This article gives a glimpse into what is likely to be the next trending film on Twitter, after the fuss about Inception has waned. But, what medical issues could possibly arise from this, 'the most horrific film ever made' (according to the film's own production notes)?

I will skip the debate about the ethics of decency and focus instead on the film's content, which tells the story of a surgeon whose goal is to create a human centipede. This scenario may require a little clarification, which the Director, Tom Six, has been happy to provide in interviews: the human centipede is a series of humans sewn together mouth to ass (See one of the film sketches above).  Perhaps the most obvious place to start is in the field of bioethics and, in particular, within the conversation about human enhancement and posthumanity?

Thus, would a series of humans sewn together in such a fashion be a step too far in our pursuit of human enhancements, or would our most liberal bioethicists be able to find some value in such a modification to our biological characteristics? Would this example be a form of ‘radical transhuman enhancement’ (Miah, 2008) that demonstrates the limit of a liberal approach to human enhancements, or could the creation of a human with 100 legs ever be conceived as an enhancement of our humanity?

What at first glance seems to be a simple case of unethical conduct and a morally dubious aspiration, does, on closer inspection, reveal itself as an example that gets to the heart of the debate over the ethics of human enhancement. Indeed, considering this peculiar case can shed light on the value of more familiar examples of enhancement, which aspire to make us functionally better in more familiar ways, but which also imply a transformation to an aesthetic value of our human condition.  The film also reminds us that our biological characteristics may be conceived as optimal only when our societies are adequately equipped to accommodate radical deviations from a biosocial norm. Often, we fail miserably at such accommodation, as the history of disability studies reveals.

Yet, to really come to terms with the merit of the human centipede as a condition of human existence, it is necessary to delve into the deliciously disgusting detail of this transformation. Just to be clear, the film does not imagine genetically engineering our species to become a new chimera, with anatomy thus positioned. Instead, it depicts cognisant adults, capable of realizing they are being transformed in a way that they are likely to find distasteful at best, but more likely tortuous and degrading. These people will not only have the mental capacity to know the full extent of their suffering, but will also have the sensory experience through which they will perceive the horror of their circumstances.

Consequently, it is an open and closed case in terms of it involving a medical professional taking advantage of other people, but to close the conversation here would be to spoil the fun of this debate. Let us ignore this transgression for the remainder of the discussion, even if it means I will get into trouble for doing so.

Thus, let us suppose that the transformation of individuals into the human centipede were sought on account of it creating an enhanced human. What could this possibly involve? Perhaps having 100 legs would be better than having just two for many tasks we seek to undertake. It may mean we are less likely to fall over and injure ourselves, for instance, or that we could walk more quickly, or move with greater agility to traverse difficult terrain like never before.

Yet, the challenge with providing examples to explain how humans may benefit from being sewn together to form a centipede is that any such change would be considered valuable only in a world that is very different from the one we live in today. In other words, imagining the value of radical transhuman enhancements requires first coming to terms with humanity’s future needs and desires. It also requires understanding how these needs may evolve incrementally, thus leading to a slow uptake of gradual enhancements, until we reach a point which, today, we would consider a radical departure from our species category of homo sapien.

Of course, those ethicists who are closer to the policy making side of medicine and technology, rather than the philosophical debates, will cringe at this argument, asking only for the specific instances in which the modification could, in even the most generous sense, confer value. In short, they would want to know what would be the point of creating a human centipede, before even hearing a case on behalf of its creation? From this perspective, if one cannot imagine such circumstances and thus convey the merit of it coming to effect, then such ethicists would confirm that these changes would be medically unethical, irrespective of the many other issues the example of the human centipede raises.

A further concern involves where we focus our attention, when imagining the dimensions of our humanity that are affected by this metamorphosis. After all, it may be a mistake to focus on the benefit of having extra legs. We might instead focus on the fact that these 25 people – arms and legs function as the centipede’s legs - would only have one bottom to wipe when using the toilet! Alternatively, having 25 brains may confer an advantage or a disadvantage depending on whether and how they are connected, or whether the connection is series or parallel. Indeed, it may matter more whether the 25 people all get on with each other, or if they spend most of the day arguing in circles. Another consideration may be how long a beast of such description would need to spend undertaking daily maintenance tasks, such as eating, simply to remain functional. A daily schedule where 20 hours of a day are spent eating may not be the most enhanced lifestyle we could imagine for humanity.

