends on the nature of each particular
technology. The significant rise and rapid advancement of human enhancement
technologies nowadays, especially artificial organs, poses a new breed of questions and
challenges the ethics and morality of our society.
In the recent years the field of artificial limbs and muscles has shifted swiftly from the
domain of therapeutic devices to the emerging field of technologies that enhance the
natural human body capacity and capabilities. For example, prostheses are designated to
help amputees to live better life and interact with the surrounding environment properly.
The progress of this particular technology has reached a stage that amputees implanted with
cutting-edge prostheses manage to outrun able-bodied runners. Another direction of
development of artificial limbs is the bionic devices. Their designation and specifications
allow possessors to enjoy better mobility and swiftness and even control them by thoughts.
Along with improved specifications to assist amputees and other patients, scientists and
researchers have extended the utilization of these technologies to serve healthy individuals
as well. Considering human body limitations, the advantages such technologies could
provide to healthy adopters have been spotted by variety of scientists, biohackers, military
and even major international corporations. The recognition of the advantages of advanced
artificial limbs and muscle technologies for able-bodied possessors might trigger more
intensive research and further development of diverse models and designs. In general, the
production of such devices has evolved these days based on less sophisticated production
process, 3D printing and lightweight construction materials. In light of these considerations,
potential rise of diverse models available on the market seems technically plausible in
future. On the other hand, corporations and military strive for boosting the performance of
their personnel. As some national authorities around the world have already analyzed the
possibility of enhancement of workers’ performance through human enhancement
technologies, significantly increased levels of strength, endurance and mobility of human
body might become a game changer in some industries. Boosting weight lifting capacity and
muscle capabilities of workers in labor-intensive jobs such as construction might contribute
to companies outranking competitors and achieving market leading position. When it comes
to military, development of superior soldiers might be achievable through the employment
of artificial limbs and muscles. The topic of HET in terms of military utilization has been
around for a while and numerous experts and researchers have addressed their views and
concerns. The influence of biohackers and individuals devoted to augmenting their bodies,
especially in light of Transhumanism, should not be neglected as a drive for acceleration of
the research and development in this field as well. In other words, on the grounds of the
witnessed technical progress at the domain of artificial limbs and muscles and driven by the

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demands of major organizations as well as aspirations of individuals an expected expansion
of the artificial limbs and muscle technologies market might not be a mere speculation.
Taken all together, artificial limbs and muscle technologies at some time in future might
become advanced enough to be preferred and employed by many able-bodied possessors.
Along with advantages offered and the requests of utilizations by corporations and army, the
combination between an increasing number of available and accessible devices and a rising
acknowledgement of these technologies as adequate solutions of various ongoing problems
might end up in overwhelming strive for employment of such technologies in many aspects
of human life. A state of abundant of artificial limbs and muscles might occur in future and
this thesis will investigate any indicators in these days such scenario to happen and reinforce
the foreseen possibility. The current thesis does not intend to predict the level of probability
or a time frame a state of abundance of artificial limbs and muscles to be established.
Furthermore, the adoption and employment of these devices might challenge ethics,
morality and law in various aspects. In that perspective the thesis will highlight a few
consequences that are considered to affect individuals and society in multiple aspects. One
of the undesirable effects is believed to be coercion. If corporations and military appreciate
artificial limbs and muscle technologies as a means to achieve their objectives, the personnel
might be coerced to be implanted with such devices. Coercive enhancement is considered as
one of the most plausible potential harms in terms of increasing employment of human
enhancement technologies. That notion is shared by scientists, scholars and ordinary people
participating in surveys.1
Coercion is intensively discussed topic not only within academic
world but also in terms of military. In light of these considerations, questions are calling for a
thorough discussion based on the present legal framework. Can people be ordered by
superior authority to be enhanced with artificial limbs and muscles? To what extent can
workers be ordered by their employers to be augmented with such devices? To what extent
can soldiers be ordered to be implanted with advanced military designed artificial limbs and
muscles?
In this thesis human enhancement technologies and particularly artificial limbs and muscles
will be explored and described briefly to make the reader familiar with the genesis of the
research question. The second chapter will introduce definitions of human enhancement
technologies and artificial organs as well as present the nature of artificial limbs and muscle
devices. Next, in the third chapter, coercion as an undesirable effect will be outlined in the
terms of possible significant rise of artificial limbs and muscles on the market. The concept of
coercion will be described in general and in respect to human enhancement including forms
of coercive enhancement. The legal implications of coercive enhancement in terms of
artificial limbs and muscle technologies will be considered in two aspects as well - the
specific domains of business companies and military. In light of these considerations, only
the explicit coercive enhancement will be examined more precisely through its implications
1
Academy of Medical Sciences, the British Academy, the Royal Academy of Engineering and the Royal Society, Human Enhancement and
the Future of Work,2012, Available at https://www.acmedsci.ac.uk/viewFile/publicationDownloads/135228646747.pdf, p.44-45

6
regarding the legal relationship between employer and employees and inside military
organization. These are specifically picked due to the limited nature of the thesis and with
regard to possible employment of human body augmentation in business companies and
military. Given the preceding, the research question would be presented in legal perspective
aiming to analyze whether coercive enhancement intercepts human rights and to what
extent. Among the list of recognized human rights at international and constitutional levels,
the thesis will spotlight the right to bodily integrity and investigate to what extent coercive
enhancement interferes with it. The right to bodily integrity guarantees person’s corporal
inviolability and so any forcible enhancement involving physical intrusion into human body
might clash with this right. Chapter four will be devoted to analyzing and evaluating to what
degree the coercive enhancement might interfere with the right to bodily integrity in the
perspectives of military and employment in business companies. As the implantation of
artificial limbs and artificial muscles might include intrusion into human body to a severe
degree this comprises an additional reason why the thesis focuses on the possibility for
boom of coercive enhancement in future.

7
Chapter 2: Artificial limbs and muscles in light of
human enhancement technologies
2.1 Introduction
In the current chapter a brief explanation of the nature of human enhancement and the
technologies in its scope it will be provided. Furthermore, among all present known human
enhancement technologies this thesis will concentrate on artificial organs. The aim of the
present chapter is to explain in short the essence of artificial organs and establish a basic
understanding of their multiple applications. Next, this chapter will emphasize on two
particular artificial organ technologies, namely the artificial limbs and muscles. Why artificial
organs are of importance and particularly the artificial limbs and muscles?
In the last decades, the field of human enhancement technologies is being developed at a
phenomenal rate. Increasing number of emerging technologies is being presented to the
public including human genetic engineering, neurotechnology, cognitive enhancement and
3D bioprinting. These should be added to the list of existing human enhancement
technologies such as PGD, plastic surgery, prostheses, doping, natural organ replacements
and artificial body organs. In order to comprehend the designation of each technology, an
adequate piece of knowledge about the definition of human enhancement technologies
ought to be provided to the reader. In such manner, the human enhancement technologies
could be delineated from any other technologies and then introduced their aspects of
employment. Furthermore, after presenting the main characteristics of human
enhancement technologies, this chapter will aim attention at artificial organs as in the scope
of human enhancement technologies. Later on, the field of artificial organs will be exhibited
by their principal characteristics. Once the artificial organs are introduced and described
briefly, definitions for artificial limbs and muscles will be reviewed as well. As the focus of
the paper is the employment of artificial limbs and muscles, this chapter will explain to what
extent artificial limbs and muscles are in fact both artificial organs and human enhancement
technologies in the same time. In that way, the chapter will connect the artificial limbs and
muscles with the broad field of human enhancement technologies. By introducing and
describing the nature of human enhancement technologies and the employment of artificial
limbs and muscles, the next chapters will elaborate on the foreseen scenarios and probable
dangers related to establishing a state of abundance of these technologies on the free
market.

