Love is a common foundation for cross-cultural bioethics

pp. 49-60 in Letters to Sybilla. Ausgewahlte Briefe von Mitwirkenden am interkulturellen EXPO-Projekt der Evangelischen Akademie Loccum , ed. S. Fritsch-Oppermann (Evangelische Akademie Loccum, 2000).
Author: Darryl R. J. Macer
Across cultures the gift that we hope to receive when we are born into this world is love. The gift that we can share with others is love. This is a reflection of God in us. It is the biological heritage given to us by our genes, the capacity that evolved in us to allow us to overcome selfishness that destroys the harmony. Our social heritage also gives us love, as the society tries to pursue harmony between individuals and communities. The new society is the International Society, the Global Community, a heritage we hope for the future that is still being born out of cycles of war and peace.

This essay argues that glove of lifeh is the simplest and most all encompassing definition of bioethics (Macer, 1998), and it is universal among all peoples of the world. I argue that this is the common ground for cross-cultural dialogue, and the goal we should aspire to for the future of our global community. To say that this key to life is love of life, is not new but something seen and shared by so many people alive and dead, that has become obvious. Perhaps too obvious because many seek other answers, usually more complex but not as satisfying, or universal. Love of life is seen in the bacteria who uses its last unit of energy (ATP) to move closer to food, in the dog who jumps into the river to save a drowning child, and in the love of a stranger who tunnels in the mud to free victims of an earthquake.

Whether we can use the term gloveh in the ways that I do is a matter for readers to judge. The style of this essay will be academic, but academic means in the spirit of gBioethics for the People by the Peopleh (Macer, 1994). That means describing the bioethics that we living organisms have to each other, then extending to prescribe what bioethics we should have. The need for bioethics is being re-emphasized internationally, in UN Declarations, in statements of scientists and teachers, in the views of ordinary people, and as a response to the decay in moral fabric of society.

Bioethics is both a word and a concept. The word comes to us only from 1970, yet the concept comes from human heritage thousands of years old (Macer, 1994). It 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.

The challenge for ethics is how to define a gmoral agenth. When we talk of cross-cultural dialogue do we include other species as parts of our culture? Moral agents are not only belonging to species who can manipulate the world as they like, reshaping it physically and genetically, but they may belong to a species that takes pleasure in leaving it as it is. Perhaps actions like altruism of helping another species may be the least ambiguous sign of love under the shadow of selfish genes.

Love is something not seen physically unless in actions. However, while love without acts may seem dead, the love is still there before and after the event. There have been various definitions people have put forward over the past 50,000 years. Love is one subject written about, sang about, dreamed about, fought about, more than any other, arguably in all cultures. It preoccupies the human mind, and it would be naive of Homo sapiens to think it suddenly appeared overnight in our species. We all may agree it is dominant in our mind, but how do we go from an emotion, to a system to analyze our decisions. A few quotations are:

K'fung Fu-tse, China

"Can there be a love which does not make demands on those who are the objects of love? "

Mahatma Gandhi, India

"Love is the strongest force the world possesses and yet it is the humblest imaginable. The more efficient a force is, the more silent and subtle it is. Love is the subtlest force in the world. "

Bible - Gospel according to St. John 15: 12-13, Jesus Christ, Israel

"My commandment is this: love one another, just as I love you. The greatest love a person can have for his friends is to give his life for them."

The strongest proof may be what is in our hearts and conscience. But how do I know what is in my mind is in my neighbours' mind? As societies try to protect their identity, they have tried to claim they are unique. They say that other cultures are different. Fieldwork I have undertaken in the past few years to look at people in different countries and situations, including surveys, photos, videos and notes, supports this (Macer, 1998).

There are a set of principles or ideals which people use as a common ground for bioethics, autonomy of individuals to make choices, while respecting the choices of others, justice. 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. Other terms may also stem from these ideals, such as human rights, animal rights, stewardship, harmony, but in the end these terms also come from love.

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.

There have been more books written about the subject of love then any other subject. These books date back for millennia and form a number of the basic religious scriptures that have guided ethics through time. I am going to focus on love defined as the giving of oneself in service to others and the friendship relationship, as perhaps readers will accept without written evidence that romantic love is global.

There are several basic theories of bioethics, and the first distinction that can be made is whether they focus on the action, the consequences, or the motives. Utilitarianism looks at the consequences of an action, and is based on the work of Jeremy Bentham and John Stuart Mill. The principle of utility asserts that we ought always to produce the maximal balance of happiness/pleasure over pain, or good over harm, or positive value over disvalue. Initially they focused on the value of happiness, however recently other intrinsic values including friendship, knowledge, health, beauty, autonomy, achievement and success, understanding, enjoyment and deep personal relationships have been included (Beauchamp and Childress, 1994).

