This raises a fundamental question which is the main reason behind the assembly of papers and survey data in this book. The question is a sensitive one, do people in different countries share the same thinking, and reasoning? If they do, then we could call this universalism, and it makes the possibility of universal ethics real. If they do not, then what we must aim for is cross-cultural understanding, perhaps with some degree of universalism. At the beginning I should make it quite plain that the use of surveys is only one part of the overall approach we can use to look at cultures, and that this book is intended as a contribution to answering this question, it does not claim to have the whole picture. However, the data presented here are a challenge to all of us to incorporate or explain into any description of the real world.
All human beings are found as members of some society, all accommodate some individualism within a social niche. Any ethical approach must consider the biological, social and spiritual origins of humanity. First let us consider these aspects of our heritage, then the hope that is behind universalism. This book is principally concerned with presenting the data from an International Bioethics Survey and comparisons of that data with other observations. The theme of universal bioethics is to be more fully explored in a rigourous academic text in a full book, Universal Bioethics: Heritage and Hope (1). What follows is a brief introduction to the heritage and hope for universal ethics.
Bioethics especially includes medical and environmental ethics. The word was mainly applied for issues of medical ethics in the 1970s and 1980s, but the 1960s and 1990s saw much more attention on environmental ethics. The word "bioethics" was first used in 1970 (2), however, the concept of bioethics is much older, as we can see in the ethics formulated and debated in literature, art, music and the general cultural and religious traditions of our ancestors.
Life is diverse and complex and so are the issues that the manipulation of life and nature raises. To resolve these issues, and develop principles, we must involve anthropology, sociology, biology, religion, psychology, philosophy, and economics; we must combine the scientific rigour of biological data, with the values of religion and philosophy to develop a world-view. Bioethics is therefore challenged to be a multi-sided and thoughtful approach to decision-making so that it may be relevant to all aspects of human life. Without combining both of these spheres of thought, natural science and values, we can never succeed to even approach a universal ethics. However, bioethics is not just an academic endeavour or an applied part of philosophical ethics, it is rooted in the daily life and attitudes of all people, hence the title of this book, Bioethics for the People by the People.
The term bioethics should mean the study of life ethics, but it has often been viewed only as a part. The concern with medical ethics has meant that while many people, or committees, are called "bioethics" committees, they only consider medical ethics. Likewise, ecological and environmental ethics must include human-human interactions, as these interactions are one of the dominant ecological interactions in the world. Both extremes are incomplete perspectives. In the conclusion of an earlier book, Shaping Genes (3), I said that we have much to learn from the issues raised by genetic technology, not just the nature of our genes, but the nature of our thinking about what is important in life. New technology can be a catalyst for our thinking about these issues, and we can think of the examples like assisted reproductive technologies, organ transplantation, and genetics, which have been stimuli for research into bioethics in the last few decades.
A range of questions need to be considered, but especially those raised by biotechnology and human activity in society and the environment. Bioethics considers issues affecting all living organisms and the environment, from individual creature to the level of the biosphere in complexity. All living organisms are biological beings, and share a common and intertwined biological heritage. The term bioethics reminds us of the combination of biology and ethics, topics that are intertwined.
Humans are members of the species Homo sapiens, one of the millions of species alive on the planet Earth. Fundamentally we must ask whether humans are a special form of life, different from other living creatures? We must also compare humans with other species and see where differences may be. We may also look at individual humans and ask whether there is any significant difference between individual members of the human species that could influence the ethical duties we have to them.
The method of our creation appears to be via a process of evolution, like all life on this planet. This is most consistent with the data we have. There is no conflict between a belief in the creation of the world by God described poetically in the Bible and the theory of evolution. In fact the Bible says that all creatures are made from the dust of the earth. When Darwin's books The Origin of Species, and The Descent of Man, were published there was a mixed reaction from the church (4). The Unitarian and Broad churches were favourable to the theory of evolution from the publication of it, the Catholics were mixed on the theory, but the Methodists and Low church were very opposed to it in the first ten years. The suggestion that there was a conflict was generated by scientists who wanted to replace the church as the respected authority of human society, something that they have achieved to some extent (5). Scientists used the theory and the opposition to it to create an image of a "conflict" between science and religion which has been very harmful ever since. As a more scientific world view has been adopted many people continue to think there is a conflict.
