Military Human Augmentation: Still Some Way Off

The publication of Human Augmentation - The Dawn of a New Paradigm by the Defence Concepts and Doctrine Centre (DCDC) in 2021 demonstrated the importance of this topic within UK defence.1 Human Augmentation (HA) is also referenced in the recent Defence Command Paper (Defence's response to a more contested and volatile world)3 relative perceived effort,4 reduction in muscle EMG activity,5 cognitive function,6 and metabolic activity7 inter alia.
In addition, translation of these outcome measures to military utility is not yet convincing. Another fundamental challenge with exoskeletons for military applications is power requirement. The reported improvements in physical performance in tethered systems described in these studies need to be viewed with scepticism as they will be reduced significantly once the systems carry their own power supply.
Finally, there is evidence that while performance in one domain (lifting / carrying) may be augmented, this comes at the cost of reduced performance in another (walking).8
Remote sensing and measurement has been explored as a means to prevent injury and assure the health of our fighting force. Several remote sensing systems have reached an advanced technology readiness level and have shown promise in the field.9 However, there are several key problems that range from technological challenges (e.g.
signal noise, calibration, drift, attachment-related artefact, etc) to the lack of causal evidence in the literature to link injuries or illness states with particular measurable parameters.10 This last problem is a fundamental barrier to this technology finding a military utility. We are currently at the stage of discovering what we can measure, but to be useful we need to know what we should measure.
This problem of lack of fundamental knowledge is profound in the more invasive areas of HA. Much of the means by which HA can be delivered remains entirely theoretical. For example, the specific genetic modifications of the human genome to improve muscle strength or prevent MSK injury are not known. Our literature search has not revealed any human research in these areas, meaning that deficits in understanding are unlikely to be resolved soon.
If the HA technology is to transform our fighting force within a generation then significant investment in basic human research is required now.
The scientific problems discussed above are not the only difficulties in this area. Key ethical, legal, societal, and economic problems will need to be overcome for HA to deliver meaningful performance gains. Ethical issues are discussed clearly in the original paper (1) and relate to permanence, harm, societal acceptance, military proportionality, and fairness. Another ethical problem that has not been discussed in the literature is the question of whether HA is a medical therapy.
HA intended to mitigate traumatic injury may be argued to be analogous to preventative medicine such as vaccination and may be considered within the remit of our current understanding of healthcare and medical ethics. However, HA that has no preventative medical application has no current medical analogy and cannot be considered part of healthcare as we currently understand it.
Multiple unanswered legal questions will need to be answered before HA can be used in practice (table 2). However, the UK government has no legislative agenda to clarify the law surrounding this area so these questions are likely to remain unanswered for now.
Legal Concept
Legal Questions
Informed consent
Montgomery ruling: patients must have individualised discussion of potential risks, benefits, alternatives, and implications.
If HA is not defined as a medical technology, what consenting safeguards apply?
Liability
Who is liable if harm is caused to the individual as a result of augmentation if something goes wrong during augmentation procedure or during use?
Who is responsible for the removal of HA technology in the case of obsolescence or request from the use...