Medical Ethics & Reverence for Life
- D.S.Sheriff, M.D.
Email: email@example.comEubios Journal of Asian and International Bioethics 13 (2003), 224-226.
Mission Medical College and Research Institute,Thrissur,
There appears to be a lack of consensus regarding a
governing ethical principle dealing with issues in medical ethics. Examination
of several current ethical issues in the light of Dr. Albert Schweitzer's
reverence for life suggests its wide applicability as an ethic to which
questions may be referred, and against which proposed solutions may be tested.
Extraordinary growth in scientific information and
technology, scarcity of resources, economic diversity, and ethnologic and
philosophic heterogeneity all challenge ethical thought. The same factors also
make it difficult to achieve a consensus on a governing principle that can be
the basis for ethical problem solving. Therefore, the likelihood of arriving at
a satisfactory answer to any ethical question arising in medical practice is
considerably reduced when discussants differ widely as to which
"principles" are operative in the given situation. Thus it is
appropriate to attempt to define a fundamental principle, devoid of cultural
and religious bias, which could be widely accepted as the rational basis for
ethical problem-solving. To that end, Dr. Albert Schweitzer's philosophy of
reverence for life is re-examined in the light of some of today's general
medical ethical problems.
Reverence for Life
"Reverence for life" was coined by Dr. Albert Schweitzer
(1875-1965) in Civilization and Ethics,
volume two of his Philosophy of Civilization (1923). Schweitzer saw all life as impelled by a
"will-to-live." Whether conscious or not, all life shares an inner
imperative, a metabolic, healing, homeostatic struggle to reproduce, to
survive, to prevail. "Will-to-live" in this context is
distinguishable from a conscious will (desire) to live: successful suicide
requires that the traumatic insult be sufficient to overcome life's innate
will-to-live. Despite the claim, "I think, therefore I am", thought
does not define existence. To Schweitzer, elemental consciousness of existence,
of this will-to-live, is the prerequisite of thought.
thought derives from a consciousness of one's own existence in relation to the
existence of others. True philosophy must start from the most immediate and
comprehensive fact of consciousness, which says: 'I am life which wills to
live, in the midst of life which wills to live.' ... Ethics consist, therefore,
in experiencing the compulsion to show to all will-to-live the same reverence
as one does to his/her own. There we see the basic principle of the moral which
is a necessity of thought. It is good to maintain and to encourage life; it is
bad to destroy life or to obstruct it . It is not possible to derive ethics
from thought alone. The world of knowledge and experience is so vast that one
becomes overwhelmed before being able to comprehend a meaning for the whole.
Ethics must begin from an intuitive awareness of the interdependence of all
life. We are obliged to live at the cost of other life, and thus experience
other life in our own. Yet ethics may not be realized without thought. From the
tension between awareness of existence and thought comes the concept that it is
good, not simply to preserve and to promote life, but also "to elevate to
its highest value life which is capable of development" . From
awareness of will-to-live arises the widest possible ground of understanding of
As an individual affirmation engendering respect for all
other individuals, reverence for life influences all relationships. It respects
patient autonomy, which is the basis of insistence on fully informed consent,
and enriches the concept of the "patient as a person". It evokes the
ideal of service: "A man is truly ethical only when he obeys the
compulsion to help all life which he is able to assist, and shrinks from
injuring anything that lives." . Thus the ethics of reverence for life
provide a basis for the claims of professional duty enshrined in various
medical oaths. In reverence for life, "primum non nocere" finds not
only its ethical basis, but also its positive corollary.
The Dying Patient
its affirmation of individual responsibility for ethical decisions, and in its
respect for the autonomy of others, reverence for life acknowledges the
perogative of patients to withdraw from treatment at any time, or to
"withdraw" prospectively through a clearly stated "Living
Will". Reverence for life treats all persons with dignity. It finds
dignity, not in the coming death, but in the remaining life. This was vividly
illustrated by the medical care he received during his terminal stages of life.
Because of the evident irreversibility of his condition - deepening cerebral
coma, increasing uremia and developing pneumonitis - no further diagnostic
measures or specific therapeutic measures were carried out. He continued to
receive constant and excellent nursing care, but he did not require any
analgesic medications, for at no time was there any evidence of suffering .
affirmation that "Ethics are responsibility without limit towards all that
lives"  would extend ethical concerns to the fetal patient, in the
present age of fetal surgery. Such concerns are not limited by considerations
of fetal age. Nor does Dr. Schweitzer write specifically of abortion. In his
general writings we find clear acknowledgment that in the chain of survival of
all life, life takes life, and that of necessity some choices must be made.
Yet: The ethics of reverence for life know nothing of a relative ethic. ...
[they] compel [man] to decide for himself in each case how far he can remain
ethical and how far he must submit himself to the necessity for destruction of
and injury to life, and therewith incur guilt.  Choices must always be
individualized. The ethical tension must be resolved in each case and the
ethical responsibility may not be displaced to others.