Utilitarianism is internally coherent, simple and comprehensive and can resolve dilemmas. However, there are some problems with pure consequentialism. If there is little difference in consequences, most people would consider it wrong to break a promise. Most people appreciate good motives over bad ones, although the consequences may be the same. Also it would allow violations of human rights, and could excessively limit autonomy.

Those moral theories looking at the act consider moral rules (Cox, 1968). The problem is to decide which rules should be followed, as some rules do not bring benefit to anyone. Act utilitarians look at the particular act only, and say that moral rules are only approximate guides and may be broken if maximal good is not obtained. Smart (1961) said that selective obedience does not erode moral rules or general respect for morality. However, the demands of utility mean it is difficult to draw the line between morally obligatory actions and supererogatory actions (those that are more than moral obligation and performed for the sake of personal ideals, such as love). Another problem of utilitarianism is that the interests of the majority outweigh the interests of a minority, because utility should be maximized. In this way it is consistent with democracy, and the system of referendums to decide public policy and law. Making most people happy most of the time is more important, even though a few persons or organisms may be unhappy.

Kant argued in the Critique of Practical Reason that morality is grounded in pure reason, not in tradition, intuition, conscience, emotion or attitudes such as sympathy. Kant regarded human beings as creatures with rational powers to resist desire, the freedom to resist desire, and the capacity to act by rational considerations. He said we must act for the sake of obligation and made categorical imperatives, gI ought never to act except in such a way that I can also will that my maxim become a universal lawh; and "One must act to treat every person as an end and never as a means only" (Kant, see 1959). However, if someone agrees to do something for someone else, as in work, it is ethically accepted if the person is treated with respect.

An extension of obligations or duties is to reverse the moral focus, and say that someone has moral rights. If I have a right to freedom of speech, then the society has an obligation to let me speak. Rights protect people against moral abuse, and are adopted in universal conventions on civil and political and cultural rights, despite objection to the language of rights by some in Asia, particularly in countries which do not adopt full political democracy. This is related to the close attachment of rights to the idea of individual liberty, and has been used since Thomas Hobbes as a liberal individualism. Conflicts between individual and community need to be resolved (Dworkin, 1977), however, and the language of rights is like legal rules, as introduced above. Some rights are judged to be absolute, like freedom of religious belief, which is supported in the Judeo-Christian tradition as well. Other rights are not absolute in all cases, even the right to life may be broken when another's life is in danger - and in some countries capital punishment means the right to life is broken as a punishment for some crime. Various rights need to be balanced, as do principles.

There are also theories of ethics based on community, which argue that individuality, autonomy or rights of a person, are not suited to the community structure of society. Communitarians argue that societies need a commitment to general welfare and common purpose, and this protects members against abuses of individualism, which could be equated with selfish pursuit of liberty. The question is what community we talk of, the individual family, the village, the state, country or region or global community. MacIntyre (1984) argues Aristotle considered that local community practices and their corresponding virtues should have primacy over ethical theory in normative decision making. These practices include parenting, teaching, governing, and healing.

Beauchamp and Childress (1994) in Principles of Biomedical Ethics outline the most widely accepted theory of biomedical ethics, and the one most seen in textbooks. They defend the four principles approach, based on beneficence, non-maleficence, autonomy and justice. Personal 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 (Rawls, 1971). Society should also include the future of society, future generations are also an essential part of society. I would argue that these principles all derive from love (Macer, 1998).

Some ethical theories are based on virtues, or motives. A virtue is trait or character that is socially valued, and moral virtue is a trait that is morally valued. A moral virtue may be a disposition to act in accordance with moral principles, obligations, or ideals. The final sentence of Principles of Biomedical Ethics (Beauchamp and Childress, 1994) admits the requirement, gAlmost all great ethical theories converge to the conclusion that the most important ingredient in a personfs moral life is a developed character that provides the inner motivation and strength to do what is right and goodh (p. 502). The inner motivation and strength for ethical behaviour comes from love.

Given the vast literature and familiarity with love, it is a wonder why so few of those people developing modern prescriptive bioethics have focused on it. Although the line of the Beatlesf song, gAll you need is loveh was a summary of the 1960s, the meaning of love in terms of being a practical guideline has not been fully explored. The principle of beneficence in ordinary English comes closest to love, but the former word is preferred over use of love because love has other meanings. Altruism, charity and humanity are also words related to love, but love is stronger. Because of the strength of love in positive obligations, it may be regarded as an ideal, something which cannot be attained. Compassion has also been proposed as common ground for bioethics in a Thai Buddhist context (Boyd et al., 1998). Generally compassion is focused on a particular context in suffering whereas social justice looks at inequality. Benevolence and altruism have broader meanings, not being restricted to suffering.

