Bioethics is Love of Life: An Alternative texbook

Darryl R. J. Macer, Ph.D.
Eubios Ethics Institute

Copyright 1998, Darryl R. J. Macer. All commercial rights reserved. This publication may be reproduced for limited educational or academic use, however please enquire with the author.

5. Love, culture and relationships

Human beings are organized into societies bound together by love, trust and mutual dependence. Often it is the later which sustains modern society, as there may be a lack of trust and love in many groups. Our social groups include our spouse, children, relatives, neighbours, religious group, community, workplace, village, city, nation, and international partners. As Hegel wrote in Philosophy of Right, love is "consciousness of my unity with another", and people's unity together with the universal spirit (Eliade, 1987). Each person requires love and support of other persons. Singer (1987) considered that Rousseau had too much fear of the dependence of people in love that it blinded him to the constructive possibility when a love between two people renders them interdependent.

The social origins of larger groups can be studied by sociology and history, and they would immediately tell us that most societies we think of today as countries are modern artificial creations of historical and present political power systems. Language is central to social structure. Linguistic trends are consistent with migrations of humans over the planet traced by genetics, and the origin of speech is thought to be at least 40,000 years ago. The anatomical structures of the vocal tract and larynx suggest that other land animals cannot talk the same as we can, neither could premodern Homo species (Lieberman, 1991). However, individual communication systems are found in other social mammals and birds, and they are used to discriminate between individuals. It is also clear that the language instinct is something we are born with, not a social construct we acquire after birth (Pinker, 1994). Some other behavioural systems may also be shared with other animals, as will be discussed more in the next chapter when looking at the origin of love, altruism and selfishness, and animals.

One of the impacts of the transient society, meaning the increasingly mobile communities, is more universality. Whether it be the movement of young people in search of jobs and money into Lagos, Mexico City or Mumbai, the rise in higher education bringing different students into the same City, or international marriages, we have obvious challenges to the traditional image of what a local person is. All through this there is a sense of community maintained, which has its basis in some form of love.

5.1. Culture as a system of loving individuals

As discussed above, the claim that love makes on us is broad, it is to love all people rather than just our friends. As Aelred of Rievaulx in the 12th century noted, "more are to be received into the bosom of charity than into the embrace of friendship. For we are compelled by the law of charity to receive in the embrace of love not only our friends but also our enemies". The concept of charity refers to agape, and numerous examples were given as quotations in section 2.2.

Singer (1984) wrote that "the great event in the history of thinking about love is the conceptualization of agape". He could have benefited from a broader analysis to include Eastern thinkers, like Mo Tzu or Buddha, but the same parallels can be drawn. We cannot restrict our love to those we find lovable only insofar as they are good, enjoyable, or useful. The neighbour as an object of love is any human being, as in the parable of the Good Samaritan (Luke 10: 29-37, Bible).

One of the simplest forms to observe love in action is how much hospitality is shown to family, friends and strangers. As discussed in the previous chapter, modern urban society has made it difficult to continue the traditionally more hospitable rural practices of welcoming visitors to the house. Ironically as people live closer to each other physically, in the extreme in apartment buildings, they may have more barriers to visitors than the traditional rural setting. There may be other factors for this, such as the need to protect oneself against dishonest persons who are now living in close proximity yet may be completely unknown because of population density, or whether people have a limit to the number of relationships they can sustain. It would make an interesting question to examine the number of personal contacts that people meet in their daily life in rural and urban environments, and in different societies. There would no doubt be wide individual variation.

The impact of living conditions on hospitality does not explain the cultural variation in hospitality practices. Anthropologists and historians have argued that in societies that seem as different as Homeric Greece, early Rome, medieval Provence, Sudan, the Maori, and Indian tribes of the North West Pacific Coast of Canada, hospitality was based on fundamental beliefs on the social universe, not just personal preference (Finley, 1954; Bolchazy, 1977; Heal, 1990). I think we can find it even wider if we look. We can also find debate on the extent that hospitality should be offered, within each period and society, even though there may be cultural common sense in how to respond to strangers who come to your door.

The form of hospitality may vary with sexual roles, for example in many countries a woman would have been expected to provide more food as hospitality than a man because of the traditional roles of women as a cook, but this is changing. Therefore analysis of the spirit of love and the outward sign need to be carefully considered. An analysis of hospitality in 14-17th century England (Heal, 1990), found its origins in the Christian idea of beneficence and in the knightly culture which gave a sense of obligation to give food and lodging. Few could meet the broad definition of hospitality of George Wheler (1698) who defined hospitality as "a liberal entertainment of all sorts of Men at ones House, whether Neighbours or Strangers, with kindness, especially with meat, Drink and Lodgings". This type of hospitality was located in the house and practical, involving food and accommodation.

The offering at least of a cup of tea to a visitor is found still today in many cultures, although few would offer a full meal, and fewer would offer a bed to sleep. A common line from many beggars in the USA is "Can you spare me money for a cup of coffee?", whereas it is usually food that an Indian asks for. In many other cities it is just money. Like the child in Figure 7, it could be love that is wanted. We could say that the expression of love in the form of food or shelter, two basic human needs, has a central meaning throughout the world. Communities that express more love could be expected to have adequate social welfare systems for looking after those in need, the homeless, the hungry, and the sick. They would also be expected to give love over their borders, helping the strangers in the global community, as seen in the Red Cross/Crescent/Star aid organizations and a host of others.

If we were to try to judge societies as a whole, we would have a variety of measures that could be used, but it would be difficult to claim any one was the ultimate measure of a loving country. There are wide variations in foreign aid contributions, usually finding Scandinavian countries the most generous and the USA less, among the rich countries, but these contributions may be decisions of governments and politics rather than individuals. Charitable foundations collect money, as do churches, from individuals with wide variations in the amounts given.

