- V. Manickavel, M.D. College of Medical Sciences, Kathmandu University, Bharatpur, Chitwan (Dist.), Nepal
The human species, like most of the other primates take long time to complete their growth process, which includes the physiological and sociological maturity. Human development, as any other mammalian species, mandates the initial parasitic existence of fetus on the mother. Further on, the humans also depend on the societal unit, the family for subsequent development. This slow and long process is essential for the holistic development of human beings. This unique human development is an important thread in the fabrication of our civilization. The family unit that was once pride of all the human societies is now undergoing a major change. At the same time, the importance of the family units is also being acknowledged. The recent World Health Report by WHO recognizes the family units in the Mental Health especially of children/infants and elderly. According to the world report on violence and health, the increase in violence in the society is directly linked to the breakdown of family units. The implications of some of the new biotechnologies and globalization on family are discussed in this essay.
Beyond the family the society also plays a major role in the human development. This is because humans are social animals and the social cohesiveness of the members is essential for the society to survive and progress. However, the human development is not the mere physical growth, living with basic instincts of feeding and reproducing. Each member contributes to the society's well being and growth. The growth is maintained by the mutual dependency of the members. There are rules to learn in a society; in many of the social animals they are instinctively known or learned by different means, mostly by threat and punishment.
However, the human society maintains its social connective ness mostly by other unique human qualities like responsibility, duty, love and compassion. Nevertheless, the humans, unlike the other primates or other mammals think as individuals. This self-interest, the unique human nature and the negligible individual difference of 0.01% or 0 .1% in our genome from the other fellow humans are the driving force for our technological innovations and the utilitarian consumerism. All these exercise enormous pressure on the family structure to disintegrate.
In the human life spectrum, the early and late life needs the physical support of other members for its growth. At the both ends of life, the physical support from other bonded members of the family is critical for biological and sociological growth (fulfillment) of the person. In the simpler way of life, the mutual support among the family members was extended out of love and compassion. This maintained the cohesiveness of the family traditions and the bond between members. Since, the support is mutual and love based the members never felt the stress of dependency. The society also did not feel the burden of that needed physical support required by the age constrained/compromised population.
As I have stated earlier, that, the humans use mothers, family and also other societal members for their physical, psychological and social growth. But, this is not one-sided exploitation; the children later when they become adults offered physical support to the same family members on whom they were dependent for their early development. It has been shown that, in the later years, the dependency of living on others does enhance the mental health of the elders. Similarly, the early dependency of the infants is necessary for them to become more self-confident. Further, traditions are maintained mostly by the elders, which are a valuable contribution of that age to the family/society.
One of the economic growth indicators used in the global developmental process is the number of old age "homes" exist in a country. These institutions are part of the changing scenario in both fast and slow developing nations. These homes are public institutions where people who were not making economic contributions either to household or to institutions stay together and "live". Generally, families mean the co- habitation of bonded members of various ages sharing the same home. The interaction between these bonded heterogeneous age groups were mostly compassionate and love rooted. Now, nonbonded members of homogeneous age group without any root of compassion and love are grouped to "live" in these old age "homes" with the support of public or private finance.
In the modern society, the family plays a lesser role in offering the mutual support, so, the community/society has to step in to provide the support system. This type of community involvement is necessary for the survival of our species. The major difference in this community support system is that instead of exchange of love and compassion money is exchanged for the support/service given. But, these homes are not able to provide anything for the psychological and social well being of the person who has to depend on others. The family members, who love the other person and show compassion, only give the dependency and support.
No doubt, these "homes" provide the necessary physical comforts and give the dependency and support they needed. But, money does not bring a long-tern permanent relationship. Usually emotions are not involved in this short-term relationship brought by money. Consequently, the development of any bond relationship is declining because of these transient money mediated encounters among the members of the society. In the consumer society, for its sustainability only this kind of transient relationship is promoted. Further, in the consumer society, various types of service and care may be obtained by money, but human development needs more than physical service.
