Transhumanizing War: Performance Enhancement and the Implications for Policy, Society, and the Soldier 9780773559677

Table of contents :
Cover
Copyright
Contents
Figures and Tables
Preface
1 Introduction:A Call to (Enhanced) Arms
Global Perspectives on Enhancement
2 Mapping the Human Enhancement Literature
3 Forecasting Futures and Possible Implications: The German Experience
4 Perspectives on the Enhancement of Soldiers: A French Approach
5 Human Performance in the United States Army: Enhancing the Future Soldier
Easing the Burden
6 Rationalizing the Approach to Mitigate Soldier Physical Burden: Are Iron Man or Captain America the Magic Bullet?
7 A Roadmap for Biomechanical Testing and Evaluation of Future Human Exoskeletons with Respect to Soldier Performance
8 Enhancing Performance Starts with Learning
9 The Road to Cognitive Optimization
Implications for Policy and Society
10 Insulating Soldiers from the Emotional Costs of War: An Ethical Analysis
11 Bioethics and Soldier Bio-Enhancement
12 Conclusion: The Road Ahead
Abbreviations
Contributors
Index

Citation preview

transhumanizing war

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H u m an Di me n s i on s i n F o r e i g n P olicy, Military S tud ies , an d  S e cur i t y St u di e s Series editors: Stéphanie A.H. Bélanger, Pierre Jolicoeur, and Stéfanie von Hlatky Books published in the Human Dimensions in Foreign Policy, Military Studies, and Security Studies series offer fresh perspectives on foreign affairs and global governance. Titles in the series illuminate critical issues of global security in the twenty-first century and emphasize the human dimensions of war such as the health and well-being of soldiers, the factors that influence operational effectiveness, the civil-military relations and decisions on the use of force, as well as the ethical, moral, and legal ramifications of ongoing conflicts and wars. Foreign policy is also analyzed both in terms of its impact on human rights and the role the public plays in shaping policy directions. With a strong focus on definitions of security, the series encourages ­discussion of contemporary security challenges and welcomes works that focus on issues including human security, violent conflict, terrorism, military cooperation, and foreign and defence policy. This series is published in collaboration with Queen’s University and the Royal Military College of Canada with the Centre for International and Defence Policy, the Canadian Institute for Military and Veteran Health Research, and the Centre for Security, Armed Forces, and Society. 1 Going to War? Trends in Military Interventions Edited by Stéfanie von Hlatky and H. Christian Breede

6 Violence and Militants From Ottoman Rebellions to Jihadist Organizations Baris Cayli

2 Bombs, Bullets, and Politicians France’s Response to Terrorism Christophe Chowanietz

7 Frontline Justice The Evolution and Reform of Summary Trials in the Canadian Armed Forces Pascal Lévesque

3 War Memories Commemoration, Recollections, and Writings on War Edited by Stéphanie A.H. Bélanger and Renée Dickason 4 Disarmament under International Law John Kierulf 5 Contract Workers, Risk, and the War in Iraq Sierra Leonean Labor Migrants at US Military Bases Kevin J.A. Thomas

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8 Countering Violent Extremism and Terrorism Assessing Domestic and International Strategies Edited by Stéfanie von Hlatky 9 Transhumanizing War Performance Enhancement and the Implications for Policy, Society, and the Soldier Edited by H. Christian Breede, Stéphanie A.H. Bélanger, and Stéfanie von Hlatky

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Transhumanizing War Performance Enhancement and the Implications for Policy, Society, and the Soldier

Edited by

h . c h r i s t i a n b r eede, ­s t é p h a n i e   a . h . b éla n g er , a n d s t é fa n i e von hlatk y

McGill-­Queen’s University Press Montreal & Kingston • London • Chicago

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©  McGill-Queen’s University Press 2020 isbn isbn isbn isbn

978-0-7735-5947-9 (cloth) 978-0-7735-5948-6 (paper) 978-0-7735-5967-7 (ep df ) 978-0-7735-5968-4 (ep ub)

Legal deposit first quarter 2020 Bibliothèque nationale du Québec Printed in Canada on acid-free paper that is 100% ancient forest free (100% post-consumer recycled), processed chlorine free

We acknowledge the support of the Canada Council for the Arts. Nous remercions le Conseil des arts du Canada de son soutien.

Library and Archives Canada Cataloguing in Publication Title: Transhumanizing war: performance enhancement and the implications for policy, society, and the soldier / edited by H. Christian Breede, Stéphanie A.H. Bélanger, and Stéfanie Von Hlatky. Names: Breede, H. Christian, editor. | Bélanger, Stéphanie A.H., 1972– editor. | Von Hlatky, Stéfanie, 1982– editor. Series: Human dimensions in foreign policy, military studies, and security studies; 9. Description: Series statement: Human dimensions in foreign policy, military studies, and security studies; 9 | Includes bibliographical references and index. Identifiers: Canadiana (print) 2019022486X | Canadiana (ebook) 20190224878 | isb n 9780773559479 (cloth) | is bn 9780773559486 (paper) | isb n 9780773559677 (ep df ) | is bn 9780773559684 (ep u b ) Subjects: LC S H: Military art and science—Technological innovations. | LC SH: Military art and science—Technological innovations—Moral and ethical aspects. | L CS H: Soldiers—Effect of technological innovations on. | LC SH: Bioengineering—Moral and ethical aspects. Classification: L CC U 42.5 .T73 2019 | DDC 355/.07—dc23

This book was typeset by Marquis Interscript in 10.5/13 Sabon.

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Contents

Figures and Tables  vii Preface ix H. Christian Breede, Stéphanie A.H. Bélanger, and Stéfanie von Hlatky   1 Introduction: A Call to (Enhanced) Arms  3 Stéphanie A.H. Bélanger, H. Christian Breede, and Stéfanie von Hlatky G loba l P e rsp e c t i v e s o n E nhan ce m e n t   2 Mapping the Human Enhancement Literature  25 Keith K. Niall and Erica Wiseman   3 Forecasting Futures and Possible Implications: The German Experience 56 Annika Vergin   4 Perspectives on the Enhancement of Soldiers: A French Approach 74 Gérard de Boisboissel   5 Human Performance in the United States Army: Enhancing the Future Soldier  94 Farzana Nabi Easin g t he B ur de n   6 Rationalizing the Approach to Mitigate Soldier Physical Burden: Are Iron Man or Captain America the Magic Bullet?  119 Linda Bossi, David Tack, Allan Keefe, Thomas Karakolis, and Monica Jones

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vi Contents

  7 A Roadmap for Biomechanical Testing and Evaluation of Future Human Exoskeletons with Respect to Soldier Performance 152 Thomas Karakolis, Linda Bossi, and Allan Keefe   8 Enhancing Performance Starts with Learning 174 Vicki Woodside-Duggins and Randall Wakelam   9 The Road to Cognitive Optimization 198 David J. Bryant and Keith K. Niall Implic at i ons f o r P o l i cy a nd S o ci e t y 10 Insulating Soldiers from the Emotional Costs of War: An Ethical Analysis 221 Colin Farrelly 11 Bioethics and Soldier Bio-Enhancement 238 Maxwell J. Mehlman 12 Conclusion: The Road Ahead 255 Sara Greco Abbreviations 273 Contributors 277 Index 283

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Figures and Tables

figures

All photos and images are credited to the contributing authors unless otherwise indicated. 2.1 Canadian co-authorships (2005–15) in human systems ­performance, where the institutions share at least two co-publications 30 2.2 Clusters of Canadian institutions that have collaborated with non-Canadian institutions on H S P topics (2005–15) more than twice 34 3.1 Schematic of the principal methodical approach 66 4.1 Enhancement pyramid 87 6.1 Consensus on Canadian dismounted infantry loads, by ­dismounted infantry section role, for a typical Afghanistan mission 122 6.2 Summary of interventions for soldier burden mitigation using a systems approach 130 7.1 Schematic representation of a potential experimental design for functional movement evaluation 159 7.2 Schematic representation of a potential experimental design for operational task evaluation 161 8.1 Bloom’s cognitive domain (credit: Vanderbilt University Centre for Teaching) 178 8.2 Biggs’s figure of student orientation, teaching method, and level of engagement  182

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viii

Figures and Tables

8.3 Active learning continuum (Lord, et al., “The Effect of Different Active Learning Environments on Student Outcomes Related to Lifelong Learning,” 608) 187 ta b l e s

2a.1 Placement of sub-topics under the categories of human ­systems performance 46 3.1 Overview of analyzed h p e technologies 58 3.2 Overview about aspects and first assumptions of the military teams in the creative method part 67 5.1 Major considerations identified across structural trends 103 5.2 Soldier 2035–50 attributes across u q h p s groups 108 8.1 Ellström’s levels of learning as a function of the scope of action that exists with respect to different aspects of the work-learning environment 191 9.1 Cognitive optimization: Level of effect 210

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Preface

The human experience of war is rather static in that it is fundamentally a test of endurance and desperation as soldiers seek answers to three basic questions: where am I? Where are my friends? Where is the enemy? Then came the technological innovations, which helped in answering those questions with a higher degree of certainty. More often than not, as technological innovations were introduced to this process, the impact was felt on the lethal side of things: it became easier to kill. Indeed, killing has always been a major output of technological innovation. Nuclear weapons are still unparalleled in this regard. As we put the finishing touches on this volume, we are acutely aware that technological change continues to accelerate, speeding up the experience of combat. Moreover, this acceleration has also increased the burden upon the soldier. To be sure, the physical burden is ever present and continues despite the miniaturization of technology. Indeed, the tube-based radios of the 1950s and 1960s are the same weight as the latest tactical radio sets fielded today. However, the cognitive burden is increasing as well. Put simply, soldiers are being asked to process ever more information at a faster rate. This combination of increasing physical as well as cognitive burdens has shaped much of the literature on soldier enhancement in Western militaries and this volume presents some of the latest research on these issues. In short, while increases in lethality are certainly influenced by technological advances, the dramatic and indeed, more profound changes, are occurring on the input side of the proverbial equation. In order to capture this, we wanted to include the idea of transhumanism (which, as we detail in our introduction, has Canadian origins) as an overarching yet subtle theme running through this book.

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x Preface

Throughout human history, technology has been considered simply as a tool that we use, and one that progresses over time – getting more and more complex, and increasingly capable of doing things. But until now, there has been a hidden implication behind this; technology is an addendum, a peripheral that is easily added and – more to the point – removed when done. Rifles and ruck sacks can all be doffed and stored when not in use, but enhancement technology is now making it reasonable to consider the implications of deeper integration that will without a doubt increase capability to kill and carry. How does this change our sense of being and our humanity? We hope the following pages will add to a growing process of reflection on this topic that will ultimately lead to informed and responsible implementation that will at once increase the capability of our soldiers while not jeopardizing their humanity. Like most academic projects, this book has been in the works for years. Indeed, this volume represents the culmination of work that began as a series of workshops, public lectures, and policy briefs through a partnership between the Canadian Institute for Military and Veteran Health Research, Defence Research and Development Canada, and the Centre for International and Defence Policy as well as funding from the Department of National Defence’s Defence Engagement Program and the Social Sciences and Humanities Research Council. Beginning in the spring of 2014, the Centre for International and Defence Policy began looking towards future security challenges and arrived at the topic of soldier enhancement as the field was rather sparse in terms of work that was not either alarmist or excessively technical. Starting in the autumn of 2015, we began a series of workshops and the result of these workshops is the volume you are holding in your hands now. As with any major work, this was a collective effort; the people involved go beyond those whose names are on the cover and within the pages of this volume. First we would like to thank the staff at McGill-Queen’s University Press, and in particular our acquisition editor, Jacqueline Mason, who saw the potential in this work and shepherded it through production. We also wish to thank the reviewers whose invaluable input and genuinely helpful comments further strengthened this book. We likewise wish to thank the teams at the cidp and cimvhr, in particular Maureen Bartram, Stephen Ullstrom, Erin Porter, Stéphanie Christophe, and Brianne Whitecross. As well, our research assistants Tyler Legg, Bianca Dumais, and Jean-Simon

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Preface xi

Demers all provided invaluable support for copy-editing and indexing. Finally, we wish to thank our families – for they bear the brunt, as always, of our collective distraction as we worked through this project to bring this book into reality. We are and will always be grateful. H.C. Breede, S. Bélanger, S. von Hlatky Kingston 2019

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transhumanizing war

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1 Introduction: A Call to (Enhanced) Arms Stéphanie A.H. Bélanger, H. Christian Breede, and ­Stéfanie von Hlatky

Ranging from artificial intelligence to physical augmentation technologies, the topic of human performance enhancement has become decidedly widespread and prevalent in policy circles and the media.1 Yet recent discussions have focused somewhat narrowly on the latest gadgets and new technologies that seem inspired by science fiction and the development of superhuman abilities, both physical and cognitive.2 Increasingly, scholars are challenging those in the human performance space to embed technological breakthroughs in relevant social contexts.3 In the military, that is even more important as contemporary conflicts require our servicemen and women to have a range of skills, including the ability to adapt in unfamiliar social and cultural environments.4 To this end, we present a volume that will examine human performance enhancement through multiple lenses: the physical, cognitive, social, ethical, and emotional. Moreover, we have solicited contributions from experts in different scientific disciplines and different professional sectors to break free from any intellectual boundaries that might impair the policy debate on human performance enhancement.5 The approach taken in this volume is an attempt to put the “human” back in human performance enhancement. This human dimension of war can be quite elusive in conflict but is critical to success, even for the best equipped forces in the world.6 Moreover, when service members come home after participating in conflict in an “enhanced” physical or cognitive state, how will the post-deployment transition

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be affected in both the short and long-term? The ethical quagmire that underpins the application of human performance enhancement innovation is daunting but necessary for policymakers to consider. That, however, does not mean to say there are no low-hanging fruit. Indeed, there are areas in the human performance enhancement debate that are not as prone to controversy as exoskeletons and amphetamines. For instance, performance enhancements geared toward reducing the physical strains and burdens on operators tend to be perceived as net gains, if the platforms can demonstrate cost efficiency.7 With more women in the armed forces, there has been a push to adapt military uniforms to a broader range of body types to reduce injury and discomfort.8 Beyond the cost effectiveness of reducing the physical strains on operators, human performance enhancement can also mean overcoming physical limitations. In this case, we enter the realm of augmentation and consider technologies such as exoskeletons, automatic target detection, or assisted target engagement.9 We have structured the volume in three parts to reflect some of the key debates central to the topic of human performance enhancement in the military. The volume presents a comparative assessment of how human performance enhancement has been pursued in Western countries. The contributors also offer various examples of enhancements that have been designed to ease burdens on service members. And finally, the volume grapples with some key policy and societal challenges when it comes to implementing a human performance enhancement agenda. This introduction is meant to establish some of the conceptual and scholarly foundations for the chapters to come and will be comprised of five main sections: (1) a comprehensive literature review on the application of human performance enhancement in the military; (2) a discussion on the realm of the possible versus the realm of science fiction; (3) an assessment of current military needs and an overview of technological innovations that are currently being contemplated; (4) a primer on key ethical considerations; and (5) a detailed outline of the book. t h e l i t e r at u r e

The topic of soldier enhancement has been steadily gaining importance in international scientific literature as highlighted by Keith Niall and Erica Wiseman in chapter 2 of this book. Indeed, the research and development work on soldier enhancement has been global in scale. Led

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Introduction 5

by countries from around the globe, including France, Germany, South Korea, the United States, and the United Arab Emirates – to name only a few – and through domestic and international collaborative research, a vast and growing pool of knowledge has been created on the matter of human enhancements. This has been followed by an equally vast and growing pool of opinion as to the merits of these developments. Whether through research and advocacy groups like The Greenwall Foundation10 or e m b o Press,11 or in more academically oriented publications,12 and even through some works in defence and security magazines,13 the topic of soldier enhancement is slowly building momentum. However, the literature tends to be focused either upon the science and technology or on the ethics, and rarely does the discussion delve into the question of implementation. As we have written elsewhere,14 this literature is often either enamoured with the science15 or terrified of its implications16 – the middle ground is missing. More troublingly, there has been even less genuine policy discussion on this topic, despite calls for it from both professional17 and academic sources.18 In short, the gap is one of connection. The two sides of the debate – the ethical and the technological – need to inform each other rather than exist in proverbial “stove pipes” of debates that fail to engage with each other. By placing the technology alongside ethics, this volume forces the question beyond the “what if” and into the realm of “so what.” As Niall and Wiseman will discuss in chapter 2: “Mapping the Human Enhancement Literature,” the knowledge emerging from the researches can be grouped into four metagroups. Each covering sprawling fields of research, they are approaching notions of “automation and teleoperations,” “computation and cognition,” “physiology,” as well as the ever-important ethical questions and implications raised by the implementation of any technological improvement within a human sphere, not to mention within the human body. One of the most prevalent matters when it comes to the notion of human enhancement remains that of the invasiveness of some of the procedures the enhanced potentially have to undertake. As the literature delves into the multiple possibilities that modern and future technologies offer to improve the human body beyond its natural limitations,19 there are nonetheless personal physiological and psychological implications, as well as social and ethical aspects, that have to be accounted and planned for. Those are matters covered more

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particularly by Annika Vergin in chapter 3 and Farzana Nabi in chapter 5, in German and American contexts respectively. As research advances, it will expand on the current curriculum that has so far looked at a variety of potential improvements to implement on the soldier of tomorrow. From neurosurgeries to the use of haptic interfaces and augmented reality as operational and training tools, the already numerous options are ever increasing. But as David Bryant and Keith Niall propose in chapter 9, not all is a matter of adding elements onto or into the soldier to help it fight, but also a matter of training, learning, and intellectual flexibility.20 As the authors discuss, an efficient fighting force is not only better equipped, but also more knowledgeable and adaptable on and off the battlefield. from science fiction to reality

Examinations into the question of human performance enhancement often sound like they are right out of the pages of a science fiction story and in many ways, they are. The exoskeletons being developed and tested by companies such as Raytheon at the behest of the United States Military’s Defence Advanced Research Projects Agency (da r pa ) are reminiscent of the powered suits of Robert Heinlein’s 1959 classic Starship Troopers or Hiroshi Sakurazaka’s All You Need Is Kill from 2004 (made somewhat famous by the quirky 2014 film Edge of Tomorrow, which was based on the book). Marvel Comic’s Iron Man is perhaps the best-known exoskeleton from this genre, first appearing in a 1963 comic book and later made famous through a slew of blockbuster Hollywood movies. Similarly, the bioenhancements and invasive augmentation that are described in Part I of this book should be familiar ground to readers of Richard Morgan’s Black Man (from 2007), or Peter F. Hamilton’s Commonwealth Saga (comprised of several books written between 2004 and 2016). In Hamilton’s work, the plots feature humans augmented with implants that enable instant and seamless neural interaction with a vast information network and downloadable memories to be accessed later or even serve as “back-ups” to those whose physical bodies are destroyed. Morgan’s Black Man, about biologically enhanced former soldiers, explores the challenges of remaining human after enhancement. Again, Marvel Comics has touched on these themes as well, most famously with their Captain America, who appeared first in a

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Introduction 7

comic book in 1941 and then again several decades later, with a series of blockbuster Hollywood movies. Like all good science fiction, these examples take an idea like unfettered, personal access to information or biological enhancements that make one orders of magnitude stronger than an Olympic athlete and then follow the “what if” with a “so what”? What are the implications for soldiers who are enhanced when they are no longer needed? What are the implications for universal and instantaneous access to information when that access is suddenly disrupted? Good science fiction goes there and so too does this book. As it will be demonstrated in the following chapters, the idea of soldier enhancement is not just the purview of science fiction any longer. Soldier enhancement is quickly becoming fact and these are facts that have not just technological implications, but also implications for society. How will these new applications change how military force is developed, generated, and employed? What broader implications do these new technologies have on society? While the examples from science fiction are largely still just that – fiction, the pace of development is increasing. The advances and concomitant change witnessed over the last several decades will be replicated in the coming years. Moore’s law – named after Gordon Moore who co-founded Intel in 1965 and proposed this law – states that the number of transistors per square inch will double every two years. This law, which has largely held true over the ensuing decades, is the fundamental example of the accelerating pace of change in technology. The implications, from hand-held processing power that only fifty years ago took an entire warehouse worth of vacuum tubes to complete, to continuing advances in machine learning and ever-increasingly complex (and useful) algorithms, are truly staggering and in need of holistic attention. This call for attention – indeed scrutiny – upon the social implications of accelerating advances in technology is not new. As an example, Francis Fukuyama argued in 2004 that these advances threaten fundamental assumptions about human equality.21 So much so, argued Fukuyama, that what it means to be human – with flaws that are as much problematic as they are a source of what makes life a beautiful thing – could be changed. These changes are being made today – not in the future – but in incremental ways for which the consequences may not be fully appreciated by either researchers or policymakers.22 Referred to as transhumanism, the term evokes images of bodymodification, bio-hacking, and other ideas that are familiar ground

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to readers of science fiction. As Niall and Wiseman briefly indicate in the next chapter of this book – transhumanism is a small (but growing)23 movement arguing that it is perfectly appropriate to accelerate or control what has previously been a long and chaotic process of human evolution. Indeed, transhumanists argue that people need not be constrained by their biology. The concept is seductive in its promise but becomes problematic in practice. For example, it is seductive to consider the eradication of disease from human experience, but this is also based upon two problematic assumptions. First, an ability to control the variation that makes people individual (like eye or hair colour). To this end, does perfection not lose meaning if all can attain it? A scene in the iconic 1990s science fiction film The Matrix quickly reflects this challenge, when the hero Neo is told of earlier failed attempts at creating the simulation from which the movie takes its name. The simulation of a utopian, “perfect” world was quickly rejected as inauthentic by those whom it was supposed to convince. A more stable simulation was one that was imperfect, rife with crime, poverty, and inequality. A second assumption is that we can fully understand the implications of such minute and precise changes. Consider here the furor surrounding the c r i s p r edits conducted by He Jainkui in 2018. While issues of consent dominated the initial discussion, a 2019 report revelated that these same edits designed to build-in immunity to hiv, also may shorten the lifespan of the person by almost two years.24 Peter Harrsion and Joseph Wolyniak have argued that transhumanism – as a term – is in fact of Canadian origin. Harrison and Wolyniak credit W.D. Lighthall, a Canadian historian and legal scholar,25 with first coining the term. We believe this same term captures what the science and technology of personal enhancement has the potential to do to conflict – it will transhumanize it. technological possibilities

Looking into what is or could be possible in terms of enhancement implementation for the fighting forces of tomorrow, the first focus needs to be put onto what is already achieved by the soldiers of today. Either through the ability to carry heavier loads, as Vergin discusses in chapter 3, or the capacity to monitor the vitals of allied forces to detect any potential loss of inefficiency on the battlefield, a matter

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Introduction 9

approached by Gérard de Boisboissel in chapter 4, the possibilities are numerous and varied in nature. What will have a real impact on the possibilities of such technological developments are the will of countries to implement these types of measures within their armed forces. While monetary costs are a concern, there is also the ever-important question of how invasive the process is. Are military forces willing to put their soldiers through invasive and perhaps irreversible procedures in order to enhance their combat capability? As there are ways to enhance the soldier simply through better nutrition,26 a matter mentioned in chapter 3, military forces will have a wide variety of choices regarding how to enhance their troops, and at what cost. The technological possibilities could also potentially change the way soldier recruiting is done, as the enhancement potential of a candidate could impact its suitability for its integration within a fighting force. De Boisboissel also proposes that not all enhancements need to be integrated or added to a soldier’s personal equipment and training, but that the integration of advanced machines is an avenue worth exploring as a way to supplement or even replace the ground troops for specific duties.27 In the end, the possibilities for the enhancement of soldiers are quasi-limitless when taking into consideration the various combination of specific enhancements that can be implemented at the same time. Other than the costs, as well as the invasiveness and efficiency of the procedures, the only thing to limit the possible implementations of technologies designed to make a soldier better, faster, stronger, and more efficient, is how to synchronize particular enhancements with one another without them becoming detrimental to the enhanced individuals. m i l i ta r y n e e d s

The need for improved soldiers is, for military forces, related to one particular metric highlighted by de Boisboissel in this book: an increase in efficiency. This means an increased capability to decisively impose themselves against any enemy force on any battlefield. The implementation of enhancements, while desirable, nonetheless require the inclusion of new training protocols in order to ensure the optimal use of the increased capabilities of soldiers. Therefore, military forces first

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and foremost need to put in place enhancement-specific training. But beyond this, there are specific capabilities that armed forces need improved within their ranks. Some of the most important needs for soldiers are to be able to carry a vast amount of protective equipment, weapons platforms, and sustainability sources in order to fight efficiently over various periods of time. The physiological and psychological toll of carrying such loads over lengthier periods of time has various impacts on the performance of troops on and off the battlefield.28 This is one of the needs that soldier enhancement can answer more readily. By reducing the impact of loads on soldiers, there can be an increased efficiency in conducting daily operations. But this quest for efficiency requires more than simply lessening the physical burden that soldiers have to carry in order to fight. Military troops must be cognitively adept at dealing with a wideranging array of situations in a timely fashion – and oftentimes with little to no advance warning. Human enhancement programs can answer the military forces’ need for intellectually flexible soldiers through various means (highlighted in Randy Wakelam and Vicki Woodside-Duggins’ contribution in chapter 8, and in Bryant and Niall’s chapter 9 of this book). Whether it be through new training protocols, pharmacological solutions, neurotechnological improvements, or genetic modification, there are again multiple solutions to potentially choose from that can answer the armed forces’ needs for an intellectually enhanced fighting force able to adapt on both tactical and strategical levels. While the importance of battlefield efficiency is without a doubt fundamental, there are other aspects in relation to dealing with enhanced troops that also require attention from the military forces. Enhancements will be able to be purchased by opposing forces. This creates the need to be able to diagnose the enhancements used by enemy forces, a topic that chapter 3 covers more in depth. Not only is it a concern to know how to fight a force of enhanced soldiers, but as Farzana Nabi notes in chapter 5, it is also essential for the military to consider how to ensure that their soldiers can fight when their enhancements face bugs or fail. Enhancing soldiers must not come at the price of an increased dependence upon the newfound abilities, but instead must supplement an already adept and adaptable fighter. Finally, of all military needs, the issue of medical care for enhanced soldiers is of the utmost importance. There will be an important

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Introduction 11

need for procedures to care for the wounded enhanced, as well as how to integrate them with non-enhanced troops and civilian populations. These are all questions discussed across the different chapters of this volume. e t h i c a l c o n s i d e r at i o n s

The realm of what is possible keeps expanding at an impressive pace, which begs the question of what the military’s most pressing needs and challenges are. In other words, just because a particular innovation is made available, it does not necessarily mean it is really needed or desirable.29 How can armed forces best advance military performance to maintain a competitive advantage, while not losing sight of the ethical, social, and policy implications? This volume makes the case for thinking holistically about the enhancement of performance. The ethical debate starts with the question: how far is too far? This section is meant as a primer to assist in the task of moral due diligence when it comes to human performance enhancement (h p e ) in the military. To be sure, the point is not to halt the development of innovative technologies that can improve capabilities or force protection, but to engage in critical analysis to pre-empt any counterproductive effects.30 While it is important for the military to have all the tools at their disposal and the most complete skillset for the battlefield, human performance enhancement cannot be narrowly operationally driven. As previously mentioned, service members eventually transition back to society and we must make sure that the military does not push the boundaries so far as to create too wide a gap between the armed forces and the population they serve.31 The ethical debates introduced in this section focus on both conceptual and policy issues. The aim is to provide some contextual background to the ethical considerations that underpin h p e . This discussion is deliberately general in scope, introducing some themes that are common to the vibrant literature on this topic.32 The literature crosses multiple boundaries by identifying the various ethical categories to consider such as safety, fairness, the connection to society, and dignity.33 When strictly thinking about enhancing military tasks, one can think of the benefits of hpe innovation, such as reducing physical and cognitive stressors,34 improving force protection35 and increasing lethality.36 However, for all of the benefits that are associated with h p e technologies, there are also trade-offs. What is more, these

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trade-offs are not always apparent in the short term. For example, some of the health effects are probabilistic or might only take a toll over the long-term, making it hard to truly understand the nature of those risks before an entire generation of soldiers has experimented with the technology. While service members have signed up for “unlimited liability” in the context of their professional commitment,37 governments and military leaders still have to establish some boundaries when it comes to defining acceptable risk. Another key theme that runs across the literature is the extent to which the ethical questions for the military are distinct from those that should be considered for civilians, as pointed out by Mehlman in his chapter. Various authors have proposed dimensions or criteria for assessing the merits and drawbacks of particular hpe technologies in the military domain.38 What is perhaps common to both the civilian and the military world, however, is that despite different applications, informed consent should be a guiding concept.39 Although the military and policymakers currently strive towards the progressive development of h p e capabilities,40 their potential consequences on service members, civilians, and societies at large should still be carefully measured. The ethical terrain becomes even more complex when we consider enhancing lethality, a core task of any armed forces. On this topic, ethicists express concern over the humanity of the warfighter.41 By increasing lethality through h p e technologies, is there a risk that operators will be de-sensitized to the consequences of using increasingly lethal force as their own exposure to risk is concurrently reduced? On the other end of the spectrum, enhancement can also be pro-social, meaning that they can be geared toward greater emotional or spiritual resilience.42 Finally, some ethical issues are raised about the access to hpe technologies. It is unrealistic to expect that within the military or outside of the military, everyone will have the same access to human performance enhancement aids. This brings up the question of fairness and potential friction between the proverbial h p e “haves” and “have-nots.”43 To end this section on ethical considerations, we would like to propose approaching h p e by looking at two categories of enhancements: invasive and non-invasive.44 It is our contention that the ethical questions are distinct. For invasive enhancement, the effects are potentially long-lasting and the immediate physical and cognitive disruptions can be severe. By contrast, non-invasive h p e are more benign

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and one can easily opt in and out of the benefits. In a nutshell, the ramifications are much clearer, which makes the task of “informed consent” a lot simpler to manage. chapter summaries

In the first part of the volume, we introduce four national perspectives on human performance enhancement, drawing from the experience of Canada, Germany, France, and the United States. Niall and Wiseman first offer a mapping exercise of the literature on human enhancement in a Canadian context. In doing so, they highlight the conceptual diversity involved in defence research on augmentation, enhancement, automation, and human-system interaction, which leads them to propose a typology comprised of four domains of inquiry: cognitive, physiological, automation, robotics, and telepresence, as well as ethics. For the German perspective, Vergin takes us in the realm of forecasting futures, which is central for defence planning. Through this exercise, the discussion focuses on the anticipation of military challenges and threats related to human performance enhancement. The study offers a cost-benefit analysis and war gaming of h p e technologies to assess their overall potential and usability by both allies and adversaries. Vergin identifies detection techniques as a particular area of improvement for the Bundeswehr, as well as the need to adapt training to the new realities of h p e . In the end, the recommendation is for slow-slope military innovation focused on force protection. The chapter on France, written by de Boisboissel, contrasts with the first two by posing the trade-off between the increased technology of systems and the warfighter’s cognitive abilities. Will operators be cognitively overloaded in the hpe era? The chapter is organized in a very logical and evocative way: comparing performance needs with corresponding technological solutions with the goal of maintaining tactical superiority on the battlefield. Finally, in the US chapter Farzana Nabi echoes some of the insights from Vergin’s chapter, with a focus on Unified Quest, the Chief of Staff of the Army’s Title 10 future study plan. The methodology of the exercise is quite different, as hpe is just one of many facets included in the Unified Quest design. Through this exercise, the US Army is challenged to examine the cognitive, physical, leadership, and social abilities needed by the soldier, with special attention to how human performance plays a part in each of those dimensions.

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With this overview of national perspectives at the front end, Part II delves deeper into some of the operational challenges faced by service members on the battlefield. To examine various ways of “easing the burden,” the authors each focus on distinct burdens soldiers face. Linda Bossi and her colleagues focus on heavy loads, noting that soldiers routinely carry their own body weight in gear, which makes them prone to injury. What is more, this physical stressor can also impact the soldier’s cognitive abilities. Sharing research from the Canadian Department of National Defence, Bossi et al. measures how different types of equipment fare across a series of operational tasks “in order to model integrated survivability.” Interestingly, she notes that, while emerging technologies can mitigate those burdens, their level of technological readiness is still lagging. To be useful to the soldier, these technologies have to be reliable and, in many cases, the science is just not there yet. The work by Thomas Karakolis and his colleagues complements Bossi et al.’s opening chapter by focusing on exoskeletons specifically. Exoskeletons are designed to take on some of a soldier’s load burden. Here too, trade-offs are involved. While exoskeletons can reduce the burden of heavy loads on individual soldiers, they can also reduce their agility. Karakolis et al. also find that exoskeletons can even present some level of physical risk, in that otherwise healthy human joints can potentially be strained or injured by using these devices. Karakolis et al. thus proposes a framework for assessing the benefits and drawbacks of exoskeleton technologies in order to support sound decision-making when considering the adoption of this type of equipment. Turning to the cognitive domain, Randy Wakelam and Vicki Woodside-Duggins focus on intellectual enhancement. They introduce the concept of cognitive flexibility as the optimal approach for service members who must operate in complex and unpredictable combat environments. One of the methods for achieving cognitive flexibility is active learning, which implies changing the ways that professional military education and training curriculum are currently designed. While the authors acknowledge that resistance to such change is to be anticipated, they propose a path to implementing a learning strategy adapted to the enhancement of performance. Although this chapter leans towards the optimization end of the optimization-enhancement distinction, it is included here to further demonstrate the varied opinions on what really constitutes soldier enhancement. It is but one example and there are surely others. Building on this chapter by

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Wakelam and Woodside-Duggins, David Bryant and Keith Niall delve deeper into the cognitive realm, proposing that we study the concept through the lenses of cognitive enhancement, cognitive augmentation, and cognitive support. Through this categorization, the authors engage in a critical discussion that is decidedly policy focused and meant to inform the future directions of the Canadian Armed Forces. The third and final part of the volume investigates some of the societal and ethical dilemmas involved with the pursuit of human performance enhancement in the military. Colin Farrelly kicks off the discussion by identifying the emotional costs of war as a facet that should inform the ethical assessment of h p e . Farrelly problematizes the feasibility and desirability of enhancing what he refers to as the “psychological immune system.” In layman’s terms, he grapples with the ethics of reducing the emotional cost of war. While certain pharmaceuticals claim to improve soldiers’ resilience during or after the potentially scarring experiences of war, Farrelly notes that removing this stressor can strip the soldier of their authentic battlefield experience, or worse, make humans more machine-like in how they deal with emotionally difficult situations. Borrowing from the field of bioethics, Farrelly introduces an evaluative analytical framework to make sense of the complexities of enhancement choices that bear on military personnel and their lives. Moreover, Farrelly makes clear that perhaps even enhancement is natural too. Extending the discussion on bioethics, Maxwell J. Mehlman’s chapter describes the different types of biomedical enhancements available and how they differ from other types of performance enhancing innovations. Mehlman then discusses current and future possibilities in the field of biomedical enhancement, which can help operators with sleep deprivation, cognitive overload, and metabolic underperformance while on deployment. Mehlman then grapples with the question of whether some of the objections raised in the civilian world over performance applies to the military. He argues that certain bioethical concerns are indeed unique to service members, therefore unique guidelines should be developed to inform military decision-making. The conclusion by Sara Greco ties all chapters together and proposes to summarize the key findings and themes of the volume. She also identifies the range of policy implications, for Canada and its Western allies, that could inform governments and their militaries in the near future. What is apparent from her discussion is that decision-makers and policymakers have been insufficient thus far in identifying a clear

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course of action for the adoption of emerging technologies to enhance military performance. conclusion

Research into performance enhancement invariably invokes disturbing images and troubling implications. The world of sports – professional and amateur alike – is rife with stories of athletes stripped of titles and accolades for having been found cheating by enhancing performance through increasingly sophisticated means. These sentiments are hard to shed when the object of enhancement shifts from athletes to soldiers. However, unlike sports, military conflict need not – and should not – be a proverbial “fair fight.” Quite simply, in war the costs are too high. The fundamental difference between sports and war is the idea of unlimited liability. Put briefly, soldiers are – unlike athletes – required to potentially die as part of their job; there is no limit to the liability that individual soldiers are asked to assume as part of their employment. This fundamental difference underpins the research presented in this book and the central assumption of our argument, which is that we need to explore soldier enhancement in terms of not just its costs, but also the potential benefits of those costs. In other words, we cannot eschew enhancement on ethical grounds alone. Rather, an implementation framework is needed that strikes the right balance between enhanced capability while still retaining soldiers’ humanity. Our team, whose individual research and findings are presented in this volume, broadly agree that the science and technology, whether developed explicitly for enhancement purposes or as a result of the dual-use of rehabilitation, has advanced to the point that this is an issue that needs to be addressed now. Indeed, as Michaud-Shields has argued elsewhere, society is quickly reaching the inflection point where the cost of augmentation technologies will decline enough that individual adoption rates will begin to increase rapidly. More to the point, this future is near enough to be well within the historical procurement duration of military equipment.45 For the purposes of this volume, we adopt a dual-pronged framework within which to at once assess the state of the research as well as to propose some meaningful policy options regarding soldier enhancement. First, we – in line with the work of Karl Friedl – distinguish between optimization and enhancement. The distinction between

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optimization and enhancement is an important one as the idea of evidence-based policy towards improving soldier performance is by no means a new topic. From improved fitness regimes to a recent focus on nutrition and mindfulness, militaries around the world have implemented many initiatives to optimize individual soldier performance. Although important, this is not the focus of this volume. Rather, the contributors to this volume are examining the technology and implications of efforts to enhance soldier performance beyond the limit of natural human performance. The debate about what “natural” means, however, is unsettled – as the chapters by Wakelam and WoodsideDuggins and by Farrelly both demonstrate. Regardless, we have allowed – and indeed encouraged – our team to deviate from this proposed definition as they saw fit. In all cases, such deviation is done consciously and with some interesting consequences and conclusions. Second, we further distinguish invasive forms of enhancement from non-invasive forms.46 Here, in line with the same distinction drawn by Michaud-Shields, invasive enhancements are those that generally are not reversible. This distinction is best illustrated by again returning to science fiction as the costs of these two forms of enhancement are quite varied. Two of the late Stan Lee’s now-iconic superheroes – Captain America and Iron Man – encapsulate the distinction quite nicely. Both Captain America and Iron Man enjoy enhanced capabilities, but when the battles are over and the proverbial “bad guys” are vanquished, Iron Man can remove his suit and simply be Tony Stark. Captain America will always be Captain America, even when he removes his mask and reveals his original identity of Steve Rogers. The opening scene in Marvel Studio’s 2014 Captain America: The Winter Soldier presents this challenge clearly. Steve Rogers, even while enjoying a light jog around the Washington Mall, is still the superhuman Captain America. Tony Stark, although a billionaire-playboyphilanthropist, is in fact a rather normal human being. The invasive or non-invasive distinction is clearly important and the ethical as well as operational implications differ accordingly. Coupled with the emphasis on enhancement – rather than optimization – this volume’s framework becomes clear. Each chapter in this book presents their research in line with these distinctions and the policy implications, which are made clear in the concluding chapter to this volume and demonstrates the costs and benefits associated with each. This book indeed fills a gap in the limited extant literature on the topic of soldier enhancement. Through this introductory chapter, we

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have demonstrated that not only is soldier enhancement likely, it is already happening and more problematically, implementation policy has yet to catch up. By catch up, we argue that although much has been written on the proverbial “what if,” comparatively little systematic thought has been put to the question of “so what.” As we will argue in the following chapters, not only is the technology now a reality, but the emphasis needs to be placed on how both cognitive and physical burdens can be eased for the soldier in a manner that does not further strain the connection between the soldier and their society.

notes

  1 David Pugliese, “Canadian Troops to Test Bionic Knee Brace to Boost Strength, Endurance,” National Post, 11 July 2016 (accessed 17 July 2017), http://nationalpost.com/news/canada/canadian-troops-to-test-bionic-kneebrace-to-boost-strength-endurance/wcm/133b065a-c45d-4070-8f9e8848ffd18a14; “Soldier System 2030,” National Defence and the Canadian Armed Forces, 12 March 2015 (accessed 17 July 2017), http:// www.forces.gc.ca/en/business-defence-acquisition-guide-2015/land-­ systems-332.page; Lockheed Martin, “U.S. Navy To Test and Evaluate Lockheed Martin Industrial Exoskeletons,” News release, 18 August 2015 (accessed 17 July 2017), http://www.lockheedmartin.com/us/news/pressreleases/2014/august/mfc-081814-US-Navy-To-Test-And-Evaluate.html; Knapton, Sarah. “British Military Interested in ‘Iron Man’ Flying Suit,” Telegraph, 28 April 2017 (accessed 17 July 2017), http://www.telegraph. co.uk/science/2017/04/28/british-military-interested-iron-man-flying-suit/.   2 Daniel Bertrand, “Implementation of the Soldier Systems Technology Roadmap: Two Years Down the Road,” Canadian Textile Journal 130, no. 4 (October 2013): 38–44.   3 Stéfanie von Hlatky and H. Christian Breede, “Putting the Human Back in Human Performance Enhancement,” Vanguard (May 2017): 20–1.   4 Palmer, Pete, BG (Ret). “Getting to a Good Enough Cognitive Shoe Size – an Operator’s Perspective.” Paper presented at the International Conference on Applied Human Factors and Ergonomics, Las Vegas, July 2015.   5 The contributors for this volume, as well as others from the military, government, academia, civil society, private sector, and the not-for-profit sector, participated in the 2017 Conference on International Security. This annual conference, held in Kingston, Ontario, at the Marriott Residence

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Inn from 12 to 14 June 2017, was titled “Developing the Super Soldier: Enhancing Military Performance.” For more information, visit http://www. queensu.ca/kcis/home.   6 United States Army Combined Arms Center, The Human Dimension White Paper: A Framework for Optimizing Human Performance (October 2014): 1–24.   7 Kaitlin Kelly, “Marine Corps Systems Command Awards Contract to Produce Enhanced Combat Helmet,” Marine Corps Systems Command, 9 June 2017 (accessed 17 July 2017), http://www.­marcorsyscom.marines. mil/News/Press-Release-Article-Display/Article/1208930/marine-corpssystems-command-awards-contract-to-produce-­enhanced-combat-helmet/.  8 J D Leipold, “Women Soldiers to Test Female-Specific Body Armor,” U.S. Army, 19 July 2012 (accessed 17 July 2017), https://www.army.mil/­ article/83986/women_soldiers_to_test_female_specific_body___.   9 Mike Tombu, “Enhancing Small Arms Target Engagement” (presentation, Defence Research and Development Canada, Kingston Conference on International Security, Kingston on , 13 June 2017). 10 Patrick Lin, Maxwell J. Mehlman, and Keith Abney, “Enhanced Warfighters: Risk, Ethics, and Policy,” The Greenwall Foundation (2013). 11 Cynthia Forlini, Wayne Hall, Bruce Maxwell, Simon M. Outram, Peter B. Reiner, Demitris Repantis, Maartje Schermer, and Eric Racine, “Navigating the Enhancement Landscape: Ethical Issues in Research on Cognitive Enhancers for Healthy Individuals,” embo Reports 14, no. 2 (2013): 123–7. 12 Jai Galliott and Mianna Lotz, eds, Supersoldiers: The Ethical, Legal, and Social Implications (London: Routledge, 2015); Thomas Douglas, “Human Enhancement and Supra-Personal Moral Status,” Philosophy Study, no. 162 (2013): 473–97. 13 von Hlatky and Breede, 2017. 14 Ibid. 15 Jason Gibson, James McKee, Gregory Freihofer, Seetha Raghaven, and Jihua Guo, “Enhancement in Ballistic Performance Composite Hard Armor through Carbon Nanotubes,” International Journal of Smart and Nano Materials 4, no. 4 (January 2014): 212–28; and Daniel Bertrand, “Implementation of the Soldier Systems Technology Roadmap: Two Years Down the Road,” Canadian Textile Journal 130, no. 4 (2013): 38–44; Kimberly Urban and Wen-Juo Gao, “Performance Enhancement at the Cost of Potential Brain Plasticity: Neural Ramifications of Nootropic in the Healthy Developing Brain,” Frontiers in Systems Neuroscience, no. 8 (May 2014): 1–10; Irene Tracy and Rod Flower, “The Warrior in the

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Machine: Neuroscience Goes to War,” Nature Reviews Neuroscience, (2012): 1–10; and Albaka and Okafor. 16 Jonathan Pugh, Guy Kahane, and Julian Savulescu, “Cohen’s Conservatism and Human Enhancement,” Journal of Ethics 17 (2013): 331–54.; Thomas Douglas, “Human Enhancement and Supra-Personal Moral Status,” Philosophy Study, no. 162 (2013): 473–97; Michael Gross, “Military Medical Ethics: A Review of the Literature and a Call to Arms,” Cambridge Quarterly of Healthcare Ethics 22, no. 1 (January 2013): 92–109; Cynthia Forlini, Wayne Hall, Bruce Maxwell, Simon M. Outram, Peter B. Reiner, Demitris Repantis, Maartje Schermer, and Eric Racine, “Navigating the Enhancement Landscape: Ethical Issues in Research on Cognitive Enhancers for Healthy Individuals,” EMBO Reports 14, no. 2 (2013): 123–7; and Kate Fox, “Ethical Considerations for Engineers Working in Cybernetic Implants,” Unpublished Manuscript, 2013. 17 Max Michaud-Shields, “Personal Augmentation – The Ethics and Operational Considerations of Personal Augmentation in Military Operations,” Canadian Military Journal 15, no. 1 (Winter 2014). 18 Allenby, 57. 19 Bateman, Simone, and Gayon, Jean, “L’amélioration humaine – Trois usages, trois enjeux. Human Enhancement: Three uses, Three issues,” Médecine sciences: M/S 28, no. 10 (October 2012): 887–91. 20 Howard Coombs and Randall Wakelam, The Report of the Officer Development Board: Maj-Gen Rowley and the Education of the Canadian Forces (Report, Laurier Centre for Military, Strategic and Disarmament Studies, l c m s ds Press, 2010). 21 Francis Fukuyama, “Transhumanism,” Foreign Policy, no. 144 (Sept–Oct 2004): 42. 22 Ibid., 43. 23 Moore, 1990; Al-Rodan, 2011. 24 Wei, Xinzhu, and Rasumus Nielsen, “CCR 5-d32 Is Deleterious in the Homozygous State in Humans,” Nature Medicine (3 June 2019). 25 Harrison and Wolyniak, 2015. 26 Brian Markle, Elizabeth May, and Adhip Majumdar, “Do Nutraceutics Play a Role in the Prevention and Treatment of Colorectal Cancer?,” Cancer Metastasis Reviews 29 (Aug 2010): 395–404. 27 Gérard de Boisboissel, Didier Danet, and Jean-Paul Hanon, eds, La guerre robotisée (Paris: Économica, 2012). 28 Joseph Knapik and Katy Reynolds, “Load Carriage in Military Operations: A Review of Historical, Physiological, Biomechanical, and Medical Aspects,” in Military Quantitative Physiology: Problems and

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Concepts in Military Operational Medicine, ed. Karl Friedl and William Santee (Fort Detrick, Maryland: Borden Institute, 2012), 303–37. 29 Major Cameron Leckie, “Lasers or Longbows? A Paradox of Military Technology,” Australian Defence Force Journal 182 (August 2010): 44–56. 30 For instance, see: Peter Asaro, “On Banning Autonomous Weapon Systems: Human Rights, Automation, and the Dehumanization of Lethal Decision-Making,” International Review of the Red Cross 94, no. 886 (Summer 2012): 687–709; Kimberley Urban and Wen-Juo Gao, “Performance Enhancement at the Cost of Potential Brain Plasticity: Neural Ramifications of Nootropic in the Healthy Developing Brain,” Frontiers in Systems Neuroscience 8 (May 2014): 1–10. 31 Helen Brunger, Jonathan Serrato, and Jane Ogden. “‘No Mans Land’: The Transition to Civilian Life,” Journal of Aggression, Conflict and Peace Research 5, no. 2 (Apr 2013): 86-100. 32 Patrick Lin, Maxwell J. Mehlman, and Keith Abney, “Enhanced Warfighters: Risk, Ethics, and Policy,” The Greenwell Foundation (2013); Cynthia, Forlini Wayne Hall, Bruce Maxwell, Simon M. Outram, Peter B. Reiner, Demitris Repantis, Maartje Schermer, and Eric Racine, “Navigating the Enhancement Landscape: Ethical Issues in Research on Cognitive Enhancers for Healthy Individuals,” embo Reports 14, no. 2 (2013): 123–7; Jai Galliott and Mianna Lotz, eds, Supersoldiers: The Ethical, Legal, and Social Implications (London: Routledge, 2015); Thomas Douglas, “Human Enhancement and Supra-Personal Moral Status,” Philosophy Study, no. 162 (2013): 473–97. 33 Tony Pfaff, “Risk, Military Ethics and Irregular Warfare,” Foreign Policy Research Institute (December 2011): 1–8. 34 Alison Howell, “Neuroscience and War: Human Enhancement, Soldier Rehabilitation, and the Ethical Limits of Dual-Use Frameworks,” Millennium: Journal of International Studies 45, no. 2 (2017): 133–50. 35 Gibson, McKee, Freihofer, Raghaven, and Guo, “Enhancement in Ballistic Performance 212–28; John G. Casali, Williama Ahroon, and Jeffa Lancaster. “A Field Investigation of Hearing Protection and Hearing Enhancement in One Device: For Soldiers Whose Ears and Lives Depend Upon It,” Noise and Health 11, no. 42 (2009): 69–90. 36 Michael C. Horowitz, “Coming Next in Military Tech,” Bulletin of Atomic Scientists 70, no. 1 (January 2014): 54–62. 37 Patrick Mileham, “Unlimited Liability and the Military Covenant,” Journal of Military Ethics 9, no. 1 (March 2010): 23–40. 38 Richard Edmund Ashcroft, “Regulating Biomedical Enhancements in the Military,” American Journal of Bioethics 8, no. 2 (February 2008): 47–9;

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Kenneth Ford and Clark Glymour, “The Enhanced Warfighter,” Bulletin of Atomic Scientists 70, no. 1 (2014): 1–11; Jack P. Landoldt, “Human Research Ethics Considerations: A Precursor for Ethically Implementing Advanced Technologies into n ato Military Operations,” Canadian Military Journal 11, no. 3 (Summer 2011): 14–21. 39 Tony Pfaff, Resolving Ethical Challenges in an Era of Persistent Conflict, Professional Military Ethics Monograph Series (U.S. Army War College, Strategic Studies Institute, vol. 3, April 2011). 40 See notes 1 and 2. 41 See Colin Farrelly in the third part of this volume; Robert Sparrow, “Martial and Moral Courage in Teleoperated Warfare: A Commentary on Kirkpatrick,” Journal of Military Ethics 14, nos. 3–4 (2015): 220–7; Jesse Kirkpatrick, “Reply to Sparrow: Martial Courage – or Merely Courage?,” Journal of Military Ethics 14, nos. 3–4 (2015): 228–31. 42 Alison Howell, “Resilience, War, and Austerity: The Ethics of Military Human Enhancement and the Politics of Data,” Security Dialogue 46, no. 1 (2015): 15–31. 43 Michaud-Shields, “Personal Augmentation”, 24–33. 44 Stéfanie von Hlatky, H. Christian Breede, and Sara Greco, The Future of the Canadian Soldier and Enhancement of Human Performance (report, Centre for International and Defence Policy, Queen’s University, 2016); von Hlatky and Breede, “Putting the Human Back in Human Performance Enhancement,” 20–1. 45 Michaud-Shields, “Personal Augmentation,” 31. 46 Karl E. Friedl, “Overview of the HFM -181 Symposium Programme: Medical Technology Repurposed to Enhance Human Performance” (R TO Human Factors and Medicine Symposium, Sofia, Bulgaria, 5–7 October); and Michaud-Shields, “Personal Augmentation,” 27.

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global perspectives on enhancement

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2 Mapping the Human Enhancement Literature Keith K. Niall and Erica Wiseman “Ces entités posthumaines n’existent pas encore réellement et n’existeront peut-être jamais; elles ne demandent aucune reconnaissance ontologique, éthique, ou politique, de la part de ceux qui, à l’époque présente, imaginent leur existence dans l’avenir. C’est toujours l’être humain actuel qui prête à l’être posthumain virtuel une demande de reconnaissance tout aussi virtuelle.”1

The area of human systems performance (or h s p ) is not an academic discipline, in the sense that it cannot yet be found as a department in most universities, nor is it likely to be advertised as an area of concentration for undergraduate studies. But neither is the area of human systems performance just an unsorted collection of new topics for research. In the present chapter we seek to categorize the state of Canadian research on human enhancement at a point in time, by reporting the results of bibliometric studies on human system performance. Two scientometric studies of h s p were commissioned by the Chief Scientist network of Defence Research and Development Canada (d r d c ), a part of the Canadian Department of National Defence (dnd ). The topic has been of interest to d rd c for some time,2 as it has been of interest to the Canadian Army Land Warfare Centre.3 The Chief Scientists have a particular interest in the topic. They identified the collective area of human systems performance as of prime importance, especially in light of Canadian Army concerns (called the Army’s “hard problems”). They see the importance of human systems performance as an emerging field: that is, not for its application in one or two years, but for its application in ten or

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twenty years and beyond. This falls short of a Delphic prediction by the chief scientists; it is more their notice of a significant and relevant trend.4 There appear to be some reasonable divisions or categories within this topic: that is, there seem to be four metagroups. These categories help us understand and circumscribe research in the area of human systems performance for the purposes of the present scientometric overview. They are: automation and teleoperations, computation and cognition, physiology, and ethics. Automation and teleoperations is the area of human systems performance that explores the uses of robots, automated platforms, and teleoperations to enhance human capabilities. Such devices enable human operators to sense and act at indefinite distances. Those systems may be – but are not always – zoomorphic (resembling animals) or anthropomorphic (resembling humans). Computation and cognition as a human performance issue approaches cognitive enhancement as a computational issue, through technological support. These methods include such computational aids as enhanced tools for mapping and localization, logic engines, or computation through social networking. The physiological aspects of human systems performance concern performance enhancement by the induction of physiological changes through exercise, feedback, drugs, or the modification of human tissue as in genetic engineering. Here human enhancement is conceived as a striving for diverse ideals of human potential; this stretches the definition of the first chapter, which invoked the “deliberate increase of human potential beyond that which is achievable naturally.” Ethical concerns relative to human systems performance may expand our range of concepts to tools, ideas, and applications that have been imagined or promised – and the conversation on ethics seems weighted towards the future. Prophecy can make a mirror of the future, where the projection is only our reflection – in other words our own image. Prophecy can serve to reveal our hopes and fears just as well. Any insistence on specific consequences of research on human systems performance may be just that: an image of our hopes and fears for the future. The very mention of our topic can arouse anxiety, sometimes well founded and sometimes not. Discussion of human systems performance touches on the dignity and integrity of the person, which is central to the study of ethics. That is simply to say that ethical discussion is integral to the study of human systems performance. Still, these topics are vital when military applications are under discussion. The late Hilary Putnam, a Harvard philosopher, delivered

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a most poignant expression of these concerns when he recounted a talk given by mi t mathematician and philosopher Norbert Wiener, who said “[he] had recently let it be known that he would not work any longer on defense contracts, and he stated his reasoning with his characteristic combination of simplicity and depth: ‘I don’t give fouryear-olds razor blades.’ I have been haunted by that remark ever since.”5 Any comprehensive account of human systems performance research must address the depth of similar concerns and fears. In beginning to examine human systems performance research, first one might seem to be faced with a loose collection of technologies. One might wonder how such a collection might be demarcated, or opposed to other technologies. The central notion is the improvement of human competence, rather than the notion of tool use or that of a human-machine interface. Two tempting ideas should be skirted: one is that any tool counts as a technology for human systems performance, and another is that human systems technologies can be defined as technologies “from the skin in.” The latter idea uses boundaries of the body – or differently stated, “boundaries of the self” – to demarcate these technologies. That may not be a useful trick. Consider technologies for enhanced vision, which range over helmet-mounted image fusion devices, spectacles, contact lenses, and retinal implants. The enhancement of vision may be brought about by any of these, singly or in combination. Some sit outside the head and are easily removed, others not. The idea that the boundaries of the body define hsp technologies leads to meaningless contrasts: the proposition that contact lenses but not spectacles count as such technology, or else the proposition that retinal implants but not spectacles count as such technology. The distinction is futile, since any of these means may be used to a single end. The first idea may do away with this boundary, but then it includes too much. Why shouldn’t any tool count as an h s p technology – say, a tank? Two reasons come to mind: in concept, a tank may be replaced by an autonomous system, and tanks are not designed with the aim of demonstrating human competence – or of extending human performance, which comes to the same thing. It is important to identify skilful applications of new technologies, that is, to say what is simple and pragmatic as well as what is possible. The enhancement of human vision provides one example. Occipital lobe implants exist that can restore some visual function to people who have lost use of their eyes. That solution may come to mind sooner or more easily than other means to the same ends to visual

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enhancement.6 There is a simpler and equally effective means to allow someone to picture a complex scene in perspective. That is to place a dense rectangular array of texels or vibrating elements on a person’s back, and to stimulate those texels as if they were the pixels of a visual image. Such a procedure may seem less exciting in that it does not involve brain surgery, but it does have the advantage that it is removable without trauma. The two technologies can produce the same effect in normal individuals, and the technology that may have been developed for the more extreme case of anucleate individuals may not be the best technology for enhanced vision in other individuals. In fact, it may even be the case that significant visual enhancement may be achieved by training.7 The point can be made for many technologies that count as human systems performance. The present discussion is a quick report on the state of research on human systems performance in Canada, and around the world. the canadian research community

The objective of our first scientometric study was to identify Canadian researchers and to map their collaboration networks.8 The research topics were categorized into four (non-mutually exclusive) metagroups: Ethics, Physiological issues, Computational/Cognitive Issues, and Automation/Robotics. Two major trends emerged from the analysis. First, there is a rich and continuing discussion of ethical issues regarding human optimization: from technological, medical, and social perspectives, and across stakeholders. Second, there is a notable convergence of technological and social issues. At this point, one might well ask if bibliometric measures will serve to capture real advances in research. One might say that clinging to superficial counting measures may well seem a substitute for meaningful evaluation of the import of new research. That criticism would not be entirely fair: our aim is to produce an overview of emerging areas, and counting measures do help in that regard. The chapters by Vergin, de Boisboissel, and Nabi discuss the German, French, and U.S. situations, respectively. We have also conducted an analogous study for the global situation. Research on human systems performance in Canada is fairly evenly spread between three of the four metagroups: Ethics (225 publications), Physiological Issues (223), and Computational/Cognitive Issues (202). A slightly lower proportion of publications are focused on Automation/Robotics (147). Part of the definition of these categories involves discussion of the topics that turn out to be subordinate to

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them. Leading topics in the Ethics metagroup include: Performance (94), Social issues (58), and Ethics (43); leading topics in the Physiological metagroup include: Cognitive enhancement (44), Optimization (39), and Perception (36); leading topics in the Computational/Cognitive metagroup include: Computers (53), Imaging (41), and Interfaces (37); while leading topics in the Automation/Robotics metagroup include: Robots (43), Devices (36), and User-Computer Interfaces (23). A complete listing of all topics by metagroup can be found in the methodological appendix to this chapter. We were guided by the associations of articles in our placement of topics within categories (so that simulation does not fall under Computation and Cognition, for instance). After categorizing topics, we proceeded to use the bibliographic database to pose several questions about Canadian articles on human systems performance. questions of the study

The four questions posed in the study are straightforward: (1) Who are the Canadian researchers working in human systems performance? (2) Who are the Canadian co-authors of these Canadian researchers? (3) Who are their co-authors outside Canada, by name, institution, and country? and (4) What are the most active areas of research on human systems performance in Canada? While the first three questions are presented in brief in the following pages, the majority of this chapter is devoted to the fourth question. Who Are the Canadian Researchers Working in Human Systems Performance? Of 130 Canadian institutions that appear in the dataset, the most prolific institutions are: McGill University (35); Defence Research and Development Canada (33); University of Calgary (31); University of Toronto (30); and the University of British Columbia (30). 1,034 Canadian researchers appeared in the dataset; of these, 132 have at least two hsp publications. Who Are the Canadian Co-authors of these Canadian Researchers? The dataset includes a total of 352 institutions, 131 of which are Canadian. The top Canadian institutions in the dataset are presented in figure 2.1.

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Figure 2.1  Canadian co-authorships (2005–15) in human systems performance, where the institutions share at least two co-publications



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Figure 2.1 presents Canadian collaborations for at least two copublications. The small-sized numbers on the connecting edges (lines) show the number of co-publications between institutions. The size of the disks is proportional to the number of topic publications for the associated institution. In the top left cluster, three co-­publications between the University of Toronto and St Michael’s Hospital focus on cognitive enhancement, nootropic agents, and other known specific drugs. Two of these are also co-published with the University of Calgary, one of which also looks at policies. The two publications between the University of Toronto and the University Health Network look at simulation training for laparoscopic surgery9 and ethical implications of neurosurgery to enhance personal traits.10 In the top cluster, the University of British Columbia’s (ubc) two co-­publications with the International Collaboration on Repair Discoveries (icord) focus on exoskeleton and gait and walking. ubc’s co-publications with Simon Fraser University look at an affordable arm exoskeleton and motor-proprioception platform, and a vision-based localization system using mobile augmented reality that can be used for both human and robot navigation. The large cluster in the middle includes three sub-clusters. The left includes the University of Ottawa, which has three co-publications with Carleton University, two of which focus on passive and non-passive input-based teleoperation systems under time-varying delays,11 while the other looks at the ethical considerations regarding body enhancement technologies (including drugs and implants). Carleton University has another two publications on bilateral teleoperation12 with Western University. Western University has another two publications with the London Health Sciences Centre, one also on bilateral teleoperation, augmented reality, and haptic interfaces, and another on enhanced visualization of a surgical field with a 3 d patient model during image guided epilepsy surgery.13 This last article was co-published with Robarts Research Institute. The sub-cluster in this large cluster represents Montreal-based institutions as well as Dalhousie University. McGill’s co-publications with the Université de Montréal and the Institut de recherches cliniques de Montréal (ircm) focus on cognitive enhancement, ethics, social issues, cognitive performance, and nootropic agents – to name a few topics. Five of the thirteen articles co-published by these three institutions have another Canadian institution publishing with them. The Université de Montréal has two other publications with Sacre-Coeur Hospital on circadian adjustments on sleep during night shifts.14 The ircm has

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three co-publications with Dalhousie University on the ethics of cognitive enhancement. They examine nootropic agents and policy implications. McGill University has three publications with École de technologie supérieure on exoskeletons, robotics, motion tracking, and another two publications with Université Laval, one on autonomous adaptive exploration using real-time online spatiotemporal topic modelling15 and another on pain and social coping strategies.16 The Université Laval is part of the purple sub-cluster with Defence Research and Development Canada (drdc) and the University of New Brunswick. Université Laval has three publications with d rd c that focus on decision support for the military. d rd c also has two publications with the University of New Brunswick, one from 2006 on object-based change detection in high resolution images and one on a launch and recovery system for autonomous underwater vehicles which can be used to enhance human capabilities.17 We also see four separate clusters with only two members each. The Powertech Labs and g e Digital Energy’s (left) publications look at devices and interfaces, specifically human-machine interfaces. The University of Guelph and University of Waterloo’s (top) publications look at education for competence, capacity building, and training. The co-publications of Mount Sinai Hospital and Princess Margaret Hospital (left) are on virtual surgery and augmented reality with advanced image-guidance systems.18 University of Sherbrooke and Université du Québec à Chicoutimi (bottom left) looked at the social and ethical acceptability of using nanotechnology, biotechnology, information science, and cognitive science (n b i c ) to enhance human performance.19 Who Are Their Co-authors outside Canada, by Name, Institution, and Country? The dataset includes 221 international institutions that have published with Canadian institutions. In the period of interest Canadian institutions collaborated with 221 international institutions of thirty-one different countries, mainly in the U.S. Within Canada, five major clusters of institutions share at least two co-publications. These are located in Montreal, Ottawa, Toronto, and Vancouver. Four smaller clusters (of two institutions each) can also be seen in figure 2.2. Ten other international institutions have collaborated on at least two publications with members of the five main Canadian clusters. Four of

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those institutions are in the U.S., and three are in Europe. The remainder are in Abu Dhabi, Australia, and Korea. Although Canadian authors do collaborate with international authors, they are not often co-authors with the same institution more than once. Only Harvard and the University of Queensland (Australia), share more than two co-­ publications with a Canadian institution. University of British Columbia published two articles with Stanford University. The first discusses ethical issues related to neuroregenerative medicine.20 The second focuses on the impact of wearable sensing and feedback devices for gait analysis and intervention.21 Queen’s University (Ontario) published two articles on computational simulation of bone remodelling with the Korea Advanced Institute of Science and Technology in 2010.22 The University of Calgary published two articles each with Ruhr University and the Technical University of Munich on residual force enhancement in human movement.23 Their two publications with Florida State University are on constrained optimization in human walking24 and running.25 The latter was co-published with Cornell University. University of Ottawa had two publications with New York University of Abu Dhabi (ua e ) on U-Biofeedback, a multi-media ubiquitous biofeedback system. The first is about a reference model for wearable systems designed to continuously monitor human physiology and convey messages and assistive support regarding stress levels.26 The second article presented a design to enhance stability and tracking of bilateral shared autonomous systems for real-time teleoperation applications. Defence Research and Development Canada had two publications with the US Air Force Research Laboratory (a f r l ). Harvard had three publications with l’Université Laval. Two of those, also published with the Université Lyon, were on ethical issues of noninvasive brain stimulation.27 The third publication, also with McGill University, was on social coping strategies for chronic pain. Harvard had another publication with McGill University, on the effects of distraction on motor performance.28 What Are the Most Active Areas of Research on Human Systems Performance in Canada? In order to visualize the relationships between the groups, a cluster mapping was performed (although it is not presented visually here). The larger the circle, the more publications exist on that topic while the two-digit number represents the similarity between connected

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Figure 2.2  Clusters of Canadian institutions that have collaborated with non-Canadian institutions on HS P topics (2005–15) more than twice



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topics. Details of this analysis can be found in the appendix to this chapter. The map was filtered to show medium or higher correlations, and it contains colour-coded clusters (single-publication topics were removed). That so many topics are connected here speaks to the fact that research in this domain is indeed interdisciplinary. The clusters are discussed below, in detail in terms of how they connect to each identified metagroup. e t h i c s m e ta g r o u p

Ethics Research on the ethics of human optimization has an obvious hub in Montreal where the Institut de recherches cliniques de Montréal (ircm), McGill University, and Université de Montréal have published 37 per cent of the publications in the Ethics group. Much of the literature in the Ethics group acknowledges that the ethics surrounding cognitive enhancement and human augmentation are still hotly debated in academia, the media, the public, the military, and amongst bioethicists29 – indeed the final two chapter in this volume, by Max Mehlmen and Colin Farrelly, attest to this. Nearly three-quarters (74 per cent) of the publications in the Ethics group are also found in the Cognitive Enhancement group and the Social-general group, emphasizing that the ethical issues in the field are closely related to social aspects and concerns that arise with human optimization and cognitive enhancement. Fifty-eight per cent of the articles in both the Ethics and the Cognitive Enhancement group discuss the ethical debate regarding the use of pharmacological substances for cognitive enhancement by healthy individuals.30 A few articles discuss the ethical debate on using neurosurgical interventions31 or transcranial direct current stimulation32 for cognitive enhancement. The remainder discuss developing public policy and regulatory framework for cognitive enhancement (pharmacological or otherwise).33 A recent study on the public’s perception of the use of transcranial direct current stimulation (tdcs) as an enhancement tool found that the public has shifted from misunderstanding tdcs to viewing it with cautionary realism. This is believed to be the result of moving away from focusing on tdcs as an emergent technology, to understanding its applications, benefits, and risks.34 As the work by Annika Vergin (in this volume) suggests, this is not unique to Canada.