Hare (1981) argued that if we are deciding the preferences to use in ethical reasoning we have to treat everybody as one, including ourselves: to do unto others as we wish they should do to us, and love our neighbours as ourselves, but not more than ourselves.

A word which is often used politically not only ethically as an expression of social love is solidarity. This word is more common in European English than in US English, which reflects the degree to which the spirit of it is found. Love is expressed to those who need support, money, housing, jobs, personal assistance, welfare, and generally more help than the average of society (we should note that a half of society is below average in any measure by definition). Meyers (1994) considers solidarity as indispensable to considering culturally normative prejudice and differences among persons. She considered that prejudice and emotion normally pose barriers to insightful moral reflection, and that these prejudices will be found among socially disadvantaged groups as well. People have to learn how to express love as broad empathy. She, however, considers universal solidarity as unrealistic, focusing attention on how to develop solidarity within certain groups at least.

One can be cynical about how much we desire equality, as Henri Becque, the 19th century French playwright wrote, "The defect of equality is that we only desire it with our superiors". In this case the love of others is balanced by self interest. The Theory of Justice of Rawls (1971) asks us to imagine what society we would like if we did not know where we would be in that society before we are born. As the 17th century French writer, Francois Duc de La Rochefoucald wrote "The love of justice is, in most men, nothing more than the fear of suffering injustice".

I think that we should be bold and build upon the foundations of universal solidarity that the mass media and common language is building. The mass communication media has had a great impact. The traveler can see the evidence for this in the presence of satellite dishes on rural huts, something I have seen in every country I have visited. Once electricity comes, the cable and satellite television networks are to be found, which could be said to have catapulted the internationalization that global radio broadcasts effect.

If you doubt that we are mixing the world, look at the world and ourselves. In many countries it is apparent when you walk in the street, or read the newspaper, that the country is mixed. Ever more than before, universally applicable ethical principles are to be found, and are also necessary. Many immigrants from a range of countries have come to the new countries like Australasia or America, and to the centres of the old European Empires, especially Britain and France. The practices and faiths that immigrants are accustomed to differ from each other. The indigenous people in Australasia and America, and the southern part of Africa, and with other Asian examples, have been suppressed and although they have been overrun by culture introduced from the immigrants countries, often a new culture has emerged. This continues to be a source of friction in some countries, because the groups may try to form an "us" and a "them".

Surveys and observations show the complete diversity of attitudes to any question are represented in any one society. The same can be said of the characters of human individuals, which are also seen as a range in all countries, whatever personality range we chose. A failing of human thought is that people view their society as being different from another, with sweeping generalizations. Such thinking is often tied to discrimination, for example men are..., and women are...; whites are..., blacks are..., and Asians are... . Such thinking, of "us" and "them" is a root of much disharmony in the world, and should be actively discarded from thought.

Another point of groups in society is that the groups we join within society may not follow any strict pattern, rather being mixed with people of many personalities together. Kinship and families have been a traditional grouping of people, but we often find divisions in attitudes among each member, especially if we ask them independently. Other types of social organization have become important, for example, grouping by sex, age, common interest and class.

Although there may be broad tendencies for soccer players to be more physical than chess players, aerobic classes and religious groups do not follow such divisions. If a person joins more than one group it is likely to be made of people of different personality, even though there may be social class divisions. We also may have several different identities, especially living in multiracial and ethnic communities, for example as Roman Catholic Italians with a touch of Ugandan who play Bridge, but live in Chinatown in the City of Sydney, Australia, we may join anyone of these groups when we want to be socially identified. Sports fans are yet another interesting phenomenon, with diverse social groups uniting to support a local team, and even becoming involved in close-to-war like clashes with the neighbouring fans of rival sports teams.

The results of the 1993 International Bioethics Survey suggest that there is at least as much diversity in individuals in any one culture as across the world (Macer, 1994). This could be consistent with a strong genetic determinism of behaviour, beyond social norms that mould thinking. If each culture had there own range of diversity we would expect that behaviour was environmentally conditioned by the social and educational system - however, the data suggests that inside every culture there is equal diversity - consistent with more genetic determinism.

In that 1993 survey first performed in Australia, Hong Kong, India, Israel, Japan, New Zealand, The Philippines, Russia, Singapore and Thailand, the purpose was to look at how people think about diseases, life, nature, and selected issues of science and technology, biotechnology, genetic engineering, genetic screening, and gene therapy. In total nearly 6000 questionnaires were returned from 10 countries during 1993. The questionnaires included about 150 questions in total, with 35 open-ended questions. The open questions were designed not to be leading, to look at how people make decisions - and the ideas in each comment were assigned to different categories depending on the question, and these categories were compared among all the samples. People made very interesting comments. The diversity of comments was found to be the same in different countries, suggesting that reasoning about these issues goes deeper than cultures, or religions. Although societies are different, people and families are not, and there may be a finite number of principles used in arguing about any one dilemma (Macer, 1994).

Human beings have a common ancestor but there is much variation. Racial boundaries are the most apparent differences in the world, one of the reasons why they have so often been used as a basis for discrimination. These racial boundaries are slowly disappearing with many intermarriages, though the attitudes to mixed race offspring has sometimes placed them in another group. The cause of racial discrimination is also related to social, linguistic and cultural heritage and geographical factors. Racial differences were not seen in the results to the surveys, nor were there many cases where age was related to attitude. Other forms of social stratification were also not seen as major predictors, such as wealth.

