The Future of Almost Everything, page 32
However, the 22nd century is quite another matter. By 2150 we can expect to see large numbers of self-reproducing robots, who have huge powers over their own situation, make complex decisions and interact with human beings in a very wide variety of ways. They may align their activities, form opinions, make joint decisions and form a formidable force for change. This will go far beyond the science-fiction view of mechanised creatures, with physical bodies moving around.
We also need to include all forms of sophisticated intelligent machines – which may have no physical presence apart from the chips in which their mental processes run, deep inside a factory or institution. Indeed, such intelligent entities may only be virtually present on our planet, with mega-brains running in the Cloud, interacting, monitoring, thinking, planning, controlling. It will be up to their human designers and programmers to place sufficient limits on their thinking and powers … if they can.
Common-sense approach to health-related ethics
What about ethics in health care? History shows us that what one generation regards as shocking, immoral or bizarre can feel more natural to the next.
It is also dangerous to generalise about what, say, may appeal to a Western European mind-set without considering what may be acceptable to a majority of Muslims who live under various interpretations of Sharia law in nations like Saudi Arabia, or to those in a strongly Christian nation like Zambia.
The ultimate ethical test applied to health
Whatever the issue in health care, biotech or life sciences, the ultimate ethical value will be based on our four-word phrase, ‘building a better world’. If an activity such as human cloning or creation of near non-ageing humans becomes a normal part of life on earth, will our world be a better place as a result or not, not just for today, but for all time? And for the devout Muslim, Christian, Jew, Buddhist or Hindu, is this a step towards the kind of world our Creator intends or is it a violation of the natural order?
There is an added ethical question: perhaps the most important of all. In a world where over 800 million go hungry each day, and where 1 billion have almost zero access to basic health care and only limited access to clean running water, is it right to even think about such medical exotica as we have seen in previous chapters? Access to basic health care is one of the deepest ethical challenges in the world today.
You may feel rather distant from such things – and so did I until I saw with my own eyes young children dying in places like Africa for lack of a simple antibiotic, or because the clinic had run out of malaria tablets.
Calls for euthanasia will become almost irresistible
Euthanasia will be a burning medical issue for the next 50 years in developed nations. The ‘right to die’ will be packaged with other issues, including permission for doctors to end the life of someone who is unfit to take a decision. It will always be doctors – or a court of law – who have to make that call, because someone has to decide whether the person is ‘of sound mind’, has all the facts and is not under undue pressure from others.
A growing number of doctors will take the law into their own hands in nations that forbid deliberate acts intended to shorten life. We will see more high-profile court cases and ‘mercy death’ will become a more acceptable practice, especially in countries with rapidly ageing populations.
We will also see a backlash in some nations, where people have been killed who, by most people’s reckoning, should still be alive. For example, where it is clear that a person’s life has been terminated for no other reason than they were clinically depressed, or felt negative about life because of other mental health issues, or because they felt they were a burden on their families.
One result of legalised euthanasia will be that active treatments will be abandoned far more frequently at an earlier stage, allowing ‘nature to take its course’, with symptom control measures, even if treating those symptoms makes an earlier death slightly more likely.
Countries with relaxed euthanasia laws will find elderly people taking this way out as the ‘responsible thing to do’. Length of average stay in nursing homes or hospices will fall. People who are suffering will commonly be terminated.
In the Netherlands 1% of all deaths are the deliberate killing of a patient by a doctor without the patient requesting it. The criteria for euthanasia now include chronic illness and emotional distress.
Despite all this, expect a new emphasis in medical training in most nations not just to cure but to manage death and the dying process. Palliative medicine will be a key growth area in emerging nations. We will see new breakthroughs in the relief of pain, and sales of pain-relieving drugs will rocket globally in the next decade.
Navigating health-related dilemmas
Listed on the next two pages are just a few of the hundreds of wide-ranging ethical dilemmas in the future of health care, biotech and life sciences in general. Remember that we can expect debates within each country, over each issue.
The public may be more or less well informed. Regulators may be very cautious or lacking in powers or there may not be a regulator in that sector. So it becomes very difficult to forecast how globally acceptable issues will be, such as gene screening for insurance purposes, or infertility treatment for 80-year-olds (by 2040 many 80-year-olds will be as young and healthy from a medical point of view as today’s 65-year-olds).
Each item on the list is followed by a U or an E (or several Us or Es). This indicates what I predict the level of Unease or Ease with the issue will be globally by 2030.
You may feel that you have a set of clear answers to all the above, but you are in the minority. Most scientists and doctors around the world tend to take a fairly practical view, exploring the limits of what is technically possible one small step at a time, and delegating to society as a whole the bigger ethical questions.
