GLOBAL BIOETHICS
CONTENT OF TABLE
Introduction
I-
Meaning and context of emergence of global
bioethics
1-
Definition of bioethics and global bioethics
2-
Why a global bioethics?
II-
Principle of bioethics in
the global bioethics context
1-Autonomy
2-Beneficence
3-Non-maleficence
4 – Justice
III-
Beginning and ending of
life issues: a global approach in bioethics
1- The beginning of life
2- The ending of life
IV-
The global bioethics view of human right
1- The UNESCO Universal Declaration on Bioethics and
Human Rights
2-Human rights in international or global
bioethics
Conclusion
BIBLIOGRAPHY
Introduction
With
the rapid advancement in technology, scientific understanding and research are
new challenges in the field of education, mainly educational ethics that the
global bioethics considers in a holistic perceptive. In that sense, the
curriculums need to be constantly upgraded to keep in touch with the realities and
must highly emphasis the learning of ethics in a large sense. Through the
voluntary of globalization of bioethics, there is a necessity of recognition of specific ethical facts and
demonstration of technical skills which can permit to everyone to apply ethics
in specific situations that require critical thinking and problem-solving. The
ultimate goal of global bioethics is to ensure that everybody has the capacity
to integrate and implement the various domains of learning require the
application of ethics and make a best usage of it. So, the areas that need be
considered can be commercial ethics, ethics
of health care, moral distress, ecological crisis, academic integrity issues,
sexual harassment, boundary issues, standards of care, malpractice,
confidentiality, breaking bad news, mistakes and truth-telling, cultural
adaptations, ethical conflicts, ethical issues in recordkeeping and
documentation, ethical issues in treatment planning, and ethics and state.
These areas are very limited and constitute a part of fields of study of global
bioethics, because global bioethics is too broad. In order to make a tentative
approach of demystification the whole content of global bioethics, the UNESCO[1]
chair of bioethics is gradually making inquiry and now there exists already
four volume, the encyclopedias of global bioethics exist in internet and many
bioethics journals. In the actual societies, those previous initiatives or
humans are faced with finding new ethical grounds for solving emerging ethical
problems which Hammurabi’s oath, Hippocrates’s oath, Charaka’s oath and Sun
Simiao’s oath have confronted in their periods. This is the challenge to which
the modern bioethicists, through global bioethics must resolve if he needs to
fulfill his role effectively in contemporary society. Our goal in this
reflexion concerning global bioethics is to clarify the problem of the quiddity
or essence of that holistic view of bioethics. In order to tackle this problem,
we will firstly clarify concepts and present the why of emergence of global
bioethics. Secondly, we will analyze the principles of bioethics in the global
bioethics context. Thirdly, we will analyze the issue of beginning and ending
of life in a global view of bioethics. Fourthly, the problem of human right in
an ethical perspective will be accentuated, in the globalization of bioethics
by UNESCO.
I-Meaning and
context of emergence of global bioethics
The
aim here consists into a sort of conceptual clarifications accompanying with
the context of emergence of global ethics. The clarification of concepts will
be focused particularly on the concept of bioethics and on the concept of
global bioethics. About the context of emergence, we are going to see how
ethical issues evolve through the human activities; human collaborations with
nature and human collaborations with themselves in the broad sense of the word.
1-Definition
of bioethics and global bioethics
A good manner to clarify the concept of consists to make allusion to the
voice of the encyclopedia of philosophy and that of the first person who coined
the concept. In fact, the encyclopedia of philosophy defines bioethics as:
“an interdisciplinary field of
study dealing with practical ethical issues roughly at the intersection of
morality, medicine and the life sciences. Within philosophy, bioethics is one
of several different areas of applied ethics, a domain within general normative
ethics. (…) On the most restricted view, bioethics simply reduces to biomedical
ethics, which encompasses ethical issues relating to the practice of medicine
broadly understood and the Pursuit of medical research.”[2]
In the same Perspective, Van
Rensselaer Potter was the one who coined the word in 1970 as the intersection
of biology which refers to all “living systems”[3]
and ethics which refers to “human value systems”[4].
So, the direct implication is that bioethics is a wide field of study, covering
topics from medical ethics to the development of science and the use of new
technologies. On the one hand, bioethics studies the fundamental philosophical
questions of human existence and well being, including the concept of humanity.