Albert Schweitzer (1966) with Respect for Life could be said to have used the idea of love of life as a ground for respect of life, but he did not overtly use the term love - preferring respect or reverence. He argued for a reverence for all life. 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.

One of the alternative theories of bioethics is termed ethics of care. Caring refers to emotional commitment to, and willingness to act on behalf of persons with whom one has a significant relationship. This ethic was recently revised in feminist writing, where it was argued that women predominantly display an ethic of care in contrast to men who predominantly exhibit an ethic of rights and obligations (Gilligan, 1982; Baier, 1985). However the emotions behind an ethic of care including love and interdependence are probably more universal than just seen among women, and may be more universal than the idea of individual rights.

Teilhard de Chardin considered love as the highest form of human energy (Grau, 1980). Love was mutually independent to intellectual energy, gA searching mind reveals what is lovable, while the loving mind is drawn on to search more. Teilhardian love was hopeful, moderating and controlling fear, and he asked how love can and should operate responsibly. Teilhard (1931) considered four fundamental aspects of love: attraction, affinity, sympathy and synthesizing energy. Attraction meant the drawing of elements of the world together among themselves, while affinity was a stronger term used for humans, and was related to sympathy. The synthetic energy of love was called the gtotalizing principle of human energyh.

Joseph Fletcher (1966) in Situation Ethics said love was the premier principle, and we should use case-based decision making to solve problems, always acting in love. There was strong reaction to that book and ideas, especially among those in Christian ethics (Cox, 1968). It was called a new morality, and also an attempt at democratization of theology; making theological ethics understandable to all. Some theories of virtue ethics would also put good will or love as a premier motive in judging whether an action was ethical. While situationalism may be more consistent as a theory of decision-making, there is still a need for a minimum standard to protect the weak. The law has proved necessary to prevent people and property and the environment from the worst abuses of lack of love. This year is written in the fiftieth anniversary year of the Declaration of Human Rights (1948). The Declaration and the subsequent Conventions which set out human rights, share many features seen in national constitutions of countries.

What is striking is that given all the popular support for the concept of love, why it is not the principle seen in textbooks of bioethics? One problem with case-by-case and situation ethics is that it is difficult to judge which is the best course of action in practice. However, this is not so obvious under other theories of bioethics as those authors would like us to believe. There are a variety of concepts included under the umbrella love. It is also not so clear why love is usually omitted from international law, whereas the concept of human dignity is often cited. Human dignity is arguably even more difficult to define than love.

Another problem has been the conflicting definitions and images of love, which may be even wider with different languages and cultures. I would also suggest that some academics like to have a monopoly on prescriptive bioethics, so love is too simple for definition (Macer, 1998). But descriptive bioethics has an important place in the science of bioethics, and we could also describe the views of any group as their bioethic. Another is that they can live in an ivory tower if they like, but do not expect everyone in the global community to follow their arguments, especially in a world which has often experienced the cultural imperialism of Western religion and philosophy.

Another factor against love being included in bioethical approaches to life dilemmas is the general technocraticalization of society and of public expectations of what answers are needed to solve science and technology problems. The rapid change in society brought about by science and technology has had great impact on society. It is actually responsible for the globalization, with communications and transportation. More people will read this book through the Internet than on hard copy, and more people will be reading a copy downloaded from a computer than printed in a traditional way in a book printing press. People think that a new problem needs a new answer, however what is needed is the application of old principles to new applications.

The general negative reaction to love comes from a longer philosophical tradition to dispense with emotion. Plato or Kant for example, have called emotions, feelings, passions and inclinations distractions to moral judgment (Beauchamp and Childress, 1994). Those philosophers argue that action done from the desire to do good may not be morally good unless it comes from an appropriate cognitive framework. They argue that compassion may cloud judgment. However, broad love for others should be impartial, and true compassion would not cloud judgment of what is best for the situation.

It is not a coincidence that the popular paraphrase of ethics, "love others as you love yourself", uses love of ourselves as a reference point for comparing love to others. Creatures that did not love themselves would not be expected to be alive, nor would they be expected to live long enough to have children to perpetuate the next generation. All creatures need to have a love of their own life in order to live at all. We could even describe it as a natural law of life, that self-preservation is necessary, at least until reproduction is obtained for the genes.

