Bioethics - What Does It Conceal? (Original title: Bioethik - was verbirgt sich dahinter? Merkurstab 1995; 48: 334-46. English by Christian von Arnim, FIL.)

Vol. 12, Nr. 4 Paolo Bavastro

Before giving an outline of the bioethical body of thought, I would like to describe some of the thinking found in biology and concerning the development of animals and human beings because this will give us a better understanding of the thinking on which bioethics is based. Let us start by looking at the reproductive behavior of the vertebrates.

Fish live in the water, in a fluid environment. Fertilization takes place outside the animal. The eggs are deposited in the water without any kind of protective layer. There is no care of eggs or brood.

Amphibians live in water and on land. Fertilization can take place either externally or internally. The eggs are deposited in the water and are surrounded by a quasi-protective, jelly-like mass. There is little evidence of care of eggs and no care of brood.

Reptiles have conquered dry land. Their eggs, which are surrounded by a parchment-like shell are laid on land. In some species they are "cared for" - depending on the strength of the sun the eggs are covered or partially uncovered again in order to keep as much of a constant temperature as possible. But there is minimal, if any, care of brood. The high regenerative capacity (large number of eggs) has been considerably reduced. Respiration takes place mainly through the lungs. Gill-breathing is no longer to be observed. Respiration may be through the skin or mucosa. Amphibians and reptiles are poikilothennic animals.

Birds have conquered the air. Fertilization takes place internally, and the eggs are surrounded by a hard calcium shell. Furthermore, they are laid in a nest and covered. The eggs are incubated, that is, they are nurtured. The brood is then fed and tended. Respiration is via the lung; indeed, the whole of the animal is lung - the bones are aerated. These animals also have become independent of their environment in the way they regulate their temperature. They communicate by means of differentiated sounds.

Mammals live on the earth and in the water. Fertilization takes place internally; the fertilized eggs are now "nurtured" and protected inside the body, in the womb until they mature. The tiny newborns are fed and cared for; a relationship between the young animal and its mother is evident.

In human beings this is supplemented by a very long period of upbringing which is part of development. Articulated speech is, in our view, unique to human beings.

This short, general outline already allows us to see some basic characteristics: respiration is internalized (from gills to skin to lungs) parallel to conquest of the earth as habitat (abandonment of the watery element). Offspring are increasingly protected, at first by an egg shell which grows harder and harder, then in the nest and through care of eggs and brood, until fertilization and growth are taken into the body. The number of offspring clearly decreases in this process. Care and protection become increasingly important for development; they become key characteristics - in human beings this manifests in the many years of upbringing. The gesture of internalization is very clear, with physical contact increasing; attraction, emotional tension, the inwardness of the relationship acquire new qualities.

Higher development becomes possible through the development of protective coverings, internalization, protection, nurturance, affection and security - it is the step from being open to the environment to the self- contained nature of the single individual.

I would now like to outline a few developmental stages, based on the work of A. Portmann.(1)

The higher mammals, those which leave the nest early, have similar physical proportions to the adult animal at birth: they can stand and walk; the limbs are fully developed; they are able to follow the herd a few hours after birth; their posture is similar to that of the adult animal, and the language of their gestures corresponds almost completely to that of the fully grown animal. Seen from a threefold perspective, birth occurs at the correct time in relation to the nervous and sensory system, the rhythmical system and the metabolic and limb system. In contrast, young/newborn human beings are completely helpless, differ from the adult in physical proportions and posture; verbal and gestural language is undeveloped.

When does the newborn human being reach the equivalent stage of maturity? Approximately one year after birth! Human pregnancy is much shorter than it should be for typical mammalian development. Under the criteria outlined above, pregnancy in human beings would have to be approximately 21 months. Thus human beings can be seen as physiological premature births.

In terms of their nervous and sensory systems, human beings are "ready" before birth. The rhythmical system has essentially completed its development at the time of birth. Human beings still have to mature in their metabolic and limb systems.(2) Compared to the higher mammals with their slow linear growth, human beings are characterized by an initial growth spurt which is followed by growth clearly slower than all other mammals. It speeds up again during puberty.

Human beings are the only life forms which are free from hormonal cyclical pressures in their sexuality. Because of this, reference is often made to the hypersexualization of human beings. But this fact can also be understood as dampening, reducing the periodic drive to mate which in a certain respect frees human beings from the purely reproductive side of sexuality. This reduction enables sexuality in human beings to express other soul qualities.