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Social-general The articles in the Social-general group cover a wide gamut of topics. Close to one third of the fifty-eight articles grouped in the Socialgeneral group is focused on ethics. Some of the articles related to the ethical and social issues related to the use of drugs for cognitive enhancement. One in particular discusses the public health impacts (from a social and ethical perspective) of the use of cognitive enhancers.35 Another views the growth in cognitive enhancement activities as representing a major social change with bioethical and public policy implications.36 Eight publications in the Social-general group discuss public attitudes on various aspects of cognitive enhancement including on exoskeleton technology, physicians’ attitudes toward prescribing cognitive enhancers,37 and the public’s attitude on the moral propriety of cognitive enhancement.38 Another publication in this group explores how values affect and are affected by enhancing cognitive abilities.39 Another eight publications in this group discuss enhancement devices. One study described the mosaic system, which is intended for mobile collaborative exergames that use head-mounted devices to incite movement in an effort to address obesity problems.40 Another uses mobile devices and social networks to acquire more detailed and useful contextual information that can help create smarter spaces (such as smart technology or ubiquitous computing) that focus on social context to enhance sensor data.41 Finally, another presents two regulatory approaches for managing the physiological and social effects of cognitive enhancement through non-invasive brain stimulation devices (such as transcranial direct current stimulation (td c s ) and transcranial magnetic stimulation (tms).42 Four articles discuss issues related to the military, including: augmenting cognition in complex situation management through the use of decision aids; the potential use of noninvasive brain stimulation for security purposes43; how cognitive support tools that support long-term anticipation successfully improved performance during a simulated national crisis44; and how decision support systems designed to augment particular aspects of situational awareness may affect high cognitive load and time constraints. Transhumanism The transhumanism group is small with only five publications from 2006–13. Transhumanism is one side of the debate on the ethical and

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social acceptability of human enhancement through the development of technologies (bio- or nano-based). Its defenders typically have natural science backgrounds and have very different views than “humanists” and social scientists. In particular their views differ on such issues as the identification of risk and impact, assessment of acceptability of risk and impact, and their faith in the capacity of science to overcome risks to humans.45 Trust The Trust subject group was created in an effort to group research on trust and autonomous systems. The four publications in the group look at trust-related issues with regards to technology, but not specifically autonomous systems. One article identifies low levels of trust as a barrier to successful virtual team implementation in the Canadian Armed Forces (c a f ). To tackle the lack of trust in technology, one article proposes a security system based on trust management for ubiquitous and pervasive computing environments.46 Addressing the same problem in mobile social networks, another article proposes a fuzzy trust inference mechanism called MobiFuzzyTrust for inferring trust semantically from one mobile user to another.47 c o m p u tat i o n a l / c o g n i t i v e i s s u e s m e ta g r o u p

Human Computer Interaction The Human Computer Interaction (hci) group contains twenty-three articles, with fourteen focused specifically on human interaction with robots or other devices. These robots and devices are being used to facilitate task completion and encourage user effort,48 to perform remote surveillance and interventions,49 to augment human information processing,50 or for teleoperative space applications,51 to name a few examples. Some of the challenges discussed with regards to hci, particularly with robots, are the needs for intuitiveness, stability, and control of non-human systems to increase successful interactions.52 Simulation The Simulation group has thirty-four titles, the majority from the past five years. Twenty-seven of these Simulation articles have also been

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grouped into Interfaces, Robots, Military, Adaptive, Load, and Biomechanics. The majority of the articles use simulation to test another device, tool, or hypothesis. Simulations were also used to compare simultaneous and interactive structural changes of cortical and trabecular bone types during bone remodelling. Simulation of night work was used to evaluate daytime light exposure on reducing circadian misalignment in shift workers.53 For the military, simulations are used to augment military training. A few of the articles discuss simulation as a tool, in and of itself, as a means to optimize human performance. Simulation as a tool has been effectively used to augment human performance in the medical field. These articles typically discussed haptic interfaces (those that deal with the sense of touch). One article noted that haptic technologies have proven effective in medical simulation and rehabilitation.54 Similarly, haptic and visual information were found to be critical components in creating accurate simulation and interaction in virtual reality surgical systems.55 Haptic systems, along with visual and auditory feedback systems, have also been integrated into virtual and augmented reality floor-based user interfaces and immersive walking simulations. Visualization The Visualization group has eleven articles, with the majority having been published since 2010. These articles frequently discuss mixed reality visualizations in which advanced visualizations are used in combination with real physical environments to enhance either robotic or human performance. This is a common approach in image-guided surgeries56 and has also been used with telepresence robots for home surveillance and remote interventions. Using visualization to enhance telepresence systems has also been used to support demanding collaborative human activities that use synthetic media.57 Visualizations have also been used to improve human interaction with very large datasets for exploring alternatives and understanding social networks. Ubiquitous Computing According to Hasswa and Hassanein: “Advances in smart technologies, wireless networking, and the increased interest in services have led to the emergence of ubiquitous and pervasive computing as one of

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the most promising areas of computing in recent years.” Despite that fact, the Ubiquitous Computing group is quite small, containing only six articles with one publication per year 2008–14, excluding 2010. These articles discuss mobile or smart technologies from disparate perspectives. For example, one article focused on creating a trust-based security system for ubiquitous and pervasive computing environments. Another article discussed the use of mobile devices and social networks to acquire more detailed and useful contextual information that can help create smarter spaces. Finally, one used a context-aware robotic platform to track human faces visually. p h y s i o l o g i c a l i s s u e s m e ta g r o u p

Perception Sixty-four per cent of the records in the Perception group are also found in the Visual (enhancement), Devices, Technology, Interfaces, Haptic Interfaces, and Sensory groups; 30 per cent are also found in Ethics and the Social-general groups. From the more technological perspective, perception is a feature or function researchers are trying to improve in their various devices and interfaces. For example, the effects of low light and increased signal-to-noise ratio on physiological motion perception in night vision devices were studied to find ways to enhance human perception.58 Another study on night vision devices with image intensifier technology explored the impact of their use on human performance, including stereopsis and depth perception.59 Another group of articles in the technology subset is related to telepresence. Those discussed ways to improve interfaces, interaction, and perception. Some articles discussed the effect of reducing haptic data traffic,60 the use of vibrotactile displays to improve spatial perception, the use of cognitive countermeasures to mitigate excessive focus issues in the unmanned ground vehicle environment,61 and new algorithms that reduce the haptic perception of environmental stiffness. From an ethics perspective, the articles explored the perception of medical professionals and the public’s perception of ethical issues. Some articles explored the perception of the risks associated with cognitive enhancing substances.62 Other articles looked at perceived ethical issues surrounding psychosurgery, neuro-­enhancement, transcranial direct stimulation, and the therapeutic enhancement of injured soldiers and veterans beyond normal abilities.63

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Human Enhancement/Augmentation The Human Enhancement/Augmentation group brings together articles that refer to human optimization by the terms “human enhancement” or “human augmentation” or variants (augmented cognition, augmented human, personal enhancement, etc.). Interestingly, there were only thirty articles in this group, suggesting these are not preferred terms. Two-thirds discuss a technological component of enhancement. These articles appear in the Technology, Computers, Human Computer Interaction, Devices, Interfaces, Robots, and Biotechnology groups as well. Because titles can be listed in several groups, we also find that two-thirds of the articles are grouped in the more socially oriented groups in the dataset: Social, Performance, Ethics, Military, Perception, Learning, and Transhumanism. This group represents an intersection of ideas with social import, in other words. The implication is not that human augmentation is not a large field, but rather that its importance in social and political terms often lead to its classification as a social as well as a technological issue. This implication is pursued in the chapters by Farrelly and by Mehlman and indeed is one of the guiding forces behind this entire volume. Biomechanics The sixteen articles in the biomechanics group cover a variety of human biomechanical issues, the most prevalent being human gait. In one study, a constrained optimization framework was used to examine running gait selection.64 Another investigated neuromuscular control features in gait parameter selection.65 A third looked at phase modulation during walking cycles.66 Another looked at the interdependence of features of multi-joint leg extension (for walking or running) with the intent to model and optimize human motion. Other articles introduced a Personal Lift Augmentation Device (p l ad ) designed to be worn by workers in manual lifting to reduce muscular effort, and compression and shear forces.67 Ergogenic Aids Ergogenic aids in the dataset are mostly related to the Athletics/sports, Exercise, and Diet & Supplement groups. Many studies looked at the level of ergogenic benefit gained from substances including caffeine,

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creatine, pseudoephedrine, quercetin, acute taurine, and beta-alanine, to name a few.68 Others discussed the effectiveness of physical activities as ergogenic aids, such as precooling the body before exercise, or the use of near-infrared light therapy for improving muscle function after injury.69 Some articles were specific about quantities required for ergogenic effects, while others were inconclusive. For example, one article discussed specific methods for determining the optimal amount of a substance to have an ergogenic effect on endurance performance.70 Yet another article found that the application of protein supplements to enhance soldier performance required further research to provide evidence-based guidance.71 The remainder of the articles relate to stimulant use in academia.72 a u t o m at i o n / r o b o t i c s m e ta g r o u p

User Computer Interfaces The group for User Computer Interfaces (u c i ) is a subset of the broader Interfaces group, with some overlap with Human Computer Interaction. Quite a few articles are focused on augmented imageguided surgery systems (i g s ). These articles either describe robots with innovative human-machine interfaces,73 the evaluation of new virtual or augmented display systems, or the various components required for a mixed reality igs System.74 Attentional blindness – the failure to recognize an unexpected stimulus that is in plain sight – is a risk in using augmented reality for surgeons, as well as in aviation and the military.75 Other articles discussed teleoperation interfaces outside of surgery. One discussed the applicability of brain-robot interfaces for space applications, another a 3d robot teleoperation interface for surveillance, and another the use of a neural network to reduce the information of streaming images so that objects could be identified by a small set of primary parameters for an enhanced human machine interface (h mi ). Virtual Reality Virtual reality provides an arena for sensory stimuli as well as for biofeedback, which is useful for physical and cognitive enhancement and rehabilitation. Virtual reality is often discussed in terms of image guidance systems for surgery, in terms of the virtual displays that

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are used. These tools are effective at improving surgeon performance. Virtual reality has also been used with augmented floor surfaces in immersive walking simulations. Immersive virtual reality glasses can improve the dynamic visual acuity of patients with bilateral vestibular loss.76 The c a f have used virtual models to augment military simulation-based training. Virtual worlds may be an effective tool for military training courses and distributed working groups. Barriers to the success of these virtual worlds may be lack of shared understanding or trust. Similarly, trust was found to play a critical role in establishing social links between users in mobile social networks. Telepresence According to Cha, Barghout, Kammerl, Steinbach, and Saddik, “Telepresence and teleaction (tpta) systems enable humans to operate in a remote, hostile, or inaccessible environment. The performance of these systems strongly depends on the deployed sensors and actuators and the quality of the feedback to the user.” The seven articles in this group explore ways to improve the quality of telepresence through increased interactivity, the use of mixed-reality visualization modalities, reducing haptic data traffic, vibrotactile displays, and identifying communication requirements for collaborative telepresence.77 Expert telementoring of a novice can be used to enable the novice to program a device accurately.78 Wearables The Wearables group has five publications, three from 2014. According to Pedersen79 “Wearable computers create a personal augmented reality … [which] could potentially alter mobility, interactivity and beingness (existence) in the actual world.” Wearables can facilitate task completion and encourage user effort. They may have clinical benefit for gait analysis and intervention when improving walking stability and reducing joint loading. Two articles in this group discuss the design and challenges of wearables, one with respect to interfaces implanted underneath human skin. Challenges include how to sense input, how to produce output, how to communicate between devices and external infrastructure, and how to retain electrical power.

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t h e way f o r wa r d

We do not pretend to have produced a Canadian encyclopaedia of human systems performance. Rather, we have pictured a slice in time of the unclassified literature on the subject. We believe that our overview of the subject is both new and wide-ranging. Some caveats to the present results are plainly evident, while others are hard to spot. More of our results, and fuller detail on our methods, can be obtained by request from drdc in the form of two articles by Wiseman.80 Some caveats concern the identification of individual researchers: for example, some family names are distinctive, and others sufficiently frequent to complicate the business of distinguishing individual researchers.81 Similarly, some universities and laboratories are centralized, while others have many satellites of the same name. Some laboratories produce a great number of restricted, classified, or industrially sensitive publications: classified documents fall outside the scope of our work. And at least to date, proprietary and industrial interests have slowed the development of comprehensive, entirely general search engines for scientific publications. Much of the interest in human systems performance has been on improvements in physiology. However, what may be yet unrealized is the enormous potential for improvements in cognition, especially by computational means. The possibilities are explored more closely in the chapter by Bryant and Niall in this volume. Some thoughts on human competence may help to emphasize this potential. Human competence is the often-hidden face of human performance. Human competence and human performance are opposing poles of a single concept. These opposites are known in a single insight. We tend to emphasize human performance at the expense of human competence. Did Pheidippides run from the plains of Marathon to the city of Athens to announce an Athenian victory? For many years, the notion of running a marathon was considered to be physiologically impossible. (These days, it certainly is possible.) We do recognize some physiological and biomechanical limits to human performance, though earlier notions of human physiology were narrow. We have some idea of human competence in running. Indeed, there is now talk about breaking the two-hour mark for a marathon. Psychological competence seems to be more elusive (and cognitive enhancement is a large part of the international field of research in question). What does a theory of psychological competence look like?

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Current psychological theories of logical reasoning recount characteristic errors or biases in reasoning. Yet by definition, theories that aim to explain errors in performance – to say why we cannot run the cognitive marathon – are not theories of psychological competence. We should expect a psychological theory of reasoning to explain how it is we engage in valid reasoning, or else what we may expect of the highest attainments in human reasoning. Such a theory of psychological competence accounts for our best reasoning. It is not a reckoning of failures: how we may be influenced by bias or inattention when we are tired or sick or merely uninformed. Improvements in gross physiological performance are relatively easy to measure, compared with improvements in cognitive performance. By way of example, a slight gain in the span of short-term memory would constitute an unambitious promise for transcranial stimulation techniques. The point is that we have – collectively – enormous play for improvement in human performance, more than we have may have imagined even for gains in physiology. Yet our narrative of human performance enhancement is an ideal for the present; only in that much is it an image of tomorrow. As the science fiction writer Samuel R. Delaney points out: “Only by having clear and vital images of the many alternatives, good and bad, of where one can go, will we have any control over the way we may actually get there in a reality tomorrow will bring all too quickly. And nothing gives such a profusion and richness of images of our tomorrows – however much they need to be revised – as science fiction.”82 In another context, Delaney argues: “When you hear someone say that science fiction is “about the future” or that science fiction is not good because it hasn’t portrayed the future accurately, you are hearing nonsense; if you find yourself saying it, you are saying nonsense. Science fiction is not “about the future.” Science fiction is in dialogue with the present.83 And finally, conscious of the ethical issues, we should emphasize the obvious: knowledge on this topic grows through conjecture and refutation. It develops only in those environments which foster free inquiry. It has been said by others that “In order to maximize the benefits of research, researchers must have academic freedom. Academic freedom includes freedom of inquiry, the right to disseminate the results of that inquiry, the freedom to challenge conventional thought, freedom to express one’s opinion about the institution, its administration or the system in which one works, and freedom from institutional censorship.”84

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appendix

Methods As one could well imagine, a bibliometric study includes a rather detailed application of particular statistical methods involving not just descriptive and inferential statistics, but some basic network analysis as well. In the spirit of both readability and rigour, we have elected to move detailed methodological discussion relating to our work here. To address key questions, a broad search on human optimization was conducted in databases including Scopus, Inspec, Compendex, nt i s, dt i c , and c a nd i d . An initial search produced a Canadian dataset with nearly 15,000 international publications, which was reduced to 366 relevant Canadian publications published in the period 2005–15. Terms in the keywords, abstracts, and title fields of these articles were merged. One hundred subject groups covering 351 of the publications (96 per cent of the dataset) were created to identify subordinate research areas within the dataset. To identify major players, their collaboration networks and key research topics in the Canadian landscape, the 366 references to relevant Canadian 2005–15 publications were retrieved and analyzed using text mining software and a variety of visualization tools. d e r i vat i o n o f t h e m e ta g r o u p s

This study is based upon the identification and analysis of a vast range of sources and work relating to human performance enhancement. Our initial scan of the proverbial field led us to create four metagroups, each with a wide array of topics. The metagroups and topics are presented in table 2A.1 c r e at i o n o f t h e c l u s t e r m a p s

While not presented visually, a cluster map was created of the subject groups based on a correlation matrix using cosine similarity. Cosine similarity is often used in information retrieval and text mining where terms are notionally assigned a different dimension. Documents are characterized by a vector where the value given in each dimension corresponds to the number of times that term appears in the document. Cosine similarity then provides a measure of how similar two documents are in terms of subject matter. The technique is also used to measure cohesion within clusters for data mining. The correlation

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Table 2A.1 Placement of sub-topics under the categories of human systems performance Computational/ cognitive issues • Ubiquitous pervasive computing (ubicomp) • Low-power computing • Augmented reality • Neuromorphic computing • Position, navigation, and timing • Enhanced vision • Visualization of large information databases • Exobyte computing • Cultural aids/ Automated machine translation

Physiological issues

Automation/robotics

Ethical issues

• Sleep-wake cycle • Circadian adjustment • Countermeasure chemical, biological, radiological, and toxic industrial material (TIM) agents • Galt efficiency and energy • Load carriage and soldiers • Load assistance • Exoskeleton and human • Human behaviour patterns • Self-decontamination aids • Physical avatars • Brain/neuoronal computer interface (BNCI) approaches for human optimization

• Robotics and telepresence • Telepresence latency • Telepresence and remote • Efforts and telerobotics • Live virtual constructive and simulation • Wearable/implanted intelligence sensors • Smart armour • Smart personal intelligent systems (S I R I -like agent) • On-board facial recognition • On-board microclimate management • Wound sensing • Antimicrobial nanofibers for clothing

• Cultural lexicon • Serious ­gaming and training • Trust and autonomous systems and responsibility • Autonomous systems and privacy • Social acceptance and legal consideration for human optimization

matrix shows a bi-directionally normalized (0 to 1) comparison of the relationship between two entities (subject groups) and shows the percentage of overlap between them. This cluster map was generated using TouchGraph Navigator software, which identifies clusters based on “edge betweeness centrality.” Nodes within clusters tend to be close together while nodes in separate clusters are further apart. TouchGraph’s clustering algorithm ignores long edges that connect separate clusters, thereby splitting separate connected components into the clusters that are shown.

notes

  1 Jean-François Mattéi, L’homme dévasté (Paris : Bernard Grasset, 2015), 258–9.

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  2 Peter Tikuisis, Fred Buick, Andrea Hawton, Justin Hollands, Allan Keefe, Peter Kwantes, David R. Mandel, Donna Pickering, Stergios Stergiopoulos, Megan Thompson, and Afzal Upal, “Futuristic Outlook on HumanCentric S&T,” Technical Memorandum of Defence Research and Development Canada (drdc Toronto TM 2013-060, 2013).   3 Canadian Army Land Warfare Centre, Waypoint 2018: The Canadian Army Advancing toward Land Operations 2021 (Kingston: Army Publishing Office, 2015).   4 Max Michaud-Shields, “Personal Augmentation – the Ethics and Operational Considerations of Personal Augmentation in Military Operations,” Canadian Military Journal 15, no. 1 (2014): 24–33.   5 Hilary Putnam, Realism with a Human Face (Cambridge: Harvard University Press, 1990), 206.   6 Jongeun Cha, Ahmad Barghout, Julius Kammerl, Eckehard Steinbach, and Abdulmotaleb E. Saddik, “Improving Spatial Perception in Telepresence and Teleaction Systems by Displaying Distance Information through Visual and Vibrotactile Feedback,” Presence: Teleoperators and Virtual Environments 19, no. 5 (October 2010): 430–49.   7 Hervé Segond, Déborah Weiss, Magdalena Kawalec, and Eliana Sampaio, “Perceiving Space and Optical Cues via a Visuo-tactile Sensory Substitution System: A Methodological Approach for Training of Blind Subjects for Navigation,” Perception 42 (January 2013): 508–28. For possibilities of improvement, see: Don C. Donderi, Keith K. Niall, Karyn Fish, and Benjamin Goldstein, “Above-Real-Time Training (a rtt) Improves Transfer to a Simulated Flight Control Task,” Human Factors 54 (March 2012): 469–79; Aldous Huxley, The Art of Seeing (New York: Harper & Brothers, 1942); Keith K. Niall, Jack D. Reising, and Elizabeth L. Martin, “Distance Estimation with Night Vision Goggles: A Little Feedback Goes a Long Way,” Human Factors 41, no. 3 (Oct 1999): 495–506; Keith K. Niall, “The Art of Descrying Distance,” Human Factors 41, no. 3 (Oct 1999): 511–14; Uri Polat, “Restoration of Underdeveloped Cortical Functions: Evidence from Treatment of Adult Amblyopia,” Restorative Neurology and Neuroscience 26 (February 2008): 413–24; Uri Polat, “Making Perceptual Learning Practical to Improve Visual Functions,” Vision Research 49 (October 2009): 2566–73.   8 Details of our methods can be found in the appendix.   9 Benjamin Zendejas, Ryan Brydges, Stanley J. Hamstra, and David A. Cook, “State of the Evidence on Simulation-Based Training for Laparoscopic Surgery: A Systematic Review,” Annals of Surgery 257, no. 4 (April 2013): 586–93.

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10 Nir Lipsman, Rebecca Zener, and Mark Bernstein, “Personal Identity, Enhancement and Neurosurgery: A Qualitative Study in Applied Neuroethics,” Bioethics 23, no. 6 (August 2009): 375–83. 11 Including: Shafiqul Islam, X. Peter Liu, and Abdulmotaleb El Saddik, “Teleoperation Systems with Symmetric and Unsymmetric Time- Varying Communication Delay,” ieee Transactions on Instrumentation and Measurement 62, no. 11 (November 2013): 2943–53. 12 I.G. Polushin, X. Peter Liu, and Chong-Horng Lung, “Stability of Bilateral Teleoperators with Generalized Projection-Based Force Reflection Algorithms,” Automatica 48, no. 6 (June 2012): 1005–16; I.G. Polushin, X. Peter Liu, Chong-Horng Lung, and G.D. On, “Position-Error Based Schemes for Bilateral Teleoperation with Time Delay: Theory and Experiments,” Journal of Dynamic Systems, Measurement and Control, Transactions of the ASME 132, no. 3 (2010): 1–11. 13 An Wang, Seyed M. Mirsattari, Andrew G. Parrent, and Terence M. Peters, “Fusion and Visualization of Intraoperative Cortical Images with Preoperative Models for Epilepsy Surgical Planning and Guidance,” Computer Aided Surgery 16, no. 4 (July 2011): 149–60. 14 Marie Dumont, Helene Blais, Joanie Roy, and Jean Paquet, “Controlled Patterns of Daytime Light Exposure Improve Circadian Adjustment in Simulated Night Work,” Journal of Biological Rhythms 24, no. 5 (October 2009): 427–37; Simon Chapdelaine, Jean Paquet, and Marie Dumont, “Effects of Partial Circadian Adjustments on Sleep and Vigilance Quality During Simulated Night Work,” Journal of Sleep Research 21, no. 4 (February 2012): 380–9. 15 Yogesh Girdhar, Philippe Giguère, and Gregory Dudek, “Autonomous Adaptive Exploration Using Realtime Online Spatiotemporal Topic Modeling,” International Journal of Robotics Research 33, no. 4 (April 2013): 645–57. 16 Etienne Vachon-Presseau, Mathieu Roy, Marc O. Martel et al., “The Two Sides of Pain Communication: Effects of Pain Expressiveness on Vicarious Brain Responses Revealed in Chronic Back Pain Patients,” Journal of Pain 14, no. 11 (November 2013): 1407–15. 17 Jason Currie, Colin Blaine Gillis, Juan Antonio Carretero, Rickey Dubay, Tiger Jeans, and George D. Watt, “Dynamics of Two Active Autonomous Dock Mechanisms for au v Recovery,” Transactions of the Canadian Society for Mechanical Engineering 38, no. 2 (June 2014): 213–26. 18 Benjamin J. Dixon, Michael J. Daly, Harley Chan, Allan Vescan, Ian J. Witterick, and Jonathan C. Irish, “Augmented Image Guidance Improves Skull Base Navigation and Reduces Task Workload in Trainees: A

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Preclinical Trial,” Laryngoscope 121, no. 10 (October 2011): 2060–4; Benjamin J. Dixon, Michael J. Daly, Harley Chan, Allan Vescan, Ian J. Witterick, and Jonathan C. Irish, “Surgeons Blinded by Enhanced Navigation: The Effect of Augmented Reality on Attention,” Surgical Endoscopy and Other Interventional Techniques 27, no. 2 (July 2012): 454–61. 19 Jean-Pierre Béland and Johane Patenaude, “Risk and the Question of the Acceptability of Human Enhancement: The Humanist and Transhumanist Perspectives,” Dialogue-Canadian Philosophical Review 52, no. 2 (June 2013): 377–94; Jean-Pierre Béland, Johane Patenaude, Georges A. Legault, Patrick Boissy, and Monelle Parent, “The Social and Ethical Acceptability of  nb i c s for Purposes of Human Enhancement: Why Does the Debate Remain Mired in Impasse?,” Nanoethics 5, no. 3 (Nov 2011): 295–307. 20 Jocelyn Grunwell, Judy Illes, and Katrina Karkazis, “Advancing Neuroregenerative Medicine: A Call for Expanded Collaboration between Scientists and Ethicists,” Neuroethics 2, no. 1 (April 2009): 13–20. 21 Peter B. Shull, Wisit Jirattigalachote, Michael A. Hunt, Mark R. Cutkosky, and Scott L. Delp, “Quantified Self and Human Movement: A Review on the Clinical Impact of Wearable Sensing and Feedback for Gait Analysis and Intervention,” Gait and Posture 40, no. 1 (May 2014): 11–19. 22 E.g., Il Gwun Jang and Il Yong Kim, “Computational Simulation of Simultaneous Cortical and Trabecular Bone Change in Human Proximal Femur During Bone Remodeling,” Journal of Biomechanics 43, no. 2 (January 2010): 294–301. 23 E.g., Daniel Hahn, Walter Herzog, and Ansgar Schwirtz, “Interdependence of Torque, Joint Angle, Angular Velocity and Muscle Action During Human Multi-Joint Leg Extension,” European Journal of Applied Physiology 114, no. 8 (May 2014): 1691–1702. 24 John E.A. Bertram, “Constrained Optimization in Human Walking: Cost Minimization and Gait Plasticity,” Journal of Experimental Biology 208, no. 6 (January 2005): 979–91. 25 Anne K. Gutmann, Brian Jacobi, Michael T. Butcher, and John E.A. Bertram, “Constrained Optimization in Human Running,” Journal of Experimental Biology 209, no. 4 (November 2006): 622–32. 26 Hussein Al Osman, Mohamad Eid, and Abdulmotaleb El Saddik, “U-Biofeedback: A Multimedia-Based Reference Model for Ubiquitous Biofeedback Systems,” Multimedia Tools and Applications 72, no. 3 (Oct 2014): 3143–68. 27 Jean Levasseur-Moreau, Jerome Brunelin, and Shirley Fecteau, “NonInvasive Brain Stimulation Can Induce Paradoxical Facilitation. Are These

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Neuroenhancements Transferable and Meaningful to Security Services?,” Frontiers in Human Neuroscience 7 (Aug 2013): 449; Jerome Brunelin, Jean Levasseur-Moreau, and Shirley Fecteau, “Is It Ethical and Safe to use Non-Invasive Brain Stimulation as a Cognitive and Motor Enhancer Device for Military Services? A Reply to Sehm and Ragert (2013),” Frontiers in Human Neuroscience 7 (Dec 2013): 874. 28 Cristopher Hemond, Rachel M. Brown, and Edwin M. Robertson, “A Distraction Can Impair or Enhance Motor Performance,” Journal of Neuroscience 30, no. 2 (Jan 2010): 650–4. 29 Human Rights Watch, Losing Humanity: The Case Against Killer Robots (Boston: International Human Rights Clinic, Human Rights Program at Harvard Law School, 2012). 30 E.g., Laura Y. Cabrera, Nicholas S. Fitz, and Peter B. Reiner, “Reasons for Comfort and Discomfort with Pharmacological Enhancement of Cognitive, Affective, and Social Domains,” Neuroethics 8, no. 2 (Jan 2014): 93–106. 31 Daniel Mendelsohn, Nir Lipsman, and Mark Bernstein, “Neurosurgeons’ Perspectives on Psychosurgery and Neuroenhancement: A Qualitative Study at One Center,” Journal of Neurosurgery 113, no. 6 (December 2010): 1212–18. 32 Eric Racine, Tristina Martin Rubio, Jennifer Chandler, Cynthia Forlini, and Jayne Lucke, “The Value and Pitfalls of Speculation about Science and Technology in Bioethics: The Case of Cognitive Enhancement,” Medicine, Health Care and Philosophy 17, no. 3 (Jan 2014): 325–37. 33 Veljko Dubljević, “Neurostimulation Devices for Cognitive Enhancement: Toward a Comprehensive Regulatory Framework,” Neuroethics 8, no. 2 (Oct 2014): 115–26; Simon M. Outram and Eric Racine, “Developing Public Health Approaches to Cognitive Enhancement: An Analysis of Current Reports,” Public Health Ethics 4, no. 1 (Mar 2011): 93–105. 34 Laura Y. Cabrera and Peter B. Reiner, “Understanding Public (Mis) Understanding of tDCS for Enhancement,” Frontiers in Integrative Neuroscience 9 (Apr 2015): 30. 35 Simon M. Outram and Eric Racine, “Developing Public Health Approaches to Cognitive Enhancement: An Analysis of Current Reports,” Public Health Ethics 4, no. 1 (Mar 2011): 93–105. 36 Simon M. Outram and Eric Racine, “Examining Reports and Policies on Cognitive Enhancement: Approaches, Rationale, and Recommendations,” Accountability in Research 18, no. 5 (Sept–Oct 2011): 323–41. 37 A.G. Franke, R. Northoff, and Elisabeth Hildt, “The Case of Pharmacological Neuroenhancement: Medical, Judicial and Ethical Aspects

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from a German Perspective,” Pharmacopsychiatry 48, no. 7 (Aug 2015): 256–64. 38 Nicholas S. Fitz, Roland Nadler, Praveena Manogaran, Eugene W.J. Chong, and Peter B. Reiner, “Public Attitudes toward Cognitive Enhancement,” Neuroethics 7, no. 2 (2014): 173–88. 39 Laura Y. Cabrera, “How Does Enhancing Cognition Affect Human Values? How Does This Translate into Social Responsibility?” Current Topics in Behavioral Neurosciences 19 (2015): 223–41. 40 Haifa R. Maamar, Azzedine Boukerche, and Emil M. Petriu, “3-D Streaming Supplying Partner Protocols for Mobile Collaborative Exergaming for Health,” ieee Transactions on Information Technology in Biomedicine 16, no. 6 (June 2012): 1079–95. 41 Ahmed Hasswa and Hossam Hassanein, “A Smart Spaces Architecture Based on Heterogeneous Contexts, Particularly Social Contexts,” Cluster Computing 15, no. 4 (2012): 373–90. 42 Dubljević, “Neurostimulation Devices for Cognitive Enhancement,” 115–26. 43 Levasseur-Moreau, Brunelin, and Fecteau, “Non-Invasive Brain Stimulation,” 449. 44 Daniel Lafond, Michel B. DuCharme, Jean-François Gagnon, and Sébastien Tremblay, “Support Requirements for Cognitive Readiness in Complex Operations,” Journal of Cognitive Engineering and Decision Making 6, no. 4 (Nov 2012): 393–426. 45 Béland and Patenaude, “Risk and the Question of the Acceptability of Human Enhancement,” 377–94. 46 Azzedine Boukerche and Yonglin Ren, “A Trust-Based Security System for Ubiquitous and Pervasive Computing Environments,” Computer Communications 31, no. 18 (Dec 2008): 4343–51. 47 Fei Hao, Geyong Min, Man Lin, Changqing Luo, and Laurence T. Yang, “MobiFuzzyTrust: An Efficient Fuzzy Trust Inference Mechanism in Mobile Social Networks,” ieee Transactions on Parallel and Distributed System 25, no. 11 (Nov 2014): 2944–55. 48 Aliasgar Morbi, Mojtaba Ahmadi, Adrian D.C. Chan, and Robert Langlois, “Stability-Guaranteed Assist-as-Needed Controller for Powered Orthoses,” ieee Transactions on Control Systems Technology 22, no. 2 (Mar 2014): 745–52. 49 Daniel Labonte, Patrick Boissy, and François Michaud, “Comparative Analysis of 3-D Robot Teleoperation Interfaces with Novice Users,” ieee Transactions on Systems, Man, and Cybernetics, Part B: Cybernetics 40, no. 5 (Oct 2010): 1331–42.

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50 Eric Brangier, A. Dufresne, and Sonia Hammes-Adelé, “A Symbiotic Approach to the Human-Technology Relationship,” Travail Humain 72, no. 4 (2009): 333–50. 51 Cristina De Negueruela, Michael Broschart, Carlo Menon, and José Del R. Millán, “Brain-Computer Interfaces for Space Applications,” Personal and Ubiquitous Computing 15, no. 5 (June 2011): 527–37. 52 Pawel Malysz and Shahin Sirouspour, “Task Performance Evaluation of Asymmetric Semiautonomous Teleoperation of Mobile Twin-Arm Robotic Manipulators,” ieee Transactions on Haptics 6, no. 4 (Oct–Dec 2013): 484–95. 53 Dumont, Blais, Roy, and Paquet, “Controlled Patterns of Daytime Light Exposure,” 427–37. 54 Abdulmotaleb El Saddik, “The Potential of Haptics Technologies,” i e e e Instrumentation and Measurement Magazine 10, no. 1 (Feb 2007): 10–17. 55 Antoine Widmer and Yaoping Hu, “Effects of the Alignment between a Haptic Device and Visual Display on the Perception of Object Softness,” ieee Transactions on Systems, Man, and Cybernetics. Part A: Systems and Humans 40, no. 6 (Nov 2010): 1146–55. 56 Marta Kersten-Oertel, Pierre Jannin, and D. Louis Collins, “dv v: A Taxonomy for Mixed Reality Visualization in Image- Guided Surgery,” ieee Transactions on Visualization and Computer Graphics 18, no. 2 (February 2012): 332–52; Marta Kersten-Oertel, Pierre Jannin, and D. Louis Collins, “The State of the Art of Visualization in Mixed Reality Image Guided Surgery,” Computerized Medical Imaging and Graphics 37, no. 2 (Mar 2013): 98–112; Wang, Mirsattari, Parrent, and Peters, “Fusion and Visualization of Intraoperative Cortical Images with Preoperative Models for Epilepsy Surgical Planning and Guidance,” 149–60. 57 Jeremy Cooperstock, “Multimodal Telepresence Systems,” ieee Signal Processing Magazine 28, no. 1 (Jan 2011): 77–86. 58 Robert S. Allison, Todd Macuda, and Sion Jennings, “Detection and Discrimination of Motion-Defined Form: Implications for the Use of Night Vision Devices,” ieee Transactions on Human-Machine Systems 43, no. 6 (Nov 2013): 558–69. 59 Avi Parush, Michelle Sylvia Gauthier, Lise Arseneau, and Denis Tang, “The Human Factors of Night Vision Goggles: Perceptual, Cognitive, and Physical Factors,” Reviews of Human Factors and Ergonomics 7, no. 1 (Sept 2011): 238–79. 60 Nizar Sakr, Nicolas D. Georganas, and Jiying Zhao, “Human PerceptionBased Data Reduction for Haptic Communication in Six-DoF Telepresence

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Systems,” ieee Transactions on Instrumentation and Measurement 60, no. 11 (Nov 2011): 3534–46. 61 Frédéric Dehais, Mickael Causse, and Sébastien Tremblay, “Mitigation of Conflicts with Automation: Use of Cognitive Countermeasures,” Human Factors 53, no. 5 (Oct 2011): 448–60. 62 Hilary F. Jaeger, “A Glance at the Tip of a Big Iceberg: Commentary on ‘Recommendations for the Ethical Use of Pharmacological Fatigue Countermeasures in the U.S. Military,’” Aviation Space and Environmental Medicine 78, no. 5 (May 2007): B128–30. 63 Mendelsohn, Lipsman, and Bernstein, “Neurosurgeons’ Perspectives on Psychosurgery and Neuroenhancement,” 1212–18; Gregor Wolbring, Angelica Martin, Jeremy Tynedal, N. Ball, and Sophya Yumakulov, “Exploring Discourse Surrounding Therapeutic Enhancement of Veterans and Soldiers with Injuries,” Work 50, no. 1 (2015): 149–60. 64 Gutmann, Jacobi, Butcher, and Bertram, “Constrained Optimization in Human Running,” 622–32. 65 Bertram, “Constrained Optimization in Human Walking,” 979–91. 66 Antoinette Domingo, Marc Klimstra, Tsuyoshi Nakajima, Tania Lam, and Sandra R. Hundza, “Walking Phase Modulates H-Reflex Amplitude in Flexor Carpi Radialis,” Journal of Motor Behavior 46, no. 1 (2014): 49–57. 67 Mohammad Abdoli-Eramaki, Joan M. Stevenson, Susan A. Reid, and Timothy J. Bryant, “Mathematical and Empirical Proof of Principle for an On-Body Personal Lift Augmentation Device (pla d),” Journal of Biomechanics 40, no. 8 (2007): 1694–1700. 68 Mark A. Tarnopolsky, “Caffeine and Creatine Use in Sport,” Annals of Nutrition and Metabolism 57, Supplement 2 (January 2010): 1–8; Denis M. Pelletier, Guillaume Lacerte, and Eric D.B. Goulet, “Effects of Quercetin Supplementation on Endurance Performance and Maximal Oxygen Consumption: A Meta-Analysis,” International Journal of Sport Nutrition and Exercise Metabolism 23, no. 1 (2013): 73–82. 69 Shawnda A. Morrison, Stephen Cheung, and James David Cotter, “Importance of Airflow for Physiologic and Ergogenic Effects of Precooling,” Journal of Athletic Training 49, no. 5 (Aug 2014): 632–9; Kelly A. Larkin-Kaiser, Evangelos Christou, Mark Tillman, Steven George, and Paul A. Borsa, “Near-Infrared Light Therapy to Attenuate Strength Loss After Strenuous Resistance Exercise,” Journal of Athletic Training 50, no. 1 (Nov 2014): 45–50. 70 Eric D.B. Goulet, “Glycerol-Induced Hyperhydration: A Method for Estimating the Optimal Load of Fluid to Be Ingested before Exercise to

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Maximize Endurance Performance,” Journal of Strength and Conditioning Research 24, no. 1 (Nov 2009): 74–8. 71 Tom M. McLellan, “Protein Supplementation for Military Personnel: A Review of the Mechanisms and Performance Outcomes,” Journal of Nutrition 143, no. 11 (Nov 2013): 1820–33. 72 Sebastian Sattler and Constantin Wiegel, “Cognitive Test Anxiety and Cognitive Enhancement: The Influence of Students’ Worries on Their Use of Performance-Enhancing Drugs,” Substance Use and Misuse 48, no. 3 (Feb 2013): 220–32; Paul A. Kudlow, Karline Treurnicht Naylor, Bin Xie, and Roger S. McIntyre, “Cognitive Enhancement in Canadian Medical Students,” Journal of Psychoactive Drugs 45, no. 4 (Sept 2013): 360–5; Cynthia Forlini and Eric Racine, “Stakeholder Perspectives and Reactions to ‘Academic’ Cognitive Enhancement: Unsuspected Meaning of Ambivalence and Analogies,” Public Understanding of Science 21, no. 5 (July 2012): 606–25. 73 Garnette R. Sutherland, Stefan Wolfsberger, Shusma Lama, and Kourosh Zarei-Nia, “The Evolution of NeuroArm,” Neurosurgery 72, Supplement 1 (Sept 2012): A27–32. 74 Kersten-Oertel, Jannin, and Collins, “dvv: A Taxonomy for Mixed Reality Visualization in Image- Guided Surgery,” 332–52; Kersten-Oertel, Jannin, and Collins, “The State of the Art of Visualization in Mixed Reality Image Guided Surgery,” 98–112. 75 Dixon, Daly, Chan, Vescan, Witterick, and Irish, “Surgeons Blinded by Enhanced Navigation,” 454–61. 76 David D. Pothier, Cian Hughes, Wanda Dillon, Paul J. Ranalli, and John A. Rutka, “The Use of Real-Time Image Stabilization and Augmented Reality Eyewear in the Treatment of Oscillopsia,” Otolaryngology – Head and Neck Surgery 146, no. 6 (Jan 2012): 966–71. 77 Cooperstock, “Multimodal Telepresence Systems,” 77–86. 78 Ivar Mendez, Michael Song, Paula Chiasson, and Luis Bustamante, “Pointof-Care Programming for Neuromodulation: A Feasibility Study Using Remote Presence,” Neurosurgery 72, no. 1 (Oct 2012): 99–108. 79 Isabel Pedersen, “A Semiotics of Human Actions for Wearable Augmented Reality Interfaces,” Semiotica 155, nos 1–2 (January 2005): 183–200. 80 Erica Wiseman, “Scientometric Study on Human Optimization: Phase 1 (Canada),” Contract Report of Defence Research and Development Canada (DRDC-RDDC-2015-C 235), 2015; Erica Wiseman, “Scientometric Study on Human Optimization: Phase 2 (International),” Contract Report of Defence Research and Development Canada (DRDC-RDDC-2016-C080), 2016.

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81 Kia Wiklundh, Johan Schubert, Tommy Westman, Anna Lindberg, Jonathan Westman, Kaan Korkmaz, and Jerker Hellström, “Horizon Scanning of Chinese Data Sources: A Pilot Study within the Area of Urban Warfare,” Report FOI -R–4374–S E of the Swedish Defence Research Agency. Stockholm: FOI , 2016. 82 Samuel R. Delany, “The Necessity of Tomorrows,” in Starboard Wine: More Notes on the Language of Science Fiction (Pleasantville, ny: Dragon Press, 1984), 35. 83 Delany, “Dichtung und Science Fiction,” in Starboard Wine, 165–96. 84 c i h r , nserc, and s s hrc, Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (Ottawa: Interagency Secretariat on Research Ethics, 2014).

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3 Forecasting Futures and Possible Implications: The German Experience Annika Vergin

Today, Human Performance Enhancement (h p e ) is generally understood in terms of improving human performance capability beyond that which is achieved naturally. In the context of this article h p e includes a wide range of technologies and methods from simply taking pharmaceuticals up to surgical interventions that do not serve therapeutic or rehabilitative purposes. Rather, the dual-use nature of these technologies is being leveraged to enhance performance beyond the limits of what is considered natural. Generally, within the context of this broad understanding of h p e , the effects, benefits, and “legitimacy” of h p e have to be discussed. The scope is broad and includes issues regarding equal status and treatment of h p e users within the academic community as well as discussions of the possible disadvantages of persons who cannot afford or object to h p e . Legal and ethical issues concerning h p e consequences both for the individual user and for other persons have to be part of the public discourse. It is within this context that this chapter investigates the application and the effects of hpe to soldiers and in particular, on soldiers in the German Armed Forces. Besides civilian users, the armed forces have also always had an interest in enhancing the performance capabilities of their soldiers. In the past, the scope of such enhancement ranged from using a slingshot to increase the throwing range, to the knight’s armour to reduce the risk of injury, to Second World War soldiers taking pervitin (methamphetamine or the very early version of what is commonly referred to today as “crystal meth”) in the form of tablets

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or as ingredients of “pilot’s salt” in order to enhance their physical and mental performance capabilities.1 Moreover, various hpe measures are used by several armed forces and even non-state actors in contemporary conflict. Given these realities, what are the challenges that may face the German Armed Forces from the use of hpe by enemies or allies? For this purpose, the focus of interest is placed on hpe use by potential enemies and the associated impact on own actions. As an example, during a conflict, soldiers of the German Armed Forces might be confronted with enemies who in terms of vulnerability, exhaustion, or mental effects do not act as you would expect from a “normal” person. Moreover, in the context of multinational operations with allied soldiers, the German Armed Forces might encounter h p e when it comes to taking care of wounded persons (enemies as well as partners) or treating captives. Principally, the question also arises if the German Armed Forces has to expect a change of the general threat potential due to the use of h p e by potential enemies. Ethical and legal issues will not be considered explicitly in this chapter. Nevertheless, the social discussions herein are indeed informed by them. This chapter is based on a study from the Future Analysis Branch of the Bundeswehr Office for Defense Planning in cooperation with the Fraunhofer Institute for Technological Trend Analysis.2 As a first step, the experts from the Fraunhofer Institute did a scientometric study on the current status of research into hpe in general; the approach was similar to Niall and Wiseman in chapter 2 of this volume. The individual technologies were explained and an assessment in terms of benefits, efficiency, operational readiness, and possible risks were provided, as far as they could be predicted. An important point was the broad spectrum of hp e technologies we wanted to analyze. The scope ranged from biochemical hpe to non-invasive and invasive hpe technologies to human bio-monitoring aspects. The results were recorded in profiles. Table 3.1 gives you an overview of all analyzed technologies and the following text gives you a brief summary about the different enhancement approaches. biochemical hpe

Pharmacologic Enhancement Pharmacologic enhancement of performance capability is defined as the application of substances, on or in the healthy body, that are

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Table 3.1 Overview of analyzed hpe technologies Approaches Biochemical HPE

Non-invasive HPE

Invasive HPE

Pharmacologic enhancement

Transcranial stimulation

Sensoric neuro prostheses

Nutrition-based enhancement

Exoskeletons

Deep brain stimulation

Genetic enhancement (gene doping)

Augmented Reality

Expansion of human sensoric

Silent Speech Interface systems

Tissue engineering

Human bio-monitoring

supposed to enhance physical and/or mental performance and/or prevent damage. For example, a short-term enhancement of physical performance capability can be achieved by means of pain relievers. But suppressing pain and its warning function may cause unpredictable complications, as well as severe side effects. The use of substances of this sort is hardly relevant for the military and may on the contrary even be counter-productive. On the other hand, considerable positive effects can be achieved in enhancing the mental performance capability with respect to awareness and wakefulness. Caffeine, the probably best-known stimulant, will maintain its dominant position in the civil and military sectors merely for legal regulatory reasons. On top of that, one nato partner – the US Military – has an official policy to use amphetamine and modafinil3 as stimulants in specific military situations.4 Despite the basically positive effects of such pharmaceuticals, the German Armed Forces explicitly exclude their use for enhancing its soldiers’ performance capabilities. They will only be administered for medical reasons in order to cure sick soldiers.5 Soporifics (sleep aides) and tranquilizers are other substances used by some n ato partners in order to enhance military performance capabilities by using sleep and rest phases more efficiently. For this purpose, a broad variety of pharmaceuticals are available.6

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In the civil sector, antidepressants are frequently used to increase motivation. Apart from the fact that it is not known if and to what extent they are used in other countries’ armed forces, there is to date no reliable evidence as to the desired effects. In addition, researchers have consistently been attempting to enhance other cognitive functions, such as intelligence or the learning ability. Neutral analyses state that neither today nor in the near future will noteworthy success be achieved in these fields.7 With regard to damage prevention, unquestionable success has been achieved with vaccines. In this field, considerable progress can be expected in the next years. For instance, the prevention of motion sickness through medication is easily possible today.8 All these are forms of enhancement and have met (or continue to meet) various degrees of ethical, legal, and policy resistance. Nutrition-based Enhancement of Performance Capability At the most basic level, human performance is linked to its capability to metabolize energy by consuming oxygen. From maintaining vital functions to physical and cognitive top performance, all physiological processes in the human body require a specific amount of energy, which is provided by nutrients. Newly gained nutrition science findings are applied in the development of food products and nutrition strategies in order to enhance physical and cognitive performance capabilities.9 The focus is placed on so-called functional foods, also known as nutraceutics. By administering respective products, usually supplemented with special isolated ingredients, it was possible to obtain results that to date could not be achieved by means of common diets.10 In many cases, however, scientific evidence for the effectiveness is still a problem. Genetic Enhancement of Performance Capability (“Gene Doping”) Based on a small number of special athletes, who were capable of extraordinary sporting performance due to natural gene mutations, the basic idea of gene doping evolved. With the emergence of gene therapy, it has been increasingly discussed over the past fifteen years if this technique could also be applied to the genetic enhancement of a healthy human’s performance. However, the application of genetherapeutic methods to enhance human performance capabilities proved to be impossible at present and, according to reputable

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scientists, will not be possible in the foreseeable future. It does seem possible, however, that persons or systems with ethical and moral basic values different from ours will use gene doping in the future. Apart from the application in animal breeding, its use by elite-level athletes in sports is considered probable. However, an actual enhancement of the performance capability of healthy or highly trained test persons has not been proven until now. n o n - i n va s i v e h p e a p p r o a c h e s

Non-invasive technologies are defined as approaches the use of which does not require surgical intervention. Transcranial Stimulation During the past two decades, various procedures have been developed to positively stimulate the human brain from outside the pericranium (hence transcranial).11 The two most important basic types are magnetic (tms) and electrical (direct current) stimulation (tdcs), both of which have been clinically tested. Indeed, the previous chapter by Niall and Wiseman expertly chronicles these efforts within the Canadian context. Progress in the past years has given rise to the assumption that, apart from therapeutic effects, they are able to improve various performance parameters of the healthy brain beyond the norm. The central factor for this is the so-called plasticity of the brain. From today’s perspective, when coupled with training, transcranial stimulation has demonstrated improvement of various performance characteristics of the brain. These include, for instance, voluntary motor function, cognitive abilities, as well as simply improvements in memory. The effects may be short-term or long-term. The long-term effects continue for hours and may lead to permanent changes in the brain when re-applied on a daily basis for weeks. With respect to hp e , this method appears to be promising from today’s perspective. As with most performance enhancement methods, the instrumental treatment must always be completed by individual training in order to show the desired effects. Already today, a directed use of a stimulation method combined with individual training, such as in the enhancement of cognitive characteristics, appears to be possible in theory. However, there is little insight so far and no statistical evaluations yet. In this respect, the first directed optimization approaches can actually be expected in five to ten years.

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On the other hand, there is initial verifiable success in the use of short-term effects related to vigilance over longer application periods. A study showed that stimulated test persons focused on their tasks much longer with constant attention than participants of a nonstimulated control group. Based on these findings, scientists recommend more practical research into the positive transcranial stimulation effects on a brain already engaged in conventional tasks.12 In doing so, they explicitly take perspectives relevant for military technology. Exoskeletons Exoskeletons are supposed to support persons as outer structures (in therapeutics), to assist in carrying loads or to protect their wearers. During the past fifteen years, various whole-body exoskeleton prototypes have been developed primarily in Japan and the U.S. for medical and military applications. Special lower-extremity systems have been developed in the U.S., Israel, and New Zealand, among others. Until now, exoskeletons enhance their wearer’s strength. However, it is also desired to improve velocity and jumping power.13 By now, previous models have been developed that so far do not have an adverse effect on their wearer’s walking velocity. However, an improvement of the jumping power has not been achieved yet. Whether exoskeletons can be used to a greater extent in logistics or the military with respect to extending human capacities will depend on further progress in the manufacture of individual components. Such components must be lightweight and resistant to meet the desired requirements. Besides a stable man-machine interaction at cognitive and physical levels, good carrying capability, transportability, and an enduring, reliable power supply, as well as the wearer’s acceptance remain crucial – and, to varying degrees, unrealized – factors. For this purpose, operation controls must be designed in such a way that they are intuitive and smooth and do not hamper the operator in his work.14 Previous success and research were promising and led to some successful prototypes. These prototypes have typically been used in comparatively “simple” environments, and a sufficient power supply has always been available. For military use, the engineering behind these developments needs to advance to work in harsher and more austere environments. The considerations on requirements of exoskeleton for military use described so far are rather a general overview. Chapters 6 and 7 discuss exoskeletons in more detail. Bossi et al. discuss the contribution that

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exoskeletons can make to assist soldiers in coping with heavy burdens. And Karakolis et al. show the risks and dangers of exoskeletons in military use. Augmented Reality Augmented Reality (ar) is a rather new type of it systems user interface.15 It extends the real user environment by virtual components generated by a computer in real time. The computer-generated extension of reality typically is a matter of visual information. ar can also use other types of sensory perception, such as audible or tactile information. For this purpose, the virtual information array has a fixed reference to the real objects in the respective environment. In this way, this should convey the impression that the virtual components are actually elements of the real world. In the case of visual information, this means that a computer-generated object is integrated into the user’s current field of vision in such a way that its position in relation to the current real environment does not change when the user is moving therein. This combination of real and virtual objects is then displayed by means of an appropriate display technology (head-mounted displays (hmds), handheld displays, and projection-based displays). Due to its unique integration of the real world and virtual information, a r is a most promising technology.16 However, there are still some technical challenges, especially with regard to tracking and the availability of h m d s that do not limit the user’s scope of action too much. Silent Speech Interface Systems Silent Speech Interface (ssi) systems are developed with the aim of facilitating soundless speech transmissions. This technology originates in the assistance of speech-impaired persons, but may also be required in high-noise environments. In a military context, silent communication could be an advantage in numerous situations. Another advantage of this kind of communication is that it does not require visual contact. Contrary to visual forms of communication (such as sign language or the use of gestures), it can be used in low light as or covert conditions. Some research has described different techniques suitable for the implementation of s s i systems.17 Their scope ranges from implantable components through the use of sensors detecting vibrations,

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electromagnetic signals, or facial muscle movements to the transmission of voiceless speech based on electroencephalographic procedures. Microphones using vibration sensor systems (laryngophones or bone microphones) are already integrated into firefighters’ helmets or freehand communication devices. In the past years, several projects initiated by the military have been conducted to test the fitness for military use of microphones using vibration or electromagnetic sensor systems. Some systems are used by the military today and are commercially distributed.18 Tissue vibration microphones can be connected to cell phone headsets in conjunction with an amplifier. By means of this system, the user can both speak without sound and receive spoken information. The first systems are already on the market. i n va s i v e h p e m e t h o d s

Invasive h p e methods are defined as approaches requiring surgical intervention in the human body. Clearly, the vast majority of these techniques are used for therapeutic purposes but again, as discussed in the introduction to this volume, the technologies face an acute dualuse problem as they can rehabilitate but also enhance. There is hope that the risks of such surgery will be offset by the possibilities that would result from a much closer connection between man and technology. Basically, scientists hope to be able to detect nervous signals in a clearly higher spatial and temporal resolution and stimulate them much more accurately by means of such surgical interventions. We will not describe the methods further here since our literature research results have shown that possible applications for the improvement of the performance of healthy persons are usually only speculations. Human Bio-Monitoring Human bio-monitoring is another h p e method that is increasingly being discussed as either direct technical means or at least as a basis for measures enhancing performance. Originally, respective systems had been developed to monitor medical or general biochemical processes in the human body for a longer period in order to be able to identify and treat possible dysfunctions. Human bio-monitoring systems could enable remote monitoring of soldiers on deployment and assist in averting imminent health risks and stress factors.19 Carrying

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the respective equipment could have a positive psychological impact on the soldier equipped with such a system by conveying to him the sense of increased safety: he can get medical care in any situation and can obtain help at any time, in theory. Lately, significant development efforts have been made to achieve a direct improvement of fitness and performance capability by means of appropriate systems through the application of bio feedback procedures or the integration of components for the release of performance-enhancing pharmaceuticals in human bio-monitoring systems (sample-to-answer).20 Development approaches for the adaptive improvement of man-machine interfaces based on an automated analysis of human bio-monitoring measurement results also pertain to these procedures that directly enhance performance. On the other hand, determining the current fitness condition by means of human bio-monitoring in many cases is a prerequisite for the success of subsequent performance-enhancing measures, especially by means of training and dietary change. An important critique of this trend was raised in a discussion in a small forum in early 2017. The experts question the usefulness of biomonitoring when used on a large scale by many soldiers. Who should evaluate the data volume and make necessary decisions? Is it possible and useful in combat situations to help the soldiers in this way? Furthermore, it was noted that the transfer of data increases vulnerability by tracking and hacking by the enemy. On the other hand, bio-monitoring was expressly emphasized for the care of the wounded. Again, the technology although improving information flow and thereby empowering certain actors (like medics), may also overwhelm (like fellow soldiers or commanders). The information being generated also requires filters. In short, not everyone needs to know everything. h u m a n p e r f o r m a n c e d e g r a d at i o n

As the opposite of hpe, Human Performance Degradation constitutes a threat that has rarely been considered until now. By using technologies similar to h p e methods the degradation of an enemy’s performance should be achieved in a way that is as inconspicuous and insidious as possible. In doing so, the selected actions for releasing or spreading things like new pharmaceutical substances would be similar to those methods that have been used for many centuries (like contaminating wells with dead animals). The type of the substances used and their effects on the soldiers would be new, but not the intent.

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There could be scenarios in which the water supply system of field camps would be manipulated over a long period by an illegal contamination with pharmaceutical substances in order to affect the soldiers’ behavior. It is also possible for prisoners of war (p ow) to be treated with substances affecting the mind in order to compel statements or, after releasing them, to use the soldiers against their own forces. Again, one can imagine that not only are the ethical and legal implications worrying, but so too are the broader societal ones. ta l k i n g a b o u t t e c h n o l o g i e s : s c i e n c e m e e t s m i l i ta r y

Having completed this brief scientometric analysis, the next step was to examine how this will impact upon the operations of the German Armed Forces. The challenge was to combine the knowledge of the scientists with the experience of our military leaders. In order to assess the advantages and risks of the analyzed technologies, an intensive dialogue between scientists and the individual users of these technologies was crucial – especially in a security and military environment. A particular challenge during this exchange was the encounter of the specific scientific and military terminologies, which sometimes hamper the communication and hence made it difficult to reach decisions for the future. The remainder of this chapter – along with the following chapter by de Boisboissel – seeks to connect this scientific expertise with the realities and demands of military operations. First, the results of the scientometric analysis, which was presented in the first part of the chapter, were summarized in a technical report for the German armed forces. For further work it was important that the scientists had a minimum of military understanding. Subsequently, the results were presented in a two-day consolidation workshop, beginning with the presentation of the researched technologies by the scientists. Afterwards, the military was able to intensify its technological understanding in thematic meetings, which were moderated by the scientists. Within these sessions, substantive issues could be discussed and correlated with military and security-related demands. These sessions dealt with specific aspects of the military operational demands. For further evaluation of the possible advantages and risks of the new technologies, the second day began with a creative method such as “World Café,” Syntegration, or a combination of several different methods. In our case, we combined the method of “The World Café”21 with parts of the military method of War Gaming. Three teams,

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Desktop research bibliometrie

Technical report

Experience in mission scenarios

Military knowledge

Consolidation - Workshop Thematic sessions

Creative methods

Hot topics Recommendations New perspectives

Figure 3.1  Schematic of the principal methodical approach

following the World Café method, switched to different topic tables in three rounds. At the topic tables, the teams had to do typical war game tasks. On two topic tables, the teams were blue teams and on one a red team. The blue team was presented with two scenarios. In the first, blue was allowed to have partially enhanced soldiers, but faced a fully enhanced adversary – red – team. In the second scenario, the blue team also fully enhanced, but face the same adversary. The possibilities of hpe methods in mission scenarios were evaluated quite differently depending on the team membership. But they agreed in one point: hpe technologies are fantastic new options but they are no general game changers. Table 3.2 gives an overview about the aspects and initial assumptions the military teams discussed in the different sessions. Each team’s outcomes will be discussed in detail below. Red Team None of the three red teams found the ultimate powerful or destructive hpe method to win. An interesting point was the idea that, besides the usual red team suspects such as states or terrorists, organized crime syndicates may become big players in the future like they are in cybercrime today. They have the money, they are unethical enough, and they are often technophilic. Later on they could be the supplier of the terrorists. Instead of the use of hpe technologies the teams discussed very intensive the use of hp e methods and low-tech alternatives to hpe like robots and drones. One team had the idea to use hpe methods on the political parquet to enhance the mental abilities of their negotiator. As a last aspect of the red teaming I would like to mention the different acceptance of hpe methods in different states. This could have economic and social effects following a shift in power between the states, which make military conflicts unnecessary.

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Table 3.2 Overview about aspects and first assumptions of the military teams in the creative method part Team Red

Team Blue 1

Team Blue 2 (multinational)

Which actors are to be The most urgent prob- The duty of the military commander lem – reconnaissance: to take care of the health of his considered? soldiers • Identification of 1. Organized crime • Supply and procurement for HPE technologies 2. Special forces each nationality in combat 3. Terrorists • Illegal procurement between • Estimation of ­soldiers of different nationality the resulting new (“upper range way”) power/force (in Combat) • Weaknesses and risks of the HPE technologies (for counter actions) Capabilities: 1. Human Performance Degradation (main focus) 2. Depending on mission scenario and financial possibilities

Which actors are to be Joint missions of enhanced and nonconsidered? enhanced soldiers: • Distribution of the mission/ operating time of each soldier • Group dynamics • Malfunctions and side effects of H P E technologies

HPE technologies in diplomatic context – enhanced diplomats in crisis situations

Which mission ­scenarios are to be considered? • Adaptation of planning and conduct of operations

HPE as societal idea – predominance of a state on social, technological, and economic level

HPE technologies have Focus on psychological, sociological, no disruptive technol- and legal aspects, no technological questions ogy potential. There are no game changers.

No team has found the one distinguished HPE technology.

A clear directive situation for the medical service is needed.

The civil society is the driver in questions of acceptance and use.

