Bioethics
Lecture Notes
Semantics plays a
significant role in how we perceive things and, indeed, it is no different when it concerns the subject of ethics. It is common to refer
to the desire for material wealth, mostly
expressed in terms of money, as "greed". Webster's dictionary defines greed
as "acquisitive desire beyond reason". On the other hand, the pursuit of success in the scientific and engineering
professions is referred to as
"ambition". Webster's dictionary defines ambition as "eager or inordinate desire for preferment, honor, superiority, power, or
attainment". The connotation of these terms is so different that
sometimes we tend to refer to an honest businessman as "greedy",
and to a dishonest scientist or engineer as "over
ambitious". Yet, the consequences of an unethical behavior of an "over ambitious" scientist
or engineer can often be more harmful then the unethical
actions of a "greedy" businessman. In the scandal surrounding the company Enron, no one died or suffered physical injury. On the
other hand, the developer of a drug or medical device that
results in a faulty product can cause innumerable damage to life and health of many.
Of course, in the latter case, the marketing of the product also involves a
profit consideration that is often vested with the same individuals, as it has
been so widely demonstrated in the recent high tech euphoria.
Bioethics is a subset of
the larger subject of ethics that is concerned with biological themes. The subject of ethics was of interest to human kind
since before recorded history. As a matter of
fact, attempts to understand the ethical behavior of prehistoric humans led to the
study of the social behavior of animals such as wolves or monkeys. Altruistic
behavior has been seen in nonhuman animals. For example, dolphins support sick animals by swimming under
them and pushing them to the surface so they can breathe.
Pragmatic or utilitarian causes of ethical behavior are ascribed to kinship or
reciprocity; e.g., parents making sacrifices for their
offspring. Reciprocity can be seen in cases of food sharing among unrelated animals.
Ethics is related to
morality. In the past, the subject of ethics was known as "moral philosophy", while knowledge of the physical world was
referred to as "natural philosophy".
"Philosophy" in Greek is "love of wisdom". In all human societies morality was explained using mythical origins. The sun god
Shamash offering the codes of laws to Hammurabi or God giving
the Ten Commandments to Moses has mythical elements. An
interesting pragmatic reason for the application of ethics is
also mythical. The ancient Greeks believed that Zeus gave humans a moral sense and the capacity for law and justice, so that they could
live harmoniously in larger communities and thus defend
themselves against stronger predators.
Historically, ethics has
been considered the province of religion, i.e., moral theology, and, by and large, still remains so. In most cases religion
provides an important answer to the question why
one should act ethically. The unfortunate
part of this is that
religion does not define ethical behavior adequately or unequivocally. Thus, religion, as defined by its interpreters, can also
become a messenger and promoter of, what much of the civilized
world would agree, highly unethical behavior. Recent events
have been striking examples of it.
The ancient Greeks were the
first to examine ethics philosophically and thus independently
of religion. The major proponents of it were Socrates, Plato and Aristotle in the 5th and 4th centuries BC. The belief that rational
thinking and knowledge can lead to ethical
behavior was very appealing. Plato believed that philosopher-kings
can be trusted with unchecked power because their education will have given them knowledge of the Forms, in particular the Form of the
Good, being eternal, extra-mental realities.
Being acquainted with the Form of the Good and Justice and
Beauty they will, by this knowledge alone, without any further motivation, be impelled to pursue and promote these ideals.
About the same time in the
Far East Buddha and Confucius examined ethical conduct in human affairs for its own sake; however, in time both became
religions with all their trappings. Socrates, unlike
Buddha or Confucius, did not provide instruction how people should
conduct their lives. Instead, he examined human conduct with the aim of leading a virtuous life. He believed in goodness but did not
suggest how to achieve it. His continuous
questioning of things got him in trouble by being accused of
corrupting the youth of Athens and he was put to death for it.
