Editors: Norio Fujiki, M.D. & Darryl R.J. Macer, Ph.D.
Frank J. Leavitt
The Faculty of the Health Sciences, Ben Gurion University of the Negev, Israel
John Maddox (1) and Darryl Macer (2) argued in recent issues of Nature that it doesn't. But the question cannot be answered clearly unless it is stated clearly. Surely if by a "new ethics" is meant an ethics which deals with new questions, then we are developing a new ethics. For I doubt that many of the questions in the International Bioethics Survey are treated in any work of philosophical or theological ethics older than Crick and Watson.
Of course it might be claimed that traditional ethics contains principles, axioms from which answers to the new questions might be deduced. The comparison of ethics to axiomatic science may be highly misleading, for as Aristotle said (3) we simply cannot hope for the degree of precision in ethics which is found in mathematical sciences. The traditionalist claim is also difficult because it has not yet been carried out in practice. For who has yet produced clear answers to ethical questions about interspecies gene transfer and germ-line therapy?
We Israelis have an ancient ethical tradition which has demonstrated the depth and logical fineness to meet new moral questions over thousands of years. The Japanese, like us, have also had an ancient tradition to which to turn for guidance. In visiting the Meiji shrine I was very impressed by the ethical principles, like filial respect, affection, modesty, moderation, learning and benevolence, which Emperor Meiji passed onto his people. Similarly we Jews, for thousands of years, could always turn to the written law of Scripture and the oral law of Mishna, Talmud and other rabbinical writings for ethical principles.
But I am afraid I have to confess that some of our wisest experts in Jewish Law tend to lack content and decisiveness when they turn to the tough bioethical questions. We still lack clear answers to many of the questions in Macer's International Bioethics Survey. In Beer-Sheva, Israel, some of us hope to help improve the situation by educating new generations learned in our ancient religious tradition, as well as in philosophy and in the biomedical sciences, just as our greatest bioethicist, Moses Maimonides (1135-1204) made great contributions to these three fields. But we are just at the beginning and the future will not be easy.
Meanwhile I shall try to formulate seven principles of Israeli bioethics, not as a precise axiom system but merely as a basis for discussing some points in the International Bioethics Survey. I shall try to base myself on traditional sources: Scripture, ancient rabbinic texts and Maimonides. But I am not myself a rabbi. So I cannot claim to speak for Judaism but only to state things as I see them.
THE FIRST PRINCIPLE is that we have a duty to live, be fruitful and govern the Earth. The source is of course Genesis, the first book of Scripture, Chapter I. Duties are primary and rights derivative. From the duty to live derive patients' rights to treatment and physicians' obligations to treat. The duty to be fruitful means that reproduction is not a light matter but is part of how we ought to live. The simpler animals also have a duty to reproduce, as we see in Genesis I, 22. And since rights derive from duties they obviously also have a right to live and reproduce. But the commandment to govern the earth is given to humans alone. We, and not the animals, must develop intelligent ecological policy.
THE SECOND PRINCIPLE says that the universe does not exist for our benefit. The source is Maimonides, Guide for the Perplexed III, 13. It is not for our own selfish pleasure that we are to govern the earth but in order that we may have a suitable place to carry out God's commandments.
THE THIRD PRINCIPLE is from Maimonides's Commentary on the Aphorisms of Hippocrates, Chapter I: experimentation, while often necessary, can be very dangerous. The principle is applied by Maimonides to relatively minor medical or risk-taking. Its force is multiplied many-fold when applied to things like germ-line experimentation.
THE FOURTH PRINCIPLE, taken from Maimonides's Regimen Sanitatis, the "Guide to Health", II, 3, says that nature tends to cure itself. It is best that a patient recover from a disease on his own and at his own good time. Medical intervention is only a last resort.
THE FIFTH PRINCIPLE says that family life is the ideal life for human beings. The source is Genesis II, 18, where God says: "It is not good for man to be alone. I shall make him a helpmate".
THE SIXTH PRINCIPLE says: "Be interdisciplinary". It is based on Maimonides's Laws of Judges (Sanhedrin), II, 1, where rabbinical judges are required to be learned in science, mathematics and medicine, as well as religion. This is Judaism's answer to those who wonder whether science and religion are reconcilable. We Israelis are required to reconcile them. We cannot do good bioethics without taking an active interest both in the health and life sciences and in the religious, cultural, and literary sources of moral consciousness. This synthetic approach once belonged to philosophy and Maimonides was only one of many great philosophers who were active both in science and in theology. But now that so many philosophers today have abandoned this great vocation and retreated into superspecialisation, bioethics must take up the great interdisciplinary challenge.