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2.2 Definition of human enhancement technologies
First and foremost, the term “human enhancement” includes a wide range of practices and
for that reason deserves a clarification. Obviously, one key element of the phrase is the
human, the species Homo sapiens, as a natural person. However, the term “enhancement”
raises variety of questions in different fields of study such as medicine, ethics, philosophy
and law.
One definition describes human enhancement as “the application of technology to
overcome physical or mental limitations of the body, resulting in the temporary or
permanent augmentation of a person’s abilities and features”.2
According to the Institute for
Ethics and Emerging Technologies, human enhancement should be understood as “any
attempt to temporarily or permanently overcome the current limitations of the human body
through natural or artificial means”.3
Despite the first cited definition looks narrower, the
latter comprises the same key elements. Furthermore, human enhancement is explained as
a reference to the general application of the convergence of nanotechnology, Biotechnology,
information technology and cognitive science (NBIC).4
Additionally, enhancements are
defined as “biomedical interventions that are used to improve human form or functioning
beyond what is necessary to restore or sustain health”5
. Next, another definition of
enhancements is provided by Eric T. Juengst as “interventions designed to improve human
form or functioning beyond what is necessary to sustain, or restore, good health”.6
In the
article “Coercion in Bioethics”, Jess Hasken refers to human enhancement in a very simplistic
but broad sense – “the ability to use technology to change our bodies and minds”.7
Although
some of the provided definitions above state that human enhancement encompasses
restoration of impaired human functions to previous or average levels, in the current thesis
the focus is put on the employment of human enhancement to “raise function to a level
considered to be beyond the norm for humans”.8
The aforementioned definitions give the
impression that human enhancement is an umbrella term. With regard to that, a working
definition of human enhancement would be - the ability to alter natural human mental and
physical capabilities through variety of means. Human enhancement technologies comprise
one kind of means to achieve improvement of human body capacity and capabilities.
2
John Steward, "Human Enhancement", Dartmouth Undergraduate Journal of Science, 2013 <http://dujs.dartmouth.edu/2013/11/human-
enhancement/#.V0GbxVKVq9V>
3
"Human Enhancement", Institute for Ethics and Emerging Technologies Official Website, 2016
<http://ieet.org/index.php/tpwiki/human_enhancement>
4
Ibid
5
Juengst, Eric and Moseley, Daniel, "Human Enhancement", The Stanford Encyclopedia of Philosophy (Spring 2016 Edition), Edward N.
Zalta (ed.), <https://plato.stanford.edu/archives/spr2016/entries/enhancement/>.
6
Juengst, Eric. “What does Enhancement Mean?”, Enhancing Human Traits: Ethical and Social Implications, p.29
7
Hasken, Jess (2007) "Coercion in Bioethics," Macalester Journal of Philosophy: Vol. 16: Iss. 1, Article 3. Available at:
http://digitalcommons.macalester.edu/philo/vol16/iss1/3
8
the Future of Work,2012, Available at https://www.acmedsci.ac.uk/viewFile/publicationDownloads/135228646747.pdf, p.7

9
Human enhancement technologies are defined as technological interventions to attempt to
restore impaired human performance or extend it beyond normal function, thus overcoming
the limits of the human body.9
These include a wide range of technologies increasing human
cognitive ability by improving mental capacity or alertness, ones increasing physical ability by
improving strength, sensory perception or speed and ones improving our ability to eradicate
disease and extend our lifespan. With regard to that, human enhancement technologies are
also characterized as “techniques that can be used not simply for treating illness and
disability, but also for enhancing human characteristics and capacities”.10
In his public
speech about ethics and human enhancement over a decade ago, Carl Elliot introduces his
understanding of human enhancement technologies as “the idea of using medicine, or
surgery, or other kinds of medical technology not just to cure or control illnesses but rather
to enhance, or improve, human capacities and characteristics”.11
Taken all together, the
cited definitions and descriptions can be summed up as broad range of technologies that are
initially developed to serve patients and later on are being upgraded to benefit in superior
fashion healthy humans as well. Such conclusion could be reinforced by the existence of
outdated human enhancement technologies including ear trumpets, wooden legs and
ancient eyeglasses. However, human enhancement technologies are transforming in nature
and specifications and due to the ongoing technological progress innovations in that field are
emerging significantly. This means that present forms of the mentioned out of date
technologies including hearing aids, contact lenses and bionic propulsion limb are providing
their possessors almost natural capabilities. Nowadays, the development of human
enhancement technologies is focused on improvement of the existing technologies aiming to
offer superhuman and beyond natural body capacity and capabilities. On other side,
revolutionary gadgets have been recently invented that are truly one of a kind including
Google glass, exoskeletons that are still augmenting biology with technology but it is hardly
to point a medical designation as a primary one. So, the description of human enhancement
technologies should accommodate both types of technologies that enhance natural human
capacities. The underlying idea is that a technology that is engineered to interact with and
augment human anatomy resulting in enhancing natural body capacity and capabilities
should fall into the scope of human enhancement technologies.
Employment of human enhancement technologies by healthy people only makes sense in
cases when technologies benefit the receiver to a greater degree compared to his natural
capacity and capabilities. For example, optical eyeglasses do fall into the extensive
description of human enhancement technologies. However, it is unreasonable a person with
proper eyesight to use optical eyeglasses. On the other hand, a person who desires a solid
improvement of his strength of his limbs might for replacement of these organs if there is a
suitable technology on the market. In contrast to patients who enjoy human enhancement
9
Ibid, p.7
10
Ibid
11
Carl Elliott, "What's Wrong With Enhancement Technologies?", CHIPS Public Lecture, University of
Minnesota, 1998 <http://www.ucl.ac.uk/~ucbtdag/bioethics/writings/Elliott.html>

10
technologies with therapeutic purpose, soon humans might be to be transformed to a
certain degree into an upgraded improved human organism, half-machines, half-humans.
One reason for that would be that the augmented ones would be more productive, more
functional and skillful. Enhancing normal human body capabilities and capacity might
become a powerful means of boosting the profit of business activities, way of conducting
wars, etc. The scope of the thesis would be narrowed to human enhancement technologies
disparate from therapeutic ones that enhance the human body capacity and capabilities
through its transformation into a technological packed mechanism that could accommodate
superhuman capabilities providing superior abilities to workers and soldiers.
Nowadays human enhancement technologies can be split into two main categories, namely
cognitive enhancement and physical enhancement. First, emerging approaches to enhance
human cognition include pharmacological cognitive enhancement, cognitive maintenance
and restoration, cognitive enhancement of healthy individuals as well as non-
pharmacological cognitive enhancement.12
Second, physical enhancement was initially
developed for restoration but in the last years its focus has been moving to extending
natural body capabilities of healthy people. Under the term physical enhancement are
included technologies in the scope of sensory enhancement, enhancement of mobility and
limb function, physiology and tissue engineering, cosmetic enhancement and performance
enhancement.13
In the scope of the current thesis fall only the technologies that benefit
human body in enhancement of mobility and limb function as part of the physical
enhancement technologies. They are intended to mimic the full functionality of natural
human limbs and muscles providing at least the same level of control, energy efficiency, and
usability as the natural counterparts.
2.3 Definition of artificial organs
By definition, an organ is a specialized structure (e.g. kidney, heart, and limb) in an animal or
a human made up of various cells and tissues that can perform some specialized function.
Most parts of human body that perform specialized functions in fact can be classified as
organs. When these become defective and fail to perform properly, they might be replaced
by an artificial organ or a prosthetic device. These devices are usually constructed of natural
or synthetic polymeric materials. In order to be employed and integrated into the human
body they must exhibit good compatibility with blood and body tissues with they come into
contact. Additionally, the artificial device must closely duplicate the function of the natural
12
the Future of Work, 2012, Available at https://www.acmedsci.ac.uk/viewFile/publicationDownloads/135228646747.pdf, p.13
13
Ibid, p.23

11
organ. In practice, these artificial devices are made of metals, ceramics, carbon, natural
tissues and synthetic polymers.14
Turning to the essence of artificial organs, a definition of the term “artificial organ” should
be introduced as well. So, a simple and clear definition of artificial organ is „a replacement
for natural organ in the body".15
The artificial organ is defined more thoroughly as a “man-
made device that is implanted or integrated into a human — interfacing with living tissue —
to replace a natural organ”16
. A medical dictionary describes the term artificial organ as “any
tissue, organ, limb, or highly complex biological structure that is partially or completely
synthetic in nature, and performs the tasks of the structure it is intended to replace”.17
Additional comprehensive artificial organ explanation is the following: “a human made
device designed to replace, duplicate or augment, functionally or cosmetically a missing,
diseased or otherwise incompetent part of the body, either temporarily or permanently and
which requires a non-biologic material interface with the living tissue”.18
In other words, a
few characteristics in the quoted definitions are in common including a man-made
construction identical to an exact natural human body organ, integration of the device into
the human body, interfacing with living tissue and performing tasks to replace the missing or
failing natural organ. In fact, the characteristics in common are the criteria to classify a
device as an artificial organ.
Conventionally, the artificial organs are divided in four groups: Bone/Joint replacements (e.g.
hip, finger, knee), Skin/Soft Tissue Replacements (e.g. muscle, skin), Internal organs (e.g.
heart, kidney, liver) and Sensory organs (e.g. eye, ear).19
Some artificial organs are designed
to duplicate the function of natural ones (artificial knee, hip, heart) and other augmenting
specific functions (artificial pacemaker). Despite that usually the replaced function is related
to life support, this is not always required. Other reasons of construction and implantation of
artificial organs include improving the patient’s mobility, ability to interact with the other
social members and the quality of life. With regard to the provided division of artificial
organs some sound examples of artificial organ devices are the artificial hip, the various
types of prosthesis, the artificial kidney, the artificial heart, pacemakers, the cochlear
implants and bionic eyes. The listed devices fall into different categories of artificial organs
but they all fulfill in common the main characteristics of the artificial organ definitions
above.
14
Gebelein, C.G. (1984). "Chapter 1: The Basics of Artificial Organs". In Gebelein, C.G. Polymeric Materials and Artificial Organs (PDF).
Washington, DC: American Chemical Society. pp. 1.
15
Ibid. pp. 2..
16
Catapano, G.; Verkerke, G.J. (2012). "Chapter 2: Artificial Organs". In Abu-Faraj, Z.O. Handbook of Research on Biomedical Engineering
Education and Advanced Bioengineering Learning: Interdisciplinary Concepts - Volume 1. Hershey, PA: Medical Information Science
Reference. pp. 63.
17
"Artificial Organ." Segen's Medical Dictionary. 2011. Farlex, Inc. 14 Jan. 2017 <http://medical-
dictionary.thefreedictionary.com/Artificial+Organ>
18
The Dawn of Biotechnology in Artificial Organs, GALLETTI, PIERRE M.; AEBISCHER, PATRICK; LYSAGHT, MICHAEL J.,
http://journals.lww.com/asaiojournal/Citation/1995/01000/The_Dawn_of_Biotechnology_in_Artificial_Organs_.9.aspx
19