Blue Team 1 (only national) The team Blue 1 described the mission scenario as a “David against Goliath” story. They saw themselves as non-enhanced David and had

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to fight against the enhanced Goliath. The most urgent problem for all three blue teams was reconnaissance, especially of nonvisible enhancement technologies. In principle they thought the problem was solvable with the progress in research. After reconnaissance came the search for weak points and risks of the h p e methods of the enemy the second urgent task. This knowledge could be used for training and general preparation for mission. They developed the idea of a researcher task force as supporter for the leader of the mission. Even recognizing a need to adapt the planning and conduct of operations, they did not see hpe methods and technologies as a true game changer in combat. Blue Team 2 (multinational) In these teams the main focus was on psychological, sociological, and legal aspects. One of them was the duty of the military commanders and the mission doctors to take care of the health of his soldiers. For that purpose they demanded knowledge and intelligence about h p e technologies. In addition, a clear military and/or political directive is important. In the case of enhanced and non-enhanced soldiers, they asked themselves whether a joint mission was possible and useful. How should the operating time be distributed between the different soldiers? Could a separate group dynamic develop, and how would this be controlled? Technological questions weren’t mentioned at all. All teams agreed; the civil society is the main driver in questions of acceptance and use of hp e technologies and methods. The final outcome of the whole process was a better understanding of the specific ways hpe technologies and methods could provide new perspectives for security and military priorities, and recommendations for future orientation in this area. Evaluation Currently, most h p e technologies are far from being ready for use. Some pharmacological substances, including various stimulants, are exceptions to this. Scientists are investigating their potential intensively. Some of these substances are already used in civilian and military contexts. Within the framework of military conflicts, it must be assumed that they are used by single allied forces as well as enemy forces.

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Exoskeletons and transcranial stimulation methods are but a few examples of technologies that could be of interest to the German Armed Forces in the near future. However, it must be assumed that the disruptive potential of most technologies presented so far appears to be rather small. Above all, technical-scientific aspects are decisive factors for this. For this reason, hpe technologies presumably do not require sweeping changes of established operational tactics at this time; they do not constitute a “game changer.” However, it will be necessary to develop or expand reconnaissance and detection techniques in such a way that h p e technologies used by enemies can be detected and identified. Military education and training should be adapted accordingly in order to be prepared for both confrontation and cooperation with “enhanced” soldiers. Both development and acquisition costs as well as the complexity of the technology play an important role for potential actors (in the sense of h p e technology users). However, it is perfectly reasonable to assume that cheap and easy-to-use technologies will be used not only by government actors but also by non-state actors having the necessary financial capacity and an appropriate know-how. Furthermore, a nation’s or group’s socio-cultural background also plays an important role for accepting and using h p e technologies. This socio-cultural background and the social acceptance of respective technologies resulting from it could even become major drivers for these technologies. From this perspective, especially within the civilian environment, these attitudes and perceptions could evolve to an important driver for the application of enhancement technologies in the future. Indeed, the transhumanist movement – explained in the introduction and previous chapter of this book, is an example of hpe’s proverbial early adopters. Rather than possible advantages in military conflicts, social elements such as stress to perform, technophilia, or competitiveness could, in a faster and more sustainable way, lead to an increasing use of these technologies. In the short run, it should be resolved in a discussion of values and a political discourse how society and the German Armed Forces (gaf) will deal with such developments. Within the g af, such a discourse will enable commanders to appropriately discuss this topic with subordinate soldiers. This overall care responsibility is required especially when soldiers without enhancement technologies must cooperate in international operations with those that do have and use these

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technologies. Such a debate must take in to account the possibility that in some societies, hpe is taken for granted and used extensively, while in others it may not be. On a technological level, future developments might evolve in such a way that different h p e approaches or combinations of h p e and other (current rather than competing) technologies will be combined and synchronized. However, at present there is no information about systematic research in this field, except for a few attempts to support transcranial stimulation effects on a pharmacological basis. Moreover, from this technological perspective generally the question arises whether there are alternative technologies that could be used instead of hpe technologies. Automation, machine learning, and the increasing pervasiveness of the Internet of Things come to mind. Then again, in some cases low-tech approaches might possibly lead to better and cheaper solutions too. The single largest deduction from this exercise is a need that we call “technological intelligence” or ti. Like cultural intelligence, ti’s progenitor, decision makers need to be aware of and sensitive to the rapidly changing technologies and how they can influence defense and security issues. At the same time, a deep understanding of the respective techniques is necessary in order to be able to analyze possible benefits, risks, and weaknesses. In short, decision makers need to consider how best to balance the capability enhancements while guarding against the socially damaging costs of h p e adoption. conclusion

This chapter showed that the term “Human Performance Enhancement” is just a vague description for a variety of very different technologies, a selection of which have been presented both in this chapter and in the previous chapter by Niall and Wiseman. Some of these technologies are already in use by potential adversaries and allies alike. Indeed, hpe can no longer be considered a topic of science fiction. As society responds and develops to the technological advances and in fact, begins to accept aspects of it, so too will the military need to adapt. As part of the society, the German Armed Forces will be increasingly confronted with this subject matter and will have to face the consequences to be derived from it. Non-invasive h p e technologies aiming at the protection and survival of our soldiers should definitely be considered for our own benefit with due regard to ethical, legal, and indeed social implications.

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notes

  The Bundeswehr Office for Defense Planning pools tasks, competences, and responsibilities within the German Armed Forces planning network on a level subordinate to the Federal Ministry of Defense. It provides method skills and scientific tools for the German Armed Forces and d ­ evelops the basis for the future orientation of the German Armed Forces. In this context, Security-Related Future Analysis serves the purpose of acquiring knowledge in order to update conceptual specifications and aims on a ­scientific basis and at an early stage. It provides ideas and concepts for the future orientation of the German Armed Forces in and thus constitutes a central element with regard to the long-term process of capability planning.   The studies of the Future Analysis Branch are prepared in-house. In particular, they draw on knowledge from civilian scientific institutions as well as from different federal ministries in addition to the military expertise. However, the results are not coordinated with other ministries or research institutes and it is not intended to interfere with their responsibilities. The research papers of the Future Analysis Branch do not reflect official positions of the Federal Ministry of Defense.   1 Erik Eggers, “Peppige Panzerschokolade,” Die Tageszeitung (28 Dec 2006).   2 Bundeswehr Office for Defense Planning, “Future Topic Human Enhancement” (July 2013).   3 Modafinil is a drug used for narcolepsy treatment.  4 Leader’s Guide to Soldier and Crew Endurance (United State Army Combat Readiness Center, Jan 2015): 29–31.   5 In the German Armed Forces, the administration of pharmaceuticals is governed by the German Medicinal Products Act.   6 Russell K. Gore, Timothy S. Webb, and Eric D.A. Hermes, “Fatigue and Stimulant Use in Military Fighter Aircrew during Combat Operations,” Aviat Space Environ Med 81, no. 8 (Aug 2010): 719–27.   7 Andreas Franke and Klaus Lieb, “Pharmakologisches Neuroenhancement und ‘Hirndoping,’” Bundesgesundheitsblatt 53, no. 8 (Aug 2010): 853–60.   8 Irene Klotz, “n asa in Nasal Spray Deal to Combat Motion Sickness,” Reuters, accessed 16 July 2018, http://www.reuters.com/article/2012/10/12/us-space-nasalspray-idUSBRE89B1AZ20121012; Hiroshi Kobayashi, Takamitsu Aida, and Takuya Hashimoto, “Muscle Suit Development and Factory Application,” International Journal of Automation Technology 3, no. 6 (Jan 2009): 709–15.   9 Swati Chaturvedi, P.K. Sharma, Vipin Kumar Garg, and Mayank Bansal, “Role of Nutraceuticals in Health Promotion,” International Journal of PharmTech Research 3, no. 1 (Jan 2011): 442–8.

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10 Louise Deldicque and Marc Francaux, “Functional Food for Exercise Performance: Fact or Foe?” Current Opinion in Clinical Nutrition & Metabolic Care 11, no. 6 (Dec 2008): 774; Harris R. Lieberman, Trisha B. Stavinoha, Susan M. McGraw, Alan White, Louise S. Hadden, and Bernadette P. Marriott, “Use of Dietary Supplements among Active-Duty US Army Soldiers,” American Journal of Clinical Nutrition 92, no. 4 (Oct 2010): 985–95. 11 Hidde J. Haisma, Olivier de Hon, P. Sollie, and J. Vorstenbosch, “Gene Doping,” in Nether-lands Centre for Doping Affairs Online, accessed 18 June 2013, http://www.dopingautoriteit.nl/media/files/­documenten/ 2009/Gene%20Doping.pdf; Chaturvedi, Sharma, Garg, and Bansal, “Role of Nutraceuticals in Health Promotion,” 442–8; James J. Cox et al., “An S C N9A Channelopathy Causes Congenital Inability to Experience Pain,” Nature 444, no. 7121 (Jan 2007): 894–8. 12 Jeremy T. Nelson, R. Andy McKinley, Edward J. Golob, Joel S. Warm, and Raja Parasuraman, “Enhancing Vigilance in Operators with Prefrontal Cortex Transcranial Direct Current Stimulation (tDC S),” NeuroImage 85, no. 3 (Jan 2014): 909–17; R. Andy McKinley, Nathaniel Bridges, Craig M. Walters, Jeremy Nelson, “Modulating the Brain at Work Using Noninvasive Transcranial Stimulation,” NeuroImage 59, no. 1 (Jan 2012): 129–37. 13 E. Guizzo and H. Goldstein, “The Rise of the Body Bots,” IEEE 42, no. 10 (Oct 2005): 50–6. 14 Rachel E. Cowan, Benjamin J. Fregly, Michael L. Boninger, Leighton Chan, Mary M. Rodgers, and David J. Reinkensmeyer, “Recent Trends in Assistive Technology for Mobility,” Journal of Neuroengineering and Rehabilitation 9, no. 20 (Apr 2012). 15 Julie Carmigniani, Borko Furht, Marco Anisetti, Paolo Ceravolo, Ernesto Damiani, and Misa Ivkovic, “Augmented Reality Technologies, Systems and Applications,” Multimedia Tools and Applications 51, no. 1 (Dec 2010): 341–77. 16 David C. Roberts, Stephen Snarski, Todd Sherrill, Alberico Menozzi, Brian Clipp, and Patrick Russler, “Soldier-Worn Augmented Reality System for Tactical Icon Visualization,” accessed 16 July 2018, https://www.spie​ digitallibrary.org/conference-proceedings-of-spie/8383/838305/Soldierworn-augmented-reality-system-for-tactical-icon-visualization/10.1117/ 12.921290.short?SSO=1. 17 Bruce Denby, Tanja Schultz, Kiyoshi Honda, Thomas Hueber, J.M. Gilbert, and J.S. Brumberg, “Silent Speech Interfaces,” Speech Communication 52, no. 4 (April 2010): 270–87.

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18 Tomoki Toda et al., “Technologies for Processing Body-Conducted Speech Detected with Non-Audible Murmur Microphone,” Proceedings of the Annual Conference of the International Speech Communication Association, interspeech (6–10 Sept 2009): 632–5. 19 William J. Tharion, Mark J. Buller, Anthony J. Karis, and Reed W. Hoyt, “Development of a Remote Medical Monitoring System to Meet Soldier Needs,” Proceeding of the Human Factors and Ergonomics Society 51, Annual Meeting, Baltimore (2010): 1006–10. 20 Jian Zhou et al., “Bio-Logic Analysis of Injury Biomarker Patterns in Human Serum Samples,” Talanta 83, no. 3 (Jan 2011): 955–9; H.L.H. Linh et al., “In Vivo Rapid Delivery of Vasopressin from an Implantable Drug Delivery Micro-Electro-Mechanical Device,” International Journal of Drug Delivery 3, no. 2 (May 2011): 216. 21 “The World Café Method,” accessed 19 May 2017, http://www.­ theworldcafe.com/key-concepts-resources/world-cafe-method/.

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4 Perspectives on the Enhancement of Soldiers: A French Approach Gérard de Boisboissel

How can the human deficiencies of a soldier be countered on a battlefield? Society has sought to improve the combat effectiveness of its soldiers throughout history. In order to remain the most efficient battle-hardened warriors in the field, even under the harshest of conditions, soldiers need improved protection and capabilities. Two forms for increasing performance have emerged: (1) providing better equipment than that of the foe, and (2) preparing soldiers to surpass themselves in combat by following individual and collective training exercises, or by increasing their perception abilities, or by enhancing their performance by the intake of doping substances. Soldiers face constant challenges on the field and the challenges are timeless. They must overcome human limitations such as stress, fatigue, hunger, heat and cold, loads carried, and reduced alertness. Ultimately, they must be more efficient than their enemy to defeat them. Yet, our original question is nowadays reflected by envisaging technological innovations due to digitized battlefields and the recent interconnection of soldiers with military weapon systems. It is also reflected by technological advances in the medical and pharmaceutical sectors, in nanotechnologies, information technology, and in neurosciences. Following the arms race of these last decades and considering human value to be at the heart of military decision making, will a new race for enhancement arise due to the augmentation of a soldier’s performance? And if so, for what operational goals? This is the reason why, since 2015, the Research Centre of the Écoles de Saint-Cyr Coëtquidan (crec-Saint-Cyr) has been concerned with the question posed in this anthology. How should human performance

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enhancement technologies be secured for the military and the levels of enhancement correctly determined in an operational setting? How should h p e be used in a way that enhances capability while still respecting the ethical and legal implications of these enhancements. Moreover, are there ethical and legal implications unique to French military traditions and the respect of our nation’s rules and regulations in terms of the demanding profession of a soldier? definition of an enhanced soldier

Before considering how to eventually enhance soldiers, we should first define what we mean by enhancement. In the introduction to this volume Stéfanie von Hlatky, Stéphanie A.H. Bélanger, and H. Christian Breede define human performance enhancement as the deliberate increase of human potential beyond that which is achieved naturally. The c r e c Saint-Cyr, to be as exhaustive as possible, proposes the following definition presented in its publication “Le soldat augmenté” in 20171: “Enhancing a soldier … is the action of rendering him/her more efficient in each military operation (endurance, efficiency) by: • strengthening his/her intellectual skills (mental, psychological, cognitive) and/or physical abilities, or by letting him/her acquire new ones; • using technological equipment s/he wears or using non-­ therapeutic substances or using static dynamic implants (nanomaterials) and/or external prostheses becoming one with his/ her body or by applying suitable gene therapeutic treatment, • for short or long term use, that can even be irreversible (anthropotechnics).” Furthermore, any enhancement should in theory be agreed upon without any negative physiological impact on the soldier. The definition given above is purposefully general in content to d ­ iscern various enhancement possibilities following two key aspects: •

•

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The first relates to the enhancement of the soldier by the equipment worn by him/her (non-invasive); The second relates to enhancing the soldier with various means that have a direct impact on the human body, with reversible or irreversible consequences (invasive).

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technological enhancements: easing the burden

Since the end of the twentieth century, advances in computer and electronic technologies have been the source of a major transformation and now all weapon systems are endowed with sensors and algorithms. This improves their efficiency but also increases a fighter’s cognitive load during operations. With this in mind, what solutions can technology bring in augmenting the performance of tomorrow’s soldier; providing them with tactical advantages on the field? Recent technological innovations enable a soldier to be better informed about the surrounding environment and about their personal limitations. In simple, user-friendly ways such innovations can improve remote monitoring of their physiological state and of intervention forces. Recent innovations also assist the fighter in alleviating the oldage constraint of carrying heavy equipment that reduces mobility, increases vulnerability, and causes greater fatigue. An additional cognitive load, due to ever more complex systems, must now be managed by the fighter (growing digitization of military equipment now integrated in battlefields). Consequently, informing a soldier of their tactical situation during the manoeuvre will offer them new anticipatory potentials and assist them in making decisions in a complex environment. An enhanced soldier is therefore a soldier who uses technology to improve their cognitive abilities in order to be better informed on the tactical environment, to be assisted in decision making, to be better monitored physiologically, and to augment their physical resistance by alleviating the loads they carry, all while improving their ability to deliver capability. the informed soldier

Personal Physiological Limitations To know oneself is of prime importance in military actions. A leader must be aware of the state of fatigue of their troops and the reduced levels of attention stemming either from intense periods of activity (intensive fights, marches) or from long observation periods (such as surveillance). Even if it is reasonably simple for a leader living in close proximity with their soldiers to perceive their general state, it would nonetheless be useful to develop tests determining a unit’s global level

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of attention – for example by measuring a group’s response time to visual stimuli or to simple questions. A slow response time would indicate that the unit needed to rest before partaking in further military action. Such data will help maintain soldiers fit for combat by enhancing their movements, after assessing terrain constraints and after measuring their physiological state. The same would apply to assessing stress levels and the emotional status of the group, such as ensuring that its members make the right decision by avoiding careless actions or unjustifiable moves towards an opponent. This would particularly apply to the use of lethal weapons, depending on operational constraints and requirements. Being informed of each soldier’s heart rate would be a good indicator in this case. On the physical plane, the use of a thermometer to measure the body temperature of every individual – and indicate correct hydration levels – will determine whether a unit needs to take a pause or be provided with food and water. The same applies for measuring heart rates and body temperatures with a range of sensors embedded in soldiers’ clothes. Such physiological data can be transmitted to military medical officers who can assist unit leaders in assessing the state of each individual and offering soldiers direct health support in the field. The deterioration of mental performance in sleep-deprived soldiers also requires stimulants in a extreme situations. To this end the French dga (Direction générale de l’armement), in collaboration with irba and the company Theranexus, has developed recently the m o d e f i project, combining Flecainide – an antiarrhythmic molecule – with Modafinil, to optimize wakefulness.2 A Soldier’s Tactical Environment Information is the cornerstone of all military actions, to retain the initiative and maintain supremacy in the field. The major contribution of battlespace digitization, at the turn of the twenty-first century, was to merge and combine various components of the Armed Forces in a very short period (air support, artillery, infantry, etc.) in order to better coordinate their effects during combat and reduce the o o da loop. Yet today’s technology within the French military context comes down to the level of the very soldier – more particularly the f e l i n System developed by safran.3 This system is designed to enhance a soldier’s understanding on their tactical environment. f e l i n is the French

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infantry combat system that combines a modified rifle with a host of other electronics, clothing, pouches, and body armour. The helmet integrates real-time positioning and information system, with light amplifiers for night vision. It entered service in late 2011, and has been used by infantry units deployed in Afghanistan and in Mali. The following developments can therefore be considered to be at the level of the infantry soldier. •

•

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Vision during operations is essential, and the saying “to see without being seen” is still relevant today. Even more so, when distance elongation is made possible with long range cameras (digital zooming). It is now feasible for an infantry soldier to be equipped with light cameras, including night and day vision, thermal imaging, and light amplification. Cameras can also be used for geo-locating detected targets through g p s . The effectiveness of soldiers’ decisions and their interactions with their environment depends on their awareness of the situation and their level of stress. The sensory data used to improve this awareness of the situation are mainly based on visual and auditory cues. However, if visual and auditory information are degraded or drawn for other tasks, this can be problematic. The aim of the mat e p (mat rice e p icritique) project is to develop vibro-tactile devices, corresponding to tactile complements in specific operational situations. This program is developed by the dg a , with the c ay l a r company and the m e d e s (Institut de Médecine et de Physiologie Spatiales).4 For surveillance missions or general patrols, analyzing images to detect movements in the zone under surveillance will indicate the presence of potential enemies. It is worth noting that movement detection should filter false alarms or alerts as much as possible (such as the movement of tree leaves in windy weather). Artificial Intelligence can be trained to filter that. Knowing the exact position of friendly forces – just as that of enemy units if possible – is of the utmost importance to properly coordinate military action and thus avoiding friendlyfire incidents. A small and discreet touch pad screen, attached on the soldier’s forearm, will activate in case of alarm or if explicitly requested by the fighter. It helps them follow key information, namely the position of friendly and enemy units. Indeed, this system helps the soldier and the commander ask the most fundamental (and challenging) of questions on the

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battlefield: where am I, where are my friends, and where is the enemy? The improvement of the transition phase between embarking and disembarking where a soldier moves from a relatively safe situation in the vehicle – where most of the external environment is masked – to a more dangerous situation outside. The combatant is then confronted with a lot of information that s/he has not been able to follow or that s/he discovers at the time s/he gets out of the vehicle. Industrial developments are underway by the thales company to smooth the transition embark/disembark and better understand the external environment before getting out. To expand on the above, a light multi-user communication interface – such as a touch tablet5 – can be used by an offboard combatant. They can fine-tune available digital tools and manage soldiers’ combat activities in the field through tactical radio, cartography, global positioning systems (g p s ), imaging, and event management, all through a remote access to connected objects such as sensors and robots. Sensors sending data on the c b r n environment can be deployed at the lowest levels of tactical leadership. It enables the latter to urgently equip their units and adapt their manoeuvres depending on the threat. An augmented reality system (which requires a full-face helmet or a simple eyelet fixed to a pair of glasses) enables an infantry soldier to integrate additional information into their field of vision on what they observe: movements, presence of friendly or enemy forces, or images from a remote camera carried by a reconnaissance robot at the head of a military engagement; all of these build an enhanced operating picture for the soldier. Assisted reality solutions, such as the one developed by the am a company,6 are less expensive and allow a connected operator to provide a remote assistance expertise on connected glasses, via a peephole worn by the soldier. This solution can provide remote eod expertise (Explosive Ordnance Disposal), maintenance support, or emergency medical assistance. In the longer term, intelligent ammunitions (drone-missile combinations such as the Switchblade manufactured by AeroVironment) could be operated by the infantry soldier from his combat position with direct visual feedback. The weapon could then be loaded and target-locked until impact and detonation, or deactivated in case of risk or mission termination.

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On the logistics level, demand for water and ammunition can be anticipated by automatically analyzing the consumption of ammunitions within units, shells, and water packs. A request for supplies can thus be placed automatically.

Using the equipment described above nonetheless requires heavy training for units to master such technologies before becoming operational. Moreover, their high cost will limit their use, probably reserved to group leaders or one of their assistants who specialize in operating such equipment. To see from afar through weapon systems is also somewhat of a new component of tomorrow’s battlefields. Aircraft or remotely piloted vehicle (rpv) operators have already integrated this notion in their modus operandi; nevertheless, it is somewhat a novel capability for land forces who are still highly dependent on a combatant’s direct line of sight in the field. These skills involve analyzing threat perceptions and managing the tactical situation through systems as well as avoiding errors in interpretation. Such advances in technology, which are now being applied through deliberate human system interactions techniques. In short, soldiers must now figure out what to do with this increase in situational awareness and understanding. Thoughtful and deliberate policies need to be crafted – whether as doctrine at tactical and operational levels or as security policy at the strategic and political levels – in order to optimize these new developments. the

“lightened”

soldier

To be enhanced, soldiers must regain the freedom of movement that is diminished by the loads they carry during operations. Moreover, as demonstrated in the previous section, through operating ever more complex systems soldiers are increasingly burdened by a growing cognitive load. Enhancement means – indeed this is one of the central themes of this book – the easing of burdens, physical as well as cognitive. Load Reduction Long marches and manoeuvres in hostile environments are an inherent component of ground action in a military context and the advantages offered by technology that can ease the physical burden are clear. As

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an example, mule robots – similar to the prototypes developed by Boston Dynamics, ne x t e r , and t h al e s – could be used to carry bags and supplies and would advance at the pace of military operations. Exoskeletons could also be used to carry heavier items, such as missiles or ammunition, for greater distances with less physical wear on the soldier (such as exoskeletons developed by the French rb3d Company). However, usage constraints are very high because exoskeletons can inhibit soldiers in their ability to engage in close combat (seeking cover from enemy fire or effectively returning fire) or in case of injury. Such equipment can be cumbersome and only small numbers per unit are a possible option due to their expense. In terms of muscular fatigue, external muscular physical assistance equipment, which is similar in concept to an exoskeleton but is an assistive and not an augmentative system, would assist the soldier in their physical effort during long marches or important raids. The e x o m ov e (leg-muscle support) for example, proposed by two French companies, as well as sa f r a n and b - t e m i a , are all examples of these simplified exoskeletons. Lighter and less cumbersome, such equipment could realistically be provided to a whole unit. It has been tested by cadets at the Saint-Cyr Military Academy. The French Army questions the possibility of integrating it into the next generations of f e l i n .7 Reducing the Cognitive Load As systems are more and more efficient but growing in complexity. Systems should be designed with user-friendly, easily accessible, ergonomic information with no specific action required by the operator (such as complicated menus) and merged together to avoid information overload using different types of equipment. A central communication unit, incorporated in the soldier’s equipment, would be required for data transmissions. The information would then be bundled, merged, and presented in a simple, ergonomic interface via a flexible screen embedded in the soldier’s clothes or via enhanced reality. In short, human-system interaction needs to be thoughtful and intuitive. Here again training is required to avoid a “tunnel effect,” which is the risk for an operator of getting muddled and staying focussed on one sole piece of information. For manning tele-operated devices such as robots, it’s advisable to focus on gesture controls (such as with a haptic glove) or voice controls (through a bone-conduction or “osteophonic”

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communicating apparatus) to free the hands of the infantry soldier, which should always be positioned very close to their weapon. While still early in its development, research on the possibility of controlling physical objects through a mapping and translation of human thought is showing some early promise. This is the purpose of the Brain app program of the dga in collaboration with the Marc Jeannerod Institute of Cognitive Sciences and the Claude Bernard University of Lyon 1.8 Decision Support System The main developments involving artificial intelligence techniques concern decision-making and execution processes rather than replacing humans.9 Decision support systems, based on artificial intelligence, can thus be used to process information in order to present it in a clear and intelligible manner to a military decision maker. The issue of languages, in a foreign country, that a soldier does not know could be solved by accessing simultaneous translations via an audio translation server. It could be reached on demand through the soldier’s communications device giving them greater peace of mind that they will be able to make themselves be understood. Finally, technology improves the decision process in detecting and identifying targets based on the consultation of a target database, initially approved by a military authority. It helps the soldier to detect and discriminate potential targets even if s/he remains the final decisionmaker in launching lethal weapons. As this is a sensitive database, any information must be coded and saved on a tactical cloud at the rear of the device in contact. better-equipped soldiers

Not only are technologies such as the wearable computing devices or exoskeletons described above being developed, but the clothing and protective garments of soldiers are also being examined for ways to enhance soldier performance in a non-invasive manner. Protective Equipment Tomorrow’s military garments will automatically regulate thermic variations by systematically heating or cooling military dresses. In case

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of injury, such “intelligent” clothes could also detect and automatically constrict affected human tissues and administer a sedative drug. Moreover, a soldier needs to manage their sleep pattern and rest/ work cycles, which can then be adapted to the needs of the operation. With components tagged on the skin, technology will provide the means for a combatant to adapt their pattern depending on the mission. As but one example, over short periods, special forces will thus be able to afford cycles of rest of only one hour for every eight hours of activity. Operational Advantage Equipment 10 In the more distant future, nanotechnologies will be a wellspring of ingenuity for forthcoming military equipment and supplemented by new materials with amazing properties. In this way, integrating nanostructures into military equipment could potentially create structures with extra-strong adherence onto gloves or shoes, empowering soldiers to climb any wall. On observing the animal kingdom – the teeth of limpets, for example – we can observe the ultra-solid grip structure used by these gastropod molluscs clinging onto rocks. New materials such as graphene (200 times more resistant than steel) have the potential of creating extremely light, flexible bulletproof structures. Other materials would provide the means in obtaining a near-zero radar signature or developing invisible thermal cloaks, even light invisibility cloaks: nanomaterials currently undergoing laboratory tests have the capacity of trapping light in tiny gaps between vertically placed carbon nanotubes, and can even increase heat dissipation. Some fabrics could have absolute insulating properties, be totally waterproof and resistant to other liquids or chemical sprays. The development of integrated nanomotors will increase equipment ventilation to regulate the temperature of the combatant, especially in hot regions of the world. Similarly, new electronic components reduced in size could be incorporated in clothes to serve as antennae, freeing an infantry soldier from carrying external communication gear. Finally, the recharging of batteries would be assured by nanomotors, activated by a simple movement of the human body, which would stock large quantities of gas or liquids in nanoporous materials – metal

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organic frameworks or mofs, for example11 – and that’s an appropriate way of reducing the size of batteries in the future. i m p l i c at i o n s o n t h e o r g a n i z at i o n o f i n fa n t ry s o l d i e r s

Although still some years in the distance, these technologies are developing quickly. Indeed, given the various systems and technologies discussed thus far and their use in military missions, a human dependency on technological equipment to support a serviceman’s actions is going to happen that changes the traditional way operations were managed and will require specific training and an adaptation to such new tools. What are the implications of these for the French Army? For the enhanced soldier, extra training with recent technologies is required, covering as many operations as possible. This will have a cost that will be added to initial technological costs. The financial burden of an enhanced soldier will therefore be high for the following reasons: (1) the costly equipment s/he will use, (2) the time spent on training to use such equipment, and (3) the time needed for the maintenance of such equipment. This has resulted in a real need to think about how military forces will be organized and employed in the future. As but one example, the above constraints will reduce the viability for airborne operations. This section will examine how these technologies could impact the organization and operations of the French armed forces. Apart from essential tactical units or special forces, carrying out high risk missions where all appropriate means are made available, it is likely most infantry soldiers will not be equipped with recent technology – except for low-cost sensors. Here again, they will probably be reserved for selected individuals in a combat group, notably the group leader. Consequently, having first gathered information on the physiological state of their soldiers and themselves, the group leader will then be able to gain a better understanding of the tactical environment by using surveillance and target-­tracking technologies, and thus be in a better position to take decisions on the battlefield. Furthermore, a risk of information jamming between members of a group can also appear (jamming or spoofing of sensors or imaging, as but one example) and, as soldiers in the field only use radio waves to communicate, the need to master air-wave communications systems in the field is of paramount importance prior to any military engagement.

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a s s e s s i n g t h e n e c e s s i t y o f i n va s i v e s o l d i e r enhancement

What Are the Needs of the Armed Forces? The modern battlefield is an incredibly inhospitable place for human beings. Soldiering is about lasting, defeating the enemy, and fulfilling a mission in an unfriendly environment where the opponent is trying to get the tactical surprise and quite simply – kill you. Indeed, this is the situation soldiers face as part of Operation barkhane, the French military intervention in Mali. With this in mind, this next section will conduct a needs analysis based on these operational realities. The use of non-therapeutic pharmacological substances and static or dynamic implants on an individual’s physiology over a short period will theoretically help soldiers in their mission. A military entity has nonetheless the duty of prohibiting certain military actions even if risks may be heightened for the soldier in the field. This is notably the case when appraising the effects of enhancement on personal or collective levels, by defining limits that cannot be crossed to respect a combatant’s human dignity and avoiding artificial illusions of invincibility. For instance, any potential sequels resulting from the enhancement of a soldier should be avoided. There is currently a study ongoing on this topic in the Saint-Cyr Military research center (crec Saint-Cyr). Moreover, if all the means should be provided for a soldier to fulfil their mission, a zero-risk situation is a serious fault in an unpredictable military context. Indeed, an enemy’s conduct can never be predicted; if it could be, wars would never last very long. If technology entails higher security and more efficiency, it would be unrealistic to assume it can provide a definite solution in countering risk. Enhancing the Human Body: Dangers and Risks As an introductory remark, we should bear in mind that the options offered in enhancing the performance of an individual arise as soon as s/he embraces the military profession, then throughout his/her career, healing potential injuries associated with possible enhancements and until his/her return to civilian life. The nbic revolution (nanotechnology, biotechnology, information technology, and cognitive science) opens a new field of multidisciplinary, scientific research and raises new perspectives in engineering the human body. If recent technological processes are reasonably

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acceptable for healing or repairing the bodies of injured soldiers during military operations, their use may be objectionable for healthy individuals. Indeed, this is the fundamental issue of dual-use described in the introduction to this volume. The main barrier would be a cultural one as acceptance levels vary from one culture to the next. We can already see that a culture of individual competition and performance is more apparent in certain countries. This can lead, for instance, to more students taking doping substances before attending an exam or certain sports events.12 Some of today’s students will become tomorrow’s soldiers and will no doubt have a natural tendency to repeat such practices and behaviour in combat. They will also have the tendency to seek acceptance for such practices.13 Therefore, as soldiers in combat reach peaks of danger and violence in a very hostile environment, they will naturally seek to increase their chances of survival by every available means. In short, the acceptance and subsequent adoption of enhancement technologies will certainly vary from region to region and country to country. Other barriers are linked to the dangers new technologies can foster and the risk of us playing the sorcerer’s apprentice – which will, in this case, no longer have an impact on the soldiers’ environment but will instead impact the soldiers themselves. Indeed, risks to health can emerge with possible effects on manifesting only in the mid- and longer term, with added risks of addiction and psycho-trauma once the effect of enhancement and the sentiment of invulnerability have dissipated. To avoid such shortcomings, relevant legislation must be cautious and could bring a slowdown in experimentation and medical approvals for the use of this or that substance. Apart from the risks mentioned above, social ones will appear because enhancing individual performances will inevitably lead to a culture of enhancement. It will create tensions between units having a potential benefit from such enhancements, those authorized to implement them and others unable to do so due to insufficient capacity and the lack of authorizations (such as medical, or legal). Such tensions will also arise between allied states with a discrepancy emerging amid nations mastering enhancement technologies and those with insufficient technological capacity or simply because they have not received the legal approvals to implement them. Another social risk relates to an uncontrolled escalation of enhancement: the race for super performance within certain fighting units. Military units have a natural tendency toward elitism. This can bring about an obligation of enhancement not to be better than another

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Military units implementing methods of enhancement

T e n s i o n

Non-enhanced military units

S u p e r i o r i t y

Figure 4.1  Enhancement pyramid

combatant but simply in having the possibility of joining and being accepted by the group. The current French position on the question of individual enhancement is a reasonably moderate one. Our nation has in fact always promoted the qualities of a group before that of an individual. As stated by Colonel Eric Ozanne,14 it’s the notion of esprit de corps and dedication that forms a cohesive group (where a troop has the fitness level of its weakest soldier). If a single soldier goes down in a military formation, the entire formation is delayed in its manoeuvre and in fulfilling its mission. Thus it is through physical training and preparation that a formation can hold out over time, supported by adequate equipment. This means that in terms of enhancement, the benefit must be considered in terms of the effect it can have on the group and its mission, while preserving the sacredness of the soldier. Inevitable Pressure from Civilians Armies are facing a general acceptance of enhancement because augmenting individual performance is now common practice in various sectors of the entertainment industry, education, and sports. Football and cycling are already highly contaminated by doping, simply because society expects extraordinary performances from its athletes and even deifies them should they succeed.

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Armies have a different way of reasoning, by promoting collective acceptance and enhancing a group’s potential for a mission. Distinct military needs will therefore have to be maintained to develop enhancement capabilities pertaining to the military. Otherwise, they will have to start from what civilians can suggest and endure what they can propose or impose. In this vein, the knowledge we have acquired on an individual’s genetic code poses some daunting questions. If the military is not yet engaged in genetic modifications, the question remains on pre-­ screening candidates before recruitment, which can seriously undermine the traditional selection process of the army. As genetic screening is now fast and inexpensive, it’s clear the army will soon have the possibility of obtaining the genome sequencing of each candidate and select them, based no longer on physical criteria alone, but on genetic criteria as well. Would a person with a gene indicating a 60 per cent risk in developing cancer before reaching their fortieth year ever be recruited? Would it be acceptable to hire this person on a short contract only? It’s worth noting that it is quite foreseeable for surveys in the civilian world to systematically focus on finding genes that confer risk. Insurance companies, for instance, can use such results to refuse a contract, or banks to block a loan. Similarly, will it be acceptable to select the best candidate for specific military tasks such as snipers, special operations forces, or command, based genetic criteria? Should genetic screening be used to pre-select candidates for a position requiring specific skills? Will the traditional s i g yc o p 15 examination – establishing an individual’s aptitude to serve in the French Army – be supplemented by reading and studying each and everyone’s genetic signature? The potential for human datafication – the quantification of human traits and abilities – is a tempting prospect, but one that risks exclusion based on algorithms rather than actual evaluation. Moreover, it assumes that such datafication will be complete. There is also a high risk not to provide young people with the opportunity of joining this true tool of social integration that is the army – whatever their initial aptitude scores are – and letting them renew themselves through individual and collective training. Individual and Collective Acceptance Soldier enhancement is borne out of a genuine need to enhance capability. If distinct types of enhancement can be identified – temporary,

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permanent, and even transmittable in the extreme case of genetic modifications (gene therapy) – accepting such methods will vary on the individual and collective level. If the basic principles are that the soldier should voluntarily accept any enhancement, and it should have no negative physiological impact, how will a military institution manage those who have already enhanced themselves? And what can it reasonably expect from its forces when civil society demands ever more performance? After all, it is quite acceptable today to take some vitamin C or have a Red Bull before a strenuous activity or prolonged period of concentration – like the proverbial “cram” prior to an exam. Can individual interests be thwarted by a strict enhancement policy if the effects of enhancement on an individual will have harmful repercussions on the group, or if personal enhancement is contrary to collective virtues? Will the collective interest eventually supplant principles of law in the freedom to control our bodies, notably depending on constraints that could be imposed on a soldier due to their condition or in case of crisis or a state of war? Such constraints could imply a disregard for their free and informed consent in view of the probable or possible risks in the ongoing mission, of its importance for the manoeuvre, and even beyond that to safeguard the health of the person concerned. Will a soldier be able to turn to their chain of command if they are not selected because of criteria deemed subjective or illegal, or if the chain of command did not permit them to be “enhanced” and thus selected for certain military specialities? The question has to be asked here again whether matters accepted in the civilian world can always be applicable in the future in the military one. Indeed, although the two impact and influence each other, the military remains a distinct component of society. It has its own, unique needs. An Example of Anthropotechnics Lionel Bourdon, Military General and Chief Medical Officer of the Institut de recherche biomédicale des armées (Army Biomedical Research Institute) or irba, believes that the idea of anthropotechnics – auto modification or alteration of your own body, such as laser eye surgery to treat myopia, or leg-lengthening surgery – will become a social phenomenon in the future and will enable irreversible improvements on the human being. Moreover, this will become increasingly societally acceptable practices over time. In that regard, prosthetic hearing repair is now commonplace, one for vision is emerging, and

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the first complete limb prostheses are now being commercialized (such as the prosthetic arm developed under da r pa’s Revolutionizing Prosthetics project, which received the approval of the U.S. Food and Drug Administration in 2014). If the performances above are first and foremost corrective ones, it’s quite probable that, in the very near future, such transformations will aim at solely improving raw performance, disregarding preventive care. To illustrate, if correcting myopia is considered as a repair, an increase in vision of 12/10th in place of 10/10th will be regarded as an improvement and an increase in a person’s capabilities, especially for professions needing strong visual acuity. So will 12/10th or more become the norm for fighter pilots and snipers? If so, will it be for the institution to ensure increased vision to candidates? And on what grounds will they be recruited? Will recruitment be based on the future best candidate to be enhanced or rather on the best candidate already enhanced? This technique also raises the question whether individuals having made irreversible changes to their bodies can join the army. conclusions

Augmenting the performance of the soldier has always been a constant preoccupation of the military. After several decades of research directed at the betterment of vehicles and weapons, it seems that a new field of investigation will begin to involve enhancing the individual. It is based on two approaches: the first one covers how technological equipment worn by the soldier poses no specific ethical and/ or legal issue; and the second one covers progress made in the medical sector thanks to the combination of new technologies with n b i c technologies. Indeed, the invasive/non-invasive distinction is helpful here. Non-invasive technologies that focus on human-system interaction and enhancement through easing both physical and cognitive burdens is one approach, while a second, more invasive view takes a holistic approach to enhancement that will have impact upon – or indeed maybe driven by – society in general. Concerning capacity enhancements with equipment allowing a soldier to be better informed and guided in their military action, it seems they will imperatively need resiliency skills and require both training and tests on all the possible situations arising during a battle, such as what to do when the technology fails. To give one light-hearted example, in 1991, one of my fellow officer taking part in a joint

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manoeuvre with the U.S. Army cames across a US infantry section. The lieutenants of both militaries receive the same order: move 10 kilometres north from their position. The French immediately take their rucksacks and prepare to leave whilst the Americans hastily sit on theirs. Surprised, the French lieutenant then asks them: “What are you doing?” before hearing the response: “We’re waiting for the truck!” If throughout the rest of the exercise the French reached their objective and complete their mission faster than their U.S. counterparts, this story illustrates how some units in the absence of support or technical malfunction tend to be more resilient than others. It is a quality all forces should retain in the battle spaces of the future. Concerning the second approach which focuses on direct actions on the human body – the more invasive (and long-lasting or even irreversible) enhancements – a new subject has been unveiled here for the military. It questions whether such developments are legitimate or even efficient. Firm determination must therefore be shown to counter the influence initiated by society in promoting and probably sanctioning experimentation, notably due to the ideological pressure of transhumanism upon society, representing humans as imperfect beings to be transformed at will. It is hence the responsibility of the French Army to draw the line that should not be crossed, provide the necessary keys to understand what needs to be enhanced, determine what’s acceptable or not acceptable and consider what can be beneficial to the armed forces and France in general. Naturally, this should not preclude some reflection on the subject because the legitimacy of enhancement is determined by circumstances of the moment and the ongoing military mission. The message delivered by the army will therefore be eagerly awaited as choices made by the military will eventually define those made by society in general.

notes

  This article is based on the paper by Gérard de Boisboissel, “Le Soldat Augmenté,” DSI HS , no. 45 (Dec 2015–Jan 2016).   1 Centre de recherche des écoles de Saint-Cyr Coëquitan, “Le soldat augmenté: Les besoins et les perspectives de l’augmentation des capacités du combattant” (Paris: Les cahiers de la Revue Défense nationale, 2017), accessed 17 Feb 2019, https://fr.calameo.com/books/0005581159f 5e895e1a2c.

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  2 Projet « R A PI D M ODEFI » M ODafinil EFficiency Improvement DGA /DS – Mission pour la recherche et l’innovation scientifique, PME Theranexus (91400) & M I N ARM / S S A/ I RBA (91223).  3 f e l i n is the acronym of the French infantry combat system developed by the French company, safran (Fantassin à Equipements et Liaisons Intégrés – Integrated Infantryman Equipment and Communications).   4 Projet «R API D M ATEP» – MATrice Epicritique, nouveau dispositif d’interaction DG A/ DS – Mission pour la recherche et l’innovation scientifique, P ME CAYLAR (91140) & Medes, I MPS – Institut de médecine et de physiologie spatiale (31405).   5 Ministère des armées, Le ministre de la Défense récompense l’innovation au sein du ministère et de la gendarmerie, updated 5 May 2014 and accessed 17 Feb 2019, http://www.defense.gouv.fr/salle-de-presse/­ communiques/ministre/le-ministre-de-la-defense-recompense-l-innovationau-sein-du-ministere-et-de-la-gendarmerie.  6 A MA , XPerteye: Interagissez en temps reel, accessed 17 Feb 2019, www. ama.bzh.  7 f e l i n is the acronym of the French infantry combat system developed by the French company, safran (Fantassin à Equipements et Liaisons Intégrés – Integrated Infantryman Equipment and Communications).   8 Projet «A S TRI D BrainAPP», Cognition augmentée grâce à un dispositif d’interface cerveau-machine (BCI ) en boucle fermée. DGA /DS – Mission pour la recherche et l’innovation Scientifique, Institut des Sciences Cognitives Marc Jeannerod, U M R 5229, Université Claude Bernard – Lyon 1.   9 Cédric Vilani, Marc Schoenauer, Yann Bonnet, Charly Berthet, AnneCharlotte Cornut, François Levain, Bertrand Rondepierre, “Donner un sens à l’Intelligence Artificielle,” Mission parlementaire du 8 septembre 2017 au 8 mars 2018, accessed 17 Feb 2019, https://www.ladocumentation​ francaise.fr/var/storage/rapports-publics/184000159.pdf. 10 In this paper, we shall not tackle the role of military robots as future weapons of the combatant, helping in outweighing a soldier’s five senses. The subject will be covered in studies published by the Centre de recherche des écoles de Saint-Cyr Coëtquidan. 11 c nrs , Les réseaux métallo-organiques : des matériaux prometteurs aux nombreuses applications industrielles, 20 Mar 2014, http://www.cnrs.fr/ lettre-innovation/actus.php?numero=133. 12 Alan Schwarz, “Risky Rise of the Good Grade Pill,” New York Times, June 2012, accessed 22 June 2019, https://www.nytimes.com/2012/06/10/­ education/seeking-academic-edge-teenagers-abuse-­stimulants. html?pagewanted=all.

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13 Gérard de Boisboissel, “Le soldat augmenté,” dsi hs , no. 45 (Dec 2015– Jan 2016). 14 Ex-commanding officer of the 2nd Régiment étranger d’infanterie (Foreign Legion), chairman of the Joint Chiefs of Staff of the Armed Forces in Guyana. 15 The s i gycop medical examination covers the following: upper and lower limbs, general condition, eyes and vision, chromatic senses, ears and audition, psyche. In French the acronym stands for: S: membres supérieurs / I: membres inférieurs / G: état général / Y: yeux et vision / C: sens chromatique / O: oreilles et audition / P: psychisme.

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5 Human Performance in the United States Army: Enhancing the Future Soldier Farzana Nabi “Man is the first weapon of battle. Let us study the Soldier, for it is he who brings reality to it.” Ardant du Picq, Battle Studies

When modern technologies such as biological, neurological, and nano components are used to enhance soldier performance, arguably an arms race ensues – as delineated in chapter 2 of this volume. The concept of the “super soldier” is no longer confined to science fiction, and presupposes that humans will continue to play a decisive role in the future operational environment (f o e ). At the forefront of this field in the United States is the Defense Advanced Research Projects Agency (da r pa ),1 a Department of Defense (D oD ) organization created in 1958 and tasked with developing emerging technologies in partnership with industry and academic sectors. da r pa pursues its research agenda through six technical offices2 focused on “transformational change instead of incremental advances.” While its mission is to invest in cutting-edge technologies in the interest of national security, its projects frequently have significant impacts outside the military, which include examples such as computer networking (the Internet was famously born out of an a r pa 3 project) and graphical user interfaces. da r pa’s initiatives are often classified, but from what is made public, its work on human performance enhancement includes cutting-edge programs at varying stages of development. One such program is the Neural Engineering System Design4 (n e s d ), which is a neural implant enabling “unprecedented

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signal resolution and data-transfer bandwidth” between digital devices and the brain. The implant acts like a translator that converts digital code to electrochemical code for the brain, enabling information processing faster than supercomputers communicating with one another. Another of da r pa’s human performance enhancement programs include Warrior Web,5 a non-invasive suit – much like a diver’s wetsuit – intended to decrease the metabolic cost of carrying the typical equipment load soldiers are required to have on the battlefield. The suit is lightweight and includes a web of closed-loop sensory data processors that protect “injury-prone areas.” Yet another is the Soldier Centric Imaging via Computational Cameras6 (s c e n i c c ) program, which moves beyond current intelligence, surveillance, and reconnaissance (isr ) capabilities to equip soldiers with enhanced situational awareness, survivability, and security via contact lenses. The U.S. Armed Forces (army, marine corps, navy, air force, coast guard) also have their own R&D organizations. For example, the U.S. Army Research Development and Engineering Command (rdecom), a component of Army Materiel Command (amc)7 includes seven8 research organizations such as the Army Research Laboratory (arl). The Human Research and Engineering Directorate (hred) falls under arl and focuses on the “fundamental understanding of Warfighter performance enhancement, training aids, and man-machine integration.”9 arl-hred includes four10 labs that focus on soldier performance enhancement, such as the Mission Impact through Neuro-Inspired Design (mind) and the Soldier Performance and Equipment Advanced Research (sp e a r ). a r l has eight initiatives as part of its technical strategy including a human sciences campaign.11 Other army laboratories filled with dedicated researchers focused on enhancing soldier performance on and off the battlefield include the U.S. Army Research Institute of Environmental Medicine12 (u sari e m ); Army Research Institute13 (a r i ) for the Behavioral and Social Sciences; and Natick Soldier Systems Center14 (nssc ). In addition to these research organizations, the U.S. Army has a four-star command focused on training soldiers, the Training and Doctrine Command15 (t r a d o c ), which has four main functions: (1) recruit and train soldiers, and support unit training; (2) develop adaptive leaders – both soldier and civilian; (3) guide the army through doctrine; and (4) shape the army by building and integrating formations, capabilities, and material. The Army Capabilities

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Integration Center16 (a rc i c ) falls under headquarters t r a d o c , and serves as the army’s think tank focused on future force design. The Human Dimension Division (h d d ), the entity I am a part of, falls under a rc i c and focuses on human performance enhancement across the cognitive, physical, and social components. Perched at headquarters, the work that h d d pursues includes concept development, involvement in army experimentation and wargaming to test concepts, and capabilities needs analysis (c n a ) across the soldier lifecycle – all in an effort to make recommendations on the needs of the future soldier (2035 and beyond) informed by research. The work conducted at a rc i c and the army labs is best viewed as an iterative process of research, informing concept development and training, and vice versa. With the aforementioned in mind, h d d conducted a series of human performance events in 2016 focused on determining the soldier attributes required to win in high-intensity conflict against a peer adversary in the 2035–50 timeframe. The guidance provided by senior leaders was to identify attributes that can be enhanced via training and education without focusing on invasive technological solutions. The following is a delineation of the process, findings, and outcome – which, again, represents only a small slice of the U.S.’s soldier enhancement efforts. As was done with the German case (chapter 3) and the French one (chapter 4), this chapter examines soldier enhancement from the U.S. perspective. unified quest: an explainer

Unified Quest (uq) is a series of symposia and simulations, mandated by Title 10 of the United States Code, and hosted by the Chief of Staff of the Army’s (csa’s) .17 Considered a future study plan, the exercise provides opportunities to critically analyze ideas about the future of conflict and examine persistent strategic and operational-level challenges. uq is intended to frame problems and identify critical solutions for the future force in order to develop an army with the capability to achieve overmatch and win in a complex world. Discussions among senior leaders at previous uq events focused on such things as fundamental changes to the character of warfare, warfighting technologies, demographics, economics, and geopolitical conditions thought to profoundly impact the conduct of military operations. As a result of these

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discussions, hdd was tasked with planning and executing a series of uq events to determine the required attributes of the future soldier. After much deliberation with the community of practice (CoP)18 – comprising researchers, military operators, and industry experts – hdd developed an integrated study plan with the goal of addressing three specific learning demands (lds): First, the exercise sought to compare U.S. structural trends compared to peer adversaries in 2035–50. Second, as a result of the structural trends, the study sought to determine the implications for human performance in the army; and third, the study aimed to determine the required attributes for soldiers to win high intensity conflicts against peer adversaries in 2035–50. Thus, the uq human performance events comprised an integrated study plan with lds that became more “military” from one event to the next. As with any study or research endeavour, terms were defined in the context of the study’s intended objectives. Additionally, the integrated study plan was designed with key underlying assumptions. For example, in the human environment there are several projected changes that will greatly impact the army. These include U.S. population and demographics, human performance advances (e.g., technological, medical), societal conditions (such as attitudes toward country, service, violence, and war), societal norms versus military norms (such as differing attitudes towards drugs, the economy, and fitness), changes in the character of war, and changes to the army’s role in unified land operations. There are several assumptions specific to the role and organization of the army: (a) the way the army trains and educates will evolve; (b) army professionals will remain committed to career-long learning and self-development; (c) technology and the physical, medical, social, and behavioural sciences will enable enhanced human performance capabilities; (d) the army will continue to subscribe to the characteristics, values, and principles of the army profession and army ethic; and (e) for the foreseeable future the army will operate in a climate of fiscal austerity, requiring greater efforts toward achieving innovation and efficiencies without additional investment beyond the rates observed today. framing the problem

Utilizing arcic’s framework for developing the future force includes the iterative process of Think, Learn, Analyze, and Implement.19 This

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framework guided the approach to the integrated study plan, which enabled h dd to think clearly about the problem, learn about, and analyze the potential capabilities of the army, and implement solutions for the future force. The approach to framing the problem entailed multiple considerations at both micro- and macro-levels. Macro-level considerations included the f o e , character of future warfare, the humanistic theory of conflict, and the human dimension concept. Micro-level considerations comprised the three lds mentioned above (such as the structural trends, implications for the U.S. Army, and future soldier attributes). As part of this framing, the problem was divided into two groups of considerations to include macro- and micro-level considerations. Macro-Level Considerations The first macro-level consideration was the Future Operational Environment. The f o e encompasses the dynamic space where the interaction of multiple variables results in a lack of certainty and predictability. U.S. Army doctrinal guidance defines the operational environment (oe) as the “composite of the conditions, circumstances, and influences that affect employment of capabilities and bear on the decisions of the commander,”20 with operational (pmesii-pt)21 and mission (mett-tc)22 variables. The tradoc G2 (Intelligence) identified twelve trends23 that are projected to have significant effects on the foe, binning them into four major categories across a timeline that extends to 2050, and includes: (1) Science and Technology; (2) Society; (3) Information; and (4) Strategic World. U.S. Army doctrine states that the “t r a d o c G2 accomplishes futures evaluation through trend analysis, relying on subject matter experts, policy institutions, and commercial, government, and academic entities to assist in an understanding of a trend’s nature, causes, and speed of development. Additionally, potential impact efforts can be narrowed down to identify those trends of relevance to the nation, the U.S. military, and in particular, the army.”24 The G2’s trends provide a frame of reference intended to help the army more clearly articulate the character of future warfare. Within the f oe , there is also discourse on the nature of war. Carl von Clausewitz, the famous Prussian general and military theorist of the early nineteenth century, maintained that while the nature of war is enduring,25 the character of warfare is constantly changing as a

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result of technology, doctrine, and the context (historical, social, and political) in which wars occur. The nature of war speaks to an inherent aspect of war. However, if in the year 2050 there are no humans on the battlefield (meaning no interactions), then this is an example of a change in the nature of war. Most senior leaders in the U.S. Army postulate that the nature of war will remain constant, that is, war will remain a human endeavour and a battle of wills, and the range of military operations (ro mo) will still exist and remain recognizable and therefore worth the effort in forecasting today. So how did u q envision a change in the character of war? The character of war – our second macro-level consideration – was predicated on Clausewitz’s edicts, and is an attribute of war and how it manifests in the world. These are thought to be changeable given the context in which wars takes place (such as specific regions, specific societies, or specific points in time, to name a few). For example, technological advances have changed the character of war (such as robots and humans on the battlefield). The running list of projected changes to the character of warfare devised as part of h d d ’s integrated study plan included the following: (1) that the technological aspect of war is greater, with cyber warfare dominant; (2) that destruction of the adversary is more challenging in the cyber realm due to the ability to shape shift; (3) that the range of tools to impose our will on adversaries without violence increases; (4) an recognition of the increased vulnerability on the homeland; (5) that war becomes more ambiguous and combat less decisive; (6) that persistent conflict will be more common and the lines between war and non-war activities will blur; (7) the importance of the strategic narrative, with information having a decisive advantage; (8) that there is an increased vulnerability to chemical, biological, radiological, nuclear explosives (cbrne) threats; (9) that there will be greater strategic effects at lower echelons; (10) despite the impact of cyber and space, physical geography still matters; (11) non-state actors will comprise the bulk of adversaries; (12) the now-classic framework of diplomatic, information, military, economy (d i m e ) will need to be recast; (13) civilian casualties will continue as conflict remains amongst, rather than outside, of populated areas; (14) that peer and symmetric are not synonymous; (15) secrecy and surprise will be harder to achieve through advances in connectivity and telepresence; and finally (16) the classic deterrence concept of mutually assured destruction (mad) has now expanded beyond just nuclear weapons.

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Our third macro-level consideration was the concept of the humanistic theory of conflict. This focused on the human aspects of war, and calls for a widening of the aperture beyond materiel and technological requirements, capabilities, and vulnerabilities. To gain better situational understanding of war, it is imperative to examine the levels of war (strategic, operational, and tactical) across the physical, mental/ cognitive, and moral/cultural/social components. If the conduct of war includes “time competitive observation, orientation, decision and action cycles,”26 it is important not only to have this understanding for ourselves (friendly forces) but also, and equally important, to have knowledge of adversaries’ worldviews, decisions, and actions. The humanistic theory of conflict assumes that living systems (such as people, organizations, and nations) must interact with the outside world, and that (military) strategy becomes one of interaction and isolation conducted in the physical, mental, and moral arenas of the “observe-orient-decide-act”27 (ooda) system. This process is dynamic in a move, counter-move mechanism at the tactical, operational, and strategic levels of war, by means of adaption of adversaries, which necessitates constantly operating in the system in order to dominate the adversary. In short, this theory of conflict places the human at the center of operations. It also served as an underpinning of the uq events, making it possible to emphasize the non-materiel, innate human capabilities that a soldier must possess to achieve overmatch – with less emphasis on technologically driven solutions. The final macro-level consideration was the human dimension itself. As the Human Dimension Concept stipulates, the army’s goal is to optimize human performance by focusing on cognitive, physical, and social components, resulting in adaptive and agile leaders, resilient soldiers, and cohesive teams.28 The cognitive component refers to the mental activity pertaining to the act or processes of perception, memory, judgment, and reasoning, with individuals’ traits and emotional processes as one of the major influencers.29 The physical component includes a holistic health and fitness approach that includes physical fitness (such as aerobic capacity, strength, endurance, flexibility, and coordination), while also attending to the nutritional, psychological, and sports medicine contributions.30 The social component entails interpersonal interactions, and how soldiers and civilians are influenced by others’ beliefs, behaviours, and feelings. Social fitness consists of individual well-being through self-discipline, developing and

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maintaining trusted, valued relationships, and fostering good communication with others.31 The macro-level considerations served as the context in which the micro-level considerations were executed vis-à-vis our u q human performance events. Thus, the macro-level considerations enabled us to frame the problem in broad terms, while the microlevel considerations enabled execution of the ideas in a focused, structured manner. Micro-Level Considerations The micro-level considerations were no less important but designated as such given the granularity of the information required to execute the ideas couched as l d s for the u q human performance events. Again, where the macro-level provided the backdrop, micro-level considerations were the details within which we forecasted our soldiers operating in the f o e . The micro-level considerations included structural trends, the foe, implications for U.S. Army human capabilities, and soldier attributes. Structural trends refer to a general direction in which the arrangement of, or relations between, the elements of a complex whole develop or change. Structural trends have the propensity to change the character of warfare, and quite possibly the nature of war itself. These include social/demographic, political, economic, environmental, and technological trends in 2035–50. For example, the year 2050 is thirty-one years from now, and when one goes back thirty-one years, it lands us in 1988. The phenomena that have shaped the present global environment could not have been forecasted and most likely fell outside the realm of human knowledge at the time. There are few facts about 2035 and beyond, and discontinuities across trend lines cannot always be accurately forecast. However, what can be said accurately is that dramatic changes in structural trends will have significant effects on the U.S. military. In the September 2016 Human Performance Working Group (hpwg ) – the first of h dd’s uq events – participants32 were given a list of defined terms and projected assumptions about the world of 2035 and beyond. These, as well as other material, helped focus discussions within groups, and established a common operating picture from which projections (of structural trends) were articulated. Three interdisciplinary work groups examined trends in the social, political,

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and economic33 arenas to determine implications for human performance within the army. They were considered by all the groups. The work groups were categorized to reflect the event design. h d d acknowledged that there would be overlap across the structural trends because in reality, one cannot separate the economic from the social, or the political from the economic, and so forth. The intent of disaggregating the structural trends was to ensure focused discussion and analysis in each group.34 uq hpwg work groups used the structured inquiry method (sim)35 to: (1) map the strategic context based on their respective work group; (2) discover the drivers of change36; and (3) identify likely implications for human performance in the Army. On Days 1 and 2 of the event, participants addressed l d 137 “What are the major considerations impacting the social, economic, political and technological arenas in 2035–50?” and “What are the drivers of change?” On Day 3, participants addressed l d 2 “What are the implications of these trends on human performance in the army?” Table 5.1 depicts the major considerations (in the context of structural trends) identified by each work group. The overlap across these major considerations is not surprising, and were filtered through the lens of each group’s respective structural trend. For example, in regards to demographic changes, the social group focused on the changing nature of the army workforce as a result of increased specialization of military occupations, and the potential of transferring the military roles to alternative populations. For the political group, demographic changes focused on health sciences extending the military age, with older soldiers joining and departing later in life. For the economic group, demographic changes focused on the rise of obesity and its impact on future recruiting and initial military training (i m t ). Political Trends In terms of political trends, this group’s implications focused on the relationship between the individual and themselves; the individual and the group; and the individual and authority. Overall, while work, country, and other traditional sources of identity will diminish in importance, easy and surreptitious communication across U.S. and global society will increase exponentially. The first key findings of the political group was that Americans will focus on the expression of their identity, identity group, ideas about privacy, significant

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Table 5.1. Major considerations identified across structural trends Major considerations

Economic

Political

Social

Demographic changes

X

X

X

Technological growth / proliferation

X

X

X

Governance / government policy

X

X

Globalization

X

X

Inequitable distribution of resources

X

Partnerships / social organizing

X

Human / gender equality

X

X

Learning

X

Threat

X

Belief system

X

virtual footprint, and methods of personal interaction. They will challenge the army to inculcate new soldiers with organizational identity, allegiance, and norms, and the army will have to examine how it assimilates the individual into the organization and develop team cohesion. Second, the group found that there will be physical and cultural separation between American society and the army. Several factors will drive this such as reduced direct exposure to the army through family and friends, with most of the exposure taking place in the virtual world, entertainment, and media. This will require the army to increase its efforts to educate the population about the army’s role in society and the benefits of joining. Third, improvements in health sciences will extend the window for military age. Additionally, for society and those considering the military, a rebalancing will occur, from material motivation (such as the need for things) to emotional motivation (such as the need for belonging and meaning). In short, the cohort of available citizens for service will expand and become even more diverse, not just in terms of race or gender, but now also in terms of age. Fourth, due to the propensity to communicate globally as well as an anticipated growth in cultural diversity within America, soldiers will have even more affinity with multi-cultural conditions and environments. This does not mean an end to the natural human

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tendency to view outsiders as cultural others. Rather, future soldiers will more easily overcome the cultural “other” barrier, more quickly sensing shared humanity. Fifth, soldiers will expect physical and cognitive standards-based tasks. The army will need to develop task-based standards and more effectively screen soldiers against these standards as they assimilate and advance throughout their career. Indeed, we may see the army move to screen-in applicants based on certain personality-based aptitudes rather than to screen-out applicants based on a pre-identified set of qualifications. Sixth, a recruit’s norms and ethics may not be in line with the army’s norms and ethics. The army will have to balance the organizational requirement for norms with societal expectations. Soldiers will more easily form ad hoc, task-based teams but will have difficulty in sustaining long-term teams and organizations. Thus, unit leadership will have to work harder on sustaining unit cohesion. Finally, soldiers will rely less on assumptions of positional authority and more on peer-to-peer social contracts. This is not an entirely new phenomenon. For example, U.S. Air Force missions are led by the best pilots as opposed to the highest-ranking pilot. Implementation of this across the conventional army will be new and change the basis of leadership. Economic Trends In addition to the political trends identified above, the economic group identified major trends as well. The group highlighted the need for leaders to understand how to integrate humans and machines as part of a cohesive team. The group also focused on the tasks and roles of humans versus machines, and the need to operate in degraded environments without the expectation of technology ubiquity. The first finding of the economic group was that soldiers must be able to fight without their machines, and be capable of executing tasks in degraded modes of operation. They must also know when their machines are being “spoofed” or “hacked.” Indeed, the story recounted in the previous chapter must not be indicative of larger trends. Second, leaders must be able to manage a variety of systems that integrate humans and machines as part of the team. Manufacturing could take place at the point of need, resulting in the army’s sustainment model changing dramatically. Third, soldiers and leaders must

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apply rapidly changing technology on the battlefield, but still have strong moral, ethical, and humanitarian grounding while making decisions about the use of that technology. Fourth, soldiers will have enhanced ability to process and analyze larger amounts of data, but humans will still be constrained by their attention capacity. Processing and analyzing of big data will still require human judgment for consequential decisions (such as moral and ethical concerns, setting goals and objectives, managing mixed systems, social interactions, resolving conflict amongst themselves, or assessing outcomes). Fifth, medical technology will allow for longer lifespans, enabling – as was already mentioned – soldiers to serve longer, but obesity rates may continue to increase and have significant impacts on recruiting and initial military training as well. The sixth major trend within this group was that leaders may have different skill sets but must be able to adopt and adapt to new technology very quickly. Sensors could monitor soldier readiness (such as hydration levels, or physiological states), but leaders could therefore spend more time analyzing data than making decisions; thus the information can become paralyzing. Finally, attracting needed talent could become more difficult. Egocentrism and narcissism may increase, with more traditional attractions of the profession of arms such as moral calling or patriotism becoming less effective. Flexible attitudes and incentives may indeed be required. Social Trends The final structural trend examined was the social trend. Here, the group focused on the innate capabilities of humans that can be enhanced through training and education, and highlighted technology as an enabler with the need to consider its moral, ethical, and emotional effects, and enable soldiers to operate successfully in “analog” mode. The social group identified six major findings. The first was that ethical and legal consequences of bioengineering and augmentation will have to be addressed in order to maintain overmatch, and identify changes that need to be made to the army’s moral compass. Indeed, this is the crux of the enhancement problem, and covered extensively in Part II of this volume. Second, changes need to be made to initial military training (i mt ) to account for variation in required complex cognitive skills, with training strategies and curricula aimed at enhancing decision-making and critical thinking. Third, soldiers must be able

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to fight degraded, requiring competence executing analog tasks. This means that soldiers cannot come to rely on the technology that they may have at their disposal. Fourth, technology and human-machine teaming will enhance problem-solving techniques, changing the role of the soldier’s judgment in strategy and planning. Fifth, specialization of military occupations and competencies as a result of technological advances will require transferring military roles to alternative populations, thereby changing the nature of the army workforce. Finally, soldiers will require emotional competence training, which may conflict with institutional norms, but points to changing values and beliefs that will change our military decisions. The uq hpwg event enabled a baseline of understanding of future societal trends and its effects on the military. Establishing an understanding of the broader trends enabled a narrowing of the lens to consider what attributes the future soldier must possess in order to operate effectively in the f oe . b r i n g i n g t h e s o l d i e r b a c k i n : d e s i r e d at t r i b u t e s

As with any study or research endeavour, terms were defined in the context of the study’s intended objectives – the term “attribute” was no exception. There are a lot of definitions and synonyms for attribute.38 hdd conceptualized attribute as “a quality or feature or inherent part of someone or something.”39 Building on the work of the uq hpwg event, the December 2016 uq Human Performance Seminar (hps) addressed ld 3, which focused on identifying the required attributes of the future soldier. The primary focus of the uq hpwg was to articulate a unified path from concepts to capabilities. hdd’s aim was not to generate new soldier attributes. The Center for the Army Profession and Ethic (cape) illustrated with their running estimate – compiled over a two-year period – that there are a lot of soldier attributes identified across a plethora of army organizations.40 The uq hps event objective was to identify the core attributes a soldier requires to operate in high intensity conflict against a peer adversary in the 2035–50 time horizon. The uq hps included three groups delineated across the cognitive, physical, and social components of human performance, composed of military and civilian participants,41 and used a future-oriented warfare vignette to develop lists of general attributes needed to operate in high intensity peer conflict in 2035–50. The U.S. Army War College comprised the fourth group and focused on senior leader attributes.