THE SEVENTH PRINCIPLE comes from the Mishnaic Treatise of the Fathers, I, 19: "Despise power". I think this means both to despise power for yourself and to suspect power in others. We shall analyse these ideas at a bit more length.
Despise power for yourself. With respect to most qualities of human character, Maimonides adopts the Aristotelian doctrine of the mean between two extremes. Be neither a miser nor a spendthrift. Be neither a coward nor fearless to the point of foolhardiness. Be moderate. But there is one virtue to which Maimonides refuses to apply the doctrine of moderation. This is the virtue of humility. We are to be humble to an extreme. Do not think highly of yourself. Do not seek wealth, luxury, or authority over others. Don't take the competition for professional advancement too seriously. If we remember that, as Maimonides stresses in his medical writings (4), most of the things which people think are good for them are really bad, and most of the things which people think are bad for them are really good, we will shun luxury, rich foods, material wealth, fame, authority over others. And we will live simple, family lives, dress simply, eat simple foods, and combine physical labour with intellectual pursuits.
Suspect power in others. An appreciation of the healthiness and beauty of a simple natural unassuming life makes one feel sorry for people who are obsessed with material wealth, professional advancement, fame and the various technological gadgets and toys which are so popular today. One also acquires what the philosophers of the 1968 student revolution called an "attitude of suspicion" towards the literary and scientific products of the obsession for power. For the obsession for personal aggrandisement can distort one's thinking so that one abandons the disinterested open-minded search for truth and health and goodness and sets one's intellect to whatever will serve one's imagined personal interests. Science becomes either ideology, propaganda in the service of certain economic goals, or merely a servant of technology for industry.
With these principles in mind, let us now turn to some specific questions in the International Bioethics Survey.
Question 1g: aborting a fetus with congenital abnormalities and Question 16, testing the fetus for congenital abnormalities. One wonders whether the motives are ethical or economic. Are amniotic fluid tests being encouraged for the good of the mother and child or in order to save governments and health insurers money which would have to be spent on raising, treating and educating a sickly and mentally deficient child? It ought to be pointed out in this context that it has been argued that dangers of radiation to fetuses are often overestimated (5). Similarly, if we approve of abortion because of genetic defects we ought to make quite sure we are not doing so on the basis of false positives. It would also be a tragedy to abort a fetus with a genetic tendency to problems which might be curable by environmental influence or medical intervention. A life, moreover, such as that of a Downs baby, which todays pleasure-loving world might see as not worth living, might be regarded entirely differently by the Downs baby himself.
Question 1h: surrogate motherhood and IVF. Surrogate motherhood is not at this time practiced in Israel because Judaism regards the woman who bears a child as the mother regardless of the source of the ovum. With regard to IVF, we must apply Principle Three, which Maimonides adopted from Hippocrates: "Experimentation is dangerous". It is already known that pre-natal and peri-natal trauma can have long term detrimental effects on the health of a person (6). And it has been claimed, although the basis of the claim needs further checking, that harmful neurological or psychological effects of assisted procreation have been found in mice (7). We do not yet know whether or not a trauma, with long-term effects, can result from being conceived in glass, rather than in the environment of warmth and sensual excitement of classical conception. We shall not know whether or not there is such a conception trauma until very large numbers of such babies are born, grow up and age under the eyes of long-term longitudinal studies. In the absence of data which cannot yet be available, perhaps adopting an orphan from an impoverished country would be better than IVF. We must also recall Principle Five: family life is the ideal. Artificial reproduction technologies may have a place when the goal is to strengthen the family, to prevent, for example, the childlessness which may be a cause for divorce. But reproduction technology is to be regarded with suspicion when the goal is to circumvent or replace the traditional institution of the family.
Questions 9 through 12 have to do with combining genes from creatures of different species. We have a number of Biblical prohibitions of mixing species. We may not actively help an animal of one species mate with an animal of another. We may not, in the Land of Israel, grow food plants of different species so close together that their roots intermingle. We may not even hitch an ox and an ass to the same plow, or wear a coat in which linen and wool are woven together. But since neither Scripture nor Rabbinic texts mention genetic recombination explicitly, the letter of the law does not forbid mixing through genetic techniques. But the spirit of the law seems to convey stern disapproval of tampering with natural species.
