- Darryl Macer, Ph.D.
Eubios Ethics Institute, Japan & New Zealand
Chair, TRT4; Vice-President, IAB4 Congress
(abridged version of the closing session plenary address)
Eubios Journal of Asian and International Bioethics 9 (1999), 34-5.
Bioethics is both a word and a concept. The word comes to us only from 1970 (2), yet the concept comes from human heritage thousands of years old. I will argue that bioethics is the concept of love, balancing benefits and risks of choices and decisions. This heritage can be seen in all cultures, religions, and in ancient writings from around the world. We in fact cannot trace the origin of bioethics back to their beginning, as the relationships between human beings within their society, within the biological community, and with nature and God, are formed at an earlier stage then our history would tell us.
There are a set of principles or ideals which have been used as a common ground for bioethics, or which at least have been suggested to be the key ones. They include the autonomy of individuals to make choices, while respecting the choices of others, justice. In all things we do, the ideal is to avoiding doing harm, and try to do good. I would argue that these principles all derive from love. While it may still be useful to retain these principles, I would like to emphasize that they are all expressions deriving from love of life. The final sentence of Principles of Biomedical Ethics admits the requirement, "Almost all great ethical theories converge to the conclusion that the most important ingredient in a person's moral life is a developed character that provides the inner motivation and strength to do what is right and good" (3). I will argue these four principles can be summarized by the word love, as self-love, love of others, loving life and loving good. The inner motivation and strength for ethical behaviour comes from love.
There are at least three ways to view bioethics:
1. Descriptive bioethics is the way people view life, their moral interactions and responsibilities with living organisms in their life.
2. Prescriptive bioethics is to tell others what is ethically good or bad, or what principles are most important in making such decisions. It may also be to say something or someone has rights, and others have duties to them.
3. Interactive bioethics is discussion and debate between people, groups within society, and communities about 1 and 2 above.
After 8 days of bioethics meetings at the 4th International Association of Bioethics World Congress, since 31st October, the theme of global dialogue was achieved by joining people from different countries together in dialogue across all topics of bioethics. The discussions of descriptive and prescriptive bioethics came together in an interactive bioethics forum.
What is a global community? The world congress is like a global forum, and we had a scattering of peoples from many countries, who share the common goal to develop interactive bioethics. I think this is global bioethics, and at least those who share this goal of learning, reflection and debate about issues of bioethics are found across the globe. Thus we do have global bioethics.
We are all mutually interdependent. This is what we mean by the global community. I hope that the world bioethics community would work as a family, as the discipline of bioethics poses a greater challenge to us than other academic disciplines. Bioethics is action as well as thought. The community is not limited to one species, or even the sentient ones, rather all species form the global community that must be considered in bioethics. One of the central relationships between humans and all other creatures is respect, companionship and love. I argue that the strongest and most universal ideal for these relationships is love, though we may need more than just love - that depends on our definitions.
In 1990 I made a word, "eu-bios", meaning "good-life". Through the Eubios Ethics Institute, a family of persons has been brought together from all over the globe. We warmly call this the Eubios family, yet it is a group of critical scholars who debate cross-cultural issues in bioethics. The warmth comes from the shared love, and I have appreciated renewal of friendships, and the many new friends met this year. The diversity of persons has deepened the sense of a global community based on a shared goal.
There are three fundamental questions. What is love? Is love a universal value and common ideal? How can we express it as a practical decision-maker? To help answer the first, in reference 1 there are several hundred quotations, covering just part of the global community. It is however, evident that love has numerous meanings in most languages, but that do agree that it is one of the highest goods, if not the highest. Some disagree that love is a universal value, however, at the first day of the Bioethics meetings at the Fourth International Tsukuba Bioethics Roundtable (most of the papers are included in this issue of EJAIB), we saw people from all continents agree with the concept of love as a universal value, for example, persons from Australia, Cameroon, Japan, Nepal, India, Russia, China, Iran, Philippines and Thailand gave examples of how the concept of love was expressed in both ancient and modern bioethics. It was enlightening to add to the numerous quotations on the subject. It included the religions of the major countries of the world, but it must still face some philosophical.
