Professionalism/Oscar Pistorius and the Rise of the Iron Man Era

Oscar Pistorius, a double-leg below the knee amputee, is a South African track athlete who made history in the 2012 Olympics by becoming the first amputee to compete in an able-bodied race. Born without the fibula bones in either leg, Pistorius participated and dominated in the 100, 200 and 400 meter Paralympic races, winning gold medals in 2004 in Athens, 2008 in Beijing and 2012 in London. His incredible times qualified him to race in able bodied events in 2007 and in 2011, he clocked a 45.07 second 400 meter dash, a time that placed him among the top ten able bodied runners world In 2012, Oscar Pistorius made history as the first amputee to ever compete in an Olympic able-bodied race. Pistorius's story is insipiring but met with controversy. Many people believe his prosthetics give him an advantage and oppose him, and other amputees, racing against able bodied runners. Supporters of Pistorius claim that he poses no threat to able-bodied runners as evidenced by his sub-standard times. In fact, many athletes view steroid use a more unfair advantage than Pistorius’s prosthetic legs. Beyond athletics, many ethical debates center on alterations to the human body including elective amputation, human augmentation, and even growing new body parts in laboratories. While the Oscar Pistorius case is limited to track and field events, it offers a glimpse into a larger ethical dilemma: Will society allow technology to slowly begin augmenting the human body, and is the Pistorius case the beginning of the end for pure human accomplishment?

Supporters
Oscar has won respect and support from rivals and teammates, as the winner of a semi-final race against Pistorius sought him out to trade numbers and embrace him. Olympic legends such as Lord Sebastian Coe and Michael Johnson have also defended Pistorius, and his right to compete in the Olymipcs, calling him a pioneer. Pistorius reached the pinnacle of Olympic honors by carrying his country’s flag in the closing ceremony, with the backing of the Republic of South Africa in showcasing his story to the world.

The official website of Oscar Pistorius shows hundreds of letters sent to Oscar in support of his achievements and efforts to compete in the most challenging races in spite of his disabilities. Many people look up to him as a role model, and he represents the athletic prosthetic company Ossur by saying “you are not disabled by your disabilities, but able by your abilities.”

Fellow amputees, both athletes and non-athletes, look to Oscar as leading the way for new prosthetic innovations and inventions. Van Phillips, responsible for inventing the “C” shaped prosthetic that led to the design of the "J" shaped racing leg that Pistorius uses, says many amputees believe they can’t walk or run with ease. The biggest obstacle is overcoming this belief, and seeing an athlete wearing and competing with a prosthetic, such as through the media attention Pistorius has received, helps to mentally recuperate an amputee and encourage them to be active again. The Amputee Coalition supports Pistorius in making artificial limbs more commonly accepted in society, and noted that many younger amputees have started to favor metal prostheses, that will be more favorable to athletics and active lifestyles.

Opponents
Pistorius's success stems from the unique design of his prosthetic legs, the Flex Foot Cheetahs, made by Icelandic prosthetic company, Ossur. The J-shape design allows for a more fluid running movement and is made of lightweight carbon fiber, weighing only 512 grams. Hilmar Janusson, Executive Vice President of R&D at Össur stated, “When the user is running, the prosthesis's J curve is compressed at impact, storing energy and absorbing high levels of stress that would otherwise be absorbed by a runner's ankle, knee, hip and lower back." .  The controversial design of these prosthetics prompted the International Association of Athletics Federation to place a ban on Cheetahs in able-bodied races in 2007, labeling them as a technical aid, effectively forbidding Oscar Pistorius from racing in able-bodied events. The ban was prompted by an IAAF funded study which compared Pistorius's athleticism to that of an able bodied athlete.  This study found that the lightweight design of the Cheetahs allowed Pistorius to swing his legs faster and  maintain a higher top speed than an able-bodied athletes. Additionally, the study concluded the prosthetic leg retained 90 Joules of energy and re-used 82 Joules during push-off from the ground. This is drastically higher than the 68 Joules found to be stored by a human leg with only 28 Joules being reused during push-offs. Pistorius claimed the IAAF study was not comprehensive. Hiring a research team from MIT, Pistorius participated in an additional study which compared his athleticism to that of an able bodied human on an actual curved track. This study found Pistorius's speed was drastically reduced off the starting blocks because the prothestics could not recreate the torque of a human foot during acceleration. Additionally, the study concluded Pistorius's performance was inhibited around the curves of the track because he does not possess flexible ankle joints. Armed with this information, Pistorius petitioned the Court of Arbitration for Sport (CAS) to overrule the IAAF decision. In 2008, the CAS ruled in favor of Pistorius and cleared him to race in able-bodied track events.