The concepts of right and
wrong as understood here in this country are based greatly on religious teachings. The predominant religion in this country
is Christianity. Christianity followed the Jewish conception of
morality as a matter of divine law to be discovered by
reading and interpreting the word of God as
revealed in the
Scriptures. Consequently, it is common to refer to the Judeo- Christian codes of ethics. During the first 1500 years of the Common Era,
Christian ethics followed the legalistic stance of Jewish
ethics, which dealt with the judgment of people who do not
observe the laws of moral behavior. This time was characterized
by the emphasis on ethical injunctions but with little about ethical philosophy. Islam, which began in the seventh century, and did also base
its ethical teachings on God's injunctions, did allow for
dialogues on the subject of ethics.
The first serious attempt
in the Christian world at philosophical considerations of ethics was that of
St. Augustine in the 4th century. However, it was not until
the 12th century that major developments in the study of ethics began. The most prominent of the moral philosophers was St. Thomas of
Aquinas who tried to reconcile the views of Aristotle with Christian doctrine.
It is of interest to note that Aristotle's views on many
subjects of the physical world, i.e., of natural philosophy where
adopted by the Church as dogma and thus impeded the
advancements in science as in the celebrated case of Galileo. The advent of Reformation, as a reaction to the immorality in the Renaissance Church,
did not lead to the independent study of ethics. The early
Protestants such as Luther or Calvin objected vehemently to the
teachings of non-Christian philosophers like
Aristotle.
Life in the United States
in politics, economics and law derives generally from the history of European culture. Therefore, it is natural that the
concepts of ethics also be determined by
European ethics. Of course, since the United States is an English speaking country and its earliest settlers were English,
it is not surprising that ethics in this country does follow
the British tradition. The main thrust of modern ethics or moral
philosophy is to attempt to lay the foundations of ethical
conduct other than religious justification of moral behavior.
British ethics in 17th to
19th centuries went through a wide range of
interpretations. There
were those who tried to define the act of doing "good" as a selfish act of satisfying ones own desires. They suggested that good
deeds are also done to others as part of an understanding that
others will reciprocate by at least not doing any harm. To police
such behavior they expected the government to enforce it. Others
believed that there are objective moral truths that can be known by some kind of moral intuition. Some suggested, similar to
ancient Greek ethics, that the pleasures of virtue
are superior to the pleasures of vice. It is
some kind of a selfish
reason for being good. Others still claimed that personal happiness is best achieved by doing other good things than those
motivated by direct egoism. A large number of
moral philosophers argued against a rational
basis for morality. On
the continent of Europe there were many moral philosophers who claimed that reason controlled passion and thus formed some sort of
universal law of ethical behavior.
In summary, studies of
Western ethics from Socrates to the 20th century included (1) disagreements over whether ethical judgments are about the world or
only reflections of the wishes of those who make them; (2)
attempts to show, despite considerable skepticism, that it is
in one's own interest to do what is good or
that it is a rational
thing to do so, and (3) debates over just what goodness and the standard of right and wrong might be.
20th century ethics has
been a continuation of the same themes with an application of ethics to practical problems. Three areas of consideration of ethics
were involved: they were metaethics, normative ethics and applied
ethics.
Metaethics deals not so
much with ethical theories or moral judgment but rather with questions about the nature of these theories and judgments. For
example, it has become more important to
consider the nature of ethics than its essence. Kind of "the medium is the message". A distinction is being made
between the subject of taste versus the subject of ethics.
In the former, we agree to disagree while in
ethics it is important
that others share our attitudes on war, equality or murder. The question of personal happiness considered by moral philosophers four
hundred years ago was reconsidered by modern
psychotherapists. It states that those who
aim directly at
happiness do not find it, as opposed to those whose lives have meaning or purpose apart from their own happiness. It is referred to as
the hedonistic paradox.
Normative ethics seeks to
set norms or standards of conduct. Normative ethics is a reaction to metaethics that states that if philosophy could do no more
than analyze words and concepts, how could it offer guidance
about what we ought to do? One of the forms of normative ethics
is consequentialism, which suggests that actions are to be judged right or
wrong solely on the basis of their consequences. An interesting
version of normative ethics is universal egoism. It is based on the principle that everyone should do what is in his or her own interests.
Somehow it is assumed that the self-interest of an individual
will benefit society. Of course, such an arrangement requires
that there be no antisocial conduct such as
stealing or cheating.