In practice what that means is that research goes ahead of debate, because in most cases scientists hate debating theoretical possibilities. They only want to debate what is possible. And of course, many fear that if what they are trying to do is debated in advance, the public outcry may block their future life’s work.
Expect open conflict at times between the general public and the research community, resulting in researchers pursuing all kinds of activities almost in secret, as can happen at present.
Dilemma
Level of ease/unease
Is it right to take action to end the life of an old, frail or sick person because they have lost the will to live?
U
Is it right to abort a perfectly healthy foetus at a stage of pregnancy where it could live outside the womb with help?
UU
Is it right to abort a perfectly healthy foetus at an earlier stage because you would prefer a baby with a different gender, or hair colour, or with more genes likely to make them good at maths?
UU
Is it right to clone yourself, by inserting a nucleus from one of your cells into an unfertilised egg, either to implant the early embryo so that one day you greet your own identical twin as a newborn baby, or to grow the ball of cells so that the tissues can be cannibalised to repair your own body?
UU
Is it right to use tissues from other people’s aborted foetuses to repair your own body? Does that encourage other people to have abortions?
UU
Is it right to use adult stem cells to repair your own body?
EEE
Is it right for two men or two women to seek to have a genetic child of their own, by some genetic means or by using a surrogate mother (as 2,000 women do a year in America) or egg or sperm donor?
U
Is it right to allow a child to be created with two mothers and one father – where one mother contributes 1% of her genes, those in her mitochondrial power packs, to correct a terrible gene defect?
E
Is it right to use injections of gene fragments into muscles to enhance athletic performance in competitions?
UU
Is it right to refuse insurance cover or a new job to someone based on the results of their genetic screening?
U
Is it right to add human genes to farmed fish to make them grow faster?
U
Is it right to add human genes to pigs so that the surfaces of their hearts are altered, enabling them to become donors to people with heart failure?
E
Is it right to add human genes to monkeys to try to find out which genes programme the human brain for speech?
UU
Is it right to use infertility treatments to allow a 70-year-old woman to have a baby?
UU
Is it right for a woman to rent out her own womb to another woman who cannot carry a child?
E
Is it right for a woman to have sex with another woman’s partner as a combined egg and womb donor?
UU
Should we allow a pharma company to take some of your genes, identify a new cluster causing your illness, and patent it so they own part of your own genome?
E
As it is, much early research is conducted away from the public eye, so that new pharma products can be developed without alerting competitors.
Expect growing concerns about ethics of using larger animals in laboratories, linked to the global boom in pet ownership. Sales of pet food and pet care already exceed $180bn a year, likely to rise to over $340bn by 2030.
Feminisation of society – impact on ethics
We will see further feminisation of many Western societies. Men are in already in retreat in many developed nations, labelled as testosterone addicts: dangerous, ill-behaved variants of the human species prone to violence, sexual predatory acts and general loutishness and irresponsibility, the victims of a growing chorus of negative comments and abuse. Patriarchal societies are rapidly becoming matriarchal. Female instincts and reactions will be the future norms.
Jobs for the girls
Most new jobs in Britain are going to women. The greatest growth area is part-time work in the service and leisure industries, while traditional full-time manufacturing workers are a dying breed. Tomorrow’s jobs will require flexibility, teamwork, efficiency – favouring women. In Japan there has been a huge increase in female influence and power at work.
In terms of consumption, 70% of online purchases of many kinds of products and services in Europe and the US are by women. In banking, 70% of online accounts in some nations are opened by men but 70% of the transactions are by women. Women buy most household goods, books, food and holidays.
Women also dominate spending in traditional retail outlets yet, despite this, most marketing executives and customer relationship managers are men. Expect this to change as companies look to re-brand in a more feminine way. Nevertheless, the feminisation of society still has a long way to go. Men clean the house, but not much more than they did. There is still a glass ceiling blocking promotion for women in many areas and women still have far less leisure time than men.
Expect new men’s liberation movements in some nations which in some ways will parallel women’s activist groups, seeking greater gender equality for men in some kinds of jobs which have been traditionally done by women, e.g. working in nurseries or in care roles. Gender-role confusion will continue, with a backlash from many women over negative stereotyping of men.
We will also see major shifts in corporate culture, especially as populations age, creating a skills scarcity. Many more women will occupy senior positions, especially on boards, with legal quotas becoming far more common, like those already in place in Germany.
But we will also see men sue women for sexual harassment, intimidation and prejudice in recruitment or the workplace, with demands for male quotas for jobs.
Impact of personal spirituality
We have already looked at radical forces within Islam and their future impact on the Middle East and far beyond. But this is part of a much wider picture, which is playing out rather differently in developing and emerging nations.
Across the developed world, as a result of all the trends described in this book, we are seeing an intense, growing hunger for meaning, often expressed in a search for spirituality, which is very different from membership of an organised religion. The great debate in a nation like the UK or France is not over whether you believe, but what you believe in, and what your own spiritual purpose is.
