We need to both examine what ideals of ethics could be universal, and also look at how to balance conflicting ideals. How do we balance protecting one person's autonomy with the principle of justice, that is protecting all people's autonomy? Utilitarianism (the greatest good for the greatest number) will always have some place, but it is very difficult to assign values to different people's interests and preferences. Different people's interests will conflict, so that there are exceptions to the maintenance of privacy and confidentiality. Many medical and environmental technologies are challenging because they involve technology with which both benefits and risks are associated, and will always be associated. Human beings are challenged to make ethical decisions, they have to. The benefits are great, but there are many possible risks - the greatest of which is to do nothing.
Even if life for many people in rich countries may have become physically easy, we cannot avoid making decisions. These decisions must be made by everyone, whether rich or poor. The more possibilities that we have, the more decisions that we make. Fortunately standards of education are increasing, but this is no guarantee that the right decisions will be made. People need to be taught more on how to make decisions, and the education system should accommodate this need of modern life. Some results of education surveys are also presented in this book from the International High School Bioethics Education Survey. Let us then look at some basic ideals of bioethics.
It is easy to see that people are different, if we look at our faces, sizes and the clothes that we wear. This is also true of the personal choices that we make. We may decide to play soccer, read a book, or watch television. We may be put under some pressure by the people around us to engage ourselves in a particular activity, or to behave in a certain way, but ultimately it is our choice. There is a duty to let people make their own choices. This is also expressed in the language of rights, by recognising the right of individuals to make choices. Respect for the autonomy of individuals is a fundamental principle of ethics, and is found in early times in those religions which recognised freedom of belief. Above the challenges of new technologies, and increasing knowledge, the challenge of respecting people as equal persons with their own set of values is a challenge for us all.
If we respect autonomy of human beings we should respect their right to have at least some property, or territory, and control over their own body. We are animals, and most animals (social insects excepted) have individual control over their bodies. In law and medicine, the emphasis on confidentiality is very important. The keeping of confidences is also necessary to retain people's trust, and has been a common feature of business and medical ethics. Autonomy is an ideal, and there are limits in cases where personal choice harms others, for example in criminal activity.
A feature of the ethical use of new genetics is the privacy of genetic information. This is one of the residual features of the existing medical tradition that needs to be maintained. We need to protect individuals from discrimination that may come in an imperfect world, one that does not hold justice as its pinnacle. There may need to be exceptions if other people are directly at risk from not knowing the condition of a patient. However, in the case of a predisposition for a certain illness, or the case of the inevitable development of a illness, the informed individual should have the right to keep this information that will affect their future life. Only when symptoms show that will affect a third party should their condition be reported if they have not already voluntary done so. There must be care in the reporting also, so that it is not widely spread. We must be careful, because we use computer databanks that contain such information, and if they can not be kept confidential, the information should not be entered to such a bank.
Privacy is an extension of confidentiality, the right to refuse questions. If medical insurance companies try to take only low risk clients by prescreening the applicants, there should be the right to refuse such questions. The only way to ensure proper and just health care is to enforce this on insurance companies, or what is a better solution, a national health care system allowing all access to free medical treatment. The problem is more related to justice.
It is accepted that humans possess unique moral wills, which is the basis for autonomy. In this section discussing autonomy, we should ask whether all people have this and whether animals also have some capacity for free moral judgement? If they are incapable of exercising, or responding, to moral claims then they do not possess the same sort of rights as humans do.
If we want to debate the issues of birth, death and the quality of life, we must ask what constitutes a person. The word "person" comes from the Greek 'persona', meaning an appearance or face, an individual appearance that has continuity through a story. Human beings change with time and experience, persons grow, creating themselves. From birth we become rational, self-aware, and through our childhood we learn and/or are moulded as our genes interact with each other and the environmental. Beings can also be treated as persons in a linguistic way, by names, and by ascribing emotions. Parents can do this as they interact with their infants in terms of psychological attributes that they assign to the infant, and we may do this to domestic animals too.
A person is generally referred to as someone who is rational, capable of free choices, and is a coherent, continuing and autonomous centre of sensations, experiences, emotions, volitions and actions. These are what may be called the characters of a person. A crucial part of our person is self-awareness, or personal identity. Our selfhood only finds its growth in social relationships, we are made fully human by our web of social relationships. However, if a person loses the capacity to communicate with others, but can receive sensory input, we still consider them a person.
During fetal life the characters of personhood are apparent in increasing ways. It is clear that the biological qualities of personhood are not present at conception. The early embryo or conceptus does not manifest the activities of a human person. It is a potential human person, at the biological level at least, rather than a human person with potential. To function as a human person a brain is needed, and in a parallel way with brain death the criteria used by some is brain life. The brain develops gradually, so it is difficult to mark a particular time when a sudden change occurs (28).
Another approach, founded in ancient Greek and Christian thought stresses being more than behaving. When a "human" possesses a soul they are a person. In Christian terms a human person is someone made in the image of God, which is not dependent on a criteria of actions. This is related to the topic of the value of life, which is discussed later in this chapter.
One of the important reasons for religions to place a high value on human life is belief in the soul. Each individual is precious and unique because they possess a soul, a spiritual status. The body, soul and spirit of the human individual are not separated but are integral in a Christian view. Before an individual becomes a self-aware person they may possess a soul. The timing of the beginning of the human individual actually coincides with the time of ensoulment, which I have discussed elsewhere.3 It is generally believed there is no intermediate in the animal kingdom, if the soul is from God then it is not necessary to envisage intermediates, but the threshold can be crossed in a single step, between animal instinct and human reflection. The timing of ensoulment in humans does vary between different religions, and within people of the same religion. In a tradition where the presence of a soul is the source of autonomy and protecting human life, the characters of personhood are less important in assigning autonomy.