Human beings also show certain specific features in their reflexive behavior. Compared to all other living creatures human beings show impoverishment and reduction in their instinctual organization. Apes cling to their mother's fur immediately after birth in a reflexive action - newborn babies, in contrast, are helpless. Set instinctive behavioral patterns are poorly developed in human beings (just think of sight, smell, hearing as well as the motor reflexes). Furthermore, human beings do not have the same fixed environment as can be observed with animals.

This brief sketch enables us to understand Portmann's view of animals as tied to their environment and secure in their instincts, while he describes human beings as open to the world with the freedom to make their own decisions and with a greater capacity for creative action. Animals live lives - human beings lead lives.

The initial retardation of development provides human beings with the possibility of freedom.

In addition, reflexive behavior in human beings shows "peculiar" characteristics. The innate reflexes in infants are present for about 3 to 5 months and then disappear again. They are learned again only at 9 to 10 months and then remain, having been made their own as it were.

Curvature of the spine, which gives the spring to our step when walking as well as the characteristic adult position of the pelvis, is only acquired at age three. From the perspective of human development, this is the stage when the infant begins to refer to itself as "I"; as adults we can remember back to age three.

With language we understand the function by which we can express our perceptions, judgments, wishes etc. and communicate them to others with the intention of reciprocal understanding through a structure of sounds and symbols in various meaningful combinations.(1)

However impressive and apt we may find some animal sounds, they remain purely an expression of an inner state, like our scream, and are not language in the above sense.(1)

Even if some researchers speak of language in the higher apes, we must not forget that this is in the form of deaf and dumb language, that is through signs, and furthermore that after 20 years of intensive practice it only reaches a level which, in human beings, occurs almost by itself in the initial years of life through passive imitation alone. In human beings these developmental steps are based on a retardation of development which can only take place in a secure environment.

Subsequent development in human beings passes through various crises (just think of the 3rd and 9th years of life, puberty, the 20th and 28th and also the 40th years). These crises represent stages in gaining maturity and they also represent further differentiation from other human beings. These crises cannot be prevented or avoided in the education process and in later life. On the contrary, they have to be accompanied and lived through.(3) Similar situations are not found in the higher mammals. Development is linear, with no comparable crises. With puberty, that is to say with sexual maturity, the animal has completed its development. Considerable aging processes begin immediately.

Giovanni Pico della Mirandola, who lived from 1464 to 1494, describes the foundation of human dignity in the following terms: Human beings, among all creatures, have not been given a fixed place on earth; they have no fixed, specific characteristics. It is their responsibility alone to discover their place, to develop their faculties. Equality between human beings rests on the possibility of determining for themselves what each one wants to be. But it is not what they accomplish, in what way and to what extent which forms the basis of equality, but the opportunity itself which they possess. Working on oneself, the realization of one's abilities, leads to the differences among individuals. Those are the grounds on which human dignity is based. They represent a key perspective in the humanist tradition.(4,5)

Let us also take a brief look at the etymology of the term "dignity" [German Wuerde]. There we find what is appropriate for human beings, the qualities founded in the nature of human beings themselves, the inner value and, to paraphrase Kant, the experience of their own inner value according to which they cannot be bought for any price.

The term Wuerde is related to Wert (worth, value) and to -waert's "to become" in Gothic. Several meanings are contained in these words. On one hand ,the rotating movement of vortices which accords with a basic etheric gesture. On the other hand, the turning around which accords with a basic educational gesture. Furthermore, these words mean turning towards something, becoming something - in old German, to turn one's attention towards something. We can clearly see a definitive, future-oriented gesture which points to the developmental possibilities of human beings irrespective of the extent to which these possibilities are realized and irrespective of the presence of such abilities, which is always individual.

Biology and behavioral research consistently look at the common elements, at correspondences, similarities between animals and human beings; but in looking at the common elements we become blind to fundamental differences between animals and human beings. Of course there are similarities between animals and human beings - but that is precisely the problem. Research into the contrasts, the differences, on the other hand, shows us the secrets, the bearing, the essence and the development of human beings more clearly. It is a language which we have to learn to read.

Emphasis - indeed, overemphasis - on the elements which animals and human beings have in common is one pillar of bioethics. The second pillar is the emphasis on human actions undertaken rationally and in waking consciousness which are tied to the nervous system as their instrument. Since with anthropological discoveries, the skull is often intact and this allows conclusions to be drawn about brain development, much is linked to the brain, with many other aspects excluded.