Biological differences may also be the root of some discrimination against people with handicaps, for example people with Down's syndrome or physical handicaps are seen as different. There are many thousands of genetic diseases that are known, and we all share many disease-causing genes, whether they be causing cancer, heart disease or weak bones. There is genetic diversity, and genetically we can show that every person has numerous genes that are related to disease. Some genes are very common, for example, around 10% of people have the gene (ApoE4) which is a risk factor for Alzheimer's disease. We are also all carriers of potentially fatal genes that could kill any future children if we have the bad luck to marry someone with one of these corresponding genes, and the bad luck that these two fatal genes join together in our offspring. Fortunately many of these genes are recessive, meaning that they will not cause disease if the other copy of the gene that we have is normal.

People could be said to be what they are seen to live or die for. Ourselves, our vocation or work, our perceived duties, our spouses, lovers, colleagues, family, all those we love. How many people can we love at one time and at what level? Many friends we see less that once a year, yet we stay close. Other people we meet in a different relationship everyday, but may stay distant. Most see their spouse every day others less frequent, but can we measure love by time spent together? Can we love people with the same intensity - to lighten our heart? How many pieces can our own heart be divided into? (Figure 8) Does the heart grow with giving or receiving love? Can our heart be broken more with love or hate? How does it change in ourselves, and can love from one person to another result in hate back? Unselfish love, agape in Greek, should not result in hate as there is little to hate in it, unless misunderstood.

One of the universal examples of love of others seen in medicine is the gift of blood. Titmuss (1972) in The Gift Relationship described blood donation as a study of the role of altruism in modern society. He argued that a social policy to have gifting of blood rather than commerce made a more loving society. There are other arguments in favour of donation as well, that it is often unnecessary, it can be safer as the poor who have a higher frequency of disease do not sell for money, it does not lead to exploitation of the poor, nor commercialization of the human body. This spirit of love has led to the extension of the principle of giving into law, and Article 3.4. of European Commission directive 89/381 requires member states to "encourage the voluntary unpaid donation of blood and plasma" (Keown, 1997).

Love is the message of our spiritual heritage, across each culture they say God is love. Why have religions fought wars with others and within different schools, while also seeking peace? It is the same as other passions of the heart, we desire one action yet we accomplish another. The spiritual origins of humanity are less mixed than the social ones, and these have been used as transnational boundaries in the past, and also today. The Islamic countries, Catholic countries, and loosely-called Christian countries, are major regions of the world. Asia has more diversity of religion, for example, Buddhism in Sri Lanka is different from that in Japan. Within Asia there are also many Christians and Muslims, and most of the world's religions.

Despite the scientific world view that is prevalent among academics, most other people find religions to be a much more important source of guidance in life than science. In questions of ethics, this is true of most people. Any theory of bioethics that will be applied to peoples of the world must be acceptable to the common trends of major religious thought. At a first look many people have suggested that the religious differences are too great and have looked towards a new type of foundation for bioethics based on humanism (Engelhardt, 1991). However, we should look again at whether the differences between religions are actually so important when it comes to bioethical thinking, and we may find that it is more important to look at the individual level between people.

The character to be a giving personality appears distributed through most societies, and may not always be associated with following of a religion which promotes giving, though it would not be surprising if both factors were selected together. Human society has also had lower and upper social classes, but society admires those who give to the poor. We can see examples of noble people giving to the poor or workers from around the world. For example, in Nottinghamshire, UK, Robin Hood took from the rich to give to the poor. In Japan, Mitukuni Tokugawa (1628-1700), who wrote The Great History of Japan, and was the Second Duke of Mito, is admired for his humbleness and kindness, and solidarity with the lower classes by constructing their gate for his residence better than his own, and not sitting elevated among the ordinary people of the society. Julian of Norwich lived in Medieval England and wrote that the qualities of homeliness, compassion and courtesy are the effects of God's love (Vinje, 1983).

Nasir ad-Din Tusi in the Nasirean Ethics of 1235 A.D. wrote that Man has a natural yearning for the synthesis that will render all individuals together, comparable to the organs of one individual, and this synthesis is love (Wickens, 1964). He considered love above justice because justice requires artificial union whereas love requires natural union. The need for justice arises from the loss of love, because if love were to accrue between individuals, there would be no necessity for equity and impartiality. He divided love into natural, like maternal love, and voluntary love. He gives the reason for love between young men as that of pleasure, while that between old persons is for common advantage, but that between good men is brought about by correspondence of substance, if their goal is pure good and the quest for virtue.

In Indian Hindu tradition, it is difficult to generalize among the traditions. One tradition says brahman ("all this") cannot be loved because the very idea of brahman precludes distinctions between object and subject, lover and beloved, rather they are together so love is not needed to join them. Love is attachment to empirical existence, and does not play a part in the Samkhya-yogins effort to isolate his individual, eternal self from all that is temporal or in the Vedantin's effort to fully realize all that is temporal (Siegel, 1978). The Bhagavad Gita reads that the man of wisdom "has no love (sneha) for any thing" (II. 57). It however, says unattached devotion to God leads to liberation, but not passionate love. The term bhakti, for love, means "to eat, partake of, enjoy, to rever, love". It has also been called devotion and is disinterested service to God, and the love of God is the supreme love, every other form of love is an imperfect manifestation of this supreme love. The Upanisads (the concluding part of the Veda) posit the transpersonal spiritual principle of brahman as the object of intuitive knowledge, while the Gita identifies the ultimate as a personal deity, Krsna, and points to him as the only legitimate object of devotion. The life of the devotee (bhakta) is based in commitment to the achievement of a high degree of self-control, indifference to both pleasure and pain, equal treatment of friend and foe alike, and compassion and friendliness toward all creatures.