In order to understand how human beings behave and how we should behave we need to look at our biological, social and spiritual origins, as we did briefly in the last chapter. Within a year or two, and certainly within this decade we will obtain the gene sequences of all of the human genes that are involved in our life, including up to 75% which may be involved in determining our behaviour. This will change the way we think, and will help develop bioethics. Behaviour is influenced by both genes and environment, and the results of this International Bioethics Survey suggest that there is at least as much diversity in individuals in any one culture as across the world. This is consistent with a strong genetic determinism of behaviour, which is another challenge of these results. 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.
Obviously the complete genetic sequence of humans, and comparison of the genetic similarities and differences to other animals poses many implications. Humans are primates, and the species most related to humans is chimpanzees, and we are in a small group with higher primates including orangutans, gibbons and gorillas. Already we know there is great similarity between chimpanzees and humans, how will it change our opinion if we find there are only 100 genes different between these two species? By difference I mean new genes or missing genes, rather than the vast majority of genes which are the same between these two species having only a few nucleotide base changes in their DNA. The similarity may be a great shock to many of us, especially considering some people still deny the similarity we already know.
Humans are also spiritual beings, and the spiritual part of life may be somehow distinct from the physical. Whether the soul of a chimpanzee is different to a human soul has been debated for millenia, and is a question already found in many religions. It is a question only God can answer, not humans. It is a non-scientific question, like many other important questions of bioethics, the value of life, the value of love, and the meaning of existence. Scientific questions are those we can disprove by experiment, and there are many that we cannot. The concept of evolution means we see humans as living creatures derived from other living forms.
What is more psychologically difficult to accept, is when sociobiologists begin to trace the origins of our ethical behaviour. However, we can see behavioural patterns in all animals, and increasingly sophisticated ones in so-called higher animals. The origins of our selfishness and altruistic (giving) behaviour are fundamental to how we behave. Excessive concern with personal autonomy could be called selfishness, and there is obviously a balance between too little recognition of autonomy which is against the dignity of a person, and too much which can clash with justice as discussed below. Autonomy should not be the most valuable principle of bioethics, even if it is the most dominant feature of human behaviour.
The Jewish-Christian-Islamic religions say that humans were made in the "image of God" (Genesis 1:26-7). What is this image? Part of this image is what we could call the "human soul", as discussed above, the part which gives dignity to humans. Another approach to investigating the soul is to look for characteristics that have been claimed to make humans higher than animals, and to which some people say reveal the soul. These include, intelligence and intellect, and language ability. It is very difficult to estimate the language ability of animals who use different communication systems. One way is to examine the complexity of the language, which would eliminate most animals from being close to humans, but there would still be doubts over some. It has been found that chimpanzees can be taught sign language, and talk to humans in it, but only to the extent of composing two or three sentence replies. This represents a stage equivalent to a human baby learning to talk, before they can start to actually make longer sentences. This creates enough doubt about their ability to give them at least certain rights, and together with social evidence some claim we should give the higher primates, chimpanzees, gorillas, orangutans, and humans, equal rights in what is called the Great Ape Project (29).
James Rachels in Created from Animals (30) advances the view that in secular philosophy we should not be speciests, but judge animals as individuals with differing moral worth which may be similar to humans. The sensitivity to pain and capacity for intelligent behaviour are the main qualities we should use to judge whether to use an organism for human ends, as is discussed later in this chapter in the section on animals. The book claims that Darwinism has undermined theological underpinning's of human superiority over animals, which is something many people will refute, especially those who are religious. At the other extreme, the views of Aquinas, who thought animals had no rights, are incompatible with what we know about the biological continuum between animals, and humans. We can argue for a religious difference between the point at which we violate the rights of humans and animals, or use the language of duties, but we certainly have duties to some animals based on their characteristics which we are increasingly becoming aware of. Our ethics must build on the knowledge that we have, and change when that knowledge informs us of new ethically important qualities of animals such as pain, self awareness and rationality.
There are dangers to making autonomy dependent upon revealed characters of behaviour, or an act-centred definition, because not all individuals are able to show acts or even have the potential for future acts. This will be discussed further later. In conclusion we must broaden our horizons to look at the autonomy of all organisms. The reason we must do so is because of justice, which is the subject of the next section.
The autonomy is limited by respect for the autonomy of other individuals in the society. People's well-being should be promoted, and their values and choices respected, but equally, which places limits on the pursuit of individual autonomy. We should give very member in society equal and fair opportunities, this is justice (31). Society should also include the future of society, future generations are also an essential part of society. As we have just discussed, animals are part of the biological community in which we live, and we also have to consider the implications of whether they possess autonomy.
Those who claim the individual autonomy comes above societal interests need to remember that at major part of protecting society is because it involves many lives, which must be respected. Individual freedom is limited by respect for the autonomy of other individuals in the society. People's well-being should be promoted, and their values and choice respected, but equally, which places limits on the pursuit of individual autonomy.
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 industrialised 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. Industrialised 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.
A fundamental way of reasoning that people have is to balance doing good against doing harm. We could group these ideals under the idea of love. Human beings are spiritual beings, sharing emotions such as love and hate, greed and generosity. Any system which fails to acknowledge this is destined to fail. The question of spiritual origins of love in humans and other living creatures, was discussed above. We need to also examine whether the altruism of animals was the precursor to love in humans or whether love is something extra - God-given. In the final analysis we cannot prove whether the extension of altruism is from God, but that is a question that respect for autonomy would leave to the individuals.
One of the underlying philosophical ideas of society is to pursue progress. The most cited justification for this is the pursuit of improved medicines and health, which is doing good. A failure to attempt to do good, is a form of doing harm, the sin of omission. This is the principle of beneficence. This is a powerful impetus for further research into ways of improving health and agriculture, and living standards.
