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I.D.I.S. - Istituto per la Dottrina e l'Informazione Sociale |
Voci per un Dizionario del Pensiero Forte |
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by Claudia Navarini Azzola
1. The problem and the term A discipline mostly known among scholars until a few years ago, bioethics has decidedly entered the public debate and has become one of the fields including most of civil issues - as St.Augustine of Hyppo (354-430) defines them in De Rhetorica - that is those issues "[...] one feels ashamed of not knowing about". In fact, the new technologies give man such a power of intervention on man himself and environment never seen before; a power so huge that regulation and supervision are needed, both on research and utilization level. The term "bioethics" was coined in 1970 by Van Rensselaer Potter, oncologist at the University of Winsconsin, in his book "Bioethics. A Bridge To The Future", based on a reflection on the risks of man self-destruction due to a biothecnological delusion of omnipotence. From then on, bioethical centers have multiplied throughout the world, taking up different positions but almost everywhere pointing out new hopes for a better future, thanks to new bio-medical technologies, along with risks.
2. The dispute about "quality of life" From the very beginning, an important and never exhausted point of discussion has been the concept of quality of life, focusing on those problems modern medicine could solve, in order to grant the highest health standards to the largest possible number of people. The first splits between the different bioethical perspectives occurred on this subject, especially between the supporters of life only when worthy - that is when whitin psychophysical acceptability parameters by a subjective or prevailing evaluation - and those who assert innocent human life’s sacrality, inviolability and unavailability, independently of weakness, illness, or handicap circumstances. More deeply, a sharp contrast between two traditionally opposing schools of thought soon became explicit: one is the subjectivist-relativist, claiming individual autonomy as the supreme moral criterion, if necessary adapted to collectivity’s needs - utilitarianism, contractualism, anarchism, behaviorism -; the other stresses the existence of changeless and universal laws in human nature, laws that must be recognized and observed in order to promote both individual and common well. Obviously, a further distinction occurs in the way such a nature is conceived: it can be reduced to mere psychophysical data - sociobiologism, materialism, psychologism - , or include metaphysical aspects; in this case, the fundamental reference is the concept of person, as the unique and unreproducible union of body and spirit, having a free and intelligent nature.
3. Various bioethics Quite obviously, the different ethical perspectives originate in the ideas about man, giving rise to as many bioethical perspectives. They are efforts of "systematical reflection about any intervention of man on living beings, a reflection aiming at an arduous and specific goal: to identify values and rules guiding human actions and the intervention of science and technology on life itself and biosphere", according to the definition given by His Excellence Msgr. Elio Sgreccia, vice-president of the Pontifical Academy for Life and director of the Centre of Bioethics at the Catholic University of Sacred Heart in Rome. For a bioethical perspective to be adequate to truth about man, the identification of such values and rules must be accomplished by an universal and solid criterion, namely by a rightly understood rational reflection. As a matter of fact, intelligence is a reliable way of knowledge of reality as it is in nature, as long as it is not used in a subjectivistic way; in other words, one should accept real world as something to be discovered and respected, and not to be invented - or re-invented - after having broken it into fragments and rebuilded it in his mind like a math exercise. The main guidelines concerning correct ethical behavior according to values and rules of bioethics can be detected by examining reality about man and his context under a natural light. Defense of life, terminally ill and dying person care, dignity of person starting from conception, aptitude to marriage and procreation, man’s responsability and rule over creation: all these issues are accessible to human reflection. Catholic Church has always been particularly sensible and watchful about such natural data, safeguarding and documenting them by a long standing and continuous production of its teaching. Such magisterium keeps on supplying opportunities for ethical deepenings, rational arguments, and even the lexicon of bioethics, within a wide and consistent doctrine. Besides that, the Church commits itself on the practical level, as shown by the christian therapeutical tradition, which originated institutions like hospitals, clinics and rest homes. Therefore, catholic teaching supports and enlightens bioethics on a natural level, to which Catholic Church adds another, the theological one, deriving from the supernatural level of Revelation and consisting in the interpretation of the sense of pain and death under the light of the mistery of Christ. This does not thwart what reason indicates: on the contrary, it integrates and clarifies it. Thus, the attempt to set up a "laical" bioethics against the catholic bioethics appears vitiated and barren, as the 1996 Manifesto for laical bioethics clearly shows. Vitiated, because the claimed "alternative" often ends up in parasiting the catholic position, defining itself mostly by contrast, that is rather stating what "it is not".Barren then, because not only a specific world-view , but bioethics in itself is threatened this way, preventing all possibility of a rational foundation by relegating the discipline in the vagueness of relativism. As a matter of fact, it is impossible to find any homogeneity of positions on the "laical" front, as a consequence of the prejudice defining it "dogmatic" to believe that human intellect is by nature able to know man and reality in general.