The obligation to live, however, which is embodied in the First Principle, takes precedence in Judaism over almost every other moral principle. We may violate the Sabbath, or dietary laws, to save a life. So we ought to be able to do recombinant genetics for the same purpose. But one sometimes wonders whether the goal is really human life and health. Consider adding foreign genes to the potato to make it more nutritious. If this were the only way to prevent malnutrition, one would have to approve of the technique, perhaps to the point of using genes from a human, no matter how disgusting the idea may be. But are we sure that redistribution of land, family sized garden plots, more careful composting to produce good cheap fertilizers and more efficient irrigation would not prevent more malnutrition than all this high-tech genetics? And would the purpose of creating this new potato really be for better nutrition? Or would it be for the careers of the scientists who invent it, the power we are taught to despise, or the profit of those who would patent it and market it ?
As for Question 11, biotechnology to make chickens less fatty, I don't know whether or not fatty chicken is bad for our health, especially if we exercise properly, as Maimonides constantly urged. And if fatty chicken is indeed unhealthy, then let's just eat less chicken and more vegetables, or grow free-range chickens, supplemented by kitchen scraps, next to the house, and they'll have less fat. Modern breeds of meat poultry, like the Cornish-Rock cross, were developed to put on weight at a very rapid rate. Perhaps a return to more traditional breeds would also help get less fatty chicken.
As for biotechnology to make more tasty tomatoes (Question 31), I don't know why all these resources should be put into catering to the gustatory pleasures of people so jaded they cannot enjoy a diet of simple, natural foods. Such a genetically engineered tomato would surely be for the sake of those who profit from it, rather than those who eat it. We must also recall Principle Three, experimentation is dangerous. We do not yet know the long term effects recombinant genetics will have on the ecology. There are some reassuring data on transgenic crops (8, 9), but much less is known than is unknown. And I think it is clear that organisms developed for fitness to survive through a process of natural selection will make a stabler contribution to the ecosystem than organisms bred for human convenience (10). The Scriptural commandment to govern the earth may sometimes require our active intervention in the ecology. But if there is no genuine need for intervention we may often govern nature best by leaving it alone. It may sometimes be worth taking a risk for the good of human health, but not for mere taste or profit, and certainly not where the same health goals can be served through simpler, more old-fashioned methods.
I turn to Question 1a, whether a woman can abort a 4 month old fetus. I assume the question is whether she morally may do so. But the question is really impossible for an Israeli to answer because we do not think about such things in unambiguous yes or no terms. Of course we are not happy with abortion. We are not only commanded to reproduce but many of us are life-loving people who want many babies. The western idea of a "planned" family is foreign to many of us. But on the other hand we have a duty to save life and we have an old tradition which insists that the mother's life is more important than that of the unborn fetus. So the answer to the question very much depends on circumstances. If abortion is clearly needed to save the mother's life then there is no question about it, we are not just permitted to abort, we must abort. On the other hand there is a good deal of divergence of opinion on cases where the mother's life is not in danger but just her physical or mental health. And in the eyes of many authorities the number of months of fetal development is quite irrelevant. Only the mother's good matters. Some rabbis permit abortion in cases of rape, for example, and others would advise against it. Some will permit it in case of Tay Sachs disease, because of the distress to the mother. And other still forbid it. But it must be stressed that in practice abortion is pretty much up to the woman in Israel, for religious tradition in our country is, as I think it ought to be, respected as an advisory and persuasive voice of Jewish conscience but seldom enforced by law.
1. Maddox, J. (1993) Nature 364: 97.
2. Macer, D. (1993) Nature 365: 102.
3. Aristotle, Nicomachean Ethics, I, 3, 1094 b 11-27.
4. Moses Maimonides, Regimen Sanitatis, III, 15.
5. Swartz, H.M., Reichling, B.A., (1978) Hazards of Radiation Exposure for Pregnant Women. JAMA 239: 1907-1908.
6. Judson, O. (1992) Nature 357: 433.
7. Butler, D. (1993) Nature 361: 102.
8. Kareiva, P. (1993) Nature 363: 580-581.
9. Crawley, M.J. et al. (1993) Nature 363: 620-623.
10. Leavitt, F.J. (1992) Nature 360: 100.