The term beneficence suggests more than actions of mercy, rather the ideal is love. The principle of beneficence asserts an obligation to help others further their important and legitimate interests. It means that if you see someone drowning, providing you can swim, you have to try to help them by jumping in the water with them. This case also includes the weighing of risks, to avoid doing harm. This is another integral part of love, and it is because we respect life. It is expressed more at an individual level, whereas justice is the expression of this concept at a societal level. Love was called the only central principle of ethics by Joseph Fletcher in a book Situation Ethics (32), following on from the idea of the golden rule, "do unto others what you would have them do unto you", and the commandments found in Christianity to love others as you love yourself.
In the previous chapter we discussed the biological relationship of humans to animals. If we consider biological relationships it is natural to ask the question whether animals share similar behaviour to humans. If they do it has some relevance for ethics, and it would establish more solidarity between animals and humans.
In evolution it is assumed that selfishness is required for selection. Natural selection means survival of the fittest, and selfish behaviour allows an individual to leave more offspring. At the genetic level it means a selfish gene will try to replicate itself and leave more progeny (33). If a gene does not do this it will not last. When we look at animals we see that some animals exhibit non-selfish behaviour, called altruism. Some even give when there is no hope to receive any genetic benefit, helping unrelated individuals. We must therefore ask the question is altruism the basis for love?
We can look at some interesting examples among animals of altruism, and analyse this from the viewpoint of natural selection, asking why that behaviour would survive. Vampire bats are not our image of a loving animal, but unrelated bats in the same colony may feed each other. If one bat is successful and another unsuccessful, the successful one may feed the unsuccessful hungry bat. This is called reciprocal altruism, because the bats may reciprocate on another night. This behaviour can be mathematically modelled in such a way to show that it could be a selective advantage for these bats, because they meet frequently, and by helping each other they help themselves leave more offspring (34).
We can ask whether males or females have genetically programmed roles in the raising of offspring. Animal studies, and human experience, shows that fathers can raise offspring, and maternalism is shared by both sexes (35). Although the mother gives birth to the child the father can care for the offspring, sometimes it is actually the usual practice, and other cases it can be induced if the mother is absent. Parental care can tie up resources, but if the offspring will die parents who want to have offspring continue until reproductive age must nurture them (36). Parent-offspring behaviour must be stable for the next generation, for the offspring to become successful parents. This means that while children can ask for food, they cannot ask for too much or else the parents will die - the genes for this behaviour must be balanced. This can be done by making the food requests also costly, which is consistent with observed behaviour in some species (37).
The precise outcome of interventions in nature or medicine is not always certain. This uncertainty can be called a risk of failure or chance of success. This is common to diverse activities such as medicine, driving a car, generating energy, or production of materials. It has taken major ecological disasters to convince people in industry or agriculture of the risks. Introducing new organisms to the environment is also associated with risk. We may never be certain to have complete control over the effects of introducing new gene sequences, and with many cases much further experimentation is required before we will be able to ethically allow full scale use of them. Ignorance of the consequences means caution in using new techniques, and this is an approach seen in the regulations governing the introduction of new organisms into the environment, the basis of quarantine regulations.
The uncertainty is more important the greater the consequences of any disaster. If we introduce very different gene combinations into the environment they could have major consequences, which may be irreversible. The new genes may enter other organisms, or the new organisms themselves may replace existing organisms in the ecosystem. The ecological system is very complex, minor alterations in one organism have effects throughout the ecosystem. We can not yet predict these affects, so we must be careful, and move cautiously. We have had bad experiences in the past to make us realise our limitations. There is only one earth and we are dependent upon it, we must walk carefully.
The idea here is that because we perform some action, we will perform another. This expression envisages a slope where once footing is lost it cannot be regained, and suggests that controls which are adequate for initial exploration may fail under increased pressure. While we may not do any direct harm with an application in question, it could result in progressive lowering of standards towards the ill-defined line beyond which it would be doing harm. The inability to draw a line is no measure of the nonimportance of an issue - rather some of the biggest fundamental questions in bioethics and life are of this nature.
An extension of love to other species could be considered under the concept of stewardship. Stewardship can apply to both the way people use other humans and the rest of nature. It has often been forgotten in the past, but has a long history in many religions, being central to a Judeo-Christian doctrine of creation. Usually people prefer to neglect it and to think of dominion of humans over the earth, treating the earth with little value, however we see what problems this has caused. There are numerous pollution problems that we can readily see, which affect humans and other species. Of special attention for bioethics is the value of biodiversity.
The inter-relatedness of all living organisms can be readily seen. All organisms need water, all organisms have the same genetic code and share similar genes. All creatures appear, at first sight at least, to be temporal, they live and they die. This relatedness is expressed by the idea that they are all alive. They share something - life. There is also a continuity between inorganic and organic, ecology refers to the relationship of every organism with the environment. Is there anything which distinguishes living organisms from non-living materials beyond that they use information to replicate, and that information is non-random?
We need to examine where the value of life comes from, and because of this value we should not do harm. Many want to protect nature, not because of its value or property, but simply because it is there. We need to look at what people imagine from the words "life" and "nature", and examples of the many comments follow at the end of this book. For this the idea of a Japanese word "inochi" is useful. Inochi can be translated as life, nature, the energy that holds things together. There are various images, as shown in the comments at the back of this book, but the inochi of every living organism is distinct, unique, and equal (38). The inochi departs when an organism dies, and is distinct from the idea of a soul. All organisms share the same amount of life, they are either dead or alive.
A similar idea is expressed in some ancient Greek thinking, and the idea continued in Western thinking with the idea of vitalism. This thinking was challenged by the discovery that the chemicals found in living organisms were the same as those found in inorganic matter. It is now possible to synthesize DNA from chemicals, and to use the information in such DNA to make proteins, such as an active enzyme. There is no longer anything vitalistic with the workings of a cell, and the genes can be changed around in a predictable way. What remains is undiscovered, but the basic mechanisms are becoming understood. However, we may still believe that life itself is special, no matter how it comes into being, or how much of the process we understand. Even if we understand the reason for a blooming flower we may still value its beauty. This value is distinct from the value given to a being because it has a soul, but there are similarities as mentioned above with regard to autonomy.
