Commentary on Macer & EACB'95

- Frank J. Leavitt, Ph.D.

The Jakobovits Centre of Jewish Medical Ethics, Faculty of Health Sciences, Ben Gurion University of the Negev
Beer Sheva, ISRAEL (Home Tel/FAX: +972-2-9963048)
(Disconnected from Friday dark until Saturday dark, Israel times)

Eubios Journal of Asian and International Bioethics 5 (1995), 146-7.
Darryl's concept of descriptive bioethics includes quantified surveys (1). For a debate on the value of quantitative methods in ethics see references (2,3). In addition, as a participant in the 1993 International Bioethics Survey, I must report that since results began to be published, a number of my colleagues in the life sciences, especially epidemiologists, have criticized the quality of the randomization and the statistical analysis. On the one hand the criticism is a little unfair because this was a pioneering effort involving enormous organizational work on the part of Darryl putting together a multi-disciplinary, multi-cultural, multi-linguistic team. Obviously such an effort will have shortcomings. But on the other hand part of ethics is being large minded, which means not being defensive but accepting and learning from criticism. Future interdisciplinary teams doing bioethics surveys should include statisticians, from the start, involved in planning the project from inception. This would mean an epidemiologist, quantitative ecologist or biomedical mathematician who is familiar with the scientific matters of which bioethics ask moral and spiritual questions. It can take longer, and the 1993 survey data is still under analysis by statisticians.

I'd also like to comment on Darryl's question: do we choose to do bioethics to make money or to save lives" Today's free-market ideology is catching on everywhere, and many people say that money, the "profit motive" is the best motive for doing anything. I write this editorial as I fly home from the East Asian Bioethics Conference in Beijing. My strongest impression is of the great interest the Chinese are showing in free market medicine, even though I had mistakenly expected to be hosted by Maoists. Although I am not a socialist myself, I have to say that before hurrying to dismantle the achievements of socialism, it would be wise to study very carefully what has happened to Eastern Europe: especially the state of Russian medicine.

As for the supposed virtues of the profit motive, I still believe that the more money you can make out of a job the more likely you are to do things which make you money, rather than working for the goals of the vocation, whether it be curing the ill, helping the life sciences get more ethical, or even a religious ministry. This is why I so abhor strikes of doctors, nurses, or university lecturers.

Of course I've just been expressing my personal opinion. Those who are strict about "scientific method" (often scientists who took a Philosophy of Science course once and have enshrined some philosopher's personal opinion as infallible dogma) will say that I am basing my opinion on "anecdotal evidence". But it ought to be possible to devise a test which would be acceptable even to the best medical journals. Just pick some accepted scale of ethical behaviour (or devise an acceptable one) and compare the ethics of the behaviour of physicians in a place like the US where physicians' income is usually related to services rendered to patients, to the ethics of physician behaviour in places like Israel where physician's income is usually unrelated to services rendered to patients. Israel and the United States should make a good comparison because although the economics of medicine are different, the science of medicine is similar. Israeli medical graduates are expected at the very least to be able to pass American board examinations.

I mentioned the Beijing Conference. Prof. Qiu Renzong and Prof. Hyakudai Sakamoto deserve thanks for organizing a great opportunity for cross-cultural understanding. The conference concluded with the founding of the East Asian Association for Bioethics. I went to Beijing considering whether to argue that the new society should include all of Asia, from West Asia to East. But even a little acquaintance with China made it clear that East Asia has its own cultures and problems. Although I believe in the aims of the Society and want to contribute to it as an individual, including West Asia directly in the society would confuse things. We in the Middle East have enough of our problems, which would simply detract from East Asian Bioethics. (Our Prime Minister Rabin was tragically assassinated while I was in Beijing. Who knows whether there will really be a "peace process in the Middle East?") So Profs. Qiu and Sakamoto were right to insist on a East Asian association, and their view was accepted by consensus.

On the subject of the Middle East, during the Beijing Conference I heard about the murder of our Prime Minister Rabin and many friends came to me to express their sympathy.The Philippino delegation was especially kind: every one of them took the trouble to approach me with condolences. But only on the plane flying home did I realize that the Philippinos suffered a much greater tragedy: 600 dead in the typhoon. It is a principle of Jewish medical ethics and should be a universal principle of bioethics that every human life is of equal value. Surely the fact that one person was a prime minister and another was not famous does not make the loss of one more tragic than the other. My wife, June, said the same in an interview in a Hebrew newspaper, but this will not be enough to stop the personality cult which the news media are building up.

At the conference, a few people mistakenly said that Beijing was the first international bioethics conference held in East Asia. In fact the Beijing conference carried on the work of the two conferences in Fukui, Japan, which were not only cross-cultural but truly interdisciplinary: Ethics was studied in the context of details of molecular biology and clinical genetics. The Fukui conferences were organized and hosted by Prof. Norio Fujiki, who has since retired from Fukui Medical School. When the history of bioethics comes to be written it will have to be noted that Asian Bioethics was founded by Norio Fujiki in Fukui.

References

1. Macer D. Bioethics: descriptive or prescriptive. EJAIB 5 (1995), 144-6.
2. Leavitt FJ. Bioethics surveys and the quantification of ethics. In Macer D. , Bioethics for the People by the People (Eubios Ethics Institute, 1994). pp. 174-176.
3. Macer D. Response: quantification of ethics. In ref (2) p. 176.

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