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Soldier attributes were discussed in the context of human capabilities, using an attribute framework42 that included: (1) the identification of a set of attributes for further refinement; (2) the development of a precise definition and composition of a required capability statement for each attribute; (3) an evaluation of attributes for conceptual clarity, operational relevance, and the ability to measure and develop metrics for them; (4) a consideration of each attribute’s relevance at tactical, operational, and strategic levels; (5) an assessment of the attribute’s past, present, and future trends; (6) identification of ways to achieve and acquire the attribute; and (7) a determination of the tensions and risks to mission and force if the attribute was not developed or included in the future army. Each group also assessed their respective attributes for interdependencies and aptly coordinated information to provide an integrated analysis. Table 5.2 depicts each groups’ attributes and related, expanded definitions. Given the redundancy in some of the attributes identified by the groups, hdd synthesized the lists to six core soldier attributes required in 2035–50 under lethal, isolated, and dynamic conditions. The (overlapping) attributes included adaptability, or the possession of the intrinsic flexibility to achieve an objective, and character, meaning the retention of a dedication and adherence to the army ethic, including army values. This in turn provides legitimacy to army operations, fosters teamwork and sustains personal wellness. The third attribute was insight, or a sustained awareness of the soldier’s external and internal conditions to predict the impact upon their performance. The fourth core soldier attribute was resilience, meaning the possesion of mental, emotional, and physical endurance to perform through and after extended operations. The fifth was operational fitness, or possession of optimized mental, emotional, and physical capabilities to overcome individual challenges, and the sixth attribute was self-­ discipline, the ability to remain internally disciplined in order to fully leverage individual resources and maintain team cohesion. These six (overlapping) attributes represent the core ones that the army needs to recruit, assess and/or train to operate effectively in the foe in order to achieve overmatch against a peer adversary. A more detailed accounting is presented in table 5.2. Recruiting individuals or assessing soldiers to determine whether they possess these core attributes is more a matter of identifying where they fall on a spectrum. It is not appropriate to assume that recruits or soldiers either have them or do not have them. It is a matter of developing metrics to

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Table 5.2 Soldier 2035–50 attributes across UQ HPS groups COGNITIVE GR O U P Resilience

Cognitive Adaptability Teaming

Mental, emotional, and physical endurance to effectively sustain operational tempo in a lethal, isolated, and evolving environment in order to successfully accomplish the mission. (C / P / S) Cognitive ability to advantageously adjust behavior, rapidly learn, and apply knowledge and understanding to novel and changing environmental, social and combat scenarios. (C / P / S) Build multi-directional trust for multiple team types under volatile, uncertain, complex and ambiguous conditions. (C / P / S)

PHYSICAL GROUP Fit for purpose The components of physical capabilities include but are not limited to: cardiovascular fitness, muscular strength and endurance, flexibility, agility, balance, coordination, power, reaction time, and speed. (C / P) A Soldier’s understanding of the physical indicators of their own Psychomental and emotional states and how to leverage that understandphysical ing for optimal performance. (C / P) awareness Resilient Encompasses the concepts of resistance, rebound, and recovery relating to mental and physical stressors. Resistance is the ability not to be adversely affected by stressors; rebound is the ability to cope with stressors and remain operationally effective; and recovery is the ability to return to the required state of health, mind, and strength. (C / P / S) Environmental The capacity to rapidly and robustly adjust to dynamically changing conditions in a range of operating environments to regain and adaptability /  sustain overmatch over the adversary and ensure mission success. endurance (C / P / S)

Character

Adaptability

Self-discipline

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SOCIAL GRO UP The social aspect of being a Trusted Army Professional. Trust is the bedrock of the Profession and is important both internally and externally to the Army. Character, in an operational sense, is dedication and adherence to the Army ethic, including Army Values, as consistently and faithfully demonstrated in decisions and actions. (C / S) Enables one to achieve desired objectives in a complex social environment by balancing pre-determined responses to known factors with improvised responses to unforeseen factors and / or blended combinations of both. (C / P / S) The ability to remain mentally disciplined in fluid moments of stress. (C / P / S)

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LEADER GROUP – A W C A leader who thinks in terms of a system of systems, understands and considers both the Army enterprise view and the interactions, interdependencies and nuances of relationships between elements and capabilities of the Army and other elements of National Power (Military and Civilian). Further, the strategic thinker “thinks in time” taking into consideration lessons of history and educated future projections into his decision-making process. (C / P) Moral A leader who models humility, high ethical and moral standards leadership and is willing to display moral courage in speaking truth into power and making decisions in accord with that moral code, ­placing the interests of the service and Nation above his / her own. (C / P / S) Strategic deci- The ability to make and accept responsibility for critical and diffision making cult decisions, which take into account all significant factors and issues of multiple actors and organizations affected and considers the increased complexity and associated risk. (C / P / S) Influential A leader who displays humility and confidence, and creates a posleadership style itive and empowering environment where others are treated as equals. He / she possesses strong negotiation and consensus building skills and routinely establishes collaborative relationships and teams across groups and organizations, recognizing that “position power” is not always an option or the most productive approach. (C / S) System of systems thinking (strategic thinking)

*C / P / S denotes cognitive, physical, and / or social interdependencies across the attributes.

identify a baseline score on adaptability, for example, and providing the training and education to enhance it. Thus, furthering such work necessitates collaboration with the army’s science and technology (S&T) community (discussed later). uq hps conclusions

The conclusions of the uq hps event were collectively derived by event participants. First, the participants endorsed the list of soldier attributes required to win in the FOE. Second, the participants identified existing assessments and psychometrics to complement ongoing efforts to administer to the soldier and officer cohorts. Third, they identified the need for delineation of pre-accession attributes (must possess prior to entering service) and post-accession attributes (can develop in-service). Fourth, the participants found that the U.S. Army needs to begin assessing recruits, soldiers, and leaders for cognitive, social, and emotional

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attributes. Finally, the participants found that much of this could be accomplished during officer and non-commissioned officer professional military education (pme), with attendance in courses such as the Basic Officer Leaders Course (b o l c ), Career Captains Course (c c c ), Advanced Leader Course (alc), or the Senior Leader Course (slc). While the U.S. Army has lists upon lists of attributes soldiers must possess to be successful, h dd was given the task to determine what attributes soldiers of the future would need to operate successfully in high-intensity conflict, within the context of the f o e . In regards to the second conclusion, aside from periodic officer evaluation reviews (oers), Army personnel are not assessed as formally and regularly as recruits. For example, the Armed Services Vocational Aptitude Battery (asvab) is administered upon entry, and the results largely determine an individual’s career track within the military.43 Multiple Army researchers conveyed that there is a need for tests that formally assess cognitive and non-cognitive attributes (such as social and emotional traits and behaviours) throughout a soldier’s career.44 For example, current measures used to identify adaptability (among other attributes) are a r i ’s Tailored Adaptive Personality Assessment System (ta pas),45 which is a personality test that assesses attitudes and behaviours focused on twenty-two facets such as adjustment and tolerance.46 tapas is used with recruits, but the recommendation was that it should be implemented army-wide throughout a soldier’s career. Another instrument recommended for army-wide implementation to measure social attributes (such as unit cohesion or self-discipline) is the Automated Collaboration Collection and Relationship Understanding Environment (accrue). accrue is a suite of software applications developed for the collection and organization of communications data (such as email, chat, and face-to-face interactions) and uses sociometric badges. The ac c rue software also analyzes data to indicate team states such as trust or cohesion. Finally, the software can provide real-time feedback to commanders on the dynamics of individual and team performance.47 Implications of the Future Operational Environment on Attributes The implications of the f o e on attributes were also identified by group participants. First, the participants found that smaller units operating in a dispersed manner place greater requirements on individuals. Soldiers operating in the f o e are more likely to be isolated

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and subject to extreme physical, mental, and emotional stress. Soldiers need to be physically robust, cognitively capable, and able to rapidly form effective and at times ad hoc teams. Dispersion requires resiliency due to a lack of redundancy in smaller units. Casualties will have a greater impact on combat effectiveness and increases the requirement for cross-training and multi-role soldiers. Replacing losses will be extremely difficult and often cost-prohibitive, based on the available pool and time. Indeed, soldiers must be employed thoughtfully, as recruiting the attributes in an all-volunteer force shows that this may not reflect the U.S. population as a whole. It will also cost more to select the right soldiers from the smaller population propensity and qualifications to serve, and therefore, the U.S. Army may not be able to meet endstrength requirements through volunteers alone. Although these factors and considerations suggest that the force will be lethal, ethical, and effective, it will not be without vulnerabilities. The ability of an adversary to target a small professional force is increasing. This is the case in terms of individualized threats and attacks, and spoofing to degrade trust within the force. Given the realities of what is increasingly being referred to as gray-zone or hybrid war, many of these attacks may manifest themselves in non-kinetic ways that are difficult to defend or deter with conventional systems and understanding. At the Senior Leader Discussion (s l d ) held on 30 March 2017, h d d presented the major findings of the u q human performance events to General David G. Perkins, Commanding General (c g ), tradoc and other senior Army leaders. The cg tradoc endorsed the six core attributes of the soldier 2035–50, and instructed h d d to lead the effort in identifying doctrine, organization, training, materiel, leadership and education, personnel, facilities and policy (dotmlpf-p) solutions across the army. This is a multi-year endeavor that requires collaboration across multiple army organizations and has the potential to change how the army recruits and how it assesses and trains future soldiers. Using the six core attributes of the soldier of 2035–50 as an anchoring point, the key question that needs to be addressed is how do we enhance human performance by implementing changes across the dotmlpf-p? Some of the issues that need to be addressed are gauging whether soldiers possess these attributes and the extent to which they can be measured, and if so, how well; and what is changeable for operational effect. The end-state is to identify current and planned

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programs (near-, mid-, far-term) that address the problem set, and propose new solutions, which like chapters 8 and 9 of this volume focus on training and education efforts beyond technological enhancements. The solutions proposed will have to adhere to the following criteria of scalability, screening in rather than screening out, improving performance, and remaining adaptable. During the April 2017 hdd workshop, the CoP provided input on the implementation strategy for the six core attributes and their respective d o t m l p f -p solutions. At the workshop, work groups were formed across various army organizations to commence work on each attribute. During the June 2017 h d d workshop, six work groups comprised of subject matter experts across military, industry, and academic organizations conducted their initial meetings to commence work on soldier attributes. Conducting research on how best to equip or increase the six attributes across the U.S. Army entails coordination and collaboration with researchers across various army labs such as a r i and A r l -h r e d . Work will also include concept development, and experimentation and wargaming during future uq events. Development of training and education programs that include the six attributes will need to be pursued by t rad o c. Again, this is a multi-year endeavour that will require collaboration across army, industry, and academic organizations. But most importantly, the onus will be on senior leaders to implement recommended changes to improve how the U.S. Army recruits, assesses, and trains soldiers so as to enhance human performance in the f o e in a way that is at once effective and scalable, and complements initiatives that are more technologically focused.

notes

  1 For more information, visit darpa’s website: www.darpa.mil   2 The Adaptive Execution Office (aeo); Defense Sciences Office (dso); Information Innovation Office (I2O); Microsystems Technology Office (m to); Strategic Technology Office (s to ); and Tactical Technology Office (t to ).   3 The Defence Advanced Research Projects Agency – darpa – has undergone several name-changes. First known as the Advanced Research Projects Agency, from its inception in 1958, it was renamed darpa in

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1972. Then, in 1993, it reverted to arpa until 1996 when it retook the darpa moniker. Many thanks to the anonymous reviewer for this nuance.  4 da r pa , Bridging the Bio-Electronic Divide, published 19 Jan 2016, https://www.darpa.mil/news-events/2015-01-19.  5 da r pa , Warrior Web (Archived), accessed 17 Feb 2019, https://www. darpa.mil/program/warrior-web.  6 da r pa , Soldier Centric Imaging via Computational Cameras (SCENICC ) (Archived), accessed 17 Feb 2019, https://www.darpa.mil/program/ soldier-centric-imaging-via-computational-cameras.   7 The majority (71.9 per cent) of science and technology (S&T) core programs are executed via am c.   8 The others include: Aviation & Missile Research, Development & Engineering Center (am rdec); Armaments Research, Development & Engineering Center (ardec); Communications-Electronics Research, Development & Engineering Center (cerdec ); Edgewood Chemical Biological Center (ecbc); Natick Soldier Research, Development & Engineering Center (n s rdec); and Tank-Automotive Research, Development & Engineering Center (tardec ).   9 U.S. Army Research Development & Engineering Command (r dec om), a r l -h r ed Overview Brief, 21 June 2016. More specifically, the goal of human sciences research at arl-hred is to: (1) “Understand and predict dynamic human behavior of individuals, teams, organizations, and societies in real world situations”; (2) “Directly and indirectly enhance individual human capabilities applicable to broad ranging scenarios”; and (3) “Discover, understand, exploit, and apply fundamental principles for the integration of humans and systems across domains, including but not limited to complex information systems, human-agent teams, cybersecurity and organizational and social networks.” 10 U.S. Army, Organizations, updated 1 Mar 2011, https://www.arl.army.mil/ www/default.cfm?page=231. ; The other two labs are the Environment for Auditory Research (ear) and Cognitive Assessment Simulation & Engineering Lab (cas el). 11 U.S. Army, S&T Campaign, updated 27 Oct 2014, https://www.arl.army. mil/www/default.cfm?page=2512; The other S&T Campaigns include: Extramural Basic Research, Computational Sciences, Materials Research, Sciences-for-Manuever, Information Sciences, Sciences-for-Lethality & Protection, and Analysis & Assessment. 12 U.S. Army Research Institute of Environmental Medicine (usa r iem) http://www.usariem.army.mil/.

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13 U.S. Army Research Institute (ari ) for the Behavioral and Social Sciences https://sslweb.hqda.pentagon.mil/ari/default.aspx. 14 U.S. Army, Natick, updated 14 Feb 2019, https://www.army.mil/info/­ organization/natick. 15 U.S. Army, U.S. Army Training and Doctrine Command, updated 16 Feb 2019, http://www.tradoc.army.mil/index.asp. 16 Army Capabilities Integration Center (arcic ) Official website: http:// www.arcic.army.mil/Directorates/Headquarters. 17 Department of Defense, United States Code, 2006 Edition, Supplement 5, Title 10 – armed forces , updated 2011, https://www.gpo.gov/fdsys/ search/pagedetails.action?collectionCode=USCODE&browsePath=Title+10%2FSubtitle+A%2FPart+I%2FCHAPTER+2&granuleId=USCO DE-2011-title10-subtitleA-partI-chap2&packageId=USCODE-2011-title1 0&collapse=true&fromBrowse=true; Title 10 of the United States Code stipulates the role of the Armed Forces and the legal basis for the roles of each service (army, navy and marine corps, air force, and reserve components). 18 Between February – August 2016, HDD conducted two workshops (March and May) in order to scope the u q human performance events, which took place in September 2016 and December 2016. 19 arcic’s Army Warfighting Challenges (awfc) are first-order questions that serve as the analytical framework to integrate the army’s warfighting functions (such as mission command, sustainment, cyber, etc.), and guide research, learning activities, modernization, and future force design. They frame learning and collaboration and focus on both concept and capability development. Because awfcs are enduring, they allow the army to integrate near-term, mid-term, and long-term efforts to deliver the future force. 20 U.S. Department of Defense, Joint Publication 3-0, Joint Operations (Washington: Department of Defense, 2011), chapter IV, iv–1. 21 The eight interrelated operational variables include: political, military, economic, social, information, infrastructure, physical environment, and time (p me s i i -p t). 22 The mission variables include: mission, enemy, terrain and weather, troops and support available, time available, and civil considerations (mett-tc ). 23 These include: (1) climate change/resource competition; (2) increase in level of human performance; (3) cyber and space; (4) economic rebalancing; (5) human-computer interaction; (6) artificial intelligence; (7) demographics and urbanization; (8) technology, engineering, and manufacturing; (9) big data; (10) collective intelligence; (11) robotics; and (12) power generation and storage.

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24 Training and Doctrine Command G2, Trends Shaping the Future Operational Environment (OE ) 2030–2050 (U.S. Army, 2016). 25 Carl von Clausewitz posited that the nature of war is enduring and includes four continuities: uncertainty; contest of wills; political objectives; and human-centric. In Carl von Clausewitz, On War, ed. Michael Howard and Peter Paret (Princeton: Princeton University Press, 1976). 26 Frans P.B. Osinga, Science, Strategy and War: The Strategic Theory of John Boyd (London: Routledge, 2006). 27 Osinga, Science, Strategy and War: The Strategic Theory of John Boyd, 35. 28 U.S. Department of Defense, Army, Human Dimension Concept, tradoc Pamphlet 525-3-7, by Training and Doctrine Command (tr a doc , 2014) (US Army). 29 U.S. Department of Defense, Human Dimension Concept, tradoc Pamphlet 525-3-7, 12. 30 Ibid., 14. 31 Ibid., 15. 32 The event took place 12–16 September 2016 at the U.S. Army War College, Carlisle, and included forty-four participants from academia (7), industry (4), government and military research laboratories (14), sister ­services (11), and joint and multinational partners (8). 33 Examples of social structural trends include education, religion, gender issues, values/beliefs, patriotism, and trust in and need for machines. Examples of political structural trends include electoral political, nationalism, regionalism, and the civil-military relationship. Examples of economic structural trends include globalization, employment, internet-based commerce and skill acquisition, and capitalism. The groups were not limited in scope. 34 Aggregation of work group findings took place in a morning plenary ­session on Day 4 of the event. 35 Adapted from K. Albrecht, “Deconstructing the Future: Seeing Beyond Magic Wand Predictions,” Futurist, July–Aug 2014, http://www.karlal​ brecht.com/downloads/Albrecht-DeconstructingTheFuture-WFS.pdf. 36 Drivers of change refer to natural or human-induced factors that directly or indirectly cause a change. 37 What are the U.S. structural trends compared to peer adversaries in 2035–50? 38 Some synonyms for attribute include: characteristic, element, quality, trait, feature, aspect, indicator, property, and mark. 39 English Oxford Living Dictionaries, “Attribute,” definition 1.2, accessed 17 Feb 2019, https://en.oxforddictionaries.com/definition/attribute.

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40 Fact Sheet – Future Soldier and Army Civilian Attributes and Competencies, report, Center for Army Profession and Ethic (c a pe, 2015). 41 There were sixty-seven participants at the hps representing the following organizations: U.S. Army Forces Command; U.S. Army Training and Doctrine Command; U.S. Army Research, Development, and Engineering Centers; Army Research Institute; Asymmetric Warfare Group; the U.S. Army War College; allied partners (United Kingdom, Canada, and Australia); academia; industry. Twenty-six participants were subject matter experts with doctoral degrees across the physical, cognitive, and social sciences; and twenty-six participants were senior leaders in the military. 42 This framework was developed by arci c hdd and vetted with army senior leaders. 43 All of the U.S. military services use the asvab . 44 U.S. Army Research Institute, Personnel Assessment Research Unit, Validating Future Force Performance Measures (Army Class): Concluding Analyses, ed. Matthew T. Allen, Deirdre J. Knapp, and Kimberly S. Owens (Fort Belvoir, va: U.S. Army Institute for the Behavioral and Social Sciences, 2016). 45 U.S. Army Research Institute, Personnel Assessment Research Unit, Assessing the Tailored Adaptive Personality Assessment (tapas ) as an mos Qualification Instrument, ed. Christopher D. Nye, Fritz Drasgow, Oleksandr S. Chernyshenko, Stephen Stark, U.C. Kubisiak, Leonard A. White, and Irwin Jose (Fort Belvoir, va: US Army Research Institute for the Behavioral and Social Science, 2012). 46 Others include: mobile-based measures; Leader Profile Assessment; critical thinking assessments; the Asymmetric Warfare Group (awg) and Johns Hopkins University measures; and ARI and Army Research Labs (a r l) socio-metric measures. 47 Human Research & Engineering Directorate (hr ed), U.S. Army Research Laboratory, Brigade-Level Staff Interaction Patterns: Summary of Preliminary Findings, ed. A.H. DeCostanza and K.L. Orvis (Fort Belvoir, va : U.S. Army Research Institute for the Behavioral and Social Science, 2012).

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easing the burden

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6 Rationalizing the Approach to Mitigate Soldier Physical Burden: Are Iron Man or Captain America the Magic Bullet? Linda Bossi, David Tack, Allan Keefe, Thomas Karakolis, and Monica Jones Throughout history, the dismounted soldier has had to carry heavy combat loads while marching long distances under very demanding terrain and environmental conditions. While they can doff their packs and much of their sustainment load once they arrive at their objective, they must still be fit to fight while wearing significant assault or fighting loads. As General Marshall noted, the infantryman is “a beast of burden” but his “chief function in war” does not really begin until he delivers that “burden” on the objective.1 This chapter introduces this section’s topic of “easing the burden,” presenting the enduring problem of soldier physical overload, characterizing its prevalence, severity, causes, and consequences, and then examining the potential for Human Performance Enhancement (h p e ), deliberately increasing human potential, beyond that accomplished naturally, to help mitigate the problem. In contrast to many other chapters in this volume, this chapter suggests many alternative, perhaps simpler, more cost-effective, and more readily acceptable solutions that could, and probably should, be exploited before h p e is developed sufficiently to successfully mitigate physical overload, at least for the dismounted soldier in the near-term. historical and enduring problem of overload

Soldier loads have increased throughout the ages,2 so concern about soldier overload is not new. Studies to determine maximum soldier

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loading go back over a hundred years and, based mostly on physiological response, conclude that the soldier should not carry loads of more than one-third of their body weight.3 Most militaries recommend slightly lower doctrinal fighting loads of 30 per cent of body weight, recognizing that load carrying ability will be compromised by operational stressors,4 and allow for higher marching or administrative move loads at 45 per cent of body weight for the average soldier.5 The question of how much load a soldier can, or should, carry is a complex one to answer and depends on so many soldier system factors: the soldier’s own capabilities, the clothing and equipment worn and carried, their missions and tasks, and the environment in which they must operate. The question is therefore unlikely to be answered with a single number reflecting percent of body weight.6 It is interesting to note that load limit guidelines for mules and horses (actual “beasts of burden”) are limited to less than these typical soldier doctrinal soldier loads7 when their energy expenditure to carry loads is significantly less than that of humans,8 and they, unlike soldiers, are not required to go into battle when they have delivered their loads to their objective. t h e p r e s e n t - d ay o v e r l o a d e d s o l d i e r

The “beast of burden” analogy9 persists in the terminology used today; overload of soldiers due to equipment weight has been associated with the term “soldier burden” across many allied nations,10 and scientific literature refers to load weight almost exclusively when burden is discussed. The authors believe that this term should be defined much more broadly than equipment weight. It should integrate combined and cumulative impact of all stressors, physical or psychological, imposed on the dismounted combatant, if only to draw attention to the myriad of contributors and potential mitigating strategies for soldier burden. Stressors include: environmental, such as extremes in temperature, humidity, altitude, precipitation; metabolic, due to work performed; load or equipment properties, not limited to mass, but also considering mass distribution, coverage, bulk, stiffness, breathability, thermal resistance; as well as psychological, such as mental workload, fatigue, and combat stress. The focus of this chapter is on physical stressors and physical burden mitigation, though it is recognized that these will certainly be exacerbated by the simultaneous presence of the psychological stressors faced by our soldiers on operations.

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The loads carried by soldiers today are at record highs.11 Figure 6.1 shows the typical load carried by dismounted Canadian infantry soldiers, by role, during recent operations in Afghanistan. Required items of equipment or supplies were determined through consultation and consensus building with a group of six multi-deployment-­experienced staff and instructors serving at the Canadian Army’s Infantry School (at the Combat Training Centre, Gagetown, New Brunswick). Data in figure 6.1 refer to a short-range patrol scenario of less than four hours duration, under temperate conditions. Clearly, soldier loads are well above the established maximum loads of 30 per cent and 45 per cent of average body weight for fighting/ assault loads and approach march loads, respectively. For perspective, the percentage body weight values translate to 26.04 kg and 39.06 kg, based on the average Canadian male combat arms soldier body weight of 86.8 kg.12 In figure 6.1, the Section Commander’s load is at 65 per cent of the average soldier’s body weight, more than double the recommended maximum. However, not all soldiers are average, so even these load limits, if followed, would further burden all those soldiers who are below the average body weight. While clothing and much personal protective equipment (p p e ) may be sized to soldiers, and therefore lighter in weight for smaller soldiers, many of the heavier items carried – such as weapons or ammunition – do not cater to the variability in soldier size and load-carriage capacity. To make matters worse, soldiers rarely train for operations with loads representative of those carried on operations. This often leads to soldiers dealing with serious physical overload for the first time in an operational theatre along with many other new operational stressors. It is no wonder that many allied nations are trying to tackle the problem of soldier burden with high priority. w h y s u c h h e av y l o a d s ?

A number of factors have likely contributed to the increase in combat loads over time. While perhaps counterintuitive, technological innovation is more likely to have added to the soldier’s load than reduced it, because of the new capabilities offered.13 Soldier modernization programs have fielded important new technologies and capabilities down to the individual soldier level (e.g., gps, soldier radios, night vision equipment, weapon-mounted sensing, aiming and illumination aids, underslung grenade launchers, breaching equipment, or electronic

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Load weight (kg)

60

Sustainment

50

Non-power subsistence

40

Power

30

Other protection

20

Ballistic protection

10

C4I System Enhanced vision

0 Sect Sect 2 I/C Comd

Rfmn Grenadier

Dismounted section role

Light MGnr

Ammo Weapon system

Figure 6.1  Consensus on Canadian dismounted infantry loads, by dismounted infantry section role, for a typical Afghanistan mission *Horizontal lines represent maximum recommended or doctrinal loads for the average soldier weight (86.8 kg): the upper line represents 45 per cent of average body weight for administrative moves or marching order, and the lower line represents 30 per cent of body weight for patrolling, advance to contact missions or fighting order. (Sect Comd = Section Commander, Sect 2 I / C = Section Second in Command, Rfmn = Rifleman, Light MGnr = Light Machine Gunner).

countermeasures). Most of these new capabilities require power, and since batteries are not standardized across equipment procurements, soldiers must now carry and manage multiple types of batteries, adding to their burden. The nature of counter-insurgency and adaptive dispersed operations can make re-supply difficult, particularly in immature theatres of operation. Sustainment loads of consumables (such as ammunition, batteries, food, and water) may be higher than ever due to a lack of confidence in re-supply, real or imagined. Potable water loads are also higher due to the hydration requirements imposed by hot climates, as experienced on recent operations. Finally, our soldiers are wearing more ppe, or body armour, as a result of the emergence of new threats such as Improvised Explosive Devices (ieds). While intended to enhance survivability, the ppe is burdensome by nature, adding significant weight, restricting movement, increasing ensemble bulk, and interfering with normal heat dissipation. The overload situation may well be due to many other long-standing reasons that others have identified,14 including: lack of appreciation for the dangers of and how to mitigate against overload; concerns about injuring soldiers in peacetime by undertaking more

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operationally realistic training; fear of not having critical supplies in the rare event they might be needed; anxiety over having to justify making a balanced risk decision and ordering men to reduce their protective posture when conditions really do warrant this; lack of sufficient airlift or ground transport; or failure in leadership to do proper mission-specific load planning or to provide clear guidance and monitor its enforcement. Several nations have ppe that is designed to be modular or scalable in nature, as well as doctrine that permits adoption of armour protection levels with varying degrees of encumbrance15 to take into account mission, environment, terrain, and threat conditions (m e t t-c). The extent to which other nations’ soldiers actually modify their protective posture to balance protection with the risk of burden-related injuries or performance decrement is not well-documented, with the exception of one United States Marine Corps (usmc) command and staff college paper.16 That paper supports what we have heard in focus groups with Canadian soldiers – that armour protection level decision-making in recent counter-insurgency operations was not typically delegated down to tactical units, and that orders were typically to maximize protection at all times. This may reflect lack of awareness of the consequences of overprotecting, and lack of appreciation for the fact that passive protection should be one’s last resort in terms of integrated survivability. While some authors argue that overload can be dealt with through effective leadership (i.e., better load planning and enforcement of mission loads),17 it may well be that there is insufficient knowledge about the causes and impact of overload and burden, the trade-offs between loads, task performance, injury risk, operational impact, and the strategies needed to effectively deal with these.18 w h at a r e t h e r i s k s o f o v e r l o a d ?

Soldier load carriage has been studied for more than a century so there is much evidence of the impact and risks of overload. Scientific literature is replete with evidence of increased physiological strain in response to increasing soldier load weight (for a summary see Knapik and Reynolds 2012). Whether loads are carried in packs, worn on the torso, or carried in the hands, as load weight increases, so too do many indicators of physiological strain, including: the metabolic or energy cost,19 heart rate,20 respiration rate,21 muscle activity,22 and blood lactate levels.23 Increases in physiological strain can lead to

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more rapid onset of fatigue, degraded performance, and increased risk of over-exertion or musculoskeletal injury. There may also be increased risk of heat casualties, if soldiers are carrying loads while operating in challenging conditions such as high heat and humidity, altitude, steep, uneven or soft terrain,24 or at a fast pace, especially if encumbered by p p e .25 Load carriage literature also reveals significant impact on movement biomechanics with increasing soldier load weight (for reviews, see Orr, Johnston, et al. 2012; Knapik and Reynolds 2012) regardless of how loads are carried (in backpacks, on the torso, or borne by the extremities). Any load-related changes to gait or movement biomechanics are important as they can not only impair mobility performance, but also lead to increased discomfort, musculoskeletal injuries,26 as well as the longer-term risk of osteoarthritis.27 Several detailed reviews28 summarize the following medical implications of load. After foot blisters, the most common load-related injuries are musculoskeletal, affecting the lower limbs (e.g., localized pain, strains, sprains and stress fractures, and several nerve compression injuries that cause numbness, tingling, pain, weakness or temporary paralysis).29 The back is the next most common site for load-induced injury, with low back problems likely related to exaggerated body lean angles associated with heavy pack loads, as well as the asynchrony with which heavy loads move with the body.30 Rucksack palsy, a common debilitating injury associated with backpacks, results from entrapment of the brachial plexus by the lower shoulder strap in the armpit.31 Body armour may also contribute to increased risk of over-exertion32 or heat illness33 due to its weight, coverage of the body with non-breathable materials that hinder heat dissipation, and inherent stiffness, requiring increased effort to overcome restrictions to movement.34 Soldier overload has contributed to spiralling numbers of musculoskeletal injuries, resultant disability payment costs,35 loss of combat-readiness, and perhaps even casualties or fatalities.36 The incidence and severity of the problem is unknown, since medical records rarely record the context of operational or occupational injuries in sufficient detail to relate to equipment worn or loads carried. The literature provides unequivocal evidence of impairments to military-relevant physical task performance with increasing load weight,37 regardless of how that load is carried by the body. Significant performance decrements with increasing load have been demonstrated

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for operationally relevant mobility tasks such as marching,38 distance running,39 high intensity explosive sprints or agility runs,40 and obstacle or combat mobility course completion.41 More recently, performance for more tactically relevant movements such as bounding rushes, manoeuvre under fire (ma nu f ), or break contact drills has been shown to be significantly affected by load weight.42 An early study43 and several recent reviews44 concluded that for every kilogram of load, one can expect to see approximately 1±0.5 per cent decrement in mobility performance (straight runs, mobility/agility or obstacle courses). This decrement is surprisingly consistent considering the range of task methods, load conditions, and participants involved in those studies. This may not seem like much of a decrement, unless one considers by just how much soldier loads exceed recommended limits, and just how vulnerable soldiers may become when slowed down while under enemy fire. Several researchers have demonstrated, at least in a few limited scenarios, that load-induced mobility decrements significantly affect soldier susceptibility to enemy fire.45 Intuitively, at least, this seems linked to ultimate survivability on the battlefield and perhaps even mission success. Even perceptual and cognitive task performance could be impacted by physical overload. Although less equivocal than studies of the physiological, biomechanical, medical, or physical task performance impacts of load, several studies have indeed demonstrated that, with increasing physical load, decrements in perception (i.e., of threats), or impaired cognition (i.e., understanding or retention of orders) are indeed possible,46 contributing to the risk that overload could have on soldier survivability or mission outcome. i s s o l d i e r a u g m e n tat i o n o r e n h a n c e m e n t the solution?

Might human performance enhancement (h p e ), as defined and described by the editors and previous chapter authors, offer the solution to the problem of soldier burden and overload? Let us first examine the potential for biochemical h p e , as categorized in chapter 3. There probably isn’t an international level sport that isn’t concerned about the use of performance-enhancing substances by its athletes looking to gain the decisive edge needed to win. Can and should such substances be exploited for official military use to increase soldier capabilities beyond what is achievable naturally? Anecdotally, soldiers

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may already be using steroids and other substances on their own in spite of policies and health warnings that discourage the abuse of such substances.47 Some countries actively invest in research to develop or better understand the performance and health implications of ergogenic aids. The U.S. Army, for example, makes available to its soldiers “Hooah” caffeine gum to counter the effects of fatigue on operations.48 It is one thing, however, to turn a blind eye to individual use of performance enhancing substances, or to make available a commonly ingested substance such as caffeine in a readily ingestible form. It is quite another to develop, produce, issue, and require the use of performance-enhancing substances by armies to achieve the decisive performance edge needed in battle. Unfortunately, even systemic use by the military of life-saving pre-treatments or antidotes has proven to be controversial (e.g., use of potentially life-saving nerve agent pretreatment tablets has been associated with Gulf War Syndrome; antimalarial treatments with psychoses; anti-mosquito permethrin treatments of fabric with other health issues). What about the potential for more invasive, more permanent h p e such as that employed in the movies to create Captain America? Biotechnology and genetic engineering approaches, discussed in the previous section of the book, offer the opportunity to create “super human soldiers” who are more effective on operations, better able to carry loads, further, faster, longer, with perhaps less potential for acute musculoskeletal injury and more resilient to the stresses of combat49 though it is doubtful that bioengineering future soldiers could ever be seriously considered as a solution for overload given the likely myriad of associated legal, medical, moral, and ethical issues previously presented by at least one author50 and discussed throughout this book, and specifically in chapters 10 and 11. Surely less invasive and less-permanent hpe alternatives should be considered as the solution to soldier overload and burden. For example, for over a century, scientists and engineers have been developing exoskeletons in an effort to augment or enhance human movement,51 and interest in their application to mitigate soldier burden has increased dramatically in the past ten years or so, as highlighted in chapters 2 and 7. As described in chapter 3, exoskeletons arose from rehabilitative medicine (to assist injured or disabled wearers regain normal limb function and mobility) and they are now being exploited to assist able-bodied wearers perform mobility tasks beyond normal human capabilities. Once considered science fiction and depicted only

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in movies such as Iron Man, this technology has made its way into mainstream science. Typically highly customized, close-fitting, wearable assistive devices that may or may not be powered, exoskeletons, sometimes called exosuits52 or dermoskeletons,53 are intended to act in concert with the wearer’s movements, to augment wearer performance, enhance their load-carrying capacity, strength and/or endurance.54 They may have rigid framing elements, intended to transfer external loads to the ground55 or they may be soft, compliant, biologically inspired “exosuits” and assist normal muscular action through actuated cables.56 Might an “Iron Man”-like suit57 or exoskeleton be the solution, the “magic bullet,” to the problem of soldier overload? Well-funded U.S. government research programs are exploring the potential for exoskeletons to help soldiers carry their extreme loads more effectively, or help them carry more, and thereby improve soldier mobility and effectiveness on the battlefield whilst reducing potential for musculoskeletal injury. The U.S. Special Operations Command Tactical Assault Light Operator Suit (talos) program aims to dramatically improve the protection of special forces personnel (i.e., maximize coverage of the body with armour) through the use of powered exoskeletons.58 The U.S. Defense Advanced Research Projects Agency (darpa) Warrior Web program, supported by the U.S. Army Research Laboratory (arl), on the other hand, is developing a low-powered soft suit, intended to be worn underneath the uniform, to augment soldier load carrying capabilities and allow them to carry up to 100 pounds of equipment without risking joint and back injuries.59 Multiple examples of exoskeletons exist worldwide, including but not limited to: Warrior Web;60 Human Universal Load Carrier (hulc);61 uprise; 62 Knee Stress Releaser Device (K-srd);63 Exo-buddy;64 exos 2;65 bleex; 66 or Hercule.67 Many international defence research organizations are currently investigating the potential of such example exoskeletons for increasing soldier performance beyond that which is currently or naturally possible. To date, many attempts to enhance human motor abilities with exoskeletons have failed. While there have been many claims of the potential of exoskeletons to reduce the energy cost of walking,68 all too often, studies have only compared energy costs of walking between powered and unpowered modes, and have not compared to the energy cost of walking without the exoskeleton. In other words, the systems have not been able to fully overcome the energy cost associated with carrying the extra weight of the system itself, so

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therefore, when worn, they actually increase the energy cost of walking.69 As well, they induce significant changes to gait biomechanics,70 which can lead to injury and even osteoarthritis, as mentioned in a previous section of this chapter. When wearing loads of twenty, forty, and fifty-five kg, use of one exoskeleton prototype actually increased energy costs to unsustainable work rates, even for healthy, young males.71 While trial participants have perceived that exoskeletons make load carrying easier,72 it is only very recently that researchers have been able to demonstrate real energy savings over unassisted walking on level treadmill walking with a soft unpowered exosuit,73 hence the recent heightened excitement amongst defence organizations over their potential. Challenges remain if exoskeletons are ever to become mainstream, particularly for dismounted soldier application, including: weight; power demands (though there is certainly potential for exoskeletons to also support power generation to a limited degree); uncomfortable interfaces; reliability and maintainability issues; requirement for customized fit; compatibility with wide range of soldier sizes, equipment, and tasks; and cost, to name a few.74 Certainly, and as a minimum, exoskeletons will need to prove themselves under rigorous testing, a framework for which is described in chapter 7. It has been suggested that widespread implementation of worn assistive devices for burden mitigation in dismounted operations is at least a decade or more away,75 though they may be implemented sooner for specific operators (i.e., special operations, infantry heavy weapons sub-units)76 or in limited scenarios with frequent repetitive manual material handling, as in logistics functions, since they are now already being tested for their potential to reduce muskulo-skeletal injuries for lifting heavy load in commercial retail applications.77 If Iron Man or Captain America aren’t going to solve these burdens, at least not in the short-term, what is the solution? The authors contend that the enduring problem of soldier burden will only soon be successfully mitigated through small incremental gains across a whole range of interventions. There is no magic bullet to this enduring hard problem; a soldier-centric, holistic systems approach is needed.78 proposing a systems approach t o b u r d e n m i t i g at i o n

Across many domains and applications, a systems approach considers the following to be the main interacting components of a complex,

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human-centric, socio-technical system, such as “The Soldier System”79: Technology/Tools, comprising all the technology, clothing, equipment worn, carried, consumed, or operated by the soldier; the User(s), representing the immense variability in the soldier population in terms of physical, physiological, or psychological characteristics and capabilities; the Tasks that soldiers must perform, whether physical, p ­ erceptual, or cognitive, in training or on operations; and the Environments in which soldiers must operate, including physical environments (temperature, humidity, precipitation, terrain, altitude, etc.) as well as organizational environments (policy, doctrine, leadership, discipline, organization, reward structures, etc.). Representative, though non-exhaustive, burden-mitigating strategies will be exemplified for each of these interacting “t ut e ” system components in turn and are summarized at figure 6.2. Tools or Technology Solutions Whenever possible, getting the load off the soldier should be the primary goal. Alternatives to exoskeletons include: off-loading technologies such as carts,80 manned or unmanned tactical carriers, vehicles, or robots.81 Wheeled carts, whether attached to the soldier,82 or simply assisted by the soldier,83 have been studied, though they are not without challenges in terms of load stability and ability of the soldier to respond appropriately to threats when attached or handling them. A carrier, manned or unmanned, could carry section loads and combat supplies plus provide a source of power, recharging capability, casualty transport, and information collection (isr), to name a few functions.84 Autonomous follower load-carrying robots offer great potential for burden mitigation in the mid-term, presumably with less demand for soldier attention and intervention.85 As is the case with exoskeletons, many of these high-tech off-loading solutions have challenges to overcome for the near to mid-term, particularly related to portable power, stealth, and ability to traverse very complex terrain under harsh weather conditions. Advances in material science could lead to reductions in the weight (or bulk or stiffness) of individual soldier system components (e.g., caseless ammunition), although there is consensus that the most that can be expected is about 6–10 per cent.86 Without accompanying doctrine and leadership, there is also concern that soldiers will simply offset any weight reductions by carrying more combat supplies such as water and ammunition. Incremental weight reductions

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Research to inform tradespace between loads & their impacts

Improved logistics re-supply

Personnel selection/recruiting/retention Physical conditioning & testing Education and training

Decision aids

Soldier enhancement

USER

Education

Load planning

Attitudes

Physiological monitoring

Doctrine

TASKS

Adapt task

TOOLS

Lighter materials Better integration

Reduce work rate Increase rest breaks

Human factors & ergonomics

ENVIRONMENT

Increase hydration Modify protection levels

Active or passive cooling Off-loading technologies

Figure 6.2  Summary of interventions for soldier burden mitigation using a systems approach

should be mandated for any acquisition of new equipment that replaces current capabilities, even if the replacement item has more functionality or capability. Recommended weight limits and centre of mass guidelines have been empirically developed for some soldier system components such as integrated headwear87 or soldier assault weapons,88 that reduce sub-system weight in order to reduce burden, and minimize discomfort or injury potential while ensuring acceptable combat task performance. Alternative approaches to soldier equipment design and integration offer the potential to reduce the burden parameters of weight, bulk, and stiffness. Body armour weight burden may be reduced by 10–20 per cent by refining body armour requirements, improving testing reliability, and requiring more tailored, better-fitting armour.89 Enhanced fit will also reduce ensemble bulk and stiffness. Modularity and scalability of armour protection can achieve as much as 20–45 per cent weight reduction,90 if implemented along with doctrine, training, leadership, and validated decision supports to ensure its effective use. Additionally, while armies may save money by designing and buying

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one design or solution for all soldiers and all missions, this may actually compromise real potential for burden mitigation. Equipment that is specific to dismounted infantry and those soldiers most vulnerable to the risks of overload should be acquired with burden mitigation and optimized performance in mind, even if it comes at greater initial or through-life cost. Finally, where thorough work domain and task analysis show that it is warranted, consideration should be given to integrating multiple capabilities or functionality into one item, to avoid having a “Christmas Tree” approach to soldier system integration. If all soldiers need multiple capabilities for most missions, those capabilities should be integrated into one item to realize weight and bulk savings in housings, power supply, and controls (e.g., integrated laser aimers/illuminators). Even simple load carriage equipment design and packing changes can help reduce burden (for a summary, see Joseph J. Knapik and Katy Reynolds, “Load Carriage in Military”91). Energy costs can be reduced for loads carried closer to the body’s centre of mass, loads that are symmetric, or loads that move in concert with the body.92 There are advantages of internal over external framed packs, as well as the use of pack hip belts.93 Pack suspension strap design can help to reduce peak underlying tissue pressures94 or shear forces on the spine.95 Incorporation of stiffness elements into load carrying equipment can help transfer more of the load to the hips.96 Any or all of these can reduce the incidence and severity of load-related health issues, such as rucksack palsy or lower back pain. Mitigation of thermal strain through equipment design is paramount. Increasing air permeability of clothing and equipment (through materials, ventilation options, or modularity) will increase tolerance to heat by permitting more passive sweat evaporation.97 Personal micro-climate cooling options have been successfully implemented for military personnel operating within vehicles or crew spaces98; technologies include active liquid- or air-cooled systems, and passive systems that employ phase change materials such as ice or salt,99 or systems that transfer heat to the outside of the armour through conduction.100 Few are currently suitable for dismounted operations due to a wide range of challenges: high power demands; requirement to be tethered to the cool air/liquid source and power supply; excessive system weight; inefficiency or short duration of effectiveness; and burden imposed by the cooling vest or carrier when not active.101 However, intermittent cooling, an option for soldiers supported by a

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carrier or robot, may be highly effective for situations where workloads are intense and where tethered systems are inappropriate.102 To facilitate mission-specific load planning, military commanders and soldiers would benefit from decision support tools that allow them to readily understand the many contributors to burden and their impacts. Commander’s guidance documents103 and soldier aide-­ memoires are a good start, but given the rise in computing technology on the battlefield, there is an opportunity to provide decision support that is much more powerful. Load and mission planning tools have and continue to be developed104 that could allow the user to enter or download soldier information, mission factors, select items of equipment needed for the mission. There is an opportunity to provide decision assistance models, based on research, that would inform decisions regarding: load weights, recommended distribution of loads across the section, energy costs of movement with loads,105 implications of loading on an individual and/or section/platoon performance, risk of over-exertion or heat illness, hydration or work/rest schedules, or even recommend alternative routes that would be optimized for the user’s prioritized goal (speed, energy cost, stealth, etc.). Much more research is needed to improve the accuracy and reliability of the complex models underlying such decision support tools. Physiological monitoring systems also show potential. Focus groups with soldiers reveal insufficient understanding of the signs, symptoms and risks of heat illness. Physiological monitoring might be acceptable for use in training so that soldiers and leaders can learn individual responses to heat, overload, and other training stressors.106 Real-time remote monitoring of soldier burden indicators, readiness, casualty risk, and actual injuries might eventually be achieved, and when networked with above-mentioned decision-support tools, help leaders, commanders, and their supporting medical chain on operations. A significant challenge is the weight of batteries needed to sustain modern combat missions.107 Better power system integration is being pursued by Canada and her allies, including: standardization of power sources to minimize the number of different battery types carried by each soldier, better distribution and management of power on the soldier, automatic charging whenever the soldier is seated in the carrier, as well as generation of power, by capturing solar energy or the energy harvested during normal human gait108 to recharge batteries on the soldier on the move.

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Finally, targeted air-drop and the increasing use of blue-force tracking by all friendly forces will lead to improved accuracy, timeliness, and reliability of combat re-supply. Increased confidence and trust in re-supply could lead to better load planning practices by leadership that balance risks between enemy and burden-related losses, and could reduce loads by tempering soldiers’ natural inclination to pack for all possible worse-case situations. User Interventions Fitness measures correlate highly with load carrying capacity and performance109 as well as reduced load-induced injuries.110 Lean body mass (or low percent body fat) is probably the strongest predictor in terms of marching111 and it also relates to heat tolerance.112 Muscular strength and endurance are the next most predictive of marching performance under loads,113 followed by aerobic fitness.114 Important fitness correlates of obstacle course performance, on the other hand, appear to be muscular strength and endurance measures such as maximum number of sit-ups or push-ups in a prescribed time, or composite Army fitness scores,115 with aerobic fitness to a lesser degree.116 Load carrying experience is also important to either task.117 It has long been recognized that regular physical training that includes aerobic exercise, resistance exercise and road marching can improve extended load carriage marching performance,118 though there is wide variability in the approach and training regimen. A 2010 narrative review119 recommended specific load carriage training, two to four times per month, with loads sufficient to elicit aerobic fitness development, ensuring that duration and distance gradually progress to avoid acute and overuse injury risks. In a more recent systematic review,120 the greatest effect size was seen with progressive resistance training (focused on the upper body), combined with aerobic training and performed three times per week over at least four weeks, augmented with progressive load carrying exercise once weekly. There is growing evidence that performance of high-intensity combat mobility tasks such as rushes, fire, and movement, or break contact drills, is also related to physical fitness and can be improved through targeted physical conditioning and practice of those combat movements.121 Authors of these studies stress the importance of a shift from purely endurance running, typical fitness training undertaken by most combat units,

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to a more sprint-based speed-training approach, in order to improve performance on these tasks so critical to battlefield survivability. It is critical that soldiers train as they will fight, by wearing and working in realistic operational loads, clothing, and equipment configurations. The weight, bulk, and stiffness characteristics may change the way soldiers must complete tasks and, in life and death situations, these actions must be automatic, only possible through extensive practice and muscle memory. While physiological heat acclimation can happen in a couple of weeks of exercise and exposure to environmental conditions,122 getting used to the discomfort associated with local high skin temperatures and sweating that cannot be compensated under non-breathable armour, so that it is not a distraction from performing other important perceptual and cognitive tasks, will require much longer exposure and experience. If modular, scalable protection is introduced, it will be essential to exercise alternative armour configurations over a wide range of missions, tasks, environments, soldiers, and leaders in order to build sufficient experience for leaders and soldiers to confidently decide on the best configuration for a given scenario. Mission, Task, or Environment Adaptation While units cannot always choose to undertake a mission or task, a number of mission or task attributes can be adjusted to modify the impact of burden on the well-being and performance of soldiers, including: scheduling the mission for a cooler time of day; slowing pace of work123; introducing more frequent or longer rest breaks124; more frequent hydration; reducing protective posture (enabled by a modular, scalable protection system); sharing a task or load amongst more soldiers; or off-loading a task to another sub-unit or a nonhuman (carts, mules, tactical vehicles, or robots). Similarly, soldiers will rarely be able to alter the physical environment in which they operate. However, they can make choices in terms of their microenvironment, choice of tactics and use of ground. Maximum use of clothing ventilation, shading covering exposed skin, or reducing protective posture, are behaviours that occur naturally. Keeping stealth considerations in mind, they can also choose routes to minimize exposure to hazardous or challenging conditions. They might choose a route with overhead tree canopy to avoid exposure to precipitation or blazing heat. They might choose terrain that is flat versus hilly,

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hard-packed versus rough, or terrain that offers more cover, minimizing the requirement to get into prone firing postures during rushes. These decisions will be facilitated by a system that provides networked communications, situation awareness, terrain visualization, as well as mission and route planning tools and provides these tools to soldiers and leaders in training, not just on operations, so that their use becomes familiar and their reliability improves. Confidence in their utility will be instilled through lessons learned and experience. Soldiers and units often have choices about the environment in which they rest. Enforcing good operational and sleep hygiene practices will be important as the cumulative stresses of combat and exposure to challenging environmental conditions often lead soldiers to take shortcuts (e.g., not bothering with preparation of shelters, heating rations, etc.) which can affect mood, well-being, and impact on resilience and performance. Organizational and System-Level Strategies The importance of educating soldiers, leaders, and all stakeholders involved in the soldier system about burden cannot be overstated. Knowing the causes and factors contributing to burden, having a thorough understanding of the implications, risks, and outcomes associated with burden, and being exposed to the range of potential mitigating strategies, will be critical to ensure that every opportunity is taken to identify and implement incremental improvements across all lines of development (e.g., equipment, doctrine, training, organization, infrastructure, policy, etc.). However small these increments may appear, the collective impact that can be achieved within a culture focussed on burden mitigation may be very significant. It has become readily apparent, through focus groups and interactions with soldiers and sub-unit leaders, that few understand the health, injury, performance, or survival implications of every kilogram carried into battle. Soldiers speak of heat stress due to body armour without realizing that the more discretionary loads they choose to carry may contribute equally if not more to their physiological stress. Figure 6.1 provided some insights; for most section members, load proportions are highest for ammunition, then weapon system, nonpower subsistence (water, food, and food preparation equipment), then ballistic protection (armour and helmet), before other protection and sustainment loads. Soldiers almost unanimously prefer to get rid

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of protection to take more ammunition. While armour is heavy, uncomfortable, bulky, and hot, and does indeed hamper mobility, it saves lives. On the contrary, soldiers do not appear to question the high proportion of subsistence (water, food, food preparation equipment) and sustainment gear (load carrying equipment, overnight gear) they carry for such a short mission. The greatest contributor to their loads is typically ammunition, yet among the hundreds queried very few soldiers said they had ever expended – moreover very few even knew of any other soldier who had ever expended – a full load of ammunition during a firefight. Similarly, no one had ever heard of a failure in resupply. There certainly must have been more occasions when these occurred, however, this behaviour and attitude lends support to the concern about high ammunition loads that has been repeatedly expressed by senior officers in the literature reviewed.125 They attribute much of the overloading problem to a failure in leadership and insist that leaders need to do better specific-to-mission load planning, give proper direction, and monitor compliance in order to balance the risks between casualties due to burden and those due to enemy action. By taking a systems approach, however, mitigating strategies are many and certainly include proper load planning by leaders, but additionally include: re-evaluation of doctrine that dictates load lists, particularly minimum ammunition loads, to discourage overload; appropriate implementation of physiological monitoring systems126 that inform (or validate) decision support tools; routine exercising of the logistical resupply chain alongside combat unit training so that problems are ironed out in training rather than operations and to instill confidence in resupply127; and a focus on improving the quality and frequency of marksmanship training to ensure that aimed shots hit their mark with fewer rounds,128 to name a few organizational, system-level strategies. Burden mitigation should remain a research and development priority. Research has not always reflected the extreme loads and conditions (tasks, environments, human variability, etc.) reflective of operational reality. Many studies examining the impact of soldier clothing, equipment, and loads, or any burden mitigating strategies, may need to be repeated in a more ecologically relevant context. Knowledge gaps remain and include identification of important predictors of operational task performance, and then modelling the complex relationships amongst all burden contributors (not just load weight), so that soldier clothing and equipment design interventions

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may be appropriately identified, prioritized, and implemented. Soldier burden research to date has focused, almost exclusively, on the impacts of external load weight; this is perhaps not too surprising, since weight appears to be the biggest driver in terms of mobility effects (70 per cent according to129). However, given how difficult it has been for armies to successfully reduce soldier loads, consideration should at least be given to the contributions of other soldier equipment mass properties to help identify other solutions. As a first step, researchers are developing more accurate and reliable methods to characterize encumbered soldier and soldier equipment mass properties such as bulk,130 ppe coverage,131 and stiffness,132 or restriction to range of motion.133 These mass properties (in addition to weight) are also being evaluated in terms of their contribution to mobility task performance,134 to help prioritize where future investments should be directed in terms of soldier clothing and equipment design to mitigate burden (e.g., should we invest in thinner or more flexible armour solutions?). There also remains a serious lack of understanding of the tradespace between what soldiers wear and carry, their physiological readiness, their operational task performance, and the impact of these on their individual and their military unit’s overall operational effectiveness in terms of mobility, vulnerability, lethality, and integrated survivability. Once these trade-offs are quantified and adequately modelled, a whole range of analysis tools and decision aids can be developed, refined through experience and systematic data collection to improve their accuracy and reliability, and implemented so that all stakeholders – from researchers through those responsible for soldier system capability development, to soldiers and their entire chain of command – are enabled to make evidence-based decisions that will together achieve success in terms of soldier burden mitigation. More detailed, context-specific data are needed to understand the cause factors contributing to injuries, whether operational or occupational. Knowing the specific clothing and equipment worn, loads carried, environmental conditions, in addition to usual information gathered about what the soldier was doing when an injury occurred, can help to identify and replace injurious equipment (e.g., poor rucksack design) or practices (e.g., overloading soldiers on training courses to “toughen” them up). Strategically, investments should be made to build and validate equipped soldier virtual modeling and analysis tools and capability so that future alternative equipment and loading options can be assessed more quickly, accurately and cost-effectively

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in a Virtual Soldier Proving Ground.135 This would certainly not replace soldier-in-the-loop testing, but would enable efficient objective assessment of many more iterations of concepts and designs. Applying an evidence-based user-centred focus in the specification, design, testing, and acquisition of soldier equipment will ensure that proper attention is given to equipment implications on soldier physiology, biomechanics, injury risk, performance, and operational effectiveness. In a National Research Council report on Making the Soldier Decisive on Future Battlefields,136 several report recommendations speak to the importance of principles typically espoused by Systems Engineering and Human Systems Integration specialists, including the need for: a metrics-driven system of systems engineering environment with sufficient seniority, influence, and authority responsible for developing methods and analytical tools to evaluate and acquire total system solutions for soldiers and small tactical units; maintenance and evolution of a comprehensive set of measures of performance, effectiveness, and outcome (mo p s, mo e s, m o o s) for assessing capability improvements to the soldier system and regular assessment of the soldier system as it changes over time; investment in analysis architecture and infrastructure including the full range of human-system, engineering, and operational research modelling and analysis tools to enable “what-if” and sensitivity analyses to help prioritize burden mitigating strategies and support development of trade-off decisionmaking tools; and assembly of a consortium of multi-disciplinary cross-functional experts and stakeholders to implement analyses of the Soldier System, leverage existing research and development, and consider all intervention types (technology, doctrine, tactics, personnel, policy, etc.) in order to develop, identify, and seize opportunities for soldier burden mitigation, performance improvement, and to gain the decisive edge on the modern battlefield. conclusion

It won’t be Captain America or Iron Man that will ensure the survival and effectiveness of dismounted soldiers, at least in the foreseeable future. The invasive hpe approach used to create Captain America is probably a non-starter given the myriad of legal, moral, and ethical considerations likely to delay its acceptability. Even less permanent pharmacological hpe is unlikely in the near-term, until long-term use of ergogenic aids, including their use in combination with other typical

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battlefield stressors, has been proven to be safe, and until they are accepted for widespread use in society. Considering their low technology readiness level, integration challenges, and complexity, at least in the short term, Iron Man-like exoskeletons, though relatively noninvasive when compared to bioengineering hpe, may pose more risk than opportunity for dismounted soldiers whose lives depend on simple, robust, reliable technology and their ability to move and perform combat tasks with speed and agility on the battlefield. Just as the factors contributing to soldier burden are multi-faceted, so must be the strategies for mitigating burden. The complete spectrum of technology, user, task, environment, and system-level interventions must be considered by all stakeholders at all stages of the soldier and the soldier system life cycle. Aiming for incremental gains across all of these opportunities is our best shot at significantly reducing soldier physical burden and ultimately ensuring the survival and effectiveness of our dismounted soldiers in the near-term and into the future, when hpe options become more realistic.

notes

  1 Samuel L.A. Marshall, The Soldier’s Load and the Mobility of a Nation, (Washington: Combat Forces Press, 1950).   2 Joseph J. Knapik, and Katy Reynolds, “Load Carriage in Military Operations: A Review of Historical, Physiological, Biomechanical, and Medical Aspects,” Military Quantitative Physiology: Problems and Concepts in Military Operational Medicine (2012): 303–7.   3 N.V. Lothian, “Army Hygiene Advisory Committee Report No 1 on the Load Carried by Soldiers,” Journal of the Royal Medical Army Corps 37, no. 5 (1921): 342–51; E.P. Cathcart, “Army Hygiene Advisory Report No 3 on Maximum Load to be Carried by Soldiers,” Journal of the Royal Medical Army Corps 41 (1923): 161–78; M.F Haisman, “Determinants of Load Carrying Ability,” Applied Ergonomics 19, no. 2 (1988): 111–21; M.R. Pierrynowki, David A. Winter, and Robert W. Norman, “Metabolic Measures to Ascertain the Optimal Load to be Carried by Man,” Ergonomics 24, no. 5 (1981): 393–9; and Zuntz, and Schumberg, “The Physiology of Marching,” British Medical Journal 2 (1901): 360–2.  4 Marshall, The Soldier’s Load.   5 Jace Drain, Robin M. Orr, Renee Attwells, and Dan Billing, “Load Carriage Capacity of the Dismounted Combatant – A Commander’s

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110 Robin M. Orr, Venerina Johnston, and Julia Coyle, “Load Carriage: Minimising Soldiering Injuries through Physical Conditioning – A Narrative Review,” Journal of Military and Veterans Health 18, no. 3 (2010): 31–8. 111 Claudy L. Koerhuis, Bertil J. Veenstra, Jos J. van Dijk, and Nico J. Delleman, “Predicting Marching Capacity while Carrying Extremely Heavy Loads,” Military Medicine 174, no. 12. (2009); and Jason Lyons, Adrian Allsopp, and James L. Blizon, “Influences of Body Composition upon the Relative Metabolic and Cardiovascular Demands of LoadCarriage,” Occupational Medicine 55, no. 5 (2005): 380–4. 112 McLellan et al., “Encapsulated Environment.” 113 Koerhuis et al., “Predicting Marching Capacity; Joseph J. Knapik, Jeffery Staab, Michael S. Bahrke, John O’Connor, Marilyn Sharp, Peter Frykman, and James Vogel, “Relationship of Soldier Load Carriage to Physiological Factors, Military Experience and Mood States” (Natick: usa r iem, 1990). 114 Ibid. 115 Peter N. Frykman, Everett A. Harman, and Clay E. Pandorf, “Correlates of Obstacle Course Performance among Female Soldiers Carrying Two Different Loads” (nato rto hfm Specialists’ Meeting on “Soldier Mobility: Innovations in Load Carriage System Design and Evaluation,” Kingston, 2001); Clay E. Pandorf, Everett A. Harman, Peter N. Frykman, John F. Patton, Robert P. Mello, and Bradley C. Nindl, “Correlates of Load Carriage and Obstacle Course Performance among Women,” Work 18, no. 2 (2002): 179–89. 116 Frykman et al., “Correlates of Obstacle Course Performance.” 117 Knapik et al., “Relationship of Soldier Load Carriage.” 118 Knapik et al., “Soldier Load Carriage.” 119 Orr et al., “Load Carriage: Minimising Soldiering.” 120 Knapik et al., “A Systematic Review.” 121 Nick Barringer, and Martin Rooney, “The Rush – How Speed Can Save Lives,” Infantry (April–July 2016): 9–12; and Billing et al., “Effects of Military Load Carriage.” 122 McLellan et al., “Encapsulated Environment.” 123 n ato, “Management of Heat and Cold Stress.” 124 Tom M. McLellan, “Tolerance Times for Continuous Work Tasks while Wearing nbc Protective Clothing in Warm and Hot Environments and the Strategy of Implementing Rest”; James B. Carter, E.W. Banister, and James B. Morrison, “Effectiveness of Rest Pauses and Cooling in Alleviation of Heat Stress during Simulated Fire-Fighting Activity,” Ergonomics 42 (1999): 299–313.