Early human cultures worshipped the mystery of life in various ways. The earliest cultic figures from palaeolithic ages are mother figures. Mother Earth was worshipped under many names in America, India and Europe. Mother Earth is worshipped in some rituals, she is set against the Father of Heaven. The symbol leads to a more dualistic view of the world. The creation narratives in the Old Testament are polemics against the Canaanite matriarchical cults. The pre-Aryan, Indian Jains saw the Universe as a colossal human being, the organism of the World Mother was populated by living things without number. There are numerous other symbols that have been used for the world, like the feast, or the dance, the theatre, as music or as play. These ideas unite the things of the world together (39). In a similar spirit, recently the Gaia hypothesis has been advanced, that the earth as a whole is alive (40).
In a Judeo-Christian view, nature is created by God, nature itself is not divine but is the handiwork of the Lord. Therefore humanity does not face a world full of ambiguous and capricious gods who are alive in the objects of the natural world. Nature is not terrifying, as it is to those primitive cultures that view every act as gods response to their actions. The Bible does not discuss the method of creation, but merely says that God created the world by His Word (41). The Biblical view of the relation of man and nature is that they are both continually dependent on God. Humans have been told to subdue, cultivate and take care of the earth, to multiply and to have dominion over the created order (Genesis 1:28, 2:15). A Christian's vocation is to continue the "good" work of creativity (42). This is a huge responsibility, and demands much positive action for those that accept this paradigm. The world was made good, but humans chose evil. A very common alternative world view is that humans are innocent, but trapped in an evil world. We see this view in some Asian traditions that look on the visible universe as illusory or insignificant or evil. Matter is seen as relatively bad, goodness is only attributed to the spirit, and the religious task is to transcend the world.
There have been some who argue for a reverence for all life, such as Albert Schweitzer (43). This approach makes no distinction between higher and lower life forms, saying that we can not judge other lifeforms in relation to ourselves. It does make the point that it is very difficult for us to understand or judge the importance of other living organisms in the natural order. The only reason for harming life he sees is necessity. However, what is "necessary" can vary widely between cultures. This is consistent with the use of ideals in bioethics, as useful principles for decision making.
The idea of a vital energy of life is still found in many people's thinking. Even if they understand the biological reductionism of genetics they may still believe that there is a special "energy" or "essence" associated with being alive. Whether or not we do, we may still want to protect life. On the otherhand, we may attempt to destroy diseases, because they destroy the lives that we value. By more research into the way people look at nature, we can find shared universal ideas about the relationship of humans to the earth and human responsibility to nature. We should emphasise the value of being alive and the principles of do no harm and environmental stewardship common to the roots of all people's beliefs.
Another metaphor is that the earth is just as a machine. This has led to a segregation of the divine from the world, including the world of human beings, and ultimately leads to atheism, that the world machine, and human beings, can function without God. It also leads to devaluation of nature and life, as discussed further in a paper on Darwinism by Azariah in this book.
Human life affects other organisms and the environment and it always will. We can see the effects of human activity everywhere in the world, from in the atmosphere to throughout the oceans, from the poles to the tropics and from the coastal lowlands to the highest mountains. The amount of land that we use to live in and grow our food on, and the amount of resources that we use, can be easily seen. However, it is the substances and wastes that we produce that may have the greatest effect. We produce new substances and release very large quantities of naturally occurring substances that may disturb local and global cycles.
The flow of these substances is important. Such cycles do change with time. Nature has a history from a beginning and it changes, or evolves. The physical world regularly changes, for example ice ages. Some organisms die and others thrive. Nature has changed in dramatic ways in the past. The current number of different species that are alive may be only a few percent of the total species that have existed since the dawn of life. At no time in the past has nature been more dynamic than today because humans are rapidly changing it. We are raising the temperature of the earth. We are depleting the ozone layer and increasing the amount of UV radiation reaching the surface. We are causing the extinction of tens of thousands of species, and within our lifetime we may see the extinction of a quarter of the world's species. We are adding many pollutants to the environment. We are making many new crops, and are using genetic manipulation to change lifeforms themselves. We are increasing our population rapidly, which exponentially increases the problems. Today we can doubly say that nature is dynamic, maybe too much so!
Biodiversity is a word used to picture the great diversity of living organisms on the planet. Just as the individual processes of life are dynamic, so is the composite of the lifeforms. The idea of dynamism also implies a balance. This is illustrated by the words biosphere, foodwebs or ecosystem, with the largest ecosystem being nature itself. The dynamic nature is implied in both science - the second law of thermodynamics, and religion - in the Biblical doctrine of creation and preservation; and Asian religions with "harmony". Nature changes with time; some organisms die and others thrive, and has done so in dramatic ways in the past. There are various religious stories to support preservation of biological diversity, the most famous of which is the story of Noah, which is shared by the Judeo-Christian-Islamic traditions. Noah preserved all the domestic and wild animals from environmental catastrophe, a catastrophe that it says was caused by the actions of humans.
The balance of nature, the way different species at different levels of the food web exist together, is delicate. Some eating others, while others eat them, and others dependent on the modification of the environment made by another species, with competitors at every level. There is an important inbuilt tendency for species to reproduce so quickly to be able to increase their numbers, yet this does not occur dramatically in a balanced ecosystem, in the competition for resources, the struggle for existence, each species tries to survive to reproduce. This concept is very old, it is seen in Plato's Timaeus who answers the question "in the likeness of what animal did the creator make the world?" with the answer that god did not make the world like any one species but rather as "one visible animal comprehending within itself all other animals of a kindred nature". The idea highlights how life itself is intertwined, in a web of complex relationships. There is also a continuity between inorganic and organic, ecology refers to the relationship of every organism to the environment.