12
Taken all together, the listed characteristics place artificial organs at the domain of human
enhancement technologies under the category of physical enhancement. The initial purpose
of artificial organs is to restore to some extent impaired human performance and enhance it.
The other aspect of the designation of human enhancement technologies, namely the
extension and improvement of natural human body capabilities and capacity beyond the
norm, is also covered by the variety of the modern artificial organs such as artificial limbs
and muscles. What is more, these devices do interact with human anatomy and that is how
they augment human body to a degree depending on the artificial limb implanted.
2.4 Definition of artificial limbs
Artificial limbs are artificially made devices that substitute or replace a natural limb of a
person. These mechanical devices are intended to restore a degree of normal function of
people missing a body part by replacing the natural limb. Devices that qualify for artificial
limbs are the limb prostheses. One medicine dictionary describes prosthesis as “an artificial
substitute for a missing part, such as an eye, limb, or tooth, used for functional or cosmetic
reasons, or both”20
The same medicine dictionary refers to artificial limb as “a replacement
for a missing limb” which is quite broad in sense. Limb prostheses are principally divided
based on the part of the human body that is replaced into the following groups: below the
knee (transtibial), above the knee (transfemoral), below the elbow (transradial) and above
the elbow (transhumeral). Moreover, limb prostheses could be distinguished based on more
characteristics including the construction material, design technology, functions and
designation. The history of employment of prostheses proves that limb prostheses were
initially used to restore the normal functionality of impaired human body limbs. It is not a
secret that prostheses have been used since the Ancient times and there are many
prototypes found from that period of time.21
Still the prostheses are being employed
primarily to replace missing limbs lost through trauma, disease, or congenital conditions.
However, due to the rapid development in the last decades, scientists come up with models
of prostheses that actually exceed and outmatch the capabilities of natural limbs. In fact, the
actual models of artificial limbs greatly vary and differ in construction materials, functions,
capabilities and design. For example, the J-shaped, high-performance carbon composite
prostheses that Oscar Pistorius was equipped with, indeed, secured him “25% less energy
than able-bodied runners to run at the same speed” and ”less vertical motion combined with
30% less mechanical work for lifting the body” which was ruled as advantage over able-
20
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. (2003). Retrieved January 14 2017
from http://medical-dictionary.thefreedictionary.com/prosthesis
21
Catapano, G.; Verkerke, G.J. (2012). "Chapter 2: Artificial Organs". In Abu-Faraj, Z.O. Handbook of Research on Biomedical Engineering
Education and Advanced Bioengineering Learning: Interdisciplinary Concepts - Volume 1. Hershey, PA: Medical Information Science
Reference. pp. 68.

13
bodied opponents by the International Association of Athletics Federations.22
This single
remarkable instance illustrates the ability of modern prostheses not only to restore or
duplicate the function of a missing or failing natural limb but also to add superiority to the
natural body capacity of the device possessor.
However, not only prostheses are in the scope of artificial limbs technologies. The micro-
processor limbs, known as "bionic legs", are also spotlighted by scientists and military
experts as a technology with proven benefits that military amputees could employ. These
cutting-edge devices literally transform the lives of the technology possessors and offer
them “greater stability and mobility.”23
What is more, advanced models of bionic limbs are
not only designated to serve the military veterans. Many amputees around the world are
reported to enjoy the advantages of such progressive devices and some even control them
by mind.24
Under these circumstances, modern artificial limbs not only fall into the field of artificial
organs but they do qualify for human enhancement technologies. Compared to the
definitions of human enhancement technologies mentioned above, the designation of
artificial limbs nowadays not only serves the amputees and patients but also could provide
superior specifications compared to natural human limbs in good condition.
2.5 Definition of artificial muscles
The human body naturally consists of numerous soft tissues such as muscles, connective
tissues and fatty tissues.25
Natural muscles provide the precise control of movement of parts
of the human body. When it comes to soft tissue replacement devices, the artificial muscle is
one significant piece of technology. In that light, artificial muscles attempt to emulate the
characteristics of natural muscles and the motion of a particular human organ. One
definition of artificial muscle is “a generic term used for materials or devices that can
reversibly contract, expand, or rotate within one component due to an external stimulus
(such as voltage, current, pressure or temperature).”26
Additional try to define the artificial
muscle results in “any material, or device, whose shape can change in response to a
stimulus” which allows a broad range of devices to be labeled as artificial muscles.27
Similarly
to the natural muscle, any artificial muscle is characterized by “its ability to contract in
22
"'Blade Runner' Handed Olympic Ban", BBC SPORT, 2008 <http://news.bbc.co.uk/sport2/hi/olympics/athletics/7141302.stm> [accessed
16 January 2017]
23
"'Bionic Legs' For Military Amputees", BBC News, 2013 <http://www.bbc.com/news/uk-politics-21497473>
24
"Brain-Controlled Bionic Legs Are Finally Here", Popular Science, 2015 <http://www.popsci.com/brain-controlled-bionic-legs-are-here-
no-really>
25
26
Mirvakili, Seyed M. (2013). Niobium Nanowire Yarns and Their Application as Artificial Muscle (M.A.Sc). University of British Columbia.
27
Tondu B., What Is an Artificial Muscle? A Systemic Approach.. Actuators. 2015; 4(4):336-352.

14
response to a chemical or physical stimulus” which describes any artificial muscle as “a kind
of actuator generally defined by analogy with the skeletal muscle”.28
Although these
references are quite technical, the artificial muscle technologies could actually fit into the
scope of the artificial organs definitions. When the artificial muscle mechanism is integrated
into the human body and substitutes the functions of natural muscles it should be counted
as an artificial organ. This conclusion is reinforced by inclusion of artificial muscles in the
division of artificial organs introduced by Charles G. Gebelein.29
Research on artificial
muscles capable of mimicking human muscle response is advancing at a phenomenal pace
and the new inventions would be probably utilized to interfere with medical devices that
need to be implanted or attached to human body such as artificial-muscle-powered-
prostheses, artificial diaphragm to help people breathe or just to replace or augment any
muscle in the body that is failing. A recent breakthrough in the research and development of
artificial muscles was introduced as “inexpensive high-strength polymer fibers used for
fishing line and sewing thread can be easily transformed by twist insertion to provide fast,
scalable, nonhysteretic, long-life tensile and torsional muscles”.30
These artificial muscles
from fishing line and sewing thread have the abilities to “lift loads over 100 times heavier
than can human muscle of the same length and weight, and generate 5.3 kilowatts of
mechanical work per kilogram of muscle weight, similar to that produced by a jet engine”.31
By the integration of such ground-breaking artificial muscles into the human body, patients
with malfunctioning natural muscles would benefit and the proper functionality of their
body would be restored to some extent. On top of that, integration of artificial muscle with
the cited specifications additionally enhances the body capacity and capabilities of healthy
possessors of the technology as well. So, artificial muscles would account for human
enhancement technologies in certain cases. Namely, when they are integrated into human
body and at the same time restore impaired human performance and/or extend it beyond
the natural limits of human body. With the progress of biotechnology scientists might
manage to invent more advanced artificial limbs that not only attempt to emulate the
capabilities of natural muscles but also to provide their possessors superior muscle
capabilities compared to non-augmented humans.
28
Ibid
29
30
C. S. Haines and others, "Artificial Muscles from Fishing Line and Sewing Thread", American Association for the Advancement of Science,
343 (2014), 868-872 <http://dx.doi.org/10.1126/science.1246906>.
31
Ibid