It also examines our basic assumptions on morality and ethical principles and
codes of conduct. Bioethics not only analyzes what the rules or limits of
“right” and “wrong”[5]
action might be in various circumstances, and what characterizes the “good
life” or life in general. It also scrutinizes our fundamental
conceptualizations of a “human being” and “moral agency.”[6]
On the other hand, bioethical questions are connected to wide questions of
justice and fairness. These are evident in studies on the distribution of
power, position, and resources; but they can also be recognized in accounts of
the scientific
inquiry itself.
Now, let us analyze and define the addition of the word global to the
concept of bioethics, what give us global bioethics as the large view of
bioethics.
Due to
the fact that we are in a world gradually and continually globalized, the
questions of bioethics are more and more clearly recognized to be transnational
and issues can be addressed only with international or wordless action.
Contagious diseases, Modified Genetically Organisms, changes
in biodiversity, the consequences of the use of advanced biotechnology, the
effects of climate change, and other environmental problems do not respect
national borders. We have also practice medicine, conduct research, and do
business with example in pharmaceuticals, across borders. In order to respond
rationally to various bioethical challenges, we need to acknowledge our global
interdependence and work together despite our cultural, religious, economic, geographical, and political differences.
Consequently,
one way to define “global bioethics” is to outline its main areas of enquiry
and their scope. Global bioethics, according to this approach,
deals with “issues that arise out of a globalized condition or are international
or transnational in nature”[7].
Although this approach can also be taken by philosophers, it is
evident that philosophical argumentation alone does not suffice to deal
with complex cross-border issues in which politics and power relations assume a
central role. In that sense, combined multidisciplinary academic efforts are
needed to understand the multifaceted challenges involved in global bioethics. However,
let us use Potter in order to see the philosophical view of global bioethics.
For him, global bioethics is “an interdisciplinary subject which shall entail
not just medical and environmental ethics, but social or cultural and religious
ethics. He says that his initial conception of bioethics was to bridge the gap
between the sciences and the humanities. Potter wanted bioethics to be applied to all
of life.”[8]
Another way to define the word “global” in global bioethics is in
reference to normative universal frameworks that promise to solve problems in
international and cross-cultural contexts. Many proponents of global ethics and
global bioethics have attempted to find a prescriptive ethical
framework that could provide universal moral principles, norms, and core
standards of judgment for assessing different culturally oriented approaches. In
effect, Global bioethics, as a philosophical field of study that subscribes to this line, is often in the same
line with ideological ethical accounts that attempt to articulate a universal
set of ethical rules for all to follow. Sometimes theory and practice, values
and facts, and ideals and practices get tangled together. The theoretical
effort to search for universal moral principles is often interpreted as being a
part of the political, social, and economic trends of globalization. In that sense,
globalization, for some, represents a form of neo-imperialism that assimilates
cultural diversity toward mono-cultural practices.
2-Why a
global bioethics?
Before enter into global bioethics, it is necessary to see how bioethics
evolves and directly makes a deduction with global bioethics which would not
exist if bioethics does not. Since the ancient philosophy, the question of
ethical practice evolves. Until the 1960, discussions about ethics were largely
confined to philosophical and theological
studies. Advances in technology and medicine, together with increased
concern for individual rights and freedoms, led to the rebirth of the field of
bioethics in which theologians,
philosophers, lawyers, and other scholars engaged in public discourse on applied ethics. The word “bioethics” and
its field of study experienced, in 1970 and
1971, a dual birth in Madison, Wisconsin, and in Washington, D.C. Van Rensselaer Potter, at the University of
Wisconsin first coined the term; and Andre Hellegers, at Georgetown University, soon adopted the word “bioethics”
and for the first time used it in an
institutional way to designate the academic field and movement regarding
public policy and the life sciences[9]
For
Potter, the word “bioethics” had an environmental and evolutionary significance; whereas Hellegers, the Dutch
obstetrician and fetal physiologist and demographer who was instrumental in
founding the “Kennedy Institute of Ethics” at Georgetown
University, used the term more narrowly
for medicine and biomedical research ethics.
Potter’s use of the term “bioethics” was initially marginalized, whereas the Hellegers Georgetown
biomedical connotation of the word came to dominate the emerging field of
bioethics in academic circles and in the mind of the public. Potter identified
the overriding human problem that led him to advocate attention to a new area that he called bioethics. It was
the problem of “survival of the human
species, nations and cultures”[10].