Although legally allowed to race, Pistorius is opposed many athletes and fans concerned about the precedent Pistorius sets. After the IAAF ruling, news writers spoke out against the fairness of Pistorius's mechanical legs. Gregg Doyle, a writer for CBS sports argued that although Pistorius's story was inspiring, his race would set a precedent that would never be removed, no matter how advanced prosthetics become. The most notable athlete opposed to Pistorius is Olympic sprinter Michael Johnson. Johnson set world records in the 200 and 400 meter races and is considered to be the best sprinter to ever compete. Johnson elegantly captured the complicated nature of the situation by stating, "I consider Oscar a friend of mine, but he knows I am against him running, because this is not about Oscar; it's not about him as an individual, it is about the rules you will make and put in place for the sport which will apply to anyone, and not just Oscar. If it was just about Oscar my position would be: ‘Absolutely, let him run." .

Generalizing the Case: The Future of Humans and Prosthetics
There are currently approximately 1.7 million people in the United States living with amputations. Advances in prosthetic limb technology are undoubtedly improving the quality of life for each one of these people, but where will these technologies begin to cross the line by surpassing natural human function, and further, into no longer just being developed for amputees? Members of several different social groups find themselves in an ethical dilemma between what is considered therapeutic treatment (replacement) versus human enhancement (augmentation).

Elective Amputation
An ethical debate is centered around removing healthy limbs. The Hippocratic Oath binds doctors to “first, do no harm,” but can this vow be outweighed by overall positive results? Ann Kornhauser, a New Yorker in her late 50’s, lost half of her left foot due to a rare tumor, but after years of pain and discomfort from her prosthetic foot, she opted to have a larger portion of her perfectly healthy leg removed to just below the knee in order to better fit a promising new prosthetic. Similarly, an Austrian man named Patrick, lost three of his fingers in a work accident, and was unable to use his hand for three years. He also opted to remove his otherwise healthy arm to be replaced by a bionic one to regain use of his hand. While these impaired patients are removing healthy limbs to ultimately gain additional functionality, will this practice become acceptable for people with complete functionality to avoid the negative effects of diseases like arthritis?

Human Augmentation/Enhancement
A second category includes those who are not replacing body parts with biomechanical versions, rather are adding technology to their bodies to enhance its functionality. Kevin Warwick refers to these people as cyborgs, and he himself became the first. He underwent surgery to implant this {pic} microelectrode into his forearm. He could successfully control a robotic hand across the internet, perceive ultrasonic impulses, communicate telegraphically with his wife (who also had an implanted microelectrode), all using just his mind. He comments that some of the functionalities may be of use to people with disabilities. For instance, the ultrasonic sense could be used by a blind person, and the telegraphic communication could be useful for other impairments. But, are these added benefits only ethically justified for people with no disabilities just for added human functionality? Another presently developing technology is the powered exoskeleton. This is a suit that would likely be worn by a soldier. It boosts strength and endurance using battery powered hydraulics and motors to assist the soldiers' muscles by providing a portion of the required energy. Some argue body enhancements and therapy should only be implemented to promote peace, not violence, but there is a possibility that a suit of this kind could preempt injuries that result in amputations in the first place.

Beyond Prosthetics
3D printing technology is extending its applications to include printing of human organs like hearts, lungs, bones, ears, and skin. Scientists are even researching the possibility of growing hearts and lungs using stem cells. Scientists at Berkeley have developed artificial skin using a pressure-sensitive electronic material. This material allows the skin to experience touch and feel, enabling the patient to intuitively know how tightly to hold on to something based on its fragility and weight. For example, lifting a heavy pan without dropping it, or holding an egg without cracking it. Lawrence Bonassar, a biomedical engineering professor at Cornell University, is researching artificial organic ears, which use collagen as "scaffolding," which is then covered by cartilage cells. These ears can be used for patients involved in accidents who have lost part of their outer ear, or patients with congenital ear deformations. These advances seem nothing but beneficial considering the long list of patients waiting on the donor list, nevertheless artificially growing organs becomes an ethical dilemma. Will it change how people live? Would people just smoke for years, knowing they can buy a replacement lung in the future? Will rich people be able to replace their body parts indefinitely, while poor people would have no such access?

Ultimately the question becomes, to what extent will society allow technology to be integrated with the human body, and at what point does treatment and replacement turn into enhancement and augmentation? In the case of Oscar Pistorius, artificial limb prosthetics have allowed him to compete at the Olympic level among able-bodied runners, but on a broader scale in day-to-day life, it remains to be seen what technologies will be deemed socially acceptable, and who will be allowed to use them.

Future Research
The case of Oscar Pistorius will not be unique in the world of sports or technological innovation. Many related fields will reveal a more complete understanding of the controversy and what the future will hold. Further related topics that could be researched include:
 * Prosthetic innovation
 * Elective surgery and amputation in sports
 * Wearable human augmentation devices