Hindu social ethics find two basic ways for a person to base their life, the way of the worldling (pravrtti) and the way of the ascetic (nivrtti). The passionate love, kama, is the basis of four stages of life and can foster a desire to live in harmony with the will of God or to be united with God (Eliade, 1987). The Vaisnava Sahajiya cult of Bengal in the 16th century attempted to make a clear distinction between desire or passion (kama) and the altrusitic love of God (prema). Prema can disengage one's attachment to the self and transpose feelings of selfishness and greed into the total commitment to the pleasure of Krsna. If we look at Indian society we see respect for nature and for others in society, and there are other traditions which explore love. The example shows us that the concept of social love, and the concept of social harmony may be separate in tradition, but I would argue that it is a matter of semantics.

There are still writers in the Western tradition who have emphasized that the fact that human beings are in relationships with others means ethics should not be based from an individual viewpoint. Eugene Fontinell (1968) argues that the world is a world in process, and it is not a world of substances but a world of relations, called processive relationalism. The human person is treated as communal entity who can achieve greater individuality only by greater participation in the various sorts of communities, families, and culture of which the person is an expression. Love can be considered as the means to bring separated persons together as a unit (Dilman, 1987).

Before we go on to look more in detail at the bioethical theories that are associated with particular cultures, there is another apparently universal phenomenon. It is that despite the idea that love of money corrupts, without money in a society solidarity within a group may breakdown. When faced with economic hardship most families focus on their own survival and feeding the family members first. We can see this among refuges and in wars, where people fight for food at least for their own children. William Caxton in The Game and Play of Chess (1476) observed "Love lasteth as long as the money endureth". There are exceptions, and I would suggest that the richest people in the world may not be the most generous generally, as the two traits of gathering money and sharing money seem to be contradictory, however once a society reaches a reasonable standard of sufficient food we often see many more voices in that society asking for sharing of wealth.

Solidarity also appears easy to lose in a society, as seen with the examples of countries privatizing health and social welfare systems after establishing them. Some have remarked that New Zealand was the first country in the world to establish full social welfare based on a person being entitled to all because of their existence as a person, yet it was also the first to attempt to do away with this system. However, many basic parts remain, so it would be unfair to make a complete generalization that social welfare is dead. Many countries have followed this pattern, and the USA has not reached the full universal health care system so it does not have so much to dismantle. The pressure to privatize health systems was growing financial debts, supporting the views that you may need the sense of financial sufficiency before showing full solidarity, and that economic recession leads to more selfish thinking. Sadly such recession also leads to more need.

The presence of resources and wealth may make our ethical attitudes more generous, not only to human beings in social welfare, but also to the environment and animals. We can see this by the growth of animal rights in richer countries. De Waal (1996) considered morality as a floating pyramid with the buoyancy of the concept determined by the resources available, but always with the order from top to bottom, self, family/clan, group/community, tribe/nation, all of humanity, all life forms. The exception however, is religious prescriptions against killing of animals, seen in Hindu or Buddhist countries, or Eastern countries where some parts of nature in religious temples or sanctuaries are preserved despite immediate human needs to harvest them.

5.2. Systems of bioethics in different culturecultures

There may be many common features of societies, but despite the individual similarities there are linguistic and religious differences which have lead to the adoption of cultural-specific systems of bioethics. Dependence upon group living for survival is a basic human characteristic. There has been much written about the differences in bioethical systems, reflecting the general trend discussed above to separate "us" and "them". The trend to separate results in war and conflict (Figure 10). Some writers like MacIntyre (1984) portray a pluralistic society that is too fragmented by disagreement and conceptual diversity to sustain rational discourse, while others are less pessimistic (Stout, 1988; Macer, 1994). Rather than continuing to accept unquestioned the viewpoint we have on the extent of cultural diversity, let us examine the ways of bioethics in different countries and re-evaluate what criteria for similarity and difference we should be using.

In 1993 a Parliament of the World Religions was convened. It included peoples from many religions and cultures, who came together and made a Declaration toward a Global Ethic (Kung, 1996). They wrote that an ethic already exists in the religious teachings of the world which can counter the global distress. They included four irrevocable directives common to religions:

1) Commitment to a culture of non-violence and respect for life;

2) Commitment to a culture of solidarity and a just economic order;

3) Commitment to a culture of tolerance and a life of truthfulness; and

4) Commitment to a culture of equal rights and a partnership between men and women.

They pointed out several directives that are found in all religions, including: have respect for life. They extend this principle of respect to the lives of animals and plants. Another was to deal honestly and fairly; to speak and act truthfully, and to respect and love one another.

Basically if we are looking for differences we will find differences, and if we are looking for similarities we will find them, it is a question of the width of the concepts we are using. For example, if I emphasize individual autonomy I could exercise that autonomy after consultation with my family or friends, and seek consensus and agreement with them, or I could make decisions completely independent of others and just inform them of the decision that I had made. Both of these cases are expressions of autonomy, because they are self governing of the person involved, but this question of the unit of autonomy and the consultation with others has been used to claim that the bioethics of Western and Eastern people are fundamentally different. In fact over time the Western tradition of involving others in decision-making has changed to become more independent but there is still wide variation in all societies over the consultation within a family, the issues that are discussed, and the affect those discussions have on the persons decisions. The change to more individual based societies and nuclear families has also been observed in Eastern countries, like Japan (Ochiai, 1998).

I do not have space to review all social systems, but discuss some examples keeping in mind the question of universality consistent with recognition of individual diversity. One of the assumptions of modern ethics is that all human beings have equal rights which should be protected, and recognized. Fifty years ago, in 1948 the Universal Declaration on Human Rights was signed, and it has now reached all countries in the world although the acceptance by governments is not universal or consistent.