In ethical conflicts humans can arrive only at subjective
decisions. No one can decide for him at what point, on each occasion, lies the
extreme limit of possibility for his persistence in the preservation and
furtherance of life. He alone has to judge this issue, by letting himself be
guided by a feeling of the highest possible responsibility towards other
increased costs of health care, have forced planners and practitioners in the
developed nations, as their Third World counterparts always have, to face
ethical questions arising from limits in health care resources. Economist
Lester Thurow pointed to the ethical burden now forced upon individual
practitioners who must choose between a practice style which will use any
treatment (even an experimental one) which does no harm, and practice which
will use a treatment only when one is "sure that it will make a noticeable
improvement."  Dr. Schweitzer's experience in Africa seems to advance
much the same argument. Dr. Schweitzer was criticized for his seeming slowness
to adopt new treatments and new technology at his hospital in Africa. Yet he
seems to have been quick to adopt new treatments that were clearly beneficial
and could be administered with minimal toxicity in the primitive environment of
his practice. He was slow to electrify the Lambarene hospital, fearing
inordinate dependence on the difficult and uncertain chain of fuel supply. 
His concerns foreshadowed the later literature on "appropriate
technology" in the developing world .
matters of corporate or social policy, such as allotting the use of scarce
medical resources and administering systems of health care, ethical
responsibility still evolves on decision-makers individually. Holding
"supra-personal responsibility" (as in management) does not relieve
personal responsibility to act ethically: I am not at liberty to think, that in
the conflict between personal and supra-personal responsibility I can balance
the ethical and the expedient to make a relative ethical, or even annul the
ethical with the purposive; I must choose between the two . Reverence for
life argues that the corporate decision-maker (the manager of health care
resources) must also act so as to "obey the compulsion to help all life
which he is able to assist" .
Dr. Schweitzer wrote specifically about animal
experimentation: Those who experiment with operations or the use of drugs upon
animals, or inoculate them with diseases, so as to be able to bring help to
humankind with the results gained, must never quiet any misgivings they feel
with the general reflection that their cruel proceedings aim at a valuable
result. They must first have considered in each individual case whether there
is a real necessity to force upon any animal this sacrifice for the sake of
mankind. And they must take the most anxious care to mitigate as much as
possible the pain inflicted .
Reverence for life is not a creed. Reverence (Ehrfurcht)
implies awe, wonder, and respect rather than worship. It provides a basis for a
mystical sense of oneness with all life, but it accepts life as it finds it,
without intruding on the question of the meaning of life. It conflicts with no
religion. Its insights enrich them all, and provide a basis for broader
understanding among peoples of different religion. It is not a code. Schweitzer
refused to define rules or values for individual lives, stressing instead
individual responsibility and individual decision-making . "To become
ethical means to begin to think sincerely" . Reverence for life is the
basis for individual thinking rather than rule-making. It is not a cause, and
does not give rise to any particular political agenda. Reverence for life is
not argued in terms of personal "right", and does not appeal to
enforcement. Nor is it argued in terms of mere sentiment. Its ethics appeal to
a strong sense of personal responsibility, and require rigorous individual
analysis of all factors bearing on a life-question. Illumination of ethical
problems by the lamp of reverence for life does not automatically provide
universal or even predictable answers to problems in patient care. It does,
however, establish the ethical milieu in which appropriate questions are
raised. It sets the tone of discussion, respecting the life that is the subject
of discussion, and the lives and views of all lives affected. It provides the principle
against which proposed solutions can be tested. Physician-patient interaction
is a dynamic "quantum field" in which action is not governed by
ethical insight alone. A clinical "uncertainty principle" dictates
that one may not be able to satisfactorily isolate a particular ethical rule in
the complex field of economic, legal, scientific, and technologic forces
competing in the shaping of any action. Reverence for life does not yield a
generalized protocol for care. Reverence for life must be viewed as the field
itself, in which clinical decisions are always formed in an attitude of
"sincere thought". It is now 62 years since the publication of the
"Philosophy of Civilization",
and 20 years after its author's death. There have been many changes in society
and in medical technology and practice. Yet as this study suggests, the ethics
of reverence for life are pertinent to a broad range of current medical ethics
issues, and deserve continued study and application.
1. Schweitzer A: Philosophy of Civilization. New York
(Macmillan) 1949. Reprint 1981, Tallahassee (University Presses of Florida). p
309. 2. Schweitzer A: Out of My Life and Thought. New York (Henry Holt) 1933. p
3. Philosophy of Civilization. p. 310.
4. Dr. David Miller quoted in: Brabazon J: Albert
Schweitzer - A Biography. New York (Putnam) 1975. p.465.
5. Philosophy of Civilization. p. 311.
6. ibid p. 317.
7. Thurow L: Medicine versus economics. N Eng J Med 1985
(Sept 5); 313:611-614.
8. Brabazon, op cit, p 341 f
9. Lomax CA: The design and use of appropriate health
technologies for developing countries. J.Med.Engineering & Technology 1980
Jan. 4(1): 11-15 (18 ref.).
10. Philosophy of Civilization. p 324.
11. ibid p 318.
12. Out of My Life and Thought. p 271.
13. Philosophy of Civilization. p 308.
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