Most people are aware of the loss of species and "nature". Because the abundance and complexity of ecosystems has not been able to be assessed, an accurate estimate of the rate of species loss is not currently possible. While only 1.7 million species have been identified, 5-30 million remain yet to be identified. The problem of diversity loss is broader than the extinction of species, because diversity losses can occur at each level of biological organisation. Although the loss of a few individual species may seem unimportant, the disappearance of a few species can dramatically affect the ecosystem from where they disappeared. The current rate of loss of species is greater than the estimated rate that species evolve.
We need to ask whether there is ethical value in having different species? While we can argue for human benefit from biodiversity, is there any ethical value in maintaining different species? A related idea is that of "species integrity", i.e. species should not be mixed, which was examined by several questions in the International Bioethics Survey (Q9-12). Modern biologists generally think of species as reproductive communities or populations. There is no universal or absolute rule that all species are discretely bounded in any generally consistent manner. One species may exchange little or no genetic material with related or adjacent species, while others may do so all the time. Species exist in nature as reproductive communities, not as separate creatures. The cross between a horse and a donkey, the mule, is certainly accepted in many cultures.
Both cell fusion (joining two cells together to make a cell containing parts or all of both cells) and genetic engineering techniques, allow species barriers to be readily overcome. To challenge the integrity of a species requires more than a single gene change. Mammals like mice contain 50,000 or more genes and changing a small number of genes will not violate species integrity. Preservation of each species as a species is important, so we should not lose each species' identity, but the question of changing genetic identity of individuals for human utility is harder to answer. The new strains should not be thought of as special, manmade, forms of life, considering the wide genetic variation naturally occurring. In fact to think that we are the "makers" is "pretending to be God", or arrogance.
We can at best, or worst, generally only modify existing attributes. The exception is to add additional genes for human benefit, for example medical proteins in the milk of animals, or vaccines into banana. New genes can be designed by human ingenuity for generally medical reasons, but the ethical issue is what we do with them, not to modify something for human benefit - or else we should stop building houses, and more relevant, we would have to stop traditional agricultural breeding. For conservation of biodiversity we should maintain unmodified organisms and ecosystems separate from agricultural areas, and encourage diversity of crops.
If we consider a complete bioethics we must include the duties we have to human beings, and can argue for conservation from human dependence upon the environment. Preservation also has socio-economic benefits, and in some countries nature tourism is a or the main income earner. Reduced diversity also eliminates the options to use untapped resources for agriculture, medicine and industry. More value could be obtained by harvesting the renewable resources from tropical forests than deforestation (44). In agriculture the use of wild crops in breeding crop plants has accounted for half the production increases, and is estimated to account for US$1 billion annually, in U.S. Agriculture. Future gains in production will also depend on the use of genetic diversity as well as genetic manipulation. Nature provides the raw materials, the genes. There are indirect benefits of wild species such as the role in pollination, pest control, storing flood waters, and detoxifying many pollutants to name a few.
Human beings affect all the world, most directly when they exploit or use resources. Human beings are dependent upon this use, and we need to consider agriculture and aquaculture in particular. Nature includes both agricultural land, cities, and wilder regions - all is nature. We need to have an integrated view, and not consider agricultural areas as areas which are "artificial". At the same time plans to green deserts with genetically engineered trees and plants may concern us - though such future forests would be part of nature - as would a potato making plastic.
We can alter the genetic blueprint of organisms much more easily than in the past with genetic engineering. The introduction of genetically modified organisms into the environment presents ecological risks that we must be careful to minimise. However, stewardship also leaves room for the genes of organisms to be altered if it presents a better alternative to the other options available for providing food for other members of the human race. There is no inherent "sanctity of the genes" in this approach, however, we may value to maintenance of existing species and "natural" nature beyond our agricultural use, as the survey results show world-wide.
Food concerns are basic to humans, and need to be considered in bioethics. Agriculture has been more than the supply of food, it has been credited with the birth of "civilisation" and cultures, when humans changed from hunter gatherers to planting crops and having domestic animals. The food supply is sufficient now, if distributed properly, however, we cannot trust people to give food to the hungry. Improvements are still necessary, especially given the increasing areas of the world which have salty ground and unpredictable rainfall.
Some of agricultural issues are transnational, for example ocean resources. Currently, 98% of the food products of humans are obtained off 7% of the world's surface area. From the oceans, 71% of the world's surface only 1% of the foodstuffs are harvested. Aquatic food proteins are an important source of animal protein, but this proportion needs to grow in the future. Only about 30% of the world's fish catch is from cultured areas, whereas fish like tuna are almost entirely from the use of international ocean resources. Most maritime nations have declared 200 mile limits within which they claim prior rights to exploit marine resources, including fish. Therefore international fishing strategies are necessary, and we can see many examples of over-fished species. The form that such fishery protection takes is often to enact quotas, a given number of fish of each species that should be caught. Fish have been well studied wild animals because of the need for a knowledge of their biology in the management of sustainable fishing. Quotas were introduced to North Atlantic fishing since 1970.
Agriculture produces food, but it needs to be sustainable. The most efficient production is using plants, and eating grains and vegetables. Assuming that realistically animals will continue to be eaten, we need to think that animal species differ in their efficiency of converting plant material to animal protein. Animals also produce a lot of waste, for example in 1970 the animal population in the USA was estimated to be 564 million head, which produced the waste equivalent to 2 billion people.
Some people, from all countries, say that some developments of science and technology such as genetic engineering are interfering with nature because "nature knows best". In all activities we should not ignore the detrimental interventions that our lifestyle has upon nature. We have some good reasons to interfere with parts of nature, for example, we try to cure many diseases that afflict humans or other living organisms and we must eat.