We can argue for the foundation of human rights from secular philosophy or religion, but also from love. There are numerous human rights, but the right to life is based on love of both personal life, and autonomy, and justice, the respect for others. The constitutions of all countries also reflect at least some of these rights, and only eight countries in the world lack a constitution (including New Zealand and UK).

Perhaps the most common violation of respect for persons, or love to others or human rights, is war. War is a universal phenomenon, and modern wars have generally become more bloody and longer as methods for killing and supply systems developed. As archaeological evidence is uncovered it has become more apparent that ancient societies that were thought to be peace-loving had major wars, such as the prehistoric North American Indians (Pringle, 1998). This should not be a surprise since Neanderthals seem to have been out competed by Homo sapiens, and Homo sapiens out-competed previous species of the genus Homo that had spread around the world earlier. It cannot be proven that climate was not the major cause of extinction, however at least populations were in competition and we can expect that wars occurred. Wars may suggest that hate is stronger than love at times, but they at least show that human passions are very strong, and stronger than the common sense which says that wars are bad for a society in the long term.

All people will at times have conflict with others, conflict with the will of others or even life against life. Force can be used to solve these conflicts, but this may not mean violence or even threats, rather it can be the force of non-violence. One of the greatest victories of non-violent protest has been the liberation of India from colonization, which resulted in Independence in 1948. The key person in this was Gandhi, who said that love demanded non-violence. Gandhi (1927) wrote that "Belief in non-violence is based on the assumption that human nature in the essence is one, and therefore unfailingly responds to the advances of love". He coupled non-violence to the doctrine of Satyagraha, soul force, as a spiritual power which is exercised in love against all material power. Gandhi built his concept out of Hindu Ahimsa (do no harm), and Christian and rational ethics. He regarded the only means for realization of Truth is ahimsa. He considered that a person must of their own free will put themselves last among his fellow creatures if salvation was to be had. In Jainism virtue consists in the fivefold conduct of a person who has knowledge and faith. The first of these is ahimsa, which can also be called innocence, but it is not mere negative abstention, but positive kindness to all creation (Radhakrishnan, 1940).

Martin Luther King and partners applied non-violence to attempt to remove racism from the USA, in their case using the power of television as well to convince the other citizens of the cause. Non-violent strategies may require a minimum sense of social responsibility and order, but they have worked in breaking down the Iron Curtain of Eastern Europe, and can be expected to work in the future also. However, there may be cases where the great number of lives lost without aggressive action will overwhelm most of our reservations about taking of human life to protect others, and probably we all have some limit for the number of lives we tolerate to see lost while maintaining a non-violent moral stand (though usually apathy is the main cause for death from war that is not opposed by the international community).

One of the most common images across the world of love is maternal love (Figure 11). In religions we can see many examples of this. In Christianity Mother Mary is portrayed as the ideal all giving mother, especially venerated in Roman Catholicism. Feminine love has also been praised through time, for example Julian of Norwich who was deeply convinced that God was love and expressed this in a gentle personality (Vinje, 1983; Llewelyn, 1985). In Buddhism, the white goddess Tara the Shakti of Avalokiteshvara (in Japanese Kwannon, in Chinese Kuan Yin) is the goddess of love and mercy. As the goddess of creation she is the deity who gives children to families. In Japanese tradition Kannon once turned Hell into Paradise, so the god of Hell sent her back to earth because hell should remain gloomy (Knappert, 1995). In Java, the moon goddess, Dewi Nawang Wulan, is associated with love and fertility. It is not surprising that maternal love is universally recognized as godlike, the demands of feeding and nurturing a newborn infant are at the limit of normal attention one person can give to another.

Westermarck (1906) argued that not only was maternal love universal but so was father's love of his children. He considered it equally primitive that men support and protect their family. Biologically we can argue for the importance given the investment can lead to survival of the genes of the father not only the mother.

Children are also universally expected to honour their parents and look after them, however in practice modern society has tended to a nuclear family with less protection being given to parents. Nevertheless when most of us are asked whether we would love our mothers more than the neighbour we would put our family first. Long postmenopausal life-spans distinguish humans from all other primates, but it has been suggested to be due to mother-child food sharing which means aging females can increase their daughter's fertility (Hawkes et al. 1998). Only in humans do mothers provide the substantial proportion of their weaned children's diets, and this division of labour has made human society more complex and allowed the species to support more aged members than other animals.

Rawls (1971) assumed that psychologically a child only loves parents if they manifestly first love him. The child's actions are determined by certain instincts and desires, and their aims is determined by rational self-interest. Rawls writes, "Although a child has the potentiality for love, his love of the parents is a new desire brought about by his recognizing their evident love of him and his benefiting from the actions in which their love is expressed." However, love of children can also been seen for parents which they have never met, such as lost fathers by separation or by donor insemination of sperm, or adoption of children away from their genetic parents. However, they still need to trust themselves and others in order to show love. The curiosity of knowing one's roots may also be self-interest in development of our personal psychology and identity. Normally, however, by parental love a child develops a sense of their own value.

Humans also have a long gestation period, nine months, through which the pair-bond should be maintained which could be seen as a reason for the development of a strong romantic love or attachment. While more bird species are monogamous than mammals, we can question whether birds share the depth of feelings of love that humans, and it may be a form of genetically selected love-bond. Humans are unique in that the females are sexually active even when not ovulating, a trait that has been linked to the development of bonds between people. Biologically we can argue that sex in humans first has a function of emotional bonding, and secondly reproduction (Wilson, 1978). However the Roman Catholic Church uses natural law theory to suggest the reverse, something which is not supported by the behaviour and characteristics of human love and sex. If natural law theory is not based on biological nature, than it weakens its claims of authority. It has been used as an argument against contraception, and against forms of sexual relationship that are not procreative, however, naturally most human mating is not.