While universality was shown quite well, one of the conclusions is that we do need to look more carefully at the scope and meaning of the word love in different cultures. However, this applies to all words and the vocabulary that is used. For example do we use autonomy for individuals, for families, groups, city-states, or countries. Justice can be also applied in numerous ways. All words have linguistic ambiguity.
I actually think some reject love because it is just too simple to understand. But we still have to ask the third question, can it be practical? Joseph Fletcher (1966) in Situation Ethics (4) said love was the premier principle, and we should use case-based decision making to solve problems, always acting in love. Fletcher divided decision-making into three basic approaches, 1. antinomians, who reject rules as well as general principles of morality; 2. legalists, who think that some moral rules are absolute and inviolable no matter what the circumstances, and 3. situationists, who lie between, rejecting absolute moral rules but finding general moral principles to be helpful.
The challenge is for us to do what has been talked about around the globe throughout human history. We can see examples of this conflict in local debates, for example Buddhism and Hindi rituals, Mo Tzu with universal love and Confucius with emphasis on family duties, and Christian love of neighbour as a response to Jewish legalism. Importantly, we can also see this tension within each of those schools of thought, and probably across all cultures of the world. It is a question for on-going research.
Two other examples of bioethics based on love are, the book The Gift Relationship (5) which took the example of donating blood and called for a general social philosophy of giving in society, which Titmuss called creative altruism. Another book exploring love as a basis for medical ethics is Moderated Love (6) in which Campbell includes brotherly love or philia (friendship based on mutual understanding and respect) and agape (concern for all humankind).
We all may agree love is dominant in our mind, but how do we extend an emotion, to a system to analyze our decisions? Other questions we could discuss include the boundaries to love, love for oneself, other people, animals, nature or all of life? How much "Love of our own life" is ethical, considering autonomy, selfishness and altruism? Love of oneself can also be called autonomy by some and selfishness by others, can we separate them? We can look at definitions of love that stretch across species boundaries.
Love preoccupies the human mind, and it would be naive of Homo sapiens to think it suddenly appeared overnight in our species. I argued in reference 1 that helping another species may be the least ambiguous sign of an all-giving love above the shadow of selfish genes. This concept should not be unfamiliar to many, who live with pets of other species, but is there something deeper than personal companionship? How to we judge what is the greatest good for the greatest number, the action which will produce the most love? The values that will be regarded as good need to be defined. Looking among cultures the value that seems premier is life itself, and its preservation, therefore the conclusion that bioethics is love of life.
We are left with the challenge to apply love to cases where we have disputes and balancing of options, be it abortion of the handicapped fetus or using surrogate mothers to grow up clones. Love demands human rights protection, from love of life, balanced by the only ultimate source of reconciliation between countries, respect and love. The standard of love does suggest that a person who fails to love is morally deficient. We can ask whether the presence of an ideal puts someone off striving harder to help others? Do people just give up totally and become bad? Generally we would not think so, though some hope should be given when we are disappointed by our own failings to reach the ideal. At least we can conclude that we should all try a little harder to reach the common ideal, and the world would be a better place.
I would like to end with a poem I wrote during the Congress,
Love, life and to live
To those who wait, life will proceed.
To those who chase, life will soon pass.
To those who sit, life will be remembered.
But for those who are loved, will end in peace. Let us love.
That is my challenge to myself, and all of us at the end of the Congress. Let us love. Then global bioethics is possible. I suggest that these four principles of love bioethics, self-love, love of others, loving life and loving good, are a simple approach to discuss global bioethics.
1. DRJ. Macer, Bioethics is Love of Life (EEI, 1998).
2. Van R. Potter Bioethics, Bridge to the Future (Prentice-Hall, Englewood Cliffs, 1971).
3. T.L. Beauchamp and J.F. Childress, Principles of Biomedical Ethics. Fourth Edition (Oxford University Press, New York, 1994). p.502.
4. Joseph Fletcher, Situation Ethics: The New Morality (SCM Press, London, 1966).
5. Richard M. Titmuss, The Gift Relationship : From Human Blood to Social Policy. Expanded edition (New Press, New York, 1997).
6. Alastair V. Campbell, Moderated Love: A Theology of Professional Care (SPCK, London, 1984).