His objective was to identify and promote
an optimum changing environment, and a comfortable human adaptation within that
environment, so as to sustain and improve the civilized world. Therefore, the
ultimate goal of this discipline, as Potter saw it, was “not only to enrich
individual lives but to prolong the survival of the human species in an
acceptable form of society.”[11]
Potter’s substantive vision of bioethics was anthropocentric (human survival),
rather than biocentric (survival and well-being of the biosphere). Hellegers,
through his favorite obstetrical metaphor, best
describes his founding role in bioethics. Recalling his comment that
“the word ‘obstetrician’ means ‘one who is
present at’”[12],
we can say that Hellegers facilitated the development of bioethics by being the
intellectual midwife who stimulated ideas
and reflection in others. Hellegers
described his own role in bioethics: as “a bridge person between medicine
and philosophy and ethics.”[13]
Now,
we can bring out the deduction of context of emergence of global bioethics from
that of bioethics by saying that the main thesis in global bioethics is to
bring global and local aspects closer together when looking for international
guidelines, by paying more attention to particular cultures and local economic
and social circumstances in reaching a shared understanding of the main values
and principles of bioethics, and in building 'biodemocracy'[14].
It is an incontrovertible fact that today Bioethics is a global need.
That
bioethics has long been part of man’s ethical thinking brought home to us when
we consider that bioethical content can be found in almost all ethical codes
known to us from time immemorial. Perhaps the most ancient is the Hammurabi
code (17th century BC) from the time of Hammurabi to the recent
declarations of the World Medical Association (declaration of Geneva and
Helsinki) bioethics receives considerable notice in codes of ethics.
In the west the Hippocratic Oath popularized
Greek bioethical thinking. In the Indian context the ethical codification of
the great physician Charaka set the standards of medical practice. In the great
civilization of China Sun Simiao hailed as the king of Physicians wrote a book
on the sincerity of great physician which contained passage of enlightened
ethical import. Thus we may conclude that those examples provide us a
sufficient argument in favor of the globalization of bioethics in the past and
today.
The
Hippocratic Oath, well known throughout the globe descending from ancient Greek
medical practice since fifth century BC, provides basic ethical guidelines
applicable even for today. The basic ethical concepts embedded in this oath are
still valid for a complex current socio-political system with highly
commercialized scientifically advanced medical practice. With the development
and the spread of modern scientific medicine throughout the globe the values
and ethical concepts ingrained were also carried along with it and known to
many cultures.
In
contemporary society we see commercialism becoming more and more decisive in
policy making. Furthermore, we live in a permissive society where major ethical
codes of religious origin are having their very foundation eroded. We are faced
with finding new ethical grounds for solving emerging ethical problems which
Hammurabi, Hippocrates, Charaka or Sun Simiao has confronted. This is the
challenge to which the modern bioethicists must rise if he needs to fulfill his
role effectively in the society of our time.
In
addition, Global bioethics evolves through the
Council of Europe in 1982, in its Recommendation
934 on genetic engineering from the standpoint
of human rights. It says “Human rights imply the right to inherit a genetic
pattern which has not been artificially changed.”[15]
However, we are now going to accept “gene
therapy” which necessarily changes the human genetic patterns artificially in
the name of medical treatment. This might promise the future “improvement of humans”, possibly towards “human happiness”.
Moreover, the new Global Bioethics will stand on the new philosophy concerning the harmonious
relationship between nature and human beings as analyzed previously with Potter
and Hellegers. In that sense humanism
will be extended beyond human-centrism
by integrating the ethos and wisdom of Asia[16].
But it
is not necessarily altruism either. It always seeks some sort of holistic harmony of the antagonists. One might be afraid that this kind of holism is a sort of paternalism which was already rejected in the beginning of recent
bioethics in the honored name of ‘personal autonomy’. However, we should notice that some new bioethical issues such as
issues of genetics and of the environmental crisis necessarily require some sort of communitarian way of thinking
from the global point of view.
II-Principle of bioethics in the global bioethics context
Ethical
dilemmas are not only proper to medical
situations, but also to all situations which require a practical ethical
intervention. This reflexion concerns more the medical situations because, in
order to clarify and solve some ethical ambiguities faced by medical
practitioners, due to the problem linked to new medical technologies, four
ethical principles have been establish.
Those principles aim to regulate and resolve problem in the context of
bioethics and consequently that of global bioethics. That is why Gert,
Culver and Clouser in their book entitled Bioethics:
A return to Fundamentals affirms: “The
principles of biomedical ethics emerged from the work of the National
Commission for the Protection of Human Subjects of Biomedical and Behavioral
Research”[17].