In many respects the brain takes a special position. Brain development alone is not sufficient to explain everything in terms of a linear progression since "further" development mostly involves the involution, inhibition and suppression of automatic nervous responses which alone make higher co- ordination possible. The suppression of automatic nervous responses can also be seen as the biological basis which makes freedom possible - liberation from the pure functionality of the organs.

Secondly, the brain and the whole of the central nervous system are the "most dead" elements in the human organism. A short time after birth the capacity for cell division has been irreversibly lost in nerve cells, in contrast to the other cells in the organism. Thirdly, the blood-brain barrier means that the central nervous system is in a special position from an immunological perspective. It is the subject of debate whether or not the immune system needs to be suppressed for brain transplants or, rather, partial-brain implants, since rejection practically never takes place. The sphere of the brain is, as it were, excluded from biological individualization. From an historical perspective, Descartes (1596-1650) increasingly turned to the observation of brain function, seeing the brain as the originator and motor of physical processes.

Before going on to analyze and describe some key concepts in bioethics, it has to be stated that when we use the term bioethics in what follows, it is applied in the sense of a specific set of ideas. It would take us too far to describe in detail the extent to which this thinking has already taken hold of and been put into practice in society today (we need only recall the legalized euthanasia, that is to say killing on demand, in Holland). There are many "ethical" institutes in Germany and in the world. Each has to be observed and investigated in detail in order to know where it stands inwardly. Nor should it be denied that there are other institutes - not many, unfortunately - which base their thinking on the dignity of the human being.

The Australian, Peter Singer, born in 1946, is probably the best known representative of bioethics. He has been concerned with animal welfare for a long time. Emphasis of the equality between animals and human beings as well as exclusion of the differences is one of the starting points for bioethics. In what follows, I will attempt to set out, mainly through quotations, some of the typical thinking on which bioethics is based:

To give precedence to a living being merely because it belongs to our species would put us in the same position as the racists who give precedence to those who belong to their race.(6)

The biological facts linked to our species nave no moral significance."(6)

He describes such an attitude as "speciesm."

What is the difference between human beings and animals? Here we find the key to bioethics. Peter Singer wants temporarily to suspend the "complicated" concept of human being - "a relic from the Middle Ages" - and replace it with two other concepts. The purely biological side he describes as "member of the species Homo sapiens" while the specific element is called "person." But methodologically he never undoes this division to restore unity. On the basis of a dictionary entry - believe it or not! - he outlines the concept "person" as a rational, self-conscious being with reasoning and the ability to state preferences with regard to future existence. This includes "self-awareness, self-control, sense of future, sense of past, the ability to enter into relationships with others, care for others, communication and curiosity."(6) Thus, bioethics does not consider embryos, newborns, mentally retarded children or mentally confused elderly people as persons since they do not fit this definition. Under certain circumstances it would thus be permissible to kill these "non-persons" since they do not possess dignity.

If one kills these people (he quotes the example of a philosophy professor who is just writing a book) without their consent, one interferes with their wishes for the future. If one kills a snail or a one-day-old child one does not interfere with wishes of this kind because snails and one-day-old children are not capable of having such wishes.(6)

On his reasoning:

Bioethics is a discipline which Questions underlying values and ethical standpoints which until now were held to be sacrosanct."(7) "It is a characteristic of moral enlightenment, or a moral philosophy based on it (bioethics), that it asks questions about subjects which most people would consider beyond question and self evident: Why should one not kill? Why should one help the needy?" etc.(8) It refers explicitly to the age of enlightenment in the 17th and 18th centuries (sic!).

Where, then, does moral enlightenment lead? It clearly has a disillusioning effect; ... it removes certainties and does not always provide something in their place; often it merely provides solutions which are clearly provisional."(8) Typical in this respect are sentences in the conditional. Uncertain formulations and a lack of definition are characteristic of P. Singer's views. Statements are issued like cardinals' decrees in the Middle Ages, the basis of which would need to be questioned, such as the above definition of "person" or of "brain death" which, according to H. M. Sass, has a basis in ethical tradition "because it (the brain death proposal) is supported by both Western humanist and Christian tradition."(9)

Peter Singer states two premises in an article: (1) it is wrong to kill an innocent human being and (2) a human fetus is an innocent human being.

Here, I want to quote a longer section from the original because it is very characteristic of this way of thinking.