People have minds which search for knowledge, and we can understand more and more of the world. A primitive picture of God is to use "God" to explain things we do not know, this could be called "god of the gaps", we use "God" to explain what we do not yet understand. This is not a Christian idea. Rather, whatever we know of the world we should be appreciative of our existence. There is, however, a difference in our outlook if we believe that the world was created by pure chance or if it was created with a purpose, but this itself is a nonscientific question, a question which no one can ever disprove.
The types of evidence that can be found to support the theory of evolution come from observations of past organisms in fossilised or preserved remains, by comparing the genes of different species alive today, and by our limited period of observation of biological species in the world and in laboratory experiments. The strongest evidence for an evolutionary process of genetic change comes from analysis of DNA and gene sequences among different individuals and organisms. Using techniques of DNA amplification, in the Polymerase Chain Reaction (PCR), a single copy of DNA can be analysed, so that ancient preserved tissue can be compared with other sequences. From this the changes, from those of a single base to those of gene duplication, rearrangement or deletion, can be investigated.
Mitochondria are small parts inside cells, organelles, which produce the cell's energy. They contain DNA, and the changes can be detected. When a sperm and egg fuse to begin a new human individual the mitochondria come from the cytoplasm of the egg because the sperm does not contain contribute cytoplasm to the egg, only the nucleus, so the inheritance is from the mother. It is believed that all modern humans inherited their mitochondrial DNA from a common female ancestor (6). There is debate however about when this ancient Eve lived. In 1987 Allan Wilson of the University of California, Berkeley, claimed that the data supported an Eve who lived 200,000 years ago in Africa (7). They studied the differences in mitochondrial DNA in samples taken from many people of many races and tribal groups. They found greatest diversity among Africans, consistent with people having lived longest in Africa where they originated. They then estimated the time taken for the DNA mutations to occur. Another method of comparison of DNA sequences is to compare the different forms, or alleles, of a single gene, called polymorphism. Some genes have many alternative alleles, all of which are slightly different yet perform the same function (Some alleles do not perform the function adequately or at all, and these are genetic-disease-causing alleles). Part of the Human Genome Project involves taking samples of DNA from 300-500 diverse human geographic populations, which is called the Human Genome Diversity Project. What can also be done is to look at DNA from human remains over the last few thousand years, and this can form a more accurate picture of the spread of human tribes and cultures. However, this study itself raises ethical issues (8).
Africa is also suggested as the origin of modern humans by fossil evidence. The earliest member of the genus Homo appears to be
Changes in DNA sequences have also been used to trace the way that different organisms evolve, called phylogenetic trees. We can compare the DNA of species alive today, and investigate trends in the sequence change, and we can also look at DNA from past organisms which is a more direct measure of the change over time. The movie Jurassic Park, based on the novel (10), was based on some scientific accounts of extracting DNA from insects that had been preserved in amber for 65 million years. Such DNA sequences have been reported, but there are fundamental questions about whether DNA sequences obtained are really those of the insect, as the DNA chemically changes over such long periods of time (11).
Human beings are created in the midst of an intricate biodiversity, which is yet to be comprehended. The process or time scale over which all life was made is not so remarkable as the species and ecosystems that we have today, or those that we can see from the fossils. The debate over the method and time frame of evolution is likely to continue for a long time, and may not ever be resolved, but we can marvel at the diversity of life, and also consider the shared biological origins.
Although we have a common ancestor, there is 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.
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.
Human beings are organised into societies, and our social groups include our spouse, children, relatives, neighbours, religious group, community, workplace, village, city, nation, and international partners. The social origins 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. Perhaps the best example of the artificiality of the national borders is the division of Africa, an artefact of colonial power struggles between Britain, France and Germany. The attempt to stop further wars in Africa by the regional congress is only a partial success, because further power struggles resulting from the earlier separation of tribal boundaries can easily be used to engender conflict.
We could consider that wars are a sign that universalism is already lost, however, if we really look at origins of most wars they are caused not by clashes between ideologies and customs of ordinary people - most are caused by certain charismatic individuals who are seeking further power. They may draw upon the perceived differences between cultures, often generated with the help of the media. They utilise the sense of national identity that is attractive to one part of human beings - we all have an urge to be identified as a member of some community. Sometimes religious groupings are used, sometimes racial differences, and these are usually combined with ethnic differences and the promise of better economic conditions.