The idea that genetic engineering is in some way interfering with nature lies more in the idea that genes are a foundation of life. The idea is that genes in some way are more sacred than other parts of the organism. However, DNA and entire genes can be made by purely synthetic procedures in a laboratory. A new catch phrase is "Genethics" (45), which suggests that the problems raised by genetic technology cannot be dealt with ethically by existing ethical principles, or by Western morals, and we must turn to Eastern religion. However, the Western Christian tradition has the principle of stewardship, which is balanced with support for the creativity of humanity to find new technology. While the use of genes may be seen as novel, we have had a very long history of genetic manipulation using conventional techniques of plant and animal breeding, but only recently do we understand the details of why they worked. We should consider our knowledge when implementing any new variety of organism, however it was made.
For some there is a feeling that we should not explore all the secrets of life, that the mystery of life will be gone if we discover too much. However, as many scientists will say, the more we know, the more appreciative of the workings of life we become. The fact that we have practical requirements, such as to feed, house and heal people of the world, are major justifications for the pursuit of practical knowledge in any system of religion or philosophy that places a high value on human life, it is the principle of love.
A negative science fiction image has been easily promoted and is appealing to the human imagination. The fascination with creating "new forms of life" is coupled to a fear of how far it might be taken. The Frankenstein Factor was coined by Gaylin (46) as a suitable name for the wild scenarios imagined by some people, which represent the fear of the unknown, as symbolised in the movie. There are many movies which play on similar themes, in 1993 the blockbuster movie Jurassic Park (10) brought genetic engineering into the imagination of many. These are very powerful in shaping public perceptions. There have been many accusations that scientists are "creating new life forms", however, our present technology is capable only of transferring one or a few genes into a genetic background containing the order of a hundred thousand genes.
The term "Playing God" is a term applied to situations where humans make life or death decisions without reference to God, this being seen as pride or arrogance. It may not be the use of power and creativity that is wrong, but rather attributing power to our own resources. This reasoning is found in different cultures. What is wrong is not the act itself, but the attitudes that could be involved. However, useful applications of technology are positively advocated in some religions, such as the Judeo-Christian tradition which suggests co-creativity with God is part of good stewardship of the earth's resources.
The expression suggests that we should be cautious in the use of technology whose potential risks and side-effects we do not fully understand, the idea of do no harm, as discussed above. The idea is that while God may understand all, we do not, so we should only tamper cautiously with things as basic as genes, or new life and death.
Whether or not nature itself has "rights", we certainly do have many duties to it. We should not manipulate it solely to satisfy human desire. The theocentric approach challenges two common tendencies. Some religions tend to blur the distinction between God, humans and nature, leading to a glorification of nature. However, industrialised thought tends to divide humans from nature, seeing nature as something to exploit for human comfort. The same could be said of some interpretations of Darwinian theory, as explored by Azariah in this book. We must remember that we are creatures, part of nature, which is another interpretation of evolution. We are currently in a crisis of domination, not just an ecological crisis, but a crisis of our whole life system, brought upon the entire globe by ourselves. The origin of this crisis is in human behaviour and attitudes, and the tremendous power of our technologies to shape the world. As a reaction against this some people attack what they see as the cause, science and technology, and its effect upon people's philosophy; however, the real cause is the age old problem of human selfishness, which has become embedded in the short term economic desires of many businesses and governments.
The greatest public concern is over the mixing of human and animal genes. There is generally more concern about insertion of animal genes into humans then concern about insertion of human genes into animals. However, some people object to the insertion of human growth hormone, or hemoglobin, genes in pigs. These animals may be used to make medically useful proteins, and could be considered just an extension of the modern dairy industry which tries to increase milk production in cows. There is also research to produce transgenic animals which can be organ donors for humans. This is technically difficult, but perhaps possible - but at first people may consider this concept "playing God". However, eating animals, or having inbred dog varieties is considered acceptable, which suggests that it will be within the bounds of common morality to use animals for organ donors. One could argue that medical need is a greater reason than the desire to eat meat, so that this will be accepted. However, one can also say that everyone has some limit to changing nature, and we do not know where this is.
In most people's minds there are some differences between animals and plants. Philosophers can argue that there are morally significant differences between animals and plants, such as the capacity to feel pain. The question of whether animals can think is related to autonomy. This section is also strongly linked to the concept of "do no harm", which has a basis at a more fundamental level - the level of being alive.
If we are going to harm life, a departure from the ideal of doing no harm, it must be for a good motive. Such a motive might be survival, and we can see this as natural - all organisms consume and compete with others. Plants compete with each other for space to grow, animals eat plants or other animals, bacteria and fungi also compete for resources and space - sometimes killing other organisms and other times competing without direct killing. Destruction of nature and life by humans is caused by two human motives - necessity and desire. Basically, it is more ethically acceptable to cause harm if there is necessity for survival than if it is only desire. This distinction is required ever more as human desire continues to destroy the planet.
The motive for using animals alters the morality of their use in some religions, suggesting these concerns have a long history. Animal sacrifice for worship is used in Islam, but they would generally condemn scientific research or battery farming. Vivisection is allowed under circumstances where there is no pain or disfigurement and if other animals benefit. The use of animals in science is under the same moral codes as applied to humans. Even though the animals possess a lower consciousness, Islam says animals know their own mode of prayer and psalm, a voluntary act of praise. The killing of any breathing beings, except for food or religious sacrifice, is high on the list of deadly sins. Hindus, Jains and Buddhist believe that we will be reborn as another living animal, which creates their bond of caring and compassion for animals. So they will reject animal sacrifice, even though the sacrifice of an animal won't kill what is essential, in the reality, the soul, of that animal.