One measure of bioethics is the expression of virtues. There are some social customs or games or interests where excellence is less universally appreciated as a positive character in a person. MacIntyre (1984) explored virtues, looking at goods internal to social practices, goods for the whole human life and ongoing traditions. By social practices he defined "any coherent and complex form of socially established cooperative human activity through which goods internal to that form of activity are realized in the course of trying to achieve those standards of excellence which are appropriate to...that form of activity, with the result that human powers to achieve excellence, and human conceptions of the ends and goods involved, are systemically extended" (p. 187). Internal goods come from the activity itself, while external goods may come from reasons that are not associated with excellence in the activity. He tries to give examples of activities of social practices, like arts, sciences, and games, but he says other practices like bricklaying or planting tulips do not because he claims they do not have established systems for excellence. Perhaps the bricklayers of the world would disagree, and he could be accused of elitism by claiming that bricklaying is not an art but philosophical thinking is. He included medical practice as a social practice. I would argue that the pursuit of excellence is admired in most activities, and there would be more consensus that it is better to be doing our best at something than accepting to be mediocre, than there is consensus on what is an "art", and what is not. Love of our own life would support the concept of pursuit of excellence, because we will strive to do the best we can to pursue our potential to the fullest, and socially this drive for being excellent, professional, or as good as we can be, is admired in others as well as we personally attempt it and developing our self-confidence.

Fletcher (1966) argued that justice and love are inseparable, and that justice is love using its head, calculating its duties, obligations, opportunities, and resources. He said that if an action or policy was loving, it will be just. The more just, the more loving; and vice versa. Many critics of Fletcher disagreed with the view that love was equal to justice. Some consider justice is usually impersonal while love is personal (Brunner, 1945). Justice can be defined as distributive justice, giving each person his due, or communitive justice which establishes a collective order of freedom and mutuality. While love is self-sacrificing, justice is always an accommodation of the interest of each in relation to the other (Niebuhr, 1941). There are transcendent principles of justice, such as freedom, equality, order and mutuality found in most societies, but these principles are applied by contending interests (Williams, 1967). There are ideological biases in each issue that justice is evoked to serve. We could say that justice should be another form of the embodiment of the spirit of love.

Loving concern seeks the widest distribution of benefits which is what justice is. However, situation ethics does not necessarily support any political viewpoint or standpoint on one issue like pacifism, or socialism, it treats each based on the situation. Catholic moralists separate love as supernatural virtue and justice as a natural one, stating that we must be just in our actions but it is our virtue to be loving - which Fletcher (1966) considered absurd. Rawls (1971) tried to distinguish between love of humankind and justice, writing that the love of humankind has a greater intensity and persuasiveness of the desire to love, going further than demanded by justice. Still love and equality are closely connected, as Erich Fromm wrote "The social process requires the standardization of man, and this standardization is called equality". In a positive sense we could call this standardization the process of bonding (Eibl-Eibesfeldt, 1971). We should not consider the worth of persons but their needs (Smith, 1974).

We can turn to specifically medical ethics and we see a number of common trends, one of which is justice. Judaism includes guiding regulations for the appropriate behaviour of followers in Jewish Law, both the rabbinic tradition or Talmud, and the Torah (scripture). There is a description of the proper attitude people should have to wise doctors written about 180 B.C. in the Old Testament Biblical book, Ecclesiasticus 38: 1-15. It describes a physician who conscientiously practices his profession and is an agent of God. This attitude is found in Judaism, Christianity and Islam. A principle ethical code is the codification formerly ascribed to Moses Maimonides (1135-1204). Unlike the Hippocratic Oath, but in common with some codes, such as the ancient Chinese code, and Christian charity, there is the idea of helping the poor and needy, which we can call social justice (Jakobovits, 1975).

Modern Islamic ethics uses a system based upon moral law as recorded in the Koran and the Hadith, and is basically "Allah's will be done". If an explicit reference to the classical sources of Islamic law cannot be found, then it may be considered in the light of "public benefit" (Maslaha). Islamic ethics is gaining importance because of the number of Muslims in the world and the greater desire to follow the Islamic lifestyle by them. Islamic medical ethics was largely formulated during the ninth and tenth centuries, while Arab scholarship was at its zenith, with influence from the Hippocratic corpus. Islamic culture is based on the Koran, with the medical tradition having dual sources from scripture and the Hellenistic world. What was to emerge was not a dichotomy but the growing Muslim civilization developed a mixed approach of drawing on other values, the way of "adab" (Nanji, 1988). This balance was framed in the ninth century work "Practical Ethics of the Physician" , which actually was written by a Christian, Ali al-Ruhawi.

The former Soviet-block communist world is in a process of change back to Christian roots, and has undergone a process of transition. Socialist medical ethics also involves using oaths, for instance the "Oath of Soviet Physicians" in 1971, which replaced the Hippocratic Oath. The pledge of loyalty changed to the service of people and for the interests of Soviet society. This is in contrast to the Hippocratic Oath where the physician must work for the sole interests of the patient. In socialist countries the right to personal health care was also stressed. However, with the fall of communism in Eastern Europe many countries have rapidly lost such ideals of justice and have switched to private medicine, and social justice is being lost as an ideal especially in the economic recessions. Nevertheless, the physicians are still respected much more than the government.