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125 Ezell, “Battlefield Mobility”; Marshall, The Soldier’s Load; Townsend, “The Factors of Soldier’s Load.” 126 Burrell et al., “Integrated Physiological Monitoring.” 127 Ezell, “Battlefield Mobility.” 128 Knapik et al., “Soldier Load Carriage.” 129 Monica L.H. Jones, Sy A. Lois, Jenkins Glenn, Michel B. DuCharme, and Linda Bossi, “Relative Contribution of Bulk, Stiffness and Weight of PPE on Soldier Performance,” International Congress on Soldier Physical Performance (Boston, August 2014). 130 Todd Garlie, and Hyeg J. Choi, “Characterizing the Size of the Encumbered Soldier” (Natick: U.S. Natick Soldier Research, Development and Engineering Center, 2014); Monica L.H. Jones, Phillip S.E. Farrell, and Allan A. Keefe, “Encumbered Anthropometry Protocol Development” (2013 International Ergonomics Society Digital Human Modeling Symposium Ann Arbor, 2013); and Monica L.H. Jones, K. Han Kim, Allan A. Keefe, Phillip S.E. Farrell, and Linda Bossi, “A Pilot Study of ThreeDimensional Equipped Anthropometry,” 19th Triennial Congress of the International Ergonomics Association 2015 (Melbourne, Australia, 9–14 August 2015). 131 Pierre Meunier, David Tack, Angela Ricci, and Linda Bossi, “Helmet Accommodation Analysis Using 3D Laser Scanning,” Applied Ergonomics 31, no. 4 (2000): 361–9; and Hasselquist et al., “An Investigation of Three Extremity Armor Systems.” 132 Ian Horsfall, Stephen M. Champion, and C.M. Watson, “The Development of a Quantitative Flexibility Test for Body Armour and Comparison with Wearer Trials,” Applied Ergonomics 36, no. 3 (2005): 283–92. 133 K. Blake Mitchell, “Standard Methodology for Assessment of Range of Motion while Wearing Body Armor” (Natick: U.S. Natick Soldier Research, Development and Engineering Center, 2013); and K. Blake Mitchell, Hyeg J. Choi, and Todd N. Garlie, “Anthropometry and Range of Motion of the Encumbered Soldier,” 2017. 134 Jones et al., “Relative Contribution of Bulk.” 135 Allan Keefe, Linda Bossi, Chang Shu, Pengcheng Xi, and Monica Jones, “A Framework for Anthropometric and Digital Human Modeling Tools for the Canadian Armed Forces” (Digital Human Modeling Conference, Montreal, 2016); and Warren Duffie, “Building a Better Grunt: ONR Sponsored Technology to Lighten Marines’ Loads,” 2015, accessed 31 May 2017, http://www.navy.mil/submit/display.asp?story_id=87565. 136 Hatch et al., “Making the Soldier Decisive.”

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7 A Roadmap for Biomechanical Testing and Evaluation of Future Human Exoskeletons with Respect to Soldier Performance Thomas Karakolis, Linda Bossi, and Allan Keefe

Technological advances have historically led to improvements in human performance. In athletics, pharmacological interventions such as amphetamines, synthetic steroids, or other types of synthetic hormones are generally the most talked about. However, engineering advancements have also led to improved human performance. Continuing with the athletics analogy, advancements in footwear and track and pavement conditions have led to marked improvements in running performance over the past half century.1 Engineering advancements in footwear and track and pavement conditions follow a similar paradigm to that which already exists in human performance, in this case athletics. Exoskeletons on the other hand introduce a whole new paradigm in human performance, and therefore likely require a specific new assessment paradigm. In the context of soldier performance, human exoskeletons have the potential to lead to dramatic performance improvements for certain soldiering tasks. Exoskeletons may one day improve a soldier’s strength, speed, and endurance. In addition to improving soldier performance, exoskeletons may also have the ability to prevent injuries by lowering the mechanical demands placed on a soldier’s body. However, exoskeletons will likely come at a cost. In addition to the obvious monetary cost, exoskeletons may also inadvertently reduce performance for other soldiering tasks that they were not intended to improve, and may even potentially cause injury by causing changes to soldier movement patterns and tissue loading.2 Many of the ethical concerns surrounding

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human enhancement (including exoskeletons) were previously discussed by Niall and Wiseman in chapter 2. Therefore, this chapter will build upon the discussions in the previous chapter and propose and discuss a roadmap for biomechanical testing and evaluation of future human exoskeletons with respect to soldier performance, all with a view to easing the physical burden placed upon soldiers. Upon initial reflection, it may be easy to assume that the ethical considerations surrounding exoskeletons may be minimal because exoskeletons are often viewed as a “non-invasive enhancement.” This is because the effects on the wearer are generally thought to be revisable, since the wearer can ultimately just take the exoskeleton off. Enhancement technologies such as drugs or embedded computers are considered to be invasive because they cannot be as easily removed by the user. Although it is true that a wearer could take an exoskeleton off, this does not necessarily mean that the device will always be non-invasive. As discussed, with prolonged use over a time frame of weeks, months, or years, exoskeletons have the potential to cause chronic injuries by changing soldier movement patterns that may ultimately reduce tissue loading for some tissues, but increase loading in other tissues. Since tissue loading is a generally accepted cause of injury to the musculoskeletal system, and injuries take time to heal or sometimes never fully heal, the effects of wearing an exoskeleton may not be as reversible as simply taking the system off. Given those required ethical considerations, it will be important to fully test and evaluate any future human exoskeleton to properly quantify the associated performance implications. Only by identifying, evaluating, and quantifying as many of the benefits and drawbacks as possible will military leaders be able to determine the true value of equipping their soldiers with exoskeletons. In the following sections, a comprehensive approach to evaluating exoskeleton designs will be discussed. The approach may be used to either evaluate the design from the perspective of utility and procurement, or may also be used from the perspective of an iterative design process to identify deficiencies that may be addressed in future designs. Finally, it is believed that the approach will also help improve the fundamental understanding of humans interact with current exoskeletons, and how humans may react with future exoskeletons over time. The comprehensive approach discussed is conceptually divided into: testing categories and testing environments.

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The testing categories that will be discussed are as follows: anthropometric considerations; functional movement evaluation; effect on simulated operational task performance; effect on operational task performance; compatibility; and injury risk assessment. The testing environments that will be discussed are: academic ­laboratory environment; applied laboratory environment; and field environment. Finally, considerations must also be given to the natural training, learning, and human adaptation that will occur through prolonged use of any exoskeleton. Although everything that is presented herein should be read with training, learning, and human adaption in mind, to limit the scope of the roadmap presented these topics will not be thoroughly addressed in the present chapter. The topic of active learning is thoroughly discussed by Wakelam and Woodside-Duggins in chapter 8. There may also be a role that exoskeletons can play in the type of cognitive optimization discussed by Bryant and Niall in chapter 9, through the relationship between physical exertion and cognitive abilities; however, this complex topic will also be considered out of scope for the present chapter. background

Exoskeletons are currently being developed and used in a wide variety of human health and performance domains. A search of the PubMed database on 30 April 2015 for the term “human exoskeleton” revealed over 396 papers published in peer-reviewed scientific journals on the topic. The body of literature continues to grow at an impressive rate, with follow-up searches of the same database on 6 June 2016 revealing 494 papers, and on 7 February 2017 revealing 569 papers published in peer-reviewed scientific journals. The rate at which literature is published on the topic continues to increase, and this is not surprising given that the number of potential applications for exoskeleton use is nearly endless. Some current application trajectories include: improving efficiency during healthy human walking,3 medical devices that assist patient rehabilitation,4 and improving human performance on the battlefield.5 Along with the proliferation of exoskeleton literature, there has not been an accompanying general acceptance of a definition for what an exoskeleton is … or is not. The literal definition of an exoskeleton is: a skeleton that is outside the body. This literal definition is far too

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generic to be of any use in any substantive conversation on the topic. As a result, a more specific or operationalized definition is often provided. This book is a perfect example of the need for operational definitions of the term “exoskeleton.” Previous definitions for exoskeletons are already provided in chapters 3 and 6. Unfortunately, since the operational definition for an exoskeleton will likely always be context dependant, a commonly accepted universal definition will likely never be agreed upon. Therefore, for the purposes of this roadmap, an exoskeleton will be operational defined as: a wearable synthetic device or technology that supports human movement to create an increase in strength or endurance. Given the diverse applications of exoskeletons, there is a diverse toolkit for measuring the effectiveness of an exoskeleton. For medical devices designed to assist in rehabilitation, measuring the effectiveness of an exoskeleton is generally indicated by the capacity of the device to improve patient outcomes. This can sometimes be simply measured as the time required for completing a rehabilitation program or the return of the ability to complete certain activities of daily living.6 For devices designed to improve the efficiency during healthy human walking, measuring the effectiveness of an exoskeleton is generally considered as the ability to reduce metabolic cost.7 With respect to improving human performance on the battlefield, measuring the effectiveness of an exoskeleton is much more challenging. The modern battlefield is a complex environment, and success is modulated by a number of different factors. Fundamentally, there is a balance between the survivability of soldier and their lethality. Body armour, load bearing equipment, food, and water – amongst other items and equipment – reduce the soldier’s ability to kill. In recent decades, this burden has increased and current equipment favours survivability over lethality. Put simply, the physical burden of equipment has made it harder for soldiers to fight. For example, body armour can improve survivability by protecting the soldier but consequently reduces lethality by impairing the soldier’s tactical mobility and thereby impairing the ability to effectively engage a threat. Alternatively, equipment can also improve survivability in one sense, but also reduce survivability in another. Moreover while armour can improve survivability by providing protection, it can also potentially reduce survivability by reducing the speed at which a soldier can seek cover from a threat, and thereby increasing their likelihood of being hit. For traditional equipment such as body armour, standards are continuing to be developed to assess

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individual pieces of equipment, and entire equipment/clothing ensembles, to determine their effect on both survivability and lethality.8 These standards, as well as a proposed systems approach to reduce soldier burden, are fully discussed by Bossi and colleagues in chapter 6. Exoskeletons mark a considerable paradigm shift in the potential for equipment to have a net improvement in either survivability or lethality. For example, exoskeletons may one day be able to reduce the burden experienced by a soldier wearing heavy body armour by supporting the weight of the armour. Having an exoskeleton support heavy body armour can allow a soldier to benefit from the protective aspect of the armour without having to experience the associated reduction in speed at which the soldier can perform his tasks,9 thereby not increasing the likelihood of being hit. Alternatively, if an exoskeleton could reduce the metabolic cost of a soldier’s approach to engage a threat,10 the exoskeleton could indirectly increase lethality by increasing the energy reserves available to the soldier when engaging the threat. Given this analysis, it will be extremely important to thoroughly evaluate any exoskeleton device before it is used in either an operational or training environment. Therefore, the following sections will discuss the potential options available to test exoskeletons from the most basic fundamental evaluations to the highest, most operationally relevant evaluations. Human exoskeletons will likely be able to provide a number of benefits with respect to human performance; however, there will also be a cost associated with the benefits. This cost may also go beyond a reduction in human performance. By their very nature human exoskeletons will pose an injury risk to the individual wearing the device by potentially changing the movement patterns and tissue loading associated with performing operational tasks.11 Before equipping soldiers with costly exoskeletons, it will be important to quantify the amount of net performance benefits the system provides (net performance benefit = performance improvements – performance reductions) and weigh the benefits against both the monetary cost and the potential for increase in injury risk. This is the framework through which we propose evaluating exoskeletons for our soldiers. But this begs the question: using what criteria do we determine benefit or cost?

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t e s t i n g c at e g o r i e s

The testing and evaluation criteria for any future human exoskeletons will likely fall into one of the following proposed categories: (1) anthropometric considerations; (2) functional movement evaluation; (3) effect on simulated operational task performance; (4) effect on operational performance; (5) physical and electronic interactions with other equipment (such as issues of compatibility); and (6) injury risk assessment. Testing and evaluating future human exoskeleton systems will be required in all categories in order to ensure the net effect on performance is a positive effect. Anthropometric Considerations Recently, the Canadian Armed Forces (caf ) completed an anthropometric survey characterizing the size and shape of all members of the c a f. 12 One key outcome of the survey was a quantification of the diversity of the population, which will be key to evaluating any potential benefits of the device. Some key considerations include: evaluating how an individual’s shape and size affects the performance of the exoskeleton and the individual’s performance within the exoskeleton, making sure any new exoskeletons will fit the intended population. It has been suggested that how an exoskeleton system physically interfaces with the user affects the performance of the exoskeleton, and improper design may result in severe injury.13 For this reason, future exoskeleton interfaces should be adjustable so they may accommodate the broadest range of the c af population. Additionally, for powered exoskeletons, control algorithms may potentially have an interaction with the human/exoskeleton interface – making any anthropometric considerations that much more important. In addition to the relatively complex interactions between an individual’s shape and size and the performance of the exoskeleton, there are a number of other factors that should also be considered. These include the robustness of the exoskeleton design to be effectively used by a wide range of the intended population. For example, if an exoskeleton design is not adjustable at all and a custom device must be created for each individual user, the exoskeleton design may be extremely difficult to practically implement in a military setting. Alternatively, there is a risk that even a robust design that fits a wide

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range of potential user size and shapes may not be truly optimized for any of the size and shapes, thus rendering the design less effective. Given the diversity of armed forces populations, anthropometric considerations will likely be a driving factor in all future exoskeleton design and possible procurement. Functional Movement Evaluation Building upon the anthropometric considerations listed in the previous sub-section, functional movement evaluations should be initial dependent variables when determining the overall effectiveness of an exoskeleton, as well as how well the exoskeleton meets the anthropometric considerations required. The term “functional movement” can have a variety of different meanings and interpretations depending on the field of literature and the specific context in which it is being used. For the purposes of this section, the term “functional movement” will be used to describe relatively simple movements that either individually can complete a simple physical task or combined can complete more complex physical tasks. Functional movements can be either single-plane or multi-planar; however, for the purposes of initial exoskeleton evaluation it is suggested that limiting evaluation to single-plane may be more beneficial. When evaluating functional movements in an exoskeleton, dependant variables can be in the form of range of motion (single-joint or multijoint), strength, and stiffness. Some potential questions that a functional movement evaluation may answer include: How does the exoskeleton affect the range of motion across the joints that it spans? If the exoskeleton covers the leg, how does it affect knee joint range of motion? Can exoskeletons help extend range of motion over time? Is there any strength improvement associated with the exoskeleton? Are there any potential losses in strength associated with exoskeletons that are primarily designed to reduce metabolic cost of task performance? Although this list of questions is not intended to be a comprehensive list, it does give an idea of what a functional movement assessment may be used for, and why it may be beneficial when assessing the effectiveness of an exoskeleton. As an example, figure 7.1 shows a potential experimental design schematic that may be used in the functional movement evaluation of an existing or proposed exoskeleton. On the bottom level of the

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Sagittal

Squat

Walk

Transverse

Frontal

Run

Side step

Cross over

159

Side stairs

90o turn

180o turn

Figure 7.1 – Schematic a Potential Figure 7.1  Schematic representation ofRepresentation a potentialofexperimental design for Experimental Design for Functional Movement Evaluation functional movement evaluation

schematic are a number of simple functional movements. Each of these functional movements is grouped by the primary plane of the movement. The movements can be evaluated in isolation, or the evaluations can be compiled to provide an aggregate assessment of the exoskeleton for functional movements in a given plane. The next level above the functional movements contains the three planes of human movement (sagittal, frontal, and transverse). Again, each plane can be evaluated in isolation, or the evaluations can be compiled to provide an aggregate assessment for functional movements across all planes. Effect on Simulated Operational Task Performance Based on the “functional movement” definition provided in the previous section, functional movements can either be simple physical tasks in themselves, or can be combined to perform more complex physical tasks. For the purposes of evaluating exoskeletons from a biomechanical perspective, the discussion herein will focus solely on physical tasks. This is not to suggest that exoskeletons will not likely have an effect on cognitive tasks14 in addition to their obvious effect on physical tasks. Furthermore, this section will be limited in scope to operationally relevant military tasks. When evaluating simulated task completion in an exoskeleton, dependant variables can be in the form of time to task completion, accuracy for completed tasks, metabolic cost to perform the task, or an integrated metric including a combination of time, accuracy, and metabolic cost. As a non-exhaustive list of examples, some potential

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questions that a functional movement evaluation may answer include: for locomotion tasks such as marching, running, and crawling, what types of quantifiable advantages/disadvantages does an exoskeleton provide? For simulated operationally relevant tasks such as: window entry, stair climbing, traversing over walls, hurdling over lower obstacles, dragging a casualty, entering/exiting a vehicle, what types of quantifiable advantages/disadvantages does an exoskeleton provide? Figure 7.2 presents a potential experimental design schematic of some operationally relevant tasks that may be assessed. Analogous to the schematic presented in figure 7.1, the schematic in figure 7.2 is designed to give a graphical representation of how evaluations for each individual task can be compiled to provide an aggregate assessment. Although exoskeletons have the potential to improve human performance during specific tasks, they also have the potential to reduce performance during other tasks. Therefore, an exoskeleton should rarely (if ever) be assessed based upon a single task, no matter how operationally relevant that task may be. From the perspective of operational task evaluation, a holistic approach should generally be considered. An example of a holistic approach to evaluating operational task performance is the Load Effects Assessment Program (leap).15 leap is an instrumented mobility/obstacle course that is used to assess timing and performance on operational relevant tasks while wearing a range of operational and experimental clothing and equipment configurations. The individual operational tasks performed include the following obstacles: tunnel and hatch, sprint, stairs and ladder climbs, agility run, casualty drag, windows, bounding rushes, balance beam, craws, and courtyard walls. Traditionally, these obstacles are run consecutively in a timed course. In addition to the timed course, the l e a p also has ancillary test stands, including: a horizontal weight transfer, a vertical weight transfer, a vertical jump, and a marksmanship test stand. The duration of time the simulated tasks are performed or the number of repetition performed should also be considered. For example, an unencumbered soldier can perform the timed portion of the l e a p course in approximately five to six minutes, and an encumbered soldier wearing a full fighting load can perform the course in approximately seven to eight minutes. An obvious question that arises is: will wearing an exoskeleton for seven to eight minutes provide a sufficient amount of time to assess the device? Longer duration assessments will likely be required. These longer duration

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OVERALL ASSESSMENT

Lift and place task

Stair climb

Ladder climb

Obstacle course

Body drag

Obstacle hurdle

Beam walk

Figure 7.2  Schematic representation of a potential experimental design for operational task evaluation Figure 7.2 – Schematic Representation of a Potential Experimental Design for Operational Task Evaluation

assessments will likely come in the form of actual operational task performance assessments. Effect on Operational Task Performance Assessing the effect of an exoskeleton on simulated operational performance will likely provide valuable information in designing and evaluating exoskeletons; however, there are a number of limitations associated with the simulated approach. Beyond the relative short durations typically used for simulated task performance assessments for other types of soldier equipment (such as leap), a soldier participant’s approach to the task, and strategy used to complete the task is likely different for a simulated task compared to an actual task conducted during operations. For this reason, assessing the effect of an exoskeleton on operational task performance will also be required. With that being said, there are also limitations and drawbacks to assessing actual operational task performance. Operational task performance is generally more complex than simulated tasks, and does not generally lend itself to being evaluated in an objective manner. For example, it is more difficult to objectively measure the outcomes of a reconnaissance mission than it is to measure the time to complete each of the individual obstacles on the l e ap course. Perhaps one could measure the time taken during the approach on the mission; nevertheless, controlling many of the confounding factors in this scenario would be a logistical challenge – if not impossible. Furthermore, assessments of operational task performance will likely be done in training rather than during deployment for a number of reasons. The most obvious reason is that during deployment completing the mission is the highest priority objective, and secondary

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objectives – such as exoskeleton assessment of evaluation – will be of much lower priority. Therefore, it is believed that the order in which the proposed testing categories are employed will be often sequential in nature: anthropometric considerations, functional movement evaluations, simulated operational task performance; followed by a decision of whether or not to use in training and/or deployment. With that being said, once the decision has been made to utilize the exoskeleton (such as after it has passed all the other types of assessments/testing categories), continued assessment is still desirable since on deployment is likely when it is most critical to have a high functioning exoskeleton. Regardless of how well functional movement testing and simulated operational task assessment was planned and conducted, differences will likely still exist between previous assessment performance and field performance. There are logistical limitations with every type and step of evaluation, but it is probably going to be most limiting on operations. Operational task performance will probably only be done once it is believed there is a high likelihood that the exoskeleton will be beneficial based upon functional movement evaluation and simulated operational task performance. Compatibility For the purposes of this chapter, compatibility refers to the physical interactions with all the other equipment a soldier normally carries. One obvious reason to employ an exoskeleton is to reduce physical burden caused by having to carry a full fighting load. Therefore, the exoskeleton must naturally be compatible with the current fighting load, or the current fighting load must be adaptable to accommodate the exoskeleton. Alternatively, the exoskeleton could perform the functions of all of the critical pieces of equipment in the current fighting load that the exoskeleton cannot accommodate. Some examples of questions associated with physical interactions with other equipment include: How does an exoskeleton interact with personal protective equipment? Will the exoskeletons serve as p p e ? How will an exoskeleton interact with weapons? Will weapons be integrated into the exoskeleton? How will an exoskeleton interact with other equipment (such as radio, g p s , first-aid)? This challenge of compatibility is by no means trivial yet it may not be given the lack of emphasis it deserves. Equipment compatibility

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remains a concern within many nations’ armed forces, and between nations.16 Prototyping and experimentation remains the gold standard when trying to define the physical interactions between equipment, although, digital human modelling technologies continue to improve and are beginning to serve a more valuable role in compatibility assessments.17 Musculoskeletal Injury Risk Assessment The final test category to be discussed is the assessing of injury risk associated with using an exoskeleton. For the purpose of this section, musculoskeletal injury will be defined as a mechanical disruption to biological tissue that results in either pain or a decrease in performance.18 Exoskeletons have the potential to, and likely will, change the mechanical loading environment that the wearer’s musculoskeletal system (biological tissues) experiences. In some cases, an exoskeleton can be designed to reduce the mechanical loading of certain tissues thereby decreasing the likelihood of injury. However, unless the decreased load is transferred entirely externally to the wearer (e.g., load entirely to the ground), there is a concern that the mechanical load will be transferred to a body region that does not normally experience the type of loading caused by the exoskeleton. Human biological tissue has the ability to adapt to the mechanical loading environment that it experiences,19 but biological adaptation takes time. Furthermore, some tissues have a greater ability to adapt than others.20 Therefore, there exists a concern that any new loading experienced by certain tissues is beyond its capacity, causing an injury. This can happen on an acute level, but is more likely to happen as a result of repetitive usage (chronic). Acute injuries will more likely be the result of a failure or malfunction of the exoskeleton, since it is not likely an exoskeleton will be purposefully designed to cause acute injury. Injury risk assessment should always include two potential mechanisms: acute injury risk due to exoskeleton malfunction, and chronic injury risk due to augmentation of joint mechanics resulting from exoskeleton usage. Although exoskeletons have the potential to reduce mechanical loading to the wearer’s biological tissues in some regions of the body, and they have the potential to improve human performance, they also have the potential to cause injuries. This should always be considered when assessing the effectiveness of an exoskeleton.

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testing environments

When it comes to testing technologies, broadly speaking there are three types of environments the invention or creation can be tested: academic laboratory environment, applied laboratory environment, and field environment. Each environment poses a set of unique challenges and opportunities when it comes to assessing exoskeletons. This section will discuss the unique challenges and opportunities for each environment with respect to exoskeletons. Fundamental Laboratory Environment Fundamental experimentation in a controlled laboratory environment has many advantages and disadvantages. The chief advantages are (1) the ability to control the experiment by manipulating certain independent variables while holding other independent variables constant and (2) the ability to use more complex and sensitive outcome measures than generally available in an applied or field environment. Controlling variables in any scientific experiment is advantageous because it allows causality to be determined. In simpler terms, this means that if an experimenter is able to manipulate only one variable, while controlling all others, the experimenter is able to reasonably assume that the changing independent variable is what is causing the change in the dependant variable. Generally speaking, this is different from observational-type research in that when a predictor variable is observed to have changed – in a field study, for example – the associated change in an outcome variable can be described as being related to the predictor variable but not necessarily caused by the change in the predictor variable. An example of this specific-to-exoskeleton assessment would be if an experimenter was interested in changing the level of torque applied by a powered lower extremity exoskeleton about the knee joint. In a controlled laboratory environment, the experimenter would be able to control the tasks performed by the participants and therefore be able to report with a higher level of confidence that any associated changes in the dependant variable is caused by the change in applied torque. On the other hand, in a field experiment, if the applied torque of the exoskeleton is changed without the ability to control the tasks performed by the participants, as would likely be the case, the conclusion could not be made that the associated changes in the outcome variables were caused by changes

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in the torque because the tasks performed by the participants may have also changed. In terms of assessment equipment that can be used in a laboratory environment, there are a number of choices that include equipment such as: motion capture systems, electromyography to measure muscle activation, force platforms to measure ground reaction forces, dynamometers to measure external forces beyond ground reaction forces, pressure sensors, 3 d scanners to measure anthropometrics, etc. Further description and examples of the tools include: strength and range of motion testing while wearing in service and experimental personal protective equipment, using a multi-joint computerized dynamometer; three-dimensional whole-body and body segment anthropometric scanning systems to determine size and shape considerations for the Canadian Armed Forces population in both a semi-nude condition and while wearing full fighting order; and a fully instrumented biomechanics lab including motion capture, force plates, and electromyography. The major disadvantages most commonly associated with a fundamental laboratory environment are factors such as high cost, high required level of expertise, large amounts of data reduction, and the high level of control leading to low levels of realism. Fundamental laboratory environments are never able to truly simulate the experiences in the field, and therefore the findings in a fundamental laboratory usually cannot be applied directly to operations. No matter how well designed a laboratory experiment is, participants will to some extent act differently in the lab due to the artificial nature. However, such efforts are often a useful first step towards larger, more complex (and hence realistic) trials. Applied Laboratory Environment An applied laboratory environment offers a number of different advantages and disadvantages when compared to either a fundamental laboratory environment or a field environment. The same level of control that is available in a fundamental laboratory environment is not generally available in an applied lab. In addition to that, the same level of assessment equipment and technology is also not generally available in an applied lab. Alternatively, a laboratory environment does offer more control than a field environment where very little control is generally available. Unlike in a field study, where observational

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research is most common, an applied laboratory environment allows for some experimental control while still having participants complete simulated field tasks. Therefore, an applied laboratory environment can be thought of as a hybrid between a fundamental laboratory and a field environment. It allows for a reasonable level of experimental control, while still allowing participants to complete similar types of tasks as they would in the field. Specific to exoskeleton assessment, one example of an applied laboratory environment is a leap facility. The leap facility is previously described in this chapter. In this type of lab setting, participants can perform the same operational tasks they would perform in the field. Examples of some soldiering tasks that may need to be performed in an exoskeleton in the field that can be simulated in an applied laboratory environment include: stairs and ladder climbing, bounding rushes, climbing through windows, or crawling. Field Environment Ultimately, the goal is to test an exoskeleton in the field using a fielddeployable measurement system. There is still much work that needs to be done on field deployable measurement systems, but such systems are currently being developed.21 These systems should be able to collect similar types of metrics as the laboratory based systems (such as motion capture, emg, external reaction forces, as but a few examples), and be minimally intrusive to the wearer. The BioEx system is an example of a field deployable measurement system that could one day be used to test exoskeleton systems.22 The BioEx system has the ability to capture both joint angles of the wearer as well as the exoskeleton system independent of each other, with the goal of modelling the interaction between the exoskeleton and the wearer. The system can be worn in a fundamental or applied laboratory environment, but the true promise in the system lies in its ability to capture objective data in a field setting. In general, there also exist a number of drawbacks while assessing in a field environment. These drawbacks include: power requirements can be difficult to meet in the field, networking electronic components and data collection can be a challenge, durability of all equipment for a field environment, and environmental limits like temperature or rain. The natural progression of development and experimentation of an exoskeleton is envisioned, given this analysis, to sequentially move

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through all the environments: fundamental lab, applied lab, and field. This will likely be the most effective way to assess an exoskeleton. general discussion

The tests currently being employed to assess modern soldier equipment are only a starting point for what is needed to properly assess future human exoskeleton systems. Advanced metrics will need to be developed to ensure all the categories for testing and evaluation are covered. Only after proper testing and evaluation can informed decisions be made to determine the true value of a specific human exoskeleton system. Some of the test categories may interact with each other. For example, human anthropometry may have an interaction with compatibility. On a larger individual a given exoskeleton may not interact with a certain piece of equipment – a helmet, for example – but on a smaller individual the exoskeleton may interact with the helmet because the individual wearing the exoskeleton may have a shorter neck and therefore their helmet brim is closer to their torso. The opposite may also be true where larger individuals wearing larger exoskeletons may have more physical interaction and compatibility issues because a larger exoskeleton simply takes up more proverbial real estate. Human diversity is a factor that continues to challenge ergonomists, engineers, and designers. Manufactured physical structures and mechanical devices still cannot be designed to properly accommodate all of the diverse shapes and sizes of human beings. In addition to anthropometric variability, the strategies and movement patterns humans adopt to accomplish the same task vary greatly person to person. Both anthropometric and movement strategy variability cause varying mechanical demands on the biological soft tissues that make up an individual’s natural musculoskeletal system. Additionally, the capacity of each individual’s tissues to withstand varies dramatically between cases. Throughout their lifetime, an individual’s biological tissues adapt to mechanical demands placed upon their tissues based upon their anthropometrics and movement patterns.23 Interfacing with an unfamiliar or unhealthy external physical environment can result in injury either through an acute event or over an extended period of exposure. Exoskeletons can potentially create both unfamiliar and unhealthy external environments immediately surrounding the wearer.

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For example, an exoskeleton designed to improve human performance by increasing the energetic efficiency of gait may also augment the mechanical loading in the knee joint,24 increasing the likelihood of chronic pathologies such as osteoarthritis. As discussed throughout the previous sections, there will likely always be a trade-off between a controlled experiment (environment and tasks) and a realistic experiment (environment and tasks). Therefore, before any new exoskeleton is adopted for military applications, the device should be biomechanically assessed to create a comparison between the biological loading environments while wearing and not wearing the device. Knowing exactly how much they improve task performance by will help with weighing the benefits of improved task performance against some of the other potential drawbacks listed in this paper (namely: cost and injury risk). The key points that have been highlighted throughout this chapter are: when evaluating exoskeletons, the choice of simulated tasks should be operationally relevant; the ultimate goal of evaluating the utility of an exoskeleton will be to quantify the advantages provided in training and in theatre; and before we start equipping our warfighters with integrated exoskeletons, we need to make sure we are confident they will improve their performance. This is why our anthropometric, functional movement, simulated task completion, and field trial evaluations are all so important. Policy Implications Finally, each issue outlined in this chapter, and specifically discussed in this section, has a number of practical implications associated with the policies that will eventually have to be developed surrounding the usage of exoskeletons. For example, given the scale of human anthropometric variability in the Canadian Armed Forces (c a f ) and the relatively intimate nature in which exoskeletons must interact with their user, it is unlikely any exoskeleton designed will be adaptable to a one-size-fits-all model. It is more likely that exoskeletons will need to come in a number of different sizes, or may even need to be customized for the individual wearer. Sizing and customization will come at additional financial and logistic cost, and decisions will ultimately need to be made based on whether the performance or injury-­prevention benefits of an exoskeleton outweigh the financial and logistic cost. Will there be a day when every new recruit in the Canadian Army is equipped with their own personal, custom-built exoskeleton? Unlikely.

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Continuing along the same lines of human diversity, there is also a conceivable situation where given some individuals’ movement patterns and tissue tolerances, a specific exoskeleton may be beneficial to their performance; however, given another (let’s say smaller) group of individuals’ different movement patterns and tissue tolerances, the same exoskeleton may be extremely detrimental to performance, and even injurious. What will the caf’s policy be in this circumstance? If the exoskeleton has been shown advantageous to the “average” Canadian soldier, should all soldiers be required to wear it? Will there be appropriate individual metrics to determine which soldiers would gain the most benefit from an exoskeleton? Will soldiers ultimately be recruited and selected based on their compatibility with the “inservice exoskeleton?” These are just a few of the policy implications that must be considered as exoskeleton technology continues to develop. We believe these implications only further highlight the need to develop robust research surrounding the testing and evaluation of future exoskeletons, as discussed in this chapter. Only with established testing and evaluation procedures in place will the caf be able to make informed decisions on exoskeleton procurement and usage. conclusions

Exoskeletons are continuing to be developed at a rapid rate by industry, academia, and militaries around the world. As stated at the beginning of this chapter, exoskeletons have the potential to improve a soldier’s strength, speed, and endurance. In addition to improving soldier performance, exoskeletons may also have the ability to prevent injuries by lowering the mechanical demands placed on a soldier’s body. Even given the tremendous potential of exoskeletons to improve a soldier’s overall performance, there also remains a potential for exoskeletons to have a negative effect on both soldier performance and health. Specifically, although exoskeletons may have the potential to reduce injury risk for some common soldiering injuries, they may have the potential to increase the risk of other types of injuries. Therein lies the exoskeleton ethical conundrum. Although exoskeletons are generally thought to be minimally or non-invasive, prolonged use of exoskeletons can lead to inadvertent changes in soldier movement patterns, which could ultimately lead to unintended chronic injuries. Proper testing and evaluation of exoskeleton technologies is crucial. Proper testing and evaluation is the only

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way to ensure future exoskeletons will have a net benefit to soldiers during their military careers, and beyond.

notes

  1 David Epstein, The Sports Gene: Inside the Science of Extraordinary Athletic Performance (London, UK: Current, 2013).   2 Karen N. Gregorczyk, Leif Hasselquist, Jeffrey M. Schiffman, Carolyn K. Bensel, John P. Obusek, and David J. Gutekunst, “Effects of a Lower-Body Exoskeleton Device on Metabolic Cost and Gait Biomechanics during Load Carriage,” Ergonomics 53, no. 10 (Sept 2010): 1263–75, doi: 10.1080/00140139.2010.512982.   3 Philippe Malcolm, Wim Derave, Samuel Galle and Dirk De Clercq, “A Simple Exoskeleton That Assists Plantarflexion Can Reduce the Metabolic Cost of Human Walking,” PloS one 8, no. 2 (Feb 2013): e56137.; Steven H. Collins, M. Bruce Wiggin and Gregory S. Sawicki, “Reducing the Energy Cost of Human Walking Using an Unpowered Exoskeleton,” Nature 522, no. 7555 (June 2015): 212–15.   4 Jan F. Veneman, Rik Kruidhof, Edsko E. G. Hekman, Ralf Ekkelenkamp, Edwin H. F. Van Asseldonk and Herman Van Der Kooij, “Design and Evaluation of the lopes Exoskeleton Robot for Interactive Gait Rehabilitation,” ieee Transactions on Neural Systems and Rehabilitation Engineering 15, no. 3 (Sept 2007): 379–86; Guan De Lee, Wei-Wen Wang, Kai-Wen Lee, Sheng-Yen Lin, Li-Chen Fu, Jin-Shin Lai, Wen-Shiang Chen and Jer-Junn Luh, “Arm Exoskeleton Rehabilitation Robot with Assistive System for Patient after Stroke,” 2012 12th International Conference on Control, Automation and Systems (17–21 Oct 2012); Pilwon Heo, Gwang Min Gu, Soo-jin Lee, Kyehan Rhee and Jung Kim, “Current Hand Exoskeleton Technologies for Rehabilitation and Assistive Engineering,” International Journal of Precision Engineering and Manufacturing 13, no. 5 (May 2012): 807–24; Alberto Esquenazi, Mukul Talaty, Andrew Packel, and Michael Saulino, “The ReWalk Powered Exoskeleton to Restore Ambulatory Function to Individuals with Thoracic-Level MotorComplete Spinal Cord Injury,” American Journal of Physical Medicine & Rehabilitation 91, no. 11 (Nov 2012): 911–21.   5 Karen N. Gregorczyk, Leif Hasselquist, Jeffrey M. Schiffman, Carolyn K. Bensel, John P. Obusek, and David J. Gutekunst, “Effects of a Lower-Body Exoskeleton Device on Metabolic Cost and Gait Biomechanics during Load Carriage,” Ergonomics 53, no. 10 (Oct 2010): 1263–75, doi:

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10.1080/00140139.2010.512982; Robert Bogue, “Exoskeletons and Robotic Prosthetics: A Review of Recent Developments,” Industrial Robot: An International Journal 36, no. 5 (Aug 2009): 421–7.   6 Esquenazi, Talaty, Packel, and Saulino, “The ReWalk Powered Exoskeleton to Restore Ambulatory Function to Individuals with Thoracic-Level Motor-Complete Spinal Cord Injury,” 911–21; Marcello Mulas, Michele Folgheraiter, and Giuseppina Gini, “An emg-Controlled Exoskeleton for Hand Rehabilitation,” 9th International Conference on Rehabilitation Robotics, 2005 (28 June–1 July 2005); K.H. Low, “Robot-Assisted Gait Rehabilitation: From Exoskeletons to Gait Systems,” 2011 Defense Science Research Conference and Expo (dsr ) (3–5 Aug 2011).   7 Collins, Wiggin, and Sawicki, “Reducing the Energy Cost of Human Walking Using an Unpowered Exoskeleton,” 212–15; Gregorczyk, Hasselquist, Schiffman, Bensel, Obusek, and Gutekunst, “Effects of a Lower-Body Exoskeleton Device on Metabolic Cost and Gait Biomechanics during Load Carriage,” 1263–75, doi: 10.1080/00140139. 2010.512982; Malcolm, Derave, Galle, and De Clercq, “A Simple Exoskeleton That Assists Plantarflexion Can Reduce the Metabolic Cost of Human Walking,” e56137; Luke M. Mooney, Elliott J. Rouse, and Hugh M. Herr, “Autonomous Exoskeleton Reduces Metabolic Cost of Human Walking during Load Carriage,” Journal of Neuroengineering and Rehabilitation 11, no.1 (May 2014): 80.  8 Linda L . M . Bossi, Monica L . H . Jones, Alison Kelly, and David W. Tack, “A Preliminary Investigation of the Effect of Protective Clothing Weight, Bulk and Stiffness on Combat Mobility Course Performance,” Proceedings of the Human Factors and Ergonomics Society Annual Meeting (September 2016); Thomas Karakolis, Britanny A. Sinclair, Alison Kelly, Phil Terhaar, and Linda L.M. Bossi, “Determination of Orientation and Practice Requirements When Using an Obstacle Course for Mobility Performance Assessment,” Human Factors (Jan 2017): 18720816686611, doi: 10.1177/0018720816686611; K. Blake Mitchell, Jessica M. Batty, Megan E. Coyne, Linda L. DeSimone, and Carolyn K. Bensel, Reliability Analysis of Time to Complete the Obstacle Course Portion of the Load Effects Assessment Program (l e a p ) (Natick: Army Natick Soldier Research Development and Engineering Center, 2016); Stephen M. Cain, Ryan S. McGinnis, Steven P. Davidson, Rachel V. Vitali, Noel C. Perkins, and Scott G. McLean, “Quantifying Performance and Effects of Load Carriage during a Challenging Balancing Task Using an Array of Wireless Inertial Sensors,” Gait and Posture 43 (Jan 2016): 65–9.

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  9 Bossi, Jones, Kelly, and Tack, “A Preliminary Investigation.” 10 Collins, Wiggin, and Sawicki, “Reducing the Energy Cost,” 212–15. 11 William Charles Whiting and Ronald F. Zernicke, Biomechanics of Musculoskeletal Injury (Champaign, i l: Human Kinetics, 2008); Don B. Chaffin, Gunnar Andersson, and Bernard J. Martin, Occupational Biomechanics (New York: Wiley, 1999). 12 Alan A. Keefe, Harry Angel, and Brian Mangan, 2012 Canadian Forces Anthropometric Survey (cfas ) (Ottawa: Defence Research and Development Canada, 2015). 13 Zahari Taha, Anwar pp Abdul Majeed, Mohd Yashim, Wong Paul Tze, and Abdul Ghaffar Abdul Rahman, “Preliminary Investigation on the Development of a Lower Extremity Exoskeleton for Gait Rehabilitation: A Clinical Consideration,” Journal of Medical and Bioengineering 4, no. 1 (Jan 2015). 14 Brian Carlson, Adam Norton, and Holly Yanco, “Preliminary Development of Test Methods to Evaluate Lower Body Wearable Robots for Human Performance Augmentation,” Proceedings of the 19th International Conference on Clawar 2016 (Sept 2016). 15 Linda L.M. Bossi, Mark Richter, David W. Tack, Alison Kelly, Mark Patterson, and Mike Lafiandra, Load Effects Assessment Program (leap ): A Systematic Multinational Approach to Understand and Address Soldier Physical Burden (Ottawa: Defence Research and Development Canada, 2014). 16 Cihangir Akşit, Smart Standardization: A Historical and Contemporary Success at nato , 2014. 17 Mohammad Bataineh, Timothy Marler, Karim Abdel-Malek, and Jasbir Arora, “Neural Network for Dynamic Human Motion Prediction,” Expert Systems with Applications 48 (Apr 2016): 26–34. 18 Shrawan Kumar, “Theories of Musculoskeletal Injury Causation,” Ergonomics 44, no. 1 (Jan 2001): 17–47. 19 Michael Kjaer and Stig Peter Magnusson, “Mechanical Adaptation and Tissue Remodeling,” in Collagen, ed. Peter Fratz (Potsdam: Springer, 2008), 249–67. 20 Michael J. Mueller and Katrina S. Maluf, “Tissue Adaptation to Physical Stress: A Proposed ‘Physical Stress Theory’ to Guide Physical Therapist Practice, Education, and Research,” Physical Therapy 82, no. 4 (Apr 2002): 383. 21 S. Brandon, M. Brookshaw, A. Sexton, and C. McGibbon, “Biomechanical Evaluation of a Dermoskeleton during Gait,” 19th Biennial Meeting of the Canadian Society for Biomechanics (19–22 July 2016).

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22 Ibid. 23 Kjaer and Magnusson, “Mechanical Adaptation and Tissue Remodeling,” 249–67. 24 Collins, Wiggin, and Sawicki, “Reducing the Energy Cost,” 212–15.

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8 Enhancing Performance Starts with Learning Vicki Woodside-Duggins and Randall Wakelam

Many of the chapters in this collection discuss performance enhancement in terms of physical attributes and capabilities, but cognitive and intellectual enhancement are equally important to getting the most out of both human and material resources. Elsewhere in this volume contributors look at ways of easing the cognitive burden. This chapter examines more how cognition deals largely with the process of knowing or perceiving. Certainly optimizing cognition is essential in enhancing the soldier’s recognition of what is going on around them, as the soldier who does not have a full picture of what is happening in the battlespace is a risk both to themselves and to peers. Our chapter, however, looks beyond knowing; we believe that humans and even some artificial intelligence (ai) can know and react to known information, but that at the upper end of cognitive processes humans have, or should have, the ability to go beyond knowing “what” to do and “how” to do it but also “why” they might or might not do something. In other words, they should be able to apply judgement and ethics in making decisions. They must, for example, be able to decide if a particular tactical or strategic approach is appropriate to the circumstances before them; and if it is not, it is important that they have the intellectual capacity and capability to look for new solutions and the moral capacity to make judgments that go beyond simply determining what is practicable. If we want to imagine a Star Trek episode, regardless the series, we see future warriors informed of myriad facts by technology. They have this information, this knowledge, in some cases enhanced by ai , but ultimately they – the leaders – need to make judgements about what this information is telling them and what they might want or need to

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do about it, and they have also to apply values when making decisions and taking action. Remaining with the science fiction inspirations, the ideas (and consequences of) learning as enhancement have been examined in such works of fiction – most notably Orson Scott Card’s classic Ender’s Game, in which training as enhancement is explored at its most extreme degree.1 Making the best possible choice in a complex and chaotic environment is equally important both in the battlespace and in all levels of headquarters. Developing the mental flexibility and adaptability needed to successfully deal with “wicked” problems has been well understood since the time of the ancient Greeks and can be seen more recently in the professional development philosophies and programmes of Western militaries. Wicked problems are defined as novel and illdefined with a matrix of interdependencies. They are complex in nature, and additional aspects of the problem are often unveiled only during the process of solving the problem.2 To address wicked problems, new ways of thinking are required. Cognitive skills are needed by officers and leaders at all levels of command and can be “generated” most effectively through various learning strategies which can be collectively termed as “active learning.” This chapter explores the concept and practice of active learning. The authors approach the issues from the backgrounds of an operatorturned-educator, first at the staff and war college level and subsequently with officer cadets in undergraduate programs, and also from the perspective of an officer involved in technical- and tactical-level instruction, and now a specialist officer in individual training and education, which includes educational development. We begin with explanations of some concepts of learning and go on to provide a number of historical and recent examples of this learning approach, before turning to the challenges currently facing the Canadian military in developing and implementing active learning across a range of education and training programs from technical training to the highest levels of professional military education. As importantly, this chapter examines the issue of resistance to this form of learning and suggests ways to mitigate the problem. w h y d o m i l i ta r i e s l e a r n ?

Before looking at learning concepts and practices it is necessary to identify the goals of learning programs. Taking the military as a single

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complex entity it can be readily understood that day-to-day activities range from the simplest of technical tasks performed by junior personnel to the most complex of strategic-level processes that are found at the level of governments and coalitions. It seems that a mix of training and education provides the skills and knowledge required in the military profession. Why both? For those relatively simpler technical tasks the ability of the learner to apply a standard response to a predictable situation, such as changing a flat tire, denotes a training solution to meeting the learning outcome. For more complicated or complex tasks where there may be many conflicting variables and no predictable correct response, education that will allow a reasoned response to an ill-defined problem is more appropriate. This difference between training and education has been described variously by such agencies as the U.S. Marine Corps and senior personnel in Canadian military education.3 However, the source of the training-education model is unclear. To say that all learning needs can be easily separated into training or education is arguably incorrect. Even in something as simple as changing a tire there is a degree of critical thinking required. Is the surface that the task will take place on stable enough to bear the weight? In a military context, is there a tactical threat that overrides even stopping to change the tire? At the other end of the professional scale, being able to work effectively at the civil-military interface, where defence policy is formulated and implemented, the practitioner must have some knowledge of geopolitics upon which base their thinking. This range of knowledge and skills was described in the Report of the Officer Development Board, a 1969 study led by Major General Roger Rowley into the learning needs of the then-newly unified Canadian Armed Forces and its officer corps.4 The report indicated that various levels of what we might now call “competencies” wax and wane as an officer progresses up the career ladder. Intellectual competence was deemed important even at junior officer ranks and steadily grew in importance throughout the career. While that report focused on officer competencies, we can today easily see parallels for non-commissioned personnel. Significantly, the report, even in 1969, saw an undergraduate degree as the basis for officer effectiveness, calling it a “training of the mind, an imparting of vigour to the intellect.”5 This sentiment was echoed in March 2017 by General Jon Vance (the Chief of the Defence Staff in Canada) when offering his perspective on the utility of education saying that officers are paid for their

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brain. Additionally, he said that leaders must be prepared in the current security environment to consider past experience but to use that as a basis for dealing with new unpredicted issues and threats. In one such example, he speculated about the military’s willingness to recruit a cyber expert “off the street,” but this cyber expert would perhaps be in a wheelchair and not employable in the traditional sense on the field of battle.6 A second perspective that will help us understand the value of active learning is Bloom’s Taxonomy of Learning (figure 8.1), developed in the 1950s by U.S. educator Benjamin Bloom. Bloom divided learning into three domains: the psychomotor, the cognitive, and the affective. Briefly put, the first dealt with the brain and the body working together to get things done, the second with reasoning and the third with values and ethics.7 Within each domain there were various levels of mastery. In the psychomotor domain the new recruit would be shown how to load, aim, and fire a personal weapon, eventually becoming an expert marksman and perhaps go on the development techniques for a newly designed weapon. In the cognitive domain (illustrated below), one might progress from basic knowledge of international relations (remembering and understanding) via introductory courses, to formulating n ato policy when working in the alliance headquarters after years of experience and advanced education. Within the affective domain a new service member would be expected to understand and apply rules of engagement but then might later be called upon to use ethical concepts to develop new laws of armed conflict for Cyber. a c t i v e o r pa s s i v e l e a r n i n g : i s o n e b e t t e r ?

Members of a military require competencies across all three domains, but how then do we prepare these individuals for the specific jobs that they will fill, each of which includes a range of tasks as well as associated skills and knowledge? In other words, what are the best learning strategies to allow personnel to acquire, retain, and employ concepts, techniques, and values most effectively, and when these concepts and techniques are not sufficient for the problem at hand, to have the intellectual depth and flexibility to develop new ones? As a preliminary answer we posit that active learning, which we define more precisely later, provides for the most effective acquisition of not just skills and knowledge as they may be applied, but also that it allows learners a degree of freedom that promotes self-regulated

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Figure 8.1  Bloom’s cognitive domain

learning and the intellectual flexibility associated with it. This approach is not new; we can look back as far as antiquity to see it applied in the Socratic method. A more modern version of this method is the Oxford tutorial. The Oxford tutorial system consists of one-on-one interchange between the tutor and the student.8 It is based upon the Socratic method,9 in which the tutor uses questioning and debate to encourage the student to examine issues in new ways and, by extension, to develop the intellectual flexibility mentioned above. The process of the tutorial looks more at the “why” than the “what” of an issue, a notion that is discussed in more detail shortly.10 It is not the tutor’s job to “teach” as the term is commonly understood. The tutor does not “convey information. The student should find for himself the information. The teacher acts as constructive critic, helping him sort it out, to try it out sometimes.”11 There is a requirement for the tutor to have an expertise in the subject matter that forms the frame of reference for this intellectual growth.12 Without such expertise, the tutor is largely unable to maximize the learning experience, being unable to shape the context for the learning.13 A tutor for the natural sciences would not be a particularly good choice, for example, for a student of engineering or theology. In a military context

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we would not imagine putting a communications instructor in front of a group of pilot trainees. What is important about the “why” factor? In a study of professional education in nineteenth-century Ontario, the authors explore how the three traditional professions – divinity, medicine, and law – recognized that technical proficiency had to be accompanied by a liberal education that remained “the touchstone of the educated man: it constituted a training in character and culture, the necessary prerequisite to framing technical expertise within ‘scientia.’”14 This scientia – knowledge – was thus a fundamental component of the individual’s formation, giving the professional the ability, in theory at least, to see the bigger picture. Similarly, in a study on professions the author notes that several professions argue that a professional is better prepared in their undergraduate program by having a broad knowledge of theories that can be a “guide [to] discretionary judgement” rather than a narrow ability in only some of the practical applications of the profession.15 Both studies arguably underscore the need to be able to think beyond “what” needs doing and “how” to do it, but to see “why” some task needs doing and “how best” to undertake or perhaps rethink it. At the other end of the spectrum from one-on-one or one-on-smallgroup learning – in what we might see as more common classroom learning, where the instructor presents knowledge to a large class – has evolved from another historical precedent. The introduction of wide public education in the eighteenth and nineteenth centuries, as a product of the Enlightenment, led to reasonably efficient (in terms of teacher-student ratios) teacher-centred techniques. Two British educators, Andrew Bell and Joseph Lancaster, developed similar systems to provide group learning using one teacher and a number of teaching assistants. In essence, the teacher provided the lesson or knowledge, which the assistants had the other more junior students repeat. The methodology was in essence one of passive rote learning, which was a great improvement in comparison to a complete lack of education in earlier times but still did little to foster critical thinking. The Bell-Lancaster system might have disappeared over time to be replaced with some other pedagogy that would promote critical thinking. Such, unfortunately, has not been the case – at least not in some classrooms,16 including post-secondary classrooms. In many universities and professional training programmes, including those of the military,

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instructor-centred learning is common. University lecturers “lecture” with the notion that students will learn by receiving the wisdom, or at least lectures, of the professor. One noted educator has painted this as something akin to unscrewing the top of a student’s head and pouring in some ideas.17 Similarly, in a training scenario students are frequently expected to learn by listening to the instructor’s words, reading the PowerPoint slides, or perhaps watching a demonstration. In training, at least, there is often a degree of “hands-on” application. Such delivery of learning is deemed “passive” in that students are not actively engaged in the receiving process and the mastery of the material, and passive delivery is relatively easy for the instructor who needs only to push the information at the students. As opposed to the training of the mind, it has the flexibility and curiosity to deal with the unknown. This aspect is important for the leaner and they must develop the self-assurance to approach the unpredicted with the confidence so that they can deal with those wicked problems – problems that defy solution but nevertheless must be solved. How, then, do we create learning environments where we provide both knowledge and skills to undertake certain tasks, but also to engender the intellectual flexibility to find answers where no answers are readily apparent? This is a question that has vexed one of this chapter’s authors for the past two decades, first as directing staff (ds) at the Canadian Forces College and more recently while teaching a range of undergraduate and graduate courses at the Royal Military College of Canada. Students have ranged from colonels and security executives to second year officer cadets. All of these students have seemed to respond better to looking for answers themselves than to being fed, or in some cases almost force-fed, a “d s solution” to a problem.18 We now turn to at the principles and practice of active learning as it is, and as it might more broadly serve as a key pedagogy in military education and training programmes. Moreover, we view such shifts in pedagogy as performance enhancing. doing active learning

In the 1960s and 1970s, the intake of students seeking education increased to include not simply academically committed students who wanted to become professors and create knowledge, but those needing an undergraduate degree to enter a given career. The result was an

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influx of students with diverse backgrounds and expectations. Within educational institutions, teaching methods that worked for academically driven students no longer worked for the student population, mainly because academic students tend to naturally use deep approaches to learning.19 In response the student body started to demand better teaching practices as an important aspect of their educational experience, and the scholarship of teaching within educational institutions was born.20 Biggs advocates: “Good teaching is getting the most students to use higher cognitive level processes that the more academic students use spontaneously,” as demonstrated in figure 8.2.21 Biggs demonstrated how student engagement at the passive end, denoted by “A,” can create a large gap between academic and nonacademic students. At the active end, denoted by “B,” the gap is minimized. We can see in Biggs’s statement exactly the same sort of reasoning that Rowley and Vance have and do advocate. The workforce is also influencing teaching practices. There is a demand for improved student performance upon graduation, enabling students to seamlessly enter the workforce. The very nature of work is changing as the industrial age, where jobs were stable and fixed, diminishes and the knowledge age, where organizations must continually adapt, proliferates.22 Some are suggesting that the idea of a job may become obsolete.23 This is because workplaces are becoming increasingly dynamic, characterized by novel and ill-defined problems or what Vance and others call “wicked problems,” where individuals need to adapt to remain relevant.24 As a result, scholars have cautioned that the “need for learning has acquired new meaning in the knowledge era.”25 The literature also identifies that those who are professionally successful are those who have highly developed learning capabilities.26 These capabilities enable someone to not simply reason well, but to seek knowledge and insight. Individuals must “manage their own learning processes” and be “able to identify their learning needs and initiate, monitor, control, and evaluate learning strategies to address these needs.”27 To be prepared for the future, students need to become more responsible for their own learning. In addition, they need to be given opportunities to develop their inherent learning skills so that they take on a more participator role in their own knowledge acquisition journey. These skills can be developed by focusing not solely on what is taught to students, but on how it is taught. That is why we are advocating active learning methodologies.

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Figure 8.2  Biggs’s figure of student orientation, teaching method, and level of engagement

promoting learning through active learning

Active learning was first defined by Bonwell and Eison, who presented this concept as: “instructional activities involving students in doing things and thinking about what they are doing.”28 In the early 1900s active learning was popularized by theorists such as John Dewey, who believed that “education must be conceived as a continuing reconstruction of experience ... the process and goal of education are one and the same thing.”29 In 1949, Ralph Tyler stated that “learning takes place through the active behavior of students, it is what he (or she) does that he (or she) learns, not what the teacher does.”30 He advocated for the creation of learning experiences that initiate actions and thus enable learning. Research from the 1980s and 1990s has shown that active learning improves learning markers including: the ability to self-regulate learning, motivation, academic performance, retention of information, and self-esteem.31 Methodologies involving activity provided individuals with opportunities to “gain mental power” and “hold firm the information or knowledge they acquired.”32 Active learning seeks to shift from teacher-centred pedagogies to student-centered pedagogies.33 As a result, individuals do not simply passively participate in the learning process, but rather are cognitively active participants.34 Cognitively active students use deep and inductive approaches to learning and

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become better self-regulated learners. Active learning prevents knowledge from becoming inert knowledge. Inert knowledge that is acquired without direct relevance to a learner’s needs is bound by context and therefore is not available for application to novel problems.35 Active learning encourages students to move beyond surface learning to deep learning, as students participate in the construction of their own learning.36 Surface learning tends to focus on rote learning, as seen above in the Lancaster-Banks approach, where individuals memorize facts and descriptions, but fail to appreciate connections that formulate cause-effect relationships or to recognize the relevance and importance of these types of connections. In comparison, a student using deep approaches to learning intends to “understand and seek meaning and, consequently, searches for relationships among the material and interprets knowledge in the light of previous knowledge structures and experiences.”37 Deep learning involves reconciling prior knowledge with new information and this inquiry process produces a conceptual framework, permitting “the student to apply what was learned in new situations and to learn related information more quickly.”38 Bransford’s inclusion of “new learning” again reminds us of the essential need to be able to deal with new and evolving problems for all levels of military practice. Active learning therefore produces a more meaningful and motivating learning experience, and encourages students to want to control their own learning. Here too we can immediately see the relevance for the military professional. Active learning not only improves learning of specific content but can also enhance one’s ability to learn. Active learning also involves students using inductive learning versus deductive learning.39 Deductive learning involves introducing definitions and principles to students, followed by application of this knowledge and is typical of lecturing. In this approach, “the instructor introduces a topic by lecturing on general principles, then uses the principles to derive mathematical models, shows illustrative applications of the models, gives students practice in similar derivations and applications in homework, and finally tests their ability to do the same sorts of things on exams.”40 Prince and Felder highlight the flaw of this approach in that students do not learn for themselves why the information is important, except that it will be tested, or is potentially important in their future careers. Active learning relies on an inductive approach where students are given specifics, such as a set of observations or a case problem.

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Through the act of trying to solve the problem, a need is generated for “facts, rules, procedures, and guiding principles.”41 This need serves as motivation to participate in knowledge construction as a means to solve the problem. In turn, students are highly motivated to learn the new information and mobilize it into an actionable result. In addition to these advantages, active learning increases an individual’s self-regulation of learning. Self-regulation of learning refers to an individual’s active control over their metacognition, motivation, and behaviour.42 An individual also monitors their progress in the learning experience as they move towards the learning objective. Selfregulated learning is considered a necessity for lifelong learning.43 Lifelong learning refers to an individual’s continual pursuit for learning opportunities throughout their lifespan for personal development or professional advancement. Self-regulated learning produces a readiness to orient mental abilities to achieving learning goals.44 With active learning, students become the source of the knowledge thereby decreasing their dependence on the teacher.45 Students also begin self-assessing and recognizing the gaps in their understanding. Learning as a result becomes more intentional and generative. Grabinger and Dunlop describe active learning as a cognitive apprenticeship.46 In a cognitive apprenticeship, the teacher models for students how to mobilize knowledge to complete cognitive tasks such as solving problems. This is often done using thinking aloud protocols, where the teacher shares explicitly their thought processes while solving a problem. The teacher then gives a problem to a student or group of students and facilitates the students’ problem solving through coaching, mentoring, and scaffolding until eventually the students can solve similar problems – and eventually, novel problems – independently. Though active learning offers many benefits, it also requires changes that many students are not prepared for. The result is student resistance to that pedagogical change. It may take the form of teacher blame, reluctant compliance, avoidance, or disruption.47 Nonetheless, it is also important to consider the student perspective. Most are striving for high academic performance, so it is reasonable to expect that students are concerned with how to adapt to new pedagogies. Further, students have expectations and preconceived notions of how the learning experience will unfold. If students have been successful with traditional approaches, their apprehension is understandable given the importance of academic performance for their future. Students may also be managing large amounts of change, particularly in the

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first year of university. It is easy for students to feel overwhelmed by and hesitant towards new pedagogies, especially when these pedagogies require students to be more responsible for their own learning. This tension can exist in both training and educational situations. a c t i v e l e a r n i n g i n m i l i ta r y t r a i n i n g a n d e d u c at i o n

Within military training, a student is expected to accomplish a task by completing a specific sequence, creating a product, or both. These outcomes categorize this approach as performance-based. The process almost follows an “if this, then that” type of structure. A common method for teaching is “edi,” which stands for explanation, demonstration, and imitation. This includes aspects of active learning and resembles the cognitive apprentice example from earlier. An instructor first explains what is expected and how to complete the tasks. The instructor then demonstrates the task or part of the task and students are given an opportunity to complete the task. Though this pedagogical methodology is often new to students, the methodology is repeated sufficiently allowing students to adapt to it. Within training, students are given multiple opportunities to complete tasks. As a result, doing the task successfully or not successfully, orients the student on how to correct their performance. Being responsible for one’s own learning is necessary in order to succeed, mainly because students must eventually perform tasks independently. It is the attempts at completing the task that initiates the adoption of this responsibility. If there are multiple attempts including various contexts, then the inductive learning component suggested by Prince and Felder is included. If minimal attempts within limited contexts are not provided, then the learning is deductive and students do not fully understand “why” a task is completed the way it is. The importance of this becomes increasingly relevant as an individual advances in their career, and facilitates an evolution that should in fact be included early in one’s military career. This is by no means suggesting to erode doctrine, but rather to truly enable an individual to appreciate doctrine. It is the inductive learning that enables the transfer of knowledge to other problems. It is also because of an appreciation of the “why” that someone is able to identify when a specific situation is novel and able to therefore adapt. When approaching how to shift from a teacher-centered to student-centered methodology, the learning experience should be

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considered in terms of surface versus deep learning and deductive versus inductive learning. As suggested by Pundak and Rozner, adopting new pedagogies will require effort and specifically time in the classroom using the new method.48 Teachers must be prepared to deal with feelings of inadequacy and even publicly make mistakes. Teachers must also be prepared to continually adjust the enactment of the new pedagogy if there is a disparity between the ability of the students and the participation requirements of students within the new learning experience.49 To adequately prepare for the implementation, student resistance should be accepted and planned for as part of the implementation process of curriculum change. Having a positive attitude to resistance can also be beneficial. Ford, Ford, and D’Ameilo suggest that there is such a thing as thoughtful resistance that can be used as a vehicle to facilitate change instead of impeding it.50 Having a perspective that accepts resistance can assist one to prepare for resistance when it occurs. Given that active learning requires “engaging students in the learning process,”51 there may be a need to incorporate a blend of teachercentered and student-centered methodologies in the beginning to facilitate pedagogical change and acceptance by both students and teachers.52 Active learning can therefore be described on a continuum, as offered in figure 8.3.53 The instructor-controlled end of the continuum includes teaching methods that combine teacher-centered methods with student-­ centred methods. At this end of the continuum, a teacher pauses between lecturing to allow for activities where students can engage with others and the content to ensure understanding. These activities include one-minute papers, polling, or small group discussions. The student-controlled end of the continuum includes teaching methods such as inquiry-guided learning, problem-based learning, and projectbased learning.54 With these activities, the learning experience is entirely through active learning methodologies. Teachers spend more of their time coaching and facilitating the learning experience for the students. While there are still many classrooms where instructor-controlled lecturing and PowerPoint are used, combining problem or inquiry based learning with technology in a student-controlled active learning framework is gaining ground. One largely successful pairing of the two has been used at the Royal Military College, where an

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Enhancing Performance Starts with Learning 187 Collaborative learning Collaborative learning Informalgroup group activities Informal activities

Problem-based learning Problem-based learning Problems thethe course Problemsdrive drive course

Instructor Instructor controlled controlled

Student Student controlled controlled

Active learning Active learning Interactive lectures Interactive lectures

Cooperative Cooperative learning learning Structured team Structured team activities activities

Project-based or studio learning Project-based or studio learning Interactive lectures Interactive lectures

Figure 8.3  Active learning continuum

introductory course in military history has moved away from lecturing by the instructor. The course is a full year survey that looks at military advancement centred largely on Western Europe, and is a required course for History and Military and Strategic Studies majors (there are typically twenty-five second-year students in the class). Adapted from Sugata Mitra’s “Minimally Invasive Education” concept,55 students are given relatively open-ended research questions that allow them to explore and report back on issues of importance in an assigned domain. The instructor meets with the students several times in the course of their research to see what they have discovered and to suggest specific issues and interconnections they may have missed. Once the individual questions are answered, each group integrates their findings and presents them to the balance of the class. As an example, a group of five students looking at operations in the Second World War would answer a set of questions dealing with German manoeuvre warfare and its success/failure; Soviet manoeuvre warfare – mass versus operational manoeuvre; U.S. theatre level manoeuvre in the Pacific; the role of armour in creating manoeuvre (airpower and manoeuvre being looked at by another group); and finally the role of logistics in enabling manoeuvre. Experience over two cohorts has revealed an initial reluctance from about 25 per cent of the class to try something new. Concerns range from a departure from the known process of taking notes, to having

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trust in working in small groups, as well as doubting that what the students discover is actually valid with respect to answering assigned questions. There are four or five of these research assignments (depending on class size) over the course of the year, and generally by the end of the second of these, concerns have been allayed. The overall result at the end of the year is an ability to investigate and report back competently, but also to retain information and to make linkages across different eras and themes. Though active learning may require significant effort when being introduced into the learning experience, it has been shown to improve student performance, while decreasing failure rates. 56 Deep and inductive learning are desirable to train and educate the mind. Chin and Brown suggests that teachers should be prepared to scaffold student thinking and encourage students during the learning process.57 This can be made easier by having an awareness of students’ understanding. If teachers know where student knowledge begins it will be easier to monitor as learning continues. Active learning methodologies are not simply to help students appreciate their learning but to provide opportunities for teachers to assess student progress so that the learning experience can continuously be adapted. Active learning methodologies ask students to not simply improve their mental structures but to purposefully participate in knowledge building.58 These active learning methods also “afford students the possibility and the motive to work their way to the solution in their own idiosyncratic way.”59 As a result, students have a better understanding of how they learn and a better appreciation for the work required to effectively learn. Knowledge building is therefore a personal experience that is meaningful and situated in the social and physical context where it occurs.60 It may reflect more informal learning where students are so entrenched in the problem or project that they do not realise that they are learning. Learning becomes a by-product of doing the work to solve the problem or complete the project.61 To be cognitively active, individuals must take more responsibility for their learning. In order for this responsibility to shift from teacher to student, different teaching methods are required. Weimer highlights that in traditional lectures, the teacher makes all of the learning decisions regarding how learning will occur.62 Chin and Brown highlight that learning takes effort.63 Students need an opportunity to create their own meanings by integrating new knowledge with existing knowledge constructs. This is not possible if knowledge is passively

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transmitted and structured by the teacher. For if learning remains teacher-centred then “students will never learn how to make them (learning decisions) on their own.”64 This is why the literature supports active learning where learning is student-centred. Without student ownership of their learning, students will not be prepared for lifelong learning and to transcend into the knowledge era of the twenty-first century. Currently, employers have a demand for individuals with high-level analytical and critical thinking skills, who can clearly communicate their ideas and participate as a member of a team in professional practice. Passive and deductive approaches are not preparing students for this eventuality, as such approaches are reflective of an industrial era and not a knowledge era. The requirement to learn new things to solve current problems is an eventual reality for students. They will venture into a complex world of continual change and novel problems. The ability of individuals to continually learn to solve these problems is an organizational human resource capability that organizations are currently struggling to fill. active learning to support transition to workplace

Organizations also realize that individual learning is necessary for organizational learning to occur. This is because organizational learning is due to “changes in organizational practices that are mediated through individual learning or problem-solving processes.”65 To create a strong organization, you need to ensure individuals have strong learning capacities. Within the workplace literature, “an individual’s ability to act knowledgeable, effectively, strategically and reflectively in a situation involves a union of practical and theoretical knowledge.”66 It is no longer simply about knowing, but more about using knowledge to participate more effectively in the doing.67 This first acknowledges that knowledge needs to be mobilized, and that mobilizing knowledge in of itself will create new knowledge. It also acknowledges that learning is not solely dependent on the active behavior of the learner,68 but results from the “reciprocal interaction between the individual and workplace.”69 This new perspective acknowledges that the individual is not isolated in the learning process, and that learning takes place in a context that has a practical and social basis.70 What is also recognized is that knowledge may need to

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be mobilized in situations that it was not previously conceived in order to solve novel and wicked problems. To meet the complex and dynamic workplace filled with wicked problems, views of learning must shift away from an “if this, then that” approach to learning. Learning must instead be more holistic, concerned with developing learning capabilities for situations in order for wicked problems to be solved, “individuals or groups of individuals must begin to question established definitions of problems or objectives and to act to transform ideologies, routines, structures or practices.”71 To meet this requirement Ellström provides a learning model that may help improve the understanding of it. Ellström makes a distinction between two types of learning: (1) adaptive and (2) developmental learning. He advocates considering the scope of action with respect to the tasks, methods, and results of workplace learning (table 8.1). As identified in table 8.1, levels of learning are categorized by task, methods, and results, as well as whether these aspects of work are given or not. Adaptive learning concentrates on mastery and improvement of task performance of routine work activities. Developmental learning involves re-evaluating current workplace practices and creating new workplace practices to address complex and novel problems within the workplace.72 Ellström suggests that these two modes of learning are complementary, and can thus be viewed as being on a continuum. Adaptive learning and developmental learning can be further broken down into reproductive, productive type I, productive type II, and creative learning depending on given and not given aspects of work.73 Though this model was created for the workplace, it can be used to guide the development of activities in all learning environments. It captures a shift from routine activities to activities that require a formulation of action. The first represents an action in response to a known, and the second represents an action to unknowns. Active learning predicated on deep learning and inductive learning will enable individuals to more effectively deal with unknowns. active learning to support emerging needs

There are several emerging unknowns that members of the military must face. First there is adjusting to the disruption of artificial intelligence, where individuals will be pushed increasingly large sets of

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Table 8.1 Ellström’s levels of learning as a function of the scope of action that exists with respect to different aspects of the work-learning environment Levels of learning Adaptive learning Aspects of the work-learning situation

(1) Reproductive

Tasks Methods Results

Given Given Given

(2) Productive, type I Given Given Not given

Developmental learning (3) Productive, type II Given Not given Not given

(4) Creative Not given Not given Not given

data and be expected to appreciate a situation based on evidence. As automation increases, the remaining work will involve analysis and creation of new practices.74 Second, different thinking is required to address ethical and global peace and security issues. When discussing the need for educated officers, Horn and Bentley highlight that “those who refuse to open their minds are doomed to suffer the limitations of their narrow, restricted and outdated beliefs.”75 It is advocated that individuals need to be able to question how things truly exist in the complex ambiguous world, and with an ability to “generate new ways of thinking” will be able to see what the world could be.76 This requirement was recently confirmed by Lieutenant General Christine Whitecross, Commandant of the North Atlantic Treaty Organization (nato ) Defense College, who commented on the college’s effort to “help people learn to think, to be innovative, and to appreciate a diversity of opinions, cultures, and backgrounds.”77 She explains how this ability to think is vital to find consensus in nato and to address issues of peace and security. Learning approaches should include opportunities to apply principles to unstructured and ill-defined problems, and to reflect on these judgements.78 Using inductive approaches that require deep learning can prepare individuals for workplace and global issues. conclusion

Militaries are no different in their need for such members; indeed, militaries have always needed personnel who could solve problems and communicate their solutions to superiors, peers, and subordinates.