If, there is no bond developed between the members of the society, the members of that society normally loose the sense of belonging. Further the "home" members are homogeneous only in the age and do not have anything in common to be emotionally attached with each other. Because of the absence of heterogeneous age interactions in the group members, emotional attachment normally does not develop among the group members within these "homes". If, emotional involvement does develop in these "homes", it tends to break down within a short time. Thus, this artificial grouping affects the mental well being of the "home" members. This is seen in the present day old age homes as well as foster homes.
Now, care in these "homes" is offered for a price and as stated before, there is no development of bond in this relationship of care receivers and providers. Because of the transient relationship without love and compassion, the mental well being of this age group becomes a health issue in many countries. Consequently, their physical well being is also compromised. Some countries have started to induce the young family members to take care of the elders of their family by providing financial support from public purse. Excluding the elder members from the family units for economic reasons and keeping them in separate "homes" had increased the financial burden of the society considerably. Further, the other contributions of this age group to the family and society is also lost. We are now beginning to understand the effect of this trend in the society.
These homes were indeed part of some traditional societies, but elders opted themselves to live in these homes for spiritual and personal development. Now, elders are forced to stay in these "homes" because of their lesser role played in the families and for economic reasons. In some cases, the elders wanted to be "free" from the family and elected to live in these "homes".
The societal unit, family, which gives a special status to the mother because of the physical support she offers to the fetus, the future member of the society. The family and the society acknowledge the sacrificial endeavor of one human in bringing another one to this society by unique celebrations and traditional rituals. In simple societies pregnant women are specially protected against physical elements like weather, wild animals and similar other elements which may endanger her and fetus. Similarly, after birthing, they receive special care and recognition from the family members. Even though, the infant is free from the womb and becomes independent of placental nutrition, it still needs the mother for the nourishment and protection from the physical elements, which to a certain extent is offered by other members also. This stage of dependency of the infant on the mother and other family members is also recognized by the family and society and celebrated in many human societies. This type of dependency of one being on another is seen in many animal species especially in the primates. They do exhibit a social 'organization' like family and the members of the group offer assistance in birthing and protection for both mother and infant.
The physiological dependency of the fetus, infant and child on the mother, parent, and family is not mere one sided. Like any other society in the Nature, whether plant or animal interdependency is a requirement for the survival of a species. The new life (off spring) in the animal and plant kingdom uses the older lives to have its genesis and it may appear as one-sided exploitation. But, the new life contribute to the protection of that society and perpetuation of that particular species. In this manner a community and society begins in this world. This subtle interdependency is the corner stone of a society and is seen in all biospecies, may be in nonbiomass also. The dependency of the early development of the humans on other members of the family and society is balanced. The members who received support lend the same to those who were in need of that especially in the later developmental years. This mutual support system in the humans is the strong cementing factor in the family and on which our modern civilization is built upon.
Till recently, the family units offered full support in the early development of humans. However, now birthing and nurturing of the mother and infant mostly occurred within the hospitals. In this public or private fund supported industrial set-up, aliens provide the care for money. Many of the problems associated with birthing that, we recognize now, did not exist or were not recognized before. Nevertheless, currently, in many fast-developing societies birthing is being encouraged within the family homes rather in the public supported industrial set-up of the hospital.
However, the support given by the traditional family members in the early phase of human development is about to go through a major change. This major change has the potential to destroy the social fabric of the modern civilization. The new reproductive technologies are already in the verge of undermining the role of two human beings, a male and a female in the embryo production. Especially the role of the mother in the conception of the embryo and nurturing is very much marginalized. Machines (incubators) are now able to support the growth of premature babies even if they weigh only 1/10th of the normal weight (285 gms). The heroic measure of saving preemies with machines does questions the need of another human being i.e. mother in fostering the growth of the fetus or bringing a new life. The role of the mother in providing nutritional requirements and comfortable apt environment for the growth of an embryo is not properly understood and given the right place in the present modern society. The development of an infant is not mere physical transformation of an embryo into a fetus with nutritional supply and environmental protection. This transformation however, needs the human "touches" also. Moreover, this connectivity is vital for the woman to transform into mother. The transformation of women to mothers is enhanced by the connectivity in the reproductive process. The new reproductive technologies deny the privilege of women to transform into mothers.