In fact, those basic principles of bioethics are: autonomy, beneficence,
non-maleficence and justice.
1-
Autonomy
In
this principle, autonomy is based on the theory of respect for persons which
hold that individual persons have rights to make their own choices and take
decisions as they wish. This principle integrates or incorporates two ethical
dimensions: the first holds that the patient is free or self-determinant. The
second states that a patient with diminished autonomy should be protected or
assisted. In the first aspect, the patient has autonomy of intention, thought,
and action when making decisions concerning health care procedure. Thus, the
decision making must be free of constraints, influence or coaxing. In order
for a patient to make a fully informed decision, he or she must understand all
benefits and risks of the procedure and the likelihood of success. In the
global sense of bioethics, this principle should be respected independently of
the race, culture, social status, individual state (clean or dirty), gender and
must be applied anywhere the need is present.
However, as we can see in the second aspect,
there are situations in which a patient is not longer capable of making
decision concerning his healthcare. Among those situations, we can notice the
use of higher medical and technical jargon which is not always accessible to a
lay person; the case of a patient in an irreversible coma placed under life
assistive machine. In such cases, the patient needs to be assisted in
decision-making. Nevertheless, we should retain in this principle that moral
rules of autonomy requires physician or medical practitioner to: tell the truth, respect the
privacy of others, protect confidential information, obtain consent for
interventions with patients and, when asked, help others make important
decisions[18].
Gillon[19]
outlines four specific areas where a doctor may act without regard for the
patient's
Autonomy:
-
Patients
have given their prior consent that the doctor can make decisions as they see
fit.
-
Respect
for one patient's autonomy directly conflicts with another patient's autonomy
or safety, or where it could conflict with an aspect of justice.
-
Where
someone used to have autonomy but no longer does.
-
In an
emergency where a patient's life is at risk.
2 - Beneficence
This principle refers to the act of
“mercy, kindness and charity and in suggestive of altruism, love humanity and
promoting the good of others”[20]
like affirms Beauchamp. Beneficence also, is not restricted to the medical
situation proper to bioethics; but can deal with the global bioethics context
because the act of love, caring others and compassion is not only restricted to
a doctor. Therefore, in the global manner, this principle belongs to every body;
what makes it global in the global bioethics context. The parable of the Good
Samaritan is the example of the global bioethics impact of this principle. Since the love of medical practice is the
love of mankind[21]
as we observe in the Hippocratic conception of medical art, the second basic
principle of bioethics is that of beneficence. This principle requires that the
procedure be provided with the intent of doing good for the patient
involved. It also demands that health care providers develop and maintain
skills and knowledge, continually update training, consider individual circumstances
of all patients and strive for their benefit. According to Beauchamp and
Childress, the principle of beneficence comprises particular rules such as:
“Protect and defend the rights of other, prevent harm from occurring to others,
remove conditions that will cause harm to other, help persons with
disabilities, rescue persons in danger”[22].
Here, all should be done for the benefit of patients. In other words, this
principle is the positive requirement to further the patient’s interest.
3- Non-maleficence
If the principle of beneficence recommends
doing good, the principle of non-maleficence
requires us to avoid harm to the patient, or what would be against the
patient’s interests. Briefly speaking, it is the requirement to refrain from
doing what damages the patient’s interest. This principle deals with the
Hippocratic imperative to physicians or medical practitioners: “do not harm”.
The principle of non-maleficence includes moral rules such as: “Do not kill, do not cause pain or
suffering, do not incapacitate, do not offense, do not deprive others of the
goods of life.”[23]
In that perspective, the fact that we must avoid to cause pains to others, not
concerns only the biomedical situations, but also the ecological or
environmental situations with trees and animals in the context of global
bioethics.
4 – Justice
The idea that the burdens and benefits of new
or experimental treatments must be distributed equally among all groups in
society requires that procedures uphold the spirit of existing laws and are fair
to all players involved. So that, the health care provider must consider four
main areas when evaluating justice: fair distribution of scarce resources,
competing needs, rights and obligations, and potential conflicts with
established legislation. Moss &
Siegler clarify more
when affirms “The principle of justice underlies concerns about how social
benefits and burdens should be distributed. For example, is it fair that two
patients, otherwise similarly situated, are treated disparately by the health
care system because one is affluent and the other is indigent? Between two
otherwise similarly situated patients in need of a liver transplant, who should
receive the one organ that is available-the recovering alcoholic who has been
sober for one year or the patient dying of biliary atresia?”[24]
The existence international regulation of justice in the environmental domain
like in the medical domain is the roof that the principle of justice is an
importance one in the global bioethics perspective.
