The Bioethicist of the Future: Commentary on Pollard and Gilbert, and Melanie Rock.

- 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)

Eubios Journal of Asian and International Bioethics 7 (1997), 133-134.

I'll begin with some remarks on Pollard & Gilbert's paper in the current issue. Then I have some general remarks about bioethics, after which I'll conclude with a comment on Melanie Rock's paper in the previous issue.

I think the main message of Pollard and Gilbert's (EJAIB 7 (1997), 131-3) idea of "bioscience ethics" is the plea for bioethicists to be more informed about the biological, scientific details of the subjects the ethics of which they are studying. This plea is important because philosophy during the past fifty years became an abstract, academic subject with little or no grounding in the sciences or religion. Every great philosopher of the past was seriously involved in science and studied religion deeply. Great philosophies and ethics grew from attempts to grapple with conflicts between science and religion. But after World War Two philosophers in England and North America got the idea they could do philosophy of mind without studying psychology or neurobiology, philosophy of science without studying science, philosophy of mathematics (as I am sorry to admit I used to do myself) without studying enough mathematics and medical ethics without reading medical journals or bothering to cross the street from the philosophy department to hear some lectures in the medical school. Seen this way, Pollard and Gilbert's bioscience ethics is not "a new conceptual approach" but a return to the grandeur of the past. Bioethics must take up the great interdisciplinary work which philosophers once did and have now abandoned.

But we cannot for all that, forget that knowing the scientific facts is not enough to tell us what is right and what is wrong. The distinction between facts and values still exists. Knowing the facts, for example, about what drugs can do to a fetus is not sufficient to bring you to the conclusion that it is unethical for a pregnant woman to take drugs, unless you already have the prior ethical principle : "it is wrong to do physical harm to a fetus.". But this is a value judgment, an ethical principle which we do not learn from biology but from non-scientific sources like philosophy or prophesy or feeling. So although bioscience is crucially important to bioethics it is not the whole story.

Anyone with only a philosophical background who wants to do bioethics must work very hard to catch up with the necessary scientific and spiritual sources. Personally I found that my training in philosophical logic was a great help for the sharp reasoning needed to get into new fields, but I have to admit that even after six years teaching in a medical school, hearing medical and biological lectures and reading the journals, I still find much medical and biological literature incomprehensible. Similarly, I have tried to learn Jewish spiritual sources for which my philosophical background did not prepare me. I had to learn three new languages, Hebrew, Aramaic and Yiddish and I studied in Yeshivot and in private sessions with rabbis. But I still feel absolutely inadequate for bioethics. The bioethicist of the future will have to be a new kind of person for a new kind of world. She (I write "she" not because of the current fashion of playing with gender pronouns, but for serious reasons which I'll explain at the end of this editorial.) will not come from philosophy but from the health and life sciences. Many of them will be nurses, a profession which combines human feeling with biological science. The bioethicist of the future will also have no less profound training in spirituality. And this will not be from one religion alone but cross-culturally to engender the dialogue among the many peoples and prophetic traditions which share the same biosphere. Those of us who came to bioethics from philosophy have to be humble enough to understand that we are a transitory phenomenon. We can help educate the bioethicists of the future, but we'll eventually have to step aside.

A further point also needs discussion. Pollard and Gilbert don't take a clear stand on abortion. But if it is unethical to cause physical harm to a fetus would it not also be unethical to kill it ? And if it is ethical to kill it, why should it be unethical to cause it physical harm ?