15
Chapter 3: Possible coercive enhancement of people
by artificial limbs and muscles
3.1 Introduction
In the previous chapter this thesis introduced human enhancement and human
enhancement technologies through definitions and outlining the wide range of aspects these
indeed cover. In that context, artificial organs were spotlighted and explained briefly as a
significant part of the human enhancement technologies these days. Furthermore, in the
field of artificial organs artificial limbs and muscles were presented and described in short
aiming to establish a basic understanding regarding nature and applications of both
technologies. So, the preceding determines further elaboration in this chapter on the
foreseen consequences a rapid development these technologies might bring to human life.
In this chapter one scenario related to proliferation of artificial organs and especially
artificial limbs and muscle technologies would be exposed. The research and development in
the field of human enhancement suggests that in the near future an increasing number of
devices that enhance people might be available on the market. Statistics and arguments in
this favour will be provided in the next paragraphs in order to reinforce a possibility of an
expected establishment of a state of abundance of artificial limbs and muscle technologies.
Next, having such possible state of availability of devices on the market and the superior
benefits they might provide to the possessors in future will have inevitable consequences for
humankind and the agenda of lawmakers. The thesis will make an attempt to outline the
foreseeable consequences that are predictable at the moment based on the current level of
scientific knowledge and statistics. Human enhancement technologies are true disruptive
phenomenon in the fields of medicine, ethics, law and technology. In that context, it is
natural that there will be both positive and negative effects of them. In light of that, social
coercion is one feasible undesirable consequence that already bothers scientists and
policymakers. This chapter will examine how relative and substantiated in fact this concern is
and then some examples of expected coercive enhancement across society will be given. The
reason to focus on the coercion related to the distribution and accommodation of human
enhancement technologies as one crucial consequence will be also clarified and furnished
with arguments later on. Finally, the chapter will narrow the scope of coercive enhancement
that might arise to the single aspect of people who are ordered by a superior authority to be
enhanced. Doing so, the chapter will showcase and describe the foreseeable problem
connected with human enhancement technologies and coercion with the aim to further
crystallize the legal implications of this feasible effects proliferation of artificial organs and
especially artificial limbs and muscles technologies.

16
3.2 Establishing a state of abundance of artificial limbs and muscle
technologies
Any expectations for expanding the availability and accessibility of artificial limbs and muscle
technologies in future should be first considered in the perspective of expected rise of
distribution and application of human enhancement technologies. In the current thesis the
term “abundance” should be apprehended as a diversity of devices available on the market
providing variety of benefits to a broader scope of potential possessors. This thesis does not
intend to predict when exactly a state of abundance might be established in the future. It
attempts to substantiate a possibility of such course of events some when in future and to
spotlight the factors and indicators for such scenario. In that manner, the current thesis
pinpoints several examples of advanced devices in terms of artificial limbs and muscles
outlining their designation and advantages. Second, the thesis brings on the table numerous
reports by variety of national authorities and adds these to business forecasts. Third,
investigating the drives for possible trend of establishing an abundance of models also aims
to reinforce an expectation for establishing a state of abundance of artificial limbs and
muscle technologies. That is why, before all else the thesis will examine whether a more
considerable role of human enhancement technologies in human life is foreseeable.
The progress of converging technologies and human enhancement technologies is not a
mere speculation but an ongoing process that has been admitted by politicians, scientists
and researchers. The Technology Assessment on Converging Technologies Report, published
by Policy Department Economic and Scientific Policy and commissioned by the European
Parliament, confirms converging technologies as the new challenge at the moment and
expresses belief that could contribute to tremendous changes in the way humans think and
even beating death.32
Additionally, the report elaborates on the expected exponential
progress of cognitive technologies due to the computer capacity development. As driving
forces for an immense advancement are pointed out the defense and military needs to
produce smarter and stronger soldiers, the medical field concerning age slowing, curtailment
of death and life extension along with the aspirations of biotechnology enthusiasts and
hackers.33
Later on, the report states that NBIC convergence is “already taking place in the
laboratories and research departments of contributing convergent disciplines” and policy
makers have spotted the NBIC convergence trend.34
Next, the so-called American report on
NBIC converging technologies, issued by the National Science Foundation (NSF) and
Department of Commerce in 2002, concludes that “the new developments will be
revolutionary and must be governed by respect for human welfare and dignity”.35
Although
32
European Technology Assessment Group, “Technology Assessment on Converging Technologies Report”, 2006,
<http://www.europarl.europa.eu/thinktank/en/document.html?reference=IPOL-JOIN_ET(2006)375882> page i
33
Ibid, page i-ii
34
Ibid page iv
35
Mihail C. Roco and William Sims Bainbridge , “Converging Technologies for Improving Human Performance NANOTECHNOLOGY,
BIOTECHNOLOGY, INFORMATION TECHNOLOGY AND COGNITIVE SCIENCE”, 2003, Springer

17
a bit outdated and not necessarily reflecting the views of the United States Government and
European Parliament, these comprehensive reports demonstrate that plot of rapid
development and progress of converging technologies and human enhancement
technologies is feasible and based on the current progress of information technologies,
nanotechnology and medicine. On top of that, the fact that in 2003 the Health Council of the
Netherlands also issued a report on Human enhancement, where it is confirmed that “during
the next decade, new substances and methods for engineering healthy people will probably
emerge in a rapid tempo. They vary from cosmetic gene therapy and a new generation of
anxiety inhibitors and mood modulators, to psychotropic medication that boosts cognitive
abilities (concentration, memory) and a drug that would allow women to optimise their
sexual functioning. Billions are being invested in development” also reinforces the
anticipated trend of proliferation of human enhancement technologies in the future.36
Indeed, more than a decade later the cited predictions seem not to have happened on such
massive scale but in terms of methods for construction cheaper prostheses and artificial
muscles significant progress has been witnessed. This indicates for a greater probability of
the outlined in the report course of events sooner to occur. The Human Enhancement and
the Future of Work Joint Report by the by the Academy of Medical Sciences, the British
Academy, the Royal Academy of Engineering and the Royal Society explores the implications
of human enhancement technologies for the future of work which is obviously recognized as
a pressing topic due to the admitted “widespread use of enhancements” and the
anticipations that “demographic shifts will be accompanied by changes to the nature of
work, and both of these transitions will influence the context in which enhancements might
be used”.37
All mentioned reports reiterate that the widespread of human enhancement
technologies has been happening for over a decade and indeed second that such trend is
predicted to last for a long time and grow in a considerable fashion. Although these reports
are not evidence certain probability that in future human enhancement technologies will
take over human life for sure they do indicate that the possibility should be considered
seriously.
One determinant for a possible proliferation of human enhancement technologies in future
is the proactive process of research and development happening across fields of
biotechnology, engineering and computing in the last decades. As the population worldwide
ages and given the advancement in the other medical technologies over the past few
decades, patients will come to expect the same improvements in the human enhancement
field as well. With regard to that, devices such as cochlear implants, artificial hip,
pacemakers, artificial kidney, and bionic eyes have been serving millions of patients in the
last years so scientists and researchers are attempting to upgrade these technologies
constantly. Scientists come up with improvements of existing well-known human
36
Health Council of the Netherlands. Human enhancement (Ethics and Health Monitoring Report 2003 no. 4). The Hague: Health Council of
the Netherlands, page 5
37
the Future of Work,2012, Available at https://www.acmedsci.ac.uk/viewFile/publicationDownloads/135228646747.pdf,, page 9

18
enhancement technologies such as cosmetic enhancement, reproductive technologies and
pharmaceutical means. At the same time, new breakthrough devices and technologies that
revolutionize the performance of natural human body are invented. In that scope fall
groundbreaking achievements regarding the domains of physical performance enhancing
drugs, smart drugs, organ replacements, bionic limbs and implants, reproductive
technologies, germline modification, sensory implants, deep brain simulation, nutrition,
cosmetic enhancement, etc.
Another substantial factor for an expectation of a state of abundance of human
enhancement technologies is the military research and development in that field. As far as
military human enhancement projects are concerned, it ought to be highlighted the
immanent commitment of researchers to construct cutting-edge military technologies and
their efforts to augment natural human capabilities. In his article “Emerging Military
Technologies: Balancing Medical Ethics and National Security”, Efthimios Parasidis describes
the twenty-first century as “the age of the biomedical military”.38
His conclusion is based on
a statement of the U.S. Department of Defense (DoD) that “one of its primary goals is to
exploit the life sciences to create soldiers with superior physical, physiological, and cognitive
abilities”.39
The article references to projects that include: “(1) developing drugs that can
reduce fear, increase aggressiveness, or keep individuals awake and alert for up to seven
days straight; (2) genetically engineering the human immune system so that it is able to
recognize and adapt to any pathogen; (3) creating implantable electrodes that permit
human-to-human and human-to-computer communication via thought alone; and (4)
establishing human-to-computer interfaces that are able to detect a person’s neurological
state and release neurochemicals that can combat fatigue, enhance mood, suppress or
improve memory, or facilitate learning’’.40
So far, there are numerous HET being developed
to advance the performance of soldiers and enhance their battle abilities. For example, the
exoskeleton suits, artificial blood, artificial muscles and joints being developed and tested at
the moment are anticipated to be put into practice soon.41 42
The US Defense Advanced
Research Projects Agency (DARPA) is devoted to support the US army with breakthrough
technologies for national security. Some among the human enhancement technologies
developed by DARPA could be evaluated not only as tries to design a futuristic super-soldier.
Instead, the mentioned military projects and inventions might revolutionize the ordinary
human being. It should be no surprise if in the future most of the human enhancement
technologies prototypes designed for military purposes actually become available on the
market. For example, the exoskeleton suit could be used by both disabled veterans and
38
Efthimios Parasidis, Emerging Military Technologies: Balancing Medical Ethics and National Security, 47 Case W. Res. J. Int'l L. 167 (2015)
Available at: http://scholarlycommons.law.case.edu/jil/vol47/iss1/13, p.168
39
Ibid
40
Ibid
41
"DARPA Tests Battery-Powered Exoskeletons On Real Soldiers", IEEE Spectrum, 2015 <http://spectrum.ieee.org/video/robotics/military-
robots/darpa-tests-batterypowered-exoskeletons-on-real-soldiers>
42
"First Batch Of DARPA's Synthetic Blood Delivered To FDA, Could Be On Battlefields Soon", Popular Science, 2010
<http://www.popsci.com/technology/article/2010-07/darpas-synthetic-blood-flows-lab-fda-could-be-battlefields-soon>

