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I was privileged to give the
Walter C. Randall Lecture to the American Physiological Society at the IUPS/APS
meeting in San Diego in April of this year. Walter Randall was one of the
people who insisted that the Society maintained a major interest in ethical
issues, long before others noticed! My title was “The Future of Physiology
in the Era of the Human Genome: Medical Miracles or Ethical Disasters?” In a
world where our science is subject to community and media scrutiny, we are
entering a period where ethics is regarded as of increasing importance. May
I offer a few of the points from my talk at the San Diego meeting, with
notes of some of the articles on ethics that I have read during the past
month which others may find of interest? I will welcome any comments from
readers, provided they are punchy and short.
I started by noting that we can no longer rely on automatic public support
for medical research. This is particularly true for genetic research, since
genetics deals with controversial areas such as family, race and sex. We
have to engage with an increasingly sceptical public, and convince them that
we are confident of both the morality and the value of our work.
During the 1960s ethicists became increasingly concerned that, in a widening
world, an ethics based only on Christian principles is not inclusive enough
to be compelling to everyone. To meet this concern, Beauchamp and Childress
proposed four principles that are widely accepted in all ethical
philosophies, “Western” and “Eastern,” religious and humanist. “Principalist
ethics” (based on the four principles) argues for benevolence, non-malificence
(“do no harm,”), justice and autonomy. There has been increasing emphasis,
in many first world countries, on autonomy, the concept that the individual
has the right to override any other consideration if they believe that this
is consistent with their beliefs (for a discussion see Gillon, 2003). I am
not convinced it is as simple as this, because rights have obligations. A
“right” without obligations, which disempowers, such as the so-called “right
not to know,” may be a false right. Anyone who wishes to read a bit more
about this might turn to an article that appeared in March 2005’s Journal of
Medical Ethics by Stirrat and Gill, because it expresses the “problem” very
well, and also because it gives the seminal references.
However, there is another objection to principalist ethics. Some major
philosophical systems (such as those of China and Japan) do not accord as
much importance to autonomy as “Western” systems, which are more
individualistic. There is a very exciting and well-argued article in the
same issue of the Journal of Medical Ethics from Dr. Tsai (National Taiwan
University). He demonstrates that “Eastern” philosophies do show respect for
the individual, but also show greater willingness to subordinate the rights
of an individual in the context of overriding responsibilities to a family,
or the interests of the community as a whole.
Finally, many of you will have read the Policy Forum in Science of 25th
March 2005, “Ethics: A Weapon to Counter Bioterrorism.” Although provoked by
the current world situation, this article should not be seen only, or
primarily, in the context of the aftermath of September 11. It puts forward
a “Code of Ethics for the Life Sciences” that goes far beyond this in its
implications. Clinicians have an ethical code of conduct by which they judge
how to practice medicine. It would, in my view, be of great value to have a
similar code that we could discuss with and transmit to our students and
junior research fellows, to increase their understanding of ethical conduct
in the life sciences, something I am sure that Walter Randall would have
welcomed!
I hope to follow this with some views on embryo and adult stem cell science,
my other main topic in San Diego, in a few months.
References :
1. Gillon, Raan. “Ethics Needs Principles: Four can Encompass the Rest–and
Respect for Autonomy Should be “First Among Equals.” J Med Ethics
29:307-312, 2003.
2. Somerville, MA, and Atlas, RM. “Ethics: A Weapon to Counter Bioterrorism.”
Science 307:1881-1882, 2005.
3. Stirrat, GM, and Gill, R. “Autonomy in Medical Ethics After O’Neill.” J
Med Ethics 31:127-130, 2005.
4. Tsai, D F-C. “The Bioethical Principles and Confucius’ Moral Philosophy.”
J Med Ethics 31:159-163, 2005. |