At the onset we should realise that the complete diversity of attitudes and characters of human individuals are represented in any one society. A failing of human thought is that people view their society as being different from another, with sweeping generalizations. We describe the English as conservative, the Australians as noisy, the Japanese as quiet. 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.
Language is central to social structure. Linguistic trends are consistent with migrations of humans over the planet traced by genetics (12). We see languages and communication in other animals also, but it is unclear what relationship they have to symbolism and thinking. Some studies on language origin suggest that language may have only began in the last 40,000 years. This is the same time that we see engravings or sculptures appearing. That would be 60,000 years after the appearance of modern human species. The anatomical structures of the vocal tract and larynx also suggest that other land animals cannot talk, neither could premodern Homo species (13). However, individual communication systems are found in other social mammals and birds, and they are used to discriminate between individuals. Some other behavioural systems may also be shared with other animals, as will be discussed more in the following chapter when looking at the origin of love, altruism and selfishness, and animals.
We need to 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 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 practises that immigrants are accustomed to differ from each other. Their religions may also be different, and certainly some social customs. 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".
One of the assumptions of this book is that all human beings have equal rights. There are universal human rights which should be protected, and recognised. We can argue for the foundation of human rights from secular philosophy or religion, as will be explored later. 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, despite the often assumed homogeneity. This is one part of this theory of universal ethics that can be tested, and available data relevant to these conclusions is discussed throughout the book.
Economic factors are an inseparable part of society, and trading between adjacent regions has been a major source of cultural mixing, today as in past centuries. The world has become smaller with modern trade and communications, and this is certainly one factor in the growing trend for internationalism. This is empitomised in GATT, signed in 1993. International economics helps break down geographical And linguistic barriers, 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.
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 (14). 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.
This comparison is one purpose of the International Bioethics Survey reported here. The countries chosen in the survey were chosen for two reasons, one being as representatives of the world, and the other in terms of convenience of access. Unfortunately there is no African or South American, nor Islamic country among the countries chosen. It is hoped that future studies will look at these questions in these and other countries also, as a test of the ideas discussed here. The countries chosen include India, a country of mixed religion and the major so-called "developing" country, though it has an agricultural and social history much longer than most countries. Russia represents the former communist world, another possible dominant force in shaping opinion. The Philippines is a Catholic country. Thailand is a Buddhist country and represents South East Asia. New Zealand and Australia, with some comparisons to North America, and to past European surveys, represent Christian and Western countries. Hong Kong and Singapore represent the Chinese influence, and some comparison to mainland Chinese attitudes is also made. A small sample from Israel was also included, as one Middle Eastern country. In compiling the data from these different countries, and comparing to other published data, we can form a better global picture of the reasoning used by people, and whether there are religious differences. In many issues there are not, and this will be discussed in the survey summary.
We must also learn from traditions, these are another type of data we have. There are a variety of different ethical traditions, and it is essential to consider these for the development of universal bioethics. These traditions are also part of our social heritage, though most have a more spiritual base. These different traditions should be respected to make this universal bioethics also cross-cultural ethics; respected to the extent that they do not conflict with fundamental human rights. We can find many common features that are useful to develop universal ethics. I have summarised some of the medical ethics traditions in an earlier book3 so I will not repeat that all here. A brief description of some relevant traditions follows.
The ethical tradition of Judaism is discussed in the chapter by Leavitt in this book and in another recent publication (15). 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 practises 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, there is the idea of helping the poor and needy. A key feature of Jewish Law is the overriding value and sanctity of human life, rejecting any Hippocratic, Christian or Modern compromises (16). The duty to preserve life is the dominant obligation, and this is reflected in their medical ethics, however preservation of fetal life was not reflected in the survey results from Israel.
The Christian's role model is Christ, not Hippocrates. There are five basic principles of Catholic medical ethics, those of stewardship of the body, inviolability of human life, the principle of totality, of sexuality and procreation, and the principle of double effect. There are many Catholic Hospitals and Medical Institutions which are instructed to follow the Catholic ethical codes, which differ principally from the standard Western codes with regard to reproductive questions and abortion, as we can see in the results from the Philippines. Modern Protestant medical ethics is based more on viewing the relations between the patient and the physician as a covenant (17), than the sharply formulated principles of Catholic moral theology. Christian codes regard beneficence, such as striving to do the best for the patient and avoiding harm in the Hippocratic ideal, as a command which does not just apply to the patient but an active duty to all people.