19
soldiers on duty. Today exoskeleton technology is developed to help soldiers to carry heavy
loads in the battlefield with less effort. To summarize, the conscious intention to bring
military forces on a higher level through means of human enhancement technologies might
induce more active research and development in that field resulting in high-tech
technologies that could benefit soldiers as well as civilians eventually.
The latest achievements at the human enhancement technologies domain inspire
enthusiasts to augment themselves and experiment with their bodies. So, the third drive for
substantiation of a possibility of establishment of a state of abundance of human
enhancement technologies should be the aspirations and overwhelming enthusiasm of a
growing number of people to augment their healthy bodies as well as stakeholders to
enhance their employees’ work performance. Many supporters of Transhumanism are
willing to augment their bodies and enhance their natural capabilities.43
The same applies to
biohackers who are devoted into cutting-edge technology and eager to experiment with
their own body. Especially scientists and wealthy enthusiasts are trying to facilitate different
prototypes of futuristic artificial organs in their bodies.44 45
What is more, global companies
are also looking into the development of human enhancement technologies and their
advantages. Not only individuals or groupings of enthusiasts sharing technical passion are
attached to the idea of accommodating human enhancement technologies but also major
corporations are implementing them into the work process. The exoskeleton technology
that was mentioned regarding its military application turns out to be lucrative for
multinational corporations as well. This technology is primarily designed for patients with
mobility disorders to allow them to walk.46
Some companies such as Panasonic and Hyundai
yet plan to employ exoskeleton technology on a regular basis to serve their factory
workers.47 48
Among the most useful specifications of the device is the ability to detect the
perfect moment automatically when worker is about to lift something heavy and reduce the
stress. Besides, Panasonic introduced the Ninja exoskeleton suit prototype that mimics the
natural human movement and assists the possessor while walking or running.49
The particular example of exoskeleton technology is quite remarkable because outlines how
a single human enhancement technology could be accommodated by various types of users
and benefit them – patients, soldiers and healthy people.
43
"Transhumanist Values", NICK BOSTROM <http://www.nickbostrom.com/ethics/values.html>
44
Frank Swain, "The People With ‘Animal Powers’", Bbc.com, 2014 <http://www.bbc.com/future/story/20140407-the-people-with-animal-
powers> [accessed 22 May 2016].
45
"Can We Biologically Extend The Range Of Human Vision Into The Near Infrared?", Experiment - Moving Science Forward, 2014
<https://experiment.com/projects/can-we-biologically-extend-the-range-of-human-vision-into-the-near-infrared> [accessed 22 May 2016].
46
"Exoskeletons: My Friend With A Robot Skeleton", BBC Future, 2014 <http://www.bbc.com/future/story/20140912-my-friend-and-his-
robot-legs>
47
Danielle Muoio, "Hyundai Created Its Own 'Iron Man' Exoskeleton Suit", Tech Insider, 2016 <http://www.techinsider.io/hyundai-creates-
iron-man-exoskeleton-photos-2016-5>
48
Danielle Muoio, "These Robotic Suits Will Give Workers Superhuman Strength", Tech Insider, 2016
<http://www.techinsider.io/panasonic-robotic-suits-provides-extra-strength-2016-3>
49
Ibid

20
In brief, the dynamic progress in the field of human enhancement technologies that is
triggered by the calling problems and challenges of medicine, the ongoing government-
sponsored programs and projects aimed to raise superior human soldiers and the aspirations
of biotechnology enthusiasts and companies to accommodate wide range of human
enhancement technologies for personal purposes frame a sheer grounds for a prediction for
a proliferation of human enhancement technologies in future. Each of the described
directions of the human enhancement technologies research and development serves
different objectives. Nevertheless, all these in total substantiate a possibility that a state of
great amount and supply of human enhancement technologies is plausible to be expected
sooner or later. In that context, falling into the scope of human enhancement technologies
artificial limbs and muscle devices should be also investigated whether an increase of their
availability and accessibility could be expected.
With regard to all abovementioned, it is true that any trends in terms of human
enhancement technologies are not a solid argument that the same would apply for
substantiation of a possible scenario of growth of artificial limbs and muscles on the market.
An analogy regarding the lack of relation between an increasing number of cars sold and the
amount of electric vehicles that will be sold in future is to some extent valid. However,
investigating the development of cars and the advance of their specifications as well as the
evolution of consumers’ needs and desires could prove one possible scenario of rising
production of electric vehicles in future. The same applies to self-driving vehicles that just
twenty years ago were seen only on the science-fiction movies and were not discussed
among scholars or legislators. In that context, the next paragraphs elaborate on recognizing
the determinants and indicating factors for outlining a probability of establishing a state of
abundance of artificial limbs and muscle technologies in future.
When it comes to artificial limbs, the possibility of abundant technologies gives the
impression of plausible one not that far in the future. Although at the moment the cost of
quality models of prostheses is usually unaffordable for many patients around the world, a
trend of new technologies and materials contributing greatly to tremendous cost-reduction
of the prostheses devices has been happening in recent years. Today, the ubiquity of 3D
printers and innovations in prosthetic design, manufacturing and distribution, offer a
practicable solution for the large number of people living with limb loss globally. This
technology is being improved at a phenomenal rate and nowadays an increasing number of
patients could benefit from variety of 3D-printed prostheses.50
During the last five years
many successful stories of disabled patients, worldwide equipped with inexpensive 3D
printed prostheses, were introduced to the public.51
Open-source initiatives allow everyone
to customize a 3D model of a prosthetic hand and then to print it on own 3D printer.52
50
Ventola, C. Lee. “Medical Applications for 3D Printing: Current and Projected Uses.” Pharmacy and Therapeutics 39.10 (2014): 704–711.
Print. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189697/>
51
"3D Printed Prosthetics", Enabling The Future <http://enablingthefuture.org/tag/3d-printed-prosthetics/>
52
Enable Community Foundation, 2017 <http://www.enablecommunityfoundation.org/>

21
Other complementing technologies such as 3D scanning and body modeling technologies
enable 3D scan their own limbs and have prosthetics modeled after them eventually.53
The
rising compatibility of 3D printers with new materials like lightweight titanium would provide
more durable and strong 3D printed prostheses. Despite its flourishing popularity and
endorsement among patients, scientists and business, 3D printing is not the only technology
that might significantly add to abundance of artificial limbs devices in future. The
implementation of special biomaterials such as pre-impregnated carbon fibers, polyurethane
and PE foams attempt to answer the demanding of prostheses providing patients with
comfort, biocompatibility, high performance and versatility.
The military research and development of artificial limbs for the needs of disabled veterans
and soldiers on active duty reinforce the trend of improvement of the artificial limbs
technologies. With regard to DARPA priority to maintain and enhance greatly the abilities of
the warfighters, it has already developed, to a certain point, advanced prostheses (featuring
mind-controlled limbs).54
Some quadriplegic volunteers had their brain surface implanted
with small array “to pick up these neural signals for motor control, and then to use those to
control these new, very sophisticated, robotic, prosthetic arms”.55
DARPA introduced a new
prosthetic technology that provides the patient with an almost natural sense of touch. In
fact, a young man who has been paralyzed for more than a decade has become able to “feel
physical sensations through a prosthetic hand directly connected to his brain, and even
identify which mechanical finger is being gently touched”.56
Seems that there is an ample
room for improvement, supported by the proven benefits of the technology and increasing
demand by patients, might guarantee constant progress and bright future for these
mechanical devices.
It is no secret that production of artificial limbs is a multimillion-dollar industry that cares for
its clients and aims to expand its range of customers. In that context, market analysists
around the world issue global projections for the artificial limbs and joints market. According
to the “Artificial Limbs and Joints Market Size, Application Analysis, Regional Outlook,
Competitive Strategies and Forecasts, 2014 to 2020” report “increasing geriatric population
and growing obese population are amongst key factors attributing to the growth of the
artificial joints market”.57
The conclusion of this report is that “on the basis of technology the
market is segmented into digital and manual limbs. Digital limbs are expected to grow at a
lucrative rate over the forecast period owing to advantages associated with it”.58
Another
comprehensive market report, entitled “Orthopedic Prosthetics Market - Global Industry
53
Body Labs, 2017 <https://www.bodylabs.com/>
54
"DARPA's New Biotech Division Wants to Create a Transhuman Future", 2045 Initiative Official Website, 2014
<http://2045.com/news/32738.html> [accessed 22 May 2016].
55
Ibid
56
"Neurotechnology Provides Near-Natural Sense of Touch", DARPA Official Website, 2015 <http://www.darpa.mil/news-events/2015-09-
11> [accessed 22 May 2016].
57
"Artificial Limbs And Joints Market Size, Application Analysis, Regional Outlook, Competitive Strategies And Forecasts, 2014 To 2020",
Grand View Research <http://www.grandviewresearch.com/industry-analysis/artificial-limbs-and-joints-market> [accessed 29 January
2017].
58
ibid

