Two hundred years ago Mary Shelley published Frankenstein, or The Modern Prometheus. This publication launched one of the most powerful metaphors in the ethical discourse on healthcare, medicine and medical science. It is usually regarded as the expression of horror and anxiety about science and its discoveries. In her recent book In search of Mary Shelley, Fiona Sampson defines the Frankenstein idea as “the notion that if humans play God with the ‘instruments of life’ they will produce something monstrous.” It refers to the fear that a mad scientist experiments on humans for satisfying intellectual curiosity, desire for power or wealth.

Shelley’s book may have initiated the use of the Frankenstein metaphor but the underlying idea is not new at all. The development of medicine over time has been guided by metaphors and symbolic narratives that pervades the collective imagination until today. Public opinion polls indicate that 79% of adult Americans believe in miracles. New drugs are advertised as miracle drugs. Thousands of patients travel to China each year for unproven stem cell treatment; we call them biotech pilgrims. Science nowadays is affected by ghosts: ghost publications, ghost journals, and ghost diseases. One of the most powerful metaphors is that of monster. Monstrosity refers to what is horrible in a culture. They present the bizarre, the odd, the frightening and the unexpected. But monsters can be real and imaginary. Medicine has been fascinated by monsters. Physicians collected every possible creature with unusual size and form. Very popular for these collections were conjoint twins. Many medical schools have museums exhibiting monsters showing the enormous variety of human nature. This summer I spent several weeks in hospital in Amsterdam. Within the hospital is the Museum Vrolik, a large collection of deformities and oddities. It was started by Gerardus Vrolik, professor of anatomy in Amsterdam in the early 19th century. ‘Vrolik’ means ‘cheerful’ in English. But the collection of the professor is not jolly at all. It exhibits all imaginable forms of abnormality and monstrosity.

The language of monsters has moral connotations. It produces fascination and curiosity but at the same time dread, horror and disgust. Labelling someone as monster implies rejection and exclusion. Ethically and politically it is no longer acceptable to use this language but not too long ago, children with Down syndrome were labelled as such, and today albino children in some African regions still are. Until the 20th century monsters were considered as curiosities and exhibited on public markets to make a living.

The metaphor of monster was not merely applied to natural monsters such as biological abnormalities or exotic races. Human beings themselves can develop into monsters. Josef Fritzl from Austria for example who held his daughter captive for 24 years in a secluded part of his house. He is regarded as the prototype of a monster who is no longer a human being. Physicians are not an exception; they also can sometimes be or evolve into monsters.

The last category of monsters are fabricated monsters. Here the Frankenstein metaphor comes in. In ancient mythology monsters were made by Gods. Shortly after Shelley’s publication the science of teratology emerged, also seen as the science of monsters. Experiments on embryos in the 1830s explored how and why monstrosities originated and developed. Since 1855 most monstrosities could be produced in the laboratory. These developments raise not only the possibility that artificial monsters are created with unknown risks and consequences but also that the scientist-creator might be him or herself a monster with evil intentions.

What is the significance of the Frankenstein metaphor for the ethical debate in healthcare? There is one basic question conveyed: are there any ethical limits to what we can do? Invoking the metaphor of monstrosity implies that there is disrespect for limits, that existing concepts of nature and species are disregarded, and that ethical boundaries are transgressed. It is a clear warning against scientific hubris, a protest against human arrogance. Not all scientists are ethical and reliable; not all science is aimed at the common benefit of humanity, and not all innovation is progress. With all good intentions, scientists may jeopardize the future of humanity if they do not respect the difference between what science can do and what it should do. Using the Frankenstein metaphor therefore is not an argument but an appeal to engage in an ethical, not technical or scientific debate. The metaphor is often dismissed as an emotional response, an expression of the Yuk factor. But I think it is more. Shelley’s book demonstrates that reliance on scientific rationality brings ruin and darkness. Ethical discourse should go beyond rationality and argumentation. The source of ethics, as David Hume, has argued is not the brain but the heart. Moral judgments find their origin in human sentiments and passions, i.e., feelings. Reason can discover facts and analyze concepts and their relations. But it cannot explain what actions are desirable. Philosopher Mary Midgley has applied these ideas to the use of the metaphor of monstrosity. It is not merely a matter of gut feelings or exclamation of yuck that can be easily dismissed as irrational. People who regard something, for example, developments in biotechnology such as cloning and the production of chimeras, as monstrosities, not merely express repugnance and outrage but articulate intrinsic objections. And there may be good reasons for such objections.


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