Recently, a growing trend
among philosophers is practical or applied ethics. As such, it is really not an innovation. Since Plato, moral philosophers
did concern themselves with practical questions.
Applied ethics today addresses the questions
of equality, human
rights and justice. Other current issues of applied ethics are environmental ethics, war and peace, abortion, euthanasia, and the value
of human life. All of these fall into the category of
bioethics, the subject of this presentation.
The following material on
the subject of bioethics is based largely on a 1971 book "Bioethics: Bridge to the Future", by Van Ransselear Potther,
who is credited with coining the term "bioethics".
Many chapters of the book appeared earlier as independent
articles. A major attraction of the book is the fact that it attempts to outline and, to some extent, predict the course of events for the
remaining thirty years of the 20th century. Having lived
through the end of the of the 20th century, it is very instructive to
compare the current state of affairs in the
world with the hopes,
plans and aspirations of some thoughtful people over thirty years ago.
Potter defines
"Science of Survival" as "knowledge how to use knowledge" for man's survival and for the improvement in quality of
life. In another context he refers to "knowledge how to
use knowledge" as wisdom. Being a cancer specialist, he quotes from
Norman Berrillís "Man's Emerging Mind", 1955, that: "So far as the rest of nature is concerned, we are like
cancer whose strange cells multiply without restraint,
ruthlessly demanding nourishment that all of the body need for.
The analogy is not far fetched for cancer cells no more than whole organisms know to stop multiplying, and sooner or later the body of the
community is starved of support and dies." Is man's fate
to be to the living Earth what cancer is to Man?
The science of survival
should combine biology with humanistic knowledge from diverse sources that will be able to set a system of priorities. Potter
introduced the discipline of Bioethics as a "bridge to the
future" having really in mind a bridge between the two cultures,
science and humanities. Consider your own
curriculum at the university.
How integrated are your studies of humanities with your studies of science and technology? Is it enough to leave the
integration or synergism to you as individuals or
should it be integrated into a subject like
bioethics? If
pesticides and herbicides are to be credited with the success of feeding increasing populations, can they be considered independently
from dangers they pose to our survival? As
individuals we speak of the "instinct for survival", but the sum total for all our individual instincts for survival is not
to enough to guarantee the survival of the human race in a form
that any of us would willingly accept. It is similar to
another question of ethics that we discussed
earlier, where selfish
considerations are not sufficient to attain happiness (hedonistic paradox). In the present case it is far more convincing,
because if our behavior will cause the destruction of the human
race, individual survival is a moot question.
If indeed the problem is
the separation of two cultures unable to speak to each other, should not both sides, the humanists and the scientists, make an
effort to bridge the gap? I would like to make the case that
the scientists and technologists must make the major
effort to close the chasm. Potter makes the
point that Bioethics
must be based on modern concepts of biology and not on scientifically unsupported introspection. He describes the various
concepts of biology and some of the major
historical polarizing views of "mechanism versus vitalism" and "reduction versus holism", which, in his
view, have delayed the development of a broad and united
biology-oriented value system.
Reductionism and mechanism are the aspects of biology that dissect the living organism to
ever smaller units, which when reaching the atomic level become
molecular biology. Holists are concerned with the whole
organism and claim that the determining factors in nature cannot be reduced
to the sum of their parts (gestalt psychology). Vitalism is a doctrine
that the processes of life are not explicable by the laws of
physics and chemistry alone and that life is not mechanistically determined but instead is due to a "vital principle". Potter's
view is that Bioethics should attempt to
integrate the reductionistic and mechanistic
principles with
holistic principles. Interestingly, Potter does not seek to reconcile vitalism with the other aspects of biology. He even quotes the
Nobel prizewinning co-discoverer of DNA double helix, Francis
Crick. "...And to those of you who may be vitalists I would
make this prophecy: What everyone believed
yesterday and you
believe today, only cranks will believe tomorrow".