22
Analysis, Size, Share, Growth, Trends and Forecast 2015 - 2023”, informs that “the increasing
number of old age population and growing trauma cases all over the world are creating the
high rise in demand for orthopedic prosthetic products” meaning that “these facts
represents the massive demand for the orthopedic prosthetic products globally and the
increasing trend of the requirement in coming future. The technological advancements in
orthopedic prostheses in terms of better fixation, wear-resistant material and cement less
design along with this suitable reimbursement circumstances and increasing number of
trained healthcare professionals are driving the growth of the market”.59
Next market report
points at market growth drives being the “aging global population, rising diagnoses of
degenerative joint diseases and a patients’ willingness to pursue a more active lifestyle”.60
Why the mentioned market reports substantiate a possibility of establishing a state of
abundance of artificial limbs could be answered as follows: reports in question mark some
distinct market drives that are believed to push the research and development of advanced
artificial limbs devices forward and the predicted demand for different types of artificial
limbs might result in variety of models.
Turning to the field of artificial muscle technologies, predictions for the artificial limbs
market still apply to some extent. In fact, cutting-edge artificial limbs require advanced
artificial muscle technologies. In other words, the dynamic investigation into new designs of
artificial limbs might provoke proactive development of artificial muscles as well. Next drive
for improvement of artificial muscle technologies is the field of robotics where the primary
applications include humanoids and powered exoskeletons. One crucial part of human body
is muscles that let people move and walk. Despite intensive research and development of
artificial muscles for the purposes of robotics these might still not be advanced as biological
muscles but eventually a breakthrough in this field will benefit the replacement of biological
human muscles with enhanced artificial ones.61
The artificial muscles, for either robotics or
human medical applications, need to be flexible and strong enough to replicate their natural
counterparts. Such breakthrough invention was already introduced as “inexpensive high-
strength polymer fibers used for fishing line and sewing thread can be easily transformed by
twist insertion to provide fast, scalable, nonhysteretic, long-life tensile and torsional
muscles”.62
Strong and flexible artificial muscles, constructed of light-weight and affordable
materials that are suitable to be implanted into human body, are a goal of scientists and
researchers around the world.63
Once inexpensive materials are adopted and used on a large
59
"Orthopedic Prosthetics Market - Global Industry Analysis, Size, Share, Growth, Trends And Forecast 2015 - 2023", Transparency Market
Research <http://www.transparencymarketresearch.com/orthopedic-prosthetics-market.html> [accessed 29 January 2017].
60
"New Report Offers Global Projections For Orthopedic Prosthetic And Orthotic Markets", Healio Orthotics/Prosthetics, 2011
<http://www.healio.com/orthotics-prosthetics/industry-news/news/print/o-and-p-news/%7Bc2d04446-465a-4c7d-944b-
21fd57603547%7D/new-report-offers-global-projections-for-orthopedic-prosthetic-and-orthotic-markets> [accessed 29 January 2017].
61
"The Freaky Artificial Muscles On This Human Skeleton Are The Future Of Robotics", GIZMODO, 2016 <http://gizmodo.com/the-freaky-
artificial-muscles-on-this-human-skeleton-ar-1783445499> [accessed 29 January 2017].
62
C. S. Haines and others, "Artificial Muscles from Fishing Line and Sewing Thread", American Association for the Advancement of Science,
343 (2014), 868-872 <http://dx.doi.org/10.1126/science.1246906>.
63
Leah Burrows, “Artificial muscle for soft robotics: low voltage, high hopes”, Harvard, 2016
<https://www.seas.harvard.edu/news/2016/07/artificial-muscle-for-soft-robotics-low-voltage-high-hopes >

23
scale for the construction of artificial muscles the possibility of increased amount of models
might not seem unimaginable.
3.3 Consequences of abundant availability of artificial limbs and muscles
Based on the introduced statistics, facts and market conditions one forecast is that a state of
abundance of artificial limbs and muscle technologies is plausible and the market of such
devices might expand greatly sooner or later. Under these circumstances, diverse
consequences might be expected as aftermath of the increased accessibility and diversity of
models. As human enhancement relates to enhancement of individuals and their
performance in society, the phenomenon of abundant artificial limb and muscle
technologies should be examined in the perspective of society as well. In that context, the
effects of the consequences of abundant availability of artificial limbs and muscles might be
on two main levels: towards individuals and towards society. Next evaluation of the effects
would be based on whether the technologies in question provide benefits or risks. Like
almost every piece of technology these days there are not merely positive or negative
effects upon adoption. So, existence of a great amount of artificial limbs and muscle
technologies would probably result in contrasting effects.
When it comes to the consequences of a possible proliferation of artificial limbs and muscle
technologies, the list of positives hints at a few. The first and foremost expectation is the
cost of artificial limbs and muscles to decrease due to the greater supply of such
technologies. The indirect consequence of that availability would be the increasing number
of customers that would be able to obtain a device in the scope of artificial limbs and
muscles. Based on such accessibility the positives for individuals would vary significantly.
Both aspects of utilization of artificial limbs and muscles, namely for restoration of bodily
functions and enhancement of capabilities of healthy people, are tightly connected with the
primary designation of artificial limbs and muscle technologies. Soldiers will employ artificial
limbs and muscles that improve their performance during warfare, professions that require
immense bodily strength and endurance will be supplemented by the extraordinary
capabilities artificial limbs and muscle technologies, sportsmen will be augmented to
enhance their sports records and probably establish tournaments for augmented only. There
might be collateral positive consequences in other fields such as robotics, space travelling by
astronauts, etc. Additionally, unexpected benefits might be witnessed as well. The second
consequence that might result from a proliferation of artificial limbs and muscle
technologies is the supply of a wide range advanced models on the market. In such a case
the main benefits for individuals will be related to the opportunity to obtain cutting-edge
human enhancement technology on a competitive price that satisfies their specific needs
and preferences. In other words, the segmentation of the market that might occur will
benefit the customers with specific requirements and preferences. Under these

24
circumstances, a broader employment of artificial limbs and muscle technologies might be
projected. To conclude, the two main consequences that are foreseen based on establishing
a state of abundance of artificial limbs and muscle devices might deliver considerable
advantages to a broader scope of technology adopters. Correspondingly, an expanding
degree of individual enhancement will influence society and trigger social implications.
As far as social benefits are concerned, any projected growing trend of enhancement by
individuals with artificial limbs and muscles might carry out some social implications.
Improved individual performance of workers might increase the productivity of communities
and even further promote the GDP of countries. By augmenting their bodies healthy
individuals might contribute to greater public achievements in the terms of economics,
sports, demography, science, space travelling because they will accommodate extraordinary
body capacity and capabilities.
The damaging social effects in the fields of ethics, morality and fairness that are usually
predicted related to human enhancement to some extent also apply in the particular terms
of artificial limbs and muscles. Reducing costs and greater supply of various models might
trigger problems with respect to inequality, undesirable cultural change, undesired
substitution of the human spirit, dramatic change in the conduct of war and social
coercion.64
All mentioned could be examined on both individual and social levels as these
expected issues comprise undesirable effects of the direct consequences in case of abundant
market of artificial limbs and muscle technologies.
In the context of human enhancement technologies undesirable cultural change is another
expected negative effect worth to be elaborated on. Elements of undesirable cultural change
could comprise normalisation, medicalisation and alteration of our perception of
humanity.65
Enhancement with artificial limbs and muscles at some point in future might have an effect
of standardization. That would be the case if augmentation is found on the need to comply
with a specific dominant norm meaning reinforcement of the validity of that norm. The
social pluriformity could be at stake if the normalisation norm is defined by the dominance
of enhancement and the opponents of self-augmentation are put under social pressure due
to refusing to keep up with the new social norm. In this case the normalisation in question
would express another form of stereotypes and prejudices with the possibility to result in
extreme forms such as discrimination and eventually apartheid.66
In the broad scope of
existing human enhancement technologies a striking example is the evolving understanding
of beauty based on the progress of cosmetic enhancement through plastic surgeries,
pharmaceutical means and other interventions. In the last years, the social norms in the
64
65
Ibid, p.14
66
Ibid, p.14-15

