Bioethics in India: Proceedings of the International Bioethics Workshop in Madras: Biomanagement of Biogeoresources, 16-19 Jan. 1997, University of Madras; Editors: Jayapaul Azariah, Hilda Azariah, & Darryl R.J. Macer, Copyright Eubios Ethics Institute 1997.

7. Reverence for Life

D.S. Sheriff

VMKV Medical College, Salem 636 308.

Creating public awareness and teaching the principles of ethics as general education are the prime needs of our society in the overgrowing mechanized world of fundamental research and medical technology. Therefore the study of ethics will help to maintain the dignity and respect for life. Reverence for life - the phrase coined by Dr. Albert Schweitzer sums up and defines medical ethics. The growing biomaterial technology threatens our moral fabric and heralds the arrival of human body shops. The repeated reports of sale of kidneys seen time and again in major newspapers along with liberalization policies to make use of life-saving organs for transplantation provide a theater of moral and ethical dilemmas. These dilemmas create a need to define ethics and follow a rational approach to take a balanced view of moral aspects of biotechnology and medicine. The paper will define the various ethical principles and possibly provide a framework to work towards achieving the much needed introspection.

1. Introduction

The biomaterial technology is growing into a human body shop. Blood, semen, eggs, children - all are part of a growing market including issues, organs and subparts. Women undergo surgery for the specific purpose of providing eggs for implantation in infertile women. These growing markets for human body parts create a theater for moral and ethical dilemmas enacting the scenes of concern for such dehumanizing atmosphere being created by modern medical technology. Such a spurt in human body shops in the Western world results in either a transfer of those technology to developing nations or at least motivates local industries to venture in such activities anticipating a market to meet futuristic demands. Such a development does not augur well for a developing country where poverty is still the major threat to health. Economic pressures which force the same blood donors to donate blood repeatedly (sometimes such donation being carried out without the stipulated time interval between two successive donations) may easily force the economically weaker section resort to selling their tissues for the sole purpose to earn money. Such possibilities and occurrences warrants us to prepare ourselves to take proper measures to maintain the dignity of human life and its sanctity. Such preparedness requires the need for creating an awareness among people about ethical values and to sharpen their moral sensitivities. Therefore, proper learning of ethical values and its principles requires ethics to be taught as general education and to include it as a subject in medical education.

2. What does the term ethics mean, and how it may influence medical education?

ETHICS is the study of human voluntary actions in respect to their being right or wrong. It makes a systematic study of out moral ideals and goals, our motives of choice, and our patterns of good and bad conduct. It is a science of right living. Many times the terms ethics and morals are often used interchangeably. But ethics refers to the systematic general science of right and wrong conduct. Morals or morality, refers to the actual patterns of conduct and the direct working rules of moral action. The ethics of a medical profession is the code by which it regulates actions and set standards for its members. People use different yardsticks to judge the ethical character of their actions. The appeals to immediate utility, religious authority, a sense of appropriate (or a kind of "gut feeling"), vocational commitments, self-fulfillment and autonomy, and the legally prescribed or proscribed are some factors one needs to take into account for ethical considerations.

3. Human Person is the Centre of Ethical Concern

The most important ethical criterion is the human person integrally and adequately considered. `Integrally and adequately considered' deals with different dimension of the person that constitute human well-being: body health, intellectual and spiritual well-being, which includes the freedom to form one's own convictions on important moral and religious questions; and social well-being in all its forms: familial, economic, political, international and religious. Actions (policies, laws, omission, exceptions) that undermine the human person, integrally and adequately considered are morally wrong. Actions that are judged to be promotive and supportive of the human person in the sum of his or her essential dimensions are morally right. It is this criterion in all its totality and comprehensiveness should form the very basis of our value judgments about the ethical character of our past, present and future medical interventions.

Such an ethical process needs for an inductive approach based on real experience and reflection. that is human actions medical or otherwise need to be judged for its moral character through its comprehensive impact on such a HUMAN PERSON. In applying such personal or individual criterion one must remember that a human person is both individual and social. Hence what is promotive or detrimental to the person cannot be assessed solely in terms of individual impact but must consider its overall social impact as well.