Dismissing vitalism may not
be easily accepted. Vitalism is an important doctrine in nearly all religions. In order to reconcile religious beliefs with
modern science in general and biology in particular, it will
require substantial involvement of religious
philosophers. In his book, Potter devotes a chapter and more to the work of Pierre Teilhard de Chardin, a Jesuit anthropologist
who spent his entire life in an attempt to work out a synthesis
of science and religion. As far as Potter is concerned,
bioethics is concerned with a compromise between mechanism and
vitalism. He declares himself in favor of a mechanistic view of biology and only asks that we proceed with caution or, better yet,
humility. As to the question of whether "to
temper or not to temper" with the environment and man's biology, he feels that the question has already been answered in
the affirmative. All he is asking is that we proceed with wisdom
which he defines as "the knowledge of how to use
knowledge", as mentioned earlier.
Most people cannot cope
with large doses of disorganization and uncertainty. The desire to gravitate to organized and thus secure life has been satisfied
by either religion or science. Religion provides a feeling of
certainty to the true believers. Science, even though it
provides a sense of order, may inherently be
unable to provide a
high degree of certainty. Later on I would like to come back to discuss the role that uncertainty plays in ethics. Certainty brings
the feeling of security. In free societies
security is mainly associated with material wealth. In other societies it usually requires power or influence. The route to
acquire the above is usually not conducive to ethical
behavior. Power over others is also coveted for its own sake and not
only as a means to attain security. Approval and admiration of
others is a goal in itself. With few exceptions, most people regard their own worth by the judgment of others. Herein is a small but
significant incentive for ethical behavior,
provided the general population is so conditioned by religious
or secular education. Education in ethics has the dual advantage of: 1. It encourages the individual to act ethically, and 2. It discourages
potential transgressors from unethical behavior for fear of
disapproval. The disapproval may take various forms not the least of
which is punishment.
Religion does provide a
great measure of certainty and security. Most religions deal with the relationship between an individual and a supreme being.
Such relationship can be very significant in providing an
incentive for ethical behavior. However, most religions
are in the form of organized entities and its practices are
disseminated and interpreted by individual practitioners of the faith. Once an organization, religion is fraught with all the problems
of any other government or tribal entity, of which the abuse
of power is most common.
Since religion is the
relationship of man with an unseen and unreachable supreme being, its mythical origins are quite understandable. Science, on the
other hand, requires, by its nature, that it be
continually questioned and doubted. However,
for the past one hundred
years, science acquired its own mythical character wherein we got to believe that science is synonymous with progress and
the betterment of human existence. In life sciences, the image
of Louis Pasteur proved that taking the guesswork out of
medicine guaranteed human progress. I assume that progress is
meant to provide us all with more comfortable, secure and long lives. Darwin's theory of natural evolution, based on the survival of the
fittest, has been seen as a mechanism for
progress. However, more recent views are that natural evolution selects on the basis of relatively short-range decisions and
that most species become extinct.
Uncertainty is associated
with randomness, chance or disorder. It is important to distinguish the uncertainty concerning any population, be it of people
or molecules, and the uncertainty of an individual, person or
molecule. Science developed very effective tools to
deal with behavior of large populations. Most of medical
research today is performed using statistical analysis. It resulted in enormous progress in improving the health of entire populations.
However, the results have not impacted the sense
of security of the individual or, more likely, the
expectations of the individual. In order to do so it is necessary to use the reductionist or mechanistic approach.
Molecular biology is the
first serious attempt to understand the elemental
mechanisms of life. The molecular patterns of DNA, RNA and
protein are the building blocks of life. One is tempted to compare the currently completed Genome project to the table of elements
introduced one hundred years ago. The latter gave
us modern chemistry and, to some degree, physics, with the successes in
chemical industry. A word of caution may be in order. While
chemical reactions are nearly deterministic, the passing of the molecular pattern from DNA, to RNA and on to the protein, is influenced
by various mechanisms such as mutations. Thus, even if there
were a perfect gene-copying system, the probability of mutations
is increased by many factors such as various
electromagnetic waves,
viruses and natural and industrial chemicals. In short, there is far less uncertainty in chemical reactions than there is in the
processes involving molecular biology. Having said it, one
should remember that progress in chemistry was not without the price
of serious damage to the environment.