25
terms of beauty and aesthetic appearance have changed significantly due to the
proliferation of cosmetic enhancements and the development in this field resulting in
abundance of affordable technologies such as Botox, etc. In such a context, the reported
trend of electing limb prostheses as means of self-expression for patients with upper-limb
loss is an identical mirror trend.67
However, with regard to artificial limbs and muscles it is
not only about the aesthetic norms through society but also the functional advantages they
could offer. When it comes to human enhancement as a practice of improving human body
capacity and capabilities beyond the natural degrees, the dominant norm could become the
enhancement of natural human body. In terms of artificial limbs and muscles, that would
mean more people attempting to obtain and utilize these technologies with aspirations to
comply with the dominant social norm set by the increasing number of augmented humans.
In the beginning, an abundance of artificial limb and muscle technologies might primarily
serve amputees and patients. In time, in accordance with the development of the
technologies and benefits they offer, more people might strive to augment themselves to
improve their natural limbs and muscles capabilities. At this time, the trend might be
ongoing and when an exponential growth of employment of artificial limb and muscles
flourishes the dominant norm might be established. In respect to a state of abundant models
on the artificial limbs and muscles market this dominant norm might transform into a
standard that could disrupt the social perception of human nature. Such scenario paves the
way for social coercion.
Any abundance of artificial limbs and muscles that are easily obtainable and accessible might
in fact end up in medicalization. That means extreme accommodation of augmentation in
ways offering solutions to problems that are usually handled in non-medical ways. 68
In other
words, medicalization might become the first option for resolving simple issues even in
mundane and trivial cases. Although probably legitimate in the perspective of an individual
case, the social impact might be harmful and undesirable. The risk in relation to the
medicalization phenomenon might contribute to diminishing of natural human feelings and
emotions regarding adopting the easy enhancement solutions. This is one aspect of the
replacement of authentic human nature that human enhancement technologies are
suspected of. Physical substitution of natural limbs and muscles might evolve into an
effortless way to bypass trivial issues or obstacles that in the past were solved by consistency
and tremendous efforts. For example, young athletics, not willing to improve their sport
achievements through exhausting and intensive trainings and exercises taking years,
preferring implantation of cutting-edge artificial limbs or muscles securing them
considerable advance or at least equal capabilities as the leading athletes. On social level,
the trend of medicalization might be adopted and encouraged for the sake of promoting
prosperity of nations and communities. For instance, companies might stimulate with special
67
Chris Lake, CPO, LPO, FAAOP; and Mary Lake, "Society Spotlight The Healing Effects Of Self-Expression For The Prosthetic Patient", 2011
<http://www.oandp.com/articles/2011-12_02.asp> [accessed 29 January 2017].
68

26
bonuses or lucrative contract clauses their employees to augment their bodies to be more
productive. The problem with such course of events could be explained again with possible
social coercion in terms of abuse of medical interventions and bodily intrusions.
Furthermore, it is believed that enhancement alternates the perception of humans for
humans. This is considered to be true especially if an understanding of
overinstrumentalisation of the human body is adopted, reinforcing the idea that its
appearance and functionality is more important than mentality and human spirit.69
In light of
artificial limbs and muscles, the mechanical perception of human body is fully suitable in
respect to that natural limbs are the instruments of the human body to interact with the
surrounding environment and move within it. With regard to that, the augmentation of
human body with artificial limbs and muscles indeed transforms the human into a superior
instrument to achieve objectives that are unthinkable or barely achievable through natural
human body capacity and capabilities. That would make it quite lucrative to look at human
body as a piece of hardware that can be upgraded to boost its performance for better
productivity. To put it more simply, the risk of overinstrumentalisation effect based on
abundance of artificial limb and muscle technologies on the market lays on the basis of
intended metamorphosis of the natural human body into an advanced posthuman
mechanism. How is that possible? First, in the terms of military, soldiers are contemplated as
the means to achieve the target. The human units on the battlefield are instruments to win
the battle. In light of these considerations, the military developments of artificial limbs and
muscles might turn soldiers into almost robots and replacing body parts with various devices
clashes with the law of war as the Geneva Conventions prescribe. Such plot perfectly covers
the foreseen undesirable scenario of neglecting human values in comparison to mere
mechanical functionality and utilization for achieving greater goals. Workers are also at stake
to be apprehended even more like half-machines, half-humans, rather than human persons
in connection with the employment of advanced artificial limbs and muscles that enhance
their work abilities. In other words, at some time overinstrumentalisation of human body
might be developed as a prevalent tendency having its roots in the ongoing strive for profits
maximization. A tendency in that matter would bother the fields of morality and ethics in
terms of the human spirituality.
The tendencies of normalization, medicalization and overinstrumentalisation are closely
connected with another predicted undesirable effect that might be witnessed within a state
of wide range of artificial limb and muscle models. In fact, these trends might trigger
coercion across society related to the adoption of human enhancement technologies.
69
Ibid

27
3.4 Coercion as a feasible undesirable consequence
Given the preceding, coercion across society seems like a feasible outcome based on rising
normalisation, medicalization and overinstrumentalisation of human body in terms of
enhancement with artificial limbs and muscles. In this context, the coercion might be
defined as a collateral effect based on the increasing number of acknowledged advantages
artificial limbs and muscle technologies offer and their growing accessibility. But what is
meant by coercion? How does coercion relate to the social understanding and utilization of
artificial limbs and muscles?
Coercion is a quite philosophical term like truth, good, fairness, equality and so might be
very slippery to attempt to define it. What is more, some scholars believe it has a divisive
nature and in that context Martin Gunderson described coercion like „a necessary evil".70
A long time ago, notorious philosophers such as Kant, Lock and Hobbes have established
tree criteria for coercion, namely the following: if a relationship between two people exists;
if the coercer acts coercive towards the corcee; if the coercee takes action in response of the
coerceer's act. The second mentioned criterion is the aspect that is considered as evil one.71
An explanation of that is because „coercion is typically thought to carry with it several
important implications, including that it diminishes the targeted agent's freedom and
responsibility, and that it is a (pro tanto) wrong and/or violation of right.72
When it comes to
the field of bioethics, the Bioconservatives and Transhumanists argue on the definition of
coercion but both groups see it as evil based on different reasoning.
Sometimes the term “coercion” is used in quite broad sense to describe social pressures or
the manipulative effects of advertising, one's upbringing, or the structuring of society more
generally. In other cases it is treated as a general concept that encompasses a variety of
examples of interpersonal infringement on one's rights.73
In the 20th century, philosophers
and legal theorists ended up with a more explicit definition of “coercion” and the way it
relates to other ideas. Their view on coercion connected it tightly with “the use of force or
violence, as well as to threats of the same”.74
In his essay “Coercion” Robert Nozick
established a framework for understanding coercion. Nozick's invention differs from the
traditional idea of coercion as it associates coercion “only with proposals and excludes direct
uses of force or violence as the same time it insists that coercion takes place only when the
coercee acquiesces to it; and it makes coercion explicitly dependent on the coercee's choice
to take or not take a specific action A, and mandates that a judgment about coercion must
70
Hasken, Jess (2007) "Coercion in Bioethics," Macalester Journal of Philosophy: Vol. 16: Iss. 1, Article 3.
Available at: http://digitalcommons.macalester.edu/philo/vol16/iss1/3, p.16
71
Scott Anderson, “Coercion.” The Stanford Encyclopedia of Philosophy. 2006. Metaphysics Research Lab,
CSLI, Stanford University. 30 November 2006. <http://plato.stanford.edu/entries/coercion/>
72
Ibid
73
Ibid
74
Ibid

28
refer to facts about the coercee's psychology, such as her assessment of the consequences
A-ing in light of the coercer's proposal”.75
In order to identify acts of coercion, Alan
Wertheimer introduces „two-pronged test for whether or not a proposal constitutes a
coercive threat".76
The first test actually consist of the outcome whether there is an
indication by the coercer if his proposal is refused will the coercee be put in worse position
than ought to be in. Because Wertheimer believes that “only threats coerce, but not all
threats do” he poses a second requirement. It states that the „choice forced upon the
coercee be such that the latter has no reasonable choice but consent".77
3.5 Examples of coercive enhancement across society
In his article “Regulating Human Biological Enhancements: Questionable Justifications and
International Complications” Henry T. Greely divide the coercive enhancement into three
categories, namely frank, parental and implicit, based on the current development and state
of human enhancement technologies. 78
Frank coercion could be described as direct or explicit coercion. That particular form of
coercive enhancement is considered to be the most despotic in the sense of the relationship
between coercer and coercee. Frank coercive enhancement could comprise practices such as
mandatory training sessions or physical training for employees in comparison to any coercive
intentional physical intrusions into the human body or other non-invasive enhancement
practices that enhance the coercee. As in very specific and isolated cases mandatory
treatment and invasion of human's body is legally prescribed, generally competent adults
have the almost absolute right to refuse medical treatment. In light of these considerations,
frank coercion usually needs to be regulated appropriately because of its intrusive nature.79
In light of Alan Wertheimer’s understanding of coercion, the explicit coercive enhancement
involves a wrongful threat towards the coercee from the coercer when coercee’s denial will
most probably end up in worse off based on a subordinate connection between both. In
other words, this could be explained as the most severe form of coercion as to greatest
extent forces the coercee to succumb. The legal implications of such scenario concern
human dignity, the right of bodily integrity, the right to autonomy and equality.
Second recognized form of coercive enhancement could be defined as “parental” and relates
to the coercion of children by their parents. This coercion is illustrated by the obligations of
75
Ibid
76
Available at: <http://digitalcommons.macalester.edu/philo/vol16/iss1/3>
77
Ibid
78
Greely, Henry T --- "Regulating Human Biological Enhancements: Questionable Justifications and International Complications" [2005]
UTSLawRw 4; (2005) 7 University of Technology Sydney Law Review 87 available at
<http://www.austlii.edu.au/au/journals/UTSLawRw/2005/4.html#fn30>
79
Ibid