Chinese ethics, including medical ethics, involves the convergence of Confucianism, Taoism and Buddhism (Unschuld, 1979). Communist ideology also continues to have influence, but equality and "social harmony" have older roots. In the seventh century Sun Simiao wrote "On the Absolute Sincerity of Great Physicians," sometimes called the Chinese Hippocratic Oath (Qiu, 1988). Among the commitments are equality of treatment, attempts to save all creatures, and not to seek wealth. The Confucian scholar Lu Chih (754-805) urged similar virtues, of humaneness and compassion, stating that the medical resources must be distributed fairly among the population. The Taoists and Buddhists, revised this with the concept of "Great Physicians" who possess special knowledge and responsibility, thus creating an elite. However, there is a strong emphasis upon the virtues, including the concern for equal treatment of all classes, with writers such as Kung T'ing-Hsien in 1615 attacking those physicians who had reduced medicine to a profession. It is historically interesting that before the communistic ideal of the last few decades there has been a long history of the idea of equality which is not found in the Hippocratic tradition which addresses behaviour to the individual patient only. They do share the concern for a prohibition on killing, and the two sides of ethical behaviour, to do good and not to do harm.

Japanese ethics is a mixture of Buddhist and Confucian influences combined with Shinto influence, and could be said to now be rather pragmatic and centred on the authorities (Macer, 1992b). There is universal health insurance which does support the concept of social justice and access for all to health. Informed consent is becoming accepted, and bioethics may transform Japanese society. The individual attitudes of Japanese are generally similar to Westerners, as shown in surveys (Macer, 1992; 1994).

The World Health Organization which represents the united world governments has for many years promoted a policy of "Health for All". This is based in the concept of love for all people, and social justice. While there are major problems of corruption on the world and in many societies, that spoil the pursuit of equal access for all, the ideal could be said to be shared.

5.3. Limits to freedom

All societies have introduced limits upon individual freedom. Some of the limits on action are based on the principle of loving justice, as discussed above. How do we limit freedom when it only endangers personal health? The more dangerous sports may not be privately insured because the price for all increases too much. However, the public health and emergency services will still treat someone injured by accidents. Law may impose cycle and motorcycle riders to wear helmets but love demands treating those injured more worsely because they didn't.

Public health is a field focusing on societal health issues. Laws attempt to prevent import of diseases. Persons who are considered a risk to others are locked up in jails or mental health institutions. J.S. Mill (1861) wrote that the only purpose for which power can be rightfully exercised over any member of a civilized society against his or her will is to prevent harm to others (Boughton, 1984). However, the government of a society has a duty to use public money wisely. Compulsory health and safety regulations can be consistent with paternalistic love, but if they inhibit self love and fulfillment they may diminish the freedom we give as a recognition to persons capable of love.

In religions there are various levels of compulsion given to the following of the doctrines. The idea of freedom of thought and free will means that you can have any belief you like inside your head, but actions may be controlled. In the 1990s one of the most strict societies is the Taliban in Afghanistan, who forced women to quit work, education and stay out of society, and forced religious observance according to their interpretation of Islam. At the other extreme, we can see butchers tolerated by Indian Hindus, and even those who eat beef are still welcome in the folds of the Hindu religion. There are some studies suggesting that religiousity is associated with less willingness to behave unethically (Kennedy & Lawton, 1998). There were few correlations with general bioethical attitudes and religiousity in the International Bioethics Survey (Macer, 1994). Though in some countries more religious persons made more judgmental comments against persons with AIDS, suggesting they were more ready to blame others.

Preventative health measure vary between societies. Some local councils do not allow fluoridation of water to prevent dental caries. Smoke-free environments have increased given the damage to others caused by passive smoking, rather than personal health damage. Some employees encourage exercise, and in some Japanese companies it is expected that all will exercise in the morning for their general health.

There are also limits to personal action that are seen in voluntary actions of individuals. Among young people there is a tendency to avoid being a "tall poppy" in the field, to purposely limit display of some character or ability so as not to stand out too far beyond others. This sociability is found across many cultures, and is seen even when there are rewards for pursuit of the skill to which the child may excel, so as to appear within the group. I have also seen this in language skills, where a person who can speak will deliberately not speak or make mistakes so as not to show off. There are of course individuals where there are no inhibitions to action, and also societies which tend to reinforce individual displays of ability.

We could theorize that social instincts may come from the same characteristics that lead many animal species to exhibit group activity for promotion of the group, a tract seen in insects such as ants, aphids, bees, embids, mites, termites, thrips and vespid wasps, and in many vertebrates. Many of these social animals have been known for millennia, for example the hamadryas baboon was held sacred by ancient Egyptians (Kummer, 1998), and it has the most complex social organization of any species of non-human primate. As we study more animal species we find more of the traits that have also been seen in human societies, which will be further discussed in the next chapter. In all societies there are limits to the pursuit of individual freedom for the general good of society, whether human or termite. However, obviously we do give more rights to people than we do to insects, and we have to consider autonomy of individual persons very carefully before limiting it.

When societies reached a certain size the biological principles of kinship were no longer the primary organizer of behaviour. In this case religious or political ideologies take over their roles. Tiger (1993) argued that "However complex such ideologies may be, they are, nevertheless, biologically predictable products of a species committed to generate both affiliative and separatist/agonist social networks". Tiger considered human aggression is a series of steps, and said that large-scale human conflict depends on symbolic determination of who is friend and who is foe, but once the symbolic group is established because the brain evolved to act rather than think, people expend considerable energy in doctrinal disputes sometimes resulting in actual conflict. The limits to freedom then become determined by sometimes arbitrary moral rules, for example the wearing of particular clothes as a custom, unless we can develop policy based on deeper moral principles such as love.