Christianity also agrees that scriptures and traditions show that animals do have valid claims upon us. Animals cannot be viewed simply as expendable raw materials for our designs, they do not exist simply to serve us, the doctrine of creation is opposed to anthropocentric notions. The use of animal sacrifices does not mean animals should be sacrificed for the selfish pursuits of man, the practise of animal sacrifice was to bring God into the focus of human hearts in place of their own selfish desires, and was not necessary after the birth of Christ. The Bible often mentions animals, as Israel was an agricultural community. God owns everything of creation, including all our cattle (Psalm 50:10) and He cares for them all (47). Animals should also rest on the Sabbath, and should be fed first, before the farmer (48). However, early Christian theologians such as Aquinas regarded animals as irrational creatures that weren't directly possible of human friendships. The tradition of the Roman Catholic church is to regard animals as means to human ends, and the moral objections to cruelty on animals are more concerned with fear that those inflicting pain will contract habits of cruelty, something also seen in Kant. The contrasting attitude of St. Francis of Assisi, to talk of sister cows or brother dog, is a picture which may be more appropriate for ecology.
Beyond the motive, another important criteria we use in judging the use of animals is avoiding the infliction of pain. Some distinguish pain from "suffering", but they are both departures from the ideal of avoiding harm. Suffering can be defined as prolonged pain of a certain intensity (49), and it is claimed that no individual can suffer who is incapable of experiencing pain. The capacity for suffering and/or enjoyment has been described as a prerequisite for having any interests (50) Judging pain is subjective, and there are parallels in the way animals and humans respond. Many of the neurotransmitters are similar between higher animals and humans. It is possible that animals do have a different quality of "pain", as the frontal region of the cerebral cortex of humans is thought to be involved in feelings of anxiety, apprehension and suffering components of pain. This region is much smaller in animals, and if it is surgically treated in humans it can make them indifferent to pain. There are differences seen in the types of pain receptors, some respond to mechanical stimuli, some to noxious heat or irritant chemicals, and some to severe cold. The difference between pain of animals and responses of plants (which include electrical response like animals), is that a signal is only a signal, whereas pain is something after the reception and processing of the signal in the nervous system.
We can think of ethical factors inside and organism and outside, and a summary of some factors for judging animal use is below:
Extrinsic Ethical Factors
- Human Necessity / Desire
- Human sensitivity to animal suffering
- Brutality in Humans
- Other animals disapproval
- Religious status of animals
We may all agree that animals can suffer, but the question is how much does it matter? There may be a choice between human welfare and the suffering of nonhuman animals. Many people accept that all humans are equal in moral status, and all humans are of superior moral status to nonhuman animals. From these two moral principles they put human welfare ahead of animal suffering. Peter Singer argues that these two moral principles cannot be defended within the terms of a nonreligious approach to ethics. He concludes that there is no rational ethical justification for always putting human suffering ahead of that of nonhuman animals. He argues that "if we are considering public policy in a pluralistic society, we should not take a particular religious outlook as the basis for our laws" (51). But we can ask, do we need to take rational utilitarian philosophy as the basis for public policy? Many different people's cultural and religious views are more consistent with human beings having a higher moral status than animals, and these views may have more in common with each other than with the rationalistic philosophy of academics. There are some fundamental questions about who should decide this, and it needs to be considered at greater length.
However, it is still important to summarise his argument, as it does have consequences for the way we regard animals, and we should improve their treatment. The problem with saying that humans are of higher moral status than animals is that while the human species may have higher mental capacities than animals, not all people do. The word speciesism is used to argue that in rational philosophy we cannot prove that we owe the human species any more ethical duties than we owe animal species. We should focus on the individual when considering ethics, which has been a focus of the movements against sexual or racial discrimination also. Singer argues that we should consider all beings who can suffer in our moral considerations, regardless of species. However, he would still not say that the deaths of animals are equal to the deaths of all humans, as there is an additional factor of the awareness of the future that humans have, which most animals do not have. To kill a human being destroys all the plans that they have made, a feature of humans. He also acknowledges the importance of extrinsic moral factors, such the feelings of family members if one dies (though this is shared with some other familial mammals).
At the practical level, the feeling of pain is the first major guiding principle for animal treatment. The second is that we should not kill some animals, if they have self-awareness such as higher apes, and probably other animals such as dolphins. We do need to consider the findings of animal studies on the level of self-awareness that some may possess. Our bioethics must have a basis from all data, including reasoning, philosophy and biological knowledge.
The creation of very diseased animals as models of human disease, for example cancer, and many other genetic diseases, is becoming routine, and this decade could be called the decade of the transgenic mouse in experimental biology. In this case we must try to balance the pain caused by the benefit, and this is not done well (52). There are agricultural reasons to make faster growing animals, or using animals to make products ("bioreactors"), as mentioned above. To make a chicken lay an egg full of interferon, a protein that can treat some cancer, is novel, but not beyond the daily use of animals. Ethically, if such proteins can be made in soyabeans for similar cost it is better, and if the interferon can be delivered to the body by eating only beans - that would be a great advance. Research to make edible vaccines in vegetables or bananas, is underway, which most people would accept if it can provide cheap, just and safe medical care to more people in the world.
A response to the ethical objection that it is wrong to cause pain could be to make animals that don't feel pain to use for experiments, food, or other utility to humans. We could call such animals vegemals (vegetable animals). Because pain is a basic sensation we may object to manipulating it permanently out of strains of animals (53). These type of experiments involve altering the mental requirements of animals to suite our means. In fact these futuristic beings could be engineered to give consent. The motive is anthropocentric and the means used are not interested with the life of the animals themselves, however, if they did not suffer pain than they could be regarded by many as being better off then beings that do, and many organisms that are currently used for human benefit.
If we object to these experiments, we would probably be forced away from arguments based on pain, in which the capacity of a subject for sensation, is the pre-eminent quality on which attitudes towards the treatment of that being by others is based. If we object to these painless animals being made, it may be because we hold religious views according to which we should not grossly alter the creatures of the earth, because it is "unnatural". It could be based on each being having a self, suffering being viewed as the threat to characteristic, worldly related activities which threatens the integrity of the self (54), as would the removal of sentience. The Christian view would be that God gave responsibility to humans to look after animals, and we must respect other creatures in God's creation and not misuse power (55). We may also have concerns about changing our own values, but farming already treats animals as the longterm property of humans, and decides when or how they come into existence and die, and their reproductive choice.