Similar to
microelectronics, biotechnology, the engineering of life processes for commercial ends, is changing very rapidly in ways that affect our
experience and the structure of our society as
broadly and deeply as the industrial revolution of the 18th and 19th centuries. Tensions are created between the needs for
products to make a return on investment on the one hand and
the definition of public service and the common good on the
other. Biotechnology is in the process of
transforming medicine,
agriculture and the food industries and the production of energy and chemicals. In addition to causing possible harm to
individuals, biotechnology may affect our
environment severely and/or for an unpredictably long time. The potential for the relatively easy way to produce weapons of
mass destruction are confronting us now more than ever.
Nuclear power and cruise
missiles are relevant analogies. They have been with us for decades and our experience with them may lead us to a sense of false
security. Despite enormous arsenals of nuclear weapons, no
nuclear wars have occurred with the exception of the dropping of the
atomic bomb on Japan at the end of World War
II. Nuclear weapons, as
well as chemical and biological weapons of mass destruction,
have been in the possession of democratic as well as totalitarian countries without causing the outbreak of nuclear war. Is there reason
to be sanguine? There is a Russian saying that Ivan died suddenly
even though he never died before.
The capitalist system of
economy accepts greed as a motivating factor in economic development. Does it mean that a non-capitalist system would provide
more environmental responsibility? Recent history does not bear
it out. During most of the 20th century, the former Soviet
Union was the largest industrial country that forbade
private enterprise. Yet, it demonstrated a greater disregard for the environment than the United States where, over the same period, many
laws were enacted to protect the environment.
Now let us see how
uncertainty or chance may affect ethical behavior concerning environmental damage due to industrial pollution. Earlier we discussed
forms of normative ethics known as consequentialism
and universal egoism. Would not an individual or a company of individuals refrain
from polluting the environment for fear of injuries to themselves and their
families? It will depend how certain is the profit from the enterprise as
compared with the chance of getting sick or injured from the resulting pollution. Some
will decrease their vulnerability by placing the plant in another country or in
a poor neighborhood. In the latter case they will be, in effect, supported by
the residents looking for employment and willing to risk their health, while hoping,
of course, that the chances of personal illness or injury are low. On the
other hand, dumping of toxic waste in a poor neighborhood may have no redeeming
benefits for its residents. It seems that relying on ethical behavior may not be
sufficient and that enactment and enforcement of laws are the best protection
from poisoning the environment. Maybe we can extend the term
consequentialism to include punishment as the consequence of unethical behavior. In a free society the population can vote to
enforce laws for the protection of the environment
and still let "controlled" greed remain the engine of economical progress. The pressures exerted by various political
action groups are an exercise in ethics.
Ecologically responsible
behavior by individuals or organizations is the essence of bioethics. At the start of this lecture it was stated "Bioethics
is a subset of the larger subject of ethics that is concerned
with biological themes". Potter, on the other hand, defined bioethics as a new
discipline formed to study human ethics with a realistic
understanding of ecology in the broadest sense. He claimed that ethical values couldn't be separated from biological
facts. This is probably the most significant argument for
bringing the subject of ethics into the curriculum of scientific and engineering
education.
Before we discuss ethics in
engineering, it may be helpful to examine ethics in other professions. The two most prominent ones are medicine and law. Both
have strong organizational structures to define and enforce
ethical behavior. In an indirect way, they do have legal power to
enforce its ethical codes though the power of the state. Both professions
require licensing to practice, which is usually administered within their
respective associations. Since all states consider it a crime to practice medicine or
law without a license, granting a license puts teeth into the process. Bar
and medical associations devote considerable efforts to define and establish
codes of ethical behavior. Medical and law schools include ethics in their
curricula.
Medicine and law are
professions that serve the public mostly on an individual basis both ways; i.e., the service is performed by individuals to
individuals. The actions of scientists and engineers impact
the public at large. There is seldom a direct connection between the product and
service provided to the public and the individual scientist or engineer. A faulty
design of a car can seldom be traced to misconduct by an individual engineer. The same
applies to a life scientist in a pharmaceutical company. The individual scientist
or engineer does not really see the impact of his actions on another
individual or sometimes not even on the public. Here again we come back to the
question of uncertainty or chance affecting ethical behavior. If the engineer or the
team of engineers knew personally the children who were killed in a car explosion
due to a faulty design of the gas tank, would they have acted differently?