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 civilisation developed a mixed approach of drawing on other values, the way of "adab" (18). 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 desirable characters and etiquette of a physician included being sensible, learned, pious and act without haste, and have faith in God (19).
Hindu medical ethics are different to the Christian or Islamic approaches. There are some oaths, including the Oath of the Caraka Samhita from the first century which is structurally similar to the Hippocratic Oath. There is also an instruction to pray for all creatures. The directive to leave dying patients without medical help is not found in the Hippocratic Oath (20), but is seen in some Hippocratic writings. The code is linked to the idea that ill health is because of bad behaviour in this or past lives. Since the thirteenth century there has been influence from Buddhism and Greco-Arab influence which led to Yunani medicine, which has a code similar to the Hippocratic one. The Indian philosophy also includes the idea of do no harm as one guiding principle. Indian medical ethics today includes Hindu and Western influences, plus many folk traditions and other religious groups. India includes followers of many religions, and the long tradition of living together, and the environmental aspects, as described in full by Azariah in his papers in this book.
Modern secular philosophy is different from that of either Hippocrates or religious ethics, and within the last decade has led to the emergence of the concept of patient rights (21). This came together with general civil rights, which became dominant after the 1960s, also involving environmental concerns. The American Hospital Association 1972 formulated a "Patient's Bill of Rights" in 1972, and within several years this was adopted into law by U.S. Government agencies. The Parliamentary Assembly of the Council of Europe adopted a recommendation "On the Rights of the Sick and Dying" which also states that the patient has the right to refuse medical treatment in 1976. The responsibility for bioethical decisions in the West has shifted to the individual public during the last few decades, though this has gone to the extreme in the United States.
The former Soviet-block communist world is in a process of change back to Christian roots, and is in a process of tradition. The survey in Russia allows us to glimpse into the thinking of ordinary people there, as discussed in the paper on the Russian results. 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 is 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. Nevertheless, the physicians are still respected much more than the government.
Chinese ethics, including medical ethics, involves the convergence of Confucianism, Taoism and Buddhism (22). 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 (23). 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 (24). This is certainly seen in most medical practice, though may be in a process of change. Informed consent is becoming accepted, and bioethics may transform Japanese society (25). The individual attitudes of Japanese are generally similar to Westerners, as shown in this and past surveys (26)
There has already been a book written on the subject of the similarity of traditional Buddhist concepts and Western medical ethics (27). Buddhism includes the idea that medical knowledge alone is insufficient for medical treatment, a caring relationship must also be present. Although the concept of karma (like fate) is recognised, similar to other religious traditions, human effort is also a means to lengthen human life. The sanctity of life concept is extended to animals in some types of Buddhism, as in Hinduism.
There are a variety of other spiritual origins that people in the world have, and a much fuller examination and conceptual comparison of these different spiritual origins will be in a following book. There is still further hopes and fears which we must examine, regarding universal ethics. In the following chapter we will look at common ideals that can be a basis for a universal bioethics.
We can also ask whether universal ethics is even desirable. Different societies have different goals, as do different people. This diversity is to be valued, and at the outset it must be made clear that the type of universal ethics that is being discussed in this book is one that will maintain diversity. If our capacity for diversity was lost it would not succeed. Diversity is part of what we call being human. It is what could be called an integrated cross-cultural approach to ethics. We should never expect all people to balance the same values in the same way all the time. Nevertheless, there are numerous benefits if basically similar values, or principles, can be used by all people and societies, and harmony and tolerance are two.
Even if universalism is not possible, all would agree that tolerance of cultural diversity is generally welcome. The limits to tolerance are already broadly outlined in international covenants such as the Declaration of Human Rights, and the International Treaties against abuses of human rights. One of the basic factors is whether groups with little power are oppressed, in which case the international community may attempt to restore order. There are also international treaties on environmental protection outlining some of the limits of damage to the common environment that will be tolerated by other countries, such as the convention on ozone-damaging chemicals, and on deep sea dumping. We also have economic treaties, such as GATT, defining the limits of unfair trade. However, as will be discussed later, economic priorities conflict with environmental protection, and we need better resolution of this conflict in practical bioethics.