III-Beginning and ending of life issues: a global approach in bioethics
Our aim in this chapter
consists into analyzing the issue of beginning and that of ending if life in
the perspective of global bioethics, in such a way that we can see divest
views. About the issue of beginning of life, we will more focused on the book
of the thinker Mbih Jerome Tosam; book entitled Biotechnology and the Beginning of Human Life: An Ethical Analysis. The issue about the end of life will be
focused on the result on Global Bioethics Enquiry volume 1
1-The beginning of life
The question of when human life begins is one of
considerable ethical, legal, and political
importance, particularly for public policy debates over abortion and embryonic
stem cell research. According to Dr Mbih Tosam in his book entitled Biotechnology and the Beginning of Hunan
Life: An Ethical Analysis,
“the answer to the question of when human
life begins has been changing in the course history. Any response to the
question is deeply rooted in the beliefs, values and social constructs of the
community or individual that drew such conclusions. Throughout the history of
mankind, there have been divergent and conflicting answers to the question, but
the only consistency in the answers is that they are always changing as social
context and religious morals change, or when new knowledge about the process of
embryo development is obtained.”[25]
For our
thinker, the position concerning the beginning of life is proper to the belief,
ideological or system of thinking of each person. The biological position says
that “life begin at conception (…) The first cell of a distinct human being
begins at the moment of conception – that is fertilization. Fertilization takes
lace when there is a fusion between one living sperm from a nature male and one
living ovum from a nature female. When these two are joined, a zygote is
formed.”[26]
The spiritualist position thinks that the penetration of the soul in man is the
point of beginning of human life. Mbih in his book takes the example of Plato
by saying that: “According to Plato, human life begins when the organism
receives a human soul.”[27]
The sociological position affirms the
beginning of human life in the process of socialization. Mbih affirms
“Socialization refers to the development of conscious relationship with other
people”[28]
2-The ending of life
The issue of End Of Life
(EOL) in this reflexion is present like result of enquiry made by Dr. Princy Louis
Palatty in the Scholarly Publication of the UNESCO Chair of Bioethics volume 2
of the “Global Bioethics Enquiry”. According to doctor Princy Louis[29], the
EOL is to the center of three major points of view.
The first is that
of Patient
viewpoint:
“The EOL decisions are complex, but can be
framed in terms of the benefit of treatment. It is always good to have
discussion with the patient, family and physician on EOL care. Occasionally,
frank disagreements, on a particular course of action and what best should be
done, ensues. This does not detract the importance of discussion; rather
strengthen it, to aid effective decisions. Most patients and families opt out
of ‘high technology’ and ‘high cost’ treatments, were quality of life is poor.
EOL care may sometimes be costly, uncomfortable,
undignified and ineffective. The patient decision maker should be given all
information regarding his disease and planned therapies, along with prognosis.
It is the wise to plan for any eventuality. Advance are directions are best
sought early. Patients misgivings related to physician honoring their wishes is
not always misplaced .advance directive would help to conform decision
according to ones preferences. An appropriate choice of proxy may be designated
who is well aware of his choices and would have choices relevant to his
beliefs. The proxy choice is often the spouse or children. It is only rarely
that physician or religious head is chosen as surrogate decision maker.”[30]
The second is that of Physician viewpoint:
“Physician faces hesitation in initiating and
continuing therapy or life support systems. Establishing trust and frank
discussion with patient and his family, forms an even platform for discussion
and adding ethical decision making, without regrets. The question of inserting
a feeding tube weighs down heavily on the doctor. A conscientious program of hand feeding which would be more appropriate and
choice of procedure i.e. feeding tube, is not inevitable. Misconceptions
are common. It is mandatory the physician shares his opinion and recommendation
in EOL case. Respecting patient autonomy is a very ethical decision making. The
clinical judgment of the physician is highly valued. In the absence of advance
directives, physician face dilemma on decision making, but legislations is
available in some countries on the hierarchy of decision makers. It is right to
present and resolve EOL ethical issues. The physician plays a pivotal role in optimizing
EOL decision making. The physicians endeavor to honor patient’s wishes. It is
the physician who advocates for meaningful and realistic goals. He educates
those involved of the existing laws of the land and medical possibilities in
this context.