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The wicked problems that have faced and continue to face militaries at levels from tactical to grand strategic demand practitioners who do not simply rely on received knowledge and practice, but have the ability to fashion new knowledge and practice, and to do so within the bounds of professional ethics and socials mores, using the strategies developed through active learning. To return to our introductory thoughts, we believe that active learning enhances and hopefully optimizes the soldier’s ability to deal with the “why” in making decisions that allow them to apply the limited resources available either at the tactical or strategic level in achieving the objective.

notes

  1 The editors are grateful to the anonymous reviewer for this connection to Card’s classic work.   2 Derick W. Brinkerhoff, “State Fragility and Failure as Wicked Problems: Beyond Naming and Taming,” Third World Quarterly 35, no. 2 (March 2014): 333–44.   3 Ronald G. Haycock, “The Labors of Athena and the Muses: Historical and Contemporary Aspects of Canadian Military Education,” in Military Education: Past, Present and Future, ed. Gregory C. Kennedy and Keith Neilson (Westport, ct: Praeger Publishers, 2002), 171.   4 Randall Wakelam and Howard Coombs, eds, The Report of the Officer Development Board: Major-General Roger Rowley and the Education of the Canadian Forces (Waterloo, on : Wilfrid Laurier Press, 2010).   5 Wakelam and Coombs, eds, Report of the Officer Development Board, 40.   6 General Jonathan Vance, “The 2017 Haycock Lecture on War Studies” (r mc , Kingston, 22 March 2017).   7 “An Introduction to Bloom’s Taxonomy,” Centre for Teaching Excellence, University of Waterloo, accessed 29 March 2017, https://uwaterloo.ca/­ centre-for-teaching-excellence/teaching-resources/­teaching-tips/planningcourses-and-assignments/course-design/blooms-­taxonomy; or “Bloom’s Taxonomy of Educational Objectives,” The Center for Teaching and Learning, u n c Charlotte, accessed 29 March 2017, http://teaching.uncc. edu/learning-resources/articles-books/best-practice/goals-objectives/ blooms-educational-objectives.   8 Will G. Moore, The Tutorial System and Its Future (Oxford: Pergamon Press, 1968), 15–19.

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 9 Moore, The Tutorial System and Its Future, 1. 10 Ibid., 30. 11 Ibid., 19. Original emphasis. 12 Ibid., 2. Moore refers to the concept of the “supervision of juniors by older fellows.” 13 Prof J. Terry Copp, Director of the Wilfrid Laurier Centre for Military Strategic and Disarmament Studies, in discussion with Randall Wakelam, September 2006. 14 Robert Douglas Gidney and Winnifred Phoebe Joyce Millar, Professional Gentlemen: The Professions in Nineteenth-Century Ontario (Toronto: University of Toronto Press, 1994), 355. 15 Elliot Freidson, Professionalism the third Logic (Cambridge: Polity, 2001), 95. 16 William L. Goffe and David Kauper, “A Survey of Principles Instructors: Why Lecture Prevails,” Journal of Economic Education 45, no. 4 (Oct 2014): 360–75. 17 Dr David Hefland, Keynote Address to the Society for Teaching and Learning in Higher Education 2016 Conference (London, Ontario, June 2016). 18 The practice in staff colleges of providing the instructors – the directing staff – with a suitable solution – the ds solution – to a problem (typically printed on pink paper, and thus referred to as “the Pinks,” so that it would be obvious should it fall into the hands of the students) ended at the Canadian Forces College in approximately 2000. This was done to encourage the students to develop unconstrained thinking, and to encourage the ds to accept this freedom of thought. 19 John Biggs, “What the Student Does: Teaching for Enhanced Learning,” Higher Education Research and Development 18, no. 1 (April 1999): 58; Karron G. Lewis, “Pathways to Improving Teaching in Learning in Higher Education: International Context and Background,” in Pathways to Profession of Educational Development, ed. Jeanette McDonald and Denise Stockley (San Francisco, c a : Wiley Subscription Service Inc, 2010), 13. 20 Lewis, “Pathways to Improving Teaching,” 13. 21 Biggs, “What the Student Does,” 58. 22 Edward E. Lawler, “From Job-Based to Competency-Based Organizations,” Journal of Organizational Behavior 15, no. 1 (Jan 1994): 4–5. 23 David Dubois and William Rothwell, “Competency-Based or a Traditional Approach to Training?” t and d  58, no. 4 (Apr 2004): 48.

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24 Per-Erik Ellström, “Integrating Learning and Work: Problems and Prospects,” Human Resource Development Quarterly 12, no. 4 (Jan 2001): 423–4. 25 Karen E. Watkins and Victoria J. Marsick, “Developing Individual and Organizational Learning Capacity,” Human Resource Development Quarterly 25, no. 1 (Spring 2014): 10. 26 Harold Jarche and Kenneth Mikkelsen, “The Best Leaders Are Constant Learners,” Harvard Business Review (16 Oct 2015), https://hbr. org/2015/10/the-best-leaders-are-constant-learners. 27 Susan M. Lord, Michael J. Prince, Candice R. Stefanou, Jonathan D. Stolk, and John C. Chen, “The Effect of Different Active Learning Environments on Student Outcomes Related to Lifelong Learning,” International Journal of Engineering Education 28, no. 3 (Jan 2012): 606. 28 Charles Bonwell and James Eison, Active Learning: Creating Excitement in the Classroom aehe-eric Higher Education Report No. 1 (Washington, dc: eri c Publications, 1991): 5. 29 John Dewey and Albion W. Small, My Pedagogic Creed, no. 25 (el Kellogg and Company, 1897), 6. 30 Ralph W. Tyler, Basic Principles of Curriculum and Instruction (Chicago, i l : University of Chicago Press, 1949, reprinted 2013), 63. 31 John D. Bransford, Ann L. Brown, and Rodney A. Cocking, “How experts Differ from Novices,” in How People Learn, ed. John D. Bransford, Ann L. Brown, and Rodney R. Cocking (Washington, dc : National Academy Press, 2000): 31–50; Nadine M. Lambert and Barbara L. McCombs, How Students Learn: Reforming Schools through Learner-Centered Education (Washington, dc: American Psychological Association, 1998). 32 Charles W. Eliot, “Langdell and the Law School,” Harvard Law Review 33, no. 4 (Feb 1920): 523. 33 Lord et al., “The Effect of Different Active Learning Environments,” 606. 34 Virginia S. Lee, “The Power of Inquiry as a Way of Learning,” Innovative Higher Education 36, no. 3 (June 2011): 150–60; Michael J. Prince and Richard M. Felder, “Inductive Teaching and Learning Methods: Definitions, Comparisons, and Research Bases,” Journal of Engineering Education 95, no. 2 (Apr 2006): 123–4; Jonathan R.H. Trudge and Paul A. Winterhoff, “Vygotsky, Piaget, and Bandura: Perspectives on the Relations between the Social World and Cognitive Development,” Human Development 36, no. 2 (1993): 77. 35 Bransford, Brown, and Cocking, “How Experts Differ from Novices,” 237; Scott R. Grabinger and Joanna C. Dunlop, “Rich Environments for Active Learning: A Definition,” alt-j 3, no. 2 (1995): 7–8; Alfred North

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Whitehead, The Aims of Education and Other Essays (New York: Macmillan, 1929), 5. 36 Matthew Hall, Alan Ramsay, and John Raven, “Changing the Learning Environment to Promote Deep Learning Approaches in First-Year Accounting Students,” Accounting Education 13, no. 4 (Feb 2004): 493–5. 37 Ibid., 491. 38 Bransford et al., “How Experts Differ from Novices,” 17. 39 Prince and Felder, “Inductive Teaching and Learning Methods,” 123. 40 Ibid. 41 Ibid. 42 Barry J. Zimmerman, “Self-Regulated Learning and Academic Achievement: An Overview,” Educational Psychologist 25, no. 1 (Jan 1990): 5. 43 Lord et al., “The Effect of Different Active Learning Environments,” 615. 44 Barry J. Zimmerman, “Becoming a Self-Regulated Learner: An Overview,” Theory into Practice 41, no. 2 (June 2002): 66. 45 Prince and Felder, “Inductive Teaching and Learning Methods,” 125. 46 Grabinger and Dunlop, “Rich Environments for Active Learning: A Definition,” 19. 47 Shannon B. Seidel and Kimberly D. Tanner, “‘What If Students Revolt?’ – Considering Student Resistance: Origins, Options, and Opportunities for Investigation,” cbe -Life Sciences Education 12, no. 4 (Winter 2013): 558. 48 David Pundak and Shmaryahu Rozner, “Empowering Engineering College Staff to Adopt Active Learning Methods,” Journal of Science Education and Technology 17, no. 2 (Apr 2008): 155–6. 49 Ibid., 158. 50 Jeffrey D. Ford, Laurie W. Ford, and Angelo D’Amelio, “Resistance to Change: The Rest of the Story,” Academy of Management Review 33, no. 2 (April 2008): 363. 51 Prince and Felder, “Inductive Teaching and Learning Methods,” 223. 52 Lord et al., “The Effect of Different Active Learning Environments,” 608. 53 Ibid. 54 Ibid., 607. 55 See for example Sugata Mitra et al., “Learning at the Edge of Chaos: SelfOrganising Systems in Education,” in The Palgrave International Handbook of Alternative Education, ed. Helen E. Lees and Nel Noddings (London, UK: Palgrave Macmillan, 2016), 227–39. 56 Scott Freeman, Sarah L. Eddy, Miles McDonough, Michelle K. Smith, Nnadozie Okoroafor, Hannah Jordt, and Mary Pat Wenderoth, “Active

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Learning Increases Student Performance in Science, Engineering, and Mathematics,” Proceedings of the National Academy of Sciences 111, no. 23 (June 2014): 8410. 57 Christine Chin and David E. Brown, “Learning in Sciences: A Comparison of Deep and Surface Approaches,” Journal of Research in Science Teaching 37, no. 2 (2000), 133. 58 Carl Bereiter and Marlene Scardamalia, Book Surpassing Ourselves: An Inquiry into the Nature and Implications of Expertise (Chicago, il: Open Court Publishing Co, 1993), 219; Laura Helle, Päivi Tynjälä, and Erkki Olkinuora, “Project-Based Learning in Post-Secondary Education – Theory, Practice and Rubber Sling Shots,” Higher Education 51, no. 2 (2006): 292. 59 Helle et al., 293. 60 John Seely Brown, Allan Collins, and Paul Duguid, “Situated Cognition and the Culture of Learning,” Educational Researcher 18, no. 1 (1989): 34. 61 Erno Lehtinen, “Discussion: Bridging the Individual and Social in Workplace Learning and Motivation,” International Journal of Educational Research 47, no. 4 (2008): 261. 62 Maryellen Weimer, “Taking Stock of What Faculty Know about Student Learning,” in Taking Stock: Research on Teaching and Learning in Higher Education, ed. Julia Christensen Hughes and Joy Mighty (Kingston, on: McGill-Queen’s University Press, 2010), 82. 63 Chin and Brown, 110. 64 Weimer, “Taking Stock of What Faculty Know about Student Learning,” 84. 65 Per-Erik Ellström, “Integrating Learning and Work: Problems and Prospects,” Human Resources Development Quarterly 12, no. 4 (Jan 2002): 422. 66 Lennart Svensson, Per-Erik Ellström, and Carina Aberg, “Integrating Formal and Informal Learning at Work,” Journal of Workplace Learning 16, no. 8 (Dec 2004), 480. 67 Amelia Manuti, Serafina Pastore, Anna Fusta Scardigno, Amria Lusia Giancaspro, and Daniele Morciano, “Formal and Informal Learning in the Workplace: A Research Review,” International Journal of Training and Development 19, no. 1 (Feb 2015): 1–17. 68 Tyler, Basic Principles of Curriculum and Instruction, 63. 69 Päivi Tynjälä, “Perspective into Learning at the Workplace,” Educational Research Review 3, no. 2 (Dec 2008): 12. 70 Stephen Billett, “Towards a Workplace Pedagogy: Guidance, Participation, and Engagement,” Adult Education Quarterly 53, no. 1 (Nov 2002): 29.

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71 Ellström, “Integrating Learning and Work: Problems and Prospects,” 424. 72 Per-Erik Ellström, “Informal Learning at Work: Conditions, Processes and Logics,” The Sage Handbook on Workplace Learning (Jan 2011), 106. 73 Ibid., 107. 74 Andrew McAfee and Erik Brynjolfsson, “Big Data: The Management Revolution,” Harvard Business Review (Oct 2012): 5–9. 75 Bernard Horn and Bill Bentley, Forced to Change: Crisis and Reform in the Canadian Armed Forces (Toronto: Dundurn Press, 2015), 89. 76 Ibid., 89. 77 Meredith Dault, “Collaborating for a More Peaceful World,” Queen’s Alumni Review (2018): 33. 78 William Greary and Ronald Sims, “Can Ethics Be Learned?” Accounting Education 3, no. 1 (1994): 8; Stacey Walker, “Active Learning Strategies to Promote Critical Thinking,” Journal of Athletic Training 38, no. 3 (Sept 2003): 266.

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9 The Road to Cognitive Optimization David J. Bryant and Keith K. Niall And are not we, Protagoras, uttering the opinion of man, or rather of all mankind, when we say that every one thinks himself wiser than other men in some things, and their inferior in others? In the hour of danger, when they are in perils of war, or of the sea, or of sickness, do they not look up to their commanders as if they were gods, and expect salvation from them, only because they excel them in knowledge? Socrates in Plato’s Theaetetus

w h at d o w e m e a n b y

“cognitive

o p t i m i z at i o n ” ?

It is not hard to explain the attractiveness of schemes for cognitive optimization. Even before we consider what cognitive optimization may be, we recognize that some people are just smarter – either for the moment, or as an enduring characteristic. Throughout human history, people have sought ways to become smarter. Education – as was examined in the chapter by Wakelam and Woodside-Duggins – has been a part of this effort, but people have also pursued means that require less time and effort as well. Traditional medicines of many countries, for example, have employed a wide range of foods, herbs, and other substances to enhance mental capabilities.1 Modern technological advances have accelerated these efforts as researchers have explored drugs, brain stimulation, and other techniques to improve cognitive performance. Just as there is no single motivation for pursuing improved cognitive performance, there is no single unified descriptor of the field. The catchphrase “cognitive enhancement” seems to be the most commonly

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used term, especially among researchers studying pharmacological, technological, or educational means to improve cognitive functioning.2 As we shall discuss in this chapter, there are many individual concepts and approaches that can be brought to the task of enhancing, improving, or augmenting human cognition. Recognizing the great generality of the term, we adopt “cognitive optimization” in the broadest sense to describe a field of study that has emerged. As we use the term, cognitive optimization refers to any intervention, manipulation, or system designed to improve human performance on cognitive tasks – it is an intentionally broad term used to capture a variety of approaches towards cognitive optimization. The distinction between optimization and enhancement is blurred for cognition in a way that it is not for physiology: it is the human establishment of norms of representation that is criterial in cognition. Technologies which purport to enhance human cognition are merely the mirror of, or the collective record of, human cognition. Why should there be such interest in cognitive optimization? In the literature, the distinction is sometimes made between intrinsic (aimed simply at the general improvement in the quality of life for an individual) and utilitarian (aimed at producing some tangible improvement or benefit to an individual) enhancement. Intrinsic enhancement can include rehabilitation. Work on the effects of adequate nutrition on cognitive development, for example, have been aimed at an intrinsic benefit: that children may achieve normal cognitive function, with the final aim of allowing those children to lead a normal life.3 But much of the recent work on manipulations designed to enhance cognition beyond normal levels seems to have a different, more utilitarian motivation. That utilitarian motivation often aims at the improvement of performance in narrowly defined tasks or domains (such as for academic performance). Of course we acknowledge that some technologies that have been developed will have application for rehabilitation as well, but we aim here to describe ideals rather than spin-offs. a p p r o a c h e s t o c o g n i t i v e o p t i m i z at i o n

Despite the mass of research which has examined ways to enhance cognition, there does not appear to be a single unifying paradigm underlying all this work. Pharmacological researchers, for example, have approached the problem from a different perspective than researchers examining brain stimulation. Even within a domain such

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as pharmacology, researchers may not share the same basic definitions of optimization or even cognition. Their goal may be a common one, but the means seem to be more than various. There are three main ways cognitive optimization has been explored. In a sense, this tripartite division is an uncontroversial generality about achievable effects on cognition. The first approach is that of cognitive enhancement. Cognitive enhancement is any approach designed to increase the power, capacity, or degree of competence of an innate cognitive capability (“innate” meaning widely shared and likely existing from birth). Essentially, this involves attempts to give a person “more” cognitive capacity to apply to tasks; it concerns the improvement of abstract span or capability to acquire and use information, and is not specific to a cognitive domain. Enhancing manipulations can be aimed at cognitive capacities defined either broadly or narrowly. An example of the cognitive enhancement approach is the development of the catecholaminergic drug methylphenidate, commonly known as Ritalin, which has been found to increase certain cognitive functions, such as working memory span.4 A second approach is that of cognitive augmentation. Cognitive augmentation refers to any manipulation designed to increase the effectiveness of an innate cognitive capability (it affects the “how” of cognition, rather than “how much”). Rather than seeking to increase the functionality available through an aspect of cognition, this approach seeks to help a person to use their existing level of functionality to greater effect. The person becomes able to use his or her given level of cognitive capacity for better performance than would otherwise be possible. Cognitive augmentation lends a best advantage to existing cognitive capabilities. It improves one’s ability to express ideas and abilities without distraction or impediment, or it serves to minimize impediments. For example, some forms of cognitive enhancement software have been developed that teach people practical strategies to memorize information and thereby increase their memorization performance. In the 1980s, psychologists often spoke in the same way of “training heuristics.” The third approach is that of cognitive support. Cognitive support refers to any manipulation designed to alter the task environment in such a way that it requires less cognitive capability (or different capabilities) to perform to a given standard. The approach recognizes that cognition is situated, meaning that the person who thinks or acts will act differently according to the sensible properties of the

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environment. This approach seeks to create a situation in which a person requires less cognitive capability (or different capabilities) to perform to a given standard. Cognitive support alters the task environment rather than the person, with the aim of improving performance of the human-system interaction. It supposes that the information in the hand (an iPhone, for example) serves just as well as improved cognition “within the head.” External devices can be developed which complement the natural cognitive abilities of the user, and are tailored to emphasize those natural abilities. The use of external computing devices to help people perform cognitive tasks is an example of this approach in action.5 k i n d s o f c o g n i t i v e o p t i m i z at i o n m a n i p u l at i o n s

There are a few general categories of treatments or interventions used to affect cognitive capability: pharmacological, neurotechnological, educational, and genetic. Nutrition and nutritional supplementation might be considered another distinct category. These are based largely on the academic disciplines from which they arise. Their effects on cognition may be distinct, or else complementary. The kinds of treatments or interventions studied by researchers are, to some extent, dependent on the approach to optimization adopted by those researchers (or vice versa). Cognitive enhancement is the most popular approach, receiving the largest share of research. Researchers have explored pharmacological,6 neurotechnological,7 educational,8 and genomic9 means to enhance cognitive abilities. The cognitive enhancement approach may be popular due to its focus on the individual, in particular what the individual is capable of. It may seem simpler to change individuals, rather than adapt varied environments to standards of performance which may not prove to be universal after all. The other approaches – cognitive augmentation and cognitive support – are less amenable to pharmacological and genetic manipulations than is cognitive enhancement. Greater effort in these areas has been directed to expert systems, human-system interaction, brain stimulation, and – as discussed in the next chapter by Farrelly – educational techniques. Cognitive augmentation focuses on making systems of rules clearer, and on improving the presentation of information to the individual, so manipulations that simplify task environments are particularly helpful in allowing people to achieve their best

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performance without altering the person’s inherent capabilities. External computing devices are an especially promising approach to cognitive support in that portions of cognitive tasks can be off-loaded onto a device to reduce the demands on the person. Note that we have even adopted metaphors taken from computation to describe some functions of short-term memory and reasoning, and in that way we recognize already how far they may be interchangeable. w h at a r e c o g n i t i v e c a pa b i l i t i e s ?

What constitute separable cognitive capabilities depends on the particular approach to cognitive optimization adopted by researchers. There is a long history of attempts to understand the nature of human intelligence. Some of the early formal work, such as that of Cattell or Thurstone, used and developed sophisticated correlational statistics to delineate the difference between general intelligence and separable abilities. Some researchers consider cognition at a broad level as categories of mental activity (such as attention, memory, or reasoning) that combine to govern behaviour. With this definition, there is little consideration of specific processes or components that might be differentially affected by optimization. Studies of the effect of proper nutrition and nutritional supplements often adopt a broad definition of cognition as the expected effects of nutrition are diffuse and non-specific.10 The development of general tools or capacities of the individual are assumed to have a general ameliorative effect on cognition. Specific environments or specific domains of reasoning are not the focus of their investigation. Beyond such general categories of mental function, many researchers have attempted to focus on cognitive processes or sub-systems at various levels of specificity. Generally, the proposed component cognitive processes are derived from a combination of theoretical concepts about what necessary processes make up a general kind of cognitive capability (such as breaking up memory into perceptual, working, and long-term memories) and measures invented to assess specific aspects of cognition. Traditionally, spatial ability – the ability to solve concrete geometric problems, to imagine complex objects from another perspective, or else orienteering or way-finding ability – has been one capacity that has been considered distinct from other capacities such as syllogistic reasoning, or verbal fluency.11

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The factor-analytic approach to intelligence offers an example of how cognition can be divided into distinct cognitive components or specific capabilities.12 Aside from a possible general intelligence factor (i.e., “g”), adherents of the factor-analytic approach seek to compile a comprehensive list of specific components that together govern all intelligence. Here the debate continues: either particular abilities may be considered to be subsumed under general intelligence, or else general intelligence may be thought to consist of separable abilities for the most part, abilities that may be linked by correlation but perhaps not in fact. This assumes that there are separable components of intelligence and that the separable components of intelligence can be improved, in the way that they are exhibited by people known by the archaic term: idiot savant. This kind of approach has a long history, with a focus on measuring individual cognitive components, but this activity comes closer to personality testing or test score evaluation, and does not otherwise resemble cognitive optimization research.13 Outside of the factor analytic approach to intelligence, many cognitive optimization researchers attempt to focus on specific cognitive capabilities derived from current theories of cognitive psychology. For example, many drugs have been found to enhance working memory performance, a concept of long standing in the study of memory.14 The attempt seems to be to identify effects more specifically than simply as an enhancement to memory (as but one example) but without an overall framework to categorize all components of cognition – that is to say, how the pieces of cognition may fit together or may be jointly affected. Instead, specific cognitive capabilities are identified from the evolution of concepts from cognitive psychology (where, to our knowledge, there has been no compilation of all the specific cognitive capabilities). Finally, some researchers pursuing cognitive optimization have viewed cognition in terms of how it supports task-specific performance. In these instances, researchers are generally interested in helping people perform better at a task, such as reading or study,15 for practical reasons. Thus cognition is considered only with respect to its usefulness in those tasks. Cognitive capabilities are not defined by human capability alone, but by considering the properties of the domain of interest as well. It is not very useful to speak of cognitive capabilities in the abstract, without discussing the particular structure of the domain of interest (like cartography or algebra). There is anecdotal evidence from the literature on the heredity of intelligence, as found

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in Galton, to suggest that talents in abstract mathematics are associated with talents in music composition, for instance. It is unclear what such associations may mean for enhancement, however. It is generally taken for granted in cognitive optimization research that the cognitive capabilities to be enhanced, augmented, or supported are actual functional capabilities that play a definable role in guiding human behavior. But since these capabilities are often derived from theoretical considerations, it is worth asking what evidence exists to support their existence. There is little need to consider the validity of any broad definition of cognitive abilities since the focus is less on precise definition than on accepted categories of mental activity. It is essentially axiomatic that people perceive, pay attention, remember, and so forth. When considering specific cognitive capabilities, however, one must consider the evidence that a particular taxonomy accurately captures the separate cognitive capabilities, as the theoretical foundation on which a given taxonomy rests may prove to be sandy soil. The factor-analytic approach to intelligence, for example, developed many different categorization schemes, often with very different numbers of basic intelligence components, dividing cognition in mutually exclusive ways. Extensive work on the factor-analytic approach has, over time, yielded some degree of consensus within that field but the approach as a whole is not necessarily accepted within broader domain of cognitive psychology. Much of the discussion has been on the reality of a unitary intelligence factor, G, versus a collection of independent abilities that are only considered at the same time for the purposes of psychometric assessment. With respect to specific cognitive capabilities identified from cognitive psychology, evidence is generally solid and based on decades of research. Although theoretical interpretations of working memory or attentional capacity change over time, the underlying phenomena are well-established. These definitions, however, are not necessarily as specific as those offered in the factor-analytic approach. Current psychological theories of logical reasoning recount characteristic errors or biases in reasoning. Yet by definition, theories which aim to explain errors in performance – to say why we cannot run the cognitive marathon – are not theories of psychological competence. We should expect a psychological theory of reasoning to explain how it is we engage in valid reasoning, or else what we may expect of the best in human reasoning. Such a theory of psychological competence accounts for our best reasoning. It is not a reckoning of failures: how we may be

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influenced by bias or inattention when we are tired or sick or merely uninformed. Improvements in gross physiological performance are relatively easy to measure, compared with improvements in cognitive performance. By way of example, a slight gain in the span of shortterm memory would constitute an unambitious promise for transcranial stimulation techniques. The Flynn Effect16 provides a clue that here is much greater latitude for improvement than we can imagine. The Flynn Effect chronicles huge population gains in intelligence test scores since the 1930s. The business of iq test standardization needs to take account of these continuous gains in population scores, and does. (Of course there is controversy to this – some investigators question that such gains can continue indefinitely.) The improvements are dramatic – they have been called the largest effect in the i q literature.17 The point is that we have – collectively – enormous play for improvement in human performance, more than we have may have imagined even for gains in physiology. For those examining ways to optimize task-specific performance, the nature of the underlying cognitive mechanisms is typically secondary. Evidence concerning what cognitive capabilities play a role in task performance depends on how much effort a researcher has taken to establish a link between a cognitive capacity and measures of task performance (as an example: does a researcher simply assume attention is needed for a task or attempt to measure attention as an aspect of task performance?). The lack of evidence for such a link is clear in the use of cognitive abilities in personnel selection. Selection has sometimes been made on the evidence of quick tests meant to represent a more comprehensive ability; causal links have not been established just where they are needed in this kind of explanation. The history of the 1 6 p f test through the selection and classification of military personnel during the Second World War gives us a historical example where the need for a selection instrument seems to have outstripped our understanding of the abilities in question, and our understanding of the psychometric properties of the test itself.18 e v i d e n c e t h at c o g n i t i v e c a pa b i l i t i e s c a n b e a lt e r e d

Is the prevalent excitement concerning cognitive optimization19 truly warranted? Despite the fear and anticipation that has been occasioned by talk of “post-humanism,” what is the evidence that we can improve

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cognition? The first step in answering this question is to assess whether there is sufficient evidence that some manipulations can reliably produce beneficial effects on certain cognitive capabilities. Fortunately, a great deal of research has addressed this step. The second step is to assess whether any of the reliable optimizing effects on cognition are associated with significant benefits to the individual or an individual’s task performance in some domain. Unfortunately, very little research has addressed whether optimizing cognitive capabilities produces any such positive effects. That is, even should there be a technology to improve the span of short-term memory, it remains unclear that the technology will help, say, a busy air-traffic controller. From the literature on cognitive optimization, research efforts seem to be organized around the kind of manipulation considered rather than the cognitive capability to be optimized. That is, a researcher will focus on studying the effects of a particular drug, for example, rather than studying working memory and the ways it can be enhanced. The literature is fragmented as a consequence: there is not much theoretical contact between different types of manipulation. For example, both Ritalin and computer training systems have been examined as enhancers of working memory but by separate research communities. What would be their interaction? Certainly, it is difficult to address the question which manipulation effects a greater change, since those manipulations are so rarely compared directly to one another. Divisions of research have emerged along the lines of manipulation rather than along boundaries between cognitive capabilities. This seems to have led researchers away from considering whether or how the effects of different classes of manipulations may be alike. There is evidence that all kinds of optimizing manipulations (with the possible exception of brain stimulation) can produce positive effects on broad cognitive functions. Many nutritional supplements, such as omega-3 essential fatty acids20 and prenatal choline21 have been found to promote cognitive functioning in offspring. Supplements of glucose22 and creatine23 may enhance cognitive functioning by increasing energy available to the brain. Although many drugs affect only some aspects of cognitive function, a number appear to broadly enhance cognition, such as stimulants in general24 and ampakines, a glutamatergic drug.25 Most forms of genetic manipulation, such as gene selection26 and gene synthesis27 have broad effects. An enriched environment (either enhanced nutrition or an environment that

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provides cognitive stimulation) is associated with higher levels of cognitive functioning later in life in animals.28 Some forms of cognitive training may also promote better overall cognitive performance in humans.29 Finally, regular physical exercise and adequate sleep have been proposed to promote broad cognitive functioning.30 Most forms of brain stimulation and neurotechnology have effects on specific cognitive functions. This reflects the highly specific nature of these kinds of manipulations that are targeted at fairly small areas of the brain. It is unlikely that any known kind of stimulation could have a broad, overall enhancing effect on cognition, although direct brain stimulation has been successfully used to treat a wide range of symptoms of Parkinson’s disease.31 Such unexpected effects can and will have unexpected applications, though it is worth keeping in mind the original and more global aim of cognitive optimization. The evidence for cognitive optimization of specific cognitive capabilities is piecemeal. Researchers have not sought an over-arching framework to guide their investigations of specific cognitive capabilities. Instead, researchers have focused on examining promising techniques and technologies, and identifying their effects. In this light, both pharmacological and neuro-technological manipulations have yielded effects on many specific cognitive functions. For example, studies have demonstrated positive effects on working memory from methylphenidate (Ritalin)32 and Modafinil (Provigil)33 on verbal memory of Donepezil (Aricept)34 and ampakines35 and on convergent reasoning of methylphenidate (Ritalin)36 and dextroamphetamine (Adderall).37 These are by no means the only potential cognitive functions that may be optimized by drugs. The effects of neurotechnologies, such as Transcranial direct current stimulation (tdcs) and Transcranial magnetic stimulation (tms), seem to depend on the specific placement of the stimulation. There is some evidence to indicate that these technologies can enhance verbal fluency,38 visual detection and identification,39 classification,40 working memory,41 and long-term memory.42 Other effects have been claimed. Task-specific effects are produced by other forms of neurotechnologies, such as brain-machine interfaces and external computing devices. Their goal is to have the technology take over some cognitive function rather than to enhance or augment it.43 Educational and trainingbased manipulations can produce such task-specific augmentation effects. Cognitive procedures or mnemonics allow people to perform arithmetic problems or remember large amounts of information.44

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Various cognitive training software programs have been developed to promote this kind of cognitive augmentation.45 The current emphasis in cognitive optimization research, across all different kinds of manipulations is concrete and short-term rather than abstract or programmatic. The emphasis is on discovering which manipulations produce reliable effects. The larger implication is that the research may appear unmotivated: issues important to the development of practical means are not well understood. Despite the many reliable demonstrations of enhancements by various means, there is little work to compare the sizes of the effects induced by different kinds of manipulation. Even within a single class of manipulation, such as the ingestion of drugs, there has been no definitive ranking in terms of cognitive enhancement. Researchers have shown little concern to assess the duration or lifetime of cognitive optimization (which can be fairly brief).46 The emergence of useful techniques to optimize cognition will have to take into account the practicality of those techniques in terms of effort and cost in relation to the size and duration of their effects. prospects for the soldier

The volume of research on cognitive optimization can be somewhat overwhelming to anyone considering how such research may be applied to help people function in complex cognitive environments. It is not at all clear how all of the myriad manipulations and technologies that have been developed relate to one another or whether any offer a combination of effectiveness, duration, and practicality needed for use in a real-world work setting. Further research is needed to address these issues. In this section, we consider how militaries – using the Canadian Armed Forces (c a f ) as an example – may wish to proceed in furthering, and exploiting, cognitive optimization research. The framework we developed above categorizes different efforts within the cognitive optimization field along two dimensions. On one dimension, we considered the kind of optimizing effect pursued by potential manipulations: enhancement, augmentation, or support. On the other dimension, we considered the level of cognition that was targeted by manipulations: broad, specific, or task-specific. This framework now offers a way of evaluating progress in the cognitive optimization field.

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Table 9.1 contains summaries of the cognitive optimization literature with respect to nine categories – the intersection of an approach to optimization with a level of effect – defined by our framework. What is evident from this table is that progress has not been equally distributed across all areas. It does not appear, for example, that there have been any substantial developments of manipulations that can produce broad enhancement or augmentation of cognition. On the other hand, significant progress has been made in developing techniques that enhance or augment specific cognitive capabilities. Using this framework, we have identified areas in which the caf may profit from supporting research. Those areas are highlighted in table 9.1. Areas in which we see little prospect of development within the near time horizon (ten to fifteen years) are highlighted. One area, defined by the intersection of support to cognition and a task-specific focus, is highlighted in table 9.1 to indicate that this is an area in which considerable research is already supported by the caf and where we expect to see continued advances. The remainder of this chapter will examine the areas of cognitive optimization created by our framework and discuss the relative opportunities for further development and exploitation presented by each. b r o a d c o g n i t i o n : e n h a n c e m e n t a n d a u g m e n tat i o n

Our review of the literature provides little indication that it is possible for any single manipulation to produce a general enhancement of cognition. Depictions of super intelligence in films such as Lucy or Limitless are highly unrealistic given what we know of the actual demonstrated effects of cognitive enhancers. What is known of the structure of the brain, with its numerous activation-inhibition pathways, suggests that any manipulation that enhances one neural system will necessarily inhibit other systems, thereby limiting the general effectiveness of specific enhancement or augmentation manipulations. Broad cognitive enhancing effects have been demonstrated with nutritional supplements, genomic manipulations, environmental enrichment, and some forms of cognitive training. Most of the research in these areas, however, focused on therapeutic outcomes rather than on producing super-normal levels of cognitive functioning in healthy individuals. Given the scarcity of evidence that broad cognitive enhancement is even possible, this does not seem to be an area the c a f may want to pursue. At a minimum, a research effort in this area would need to

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Table 9.1 Cognitive optimization: Level of effect Approach to optimization

Level of effect Broad

Specific

Many manipulations can produce enhancement to specific cognitive capabilities. It is not as well understood what, if any, interaction effects may occur among enhancing manipulations (e.g., enhancing W M but impairing some other capability). It has not been confirmed that enhancing effects on specific ­cognitive capabilities translate into benefits for performing realworld cognitive tasks. Some manipulations Augmentation Little evidence of (mainly related to any manipulation training/education) produces a broad have an augmenting augmenting effect effect on specific cogon cognition. nitive capabilities. Similar questions exist concerning the extent to which manipulations produce benefits to real-world task performance. Not much research Support Considering the accumulative effect has been done on of multiple human- manipulations that machine systems, it would fall into this may be possible to category, with greater interest in developcreate a system of ment of tools to supbroad cognitive port specific practical support; e.g., tasks. Mann’s (2001) wearable computing approach to designing an integrated suite of devices that support many cognitive functions. Enhancement

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Little evidence that any manipulation can produce broad enhancement to cognition.

Task-specific Manipulations directed at enhancing a task-specific aspect of cognition tend to be augmenting or supportive rather than enhancing. If one’s focus is on a particular task, there is less need to enhance cognition broadly to achieve positive effects on performance of that one task.

Some kinds of training/ education manipulations focus on very specific cognitive tasks; e.g., speed reading, visualization training. These manipulations may be of some interest to C A F but the general applicability of the approach seems limited. External computing tools and other humanmachine interfaces represent the most prominent forms of task-specific support. Practice of human-­ systems interaction can be seen as a form of taskspecific cognitive support.

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explore novel manipulations (drugs not already undergoing trials, as an example) in the hope of finding one that produced general cognitive enhancement. There are fewer manipulations aimed at augmenting (that is, helping an individual use a cognitive capability more effectively) than enhancing cognition and few of these manipulations are aimed at broad cognitive functioning. Most augmenting manipulations are kinds of educational or training systems (mnemonics, computer-based training). There does not appear to be an existing system that promises to augment cognition broadly. s p e c i f i c c o g n i t i v e c a pa b i l i t i e s : e n h a n c e m e n t a n d   a u g m e n tat i o n

There have been many demonstrations of manipulations (drugs and neurostimulation in particular) that produce reliable, albeit temporary, enhancement of specific cognitive capabilities. Moreover, the kinds of cognitive capabilities affected, such as working memory, attention, and verbal fluency, intuitively seem to be important to performing a wide range of real-world tasks. Thus, there is good reason to view these kinds of manipulations as very promising avenues for further research and development. Still, questions remain about whether manipulations developed for cognitive enhancement and/or augmentation can offer practically significant effects within the context of the kinds of tasks pertinent to c a f needs. Finding a reliable effect on a specific cognitive capability by a manipulation does not mean that the enhanced functioning of that capability will provide noticeable benefits within the overall context of an individual’s cognition. Thus, a first question to consider for any enhancing manipulation is whether the enhancing effects produced are large enough to translate into practically significant increases in an individual’s overall level of cognitive functioning? Then, if enhancements are significantly large, a second question is whether the enhancing effects produce practically significant increases in performance in associated caf cognitive tasks? We generally do not have solid evidence that specific cognitive capabilities play a large causal role in performance of any given task. Instead, we often just assume better working memory or attention will allow someone to perform tasks better. As a result, we do not know how much of an enhancement would be needed in any given specific cognitive capability to see a practical impact on real-world task performance.

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There seem to be several avenues of research that could be of interest to the c a f. There is little need to explore new enhancing manipulations, as there has been extensive work done throughout the world on drugs, brain stimulation, and – to a lesser extent – on training and educational techniques (genetic manipulations can also produce cognitive enhancements but they raise significant ethical issues). Where the c a f could benefit is from breaking with the traditional research paradigm that seeks potential manipulations and determines what effects they produce. Instead, the c a f could take a different tack by exploring what cognitive capabilities are linked to real-world tasks and determining the relative effects of existing manipulations on these cognitive capabilities. Such an effort addresses the first question posed above, whether manipulations produce enhancements of sufficient size that an individual might benefit in a practical sense. With knowledge of the relative efficacies of different manipulations, research could then address the second question of whether enhanced specific cognitive capabilities serve to produce better performance in real-world tasks that require, or at least are performed in the context of, general cognitive functioning. An area for research on cognitive support manipulations would be a whole-of-cognition approach similar to the wearable computer idea to see if it is possible to design an integrated suite of tools to support soldier cognition. This effort would require, first, studies in which individuals performing a given task (such as air traffic control) complete a battery of measures of specific cognitive capabilities then perform versions of the task that allow for quantitative performance measurement. Examining correlations among cognitive measures and task performance will identify potentially important cognitive capabilities. The second phase of research would be to administer manipulations that enhance those capabilities to individuals, have those individuals complete a series of cognitive measures at intervals (to chart the time course of enhancement) and the real-world task in question to determine whether enhanced cognitive capabilities translate into enhanced tasks performance and, if so, whether effects persist in time after administering the manipulation. The augmenting manipulations that have been explored tend to have effects on a narrow range of cognitive capabilities. These have been demonstrated to be effective to some degree. As with enhancing manipulations, there has been less research directed at determining

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the implications of augmenting manipulations on performance of real-world tasks than on simply documenting effects. However, some researchers, including some at Defence Research and Development Canada (drdc), are studying training techniques designed to produce faster and superior learning and ultimate task performance. Activities that seek to provide cognitive support to performance of a particular real-world task fall under the general practice of human-systems interaction or man-machine interface design. This has been a very profitable avenue for the c a f, and there is no reason to believe that continued study in this area will not produce even better adaptations of technological systems to human users. By adapting systems to the user, a designer is altering the task environment in ways that an individual is able to perform the task better or more efficiently without altering the individual. A third question needs to be considered: should manipulations produce large enhancements that in turn produce significant increases in task performance; also, how long do these effects persist after treatment? Pharmacological treatments produce transitory effects unless an individual becomes a chronic consumer (which raises important issues of long-term side effects). The duration of brain stimulation effects has been less intensively studied than the reliability of effects. Will continual treatment be needed to produce continued effects or will performance remain improved after some amount of time without treatment? With respect to the question of effect duration, one research question of interest to the caf would be whether enhancement of specific cognitive capabilities during an individual’s training in some skill will yield significantly better training performance. Following from this is the question whether subsequent performance after training will remain elevated in the absence of cognitive enhancement. Potentially, administering cognitive enhancing manipulations during training could produce long-lasting effects even if the main effect of enhancement is short-lived. But this depends on two things: that training completed under the effect of enhancement yields superior training results, and that training performance leads to superior task performance which lasts over time. The body of evidence reviewed by Bryant and Angel47 does suggest that any manipulation that increases training performance will result in superior task performance at all points along the skill-fade curve, although such curves tend to asymptote to similar levels after a long interval.

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conclusion

Despite the vast effort devoted to exploring numerous distinct kinds of optimizing manipulations, there has been little progress in developing a coherent program to guide cognitive optimization research toward viable practical ends. This chapter represents a first step in the process of relating the disparate research streams and identifying those areas most promising as future technologies. Distinguishing cognitive enhancement from cognitive support, for example, highlights the different potentials of pharmacological treatments and handheld and wearable computing devices as ways to increase the effectiveness of soldiers. Current cognitive enhancing drugs offer real but limited increases in basic human cognitive functioning, which may be harnessed to help soldiers reason and make decisions faster and more effectively than previously possible. Wearable computing devices, in contrast, can create human-machine systems that are more functional than a human soldier alone. What is needed now is a comparative approach to identify optimizing manipulations that offer the greatest promise of practical effect for the future.

notes

  1 Paul Root Wolpe, “Treatment, Enhancement, and the Ethics of Neurotherapeutics,” Brain and Cognition 50, no. 3 (Dec 2002): 387–95.   2 Nick Bostrom and Anders Sandberg, “Cognitive Enhancement: Methods, Ethics, Regulatory Challenges,” Science and Engineering Ethics 15, no. 3 (June 2009): 311–41; Ahmed Dahir Mohamed, “Neuroethical Issues in Pharmacological Cognitive Enhancement,” Wiley Interdisciplinary Reviews: Cognitive Science 5, no. 5 (July 2014): 533–49.   3 Ingrid B. Helland, Lars Smith, Kristin Saarem, Ola D. Saugstad, and Christian A. Drevon, “Maternal Supplementation with Very-Long-Chain N-3 Fatty Acids during Pregnancy and Lactation Augments Children’s iq at 4 Years of Age,” Pediatrics 111, no. 1 (Jan 2003): 39–44.   4 Nirit Agay, Eldad Yechiam, Ziv Carmel, and Yechiel Levkovitz, “NonSpecific Effects of Methylphenidate (Ritalin) on Cognitive Ability and Decision-Making of adhd and Healthy Adults,” Psychopharmacology 210, no. 4 (July 2010): 511–19.   5 Bostrom and Sandberg, “Cognitive Enhancement,” 311–41.

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  6 Guillaume Fond, Jean-Arthur Micoulaud-Franchi, A. Macgregor, Raphaelle Richieri, Stephanie Miot, R. Lopez et al., “Neuroenhancement in Healthy Adults, Part I: Pharmaceutical Cognitive Enhancement: A Systematic Review,” Journal of Clinical Research & Bioethics 6, no. 213 (Feb 2015): 213.   7 Martin Dresler, Anders Sandberg, Kathrin Ohla, Christoph Bublitz, Carlos Trenado, Aleksandra Mroczko-Wąsowicz et al., “Non-Pharmacological Cognitive Enhancement,” Neuropharmacology 64, no. 1 (July 2012): 529–43.   8 Florian Schmiedek, Martin Lövdén, and Ulman Lindenberger, “Hundred Days of Cognitive Training Enhance Broad Cognitive Abilities in Adulthood: Findings from the cog i to Study,” Frontiers in Aging Neuroscience 2, no. 27 (July 2010): 27.   9 Ya-Ping Tang, Eiji Shimizu, Gilles Dube, Claire Rampon, Geoffrey A. Kerchner, Min Zhuo et al., “Genetic Enhancement of Learning and Memory in Mice,” Nature 401, no. 6748 (Sept 1999): 63–9. 10 Joshua T. Cohen, David C. Bellinger, William E. Connor, and Bennet Shaywitz, “A Quantitative Analysis of Prenatal Intake of n-3 Polyunsaturated Fatty Acids and Cognitive Development,” American Journal of Preventative Medicine 29, no. 4 (Dec 2005): 366–74. 11 Nicholas G. Shakeshaft, Kaili Rimfeld, Kerry L. Schofield, Saskia Selzam, Margherita Malanchini, Maja Rodic, Yulia Kovas, and Robert Plomin, “Rotation is Visualization, 3D is 2D : Using a Novel Measure to Investigate the Genetics of Spatial Ability,” Nature: Scientific Reports 6, no. 30545 (Aug 2016): 9, doi:10.1038/srep30545. 12 Ellen L. Carroll and Peter Bright, “Involvement of Spearman’s g in Conceptualization Versus Execution of Complex Tasks,” Acta Psychologica 170 (Oct 2016): 112–26. 13 Stephen Jay Gould, The Mismeasure of Man (New York: Norton, 1981). 14 Alan D. Baddeley, Working Memory (Oxford: Oxford University Press, 1986). 15 Paul A. Kudlow, Karline Treurnicht Naylor, Bin Xie, and Roger S. McIntyre, “Cognitive Enhancement in Canadian Medical Students,” Journal of Psychoactive Drugs 45, no. 4 (Sept 2013): 360–5. 16 James R. Flynn, “Massive i q Gains in 14 Nations – What iq Tests Really Measure,” Psychological Bulletin 101, no. 2 (March 1987): 171–91; James R. Flynn, “The ‘Flynn Effect’ and Flynn’s Paradox,” Intelligence 41, no. 6 (Nov 2013): 851–7. 17 Robert L. Williams, “The ‘Flynn Effect’ and Flynn’s paradox,” Intelligence 41 (Nov 2013): 851–7.

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18 Armando Simón, “Sensitivity of the 16PF Motivational Distortion Scale to Response Bias,” Psychological Reports 101, no. 2 (November 2007): 482–4; John S. Baird, Jr, “Reliability of the 1 6 pf Questionnaire for Security Guard Applicants,” Journal of Personality Assessment 45, no. 5 (Nov 1981): 545–6. 19 Steven Petrow, “The Drugs of Work-Performance Enhancement,” Atlantic, 4 November 2013, accessed 19 June 2019, http://www.theatlantic.com/ health/archive/2013/11/the-drugs-of-work-performance-enhancement/ 281055/. 20 Joshua T. Cohen, David C. Bellinger, William E. Connor, and Bennett A. Shaywitz, “A Quantitative Analysis of Prenatal Intake of n-3 Polyunsaturated Fatty Acids and Cognitive Development,” American Journal of Preventative Medicine 29, no. 4 (Nov 2005): 366–74; Helland, Smith, Saarem, Saugstad, and Drevon, “Maternal Supplementation with Very-Long-Chain N-3 Fatty Acids,” 39–44. 21 Tiffany J. Mellott, Christina L. Williams, Warren H. Meck, and Jan Krzysztof Blusztajn, “Prenatal Choline Supplementation Advances Hippocampal Development and Enhances ma pk and c r eb Activation,” faseb Journal 18, no. 1 (Apr 2004): 545–7. 22 Gary Wenk, “An Hypothesis on the Role of Glucose in the Mechanism of Action of Cognitive Enhancers,” Psychopharmacology 99, no. 4 (Dec 1989): 431–8. 23 Caroline Rae, Alison L. Digney, Sally R. McEwan, and Timothy C. Bates, “Oral Creatine Monohydrate Supplementation Improves Brain Performance: A Double-Blind, Placebo-Controlled, Cross-Over Trial,” Proceedings of the Royal Society of London, Series B: Biological Sciences 270, no. 1529 (Aug 2003): 2147–50. 24 Bostrom and Sandberg, “Cognitive Enhancement,” 311–41. 25 Gary Lynch and Christine M. Gall, “Ampakines and the Threefold Path to Cognitive Enhancement,” Trends in Neurosciences 29, no. 6 (Oct 2006): 554–62. 26 British Medical Association, “Boosting Your Brainpower: Ethical Aspects of Cognitive Enhancements,” accessed 19 June 2019, Discussion paper from the British Medical Association (Nov 2007), http://hdl.handle. net/10822/511709. 27 Ya-Ping Tang et al., “Genetic Enhancement of Learning and Memory in Mice,” 63–9. 28 Marian C. Diamond, Ruth E. Johnson, and Carol A. Ingham, “Morphological Changes in Young, Adult and Aging Rat Cerebral-Cortex, Hippocampus, and Diencephalon,” Behavioral Biology 14, no. 2 (July 1975): 163–74.

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29 Schmiedek et al., “Hundred Days of Cognitive Training,” 27. 30 Sara Mednick, Ken Nakayama, and Robert Stickgold, “Sleep-Dependent Learning: A Nap is as Good as a Night,” Nature Neuroscience 6 (June 2003): 697–8. 31 Nicholas D. Schiff, Joseph T. Giacino, Kathleen Kalmar, Jonathan D. Victor, Kenneth Baker, M. Gerber et al., “Behavioural Improvements with Thalamic Stimulation after Severe Traumatic Brain Injury,” Nature 448, no. 7153 (Sept 2007): 600–4. 32 Nirit Agay et al., “Non-Specific Effects of Methylphenidate (Ritalin),” 511–19. 33 Danielle C. Turner, Luke Clark, Edith Pomarol-Clotet, Peter McKenna, Trevor W. Robbins, and Barbara J. Sahakian, “Modafinil Improves Cognition and Attentional Set Shifting in Patients with Chronic Schizophrenia,” Neuropsychopharmacology 29, no. 7 (July 2004): 1363–73. 34 Fond et al., “Neuroenhancement in Healthy Adults,” 213. 35 Lynch and Gall, “Ampakines and the Threefold Path to Cognitive Enhancement,” 554–62. 36 Holly A. White and Priti Shah, “Uninhibited Imaginations: Creativity in Adults with Attention-Deficit/Hyperactivity Disorder,” Personality and Individual Differences 40, no. 6 (Apr 2006): 1121–31. 37 Martha Farah, Caroline Haimm, Geena Sankoorikal, and Anjan Chatterjee, “When We Enhance Cognition with Adderall, Do We Sacrifice Creativity? A Preliminary Study,” Psychopharmacology 203, no. 3 (May 2009): 541–7. 38 Meenakshi B. Iyer, U. Mattu, Jordan Grafman, Mikhail Lomarev, S. Sato, and Eric M. Wassermann, “Safety and Cognitive Effect of Frontal DC Brain Polarization in Healthy Individuals,” Neurology 64, no. 5 (Apr 2005): 872–5. 39 Felix M. Mottaghy, Marcel Hungs, Marc Brügmann, Roland Sparing, Babak Boroojerdi, Henrik Foltys et al., “Facilitation of Picture Naming after Repetitive Transcranial Magnetic Stimulation,” Neurology 53, no. 8 (Nov 1999): 1806–12; Stefan Evers, Iris Böckerman, and Peter W. Nyhuis, “The Impact of Transcranial Magnetic Stimulation on Cognitive Processing: An Event-Related Potential Study,” Neuroreport 12, no. 13 (Oct 2001): 2915–18. 40 Zsigmond Tamas Kincses, Andrea Antal, Michael A. Nitsche, Orsolya Bartfai, and Walter Paulus, “Facilitation of Probabilistic Classification Learning by Transcranial Direct Current Stimulation of the Prefrontal Cortex in the Human,” Neuropsychologia 42, no. 1 (Feb 2004): 113–17.

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41 Felipe Fregni, Paulo S. Boggio, Michael Nitsche, Felix Bermpohl, Andrea Antal, Eva Feredoes et al., “Anodal Transcranial Direct Current Stimulation of Prefrontal Cortex Enhances Working Memory,” Experimental Brain Research 166, no. 1 (Oct 2005): 23–30. 42 Lisa Marshall, Matthias Molle, Manfred Hallschmid, and Jan Born, “Transcranial Direct Current Stimulation during Sleep Improves Declarative Memory,” Journal of Neuroscience 24, no. 44 (Nov 2004): 9985–92. 43 John P. Donoghue, “Connecting Cortex to Machines: Recent Advances in Brain Interfaces,” Nature Neuroscience Supplement 5 (Dec 2002): 1085– 8; Steve Mann, “Wearable Computing: Toward Humanistic Intelligence,” ieee Intelligent Systems 16, no. 3 (June 2001): 10–15. 44 Jakow Trachtenberg, The Trachtenberg Speed System of Basic Mathematics (London: Souvenir Press, 2000); Dresler, Sandberg, Ohla, Bublitz, Trenado, Mroczko-Wąsowicz et al., “Non-Pharmacological Cognitive Enhancement,” 529–43. 45 Joan Minninger, Total Recall: How to Boost Your Memory Power (New York: mj f Books, 1997). 46 Stéphanie Deline, Stéphanie Baggio, Joseph Studer, Alexandra A. N’Goran, Marc Dupuis, Yves Henchoz et al., “Use of Neuroenhancement Drugs: Prevalence, Frequency, and Use Expectations in Switzerland,” International Journal of Environmental Research and Public Health 11, no. 3 (Mar 2014): 3032–45. 47 David John Bryant and Harry Angel, “Retention and Fading of Military Skills: A Literature Review,” Defence Research and Development Canada, Technical Report drdc Toronto tr 2000-070 (Apr 2000).

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i m p l i c at i o n s f o r p o l i c y and society

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10 Insulating Soldiers from the Emotional Costs of War: An Ethical Analysis Colin Farrelly introduction

Rapid advances in the biomedical sciences raise the prospect that it may be possible to go beyond the traditional therapeutic aims of medicine (e.g., treatment of disease) to actually “enhance” the biology of humans. In Beyond Humanity, the bioethicist Allen Buchanan defines biological enhancement as follows: “a deliberate intervention, applying biomedical science, which aims to improve an existing capacity that most or all normal human beings typically have, or to create a new capacity, by acting directly on the body or brain.”1 From increasing the human lifespan, to improving strength, intelligence, and memory, the topic of human enhancement raises a host of ethical and societal concerns. The prospect of enhancing human performance is particularly important and controversial in two domains where maintaining, and indeed pushing, the boundaries of peak human performance is crucial to the activity – sports and the military. Athletes need to remain in the best physical condition possible if they hope to be competitive on the world stage. This pressure to be the fastest and/or the strongest has led to performance-enhancing substance scandals in sports, from cycling and baseball to weightlifting and sprinting. The names Ben Johnson, Lance Armstrong, and Barry Bonds will be remembered more for their use of performance-enhancing substances than for their athletic prowess. Enhancement within the military also raises a plethora of complex ethical issues. Countries want their military to be effective so that,

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should their soldiers be called upon to engage in risky military operations, they can successfully achieve their military objectives with minimal risk of injury and loss of life. Critics of human enhancements often object that they are “unnatural.”2 Applied to the prospect of enhancing the emotional resilience of soldiers through new memory-altering drugs (hereafter referred to as m a d s), this “unnatural” objection often invokes an overly idealized account of the role memory does, and should, play in human identity and wellbeing. For example, in the President’s Council of Bioethics Report Beyond Therapy,3 the report claims that memory-blunting interventions risk “falsifying our perception and understanding of the world.”4 As such, memory-blunting technologies could threaten the ability of the modified person living an authentic human life. In this chapter I argue that this line of objection to m ad s is predicated upon a misunderstanding of how humans already modify, edit, and supress memories in order to reduce emotional discomfort and pain. Memory modification, whether unconscious or conscious, is an integral part of the “psychological immune system.” Gilbert et al.5 describe this immune system as the brain’s ability to protect us from gloom. To help us cope with the adversity we inevitably face in a hostile world, our mind can be very selective about the information it retains, distorts, and omits. As such, memory modifications can be both adaptive (that is, positive to the individual) or maladaptive (negative to the individual). Whether or not any potential mad is, all things considered, beneficial to a soldier (and thus a true “enhancement”) will depend on the specifics of how it impacts the emotional resilience of a soldier. A drug that helps insulate against post-traumatic stress disorder (p t sd) by altering the neuroplasticity of the brain so that remote traumas can be more effectively treated with cognitive behavioural therapy is a good example of such a potential intervention. In the following section I begin to unravel the “enhancements are unnatural” objection by pointing out that the stressors of contemporary warfare are also “unnatural.” In section II I then consider the feasibility of developing a ma d to help reduce the emotional toll of warfare on soldiers by detailing a recent study on dulling fearful memories in mice by extending the period of time “recent” memories remain recent before becoming “remote” (and thus less receptive to behavioural therapy). In section III I argue that the objection that memory modifications make us “less than human” or “inauthentic”

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ignores the reality that the “psychological immune system” already involves memory modifications, many of which are unconscious. This means mads should not necessarily be ruled out of hand as inherently problematic simply because they alter our memories. If they help enhance the emotional resilience of soldiers in a way that is conducive, rather than corrosive, to a soldier’s wellbeing, then they could be considered as morally obligatory interventions to provide to soldiers at high-risk of witnessing traumatic events. However, as I detail in the final section (IV) of this chapter, there is another moral duty that should not be circumvented by a duty to enhance the emotional resilience of soldiers. That duty is to seek, as far as is possible and reasonable, to avoid placing soldiers (or civilians) in situations that will exacerbate the occurrence of traumatic events in the first place. In other words, the utilization of m ad s should not lower the high moral threshold for justified military intervention. Peace is a cheap and effective way of preventing the traumas of conflict. Peace should be the ultimate, long-term solution to the problems of reducing the emotional trauma of conflict. But in the non-ideal world sometimes military conflict is needed to avoid human traumas of a larger scale. And in that non-ideal context of the contemporary world, I do not believe the “ma ds are unnatural” objection is a persuasive argument against the development of safe and effective m ad s. m o d e r n w e l fa r e c r e at e s

“ u n n at u r a l ”

stressors

In 2011 Canada ended its nine-and-a-half year military operation in Afghanistan. It is estimated that of the 25–35,000 military members released from the Canadian Forces between 2011 and 2016, at least 2,750 of them can be expected to suffer from a severe form of posttraumatic stress disorder, and at least 5,900 will suffer from a mental health problem diagnosed by a health professional.6 The emotional toll of participating in military operations can be significant. While the armour soldiers wear when engaging in conflict has dramatically improved in the past century, thus helping to protect their bodies from external threats like bullets and explosives, the human brain that helps protect us from some of the emotional costs of trauma has not advanced. And this leaves many combatants vulnerable to trauma like ptsd. But the prospect of developing mads that enhance the psychological immune system could help make soldiers more emotionally resilient to the emotional toll of war and conflict.