The extent of this similarity in universal ethics can be scientifically measured, and data is presented and reviewed in this book. When we realise the enormity of the problem of developing universal ethics we may want to give up, yet we must realise that individual action is a necessary prerequisite for developing a world sharing common ethics. Individual shortcomings can destroy the harmony and peace of any relationship, but collectively they can have global consequences. The basic principle of ethics still is "love thy neighbour as thyself", and if this was followed there would be no need to write a book on how we may do this. This book joins others that recognise a need for guidelines to protect others and our world. The law should encourage us to think about our ethical duties, and attempts to promote justice to all, recognising our failings and selfishness (selfishness is excessive autonomy).
There are large and small problems in ethics. We can think of problems that involve the whole world, and problems which involve a single person. We can think of global problems, such as the depletion of the ozone layer which is increasing UV radiation affecting all living organisms. This problem can be solved by individual action to stop using ozone-depleting chemicals, if alternatives are available to consumers. The international convention to stop the production of many ozone-depleting chemicals is one of the best examples yet of applying universal environmental ethics. Another problem is greenhouse warming, which results mainly from energy use. This problem however can only be solved by individual action, to reduce energy use. We could do this by turning off lights, turning down heaters and air conditioners, building more energy efficient buildings, shutting doors, and driving with a light foot. These are all simple actions which everyone must do if we are concerned about our planet, yet not many do so. Energy consumption could be reduced 50-80% by lifestyle change with current technology if people wanted to. New technology may help, but lifestyle change can have much more immediate affect. This reminds us of the economic interests of the major electricity and oil companies, which slow any substantial reduction in energy use.
One of the common goals shared by many people is to make a world of more harmony. If we look around we can only see limited examples of harmony, but we cannot even dream of making a perfect world, that is God's realm. There will always be some people who do not seek harmony. One of the principle failings of many ethical systems is that they ignore the selfishness of human behaviour. Human beings often disregard ethical norms and standards, and will continue to do so. Does this mean that it is pointless to try to develop universal ethics with a goal of a more harmonious world? No, but what it means is that we must be realistic, recognising our spiritual, social and biological limitations. As Jesus said, "Blessed are the peacemakers", but he did not say that we could expect human society to be at peace in its current self-seeking state.
Some economic and social systems have been successful in limited circumstances, but they have all had problems. This is no criticism of the desirability of universal ethics, and neither is it a reason not to try. The economic and social inequalities of the world have been a feature since recorded history. Some religious systems have the longest record of social survival in history, but they have all been misused by selfish people. The system of economics often has more impact on the policy decisions than the ethical and religious norms that people follow. Wars may be fought over religious differences, but often they are based on poverty. In an ever more crowded world we can expect more, unless inequalities are lessened and nationalism and racism are squashed. The environmental crisis has added its cry to that of human suffering, and as it becomes recognised that uncontrolled consumerism is not sustainable on the planet, we need to look for a fresh and integrated approach to ethics.
This book focuses on bioethics, which could be broadly defined as the study of ethical issues of life. Issues like justice, abortion, euthanasia, and stewardship of nature have been debated for millenia. We need to consider this heritage when building a universal ethics. Differences in approaches are clear from early historical discussions of these issues, for example, there have always been people supporting and opposing euthanasia or abortion. These differences and similarities are seen within any group of people within every society (2). Basically data from opinion surveys and observation suggests that the diversity of thinking within any one group is much greater than that between any two groups, therefore we can attempt to look at basic universal principles that can be used in deciding these issues. The social environment that people grow up in, and the education strategies, are becoming more similar with time suggesting that a universal approach is even more possible now than it was a century ago.
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 editor 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 picture that is painted in this book is intended to be realistic optimism, and the practical conclusion of such universal ethics must be in the synthesis of all the traditions, ideals, and aspects of biological, social and spiritual heritage that we have. The "we" includes not only peoples of the world, but all of life, however, ethics relates to how we regulate human behaviour and so this book is written in those terms. An introduction to what this synthesis might look like is in the following chapter.
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