Physician
should facilitate interdisciplinary management of the cases. The physician also
looks to reach to the family for adequate supportive care. The physician has to
onus of communication between the decision
maker, family and healthcare provider. When home care is sought,
physician must ensure that it is a manageable option. Regular care should be
available in the home, including round the clock on call coverage for tackling
emergencies should be provided. Their responsibility of certifying expected home
death falls to the physician or his associate if he were unavailable. The
physician takes the deliberate act of euthanasia.”[31]
And the third is that of Family or caregivers viewpoint:
“EOL discussions are limited by barriers.
Facilitation of EOL discussion would enhance awareness and set up informed
realistic hopes are set. Eliciting the patient and caregivers preference is of
utmost importance. Family and kin would make sure those patients’ wishes are
known and honored. Occasionally, family members are unaware of patient needs
and wishes. Whether a patient is competent or not, the family members and care
givers need to be involved in EOL decision making. Moreover, family and
caregivers require support system to tackle
EOL status of their loved ones. The family physician helps to mediate
unobtrusively, to the need of the patient.
The
burden of honoring decisions is alleviated upon being cognizant of the
patient’s desire. It is often good to rally the forces of family and decision
maker to reach the decisions, agreeable to all. The myriad of variable &
disputed perspectives of family members should be acknowledged. A collaborative
approach is chosen to deal with EOL management. Building consensus among family
members themselves is crucial. The family members struggle to find a point of
value or procedure desired by the patient. Families prefer substituted judgment
less bothersome.”[32]
The
problematic of Euthanasia can also be range in the End Of Life issue. Defined
as the act of intentionally killing a person, painlessly, when this may be
construed as beneficial, Euthanasia as six types among which: Voluntary Euthanasia; made at the request of
a fully competent person who wishes to die. Non Voluntary euthanasia; when a person
is unable to consent due to age, physical or mental capacities. Involuntary
one; when a dying person could have been but was not asked for their consent.
Assisted suicide, when a person is given the means of information to kill
himself. Active euthanasia; where an action is performed with the intention of
causing death. Passive euthanasia; where death is intentionally caused by
inaction.
IV-The
global bioethics view of human right
The main references here are the Scholarly Publication of the UNESCO
Chair of Bioethics entitled “Global Bioethics Enquiry”[33].
We are going to analyze in this part, the interaction between human right and the globalization of
bioethics; the possibility for global bioethics to ameliorate the human right
conditions.
1-The UNESCO Universal Declaration on Bioethics and Human Rights
The globalization of
biomedical and ecological issues has created the urgent need for coordinated
intergovernmental action in order to promote respect for human dignity and
human rights in these fields, as it is clear that individual countries alone
cannot satisfactorily address the new and complex challenges. This situation
has been perceived by some intergovernmental organizations like UNESCO, which
have made significant efforts over the last decade to establish common
standards relating to biomedicine precisely and environmental. So, how to
provide an overview of the human rights instruments dealing with bioethical
issues adopted by UNESCO?
By answering this question,
we can say that the traditional
human rights instruments are clearly insufficient to cope with the complex
challenges for human rights that emerge from biomedical and ecological
developments. This means that specific common rules are urgently needed in this
area. Since health issues[34]
and biomedical technologies that accompany them
have increasingly a global nature, then the response to the new dilemmas
should also be global[35].
Aware of the need for minimal common standards, some intergovernmental
organizations began in the mid-1990’s to promote an international consensus on
some basic norms relating to biomedicine. In particular, UNESCO has been
playing a leading role in this regard during the last decade. This is not
surprising as UNESCO is at present the only global intergovernmental
organization having been involved for
decades in standard-setting activity at the intersection of sciences, ethics
and human rights[36]. Through the work of its
International Bioethics Committee (IBC), this UN agency has elaborated and submitted to its Member States for approval
three global instruments relating to bioethics: the Universal Declaration on
the Human Genome and Human Rights of 1997; the International Declaration
on Human Genetic Data of 2003 and the Universal Declaration on Bioethics
and Human Rights of 2005[37].