Faith in anything, anyone. Faith that causes ordinary men and women to hug trees in local parks. Faith that causes intelligent people to study full-page spreads of personal advice based on the position of the stars. There has been a wholesale rejection of the scientific, logical, rational model of the world that reduces all of existence to fixed, predetermined and mechanical systems.
Thus doctors are struggling with patients suffering from serious illnesses but who throw away medically approved, ‘life-saving’ medicines, and opt instead for alternatives that most doctors regard as having little or no scientific basis.
More than 17 million people in Britain alone rely on alternative medicines or therapies – aromatherapy and homeopathy being the most popular. Expect laws in these areas to tighten, requiring companies to verify the health claims made. This will intensify the scale of the culture clash between those who feel that scientific methodology is not a valid test of ‘whole person medicine’ and those who insist on ‘objective’ scientific data.
Spiritual awareness will remain central to human existence
Around 85% of people in the world today say that they recognise a spiritual dimension to life, which reflects an ancient pattern in place since the beginning of human history. While strident voices of humanistic atheism are likely to grow louder in some developed nations, they will almost certainly be drowned out globally over the next 50 years by the vast majority who remain convinced that there is more to life than atoms, molecules and bags of biodata.
In developed nations, informal expressions of spirituality seem likely to multiply, as we see further decline in organised religion. Expect growth in personal systems for meditation, in self-help guides to spiritual enlightenment.
Thus, informal attendance at synagogues, Hindu temples, mosques and churches is also likely to rise – particularly at social activities such as mother and toddler groups, homeless projects, drop-in centres, food banks, advice centres, and so on, even while formal membership falls.
These kinds of initiatives may well turn out to be a significant growth factor in the lives of churches, mosques, synagogues and temples in countries like the UK over the next two decades. We can expect more social action projects, as the state gradually runs out of cash from trying to reduce government debt.
From personal belief to organised religion
In emerging nations, we are seeing a rather different picture, with very rapid growth of global, organised religions such as Christianity and Islam, decline in local faith-healers, and far fewer people with private, ‘personalised’, idiosyncratic, informal beliefs.
There are 1.6 billion followers of Islam in the world today, 21% of the world population. Of these, 60% live in Asia-Pacific and 20% in the Middle East. Islam is likely to grow faster than world population, by around 1.5–1.8% over the next 20 years, but the rate of growth will continue to slow, as the size of families continues to fall in the nations where Islam is strongest, and where incomes are growing rapidly. As we have seen in Chapter 2, fertility rates tend to fall as wealth increases.
Christianity has 2.3 billion adherents, representing 32% of the world population, with 60% of them found in Africa, Asia and Latin America. Christianity will also continue to grow significantly faster than the world population, particularly in places like Africa and former Soviet bloc countries, as well as in China, where tens of millions have found Christian faith since the 1950s, despite a history of severe persecution. It is possible that there are already more Christians in China than in any other nation.
In Argentina over the last decade churches have sprung from nothing to number many thousands of people, and the same has been happening across most of Latin America. Africa has seen extraordinary growth in church attendance, and this is now influencing politicians and governments.
Emphasis on personal spiritual experiences
The impact of the global uprising of life-changing faith, which provokes passion and provides purpose, cannot be underestimated.
Expect divisions within each world religion between radicals who remain rooted in traditional teachings based on, for example, the Bible or the Koran, and liberals who accept or abandon whatever writings they choose in their own personal spiritual journey.
This orthodox-liberal divide is likely to sharpen over issues like abortion, euthanasia, embryonic stem cell research and gay marriage. While liberal churches will argue that they are more attractive and culturally relevant in the US and Europe, they have in fact declined very rapidly. Most church growth there is likely to be, as in the last three decades, among Christian communities that adhere to traditional teachings and express strong spirituality.
This has certainly been the case in the UK, where Pentecostal churches are growing by 5% a year, and over half of all churchgoers in London belong to black-majority Pentecostal-type churches. For example, the Redeemed Christian Church of God now has around 700 churches across the UK, from very few 20 years ago, as a Nigerian mission-movement to Britain.
The evangelical wing of the Anglican Church is also growing. Over 2.5 million people have attended a 12-week induction course to the Christian faith, designed by just one such evangelical church, Holy Trinity, Brompton, in London. However, this growth is unlikely to offset overall Anglican decline, especially among liberal, older congregations in rural areas.
Whether you are a follower of Jesus as I am, or of Mohammed, or of Buddha or the patterns in the stars, believe in karma or reincarnation, or some other life-force, or in nothing at all, spirituality is likely to remain a significant part of life, shaping our ethics, values, and politics for the next hundred years.