5.4. Universal ethics and love

Universal cross-cultural ethics should be developed to allow diverse views to be maintained even within a single community, as well as throughout the world in the global community. Even within a so-called homogeneous culture, such as Japan, there is a wide variety of opinions. The view of life that people have is individual (Macer, 1994), despite the often assumed homogeneity. International communications and economics helps break down whatever geographical and linguistic barriers that remain, though globally it has resulted in deepening divisions between rich and poor nations, another hurdle to the recognition that much of human heritage and much of ethics is universal.

Inside countries solidarity is also broken. The pursuit of individual liberties has allowed the destruction of the common space. Gaylin (1986) wrote that "I am convinced that we have reached the limits of individualism and our survival depends on rediscovering our need for community. In that process we have the opportunity to rediscover love". However, since 1986 the USA may not have become less individualistic, and one wonders where the limits really are.

The same forces that have intermixed populations, and made them heterogeneous, are actually making the world more homogeneous as a whole - making it more similar. The world is losing some diversity. The modern communication media has allowed images of different countries to be portrayed into the homes and minds of the ever increasing number of people with access to them. However, the media image is one that is moulded, consciously or unconsciously by those who transmit and select the news and commentaries of life. The image presented from one event by people and reporters is often different. Media editors actually maintain differences between societies because such news sells better. Selective news which reports on the differences between cultures is very dangerous. They must be indirectly blamed for the numerous detrimental effects of promoting a false view of the world. It will result in wars and divisions, as nationalism grows and people think that others are different from them.

There are enough problems for harmony raised by the lack of understanding due to language differences. If we think that there are 3,000 languages on this planet, we will see that there are going to be misunderstandings. If we expect others to be different then we may read more into a simple smile, frown, or gesture then was intended. Proper communication is very important. Television has brought us pictures of people in distant lands, sometimes we see similarities and sometimes differences. What kind of world does it paint? Is the picture to be trusted? The media has a major positive role to play by becoming more responsible.

Universal ethics also argues that we need to share benefits of new technology and risks of developing new technology to all people. People in developing countries should not be the recipients of risks passed onto them by industrialized countries, despite the economic pressure to allow this. We can think of the dumping of hazardous wastes to developing countries, in return for financial reward, but the environmental and human health consequences of dumping toxic waste cannot be measured. Industrialized societies have developed safeguards to protect citizens, and some of these involve considerable economic cost. While it may not be possible for developing countries' governments to impose the same requirements, they should not accept lower standards - rather use data obtained in countries with strict and sufficient safeguards of health, with the aid of intergovernmental agencies. Any basic human right should be the same in all countries, and this is one of the roles of the United Nations.

We can also consider the imbalance between rich and poor countries in energy consumption, fossil fuel consumption, and use of raw materials. The broad imbalance has been called by some a global apartheid (Haviland, 1997). One North American consumes several hundred times the resources of most Africans. So many indicators of quality of life vary between rich and poor countries, such as life expectancy, pollution-related diseases and leisure time. The right to personal enjoyment of a love of life is denied to many of the world's population by economic and social structures because of a lack of love shown to neighbour.

What is a loving relationship in the spirit of love of life? In modern human culture, "love" within human relationships is increasingly restricted to romantic and/or erotic relationships, familial love, and sometimes friendship. The expression of love of life varies with the culture, even though individual reasoning may be mixed and diverse as shown in surveys. In India young men hold each others hands, young ladies hold hands, they place an arm across the shoulder without hesitation. These same young men and women sit apart from the other gender, a habit which extends throughout life. The deep relationships are generally with friends of the same sex, though as a group, peers, protect, sing, and care for each other.

The same group spirit is seen in Japan. This could be a type of communal love, and we would infer a tendency on the justice---autonomy line towards justice. However, the definition of the boundaries of the peer group are, as not clear as it may seem to an outsider, defined by the social common sense of the individual; and the reactions of the group. As discussed in the previous chapters, the unit of autonomy may be broader than one person, but we have many cases of selfishness at a community level not only at an individual one.

Whatever ideals we or our culture accepts, they need to be balanced, and many people already attempt to balance them. The balance varies more with individuals within any culture than between any two cultures en masse (Macer, 1994). An examination of history also shows how the balancing act has varied in different times and places. From the data, and the observations of many others before, already we may see a type of universal ethics working across the world. In the last chapter I will consider how sustainable living may be possible, and the concept of bioethical maturity. A mature society is one which has developed some of the social and behavioural tools to balance these bioethical principles, and apply them to new situations raised by technology. Rather than judging others the focus should be on what we do ourselves and on how we can work to make a more loving society.

Figure 9: The social instinct to live together

Eating meals outside in an EnglishEnglish Pub garden

- Friendship has many expressions, but sharing food together is one. The desire to eat outside in the pleasant weather also expresses a love of nature.

Termite hills, Queensland, AustraliaAustralia

- Social animals such as insects express the advantages of a group

Tubingen, Germany

- The development of urban societies led to the need to develop social systems to allow many people to life next to each other, sharing communal resources.

Tsukuba Science City, Japan

- More recently people live inside larger apartment buildings

Figure 10: Resolution of human conflict by violence or not?

Kashiwa Shinyru, Japan

- The expression of differences may be decided by a samurai fight

Queen's Guard, Windsor Castle, U.K.

- Most countries spend much more maintaining armies than they do on overseas aid.

Remnants of the Korean War

- At the end of each war many lives are lost, symbolized in the relics.

Nuclear-free PacificPacific

- The protests against nuclear weapons, and the end of the Cold War, have lead to reductions in the stockpiles of nuclear weapons, but conflict remains.

Figure 11: Maternal love

Five images of maternal love.
The Mother Mary and baby Jesus (Pesselino).
Mizuko memorial shrines for lost fetuses and babies in Japan.
The love of babies by dogs, ducks and kangaroo.

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