4. Bioethical issues Anthropology, that is the study of human person and his specific nature, is therefore the basis of bioethics; it is the obligatory starting point for any further reflections, and a reference to those questions man has always posed about the meaning of life by using his intellect, especially concerning the boundaries of life - birth and death - and the problem of pain. On the one side, main issues concerning the boundaries of life are the status of embryo, human cloning, genetical trials on man and artificial fertilization; on the other side, contraception, sterilization and abortion, euthanasia, organ transplantation and suicide. When the criterion of the unavailability of life is disregarded, it is significant to consider how apparently opposite problems, such as the wish to procreate - artificial fertilization - and the wish to not procreate or eliminate the result of conception - contraception and abortion - basically correspond to a similar logic. It is easy to shift from one to the other when a human being is something that one "makes" , "chooses", or "has", and not someone to be welcomed and to be taken care of. For instance, exactly because of the introduction of artificial fertilization tecniques, a new problem has arisen: what to do with extra embryos produced to give appliers more chances of success. In fact, in vitro fertilization shows a noticeable percentage of failures, whether during conception or because of genetic and degenerative pathologies of embryos; moreover, the sponatneous abortion rate after implantation is very high. It is easy to guess the doom of unused or "surplus" embryos: freezing with no time limit, waiting for future implantation or other "uses" such as experimentations and the creation of a reserve of transplantable organs and tissues, that is to say they will be eliminated; if they were implanted, they would undergo the so-called selective fetal reduction, namely a selective eugenetic abortion to choose the "best" children only. Such a materialistic and too technical mentality helps to generate an imbalance in sexuality - and therefore in family - having repercussions on upbringing and on interpersonal relations. The increasing paedophilia and juvenile delinquency cases are a proof of that : when a child is considered an object to be purchased or manipulated at will, he will as well become a sex object; similarly, when growing up in a social context that is aberrant with regard to sexuality, birth and life, a child or a boy is unlikely to have an appropriate idea of death, thus being likely to go as far as to play with others’ safety, like in a videogame, or like he was dealing with "things", equal to the "thing" the child himself is. The issue of pain is the other main branch of bioethics and is treated in all kind of researches specifically concerning therapy such as: pharmacological experimentation; discussion on clinic cases; organ transplantation; prenatal diagnosis - when not aiming to abortion -; mental illness and neurosis care and control, psychophysical disability, drug addiction, sexually transmitted diseases and sexual disorders. A further group of researches and activities related to pain includes those aiming to reduce pain as much as possible and to increase psychophysical "wellbeing" through: pharmacology and cosmetic psychopharmacology - that is not intended for a specifically therapeutical purpose -; cosmetic surgery; genetic manipulation of animals and vegetables; occupational and sports medicine; physician-patient relationship and medical deontology; fertility regulation. Research and activities aiming at improving mankind general conditions starting from socioeconomic imbalance situations throughout the world - demography, biotechnologies applied to industry and agricolture - are also in this group, along with pain treatment concerning the palliative care of serious disability and the care of the dying persons, the so-called "terminally ill".
5. Bioethics and health policy Most of health policies originate in the importance given to human person and in the institution of family within society: a social body founded on the defense of the communion of persons within family - the communio personarum - will tend to carry out laws, educational methods, and cultural guidelines pursuing an ordered development towards this aim. The alternative is a solipsistic assertion of an omnipotent autonomy of the individual or a flattening of all differences, in the delirious attempt of a "global programming" of life, as effectively described by Aldous Huxley in his 1932 novel Brave New World, a no longer science fiction book, today.Thus, the task of true bioethics is to deepen and propose the truth about man, and to offer facts and guidelines for action directed also to the ones who are responsibles for culture and common well.
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