The weakness of the first premise is based on the need to accept the special status of human life. We have seen that the concept "human" oscillates between various meanings: "Member of the species Homo sapiens on the one hand and person on the other." Once the concept has been divided in this way the weakness of the first premise becomes obvious. If "human" is taken as equivalent for "person" then the second premise of the argument, the statement that the fetus is a human being, is certainly wrong for one cannot claim with any plausibility that a fetus is either rational or self- conscious. On other hand, if "human" is taken in the meaning of "member of the species Homo sapiens," then the conservative defense of fetal life is based on a quality which has no moral meaning and thus makes the first premise false. The following point should be familiar to us by now (my emphasis, PB): whether or not a being is a member of our species is, in itself, as irrelevant a question with regard to killing as the question whether or not this being is a member of our race. The view that mere membership of our species, irrespective of all other qualities, is of decisive importance as regards the reprehensible nature of killing is a legacy of religious teachings which even opponents of abortion hesitate to speak about nowadays. This simple recognition (sic!) transforms the abortion debate. We can now look at the fetus as what it is - at its real qualities - and can judge its life by the same standard as that of life forms which possess similar qualities but do not belong to our species. It now becomes clear that the right-to-life movement is called by the wrong name. Far from acting to preserve all life, or considering the nature of the life in question without preconceptions, those who protest against abortion but regularly eat the meat of chickens, pigs and calves merely reveal a superficial interest in the life of creatures which belong to our species. For in any fair comparison of morally relevant qualities like rationality, self-awareness, consciousness, autonomy, sensations of pain and pleasure, etc., calves, pigs and the much-mocked chickens are far ahead of the fetus at any stage of pregnancy - and if we take a less than 3-month-old fetus even fishes, indeed prawns, show greater signs of consciousness.

I therefore propose giving fetal life no greater value than the life of non- human life forms at a similar stage of rationality, self-awareness, perceptual ability, sensitivity, etc. Since a fetus is not a person, a fetus does not have the claim to life of a person, furthermore, it is very unlikely that fetuses of less than 18 weeks are capable of feeling at all because to all appearances their nervous system has not yet sufficiently developed. If this is so, then abortion up to that date ends an existence which has no value as such at all. In the time between 18 weeks and birth, when the fetus might be conscious but not self-aware, abortion ends a life which has a certain value and should thus not be undertaken lightly. But the serious interests of the woman normally take precedence over the rudimentary interests of the fetus. In fact, in a society in which highly developed forms of life are slaughtered for the taste of their meat, abortion is difficult to condemn even when it takes place in advanced pregnancy and for quite superficial reasons.

Further principles of bioethics:

"The basis of my ethics is the principle of equal concern for all interests."(10) Concern for all interests quickly deteriorates, however, into utilitarian arguments and benefit maximization. Let me quote some examples below:

Five patients will only survive if each one receives a different organ transplant. If A, who is in the same hospital for routine investigations, were killed without having to suffer fear or any other sort of pain, five would survive, and only one would die. Otherwise five would die, and one would survive.(11)

Although there is no approval of A's death, the example raises a number of issues. It is strange that such an example should be quoted at all; it is written in the conditional; the argument does not once mention the arbitrary disposability of human life of the person concerned, with only the indirect effects on others emphasized. Where, then, does that leave the interests of A, which are not analyzed at all?

In the next example we have a mixture of assertions and utilitarianism:

The change from the traditional heart and circulation to the brain death definition brings with it remarkable ethical and medical advantages (authors' emphasis). (1) Human life which no longer feels pain and can no longer communicate no longer needs to be prolonged; high emotional, ethical, cultural, medical and economic costs need no longer be borne. (2) Organs and tissue are made available to fellow human beings who would suffer in other ways or die early; medical ethos and human solidarity are provided with new opportunities to give professional and human assistance. (3) A single criterion which can be biomedically diagnosed and tested without ambiguity replaces decision-making in the individual case; we thus have an indisputable criterion which is covered by ethical tradition.(9)

A further example: In 1988 it was proposed to protect human life from the point at which the sperm penetrates the egg cell, in other words, from the time of fertilization, because at this point a unity is created which entails human development. "This position would allow some experiments to improve methods of fertility," but the result gives a "pretty meager benefit on the research side" (authors' italics).(9)

There it makes more sense to look, as we have done, for a period which brings greater benefit to embryological research than the investigation of relatively undifferentiated tissue.(9)