The new reproductive technologies will free a woman from the responsibilities of physical nurturing. However, this has to lead to the development of professional "mothers" who will do surrogacy or incubating the embryo for a price. Similar type of service was in practice in the old feudal society where "Power" was used in forcing servile woman to offer that service to ruling class. Similarly, now poor women offer their wombs to carry some body else's embryos to full term.
In the early days of surrogacy the fertilization was done by copulation where a chance of having the human touch did exist. But in the in vitro fertilization, the embryo is transplanted in the womb and not sperms. In the present day, Assisted Reproductive Technology, fertilization is carried out separately. The ejaculated sperm is injected by a sterile syringe into the woman or transfer to an artificial environment, a sterile test tube with the flushed out mature ovum. The resulting embryo is then transplanted under sterile conditions into the womb. The technology thus alienates and separates the service providers (the womb renters) from the service receivers (the end product of conception). The alienation deprives them from emotional involvement and fulfillment of a woman.
The new genome revolution and its impact on the society put the family under further strain. The technological developments now allow the possibility of having selected genes transferred in an organism, possibly in a human being. Humans tend to be or want to be the controller of changes. Normally, nature controls the directions of changes, but the new genome project "gives" an opportunity to the humans to direct changes in an organism in an accelerated manner. In the control game, human beings do the selection of traits undermining the time tested natural selection process.
In the natural selection process, testing and fitting of an organism in the environment is a dynamic process and not subjective to limited human decisions. In the process of natural selection every single gene is guided through environmental fit and need and then selected. The selection is not just based on the fitting to the immediate need or environment for a brief period. But, the selection is fostered by innumerable factors like fitting to the overall environment with all the other organisms. This selection is further based on long-term future considerations with all the partners of the biomass.
Human decisions are always made on the known (limited) and on short time benefits. Human knowledge is limited and possibly it cannot take into account of interactions within the organisms or with all the organisms exist. Some of our previous drugs trials show our limitations of our knowledge and vision. Similarly, the deliberate introduction of new species of plants and animals in a novel environment and the subsequent ecological problems due to bio-invasions do vouch for this. The second example is closer to the one we are about to launch, because of genome research. Now, instead of a complete gene assembly (an organism) we are in the game of selecting genes and introducing them in a new environment with out knowing its consequences.
Because of our ignorance and arrogance and not able to accept the unknown we are limiting ourselves. Without transcendency we always limit ourselves to bank only on the short-term benefits. Furthermore, the main driving force behind these technological ventures is marketing. Marketing thrives only on immediate profits. Because of the power of our limited knowledge, we may soon control the production of human beings as fictionalized in the Brave New World.
Now, the question we have to raise is, "what will be the role of the Family in the society?" As new technologies are increasingly applied, alienation also increases; the family and society are very much distanced from the individual. But this distancing has a price on the mental health of the individuals and our interaction and functioning in the society. All these have increased the financial burden of the society in providing health care support especially in early and late phases of human growth.
Soon, we (society) may support infant homes as we are supporting old age homes, now. These homes will control conception and early human development. These inmates as the inmates of old age homes will grow in isolation away from family units. However, we may not hear the complaint that, "my parents are not visiting us" from these infants as they may not know their own mothers and fathers.
There is no conflict of interest to declare as no financial support is received from any source for this research.
I would like to thank Mr. B.Srinivas for his assistance in preparing the manuscript. The generous grant from the Organizing Committee of IVth Asian Conference of Bio-ethics for participating in this conference is warmly acknowledged.
i. The World Health Report - 2001: Mental Health: New understanding New Hope: Geneva, W.H.O.
ii. World Report on Violence and Health (ed) E.G.Krug, L.L.Dahlberg, J.A.Mercy, A.B.Zwi & R.Lozano. W.H.O, Geneva-2002.