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Like the case of ma d s, critics of an enhancement that alters the aging process of humans often claim that such an intervention is “unnatural.”7 One way to illustrate the point that the “enhancements are unnatural” worry is not compelling with respect to an aging intervention is to emphasis the point that the aging of human populations itself is “unnatural.” So, if the aging of our populations is “unnatural” then an “unnatural” solution might be an appropriate response. In 1953 Peter Medawar described senescence (biological aging) as something “revealed and made manifest by the most unnatural experiment of prolonging human life by sheltering it from the hazards of its natural existence.”8 “Humans, and the animals we choose to protect, are the only species in which large numbers experience ageing.”9 Without the benefits of the improvements in material prosperity, the sanitation revolution, immunizations, and other public health innovations, only a small percentage of people would live long enough to suffer the chronic diseases of late life. Noting how the reduction in the extrinsic risks of morbidity and mortality have created the conditions necessary for the chronic diseases of late life to become prevalent helps undermine the “an aging intervention is unnatural” objection to developing a gerontological intervention. We humans created the conditions for population aging. If we hope to reduce the suffering that humans surviving past the seventh, and perhaps even eighth, decade of life will suffer we should support an aging intervention that delays the onset of chronic disease and disability.10 This very same point can be emphasized to support the case of ma d s. While warfare has always been a part of human life, there are many unique stressors of modern warfare that challenge the psychological immune system in ways that the psychological immune system did not evolve to deal with. The psychological immune system humans have today was shaped over the 300,000 years or so of our species’ evolutionary history. While violence and conflict continues to be a reality of life for humans, the emotional trauma caused by modern warfare is very new and distinct. “Most hostile intergroup contact among hunter-gatherers was probably ongoing or intermittent, with occasional casualties, more akin to boundary conflicts among chimpanzees than to the pitched battles of modern warfare.”11 The emotional trauma a tribal warrior might face when killing the enemy of a neighbouring tribe in hand-to-hand combat, or with a bow or spear, is very different from the emotional

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trauma of witnessing the carnage caused by an m2 machine gun, or an apache helicopter or cruise missile. The sheer scale of death and injury that the weaponry of modern warfare can inflict exceeds anything that the human psychological immune system evolved to deal with. Furthermore, there are many unique aspects of the nature of modern warfare that can add novel stress on soldiers. Intergroup conflict, in the distant past, would have had a very clear rationale – group survival. LeBlanc, for example, argues that resource stress and carrying capacity limitations are the primary cause of forager warfare.12 Combatants that killed invaders attacking their tribe would have a clear rational for why they had to take the life of others – to protect their kin. This is a very compelling justification for committing violence against others. Even offensive campaigns to take scarce resources from neighbouring tribes would have been rationalized as necessary for the survival of the group. Compare this with the strained rationalization a soldier might face after experiencing trauma in a campaign like Vietnam or Afghanistan. They might return home to mass public protests opposing the military intervention that they contributed to. Their compatriots might characterize their actions as evil, barbaric, etc. These societal pressures will add yet more strain on the psychological immune system of soldiers struggling to make sense of what happened. The conditions of modern warfare contain many unique stressors that were absent from the evolutionary past that shaped the psychological immune system. Thus, one might contend that the psychological immune system should be updated and improved to deal with the stressors of modern warfare. If mads are “unnatural,” one might retort that the stressors of modern warfare are also “unnatural.” And this deflates the strength of the “enhancements are unnatural” objection. While I think this type of rebuttal to the “m a d s are unnatural” argument is effective, it does raise a potential problem concerning the duty to minimize the risk of soldiers being exposed to traumatic events in the first place. This is especially relevant when considering cases where there is widespread opposition to the use of military force, like when the moral justification for using military force is contested. Utilizing m a d s should not lower the moral threshold for justified military intervention. This point is addressed in the concluding section of this chapter.

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mads: science fiction or the science of tomorrow?

“Memory in the biological sense is best understood as the systems underlying our capacity for retaining, storing and recalling experiences.”13 Preventing or treating p t sd by subduing fearful or painful memories via novel pharmaceuticals raise a host of interesting questions. For example, what constitutes “excellent” memory (e.g., perfect recall, remembering only pleasant experiences, etc.)? Would an intervention that subdued the traumatic memories of combatants compromise their ability to live “authentic” lives? Would it make soldiers “less human”? Or perhaps such interventions ought to be conceived of as simply an extension of more conventional therapeutic techniques, such as the narrative changes elucidated by psychotherapy or cognitive behavioural therapy? Ethical debates surrounding any biomedical enhancement tends to get highly emotive, especially when the potential technology under question is highly speculative. For example, consider an intervention that increased the human lifespan. If such an intervention is stated very simply as “adding twenty years to life expectancy,” it is not very clear what, exactly, this means in terms of the quality of life such an intervention would confer. If the twenty-year increase in life expectancy is achieved by simply expanding the frailspan, that is, the period of time people live with multi-morbidity and disability, that would not necessarily be a desirable outcome. However, if the extra twenty years could be added to the human healthspan, so the intervention in question delays the chronic conditions of aging, and perhaps even compresses the period of morbidity at the end of life, that is very different. Assessing the potential pros and cons of a potential “anti-aging” enhancement comes down to the specifics of what is gained, both for individuals and collectively as a society. Qualitative considerations also matter, not just quantitative ones (i.e., the number of years alive). I believe the same points apply to any potential mad that improves the emotional resilience of humans. Would such an intervention improve the overall quality of life of people, so they can enjoy more positive emotions, better cope with the adversity life inevitably throws their way, etc.? In my own research on the ethics of human enhancement,14 I have found it is most helpful to focus on technological interventions that have some close analogy to existing enhancing technologies. So, for an aging intervention, it is helpful to focus the

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ethical debate on a drug that mimics the effects caloric restriction has on slowing biological aging. Or a drug that activates the “longevity genes” which the longest-lived humans already have activated. Such (as of yet still potential) interventions are within the realm of conceivable because caloric restriction has been demonstrated to alter the aging process in a variety of different species. Two potential drug interventions that are now being extensively studied are those that activate the sirtuin genes (sirtuins are proteins that are activated by caloric restriction) and drugs that target a protein called to r (target of rapamycin). Rapamycin, for example, is a drug that was developed from soil on Easter Island. It is currently used as a drug to help prevent the rejection of transplanted organs for patients undergoing organ transplant. But recent experiments have found that consuming rapamycin can extend lifespan, including in mammals. The most significant study15 was published in the journal Nature in 2009. In that study mice that were already 600 days old (which is roughly equivalent to a sixty-year-old human) were fed rapamycin. This intervention increased the median and maximal lifespan of both male and female mice. Focusing on the moral stakes of such interventions is very different than those that arise when one raises the prospect of “eliminating aging” or people living to 1,000+ years. The scientific basis for contemplating such radical scenarios is much more tenuous. Talk of achieving “biological immortality” or living to 1,000 years is more likely to invoke dismissive emotive reactions from anti-enhancement critics. Hence why I believe it is perhaps more helpful to begin the discussion of “enhancement” with a focus on more modest and feasible interventions. I believe this is certainly true for a discussion of m ad s . One could invoke highly imaginative interventions that allow humans to simply pop a pill and erase any selected memory – from the memory of a bad hair day, to an embarrassing faux pas, and toxic friendships or romantic relationships. These are the kinds of scenarios that lead the President’s Council on Bioethics to conclude that m ad s could pose a significant threat to living an authentic human life. If used to blunt all the emotional unease we face in life, it will not actually enhance us because it will deny us of the ability to learn how to cope with, and overcome, adversity in life. When it comes to a potential memory-altering drug, just like any potential aging intervention, the devil is in the details concerning

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whether, all things considered, the so-called “enhancing intervention” in question actually leaves a person better off or not. The case for seeing some potential m a d s as an actual “enhancement” is more compelling, I shall now argue, when it is understood as enhancing our psychological immune system. As such, mads could be prescribed to soldiers to reduce the emotional toll of war on them. This is something that will most likely be taken in conjunction with (rather than a replacement for) traditional therapies like cognitive behaviour therapy. A recent study on fear in mice published in Cell is a great example of this, and will be the focus of my ethical analysis of improving the emotional resilience of soldiers. In “Epigenetic Priming of Memory Updating during Reconsolidation to Attenuate Remote Fear Memories”16 researchers showed that it is possible to modulate, via drugs, the neuroplasticity of a mouse’s brain, so that remote traumatic memories (i.e., an event that occurred a month ago) could be treated as efficaciously with exposure-based therapy as recent memories (i.e., day old events).17 The mice were first subjected to Pavlovian fear conditioning. At the sound of a tone, the mice would receive an electrical foot shock. Once the mice internalized the association between the tone and pain they would display a conditioned response at the tone (i.e., they would freeze). The mice were then treated the day following the establishment of the conditioned response with different behavioural therapies (e.g., exposure therapy) to facilitate fear extinction. In a different group of mice there was a delay of thirty days of exposure to these same behavioural therapies, so that their memories of the association between the tone and pain were remote memories rather than recent ones. While the behavioural treatments were successful in extinguishing recent fear memories in mice, they were unsuccessful in extinguishing the remote fear memories in the other group. Traumatic events appear to make chemical markers in the genome, and, over time, these markers make it more difficult to respond to behavioural therapy. This is why it is possible to treat the recent, but not remote, fearful memories in mice. However, what makes this recent study published Cell so significant is that they then administered a class of drugs called histone deacetylase inhibitors to the mice. These drugs appear to enhance the neuroplasticity of the brain, extending the period of time needed before traumatic events become ingrained in the genome (and thus more resistant to behavioural therapy). Mice taking this drug, and receiving exposure therapy thirty days after the

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conditioned response, were able to attenuate the fear response. Such an intervention could be considered a form of mad because the drug alters the neuroplasticity of the brain so “recent” memories remain “recent” for a longer period of time, thus extending the window for therapy to be efficacious before fearful events alter the genome. This study might lead the way to the development of new drugs that permit p t sd in soldiers (and others who suffer traumatic events) to improve the efficiency of cognitive behavioural therapy (c b t ) by limiting the likelihood that traumatic events will alter the genome in ways that make cbt less efficacious. This could be particularly important for soldiers as there is often a delay, perhaps of weeks or even months, between the time they experience a traumatic event in a military campaign and when they could begin behavioural therapy. the

“psychological

immune system” a n d m e m o r y m o d i f i c at i o n

The concern that mads are “unnatural” runs the risk of being predicated upon an overly idealized account of the role memory does, and should, play in human identity and wellbeing. For example, in Beyond Therapy the President’s Council of Bioethics argues that memoryblunting interventions risk “falsifying our perception and understanding of the world.”18 As such, ma d s could threaten the ability of the person having their memory modified from living an authentic human life. But is this worry a real danger? Much depends on what the memory modification does in terms of its impact on our overall wellbeing. I think the President’s Council of Bioethics overstates the concern when it claims that the problem is we risk “falsifying our perception of the world.” Such falsifying is precisely what the psychological immune system is supposed to do. The key insight worth noting is that some falsifications are unhealthy (e.g., those that allow an alcoholic to remain in denial about their addiction problems), but other falsifications are necessary and beneficial. To see this point, it is worth noting the various ways humans can unconsciously, as well as consciously, already modify their memories. Having an accurate perception and understanding of the world is not always conducive to our wellbeing. Why? Because life is often full of major disappointments, heartache, disease and death. In The Wisdom of the Ego, Vaillant notes: “At times we cannot bear reality. At such times our minds play tricks on us. Our minds distort inner

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and outer reality so that an observer might accuse us of denial, selfdeception even dishonesty. But such mental defences creatively rearrange the sources of our conflict so they become manageable and we may survive. The mind’s defences – like the body’s immune mechanisms – protect us by providing a variety of illusions to filter pain and to allow self-soothing.”19 Daniel Gilbert et al. describe the brain’s ability to protect us from gloom as the “psychological immune system.” “Ego defense, rationalization, dissonance reduction, motivated reasoning, positive illusions, self-serving attribution, self-deception, self-enhancement, self-affirmation, and self-justification are just some of the terms that psychologists have used to describe the various strategies, mechanisms, tactics, and manoeuvres of the psychological immune system.”20 Human life always has, and continues to be, rife with pain and suffering. The psychological immune system helps us develop the emotional resilience to cope with life’s adversity and continue to live lives with optimism and positive emotion. Memory modification is an integral element of our psychological immune system. We have a number of evolved cognitive mechanisms, tactics and strategies that help deny or edit information and facts so that we feel better. These include primitive defense mechanisms like denial and compartmentalization that can help a person resolve the cognitive dissonance they experience when facing realities that are emotionally painful. For example, a worker who consistently receives negative job performance reviews might (unconsciously) actively deny this feedback in order to protect their ego: “I know I am a great worker, and the only reason I don’t get better annual reviews is because I don’t schmooze with management like other workers do!” Or a spouse having an extramarital affair might compartmentalize the infidelity by telling themselves “It’s just a bit of fun on the side, nothing serious.” These primal defenses, while often effective in helping people resolve the pain of cognitive dissonance, are not necessarily helpful in terms of permitting them to live flourishing, happy lives. The temporary pain relief offered by the primitive defense mechanisms can be damaging when they obstruct more healthy ways of working through life’s problems to improve the experience of work (e.g., by talking to management about one’s annual performance review) and/or relationships (e.g., suggesting marriage counselling). In “The Historical Origins of Sigmund Freud’s Concept of the Mechanisms of Defense,” George Vaillant claims that Freud identified five properties of our defense mechanisms:

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1 2 3 4

Defences are a major means of managing instinct and affect. They are unconscious. They are discrete (from one another). Although often the hallmarks of major psychiatric syndromes, defences are dynamic and reversible. 5 They can be adaptive as well as pathological.21 Item number five is very important to bear in mind for our purposes. Defence mechanisms can be adaptive as well as maladaptive. So, any proposed m a d that augments these defence mechanisms by making them more or less active could, overall, be potentially beneficial or detrimental. Denial, for example, while shielding someone from dealing with painful emotions today (like guilt) can be detrimental to them in the long-term, eroding valuable social relationships and even their own health. An alcoholic might self-rationalize their dependency on alcohol by activating their denial defence mechanism (“I’m just a social person, the life of the party!”). But this defence mechanism is maladaptive in this case because the person has become dependent on alcohol to dull painful emotions instead of addressing the root cause of this pain (e.g., childhood trauma or abandonment, divorce, unemployment, etc.). More positive aspects of the psychological immune system, those that can lead to lasting improvements in well-being when activated, include humour, optimism, and compensation. Laughter, and not taking things too seriously, can help people manage the stress of life. But when it comes to comedic temperament, having the right amount is crucial. While laughing and a light-hearted attitude to not sweat the small things in life can improve our emotional well-being, an adult who treats all of life’s challenges with dismissive laughter would be a negligent parent, inefficient worker and insensitive romantic partner. When it comes to the “comedic virtues,” the Aristotelian doctrine of the mean between extremes is instructive – the right amount of a jovial disposition is the mean between lacking the disposition completely and possessing an excessive amount such that you do not take anything in life seriously. In her book Positivity,22 the psychologist Barbara Fredrickson details how optimism and positive emotions help people navigate through the challenges of life. Resilient people are better at transforming negative feelings into positive ones. These persons are not deluded, they also feel frustration and anxiety when facing stressful events. But research has shown that a 3:1 ratio for positive to negative

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emotions accounts for the difference between individuals that flourish and those that do not.23 Compensation involves distorting reality in the sense that it downplays shortcomings or failings and emphasizes instead positive attributes or strengths. For example, suppose Betty is asked if Tom, whom she has known for forty years since they were kids at school, is a good friend. Mary knows that Tom always shows up late for everything, he has always been this way, even as a child. However, Mary replies “Yes, Tom is a great friend, he has great stories from the past and is very witty!” Compensation permits Mary to have higher levels of gratitude by focusing on the positives rather than the negatives. Her memory modification enables her to continue to have a positive, healthy relationship with a person she shares a history with, despite the fact that he lacks other attributes one might expect or hope a good friend would possess (like being considerate and punctual). Cognitive behaviour therapy is a therapeutic tool that can help with depression and other disorders by helping people change the thinking patterns that lead them to fixate on negative thoughts. In Redirect,24 the social psychologist Timothy Wilson details how, through storyediting, people can edit their narratives in ways that make their lives more satisfactory. Suppose, for example, Stanley comes home from work one day to find his wife of thirty years has packed all her clothes and left him for good. Stanley was aware they had persistent marital problems for many years, but his wife leaving him was still a shock and he now suffers immense anguish and tries to make sense of the marital breakdown. There are many possible narratives Stanley could tell himself about why the marriage ended. For years Stanley’s ex-wife had emphasized his shortcomings as a husband – that he was untidy, inconsiderate, unromantic, didn’t make enough money, etc. One story Stanley could tell himself is the story “I’m a lousy person and partner.” A second possible narrative Stanley could tell himself when making sense of the marriage breakdown is the simple story provided by Stanley’s best friend, Dave. Dave’s story is “Your ex-wife is always nagging and no man could ever make her happy!” Suppose there was some factual accuracy to both the story provided by his ex-wife and the story provided by Dave. It was true that Stanley wasn’t the tidiest of people, and that he could have tried to be more romantic towards his wife. But internalizing that story as the complete story will lead to chronic low self-esteem, maybe even depression.

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Such story-editing is maladaptive. On the flip side, there may also be some truth to the claim that his ex-wife was often overcritical of him (and perhaps other people in her life). Internalizing Dave’s story could also be maladaptive, as it could prevent Stanley from doing the internal work needed to change the behaviours that contributed to the dissolution of the marriage (e.g., having better communication with his partner). The story editing that Stanley needs to make to emerge from his divorce as a healthy, happier person must strike the right balance between offering some frank assessment of how his behaviour, and his ex-partner’s behaviour, led to the relationship ending. And at the same time, that story should be compatible with an optimist outlook that Stanley could, one day, attract and keep a new partner. The right story for Stanley to construct is not necessarily the most factually accurate one of the past, but rather the story that helps him grieve and get closure on the past, make the necessary changes to his behaviour and attitude, and also permits him to retain an optimism that he will find fulfilling companionship again in the future. I have inserted this brief overview of the psychological immune system in this chapter to make clear that humans are constantly modifying their memories and editing the story of their lives. An authentic human life is not one of constructing a self-narrative predicated upon a complete, factually accurate, account of all past events. We are selective, indeed very selective, about what we remember, and the weight and meaning we give to positive and negative events. Sometimes this memory alteration is the result of primal defence mechanisms like denial that protect our ego in ways that can be detrimental, all-thingsconsidered, to our wellbeing. But other times more positive features of this immune system, like a sense of humour and optimistic disposition, truly do make our lives go better by eliciting positive emotions and allowing us to live lives with gratitude and meaning (e.g., “I had to endure fifteen job rejections to become the person I am today, a determined person who will land her dream job any day now!”). When faced with more serious traumatic events, like violence, divorce, death of a loved one, etc., cognitive behaviour therapy or story-editing techniques can be utilized to try to reduce the persistence of negative thoughts and mood, thoughts that might come from an accurate perception of the world and one’s life. Because such interventions have been demonstrated to be safe and efficacious, few object to their utilization on the grounds that they are “unnatural” or that

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the patients undergoing such treatment go on to live “inauthentic” human lives. Highlighting all of the above points in this section helps, I hope, quell the strong anti-enhancement sentiments that are typically raised against the prospect of developing mads. Namely that they are objectionable because they are “unnatural” or threaten an authentic human life. We naturally modify our memories to avoid emotional pain, it’s a capacity that helped humans survive in the precarious environments we have lived in throughout our species’ evolutionary history. p e a c e : a c h e a p a n d e f f e c t i v e way t o p r o t e c t soldiers from the emotional costs of war

When a country pursues military intervention, they put at risk the lives and physical and mental well-being of the men and women serving on the front lines of such interventions. Asking combatants to risk making the ultimate sacrifice during a military campaign comes with heavy moral responsibilities. There are at least two general moral obligations a fair society must fulfill when requesting (or requiring) soldiers to engage in military intervention. Firstly, there is a moral obligation to try to prevent, as far as is reasonable, putting a soldier’s life and health at risk by ensuring they are well equipped with the resources (e.g., armour) needed to successfully complete their mission with the smallest risk of casualties and injury. Secondly, in the event that soldiers sustain physical and/or mental injuries during military operations, medical treatment and support should be provided to them. This duty could entail, for example, providing prosthetic limbs to soldiers injured by roadside bombs, and/or cognitive behavioural therapy for conditions like post-traumatic stress disorder. These two general moral duties could be described as a duty to prevent harm to our combatants, and a duty to provide therapy for injured combatants. A country could fail the first duty – the duty to prevent harm – by not providing adequate training and/or equipment to soldiers. Sending soldiers into battle without proper tactical training could place them at a much higher risk of injury and/or death when facing opponents with a much higher degree of skill. Similarly, sending soldiers into battle without adequate equipment, such as armour, communications, or effective weapons, could increase the probability that they will sustain injury and/or death.

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While we send soldiers into the military arena with modernized weapons and armours, they still possess a psychological immune system designed to manage the emotional trauma of our primitive evolutionary past. Is there a duty to also upgrade their emotional resilience, if doing so means that fewer will suffer the emotional trauma of conditions like ptsd? So far in this chapter I have tried to undermine the case against enhancing soldiers in this way. Objections that mad s are “unnatural” and might rob soldiers of an authentic human life are less persuasive once we acknowledge that the stressors of modern warfare are also “unnatural,” and that modifying memories is a normal part of the psychological immune system. But the case in favour of m a d s will only be compelling provided such interventions actually improve, all things considered, the quality of life soldiers can live after they are done fighting. A drug that dulled the memories of war by making the primal defense mechanisms of denial hyperactive (“What war?”) would threaten an authentic life in the way the Beyond Therapy Report noted. But a m a d that enhanced the neuroplasticity of the brain so that soldiers who had the remote memories of traumatic events could respond better to cbt could be very desirable and considered an extension of the duty to prevent harm. Any presumption in favour of providing mads to soldiers to reduce the emotional toll inflicted upon them by military conflict must not diminish a prior, and even more pressing, moral duty. Namely, the duty to not place them in the hostile environment of warfare, unless doing so promotes a very pressing and substantial moral imperative (e.g., to prevent a grave humanitarian disaster, more war, etc.). However, given that we live in a non-ideal world with threats of terrorism, political instability, etc., peace is not likely to be a feasible and effective solution in the foreseeable future. In the real, non-ideal world ma ds might be an effective way of minimizing the extent to which the emotional turmoil of warfare is inflicted upon soldiers when pursuing peaceful solutions are not always viable. In this chapter, I have argued that the objection that m a d s are “unnatural” or threaten an authentic human life are not very persuasive. Much of course depends on the specifics of what a mad actually does. If novel m a d s actually help prevent and/or treat p t s d in a manner than improves a soldier’s welfare in the long-term, then it is hard to see how their use could be unethical provided doing so does

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not lower the moral threshold for ascertaining when military intervention is justified in the first place. Policy makers should keep an open mind about the prospects of enhancing the emotional resilience of soldiers via ma ds.

notes

  Acknowledgement: This chapter draws from material originally pub-

lished in chapter 7 of Colin Farrelly, Genetic Ethics: An Introduction (Cambridge: Polity Press, 2016).   1 Allen Buchanan, Beyond Humanity (Oxford University Press, 2011), 23.   2 Janet Kourany, “Human Enhancement: Making the Debate More Productive,” Erkenn 79 (2014): 981–98, 985.   3 President’s Council on Bioethics, Beyond Therapy: Biotechnology and the Pursuit of Happiness, 2003, accessed 3 February 2019, https://­ bioethicsarchive.georgetown.edu/pcbe/reports/beyondtherapy/index.html.   4 Ibid., 228.   5 Daniel Gilbert, Elizabeth C. Pinel, Timothy D. Wilson, Stephen J. Blumberg, and Thalia Parker Wheatley, “Immune Neglect: A Source of Durability Bias in Affective Forecasting,” Journal of Personality and Social Psychology 75, no. 3 (1998): 617–38.  6 http://www.parl.gc.ca/Content/LOP/ResearchPublications/2011-97-e. htm#a2, accessed 3 February 2019.   7 See Arthur Caplan, “Death as an Unnatural Process,” European Molecular Biology Organization, embo Reports 6 (2005): S72–5.   8 Peter Medawar, An Unsolved Problem of Biology (London: Lewis, 1952), 13.   9 Leonard Hayflick, “The Future of Ageing,” Nature 408 (2000): 267–9. 10 See Colin Farrelly, “Has the Time Come to Take on Time Itself?,” British Medical Journal 337 (2008):147–8; and Robert Butler, Richard Miller, Daniel Perry, Bruce Carnes, Franklin Williams, Christine Cassel, Jacob Brody et al., “New Model of Health Promotion and Disease Prevention for the 21st Century,” British Medical Journal 337 (2008): 149–50. 11 Samuel Bowles, “Did Warfare Among Ancestral Hunter-Gatherers Affect the Evolution of Human Social Behaviors?,” Science 324, no. 5932 (2009): 1249, 1293–8. 12 Steven LeBlanc, “Forager Warfare and our Evolutionary Past,” in Violence and Warfare Among Hunter-Gatherers, ed. Mark Allen and Terry Jones, (Walnut Creek, ca: Left Coast Press, 2014), 29.

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13 Matthew Liao and Anders Sandberg, “The Normativity of Memory Modification,” Neuroethics 1 (2008): 86. 14 Colin Farrelly, Biologically Modified Justice (Cambridge: Cambridge University Press, 2016). 15 David E. Harrison, Randy Strong, Zelton Dave Sharp, James F. Nelson, Clinton M. Astle, Kevin Flurkey, Nancy L. Nadon et al., “Rapamycin Fed Late in Life Extends Lifespan in Genetically Heterogeneous Mice,” Nature 460 (2009): 392–5. 16 Johannes Gräff, Nadine F. Joseph, Meryl E. Horn, Alireza Samiei, Jia Meng, Jinsoo Seo, Damien Rei et al., “Epigenetic Priming of Memory Updating during Reconsolidation to Attenuate Remote Fear Memories,” Cell 156 (2014): 261–76. 17 For an outline of the study see “Drug Helps to Clear Traumatic Memories,” accessed 3 February 2019, http://www.nature.com/news/ drug-helps-to-clear-traumatic-memories-1.14534. 18 President’s Council on Bioethics, Beyond Therapy, 228. 19 George Vaillant, The Wisdom of the Ego (Cambridge, ma : Harvard University Press, 1993), 1. 20 Gilbert et al., “Immune Neglect,” 619. 21 George Vaillant, “The Historical Origins of Sigmund Freud’s Concept of the Mechanisms of Defense,” in Ego Mechanisms of Defense: A Guide for Clinicians and Researchers (Washington, dc : American Psychiatric Press, 1992), 4. 22 Barbara Fredrickson, Positivity (New York: Three Rivers Press, 2009). 23 Barbara Fredrickson and Marcial Losada, “Positive Affect and the Complex Dynamics of Human Flourishing,” American Psychologist 60, no. 7 (2005): 678–86. 24 Timothy Wilson, Re-Direct: The Surprising New Science of Psychological Change (New York: Little, Brown and Company, 2011).

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11 Bioethics and Soldier Bio-Enhancement Maxwell J. Mehlman

The use of biomedical enhancements by members of the military raises a number of challenging issues. Do warfighters have to give their informed consent to use such enhancements, or can they simply be ordered to do so by their superiors? The type of enhancement, and degree of use, could also pose an ethical risk. This is especially true considering the potential for adverse side effects, some of which may not be known from the outset. If enhancements improve performance as intended, what effect should the improvement have on military career opportunities and awards? Can military personnel continue to benefit from military enhancements in civilian life? Finally, what rules should govern enhancement experiments on members of the military? The first question that must be asked is what counts as biomedical enhancement. A threshold question is what counts as a biomedical enhancement. In the introduction, the editors of this volume suggest that a biomedical enhancement involves the deliberate increase of human potential beyond that which is achieved “naturally.” As they admit, however, determining what is natural is problematic. One working definition of a biomedical enhancement is “an intervention that employs medical and biological technology to improve performance, appearance, or capability besides what is necessary to achieve, sustain or restore health.”1 This definition avoids the challenge of the term “natural,” but the concept of health is equally elusive. Body shapes that were associated with health a hundred years ago, for example, are now considered obese.2 Moreover, there is a tendency to describe more traits as diseases and more interventions as treatments. Some cosmetic surgeons maintain, for example, that by enhancing

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appearance they can improve patients’ mental health, arguing that their services should be deemed “medical” and, incidentally, covered by health insurance. Critics call this “medicalization.” They complain that doctors prescribe anti-depressants to counteract the ordinary tribulations of daily life rather than to treat depression, and that many male children diagnosed with attention-deficit hyperactive disorder are merely “boys being boys.” One group of authors laments that “[e]3veryday experiences like insomnia, sadness, twitchy legs, and impaired sex drive now become diagnoses: sleep disorder, depression, restless leg syndrome, and sexual dysfunction.”4 To take another example, many people suffer a mild loss of cognitive function as they age. This has led to a new diagnostic category, “mild cognitive impairment” (m c i ), which has been arbitrarily defined as performance on neuropsychological tests that is greater than one-and-a-half standard deviations from age-associated norms.5 This automatically makes approximately 1,750,000 people in the U.S. m c i -sufferers. But do they really suffer from a disorder, or are they simply going through the normal stages of healthy cognitive life, albeit perhaps a little faster than some others? For that matter, what is “normal”? In some cases, it refers to the frequency with which a trait or capability occurs within a population. A person of normal height, for example, is arbitrarily defined as someone whose height lies within approximately two standard deviations of the population mean. But at other times, “normal” bears little relation to population distributions. Normal eyesight is deemed to be 20/20, but only about 35 per cent of adults have 20/20 vision without some form of correction.6 (The 20/20 standard of normality stems from an eye chart created by a nineteenth century physician; a person with 20/20 vision could read a character on the chart approximately three-eighths of an inch high from twenty feet away.) What is normal also may vary from place to place and time to time. The average American is taller than the average Japanese, and the average height of Americans is greater now than at the beginning of the twentieth century. Standards of normality, moreover, might change as the use of enhancements expanded; if there were a drug that increased height, for example, the more people who used it, the taller the average height of the population would become. Assuming we can agree on what is normal, a drug that improved cognitive function in persons with below-normal cognitive ability, for example, would not be considered an enhancement. But a

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pharmacological agent that improved cognitive function to such a degree that the individuals exceeded population norms for cognitive functioning clearly would qualify as an enhancement. An intervention also might be regarded as an enhancement if it improved the cognition of someone with normal cognition to start with, even though the resulting cognitive performance remained within population norms. In short, the distinction between enhancement and therapy is not a bright line. It is especially difficult in the military; interventions that provided combat troops with better-than-normal vision, hearing, or cognition, or a greater-than-normal ability to tolerate conditions of sleep deprivation, dehydration, or prolonged exposure to heat, cold, or high altitude, for example, might be regarded as means to prevent injury rather than enhancements. Nevertheless, the above working definition is sufficient to allow some conclusions to be drawn about the ethical and legal propriety of military enhancement. This chapter focuses on enhancement achieved using drugs and biotechnology. Other ways to enhance performance, such as mechanical assistance (e.g., exoskeletons) and brain-computer interfaces, are beyond scope of chapter. Furthermore, the chapter addresses ethical issues. It does not discuss legal issues, such as the implications of an enhancement drug being a controlled substance, or whether giving warfighters biomedical enhancements violates the Biological Weapons Conventions or other international agreements. Finally, the focus is on the United States; other countries may have somewhat different ethical norms and values, although the basic principles should be similar. h i s t o r y o f m i l i ta r y b i o - e n h a n c e m e n t

Military biomedical enhancement is not new. Amphetamines were used widely by American, German, British, and other forces in the Second World War, and again by the U.S. in Korea.7 Caffeine in coffee and tea was also used long before that. The U.S. Air Force sanctioned amphetamines on a limited basis for the Strategic Air Command in 1960, and in 1962, for the Tactical Air Command. The Vietnam War sparked large-scale amphetamine use, with smaller amounts employed in the U.S. invasion of Panama.8 Amphetamines also were widely used in the first Gulf War.9 In 1991, the U.S. Air Force Chief of Staff, General Merrill A. McPeak, banned the use of amphetamines because,

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in his words, “Jedi Knights don’t need them,”10 but the ban was reversed in 1996 to facilitate long-distance missions being flown from Eastern Europe.11 In 2002, the U.S. Air Force was dispensing ten milligrams of amphetamines for every four hours of flying time for singlepilot fighter missions longer than eight hours and for two-pilot bomber missions longer than twelve hours. When asked why military pilots were permitted to use amphetamines when they were prohibited by commercial airlines, Colonel Peter Demitry, chief of the Air Force Surgeon General’s Science and Technology division, explained that “when a civilian gets tired, the appropriate strategy is to land, then sleep. In combat operations when you’re strapped to an ejection seat, you don’t have the luxury to pull over.”12 Amphetamines attracted attention in 2002, when four Canadian soldiers were killed and eight wounded in a friendly fire incident in Afghanistan attributed in part to use of the drug by Air Force F -16 pilots.13 Amphetamines continue to be approved for military use, but safer and more effective alternatives are being introduced, such as modafinil, a drug originally used to treat narcolepsy sold under the brand name Provigil.14 However, military interest in bioenhancement extends far beyond stimulant drugs. In 2007, the US Defense Advanced Research Projects Agency (darpa) announced a goal of “making soldiers ‘kill-proof’” by, for example, enabling them “to bring to battle the same sort of capabilities that nature has given certain animals,” including a sea lion’s dive reflex,15 and by developing a super-nutritional pill that, in darpa’s words, would permit “continuous peak performance and cognitive function for three to five days, twenty-four hours per day, without the need for calories.”16 In 2008, jason, a group of scientific advisors to the US Department of Defense (DoD ), issued a report on “Human Performance” that discussed several types of biomedical enhancements, including the potential use of a class of compounds called ampakines to enhance cognition. This report identified reduction in the need for sleep as potentially having a “dramatic effect” on the “balance of military effectiveness” so long as adversaries did not have access to the same interventions.17 In 2010, jason issued another report entitled “The $100 Genome: Implications for the DoD” that outlined an ambitious plan to employ genomic technologies to “enhance medical status and improve treatment outcomes” and enhance “health, readiness, and performance of military personnel.”18

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p r i n c i p l e s o f m i l i ta r y b i o e t h i c s

Civilian bioethics has long been governed by a set of basic principles, and the temptation is to employ the same principles when considering bioethics issues in the military. The foundations for civilian bioethics are found in the Nuremburg Code, the International Code of Medical Ethics issued by the World Medical Association, and especially the Belmont Report of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. These documents were written in response to abuses in human subjects research, including Nazi medical experiments and the U.S. Public Health Service experiment on syphilis at Tuskegee, but their principles have been extended to bioethics generally, including in the clinical setting. These principles are, first, “beneficence,” which requires the welfare of the individual patient to be paramount, and therefore imposes a duty to minimize the risks of treatment or of participating in research and ensure that the benefits of treatment or research outweigh the risks. Second, under the principle of “respect for persons,” competent persons must be permitted to make informed decisions about what is best for them; persons who are not competent, such as children and vulnerable populations, must be protected; and privacy in all cases must be upheld. Third, the principle of “justice” mandates that the risks and potential benefits of participating in research must be fairly distributed and that patients must be given equitable access to treatment. The principles that govern civilian bioethics arguably reflect core societal values of freedom, equality, and democratic decision-making.19 But these are not the core values of the military, which include selflessness, the duty to obey orders, accountability, and the obligation to look out for the welfare of one’s subordinates.20 Therefore, the civilian principle of beneficence, with its focus on individual well-being, does not fit the military core value that subordinates the welfare of the individual warfighter to the needs of the unit, mission, and state. Promoting the welfare of the individual warfighter also is a core military value, however. These competing values can be reconciled by invoking ethical principles that the international community has developed to determine when it is ethical to impose a risk of harm on persons other than one’s own troops, the principles of just warfare (jus ad bellum),21 military necessity,22 and the concept of proportionality embodied in jus in bello.23

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Proportionality Applying these principles to the imposition of biomedical risks on one’s own troops, a biomedical risk can be imposed, first, only when it is necessary24 – that is, when no less risky alternative is available to accomplish the mission.25 Second, the mission must seek to accomplish a legitimate military objective;26 it would be unethical, for example, to enrol warfighters as subjects in an enhancement experiment primarily to benefit a private drug company. Third, the nature and degree of the risk must be proportionate to the military advantage to be gained; the more important the objective, the greater the ethical risk that may be imposed. For the sake of brevity, these three maxims will be referred to as the principle of proportionality. The principle of proportionality in military bioethics also requires that risks and benefits be understood as well as possible. In the U.S. Army, this is part of “Risk Management,” which, as described in Army Techniques Publication 5-19, entails identifying hazards and assessing them in terms of severity and probability.27 Proportionality in military bioethics incorporates two other norms of military life. First, judgments about whether a risk is proportional must be made at the appropriate level of command; the greater the risk, the higher the level of command at which a decision must be made. As Army Techniques Publication 5-19 instructs, “make risk decisions at the appropriate level … r m [risk management] is only effective when the specific information about hazards and risks is passed to the appropriate level of command for a risk decision.”28 The second norm is that commanders who order warfighters to assume risks are accountable and are subject to punishment if their orders are improper. The nature and amount of biomedical risk that may be imposed on a warfighter depends on a number of considerations. One is the expected benefit, if any, to the warfighter themself. The U.S. Army was criticized, for example, for introducing the clotting agent Factor v i i into clinical practice in Iraq in 2004 before full-scale testing had taken place, which later revealed both safety and efficacy problems.29 While use of this agent before testing was completed might not be ethical to treat minor wounds that were not life-threatening, it nevertheless might be proportionate for seriously wounded soldiers for whom no other satisfactory treatment was available. Another consideration, as suggested by Michael Gross, is whether the nation is at war or at

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peace.30 The DoD has relied on this distinction, for example, to justify giving combat troops protective or therapeutic agents without their consent: In all peacetime applications, we believe strongly in informed consent and its ethical foundations. In peacetime applications, we readily agree to tell military personnel, as provided in f da’s regulations, that research is involved, that there may be risks or discomforts, that participation is voluntary and that refusal to participate will involve no penalty. But military combat is different. If a soldier’s life will be endangered by nerve gas, for example, it is not acceptable from a military standpoint to defer to whatever might be the soldier’s personal preference concerning a preventive or therapeutic treatment that might save his life, avoid endangerment of the other personnel in his unit and accomplish the combat mission. Based on unalterable requirements of the military field commander, it is not an option to excuse a nonconsenting soldier from the military mission, nor would it be defensible militarily – or ethically – to send the soldier unprotected into danger.31 Finally, a risk might be proportionate for combat troops but disproportionate for non-combat troops or those who were out of the immediate line of fire. The risk from a protective agent against nerve gas might be proportionate for troops reconnoitering a route for a critical attack, but not for those holding a quiet section of the line or far from the front. Paternalism A second basic principle of military bioethics is paternalism, which better suits the military than the civilian principle of respect for persons because of the degree to which members of the military must obey orders rather than exercise decision-making autonomy. Civilian bioethicists recognize that some persons have diminished autonomy and need to have their welfare protected by others. But in civilian life, the persons charged with guarding the well-being of persons with diminished autonomy can be physicians, family members, legal guardians, or judges, while in the military this is the responsibility of the warfighters’ superiors. Combining the principles of paternalism and

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proportionality, commanders have a duty to ensure that the biomedical risks that they impose on their subordinates are proportionate. These twin principles also guide privacy and confidentiality: commanders have a duty to protect their subordinates’ privacy and confidentiality unless and to the extent that it is outweighed by military necessity. Finally, commanders have a duty to protect warfighters’ dignity by avoiding exposing them to biomedical risks that humiliate or demean them.32 Some commentators, including the members of the Presidential Advisory Committee on Gulf War Veterans’ Illnesses33 and the Advisory Committee on Human Radiation Experiments,34 suggest that the voluntary nature of military service in the United States and other countries can restore a large measure of warfighter autonomy if prospective enlistees are informed of the biomedical risks to which they might be subjected in the service, and given the opportunity to avoid those risks by declining to enlist.35 Conversely, by enlisting, they can be deemed to have given their informed consent to the risks. However, this notion of “anticipatory consent” cannot replace the principle of paternalism. In the first place, describing the number and types of biomedical risks that enlistees might encounter with any specificity would be cumbersome and probably unintelligible; the alternative of describing them generally (e.g., “you could be asked to serve in risky medical experiments or given experimental agents without your consent”) is unlikely to provide sufficient knowledge of risks and benefits to permit truly informed consent to take place. In addition, it may not be possible to anticipate future types of risks at the time of enlistment. Finally, warfighters still need the protections afforded by paternalism and proportionality so that they are not deemed to have consented at the time of enlistment to disproportionate biomedical risks. While the voluntary nature of military service cannot solve the problem of the lack of warfighter autonomy, it does underscore the need to adhere to proper principles of military bioethics. This is because some warfighters have an opportunity to opt out of their service commitments if they feel that they are being exposed to undue risks. This was demonstrated by the actions of certain troops in response to the imposition of mandatory anthrax vaccination by the DoD. According to a congressional report, “the bulk of vocal resistance to the avip [Anthrax Vaccine Immunization Program] has arisen in the few Reserve and National Guard units included in phase 1.

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Those service members have more options than active duty personnel. If they conclude the anthrax vaccine poses more risk than benefit to their civilian and military careers, they can resign, or seek a transfer to a non-mobility position. Many have done so.”36 Fairness The third basic principle of military ethics is fairness. In terms of exposure to risk, fairness may sound like an odd principle in the military; the risk of injury or death is hardly “fair,” varying widely depending on the warfighter’s branch of service, rank, location, and job.37 Nevertheless, it is appropriate to include a principle of fairness in military bioethics to respond to situations in which commanders impose a biomedical risk only on a subgroup of their subordinates. Fairness precludes imposing the risks in a discriminatory manner, or on warfighters who are less able to bear them than others, such as physically weaker members of a unit. The principle of fairness also suggests that biomedical risk should not be used to punish bad behavior. In connection with biomedical enhancement, however, there is one important respect in which civilian and military principles coalesce. Some bioethicists contend that enhancement benefits are less important than medical benefits, and therefore a risk that might be acceptable in a treatment or therapeutic research context might be unethical in enhancement treatment or experimentation.38 The value of a benefit clearly depends on the nature of the benefit; an enhancement that substantially improved cognitive function might be more valuable than a treatment for nail fungus. Enhancements therefore are no different than treatments when it comes to balancing risks and benefits, and ensuring that the benefits outweigh the risks in order to comport with the principle of proportionality depends on the specifics of the intervention or study.39 consent

Informed consent is a cornerstone of protections for civilian patients and research subjects. However, military personnel are more likely to be given orders than asked for permission. If they cannot refuse a lawful order, even one that places them in physical danger, the question is whether they should be able to refuse to use enhancements or

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participate in enhancement research, even when doing so would pose significant risks. Moreover, given the “command culture” of the military, members of the military who are asked to give permission might not actually believe that they were able to refuse.40 Even an effort to provide information in aid of consent may seem coercive. As the House Committee on Government Reform pointed out in its critique of DoD’s mandatory anthrax vaccination program, “in a culture based on a chain of command and the power to compel, attempts at persuasion and education often devolve into intimidation.”41 Members of the military face additional pressures: superiors may condition participation in certain attractive missions on willingness to use enhancements or to serve as research subjects in enhancement experiments; unit cohesion and comradeship may lead warfighters to consent if other members of their unit do; and some may feel that it is their patriotic duty to use enhancements or participate in research.42 Nevertheless, DoD and the military services emphasize that researchers must obtain consent before military personnel may be enrolled as research subjects.43 Mindful of military hierarchy DoD rules prohibit superiors from “influencing” the decisions of their subordinates regarding participation as subjects and specifically forbid superiors from being present when informed consent is being sought.44 Except for a payment of $50 in return for having blood drawn, moreover, military personnel on duty may not be compensated for serving as subjects.45 Paternalism also plays a role here: researchers and research supervisors must believe that the risks associated with being a subject are outweighed by the potential benefit from the study before they can even seek consent. In this respect, military research resembles civilian research, where institutional review boards, government sponsors, government regulators, and the investigators themselves must reach the same conclusion before approaching potential subjects. There is one important distinction between civilian and military research that military personnel must be made aware of: unlike civilian research subjects, the so-called Feres doctrine limits the ability of members of the military to obtain compensation from the government for injuries caused by research.46 Whereas civilian subjects may receive compensation for losses such as pain and suffering and reduced future earnings, DoD rules only require researchers “to establish procedures to protect human subjects from medical expenses (not otherwise reimbursed)” that directly result from participation in more-thanminimal-risk military research.47

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A different set of ethical issues arises if the military wants to give warfighters biomedical enhancements to actually improve their performance, rather than in a formal research study. Do military personnel have to give consent, or can they be ordered to use enhancements? When military action is required, warfighters typically are not asked for permission but given orders, and they cannot refuse a lawful order, even one that places them in physical danger, without risking punishment.48 The only question then is whether an order to use a biomedical enhancement is sufficiently different from other types of orders that a different rule should apply, and in most cases, the answer would seem to be no. Why is being ordered to take an alertness pill significantly different than being ordered to stay awake during a training exercise in order to experience and become better able to combat the effects of sleep deprivation? Nevertheless, an order to use enhancements must conform to the principles of military bioethics outlined earlier: pursuant to the principles of proportionality and paternalism, superiors must be mindful of the risks associated with the use of enhancements and determine that the benefits to the warfighter, unit, and mission outweigh those risks, and warfighters should not be ordered to use risky enhancements unfairly, such as using them as punishments. There is one respect in which an order to use biomedical enhancements might require more buy-in by warfighters, however, and that is if the enhancement radically altered their appearance or behaviour in ways that some might perceive as unusual, grotesque, or highly undignified. Others might consider abhorrent remote possibilities such as genetically engineering warfighters to give them an eagle’s daytime vision, an owl’s night vision, or a dog’s sense of smell. Those asked to modify themselves in these bizarre ways arguably should be asked to consent and given the opportunity to refuse. Once again, the consent process cannot serve as a substitute for superiors’ responsibility to ensure proportionality, paternalism, and fairness. Another controversy that might arise is whether warfighters can be given biomedical enhancements that have not gone through or completed testing for safety and efficacy. In such circumstances, should warfighters be required to give their consent, on the theory that, while superiors may hope that the enhancement improved performance, they were also trying to determine if the intervention was safe and effective, and therefore the rules for research, which require consent, should apply? This question arose with the distribution of pyridostigmine

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bromide (p b ) and botulinum toxoid (bt ) vaccine to troops during the Gulf War, and with the D oD ’s Anthrax Vaccine Immunization Program (av i p ), which began in 1998. These products were given to troops to protect against chemical and biological weapons, but while they were approved for other indications, the f da had not approved them for these purposes, and therefore they were being used “off-label.” Ultimately, Congress stepped in and decided that troops could be required to use products for unapproved purposes only if a waiver of informed consent was issued by the President49 or under an Emergency Use Authorization (eua) granted by the f da during a national emergency.50 i m pa c t o n c a r e e r s a n d a s s i g n m e n t s

Biomedical enhancements that improved performance could have a positive effect on assignments, promotions, commendations, and other military benefits. Should military personnel be allowed to obtain these career advantages, or should enhanced performance be discounted or even penalized? The latter is the approach in sports, but analogizing enhancement use in the military to doping in sports is inapt: athletes who improve their performance do not produce any societal benefit as a result, except perhaps by boosting the image of their countries in the Olympics and other international competitions. On the other hand, warfighters who accomplish their missions more safely and efficiently with the help of enhancements could benefit their units and countries substantially. For one thing, this makes it difficult to understand why since 1994 the military has penalized the use of anabolic steroids,51 although the DoD directive in question only addresses the “illicit” use of anabolic steroids by military members, suggesting that the use of steroids after being ordered to or asked would not be a violation. Military enhancement can be seen as arguably closer to the enhancement used in the workplace that makes workers more productive, especially if what they produce is viewed as a benefit to society. (A less clear-cut analogy is with enhancement use in education. Should students be tested for cognition-enhancing drugs, for example, before taking exams, and punished if the results come back positive? The answer would seem to depend on whether the students can be expected to use the same enhancements in the future; if so, then enhanced exam results would be a more accurate predictor of the students’ future performance, which is the purpose of the examination.)

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If all warfighters were ordered to use enhancements, then it seems difficult to justify depriving them of resulting service benefits, especially if use of the enhancements was accompanied by significant risks. The same seems true if warfighters use risky enhancements voluntarily: their willingness to incur health risks in order to benefit others as well as themselves might be deemed praiseworthy, and therefore they should be permitted to obtain the resulting service benefits. civilian carry-over

Members of today’s military straddle military and civilian life, including reservists and members of the National Guard called to active duty, as well as base personnel and remote combatants (such as drone operators) who live with their families. Military enhancements therefore may affect performance in civilian roles. For example, enhanced warfighters could gain advantages in sports or intellectual competitions with civilians. If the military enhancements were not available to civilians and the civilians were unaware that they were competing with enhanced service members, the service members’ advantage could be seen as unfair, which could lead to serious problems if the stakes were high enough, such as large wagers, and the civilians subsequently discovered the enhancement use. Therefore, at a minimum, warfighters should disclose their enhancement use prior to competing with civilians. Additional issues would arise if the effects of the enhancements persisted after individuals left the military, since enhancements could give veterans what unenhanced civilians might regard as an unfair advantage. The prospect of post-discharge enhancement could be a recruiting incentive similar to training received in the military that improves civilian employment prospects. Again, it would seem important for veterans to disclose enhancements that civilian job competitors regarded as giving them an unfair advantage. On the other hand, some enhancements that continued to affect members of the military after they left the military could cause harm. If the potentially harmful effects of such enhancements can be readily reversed, then members of the military should be given that option before they leave the service. If the effects are difficult or impossible to reverse, then that is an important factor for superiors to consider in determining if an order to use enhancements satisfies the principle of proportionality, and for service members to be made aware of if they are asked to use them or

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to give their consent to participate in research. Another factor that must be borne in mind is that, if enhancements improve performance in civilian life, the law will take that into account when evaluating the reasonableness of risk-creating behaviors of service members and veterans. For example, automobile drivers who have superior abilities, such as better-than-normal vision or quicker reaction times, are judged on the basis of those abilities if they are sued following an accident, rather than on the abilities of average members of the population.52 Finally, military technologies migrate to the civilian sector, and military behavior can trigger civilian backlash, such as the controversy over interrogation techniques. Although they operate according to a different set of bioethical principles, military decision-makers therefore must take into consideration how their choices impact the civilian society that the military serves and protects. conclusion

The use of biomedical enhancements by the military presents a number of ethical challenges. Applying sound bioethical principles appropriate for the military is key to meeting these challenges. The challenges can be expected to increase in the future if more far-ranging forms of enhancement become available.

notes

  1 Erik Juengst, “The Meaning of Enhancement,” in Enhancing Human Traits: Ethical and Social Implications, ed. Erik Parens (Washington, dc : Georgetown University Press, 1998), 29–47.   2 Peter N. Stearns, Fat History: Bodies and Beauty in the Modern West (New York: New York University Press, 2002), 8–10.   3 Allen J. Frances, “adhd Is Overdiagnosed, Here’s Proof,” Psychology Today (blog), 23 May 2016, https://www.psychologytoday.com/us/blog/ saving-normal/201605/adhd-is-overdiagnosed-heres-proof.   4 H. Gilbert Welch, Lisa Schwartz and Steven Woloshin, “What’s Making Us Sick Is an Epidemic of Diagnoses,” New York Times, 2 January 2007, at F1.   5 Ronald Petersen, Glenn Smith, Steve Waring, Robert Ivnik, Eric Tangalos, and Emre Kokmen, “Mild Cognitive Impairment: Clinical Characterization and Outcome,” Archives of Neurology 56 (1999): 303–8.

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  6 Tim Johnson, “What Is 20/20 Vision?,” last reviewed May 2018, http:// www.uihealthcare.com/topics/medicaldepartments/ophthalmology/ 2020vision/index.html.   7 Michael Stoil, “Amphetamine Epidemics: Nothing New,” Addiction and Recovery 10, no. 9 (1990).   8 Rhonda Cornum, John Caldwell and Kory Cornum, “Stimulant Use in Extended Flight Operations,” Airpower Journal (Spring 1997), http:// www.airpower.maxwell.af.mil/airchronicles/apj/apj97/spr97/cornum.html.   9 Robert Schlesinger, “Defense Cites Stimulants in ‘Friendly Fire’ Case,” Boston Globe, 4 January 2003, A3. 10 Thom Shanker and Mary Duenwald, “Threats and Responses: Bombing Error Puts a Spotlight On Pilots’ Pills,” New York Times, 19 January 2003, 1. 11 Lianne Hart, “Use of ‘Go Pills’ A Matter of ‘Life and Death,’ Air Force Avows.” la Times, 17 January 2003, http://articles.latimes.com/2003/ jan/17/nation/na-friendly17. 12 Hart, “Use of ‘Go Pills.’” 13 Schlesinger, “Defence.” 14 Ian Sample, “Wired Awake,” Guardian, 29 July 2004, Science 4. 15 Peter W. Singer, “How to Be All That You Can Be: A Look at the Pentagon’s Five Step Plan for Making Iron Man Real,” Brookings Institution, 19 November 2009, http://www.brookings.edu/­ articles/2008/0502_iron_man_singer.aspx. 16 Jonathan D. Moreno, Mind Wars: Brain Research and National Defense (Washington, dc: Dana Press, 2006), 118. 17 jas o n, Human Performance (Report No. J SR -07-625, Mar 2008), 37. 18 jason, The $100 Genome: Implications for D oD (Report No. JSR-10-100, Dec 2010) 1. 19 Anthony E. Hartle, Moral Issues in Military Decision Making (Lawrence: University Press of Kansas, 2004), 136–41, 173. 20 Hartle, Moral Issues, 136–41. 21 John B. Chomeau and Anne C. Rudolph, “Intelligence Collection and Analysis: Dilemmas and Decisions,” in J.C. Gaston and J.B. Hietala, eds., Ethics and National Defense (Washington, dc : National Defense University Press, 1993), 123. 22 David E. Graham, “Cyber Threats and the Law of War,” Journal of National Security Law and Policy 4 (2010): 100. 23 Graham, “Cyber Threats,” 100. 24 Edmund G. Howe, “Dilemmas in Military Medical Ethics since 9/11,” Kennedy Institute of Ethics Journal, 13, no. 2 (2003): 175–88.

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25 Advisory Committee on Human Radiation Experiments, Final Report, 485. 26 Howe, “Dilemmas,” 100. 27 Department of the Army, US Army Techniques Publication 5–19 (2014): 1. 28 Department of the Army, US Army Techniques Publication 5-19 (2014): 1–2. 29 Robert Little, “Army Medicine: Untested in Battle,” Baltimore Sun, 2009, http://www.baltimoresun.com/news/nation-world/bal-te.militarymed29ma r29,0,7320913,full.story. 30 Michael E. Frisina, “Medical Ethics in Military Biomedical Research,” Textbooks of Military Medicine: Military Medical Ethics, vol. 2 (Office of The Surgeon General, Department of the Army, United States of America, 2003), 547. 31 Letter from Eric Mendez, Assistant Secretary of Defense to the Assistant Secretary of Health, US Department of Health and Human Services (reprinted in 55 Fed. Reg. 52814, 1990. 32 Michael L. Gross, Bioethics and Armed Conflict: Moral Dilemmas of Medicine and War (Cambridge: m i t Press, 2006), 101. 33 Presidential Advisory Committee on Gulf War Veterans’ Illnesses, Final Report, 1997, http://www.gulflink.osd.mil/gwvi/. 34 Advisory Committee on Human Radiation Experiments, Final Report, 485. 35 Jennifer Siegel, “Advancing Ethical Research Practices in the Military,” Health Lawyer 24, no. 4 (2012): 8; William J. Fitzpatrick and Lee L. Zwanziger, “Defending against Biochemical Warfare: Ethical Issues Involving the Coercive Use of Investigational Drugs and Biologics in the Military,” Journal of Philosophy, Science, and Law 2 (2003): 3; Howe, “Dilemmas,” 100. 36 US House of Representatives Committee on Government Reform, “The Department of Defense Anthrax Vaccine Immunization Program: Unproven Force Protection,” H.R. Rep. no. 106–556 (2000): 46. 37 Emily Buzzell and Samuel H. Preston, “Mortality of American Troops in the Iraq War,” Population and Development Review 33, no. 3 (2007): 555–66; Saul Pleeter et al., “Risk and Combat Compensation,” in Report of the Eleventh Quadrennial Review of Military Compensation, Supporting Research Papers (Alexandria, va: Institute for Defense Analysis, 2012): 359–411. 38 Nicholas Agar, Liberal Eugenics: In Defence of Human Enhancement (Malden, m a: Blackwell Publishing, 2004), 167–8. 39 Jessica Berg and Maxwell Mehlman, “Human Subjects Protections in Biomedical Enhancement Research: Assessing Risk and Benefit and

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Obtaining Informed Consent,” Journal of Law, Medicine, and Ethics 36, no. 3 (2008): 546. 40 Victor W. Sidel and Barry Levy, “Physician-Soldier: A Moral Dilemma?,” Textbooks of Military Medicine: Military Medical Ethics 1 (Office of The Surgeon General, Department of the Army, United States of America, 2003), 299. 41 Advisory Committee on Human Radiation Experiments, Final Report, 485. 42 Siegel, “Advancing Ethical Research Practices in the Military,” 1. 43 US Army medcom Regulation 40–38 (1973), e.g. 44 US Department of Defense, Department of Defense Instruction (DoDI) No. 3216.02, Protection of Human Subjects and Adherence to Ethical Standards in D oD-Supported Research, Glossary (2011): 38 (http://www. dtic.mil/whs/directives/corres/pdf/321602p.pdfDoDI. 3216.02), §§7(e)(1)(b) and (c). 45 D oD I No. 3216.02, §11(a)(1)(a). 46 Stanley v. C I A, 639 F.2d 1146 (5th Cir. 1981). 47 D oD I No. 3216.02, §10(b). 48 Article 92, Uniform Code of Military Justice, 10 US Code § 892 (2016). 49 10 us c §1107(f) (1999). 50 Project BioShield Act of 2004 (Public Law 108–276). 51 US Department of Defense, Department of Defense Instruction (DoDI) No. 1010.1, Military Personnel Drug Abuse Testing Program (2012): 5 (http://www.dtic.mil/whs/directives/corres/pdf/101001p.pdf). 52 Restatement of Torts (Third), §12 (2010).

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12 Conclusion: The Road Ahead Sara Greco introduction

As a creative exercise, it may be harmless to conceive of a population with access to human-altering sci-fi gadgets and treatments. But we cross the threshold from harmless to harmful when we fail to acknowledge these imaginations for what they are: embryonic at best, fictitious at worst. Exaggerated claims about hpe can lead to undue anxieties, unrealistic expectations, and even unfounded policies. Most concerning of all however, is that in doing so, we risk ignoring those most impacted by this technology: military service members. The situations and circumstances soldiers regularly face are real and not to be so easily analogized with games that elude the human realities of war. As a result, civil society must do its part to ensure conversations about the implementation of hp e are contextually sensitive. Bringing forward the major findings and central arguments of each chapter yields pertinent points of reflection. By connecting the dots between chapters, we come to appreciate the argument made in this edited volume: that government and the armed forces should identify non-intrusive hpe and exercise caution when it comes to more experimental and intrusive options for the soldier. By synthesizing what we have learned from this volume, this chapter offers an alternate framing: tackling the puzzle of what we do not know by pointing out gaps that have not yet been closed and considerations that are new altogether, which provides a roadmap for future investigation. Pinpointing the areas where questions – new and old – reside lends a hand to decisionmakers who need to delineate clear action plans and policies that

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balance military necessity with ethical concerns. To that end, this conclusion sets out to achieve its aforementioned purpose by discussing gaps under the following key themes: the individual soldier, the research and development arena, the path of least resistance, and the allies. the individual soldier

The Superior Soldier Perhaps society already perceives the soldier as super, even without the use of h p e . Part of the civilian-military divide may stem from a perception of differential fortitude: populations look to their service members for protection and understand the physical rigours of the job. Soldiers may be perceived as more physically and mentally fit, as well as more heroic, given a career choice of unparalleled sacrifice. So, at baseline and without any enhancements soldiers may already be viewed as superior (soldiers). In many ways these assumptions are already dehumanizing and divisive. The divide will undoubtedly grow if specific enhancements are only practiced or performed in the military, as tangible differences between civilian and military spheres often creates distance between these groups. Discussions within (and outside the pages of) this volume highlight the concern that the divide between soldiers and civilians will grow because soldiers will be endowed with enhancements and therefore, will be seen as superior. But what about the flip side? Less considered is whether the strain between the civilian and military spheres will worsen because society perceives the military as weaker as a result of its use of hpe. Failing to investigate this thread could further aggravate the strain between the soldier and society. Technical Terminology at the Individual’s Expense Like Niall and Wiseman, Vergin illustrates that many hpe options are within our purview and no longer in the realm of science fiction. Vergin’s chapter provides an overview of the technologies and methods under the umbrella of hpe, which include: biochemical enhancement (pharmacologic, nutrition-based, and genetic), non-invasive enhancement (transcranial stimulation, exoskeleton, augmented reality, and silentspeech interface system), and invasive enhancement (human bio-­ monitoring). With such a diversity of items lending themselves to hpe, the argument for an interdisciplinary approach is certainly there. This

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volume’s authors advocate for interdisciplinary research, but it is worthwhile to also consider its trade-offs. With different approaches, focuses, lexicon, and motivations, interdisciplinary research can be difficult to perform and its results challenging to translate into policy. Definitions provide a structure that helps policymakers balance the realm of possibility with the realm of ethical appropriateness. Categorization is inescapable, especially in academia, but not without its caveats and outliers. This volume defines h p e as the deliberate increase of human potential to a level beyond what is naturally achievable and categorizes enhancements into one of two types: invasive and non-invasive. Invasive disruptions tend to be immediate, severe, and long-lasting (or even permanent), from enhancements like drugs or embedded computers. Since non-invasive enhancements encompass additions exterior to the human body, like exoskeletons and other wearable devices, the effects are generally considered benign and reversible. Non-invasive enhancements provide opportunity for informed consent, which illustrates how categorization helps policymakers balance innovation and ethics. In this volume some authors depart from these working definitions, while most others expand on them. For example, Vergin uses surgical intervention as the differentiator between invasive and non-invasive approaches. If the goal is to retain soldier identity, we need to consider how individuality and relativity impact perceptions of invasive and non-invasive approaches. That is, an enhancement deemed non-invasive to one individual might be perceived differently – and as invasive – to another individual. This raises a chief concern vis-à-vis the implementation of hpe in the military: whether it is actually possible to avoid a one-size-fits-all “solution.” But is a case-by-case basis for enhancement truly feasible and if so, at what cost? Ignoring the Individual Is Ignoring the Group In his chapter, de Boisboissel addresses the theme of soldier burden, which includes discussions about cognitive load and mental health. One of the intended implications of hpe is the easing of soldier burdens, but paradoxically, the unintended effect is often burden increase. The gestalt-like approach of esprit de corps taken by (not just) the French Armed Forces can lead to a favouring of group over individual analysis. Ignoring the importance of the individual will have implications for not only the individual but also the group. Perhaps the extent

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and proportion of attention given to the individual versus the group is contingent on context. The study outlined by Nabi in chapter 5 shows the implications of a changed operational environment on soldiers. She notes that soldiers operating in future operational environments are more likely to be isolated and subject to extreme physical, mental, and emotional stress, thus increasing individual requirements. But as this volume shows, the individual soldier needs to be the top priority when it comes to hpe policy. Implications of the future operational environment will prove massive but as we learn from this volume, they remain mostly theorized. Many of these chapters paint vivid pictures of these environments but enhancement testing does not occur in these prophesized environments. To put it simply, it is insufficient for us to be trying out enhancements on current conditions when where they will likely be implemented is in future settings. Individual Benefits Are Group Benefits In their chapter, Bryant and Niall distinguish between cognitive optimization for intrinsic and utilitarian purposes. Intrinsic optimization aims to improve an individual’s quality of life, while utilitarian optimization seeks to provide an individual with some tangible benefit(s). Bryant and Niall note that work on cognitive manipulation usually focuses on utilitarian optimization for improved performance on very specific tasks. Both intrinsic and utilitarian optimization are said to target the individual and ostensibly to maintain soldier identity. However, the former focus on the well-being of the individual for the sake of the individual, while the latter seem more about individual improvement for the benefit of the group. This signals the need for continual review by investigators and policymakers to target unintended consequences of technological manipulation for the maintenance of soldiers’ quality of life. Farrelly argues a fair society has the moral obligation to support and treat soldiers who have sustained mental or physical injury during their time of service. Policymakers need to strike a balance between individual and group, and operational necessity and soldier humility; this is nothing new. Balance might be the wrong word choice and the reason why we consider benefits to the individual and group as mutually exclusive. Instead, scholars and practitioners need to consider the symbiotic relationship between helping the individual and the group from both an operational and ethical perspective.