The first, the Universal Declaration on the Human Genome and Human
Rights was adopted in 1997 with the main purpose of protecting the human
genome from improper manipulations that may
endanger the identity and physical integrity of future generations. To
this end, it characterizes the human genome as “the heritage of humanity”[38]
and declares “contrary to human dignity”
practices such as “human reproductive cloning”[39]
and germ-line interventions[40].
In addition, the Declaration intends to prevent genetic reductionism and any
use of genetic information that would be contrary to human rights and human
dignity. It is worthy of note that through this Declaration the integrity of humanity as such is regarded
for the first time in history as a common heritage to be protected.[41]
The second, the International Declaration on Human Genetic Data of
2003, which may be regarded as an extension of the 1997 Declaration, sets out a
number of rules for the collection, use and storage of human biological samples
and of the genetic data that can be derived from them. It covers, among other
issues, informed consent in genetics; confidentiality of personal genetic
information; genetic discrimination; anonymization of genetic data;
population-based genetic studies; the right not to know one’s genetic make up; genetic
counseling; international solidarity in genetic research, and benefit sharing.
The third, the Universal Declaration on Bioethics and Human Rights of
2005 has a much broader scope than the two previous documents, as it aims to
provide a comprehensive framework of principles that should guide biomedical
activities in order to ensure that they are in conformity with international
human rights law. The importance of this Declaration lies in the fact that it
is the “first intergovernmental global
instrument that comprehensively addresses the linkage between human rights and
bioethics.”[42]
As a matter of fact, the whole instrument is conceived as an extension of international human rights
law into the field of biomedicine. As noted to the Declaration, “the
Drafting Group also stressed the importance of taking international human
rights legislation as the essential framework and starting point for the
development of bioethical principles”.13 This document also points
out that there are two broad streams at the origin of the norms dealing with
bioethics. The first one can be traced to antiquity, in particular to
Hippocrates, and is derived from reflections on the practice of medicine. The
second one, conceptualized in more recent times, has drawn upon the developing
international human rights law.
2-Human
rights in international or global bioethics
Several reasons explain the strong appeal to human rights to set up
global bioethical standards. The first obvious reason is that, since biomedical
activities are directly related to the most basic human rights such as the
right to life and to physical integrity, it is perfectly sound to have recourse
to the umbrella of international human rights law to ensure their protection.
In spite of all its evident weaknesses and failures, the existing human rights system, with its extensive body of
international standards and wide range of mechanisms and international
courts, represents a considerable achievement of our time. This is why it would
be strange that a human rights framework could not be used to protect
individuals from harm in the biomedical field.
In
addition, the human rights framework facilitates the formulation of universal
standards, because international human rights law is based on the assumption
that some basic rights transcend cultural diversity. Human rights are indeed
conceived as entitlements that people have simply by virtue of their human
condition, and regardless of their ethnic origin, sex, age, socio-economic
status, health condition, or religious or political ideas. In other words,
human rights are held to be universal in the sense that “all people have and should enjoy them, and to be
independent in the sense that they exist and are available as standards of justification and criticism whether or not
they are recognized and implemented by the legal system or officials of
a country.”[43]
In such a sensitive field as bioethics, where diverse socio-cultural,
philosophical and religious traditions come into play, the universalistic
nature of the human rights framework cannot be underestimated.
Also, another reason for the appeal to human rights is that the notion
of human dignity, which is the cornerstone of global bioethical norms, is
unable alone to provide a concrete solution to most challenges raised by
biomedical advances. Although, respect for human dignity embodies the ultimate reason for the norms settled in this
field, it is not enough to simply invoke the idea of dignity to solve
the new dilemmas. Some further explanation is usually required. It is necessary
to indicate why
some practices are considered to be in conformity or not with human dignity. This necessity of specification of
the principle of dignity explains why this concept normally operates
through other more concrete notions for instance: informed consent; bodily
integrity; non-discrimination; privacy; confidentiality, etc., which are
formulated using the terminology of “rights”.
Some
ethical challenge for the right of prisoners in Africa[44]:
-Lack of access to comprehensive medical care.
Loss of liberty must not
entail the loss of a right to quality medical treatment of a proper ethical and
clinical standard.
- Poor
and inadequate feeding of prisoners. There is a direct relationship
between nutrition and health.
- Lack
of vocational training for the prisoners. Training programs for prison
are inadequate and disorganized.
-
Mentally deranged persons in prison. It is not unusual to find persons
who should be cared for by the mental health systems mistakenly ending in
prisons. Reports showed that up to 1/3 of prisoners have some identifiable
psychiatric disorders.