People teach to their children that they must take care of themselves, and strive to do the best in what they are doing. We are taught from an early age to work hard, study hard, because it will be better for us. Education at school and competition for places in higher education, and better employment, reinforces the idea that we should love ourselves. Respect for people's love of themselves or of their family has been called autonomy.

Interestingly, originally in ancient Greece, autonomy applied to self-governance of Hellenic city states. Therefore there are precedents to apply the principle to not only individuals but also families, societies and states. Many rejections of autonomy as a principle as based on misunderstanding autonomy to only apply to individuals. In family-orientated societies like Japan the concept may often be better applied to families.

Human beings are organized into societies, and our social groups include our spouse, children, relatives, neighbours, religious group, community, workplace, village, city, nation, and international partners. The social origins can be studied by sociology and history, and they would immediately tell us that most societies we think of today as countries are modern artificial creations of historical and present political power systems.

One of the impacts of the transient society, meaning the increasingly mobile communities, is more universality. Whether it be the movement of young people in search of jobs and money into Lagos, Mexico City or Mumbai, the rise in higher education bringing different students into the same City, or international marriages, we have obvious challenges to the traditional image of what a local person is.

The mass communication media has had a greater impact as evidenced by the presence of satellite dishes on rural huts in every country I have visited. Once electricity comes, the cable and satellite television networks are to be found, which could be said to have catapulted the internationalization that Global Radio Broadcasts effect.

We need to look at the world and ourselves. In many countries it is apparent when you walk in the street, or read the newspaper, that the country is mixed. Ever more than before, universally applicable ethical principles are necessary. Many immigrants from a range of countries have come to the new countries like Australasia or America, and to the centres of the old European Empires, especially Britain and France. The practices and faiths that immigrants are accustomed to differ from each other. The indigenous people in Australasia and America, and the southern part of Africa, and with other Asian examples, have been suppressed and although they have been overrun by culture introduced from the immigrants countries, often a new culture has emerged. This continues to be a source of friction in some countries, because the groups may try to form an "us" and a "them".

Surveys and observations show the complete diversity of attitudes and characters of human individuals are represented in any one society. A failing of human thought is that people view their society as being different from another, with sweeping generalizations. Such thinking is often tied to discrimination, for example men are..., and women are...; whites are..., blacks are..., and Asians are... . Such thinking, of "us" and "them" is a root of much disharmony in the world, and should be actively discarded from thought.

Despite the individual similarity there are linguistic and religious differences which have lead to the adoption of cultural-specific systems of medical ethics and etiquette. Universal cross-cultural ethics should be developed to allow diverse views to be maintained even within a single community, as well as throughout the world in the global community. Even within a so-called homogeneous culture, such as Japan, there is a wide variety of opinions. The view of life that people have is individual (Macer, 1994), despite the often assumed homogeneity. International communications and economics helps break down whatever geographical and linguistic barriers that remained, though globally it has resulted in deepening divisions between rich and poor nations, another hurdle to the recognition that much of human heritage and much of ethics is universal.

Whatever ideals we or our culture accepts, they 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 (Macer, 1994). An examination of history also shows how the balancing act has varied in different times and places. From the data, and the observations of many others before, already we may a type of universal ethics working across the world.

In order to have a sustainable future, we need to promote bioethical maturity, as I have said elsewhere (Macer, 1994). We could call the bioethical maturity of a society the ability to balance the benefits and risks of applications of biological or medical technology. 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. It is also reflected in the extent to which the public views are incorporated into policy-making while respecting the duties of society to ensure individual's informed choice. An important measure of the progress of society and cultural maturity is the degree of the development of better ethical discretion in the personal and societal use of technology. The criteria of technological progress as a measure of social progress is inadequate because technology may be misused, or may be unavailable. Part of the maturity is justice, to give everyone a fair chance. Methods to increase the ethical discretion and maturity of individuals and social systems should be developed.

In conclusion I beg us all to reconsider whether love does not share some of the features of a fundamental principle of bioethics. It is universally recognized in both tradition and modern life as a good idea. I refer readers to my book, Bioethics is Love of Life (Macer, 1998) for extensive arguments and a practical framework for decision-making. We are left with a simple fact of life, there are often no clear black and white answers to our dilemmas. There have never been and nor will there be, for many cases. As a global society we need to understand the diversity which is universal, and tolerate with love what we can. There comes a time for protection of others, but we can remember the spirit of love which says do not judge. I invite you to judge love for yourself, and take what you can. However, never belittle the power of love.

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