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HPE’S Conflict with Resilience Although he cautions against the use of such substances, Farrelly repudiates that memory altering drugs should not be used because they change individuals’ authentic selves. Farrelly’s concern with these substances stems from their ability to place soldiers in autopilotlike states. Wakelam and Woodside-Duggins talk about preparing soldiers for their experiences through active learning. But if memory-altering substances leave soldiers in autopilot, then will they practice active learning? Does this negate the utility of active learning training programs? There is a tension there, which highlights the need for continued review of existing policies and practices, not just new ones as they relate to h p e . Memory altering substances may also block a soldier’s natural psychological immune system. Farrelly explains how memory modification is part of our psychological immune system, which can be both adaptive and maladaptive. Will these drugs impact soldier resilience and if so, how? Researchers and decision-makers need to investigate this thread and decide how to balance these two types of soldier improvements. Do these memory-altering substances negate what is taught in resilience training? Consent In his chapter, Mehlman discusses paternalism, one of the principles of military bioethics. Paternalism constitutes respect for the person, which in the military sphere means order obedience, according to Mehlman. The introductory chapter offers informed consent as a way to assess the ethicality of enhancements. Here another tension appears, this time between paternalism and consent. If being in the military means being under the control of a higher order, then it is difficult to argue soldiers have autonomy. And if soldiers are not autonomous, then it is not possible for them to provide informed consent on the use of biomedical treatment. Mehlman questions whether soldiers should receive biomedical enhancements that have not passed safety inspection but stops shy of revealing another consent-related ethical dilemma. Theoretically, informed consent can only happen in the presence of full information disclosure. Many authors advocate for the use of enhancements that are known to be reliable and safe. This

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response falls short in two main ways. First, it remains predicated on the rocky assumption that we can know or foresee impact; and so, it does not account for general uncertainty, unintended consequences, and individual variability. Second, it ignores the concern of soldier autonomy and coercion. We can make conversations about hpe more meaningful by focusing on concrete types of enhancements instead of hpe writ large. HPE after Retirement The President’s Council of Bioethics Report, “Beyond Therapy,” concluded that memory altering drugs could pose a significant threat to living an authentic life. In his chapter, Farrelly unravels the argument that supports that position. For him, memory modification through drugs is not unnatural, since the human body already performs such a task without any substances. As this volume reinforces, the retention of soldier humanity is crucial. We sense Farrelly disagrees with the way stakeholders talk about and seek to prevent harm, as he sees these disproportionately target physical over emotional well-being. In other words, soldiers receive more tools that protect from physical harm. Farrelly advocates for drugs that help soldiers respond better to treatments or interventions, in lieu of ones that wipe memories. This shows discussions about memory altering drugs should be as much about “when” as they are about “what.” We mainly identify h p e recipients as active duty personnel but what about retired soldiers? Tending to soldier needs in all career phases helps maintain soldier humanity. The push to increase recruitment and retention rates could mean less attention is paid to the veterans. Perhaps an effective recruitment and retention tool is a healthy retired military population? In this volume, authors refer to veterans when they talk about the long-term effects of h p e . But we may also want to consider a more controversial proposition: the enhancement of soldiers after retirement not just before. This consideration is in keeping with the third part of this volume on the societal and moral dimensions of h p e . Service members should be able to transition – as seamlessly as possible – to civilian life in their retirement. Part of what will allow them this is a commitment on the part of the military to maintain the legitimacy of its forces, which is especially vital in a democracy.

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the research and development arena

Funded Projects The first part of the volume explores the purpose and implications of h p e from various global vantages; including Canada, Germany, France, and the U.S., respectively. Niall and Wiseman summarize findings from a study carried out by Defence Research and Development Canada and the National Research Council of Canada. Vergin outlines research results from the Bundeswehr Office of Defence Planning. De Boisboissel relays the conclusions drawn from the Research Centre of the Écoles de Saint-Cyr Coëtquidan. And Nabi reviews research conducted by the U.S. Army Capabilities Integration Center’s Human Dimension Division Research. These chapters show congruence on the classification (invasive versus non-invasive), considerations (mission duration and type, and societal conditions and norms), and concerns (soldier dependency and well-being, equipment cost, and technological glitches) regarding enhancement – a positive result for an interdisciplinary volume. hpe research still lacks clarification about what enhancements should be up for consideration. And are we really surprised by the similarities among these industrialized nato democracies? Soldier engagement with other soldiers is ubiquitous, as allies and adversaries. Therefore, it is important that we investigate how more diverse countries and potential adversaries approach h p e . Government funding mobilized the research of these early chapters, which illustrates government priorities vis-à-vis h p e . Niall and Wiseman note in their chapter that the topic of human systems performance aligns with eight out of the ten hard problems faced by the c a f. And according to Vergin, the Bundeswehr Office of Defence Planning is keen on making technological knowledge usable for decision-makers in the security or military sector. In their chapter, Bossi et al. outline a number of research programs that are exploring ­prospective enhancements in the U.S., including the U.S. Special Operations Command Tactical Assault Light Operator Suit Program and the U.S. Defence Advanced Research Projects Agency Warrior Web Program. The Canadian Defence Industry Research Program is similarly investing in Warrior Web technology. Many governments fund research for the development and testing enhancements, which shows that the topic is a priority.

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Academic Collaboration The research relayed in these pages provides a springboard for stakeholders at home and allies abroad. Decision-makers should take more than a few pages out of this book. For starters, they too can bring together different experts, topics, and views as they relate to hpe, to ensure policies are the product of holistically informed assessments. It is insufficient to simply present these differences in the same space; collaboration among researchers on the same topics needs to happen. Such an approach will help decision-makers identify a clear course of action for the adoption of emerging technologies. Karakolis et al., for example, evaluate exoskeletons from a biomechanical perspective. They acknowledge the presence of interactive effects (how physical enhancement will physically and cognitively impact an individual) but focus on the physical effects instead of the cognitive ones. Although Karakolis et al. do not elaborate on these cognitive considerations, they present their results with the caveat that their conclusions need corroboration with other, non-physical metrics. Bryant and Niall cover these nonphysical considerations in their chapter. But remember, interdisciplinary and multi-stakeholder research are not one in the same. As important as academic collaboration is – both within and between disciplines – scholarly research risks irrelevance if it does not engage and harness the expertise of all stakeholders, soldiers especially. Some Things Stay the Same Nabi describes a study that prophesizes the necessary attributes of the future soldier. Researchers studied forecasted macro- and micro-level features of the future operational environment. They identified three structural spaces where these macro- and micro-level considerations converge: the social, political, and economic spheres. Based on the forecasted changes, the study established (through feedback from human participants) prospective core soldier requirements, including: adaptability, character, insight, resilience, operational fitness, and selfdiscipline. Changes to warfighting can certainly alter soldier attributes. But we might want to look at changes outside the world of war to foretell changes to soldiers too, as the military ultimately recruits civilians. While the argument herein is in advance of non-invasive enhancements, if any enhancements (either invasive or non-invasive) leave any sort of visible and lasting (social or physical) impressions on users, it

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may be possible that these impressions do not further divide the civilian and military spheres because of an increasingly accepting and diverse society. The inevitability of change should remind policymakers to review hp e policies: the military and its makeup can change, and with it the recipients of enhancement. Is there also a case to be made for studying the continuity of soldier attributes for h p e ? Information Accessibility and the Soldier-Society Dichotomy Most often, we discuss the soldier and society in the present context, using a cross-sectional approach. But with longitudinal information, decision-makers may more easily identify adaptive and maladaptive factors that impact the relationship between the solider and society. Particularly, how might information accessibility impact societal perceptions about enhancement use by soldiers? Mehlman notes in his chapter that biomedical enhancements are not new phenomena for the military. He cites the use of amphetamines in the Second World War by American, British, and German soldiers as one such example. According to Mehlman, Canada ignored amphetamine use among its service members until an accident in 2002 that claimed the lives of four soldiers. Discussions pertaining to the increases in technology need not remain limited to the use of h p e . That is, increased access to information – afforded to us by technological developments – certainly impacts perceptions about h p e . Going forward, researchers should look into if and how greater access to information impacts perceptions relating to h p e , and whether it leads to increased or decreased acceptance rates. the environment and equipment f o r l e a s t r e s i s ta n c e

Parsimony Science fiction inspires sensationalized speculations about hpe, where the tendency is to imagine, speculate, and depart from human realities. Gripping as they may be, these perceptions can muddy policy discussions that focus more on augmentation in the forms of simple and unassuming strategies or pieces of equipment. In their chapter, Niall and Wiseman compare two procedures for the restoration of visual function: occipital lobe implants and back vibration stimulations. Why

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offer an invasive option when a non-invasive alternative exists? Like in the study of human logic, parsimony is essential. Oftentimes, the simpler the strategy, the better; and hp e is no exception. Not only is it careless to the soldier to ignore the invasiveness factor, it can also further enhance the civilian-military divide. The chapter by Bossi et al. reveals the connection between parsimony and ethics. They advocate for less complex and more mature technologies for the mitigation of soldier burden, which provide quick implementation and great consequential certainty. In their chapter, Karakolis et al. present a framework for evaluating new technologies and apply it to exoskeletons. Their conclusion: exoskeletons should be viable for future military use. That means certain shortcomings will need mitigating before the military can safely integrate this technology. While these innovations may present as low-hanging fruit, there is overwhelming agreement in this volume that it is best to wait until the fruit is ripe. With the inevitability of unintended consequences, non-invasive enhancements – like exoskeletons and wearable computing devices – are safer to endorse. Cost-benefit analyses reside closer to the prophetic versus the predictive end of the spectrum. Nonetheless, decision-makers can use cost-benefit analyses to decide whether to introduce an enhancement into the military. But we need to remember items that pass cost-benefit analyses are not purported to do no harm. Mehlman reinforces this message in his chapter, when he raises some of the ethical issues related to biomedical enhancement. His discussion of proportionality also sheds light on the challenges of cost-benefit analyses. Given the combination of risk, cost, and benefit, policymakers should consider rolling out initiatives incrementally, in a style similar to what the U.S. Special Operations Forces Command is doing with its Tactical Assault Light Operator Suit (ta l o s). As well, the challenges of conducting a costbenefit analysis of consequential depth and breadth can be reduced by bridging the legal and ethical debates on h p e . Multi-stakeholder initiatives – like the interdisciplinary h p e Group at the Centre for International and Defence Policy – are useful spaces for these kinds of discussions. And similar coordination should also occur within and between the armed forces and government. Patience Cost-benefit analyses for non-invasive enhancements, like soldier equipment, carry their own challenges – especially when we factor in

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changes to the operational environment. In their chapter, Bossi et al. identify three reasons why soldier loads will get heavier: one, smarter technology requires more power; two, war fighting terrain makes resupply difficult; and three, new threats necessitate more protective equipment. We need to balance adaptability with feasibility, as heavier loads can lead to physiological strain, altered movement biomechanics, increased risk of injury, and reduced physical and cognitive task performance. These barriers bring risk to the soldier and the operation, which is why militaries are investigating ways to alleviate such strain through invasive and non-invasive enhancements, like ergogenic aids and exoskeletons, respectively. According to Bossi et al. these augmentations need more time for development, as the costs of their use still outweigh their benefits. The way to mitigate soldier burden is by making incremental gains across interventions that vary by type, level, timing, and target. It is strategically wise not to jump the traditional gun with hpe and instead, introduce items where there is high confidence of the success for the soldier and the group. How this translates into policy is through the implementation of an iterative rollout strategy, where initiatives are introduced incrementally. Accurate Representation to and for the Population To achieve operational success and soldier safety, militaries must adapt to different threat environments and technological innovations, and become more reflective and transparent in the process. As Bossi et al. stress, aside from soldier loads being too large, soldier burden results from impersonalized equipment and load misperceptions from training. Bossi et al. investigate the problems that arise from improper equipment, which includes inappropriately sized or proportioned clothing and gear. According to the authors, soldiers typically carry over the maximum allowance. In Canada, soldiers are not supposed to carry doctrinal fighting and marching administrative loads that exceed 30 per cent and 45 per cent of their body weight, respectively. Based on the average weight of a Canadian male combatant (86.8 kg), those load weights are 26.04 kg and 39.06 kg, respectively. Not all soldiers are average weight or male, so individual burdens often far exceed the limit. Bossi et al. argue the military trains soldiers with unrealistic loads for fear of causing injury. But proper training and pre-testing lead to lower rates of injury in the field. Increasing transparency with realistic and thorough training can cut rates of injury and help increase retention and recruitment, which is especially

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important for a military that will introduce enhancements. A slow and steady iterative rollout strategy leaves space for proper training and review. The integration of new approaches and policies will take time; who is going to train the trainers? Karakolis et al. include anthropometrics as an assessment criterion for new technology. This inclusion reinforces the importance of tending to human variability, which impacts performance and outcomes. Understanding and accommodating human diversity is a continuous challenge for stakeholders, as technology still struggles to accommodate human variability that is structural, movement-based, and endurance-related. How can militaries account for diversity when implementing enhancements? One-size-fits-all “solutions” create problems at the group level too, as Bossi et al. note designing and buying for all missions compromises operational effectiveness. It seems policymakers have added accommodating physical differences to their “to do” lists but have left off cognitive variability. Cognitive identicality does not exist, which is why Wakelam and Woodside-Duggins advocate for active learning training to enhance soldiers’ cognitive flexibility. Just like Bossi et al., who argue that unspecialized equipment increases soldier burden, Wakelam and Woodside-Duggins caution that unspecialized active learning programs also increase soldier burden. This situation presents a kind of where-to-turn-first dilemma when trying to ease burdens. Decision-makers need to balance tending to different types of individual differences. Testing Environments Karakolis et al. create a framework for the purchase and use of new technologies, which they apply to exoskeletons. Their framework evaluates technology using the following six criteria: anthropometrics, functional movement, simulated operational task performance, operational task performance, compatibility, and musculoskeletal injury risk. Their work highlights the importance of environmental context vis-à-vis the assessment of hpe. Most enhancement cost-benefit analyses use the operational environment as the context of focus. As Bossi et al. show, it is important for training to also reflect the operational environment. Conversely, Karakolis et al. note the need to test equipment not just in simulated environments but in operational ones as  well. The order of their testing criteria reflects this position;

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assessments are made for anthropometrics, functional movement, and simulated operational task performance, followed by a decision of whether or not to try the technology in training, and later in deployment. Taken together, these chapters demonstrate the difficult balance that needs to be achieved between training and operational continuity, as well as testing. Not in a Vacuum Bryant and Niall outline three types of cognitive optimization – enhancement, augmentation, and support – and use these categories to classify enhancement treatments and interventions. They define cognitive enhancement as the increase in an individual’s innate cognitive capacity. Cognitive enhancements encompass pharmacological, neurotechnical, educational, genetic, and nutritional treatments and interventions. Conversely, those which give a person more cognitive capacity, they identify as cognitive augmentation. And finally, Bryant and Niall use the term cognitive support to refer to manipulation of the task environment so that individuals require less or different cognitive capabilities to carry out a particular assignment. For all three types of cognitive optimization, treatments and interventions target expert systems, the human-system interaction, brain stimulation, and education. Researchers tend to access one particular enhancement at a time. But enhancements do not exist in a vacuum; militaries will very likely concurrently use multiple types of enhancements. How can we know their interactive effects if studies only perform cost-benefit analyses on singular enhancements? This research is ambitious but necessary to gauge the realistic impact of h p e in the forces. Bryant and Niall argue for a comparative approach to assess cognitive optimizing strategies. But this proposition does not go far enough, as comparing and compounding are very different activities. So, what we need are strategies to assess the compounded use of multiple pieces of hpe. Learning Wakelam and Woodside-Duggins explore how to teach soldiers the skills to perform certain tasks and train them to exercise intellectual flexibility; a question of high pertinence in the civilian and military spheres. Their work cautions us not to confound augmentation with

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expertise. In the Canadian context, there is a perceivable push to ensure the c a f adapts to changing soldier demands, like the desire for career flexibility and mobility. Active learning provides personnel with the tools to be successful learners and practitioners, in any context. If active learning is ubiquitous – in both the civilian and military spheres – then it may help soldiers searching for a more diverse career translate their skills and knowledge through critical thinking. Qualities like improved self-regulated learning, motivation, performance, retention of information, and self-esteem benefit the individual soldier and undoubtedly trickle up to benefit groups and operations as well. Swift (Critical) Thinking We must also avoid conflating enhancement with a reduction in human control. For example, Wakelam and Woodside-Duggins stress that the need for military personnel to problem solve will not disappear with the introduction of new technologies. Some military practices and policies will lose their relevance but some others – like active learning and problem-solving training – will become even more important because of h p e . New technology should ease soldier burden and increase operational effectiveness, but it might not always. What happens when technology fails? Soldiers need proper training to ensure they can engage with technology when it works and when it does not. Soldiers must be trained to troubleshoot. Wakelam and WoodsideDuggins explain active learning as a process where learners are accountable for the construction of their own knowledge. This model helps learners apply knowledge across contexts. In a security world described as more austere and diverse, soldiers have to think flexibly. To prioritize the individual soldier here, means to ensure service members receive quality training and education throughout their career and into retirement. the allies

Collaboration among Allies Findings from Niall and Wiseman’s research corroborate this book’s objectives – to connect science and technology with the sociology of hpe, inform policy on its responsible use, and increase dialogue across

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disciplines and between practitioners. Their work shows considerable collaboration in the academic sphere, with co-authorship between academics, departments, and institutions, within and outside of Canada. Niall and Wiseman identify four focal points for the study of human systems performance: computation and cognition; performance and physiology; automation, robotics, and telepresence; and ethics. With the inclusion of many diverse topics, the utility of collaboration cannot be overstated. To that end, stakeholders should look to benchmark with academia; the dialogue in academic communities will prove helpful for practitioners. For example, Nabi provides an overview of an integrated study plan developed by the Human Dimension Division of the U.S. Army to investigate the implications of enhancement on soldier performance, in cooperation with researchers, military operators, and industry experts. Benchmarking It is important to consider how different stakeholders approach the study of hp e . Benchmarking and sharing of best practices can help achieve this volume’s aims of boosting dialogue across disciplines and between practitioners, informing policy on the use of enhancement, and connecting science and technology with the sociology of h p e . Nabi outlines the U.S. Army Capabilities Integration Center’s framework for developing the future force, which its Human Dimension Division used in its study plan on hpe. Like Vergin notes in her chapter, it is crucial for decision-makers to practice technical intelligence in order to make informed choices about hpe. The framework serves as a useful reference for stakeholders prophesizing about soldier enhancement. It also highlights the potential for collaborative research. External Propellants In an increasingly austere and uncertain security environment, militaries need to prepare for adversarial use of h p e . Preparedness comes (in part) from what Vergin identifies as technical intelligence – the ability of decision-makers to know of and react to the rapidly changing environment. But as de Boisboissel points out, h p e use will also vary across allies. According to de Boisboissel, a state’s decision to use enhancements in its military reflects not only its legal and ethical position on the matter but also its financial and technological ones.

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We need to consider the push factors for a soldier to engage in h p e , including internal pressures from within the military and external pressures from society. But there are other external pressures besides society that remain unstudied. Do soldiers or militaries feel pressure from their allies and partners to use enhancements? If these pressures exist, do they impact operational effectiveness? Could different military policies vis-à-vis hp e lead to conflict over burden sharing? the road ahead

This volume serves as a roadmap, showing where the field of hpe has come from. It also offers a prospective route for stakeholders to further advance policy and research in this area. While decision-makers require more research to formulate current and prospective policies, they can take with them the following four thematic prescriptions about: the individual soldier, the research field, equipment in the operational environment, and our allies. (1) Purposefully identified as the first policy dimension is the individual solider. Policies need to be made first and foremost with the individual soldier in mind. The soldier as a whole needs to be considered; we need to care for the mental and physical health of each and every service member during and after service. This means ensuring force members have the tools and support to pursue and achieve their career goals. It is within this domain that we can work to close the gap between the civilian and military spheres, by ensuring the force is legitimate and that soldiers remain as much a part of and connected to society as civilians. Since the isolated use of hpe in the military has the ability to further divide these two groups, it is important to limit hpe in the military to ones that are non-invasive. (2) Speaking directly to the research: remember we have only skimmed the surface of this complex and evolving area of study. Interdisciplinary research is important to continue but what this field really requires is multi-stakeholder initiatives on the subject. We need to harness the expertise of all relevant scholars and practitioners in order to achieve a research agenda with sufficient depth and breadth, and reliability and validity. (3) To protect the forces and ease soldier burden, researchers need to test and re-test enhancements. The way to advance these goals with hpe is by adopting an iterative rollout approach. hpe initiatives need

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to be introduced incrementally and based on genuine gains – pertaining to soldier safety and operational effectiveness. (4) Just as we expect and encourage scholars and practitioners to collaborate and communicate with each other on the topic, we need to set the same expectation with our allies. Given the changing nature of today’s security and threat environment, states need to be working through the challenges relating to hpe with their allies and partners. We need to be prepared if the use or different use of hpe by allies and partners impacts our forces and operational effectiveness writ large. conclusion

How quickly will science fiction become science fact? It is disputable whether we are getting ahead of ourselves by thinking the sensational science fiction depictions of hp e are in our purview. Less debatable is whether advances in science and technology are surpassing the institutional capacity to adapt to such changes. This volume responds to this lag by addressing hpe in a holistic manner, which can provide decision-makers with informed knowledge and considerations for policy on the responsible use of such enhancements. By the agency of a holistic approach, this volume provides a global perspective on the matter (Canada, Germany, France, and the U.S.), examines different types of enhancements (invasive versus non-invasive, physical versus cognitive), through multiple lenses (physical, cognitive, social, ethical, and emotional), and from authors with diverse backgrounds (academics with specializations ranging from political science to medicine, and practitioners from government and military). But ultimately, these aforementioned goals reflect a larger attempt to improve soldier humanity and spotlight the relationship between the soldier and society. Herein, evidence points to the moral and strategic need to place the individual soldier at the front and center of h p e considerations. Very clearly, this requires decision-makers to balance military necessity with ethical concerns. Abandoning the assumption that the priorities of the soldier run orthogonal to those of the group and the operation can help decision-makers strike a balance between military needs and ethical imperatives.

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Abbreviations

A C C R U E

A R L A R PA A SV A B A V IP

Automated Collaboration Collection and Relationship Understanding Environment Air Force Research Laboratory (US) Advanced Leader’s Course (US) Augmented Reality Army Capabilities Integration Center (US) Army Materiel Command (US) Army Research Institute (US) U.S. Army Research Institute of Environmental Medicine (US) Army Research Laboratory (US) Advanced Research Projects Agency (US) Armed Services Vocational Aptitude Battery (US) Anthrax Vaccine Immunization Program

B LOC B T

Basic Officer Leaders Course (US) Botulinum Toxoid

C A F C A PE CBRN C B T CCC CG C oP C SA

Canadian Armed Forces Center for Army Profession and Ethics (US) Chemical, Biological, Radiological, Nuclear Cognitive Behavioural Therapy Career Captain’s Course (US) Commanding General Community of Practice Chief of Staff of the (US) Army

A FR L A LC AR A R C IC A MC A R I A R IEM

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274 Abbreviations

C R EC

Research Centre of the Écoles de Saint-Cyr Coëtquidan (F R )

DA R PA DG A DN D DoD DOTMLP F -P

DR DC

Defence Advanced Research Agency Direction Générale de l’Armement (F R) Department of National Defence (CA) Department of Defense (US) Doctrine, Organization, Training, Materiel, Leadership and education, Personnel, Facilities, and Policy Defence Research and Development Canada

EDI EOD EU A

Explanation Demonstration Imitation Explosive Ordnance Disposal Emergency Use Authorization

FDA FELIN FOE

Food and Drug Administration (US) Fantassin a Équipments et Liaison Intégrés (F R) Future Operating Environment

G PS

Global Positioning System

HC I HDD HMD HMI HPE HPWG HSP HR ED

Human Computer Interaction Human Dimension Division Head Mounted Display Human Machine Interface Human Performance Enhancement Human Performance Working Group (US) Human System Performance Human Research and Engineering Directorate (US)

IC OR D IED IG S IMT IR B A

International Collaboration on Repair Discoveries Improvised Explosive Device Image Guided Surgery Initial Military Training (US) Institut de Recherche Biomédicale des Armées (French Army Biomedical Research Institute) Institut de recherches cliniques de Montréal Intelligence, Surveillance, and Reconnaissance

IR C M ISR

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LEA P LD

Load Effects Assessment Program Learning Demand

MA D MA N U F MA TEP MC I MEDES METT-T C

Memory Altering Drugs Manoeuvre Under Fire MA T rice E P icritique (F R) Mild Cognitive Impairment Institut de Médecine et de Physiologie Spatiales (FR) Mission, Enemy, Terrain and weather, Troops available, Time available, and Civil considerations Mission Impact thru Neuro-Inspired Design Metal Organic Framework

MIN D MOF N A TO N B IC N SED N SSC

North Atlantic Treaty Organization Nanotechnology, Biotechnology, Information ­science and Cognitive science Neural Engineering System Design Natick Soldier Systems Center (US)

OER OODA

Officer Evaluation Review (US) Orient, Observe, Decide, Act

PME PMESII- P T

Professional Military Education Political, Military, Economic, Social, Information, Infrastructure, Physical environment, Time Personal Protective Equipment Post-Traumatic Stress Injury pyridostigmine bromide

PPE PTSD PB R DEC OM R M R MC R PV SIG Y C O P

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Research Development and Engineering Command (US) Risk Management Royal Military College of Canada Remotely Piloted Vehicle ceinture scapulaire et membres Supérieurs, ceinture pelvienne et membres Inférieure, état Général, Yeux et vision, sens Chromatique, Oreilles et audition, et Psychisme

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276 Abbreviations

SIM SLC SC EN IC C

SSI

Structure Inquiry Method Senior Leaders Course (US) Soldier Centric Imaging via Computational Cameras Soldier Performance and Equipment Advanced Research Silent Speech Interface

TA LOS TA PA S TPTA TI TR A DOC tDC S TMS TU TE

Tactical Light Operator Suit Tailored Adaptive Personality Assessment System Telepresence and Teleaction Technological Intelligence Training and Doctrine Command (US) Transcranial Direct Current Stimulation Transcranial Magnetic Stimulation Technology/Tools Users Tasks Environment

U SMC UBC U C I U Q

United States Marine Corps University of British Columbia User Computer Interface Unified Quest

VR

Virtual Reality

SPEA R

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Contributors

Stéphani e B é l a nge r is associate professor of French studies at the Royal Military College of Canada (R M C ) and cross-appointed associate professor of French literature at Queen’s University. Formerly the associate director of the Canadian Institute for Military and Veteran Health Research (CIMVHR), she is now the chair of the public administration program at RMC and holds a PhD from the University of Toronto. She has conducted extensive research into how soldiers remember and recount war. G ér a r d de B o i sb o i sse l is an engineer and researcher with the Centre de recherche des écoles de Saint-Cyr Coëtquidan (CRE C) and has worked for over twenty years in the telecommunications industry. He has been instrumental in bridging the gap between industry and CREC through the management of workshops and research programs that address the changing nature of conflict and the implications of science and technology upon the role of land forces in national defence. L i n da B o s s i is a defence scientist with Defence Research and Development Canada, Toronto Research Centre, Human Systems Integration Section since 2010. She retired from the Canadian Armed Forces as a Major after serving twenty-eight years as a Biosciences Officer, specializing in human factors engineering. She has led applied research in soldier systems human factors for the Department of National Defence, in and out of uniform, since earning a master of science degree in ergonomics from the Loughborough University of Technology in 1993.

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H. Christian Breede is associate professor of political science at RMC and cross-appointed with political studies and the deputy director of the Centre for International and Defence Policy at Queen’s University, as well as the associate chair of RM C’s public administration program. He holds a PhD in war studies from R M C and has published on the topics of foreign and security policy with a research focus on societal cohesion and technology. He has deployed experience with the Canadian Army in Haiti and Afghanistan. David J. Bryant is a defence scientist with Defence Research and Development Canada, Toronto Research Centre, where he has pursued research on operational planning, inferential processes involved in situation assessment and combat identification, and cognitive strategies for information search. Dr Bryant received his BS in psychology from the University of Toronto in 1987 and his PhD in psychology from Stanford University in 1991. Throughout his career, Dr Bryant has been interested in the ecological adaptation of the human mind to the physical and conceptual structures of the environment. C olin F a r r e l ly is a political theorist, philosopher, and Queen’s National Scholar. In addition to teaching at Queen’s University, Colin has held the positions of visiting professor in U CL A’s Luskin School of Public Affairs, research fellow in the Department of Politics and International Relations at Oxford University, visitor in Oxford’s Program on Ethics and the New Biosciences, as well as permanent academic appointments at Waterloo University, Manchester University, and the University of Birmingham. He has published five books and over forty papers in academic journals in political science, philosophy, law, science, and medicine. S a r a G r e c o is a R.S. McLaughlin graduate fellow and doctoral candidate in the Department of Political Studies at Queen’s University. She is also a student fellow at the Centre for International and Defence Policy. Her most recent publication is “Not Just Insufficient but Dangerous: A Call for Adequate Regulation of the Export Control of Sensitive Space Technologies,” which won her a Graduate Research Award from the Simons Foundation and Global Affairs Canada (2015). Monica Jones is a research scientist at the University of Michigan’s Transportation Research Institute (UMTRI). She has a BSc in human

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kinetics from University of Windsor, an M S c in human kinetics from University of Windsor, a M A S c in industrial engineering from University of Michigan, and earned her doctorate from the University of Michigan. She joined D R D C as a post-doctoral fellow and helped formulate and launch the Encumbered Warfighter research program before accepting a faculty position at the University of Michigan Transportation Research Institute. T h o m a s K a r a k o l i s has been with Defence Research and Development Canada since 2014 as part of the Human Systems Integration Section. His work focuses on the biomechanics of soldier performance and injury prevention for both the Canadian Army and Royal Canadian Air Force. In the army domain he has examined the effect of personal protective equipment on soldier performance using the Canadian Load Effects Assessment Program (CanLEAP) mobility course. His work for the RCAF has examined excessive head supported mass as a potential cause of chronic pain and injury. His doctorate is from the Kinesiology Department in the Faculty of Applied Health Sciences at the University of Waterloo. A l l a n K e e f e is a defence scientist at D R D C ’s Toronto Research Centre, specializing in thermal physiology, human factors engineering, and engineering anthropometry. With DRDC since 1987, he has a BSc in kinesiology (University of Waterloo, 1987) and an M S c in thermal physiology (University of Ottawa, 1993). He leads applied research in the characterization of encumbered warfighters and the development of methods and tools for their effective integration with technology and workspaces in order to optimize performance. Maxwell j. Mehlman is distinguished university professor, Arthur E. Petersilge Professor of Law and director of the Law-Medicine Center, School of Law, Case Western Reserve University, and professor of biomedical ethics, Case Western Reserve University School of Medicine. He received his JD from Yale Law School in 1975 and holds two bachelor’s degrees, one from Reed College and one from Oxford University, which he attended as a Rhodes Scholar. In 2012, he was the principal investigator on U.S. National Institutes of Health project on ethical, legal, and policy issues raised by the use of genomic science by the military, and formerly served as the director of the Consortium on Emerging Technologies, Military Operations, and National Security.

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280 Contributors

F a r z a n a N a b i serves as the chief social scientist in the Human Dimension Division at the U.S. Army’s Capabilities Integration Center (A R C IC ) upon the request of LTG H.R. McMaster, former director, A R C I C . Previously, she was a senior lecturer in the Department of Sociology at California State University, East Bay. Dr Nabi has worked with the U.S. Army for close to a decade and deployed to Afghanistan from 2011 to 2012 as a senior social scientist for the U.S. Department of the Army, serving alongside the U.S. Marines in Helmand province, and N A TO forces in Kabul province. She holds an interdisciplinary PhD from the University of California, Berkeley, focused on policy and social welfare; a master’s degree in psychology from Santa Clara University; and bachelor’s degrees in behavioral sciences and psychology from San Jose State University. Her areas of interest include national security, human behavior, emotional intelligence, and human performance. Her regional areas of interest include Afghanistan and the Middle East. Keith K. Niall has been a defence scientist with Defence Research and Development Canada since 1989. He was first secretary (2009–14) to the defence liaison staff at the Canadian embassy to the United States of America. He was also an exchange scientist (1995–98) to the Arizona facility of the US Air Force Research Laboratory. He received a PhD in psychology from McGill University in 1988. He was editor of and a contributor to the volume Vision and Displays for Military and Security Applications (2010, Chinese translation 2014). Dav id T ac k is the vice president of operations for HumanSystems Incorporated, a human factors engineering and human systems integration consulting firm that has supported D N D and allied defence organizations (including UK A P R E , Australia’s D S T O , and U S M C Systems Command) for the past thirty years, particularly in the soldier systems domain. He has held this position since graduating with an MSc in kinesiology and ergonomics in 1991 (University of Guelph). A n n ik a V e r gi n has been working as a scientific assistant at the Future Analysis Branch at the office for defence planning of the Bundeswehr since December 2007. As the Future Analysis Branch is working with an interdisciplinary team, she is responsible for the subject area of natural science. She studied biology at the University of Potsdam and obtained a PhD in physical chemistry from the Max

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Planck Institute of Colloids and Interfaces in Potsdam. The topics she has covered within her work range from human enhancement over robotics to additive manufacturing methods, and one project deals with synthetic biology and the possible impact in future conflicts. S t é fa n i e vo n H l at k y is associate professor in the Department of Political Studies at Queen’s University and former director of the Centre for International and Defence Policy (C I D P ). Her first book, American Allies in Times of War: The Great Asymmetry, was published by Oxford University Press in 2013. She obtained her PhD in political science from the Université de Montreal, where she was also executive director for the Centre for International Peace and Security Studies. R a n da l l Wa k e l a m teaches undergraduate and graduate history courses focusing on military and air power topics at the Royal Military College in Kingston. His research includes air power, military leadership, and military education. Before coming to R M C he spent four decades in the Canadian Forces, split between flying helicopters for the army and teaching and administering military professional education programmes. He is the author of The Science of Bombing: Operational Research in R A F Bomber Command and Cold War Fighters: Canadian Aircraft Procurement 1945–1954, and co-editor of The Report of the Officer Development Board: Maj-Gen Roger Rowley and the Education of the Canadian Forces. E r i c a W i s e m a n has been a strategic information analyst at the National Research Council since 2009. In this role she provides evidence-based insights generated from text analytics and visualizations that offer an informed perspective on emerging technologies, trends, threats, and opportunities, along with an identification of collaboration networks. Prior to joining N R C she completed a PhD in knowledge management at McGill University’s School of Information Studies. Vicki Woodside-Duggins is a training development officer with the Canadian Armed Forces. She is currently serving at Military Personnel Generation Headquarters in Kingston, O N , where she is responsible for rationalized training delivery and the integrated systems approach to training initiatives. She is also a PhD student in education

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282 Contributors

and a graduate teaching fellow for Leadership in Schools at Queen’s University. Her research interests include workplace learning, active learning, leadership development, and knowledge mobilization.

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Index

Figures and tables indicated by page numbers in italics academic freedom, 44 acceptance, of enhancements, 69, 86, 88–9 access, to enhancements, 12 acquisition costs, 69 active learning, 174–92; comparison to passive learning and ds solutions, 177–80, 193n18; as continuum, 186, 187; critical thinking and, 268; definition, 182; educational demand for, 180–1, 182; introduction and conclusion, 14, 174–5, 191–2, 267–8; learning promoted via, 182–4; memory modification and, 259; in military training and education, 185–9; purpose of learning, 175–7, 266; Royal Military College example, 186– 8; as student-centred, 188–9; student resistance to, 184–5, 186; to support emerging needs, 190–1; for workforce, 181, 189–90, 191 adaptability, 107, 108, 110, 175. See also active learning

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adaptive learning, 190, 191 Advisory Committee on Human Radiation Experiments, 245 Afghanistan, Canadian mission in, 121, 122, 223, 241 age: aging and lifespan, 224, 226– 7; military service and, 102–3, 105 Air Force Research Laboratory (a fr l), 33, 34 air-wave communication systems, 84 allies, 268–70; benchmarking, 269; collaboration among, 262, 268– 71; external propellants and, 269–70 ammunition, 79–80, 129, 135–6 amphetamines, 58, 240–1, 263 anabolic steroids, 249 Angel, Harry, 213 Anthrax Vaccine Immunization Program (av ip), 245–6, 247, 249 anthropometrics, 157–8, 165, 167, 266

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284 Index

anthropotechnics, 89–90 antidepressants, 59, 239 Armed Services Vocational Aptitude Battery (asvab), 110 Army Capabilities Integration Center (arci c), 95–6, 97–8, 114n19, 116n42, 269 Army Materials Command (am c), 95, 113n7 Army Research Institute (ari ) for the Behavioral and Social Sciences, 95 Army Research Laboratory (arl), 95, 113nn9–11, 127 Army Warfighting Challenges (awf c ), 114n19 artificial intelligence (ai ), 82, 174, 190–1 attention: attentional blindness, 41; awareness and measurement of, 76–7; capacity issues, 105 attributes, soldier, 106–7, 108–9, 109, 110–11, 115n38, 262 Augmented Reality (ar), 42, 62, 79 Automated Collaboration Collection and Relationship Understanding Environment (ac c rue), 110 automation and robotics/­ teleoperations issues, 41–2; Canadian research on, 28–9; ­definition, 26; human computer interaction research, 37; loadcarrying robots, 80–1, 129; ­telepresence, 38–9, 42; user computer interfaces (u ci ), 41; virtual reality, 41–2; as weapons, 92n10; wearables, 42, 214, 264 back vibration stimulations, 28, 263–4

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Barghout, Ahmad, 42 batteries, 83–4, 122, 132 battlespace digitalization, 77 Bell, Andrew, 179 Belmont Report (National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research), 242 benchmarking, 269 Bentley, Bill, 191 Biggs, John, 181, 182 biochemical enhancement, 57–60; genetic enhancement (gene doping), 59–60; nutrition-based enhancement, 59; pharmacologic enhancement, 57–60, 68; soldier physical burden and, 125–6 bioethics, military: comparison to civilian bioethics, 242; consent, 246–9, 259–60; fairness, 246; paternalism, 244–6, 247, 259; proportionality, 243–4 BioEx system, 166 biological enhancement, 221. See also human performance enhancement Biological Weapons Conventions, 240 biomechanics research, 40 biomedical enhancements, 238–51; civilian carry-over, 250–1; civilian vs military bioethics, 242; consent, 246–9; definition issues, 238–40; fairness, 246; impact on careers and assignments, 249–50; introduction and conclusion, 15, 238–40, 251; military history of, 240–1; paternalism, 244–6; proportionality, 243–4 biotechnology (genetic enhancement), 59–60, 126, 138

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Index 285

b l e e x (exoskeleton), 127 Bloom, Benjamin: Taxonomy of Learning, 177, 178 body armour (personal protective equipment), 122–4, 130, 155–6. See also clothes Bonwell, Charles, 182 botulinum toxoid (bt) vaccine, 249 Bourdon, Lionel, 89 brain: Brain app program, 82; brain-machine interfaces, 207–8; Neural Engineering System Design (n es d), 94–5; transcranial stimulation, 35–6, 60–1, 207, 213 Bransford, John D., 183 Brown, David E., 188 Bryant, David John, 213 Buchanan, Allen: Beyond Humanity, 221 Bundeswehr Office for Defense Planning, 57, 71n1, 261 caffeine, 58, 126, 240 Canada: academic freedom, 44; automation and robotics metagroup, 26, 41–2, 46; biomechanics research, 40; Canadian researchers, 29; coauthors outside Canada, 32–3, 34; co-authors within Canada, 29–32, 30; cognitive enhancement research, 26, 29, 35–6, 39; computational and cognition metagroup, 26, 37–9, 46; demarcation of enhancement technologies, 27–8; enhancement literature review, 25–46; introduction and conclusion, 13, 25–8, 43–4; ergogenic aids research, 40–1; ethics metagroup,

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26–7, 35–7, 46; ethics research, 35, 39; human and psychological competence and, 43–4; human computer interaction (hc i) research, 37; human enhancement/augmentation research, 40; metagroups overview, 26–7, 46; methodology, 45–6; military interest in, 25–6; most active areas of research, 33, 35; perception research, 39; physiology metagroup, 26, 39–41, 46; questions posed by study, 29–35; research overview, 28–9; simulation research, 37–8; social-general research, 35–6, 39; telepresence research, 42; transhumanism research, 36–7; trust research, 37; ubiquitous computing research, 38–9; user computer interfaces (uc i) research, 41; ­virtual reality research, 41–2; visualization research, 38; ­wearables research, 42 Canadian Army Land Warfare Centre, 25 Captain America, 6–7, 17, 126, 138 Captain America: The Winter Soldier (film), 17 Card, Orson Scott: Ender’s Game, 175 Carleton University, 30, 31, 34 carriers, tactical, 129 carts, wheeled, 129 Center for Army Profession and Ethic (c a pe), 106 Centre for International and Defence Policy, 264 Cha, Jongeun, 42 character, 107, 108 Chin, Christine, 188

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286 Index

civilians: biomedical enhancement carry-over, 250–1; divide between military and, 103, 256, 263; ethical considerations, distinction from military, 12, 242; pressure from, 87–8; retirement from military, 3–4, 11, 260 Clausewitz, Carl von, 98–9, 115n25 clothes, 77, 81, 82–4. See also body armour (personal protective equipment) cognition: cognitive load reduction, 81–2; cognitive training, 206–7; physical overload and, 125; psychological competence, 43–4; soldier attributes, 108. See also cognitive optimization; computational and cognition issues cognitive adaptability, 108 cognitive apprenticeship, 184 cognitive augmentation, 200–2, 207–8, 210, 211–13, 267 cognitive behavioural therapy (c b t ), 228–9, 232, 235 cognitive enhancement: Canadian research on, 26, 29, 35–6, 39; in cognitive optimization, 200, 201, 209, 210, 211–12, 267; use of term, 198–9 cognitive flexibility, 14, 175. See also active learning cognitive optimization, 198–214; approaches to and manipulation strategies, 199–202; broad enhancement and augmentation, 209, 211; cognitive augmentation, 200–2, 207–8, 210, 211–13, 267; cognitive capabilities, nature of, 202–5; cognitive enhancement, 200–1, 209, 210,

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211–12, 267; cognitive support, 200–2, 210, 267; definition, 199; evidence for, 205–8; historical approaches, 198; intrinsic vs utilitarian optimization, 199, 258; introduction and conclusion, 15, 214, 267; military prospects, 208–13, 210; research efforts, 206, 208; specific enhancement and augmentation, 211–13; terminology for, 198–9 cognitive support, 200–2, 210, 267 collaboration, among researchers, 262, 268–71. See also interdisciplinary research comedic virtues, 231 compartmentalization, 230 compensation, 232 competence: human, vs performance, 43; psychological competence, 43–4 computational and cognition issues: Canadian research on, 28–9, 37–9; definition, 26; human computer interaction (hc i), 37; simulation, 37–8; ubiquitous computing, 38–9; visualization, 38 Conference on International Security: “Developing the Super Soldier,” 18n5 consent, 12–13, 244–9, 259–60 Cornell University, 33 cost-benefit analyses, 264 costs, acquisition, 69 crime, organized, 66 cr ispr , 8 critical thinking and problem ­solving, 105–6, 176, 184, 268. See also active learning culture. See society and culture

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Index 287

Dalhousie University, 30, 32, 34 D’Amelio, Angelo, 186 datafication, human, 88 decision making, 82, 105, 109, 132 deductive learning, 183–6, 189 deep learning, 183, 186, 188, 191 Defence Advanced Research Projects Agency (darpa): enhancement research, 94, 112n2, 241; exoskeletons, 6; name changes, 112n3; Neural Engineering System Design (ne s d ), 94–5; Soldier Centric Imaging via Computational Cameras (scenicc), 95; Warrior Web program, 95, 127, 261 Defence Industry Research Program, 261 Defence Research and Development Canada (drdc), 25, 30, 32–3, 34, 213 degradation: Human Performance Degradation, 64–5; operation in degraded environments, 104, 106 Delaney, Samuel R., 44 Demitry, Peter, 241 denial, 230–1 detection techniques, 69. See also reconnaissance; surveillance “Developing the Super Soldier” (Conference on International Security), 18n5 developmental learning, 190, 191 Dewey, John, 182 diplomacy, 66 diversity, human, 103–4, 167, 266 d s solutions, 180, 193n18 Dunlop, Joanna C., 184 École de technologie supérieure, 30, 32, 34

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economic structural trends, 104–5, 115n33 Edge of Tomorrow (film), 6 ed i (explanation, demonstration, and imitation) teaching method, 185 education, 180–1, 249. See also active learning efficiency, 9–10, 74 Eison, James, 182 Ellström, Per-Erik, 190, 191 embark/disembark transition, 79 emb o Press, 5 emotions: awareness and measurement, 77; emotional competence training, 106; emotional costs of war, 223–5 enhancement, vs optimization, 16–17. See also human performance enhancement environment: adaptation to mitigate loads, 134–5; enriched ­environments, 206–7 environmental adaptability/endurance, 108 ergogenic aids, 40–1, 125–6, 138–41 esprit de corps, 87, 257–8 ethics: Canadian research on, 28–9, 35–7; emotional nature of ethical debates, 226; enhancement and, 11–13, 221–2; exoskeletons and, 153; moral leadership, 109; need to address, 105; obligations to soldiers, 234–5; overview, 26–7; soldiers’ norms and ethics, 104. See also bioethics, military; biomedical enhancements; memory modification exercise, physical, 133–4, 207 Exo-buddy (exoskeleton), 127

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288 Index

e x o mov e (leg-muscle support), 81 e x o s 2 (exoskeleton), 127 exoskeletons, 152–70; academic collaboration and, 262; anthropometric considerations, 157–8, 167; applied laboratory environment, 165–6; challenges with, 127–8, 139; compatibility with other equipment, 162–3; definition, 154–5; effectiveness measures, 155; ethical considerations, 153; examples of, 127; field environment, 166–7; functional movement evaluation, 158–9, 159; fundamental laboratory environment, 164–5; human diversity and, 167; injury considerations and risk assessment, 153, 163, 167–8; introduction and conclusion, 14, 61–2, 152–4, 169–70; and lethality vs survivability, 155–6; literature on, 154; operational task evaluation, actual, 161–2; operational task evaluation, simulated, 159–61, 161; parsimony and, 264; for physical burdens, 81, 126–8; policy implications, 168–9; potential applications, 154; science fiction and, 6; testing and evaluation, 156, 157, 167–8; testing environments, 164–7 external computing devices, 201–2, 207–8 external muscular physical assistance equipment, 81 Factor VII (clotting agent), 243 fairness, 12, 246

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Felder, Richard M., 183, 185 felin System, 77–8, 81, 92n3 Feres doctrine, 247 field environment, for exoskeleton testing, 166–7 fitness (fit for purpose), 64, 100, 107, 108, 133–4 Flecainide, 77 Florida State University, 33, 34 Flynn Effect, 205 Ford, Jeffrey D., 186 Ford, Laurie W., 186 France, 74–91; anthropotechnics, 89–90; benefits from enhancements, 76; civilian pressure, 87–8; dangers and risks of enhancements, 85–7, 87; decision support systems, 82; definition of enhanced soldier, 75; easing burdens, 80–2; equipment and clothes, 82–4; genetic screening, 88; implications for infantry soldiers, 84; individual and collective acceptance, 88–9; individual soldier considerations, 76–80; introduction and conclusion, 13, 74–5, 90–1; load reduction, ­cognitive, 81–2; load reduction, physical, 80–1; military needs assessment, 85; operational advantage equipment, 83–4; personal physiological limitations, awareness of, 76–7; promotion of group over individual, 87, 257–8; protective equipment, 82–3; tactical environment, 77–80 Fraunhofer Institute for Technological Trend Analysis, 57 Fredrickson, Barbara: Positivity, 231

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Index 289

Freud, Sigmund, 230–1 Friedl, Karl, 16 Fukuyama, Francis, 7 functional foods (nutraceutics), 59 functional movements, and exoskeletons, 158–9, 159 Future Operational Environment (f o e ), 98, 114n23 gait, 40, 42, 124, 128, 168 ge Digital Energy, 30, 32 genetics: cognitive interventions, 201, 206; genetic enhancement (gene doping), 59–60, 126, 138; genetic screening, 88 Germany, 56–70; Armed Forces exercise for considering enhancements, 65–70, 66, 67; Augmented Reality (ar), 62; biochemical enhancement, 57–60; exoskeletons, 61–2; genetic enhancement (gene doping), 59–60; human bio-­monitoring, 63–4; Human Performance Degradation, 64–5; introduction and conclusion, 13, 56–7, 70; invasive technologies, 63–5; non-invasive technologies, 60–3; nutrition-based enhancement, 59; overview of enhancement technologies, 58; pharmaceutical administration in Armed Forces, 71n6; pharmacologic enhancement, 57–60, 68; responsibility for analysis, 71n1; Silent Speech Interface (s s i ) systems, 62–3; transcranial stimulation, 60–1 Gilbert, Daniel, 222, 230 Grabinger, Scott R., 184 graphene, 83

31392_Breede.indd 289

gray-zone war, 111 The Greenwall Foundation, 5 Gross, Michael, 243–4 group, vs individual, 87, 257–8 Gulf War, 240, 249 Hamilton, Peter F.: Commonwealth Saga, 6 haptic technologies, 38 Harrison, Peter, 8 Harvard University, 33, 34 Hassanein, Hossam, 38–9 Hasswa, Ahmed, 38–9 heavy loads. See soldier physical burden Heinlein, Robert: Starship Troopers, 6 He Jainkui, 8 Hercule (exoskeleton), 127 histone deacetylase inhibitors, 228–9 Horn, Bernard, 191 human bio-monitoring, 63–4 human competence, 43 human computer interaction (hc i) research, 37 human datafication, 88 Human Dimension Concept (pamphlet), 100 Human Dimension Division (hdd), 96, 269. See also Unified Quest study human enhancement/augmentation research, 40 humanistic theory of conflict, 100 human performance, 43 human performance degradation, 64–5 human performance enhancement (hpe): active learning, 174–92,

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290 Index

267–8; allies and, 268–70; bioethics and biomedical enhancements, 238–51; Canadian literature review, 25–46; cognitive optimization, 198–214; collaboration for, 262, 268–71; consent and, 12, 13, 244–9, 259– 60; considerations for moving forward, 270–1; definition, 75, 221, 257; demarcation of enhancement technologies, 27–8; ethical considerations, 11–13, 221–2; exoskeletons, 152–70; external propellants, 269–70; framework for, 16–17; France, 74–91; Germany, 56–70; human dimension, 3–4; impact of science fiction claims, 255, 263; incremental approach, 227, 264; individual soldier considerations, 256–60; individual vs group, 87, 257–8; interactive effects, assessment of, 267; interdisciplinary research, 256–7, 262, 270; introduction and conclusion, 3–4, 13–18, 255–6, 271; invasive vs non-invasive, 9, 17, 90–1, 257; literature review, 4–6; memory modification, 221–36; military needs, 9–11, 85; optimization vs enhancement, 16–17; parsimony, 263–4; patience, 264–5; research and development, 261–3; resilience and, 259; science fiction and, 6–7; socio-cultural considerations, 69, 86; soldier physical burden, 119–39; soldier’s retirement and, 3–4, 11, 260; technological possibilities, 8–9; testing environments, 266–7;

31392_Breede.indd 290

transhumanism and, 7–8; transparency, 265–6; uncontrolled escalation, 86–7; United States of America, 94–112; as unnatural, 222, 224–5. See also specific topics Human Research and Engineering Directorate (hr ed), 95, 113nn9–10 Human Universal Load Carrier (hulc ), 127 hybrid war, 111 image-guided surgery systems (igs), 41–2 inductive learning, 183–6, 188, 191 injuries. See medical care and injuries insight, 107 Institut de recherches cliniques de Montréal (irc m), 30, 31–2, 34, 35 intelligence enhancement, 59. See also active learning; cognitive optimization interdisciplinary research, 256–7, 262, 270. See also collaboration, among researchers International Code of Medical Ethics, 242 International Collaboration on Repair Discoveries (ic or d), 30, 31, 34 invasive enhancements: concerns and issues, 5–6, 138; ethical ­considerations, 12–13; vs non-­ invasive enhancements, 9, 17, 90–1, 257; overview, 63; parsimony and, 263–4 Iron Man, 6, 17, 127, 139

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Index 291

jamming, information, 84 jas o n, 241 Kammerl, Julius, 42 Knee Stress Releaser Device (k -s r d), 127 Korea Advanced Institute of Science and Technology, 33, 34 laboratory environments, 164–6. See also testing environments Lancaster, Joseph, 179 language translation, 82 laughter, 231 leadership, 104–5, 109 learning ability, 59. See also active learning LeBlanc, Steven, 225 lethality, 12, 155–6 liability, unlimited, 12, 16 lifelong learning, 184 lifespan, human, 224, 226–7 Lighthall, W.D., 8 load carriage equipment design, 131 Load Effects Assessment Program (l e a p ), 160, 166 load reduction. See soldier physical burden London Health Sciences Centre, 30, 31, 34 McGill University, 30, 31–3, 34, 35 McPeak, Merrill A., 240–1 Marshall, Samuel L.A., 119 Marvel Comics, 6–7, 17 mat e p (mat rice epicritique) ­project, 78 The Matrix (film), 8 Medawar, Peter, 224

31392_Breede.indd 291

medical care and injuries: cognitive optimization effects, 213; exoskeletons, 153, 163, 167–8; importance of care, 10–11; from overload, 124; research needs, 137; risks as barrier to enhancement, 86; sigyc op medical examination, 88, 93n15 medicalization, 238–9 memory-altering drugs (ma ds). See memory modification memory modification, 221–36; definition of memory, 226; ethical considerations, 226–8; histone deacetylase inhibitors study, 228–9; introduction and conclusion, 15, 221–3, 235–6; moral obligations to soldiers and, 234– 5; psychological immune system as, 229–34; resilience and, 259; unnatural stressors of modern warfare and, 223–5; veterans and, 260; working memory enhancement, 200, 203 methamphetamine (pervitin), 56–7 methylphenidate (Ritalin), 200, 206–7 Michaud-Shields, Max, 16 mild cognitive impairment (mc i), 239 military: divide between civilians and, 103, 256, 263; enhancement needs, 9–11, 85; workforce changes, 106. See also soldiers military training: active learning in, 185–9; cognitive optimization and, 213; initial military training, 105; in realistic operational scenarios, 134

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292 Index

Mission Impact through NeuroInspired Design (m i n d), 95 missions, adaptation for loads, 134–5 Mitra, Sugata, 187 MobiFuzzy Trust, 37 mobile technologies, 39 Modafinil (Provigil), 58, 71n4, 77, 207, 241 mo d e f i project, 77 Moore, Will G., 193n12 Moore’s law, 7 morality. See ethics moral leadership, 109 Morgan, Richard: Black Man, 6 mo sa i c system, 36 motion sickness, 59 Mount Sinai Hospital, 30, 32 multi-cultural conditions, 103–4 nanotechnologies, 83–4 Natick Soldier Systems Center (ns s c ), 95 National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research: Belmont Report, 242 National Research Council: Making the Soldier Decisive on Future Battlefields (report), 138 Neural Engineering System Design (ne s d ), 94–5 neurotechnological cognitive interventions, 201, 207 New York University of Abu Dhabi, 33, 34 night vision devices, 39, 78 non-invasive enhancements, 60–3; approach to, 70; Augmented Reality (ar), 62; cost-benefit

31392_Breede.indd 292

analyses, 264–5; definition, 60; ethical considerations, 12–13; exoskeletons, 61–2; vs invasive enhancements, 9, 17, 90–1, 257; Silent Speech Interface (ssi) ­systems, 62–3; transcranial ­­stimulation, 60–1 normal, standards of, 239 Nuremburg Code, 242 nutrition-based enhancement, 59, 201, 206 obesity, 36, 105 occipital lobe implants, 27–8, 263–4 operational advantage equipment, 83–4 operational environment, 98, 114nn21–2 operational fitness, 107 optimism, 231–2 optimization, vs enhancement, 16–17 overload. See soldier physical burden Oxford tutorial system, 178–9 Ozanne, Eric, 87 pain relievers, 58 parsimony, 263–4 paternalism, 244–7, 259 patience, 264–5 peace, 223, 235 Pedersen, Isabel, 42 perception research, 39 performance, human, 43 Personal Lift Augmentation Device (pla d), 40 personal protective equipment (ppe; body armour), 122–4, 130, 155–6. See also clothes

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Index 293

pervitin (methamphetamine), 56–7 pharmaceuticals: for cognitive optimization, 201, 207, 213; in German Armed Forces, 71n6; pharmacologic enhancement, 57–9, 68, 77 physical attributes, of soldiers, 108 physical burden. See soldier physical burden physiology: biomechanics research, 40; Canadian research on, 28–9, 39–41; definition, 26; ergogenic aids research, 40–1; human enhancement/augmentation research, 40; perception research, 39; personal physiological limitations and monitoring, 76–7, 132 policy, 168–70 political structural trends, 102–4, 115n33 post-traumatic stress disorder (p t s d), 222–3, 226, 229 power systems, 132. See also batteries Powertech Labs, 30, 32 Presidential Advisory Committee on Gulf War Veterans’ Illnesses, 245 President’s Council on Bioethics: Beyond Therapy report, 222, 227, 229, 260 Prince, Michael J., 183, 185 Princess Margaret Hospital, 30, 32 prisoners of war (p ow ), 65 problem solving and critical thinking, 105–6, 176, 184, 268. See also active learning proportionality, 243–4, 264 prosthetics, 89–90, 234 protective equipment, 82–3

31392_Breede.indd 293

Provigil (Modafinil), 58, 71n4, 77, 207, 241 psychological competence, 43–4 psychological immune system, 222, 224–5, 229–34. See also memory modification psycho-physical awareness, 108 Pundak, David, 186 Putnam, Hilary, 26–7 pyridostigmine bromide (pb ) vaccine, 248–9 Queen’s University, 33, 34 radio, 84 Rapamycin, 227 Raytheon, 6 reconnaissance, 68–9, 79. See also surveillance recruitment, soldier, 9, 88, 90, 205, 250, 260, 265–6 Report of the Officer Development Board, 176 research and development, 261–3; benchmarking, 269; change and continuity, 262–3; collaboration, 262, 268–71; costs of, 69; funded projects, 261; future development, 270; information accessibility, 263; interdisciplinary research, 256–7, 262, 268–9 Research Centre of the Écoles de Saint-Cyr Coëtquidan (c r ec ), 74 Research Development and Engineering Command (­r dec om), 95, 113n8 resilience, 90–1, 107, 108, 111, 231–2, 259 re-supply, 122, 133

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294 Index

retirement, from military, 3–4, 11, 260 Ritalin (methylphenidate), 200, 206–7 Robarts Research Institute, 30, 31 robotics: human computer interaction research, 37; load-carrying robots, 80–1, 129; as weapons, 92n10. See also automation and robotics/teleoperations issues Rowley, Roger, 176 Royal Military College, 186–8 Rozner, Shmaryahu, 186 Ruhr University, 33, 34 Sacre-Coeur Hospital, 30, 31, 34 Saddik, Abdulmotaleb E., 42 St Michael’s Hospital, 30, 31, 34 Sakurazaka, Hiroshi: All You Need Is Kill, 6 science fiction, 6–7, 17, 44, 263 self-discipline, 107, 108 self-regulated learning, 184 s i gyc o p medical examination, 88, 93n15 Silent Speech Interface (s s i ) systems, 62–3 Simon Fraser University, 30, 31, 34 simulation research, 37–8 sleep, 58, 83, 207, 241 smart technologies, 38–9, 70 social attributes, of soldiers, 108 society and culture: acceptance of enhancements, 69, 86; structural trends, 105–6, 115n33 Socrates, 198 Socratic method, 178 Soldier Centric Imaging via Computational Cameras (­s c e ni c c), 95

31392_Breede.indd 294

Soldier Performance and Equipment Advanced Research (spea r ), 95 soldier physical burden, 119–39; biochemical enhancements, 125– 6; bioengineering, 126; contemporary loads, 121, 122; definition, 120; exoskeletons for, 81, 126–8; historical guidelines, 119–20; introduction and conclusion, 14, 119, 138–9; mission, task, or environment adaptation, 134–5; organizational and system-level strategies, 135–8; overload factors, 121–3; overload risks, 123–5; parsimony and, 263–4; patience for, 265; research needs, 136–8; soldiers’ perceptions of overload, 135–6; systems approach to mitigation, 128–38, 130; tools or technology solutions, 80–1, 129–33; transparency and, 265–6; unintended consequences of new technology, 121–2, 257; user interventions, 133–4 soldiers: attributes of future soldiers, 106–7, 108–9, 109–11, 115n38, 262; divide between civilians and, 103, 256, 263; enhancement considerations, 256–60; enhancement definition, 75; evaluations, 110, 116n46; individual vs group, 87, 257–8; methods for increasing performance, 74; moral obligations to, 234–5; overload perceptions by, 135–6; policy development and, 270; recruitment, 9, 88, 90, 105, 205, 250, 260, 265–6;

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Index 295

retirement, 3–4, 11, 260; superior (super) soldier, 94, 256. See also human performance enhancement spoofing, 84, 111 sports, 16, 87, 125, 152, 221, 249 standards, physical and cognitive, 104 Stanford University, 33, 34 Star Trek, 174–5 Steinbach, Eckehard, 42 steroids, anabolic, 249 stimulants. See ergogenic aids story editing, 232–3 strategic thinking (system of systems thinking), 109 structural trends: economic trends, 104–5, 115n33; introduction, 101–2, 103; political trends, 102–4, 115n33; social trends, 105–6, 115n33 student resistance, 184–5, 186 superior (super) soldier, 94, 256 surface learning, 183, 186 surgery, image-guided systems, 41–2 surveillance, 78, 84. See also reconnaissance survivability, 125, 155–6 system of systems thinking (strategic thinking), 109 Tactical Assault Light Operator Suit (talos ) program, 127, 261, 264 tactical environment, 77–80 Tailored Adaptive Personality Assessment System (tapas ), 110 tasks, adaptation for loads, 134–5 teaming, 108

31392_Breede.indd 295

Technical University of Munich, 33, 34 technological intelligence (ti), 70, 269 technology: advances in, 121–2, 152; management of, 104–5; weight reduction, 129–31. See also body armour (personal protective equipment); exoskeletons teleoperations. See automation and robotics/teleoperations issues telepresence, 38–9, 42 testing environments, 164–7; applied laboratory environment, 165–6; field environment, 166–7; fundamental laboratory environment, 164–5; future needs, 270– 1; overview, 164, 266–7 thermal strain, mitigation of, 131–2 training. See military training Training and Doctrine Command (tr a doc ), 95, 98, 111 tranquilizers, 58 transcranial stimulation: duration studies, 213; overview, 60–1; transcranial direct current stimulation (tdc s), 35–6, 207; transcranial magnetic stimulation (tms), 36, 207 transhumanism, 7–8, 36–7 transparency, 265–6 trust, 37, 42 Tyler, Ralph, 182 ubiquitous computing research, 38–9 Unified Quest study, 94–112; desired soldier attributes, 106–7, 108–9, 109; economic trends, 104–5; framework for, 97–8;

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296 Index

Future Operational Environment (f o e ), 98–9, 114n23; human dimension, 100–1; humanistic theory of conflict, 100; Human Performance Seminar (hps ), 106–11, 108–9, 116n41; Human Performance Working Group (h p wg), 101–6, 115n32, 115n34; implications of foe on soldier attributes, 110–11; introduction and conclusions, 13, 96–7, 109–12, 114n18; macrolevel considerations, 98–101; micro-level considerations, 101– 2; nature and character of war, 98–9, 115n25; next steps, 111– 12; personnel evaluations, 110, 116n46; political trends, 102–4; research and development context, 94–6; social trends, 105–6; structural trends, 101–6, 103, 115n33; underlying assumptions, 97. See also United States Armed Forces United States Air Force, 240–1 United States Armed Forces: pharmacologic enhancement, 58, 126; r &d organizations, 95–6; Risk Management, 243; Title 10 (United States Code), 96, 114n17. See also Defence Advanced Research Projects Agency (da r pa); Unified Quest study United States Marine Corps (us mc ), 123, 176 United States Special Operations Command: Tactical Assault Light Operator Suit (talos ) program, 127, 261, 264

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Université de Montréal, 30, 31, 34, 35 Université du Québec à Chicoutimi, 30, 32 Université Laval, 30, 32–3, 34 University Health Network, 30, 31, 34 University of British Columbia, 30, 31, 33, 34 University of Calgary, 30, 31, 33, 34 University of Guelph, 30, 32 University of Lyons, 33, 34 University of New Brunswick, 30, 32, 34 University of Ottawa, 30, 31, 33, 34 University of Queensland, 33, 34 University of Sherbrooke, 30, 32 University of Toronto, 30, 31, 34 University of Waterloo, 30, 32 u p r ise (exoskeleton), 127 U.S. Army Research Institute of Environmental Medicine (usa r iem), 95 user computer interfaces (uc i) research, 41 vaccines, 59, 249. See also Anthrax Vaccine Immunization Program Vaillant, George, 229–31 Vance, Jon, 176–7, 181 veterans. See retirement, from military Vietnam War, 240 virtual reality, 41–2 vision enhancement, 27–8, 78, 80, 263–4 visualization research, 38

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war, nature and character of, 98–9, 115n25 Warrior Web program, 95, 127, 261 water supply, 65, 79–80, 122 wearables, 42, 214, 264. See also exoskeletons weight reduction, equipment, 129–31 Weimer, Maryellen, 188 Western University, 30, 31, 34 Whitecross, Christine, 191

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wicked problems, 175, 181. See also active learning Wiener, Norbert, 27 Wilson, Timothy: Redirect, 232 Wiseman, Erica, 43 Wolyniak, Joseph, 8 workforce: active learning and, 181, 189–90, 191; changes within military, 106 World Medical Association: International Code of Medical Ethics, 242

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