The agreed time is set at the 57th day after conception since, firstly, "there is a strong basis in humanist and theological traditions; secondly, ethical dilemmas in the protection of other embryological stages are avoided; thirdly, there is an overall balance between the further life of the early embryo and the interests of parents, patients, research, and society."(9)

Finally, one last aspect which plays an important role in bioethics, namely hedonism (pleasure and joy as motivating factors):

A difficult problem arises ... when we look at damage which is serious enough to make the life prospects of the children significantly less good than those of normal children but not serious enough to make life not worth living. Hemophilia belongs into this category ... Could euthanasia be justified here? Our first reaction might well be an unequivocal no ... But the "overall view" raises the question whether the death of the hemophiliac infant leads to the creation of another one who would otherwise not exist... insofar as the death of the damaged infant leads to the birth of another child with better prospects of a happy life, the overall sum of happiness is greater if the handicapped infant is killed. The loss of a happier life for the first infant is balanced by the gain of a happier life for the second one ... The overall view treats infants as replaceable .. ..(6)

The bioethical thinking quoted here speaks for itself; critical comment is unnecessary.

I am aware that some readers will find it hard to believe these quotes. Yet every interested person can ascertain for himself, by referring to the quoted literature, the attack mounted in bioethical thinking on human beings and human dignity.

In the autumn of 1994, a draft bioethics convention was presented to the parliamentary assembly of the Council of Europe (not the European Union) in Strasbourg which was intended to lay down on a European-wide basis the essential elements of bioethical thinking. The draft was sent to committee. After revision, the bioethics convention is to be presented again in the summer or autumn of 1995. In response to the convention, a "European Initiative Against Bioethics and its Consequences" has been set up by a number of people who are collecting signatures throughout Europe and thus want to make people aware of this thinking. To date, more than 25,000 signatures have been collected. Anyone who wants to support this initiative through their signature or by helping with distribution is requested to write to the address below. Copies of the initiative can be obtained from there (please do not forget to enclose an s.a.e.).

Paolo Bavastro, M.D. Filderklinik

Im Haberschlai 7

D-70794 Filderstadt

Germany

References
1 Portmann A. Biologische Fragments zu einer Lehre vom Menschen. Basel 1969.
2 Schad W. Die Embryonalentwicklung des Menschen als Ausdruck seiner Individualitaet. Das Schicksal manipulieren? Stuttgart 1986.
3 Lievegoed B. Lebenskrisen, Lebenschancen. Munich 1979.
4 Pico della Mirandola G. Ueber die Wuerde des Menschen. Zurich 1988.
5 Gruwez Ch. Das Recht aufUnvollendet-Sein. Die Drei 2/1995.
6 Singer P. Praktische Ethik. Stuttgart 1994.
7 Singer P. Bioethik und akademische Freiheit. R. Hegselmann, R. Merkel (eds). Zur Debatte ueber Euthanasie. Frankfurt a. M. 1992
8 Hegselmann R. Moralische Aufklaerung, moralische Integritaet und die schiefeBahn. R. Hegselmann, R. Merkel (eds.). Zur Debatte ueber Euthanasie. Frankfurt a. M. 1992.
9 Sass H M. Himtod und Himleben. H. M. Sass (ed.). Medizm und Ethik. Stuttgart 1989.
10 Singer P. Mir leuchtet nicht ein, wie man solche Werte bewahren will. R. Hegselmann, R. Merkel (eds). Zur Debatte ueber Euthanasie. Frankfurt a.M. 1992.
11 Birnbacher D. Das Toetungsverbot aus der Sicht des klassischen Utilitarismus. R.
Hegselmann, R. Merkel (eds). Zur Debatte ueber Euthanasie. Frankfurt a.M. 1992.

Other literature:

Cavalieri P, Singer P. Menschenrechtefuer die grossen Menschenaffen. Munich 1994.
Heisterkamp J. Der biotechnische Mensch. Frankfurt a.M. 1994.
Kipp F. A. Die Evolution des Menschen. Stuttgart 1980.
Lievegoed B. Entwicklungsphasen des Kindes. Munich 1979.
Portmann A. Einfuehrung in die vergleichende Morphologic der Wirbeltiere. Basel 1983.
Sass H M, Kielstein R. Wertanamnese und Betreuungsverfuegung. Zentren fuer Medizinische Ethik. Baden 1993.
Singer P. Schwangerschaftsabbruch und ethische Gueterabwaegung. H. M. Sass (ed.). Medizin und Ethik. Stuttgart 1989.