Clearly, the abhorrent image of the human centipede precludes our seeing it as an unequivocal enhancement of humanity. Moreover, the surgeon’s dementia reminds us more of Dr Frankenstein and every other example of real-life human experimentation that has besieged humanity, to its detriment. The example is made all the more complicated by the proposition that each link in the centipede would have a fully functioning brain with sufficient awareness to realize that it were attached to somebody else' bottom.

This leads us nicely into debates about conjoined twins and whether the individuals who are conjoined are worse off because of their unique circumstances. Certainly, the health risks of conjoined twins are sufficient to justify intervention in many cases, but where they are less clear, the ethical basis for separation is much more controversial. Rather, such examples remind us of our bias to think of identity as singular and biologically isolated from another sentient being’s identity. This view may reveal a bias in how we think of humanity that requires further questioning, which raises questions about the value of being a singular person.

Admittedly, I am prepared to go only so far in comparing the human centipede to conjoined twins. After all, the film is about a mad scientist with a bizarre fetish, not a remarkable surgeon aiming to improve the lives of his patients. Indeed, this surgeon is unlikely to get his experiment passed his IRB and it is even more unlikely that volunteers would sign up to the procedure, even if it were to benefit medical science. For most of us, it's hard to get passed the fact that somebody's lips – perhaps our own – would be sewn to another person’s botty and yet, this extrapolation of what many would regard a remarkably unpleasant permanent state of affairs is predicated on the basis that we have lived lives which do not require such inconvenience. The unpleasantness of the situation is further confirmed when realizing that the mechanism also requires passing excrement via this channel and subsequently through one's own digestive system, from one link to the next. Indeed, our inquiry needs to be informed by considering not just the functional, but the symbolic importance of both the mouth and the anus in human lives.

Most of what I have said could hardly be construed as a case on behalf of becoming a human centipede and, as such, I am in danger of having set up a straw man argument over a case, which, from the beginning, only barely touched on the field of bioethics. Indeed, some reviews of the film describe it as a comedy – perhaps closer to Eternal Sunshine of the Spotless Mind than Extreme Measures.

Nevertheless, the human centipede is a great film through which to discuss bioethical issues for various reasons. First, it presents us with an example of a biological modification that is unlikely to be medically required at any point soon and so does not involve us with the typical social or contextual issues that bioethical debates often face. Thus, to modify humans in this way would require a significant departure from the usual justifications employed that permit individuals to modify themselves. As well, its ambiguous functional value means that considerable work must be done to discern what value might accrue from the change, thus making one’s judgment about its merit highly subjective. Without instrumental explanations for why people might seek such changes, one’s moral compass is thrown off considerably and one may need to delve into the more symbolic dimensions of such a being and the society that surrounds it.

I have no doubt that this may be the only article ever to be written about this film’s implications for bioethics. As noted earlier, if you have a chance to hear Tom Six interviewed, you'll quickly discern that his Human Centipede may be most suited for remembrance as a comedy, rather than a horror film. Its tongue in cheek claim to being '100% medically accurate' may not be untrue, but the sheer fact that the claim is made - along with the other claim I reveal at the start of this article - indicates that the film wishes to trade on the grotesque, as a device not for serious shock, but for creating a form of surreal horror that is more David Lynch than David Cronenberg, or more Salvador Dali than Pablo Picasso.

Bioethicists could learn a lot from the Human Centipede about how we situate our claims about what enhancements do for humanity.  It imagines a world where the least obvious of biological modifications is articulated in a way that challenges what we think of as normal, natural, beautiful and ethical. While it may seem an obvious example of an unethical use of technology, given that it would involve a serious worsening of circumstances for the majority, this may only hold if you happen to be at position 2-25 in the chain. If you are lucky enough to be the head of the centipede, your point of view – literally and metaphorically – is likely to be quite different.