29
parents to allow their children receive certain enhancement such as education and
vaccinations. The extensive topic of coercion of children could be narrowed down to the
coercive acts against minors by their parents and guardians. As the law prescribes the
obligation that parents are responsible for the conducts of their minor children at the same
time parents are granted the right to prevent their children from misconducting through
coercive practices. Law leaves room for parental discretion in the terms of coercive
measures but also sometimes prescribes mandatory ones. As mentioned, in most countries
around the world the first stage of education is obligatory and parents are obliged to send
their children to school. That case comprises a mandatory human enhancement practice
that is less intrusive in terms of the freedom and autonomy of children. On the other hand,
the second mentioned example, namely mandatory vaccinations, demonstrates a legal
obligation for coercive enhancement of children that has to be executed by the parents. As
children are receivers of the enhancement eventually this form of coercive enhancement
could not be defined neither as merely direct, nor merely implicit. The legal prescription that
requires parents to coerce their children by certain enhancements for the sake of their own
and social health and well-being is very specific and unique due to the participants in this
legal mechanism for coercive enhancement. In the same way, an abundance of advanced
and inexpensive artificial limbs and muscles on the market in the future might drive to the
adoption of identical legal obligations for parents. For instance, due to the proven benefits
of limb prostheses for the individual and society in addition to their inexpensive cost a
country might adopt legislation obliging parents to enhance their children suffering from
congenital limb defects with an artificial limb provided by the national healthcare system.
Such coercive enhancement resembles the case with vaccinations due to the believed health
benefits for the individual and the prevention of infectious diseases. However, there are
many other differences either in the terms of law, or in terms of social benefits justification
between the example provided and vaccinations. One crucial difference is the fact that some
mandatory vaccinations are aimed to help prevent the spread of these diseases to others.
Third, implicit coercion could be also described as indirect or collateral. When individuals
benefit from human enhancement technologies to an extent that they significantly outrank
others in some fashion, then the enhanced ones implicitly put coercive pressure on others to
employ human enhancement technologies just to stay competitive or to avoid becoming
worse off compared to their initial condition.80
Aging television presenters that have
cosmetic enhancements to look youthful in order to compete with the young rising
presenters are a striking example of implicit coercion. This form of coercion is also called
„coercion of voluntary enhancements" further explained with the instance of the increasing
use of steroids and other performance enhancing drugs in sports when other athletes are
enhancing themselves as well.81
In other words, despite their unwillingness to take a
80
DAN W. BROCK, “Enhancements of Human Function: Some Distinctions for Policymakers”, in Parens, ed. Enhancing Human Traits, pp.
60-61
81
I. G. Cohen, What (if anything) is Wrong With Human Enhancement? What (if anything) is Right with It?, 49 Tulsa L. Rev. 645 (2014).
Available at: <http://digitalcommons.law.utulsa.edu/tlr/vol49/iss3/4>

30
performance-enhancing drug, some athletes might feel compelled to do so just to stay
competitive. From a societal perspective, enhancements might have coercive effects on
people who are not willing to augment themselves, especially in cases that fall into the
scope of the medicalisation and normalisation effects already discussed. A real example of
the medicalization and normalisation effects in the terms of the implicit coercive
enhancement is the case with the New York Times in 2006. Six letters were addressed with
regard to the issue of using drugs to alter the behavior of kids.82
One letter actually
illustrates most profoundly the undesirable situation writing the following “Anecdotal
evidence about the high percentage of children treated with Ritalin and other prescription
drugs suggest that we may be overmedicating” meaning that many of the treated children
were given drugs based on no medical reason or illness. 83
To put it more simply, the more
children are enhanced by drugs, the standard for the expected results changes and therefore
more parents might attempt to keep up within the framework of social norms by
overmedicating their children. In fact, such conformity is reflected in the Transhumans
concept for human enhancement - coercing individuals to „ pursue an artificial standard
rather than a natural one".84
So, this kind of coercion in the terms of human enhancement
technologies could be describes as “conformity enhancement”. The core of such coercive
enhancement comprises the inevitable clash between the reward that the enhanced
individuals are awarded or the goal they accomplish thanks to the enhancement in
comparison to others, non-enhanced people, struggling to compete with the augmented
ones and feeling self-driven and socially pressured to take identical measures to remain
competitive.85
Although in some situations the implicit coercion benefits society and the
majority of its members, the right to autonomy and self-determination as well as human
dignity and freedom might be at stake. With regard to artificial limbs and muscles, the cited
examples and theories might be elaborated on. A sheer employment of artificial limb and
muscle technologies due to availability of diverse advanced models on the market might
trigger fierce competition between workers, soldiers, sportsmen to have themselves
augmented in order to improve their abilities and so significantly increase their productivity,
capabilities and achievements. First, workers that are not explicitly coerced to enhance by
their employer or supervisor might be implicitly put under pressure by some their colleagues
already equipped with artificial limbs or muscles. Employment of moderate bionic arms or
legs in future might secure tremendous advantage to those workers who are involved in
labor-intensive jobs. When it comes to military, the same scenario might apply either among
colleagues in the army, either between enemy armies when soldiers are not explicitly
coerced. Turning to sportsmen, athletics are the ones expected in the future to strive to
remain competitive with other augmented with artificial limbs or muscles eventually. The
82
Blau, Jessamyn. “Using Drugs to Alter Kids’ Behavior” New York Times. November 27, 2006 Section A. p.24.
83
Available at: http://digitalcommons.macalester.edu/philo/vol16/iss1/3 p.20
84
Available at: http://digitalcommons.macalester.edu/philo/vol16/iss1/3 p.20
85
I. G. Cohen, What (if anything) is Wrong With Human Enhancement? What (if anything) is Right with It?, 49 Tulsa L. Rev. 645 (2014).
Available at: http://digitalcommons.law.utulsa.edu/tlr/vol49/iss3/4 p.20

31
notorious case with Oscar Pistorius and his cutting-edge limb prostheses hints the
advantages that advanced models of artificial limbs could contribute to their users.
3.6 People ordered by superior authority to be enhanced
As the thesis already discussed the explicit form of coercive enhancement in general, the
next paragraphs will elaborate on examples of expected coercive enhancement ordered by
superior authority. In general, by superior authority the thesis intends a higher level
authority in terms of an organisation. In hierarchical organisations everyone is subordinate
to someone else within the organization except the ones on the top of the pyramid. In that
context, higher levels of the hierarchical structure are superior authorities compared to
others subordinate to them. So, even if hierarchical structures resemble in their layout of
pyramids and the different levels existing, the hierarchical organisation within an entity
might differ significantly. The distinction could be found in the nature of relationships
between levels, the liability for insubordination and the ability to resign from the
organisation swiftly. In the light of these considerations, two particular types of entities
illustrate considerable differences with regard to the enumerated characteristics, namely
businesses and military.
This particular form of coercion in the terms of human enhancement turns out to be
expected and discussed not only at academic level but also survey respondents and military
experts. Participants in the joint workshop hosted by the Academy of Medical Sciences, the
British Academy, the Royal Academy of Engineering and the Royal Society outlined “how
pressure might also be felt from employers, both implicitly and explicitly” as a potential
social harm regarding the infiltration of human enhancement technologies.86
Due to the
globalization and global economic trends, businesses and stakeholders are driven these days
to foster competitiveness and pursue maximizing productivity based on implementation of
new technologies; employers are in position to require the employees to utilize various
human enhancement technologies. Meanwhile, military experts and scholars alert that
soldier enhancement, through biological and technological augmentation of human
capabilities is a foreseen trend and so would pose numerous ethical challenges. The
rationale of biological enhancement of soldiers would be the extension of physical
endurance and improved resilience to injuries and tortures.
In this paragraph only the explicit cases of coercive enhancement will be considered as the
implicit coercive enhancement was already discussed. As the scope of the research question
primarily covers the coercive enhancement by artificial limbs or muscles, the following
possible scenarios will be examined based on specific reasoning. In fact, nowadays
86
the Future of Work,2012, Available at https://www.acmedsci.ac.uk/viewFile/publicationDownloads/135228646747.pdf p.45

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