4. Past Experiences and Future Implications

In such a social context of medicine each individual case of promotion or omission play an important role in formulating value-based judgments. One such grave past experience of human abuse was the massive infanticide carried out in one of our States to trade tissues as specimens for Western medical schools. This despicable ignoble human abuse clearly reaffirms and reiterates the need for forming stringent ethical guidelines before embarking on the introduction of such medical technologies like non-coital methods of reproduction namely in vitro fertilization. Such methods carry greater risk of being abused as it promises greater monetary benefits to the donors and medical profession itself.

In such a context what is to be done to prevent misuse of the technology whose entry cannot be prevented as it promises to promote the well-being of the couple. The introduction and running of such methods as treatment modalities must be regulated and approved by the medical council with clear cut ethical guidelines. These guidelines must deal with authority as to who should carry out such procedures, their qualifications, which institutions to undertake such methods (taking into account of the basic facilities), and mode of selection of patients, how to handle human vital tissues like ovum, preembryos and embryos, including their storage and disposal, selection of donors of eggs or sperms taking into account the societal property to undertake such procedures based on our cultural and religious background (for example surrogate gestational as well as genetic motherhood). What are the probable ethical views in adopting or rejecting such methods?

According to Kass (1971), "Is there possibly some wisdom in that mystery of nature which joins the pleasure sex, the communication of love and desire for children in the very activity by which we continue the chain of human existence?" My point is simply this: there are more and less human ways of bringing a child into the world. I am arguing that the laboratory production of human beings is no longer human procreation, that making human babies in laboratories - even "perfect" babies - means a degradation of parenthood. Such a view considers these methods as artificial and must not be adopted for human procreation.

The perspective of Fletcher (1960) is diametrically opposed to this view. According to him: "Should we leave the fruits of human reproduction to take shape at random, keeping our children depend upon the accidents of romance and genetic endowment, of (the) sexual lottery, or what one physician calls the meiotic roulette of his parent's chromosomes? Or should we responsible about this, that is, exercise our rational and human choice, no longer submissively trusting to the blind worship of raw nature?"

Between these two extremes lies our own people's religious convictions which may approve or disapprove such methods. If one needs to adopt a pluralistic view ethical guideline so formed must conform to societal norms and needs, taking into view the individual's right to choose the best possible method of treatment. This is the prerogative of the governing professional body of medical education to set the framework for the working of such procedures. It may be necessary to license such activities keeping given the possibility of misuse of such procedures for experimental purposes, organs donations, sex selection and manipulation of genetic make up to procreate a super baby. Such possibilities are tried in cattle breeding for higher milk yield by the dairy development technologists wherein these procedures are adopted to produce more females with breeds giving more milk to attain self sufficiency. It appears ethical to carry out such procedures converting animals as dairy machines as man has the potential and power to do so.

In those areas if the advantageous outweigh the disadvantages biotechnology may be used for such economic reasons. But the same technical know-how must not convert humans to control procreation as it is done in dairy development. Respect, caution and proper vision must guide those involved in authority to see that human tissues including humans are not dehumanized and disrespected. Upholding the particular medical education. Commercialization and materialistic approach to every sphere of life and profession may erode the basic values of human life and destroy the social fabric of a system built over the years by our ancestors. Only slowly witnesses such erosion of values and disrespect for nature and natural methods all around. Exploitation of industries and industrial growth, commercialization of medical education, its training, examination system and sprouting of many medical institutions founded on vague policies seem to take the youths away from human values. It heralds beginning of a spread of social infections which eats social values keeping material benefits alone as the sole purpose of our lives. It is high time that we sense these changes before it becomes a social shock. That is why it is imperative that medical technologies and medical education must be guided by sound ethical values to upkeep the nobility of the profession and the sanctity of human life.

1. Kass, L.R. Babies by means of in vitro fertilization: Unethical experiments on the new born. NEJM 1971; 285:1174.
2. Brabazon, J. Albert Schweitzer: a biography. New York: Putnam and Sons, 1975.
3. Gillon, R. Philosophical Medical Ethics. BMJ 1985; 290:1890-96.
4. Fletcher, J. Morals and Medicine, Boston, Beacon Press, 1960.
5. Jayaraman, K. Skull ban trade, Nature, 1985.
8. Status of human life and the fetus in Hindu, Christian and Islamic Scriptures

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