One way of conceptualizing the abortion debate is by looking at the fetus as a "guest" in the woman's "house". In her famous "Defense of abortion", probably the best pro-abortion paper ever written, J.J. Thompson argued that just as you may kick an unwanted guest out of your house if you wish, so a woman may kick an unwanted fetus out of her "house". (Thompson J.J., Philosophy and Public Affairs 1 (1971), 47-60.). This kind of talk sounds horrid here in West Asia, where taking in guests is considered a high ethical duty learned both by Jews and Arabs from Avraham. Certainly if expelling a guest (as in the case of a fetus) meant certain death (if, for example there is a terrible snowstorm and no chance of finding food or shelter outside) , this would be considered high sin. But if we assume, as did J.J. Thompson, that it is ethically all right to expel a guest, even when this means death, why cannot one say to one's guest : "This is a house of smokers and drinkers, you are welcome to stay if you like, but if the smoking and drinking troubles you, please don't complain for you are only a guest" ? Indeed even one who would not dream of sending a guest out into the cold would be insulted if the guest complained too much about the host's habits. If our bodies really are our "property", and if we do not recognize divinely inspired prophetic insights into what we may or may not do with ourselves and our property, then maternal smoking, drinking, drug-use and even behavior at high risk for HIV, are not matters of ethics but of prudence. If she wants a healthy baby then such activities are unwise. But we would have no right to tell her that what she is doing is ethically wrong.

But if, conversely it is unethical to subject the guest to smoke and drunkenness, it should also be unethical to expel him or her, when expulsion would mean death. In other words if maternal smoking and drinking are unethical then so is abortion.

I must make some remarks which are only tangential to the content of Pollard and Gilbert's paper.

I promised to explain why I used the feminine personal pronoun "she" to refer to the bioethicist of the future. I have a feeling, not yet a scientific hypothesis, that over the past hundred years there is taking place a salutary and environmentally adaptive genetic mutation which is making women smarter, more energetic and more insightful spiritually than are men. I see this in every class I teach, perhaps especially in the medical school. I think the reason why men could dominate women for so many years is that they were not the same women as we have today. Today's woman can do anything she wants with a man if she only wakes up and realizes that. (The reason there are so many wife-beaters [including a famous Israeli philosopher who got into the newspapers for it a few years ago but still has his chair] is that weak men feel threatened and try to assert themselves with physical strength.) If today's women had lived a thousand years ago they would have taken over the world then, as they are doing today. In the new age many of us men may just be breeders and manual labourers (This is not a bad prospect. I know a number of families where the wife is a teacher or a lawyer or a writer and the husband works at a manual trade, as I did myself for years. It can be a healthy way of life.) The new bioethicists (or as Pollard and Gilbert want to say, the "Bioscience Ethicists" ) will mostly be scientific, spiritual, deep thinking women.

I should try to explain my use of the phrase "The New Age" in the preceding paragraph. This idea is expressed in various counter-cultural spiritual movements which seem to combine astrology with spiritual ideas from East Asian as well as ancient northern European pagan and native American religions, and with a strong emphasis on ecology and environment. I do not think it is an accident that these ideas are appearing just when Israelis are talking about the coming of "HaMashiah" (the messiah, the redemption) and Christians are talking about the Second Coming. We are all thinking of radical changes in existence which we hope will be for good and for peace. Our entire conceptual scheme may fall away, to be replaced by ways of thinking of which we cannot yet dream. The role of the new biology in this ontological earthquake is still unclear but will be immense. Bioethics, in order to fathom it, cannot allow itself to become petty and academic, as philosophy did, but must be deep and great.

In the last issue, Melanie Rock (EJAIB 7 (1997), 108-110) criticized the UNESCO - IBC report on the basis of a critique of "geneticism" which if I understand it is the idea of setting up a particular genome as a "norm" against which some qualities are seen as "desirable" and others are seen as "undesirable". This is said to be "akin to sexism or racism".

The critique lacks, however, a clear distinction between personality traits and clinical disease. It is shocking to read that Watson supposedly said that parents have a "right" not to have a child with dyslexia. In fact one of my most brilliant students in philosophy, now a close friend, has dyslexia. He is outstanding in everything except that he has trouble reading. He seems to have used spoken and heard language to develop ways of thinking which we might have been deprived of had he been tied to the written word. It would obviously be horrible to use genetics to deprive the world of dyslectic people.

But clinical disease is different. Cancer, Huntington's chorea, Muscular Dystrophy, are bad things, the people who have them are not bad people. The diseases are bad. If the Human Genome Project can help us to free people from these horrors, not necessarily by abortion but by gene therapy or other new therapies, this will be a blessing in spite of Foucault's philosophy.

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