Better yet, what if they were related to them? How about their own children? Of
course, the engineers could have still bought the car for their own and their
family's use hoping that whatever risks there were it would not happen to them.
An individual or a
corporate entity is more likely to act ethically if they are part of a society that expects such behavior. It is therefore important that
all segments of society be educated in ethical
conduct. Of particular significance is ethical education in the scientific and
technological community. After all, those are the professionals whose actions
directly affect the products and services to the consumer
and impact the environment.
In his article,
"Design, ecology, ethics and the making of things", a noted architect, William McDonough, describes the design of a Bedouin tent:
"We only have to look
at the Bedouin tent to find a design that accomplishes six things at once. In the desert, temperatures often exceed 120 degrees. There is
no shade, no air movement. The black Bedouin tent, when
pitched, creates a deep shade that brings one's sensible temperature
down to 95 degrees. The tent has a very coarse weave, which creates a beautifully
illuminated interior, having a million light fixtures. Because of the coarse
weave and the black surface, the hot air inside rises and is drawn through the
membrane. This creates a breeze from outside that drops the
sensible temperature further to 90 degrees. When it rains, the fibers swell up and the tent gets tight as a drum. And, of course, you can
roll it up and take it with you. The modern tent pales by
comparison to this astonishingly elegant construct."
He then proceeds to compare
the design of the Bedouin tent with the current approach to
architectural design. "Our modern industrial culture, however, has adopted a design stratagem that essentially says: if brute force or
massive amounts of energy do not work, you are not
using enough of them. We have made glass buildings that are more about
buildings than they are about people. The hope that glass
would connect us to the outdoors was completely stultified by sealing buildings. This design creates stress, because people are meant to be
connected with the outdoors, not trapped
inside."
The above example demonstrates
that a design can be optimized and be ecologically compatible, to say nothing about cost. Many other examples in the
design of devices come to mind; e.g., from my own
experience in the design of a control tool for a robot. The objective was to
insert a screw in a specific location in the item being
assembled. The items were aligned on a moving conveyer belt. The screw was held in an arm of the robot to be placed in a hole. When the hole was
located approximately under the robot arm holding the screw,
the movement of the conveyer was stopped long enough for the robot
arm to insert the screw. The objective of the control mechanism was to vary the
position of the robot arm so that the screw was precisely aligned with the hole.
Originally, the proposed
design of the control of the robot arm involved the use of a video camera that
recorded the movement of the item. The output from the camera was continuously
processed by a computer to determine the location of the hole and to produce a
signal to move the robot arm accordingly. Since the location of the hole required continuous scanning of the raster of the video camera,
considerable signal processing of information was
required. Our proposed design was as follows.
Four rows of an identical
number of optical fibers were arranged in a cross held by the robot arm. The
optical fibers of each row were gathered together so that the total light
captured by each row of fibers could be read by an individual light detector A,
B, C, or D. A light bulb was placed under the hole. When the conveyer stopped,
the robot arm would move until the outputs of the four light detectors were
equal thereby assuring that the center of the hole was aligned with the center
of the cross. The resulting design was simple and inexpensive.
There are many sources that provide
guidelines for ethical conduct. It is not
really the lack of
knowledge what ethical conduct is but rather how to reconcile it with other economical and social pressures and demands that we
constantly experience. Again, back to the definition of wisdom
as knowledge how to use the knowledge that we have concerning
ethical conduct. Crossroads Programs Inc., a
Vancouver business
consulting company, specializes in partnerships and business ethics. Larry Colero, a principal partner of the firm, published a short
pamphlet entitled "A Framework For Universal Principles
of Ethics". It is short but it stresses the main principles to
follow. It adopts the Socratic approach that a question leads
to a dialogue but not necessarily to an answer. Ethical conduct impacts everything but it is nearly impossible to have an answer for
everything.
Bibliography
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Please send me your questions and/or comments.