This example points us to the fact that some bioethical dilemmas must be answered by human values, even if this is regarded by many philosophers as unsound, culturally determined, and undefinable. While at first we need to apply the immediate ideals that have common ground in religion and philosophy, we have a challenge to look at the the question of the value of life - a real bioethics dilemma. Genetic engineering challenges our thinking about the use of nature (3). .c2. The question of the value of life and nature can be investigated by open questions, as has been done and reported in this book. However, the issue of what is natural will change with time. Genetic engineering can also reduce the number of animals used in toxicity testing, which is not only more ethical but more economic (56). It is ethically consistent to use lower organisms, cells, or computer models, if possible, and also to use human volunteers and epidemiological research.
People will continue to eat animals, and practical ethics must improve the ethical treatment for all animals. One area of particular concern is whether animals should be in a field or in a caged box, or factory farm. The main ethical question is confinement of animals, such as veal calves, pigs and poultry in small cages. There have been several countries which have banned the use of battery caged hens. It has been illegal to use battery cages in Switzerland since 1992. In Sweden they will be illegal from 1998. The possible boredom of animals on factory farms (57) may be another ethical argument against their use. It is interesting that many farmers in the International Survey expressed concerns about animal use, they clearly perceive images of what is a "natural" and "just" life for an animal, and what is not. People need to decide how much more they are prepared to pay for better treatment of animals, such as the costs of eliminating battery farming, or the costs in not using new animal treatments that produce cheaper milk or meat such as bovine growth hormone. The consequences on the different communities involved in agriculture of these decisions also needs to be considered, a variety of external factors, some of which will be discussed later.
The quality of life is more important for most people than the length of life. There is little value in being alive if the quality of life is terrible. Rather than spending much effort to fight genetics and disease to increase the length of human life beyond the eighty years of lifespan many in industrialised countries can enjoy, we need to spend greater effort to improve the biological, social and spiritual quality of life. This question is relevant to euthanasia, and genetic selection before birth.
Human procreation is associated with a high degree of error, because when genetic elements rearrange there are often mistakes. The number of fertilised embryos with genetic abnormalities may be about 70%, a very high figure compared to simpler animals. Most of the genetically abnormal individuals are spontaneously aborted in early stages of pregnancy. But some are born and will die later, some have a painful life others do not. If a fetus has a serious genetic impairment, with a consequence of serious mental deficiency, some people might say that the fetus does not, and will not in the future, have a "life" as "normal" humans have a life, it's potentiality is different.
Do we deny the potential for spiritual relationship between God and the most diseased forms of human life? Severely retarded individuals may never be spiritually aware - but can we judge? Many religions would argue there are no "worthless" lives. In Christianity this is because in God's eyes each human person is precious and the property of God. In Buddhism each life has its own "karma". However, most traditions support limits to interventions to save life.
This question is also related to justice. The allocation of society's resources has to consider equity rather than social merit, social productivity, quality of life, or ability to pay. Considering justice we may consider quality of life as one factor in distributing limited resources, and in fact if we don't, we are ignoring other people's lives. We do not need to maintain life at all costs, as this may not be in the patient's best interests or in God's will. One of the early statements on the distinction between extraordinary and ordinary treatment came from the Pope Pius XII (1957); "We are normally held to use only ordinary means, according to the circumstances of the situation, but are not obliged to any grave burden for oneself or another to life... Life, death, and all temporal activities are subordinate to spiritual ends."
The quality of life relates to the individual person, and conceptions of it change with time and situation. People have different hopes and ambitions, and the capacity for personal growth from a given state is important. Recently advance directives, or living wills, have been introduced which allow people to make choices before they reach a situation where their quality of life will become very bad and hopeless.
The distinction between acts and omissions is often not consistent, as in cases of letting severely handicapped newborns die. However, it may be a useful legal barrier as there is the existence of a potential slippery slope to widespread euthanasia. The law in the Netherlands allows some active euthanasia. An objection used by many to this is that it is interference with providence, but in a modern hospital one could argue that many medical treatments interfere with nature. If we regard life as sacred, then we may not agree with the modern concept of the right to decide our own life, or autonomy. If we intervene to prolong life with experimental therapy this can be just as much playing God as shortening may be.
A disease that might seem to make someone less "human", in fact may make others around them more human in the love and care that they give. There is a strong idea that ideal ethical behaviour is keeping with our true humanity, we need to be able to love to be fully human. Often much of the suffering we see in others is what we would imagine they feel if they had our sense of what is suffering (58). The suffering that is being avoided may be more that of the family than the actual individual. Yet, everyone would agree there are some lives too full of suffering to ever understand.
The issue of the value of life is fundamental in many issues in bioethics. This question is important when considering the financial investment into new technology including new genetic technology, offset against the cost of life if using genetic screening and such negative means. Despite the ideal of treating every disease, there are limits. These limits include both technical and financial ones.
While there should be no limit to our love, and we should not limit opportunities to show love, we should not take our hands away from a situation and say this is in "out of my hands", putting our head in the sand like an Ostrich. We should not knowingly make misfortune for the sake of having a chance to love. Both options, to act or not to act, are ethical decisions.
These ideals all need to be balanced, and I would claim that many people already attempt to balance them. The balance varies more within any culture than between any two, and the International Bioethics Survey combined with observations of policy and behaviour in different countries allows us to look at how these principles and ideals are balanced. An examination of history also shows how the balancing act has varied in different times and places. A fuller discussion of these will come in the later book.1 From the data, and the observations of many others before, already we may a type of universal ethics working across the world. In the next chapter, the last of this brief outline of universal bioethics, let us 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.
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