Conclusion
At
the end of our reflexion, let us recall by say that the problem which grows our
attention is that of the nature of global bioethics. In order to clarify that
problem of the quiddity or essence of that holistic view of bioethics, we are
first of all presented the definition of bioethics and that of global bioethics
and analyzed the context of emergence of global bioethics. We can bring out from
this, the idea according to which bioethics is an interdisciplinary field of
study dealing with practical ethical issues roughly at the intersection of
morality, medicine and the life sciences. Within philosophy, bioethics is one
of several different areas of applied ethics, a domain within general normative
ethics. Global bioethics therefore, can be understood as issues that arise out
of a globalized condition or are international or transnational in nature. The
answer to the question of the why a global bioethics can be taken as the
deduction of context of emergence of global bioethics from that of bioethics by
saying. The main thesis in global bioethics is to bring global and local
aspects closer together when looking for international guidelines, by paying
more attention to particular cultures and local economic and social
circumstances in reaching a shared understanding of the main values and
principles of bioethics, and in building biodemocracy. About the principle of
bioethics in the global bioethics, we have the principle of autonomy, that of beneficence,
that of non-maleficence and justice. The issue of beginning of life in this
reflexion is tackled by Dr Mbih in these words the answer to the question of
when human life begins has been changing in the course history. Any response to
the question is deeply rooted in the beliefs, values and social constructs of
the community or individual that drew such conclusions. That of the end of life
is solved by Dr. Princy Louis Palatty
through three view points: the point of the patient, that of the physician and
that of family. Finally, the realistic approach of globalization of bioethics
is made by international organization such as UNESCO. Through UNESCO, bioethics
is transnational, international, globalized in the world; this is possible
through its Universal
Declaration on the Human Genome and Human Rights of 1997 (UDHGHR); the International Declaration on Human Genetic
Data of 2003 (IDHGD) and the Universal
Declaration on Bioethics and Human Rights of 2005 (UDBHR). That
globalization of bioethics is focused on the amelioration of human right;
either on level of the health and protection or on the level environment. So,
can we now affirm with evidence that global bioethics is a myth or a reality in
regard to the continual process of crisis due to the technological effects on
environment or on medicine? What can be the place of African bioethics in the continual process of
globalization of bioethics?
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[2] Donald M. BORCHERT, Encyclopedia of philosophy, Second
edition, Vol. 1-10, Macmillan Reference USA, Thomson Gale, New York, 2006, P.
598.
[3] Van R. Potter, quoted by Warren T. Reich and used by Dr Mbih in his course
entitled “Introduction to Bioethics”, How
Bioethics Got its Name, Hasting Center Report, Vol. 23, 1993, P.6.
[4] Idem
[5] Op. Cit. P.598
[6] Op. Cit. P. 599
[8] Explanation
of Dr Mbih concerning what “global bioethics” is according to Potter in his
article entitled: “Global Bioethics Building on the Leopold Legacy” Page 5 of
his course entitled “Introduction to bioethics”
[9] Reich, W.
T., The word “bioethics”: its birth and the legacies of those who shaped it. Kennedy Institute of Ethics Journal, 4(4), 319–335. (2009a; 2009b).
[10] Potter, V. R. Bioethics: bridge to the future , Vol. 205. Prentice-Hall,
Englewood Cliffs, NJ., 1971.
[12] Sakamoto Hellegers, Towards a new “global bioethics.” Bioethics, 1975:
113
[13] Idem
[17]- Gert B., Culver CM., Clouser KD., Bioethics: A return to Fundamentals, New
York, Oxford University Press, 1997, p. 75.
[18]- Beauchamp TL. & Childress JF., Principles
of Biomedical Ethics, 5th ed., Oxford, Oxford University Press,
2001, p. 65.
[19] Gillon R. “Where respect for
autonomy is not the answer”. BMJ, Clinical research ed.1986, P.48-49.
[21]Hippocrates, The Oath, in Donald M. Borchert (ed.),Encyclopedia
of Philosophy,2nd ed.,Vol. 4, Thomson Gale,2006,
p. 373.
[24] Moss AH & Siegler M., “Should alcoholics compete equally for liver transplantation?” in JAMA, No 265, 1991, pp. 1295-1298.
[25] Mbih
J. Tosam, Biotechnology and the Beginning
of Human Life: An Ethical Analysis, Scholars’ Press, 2015, P. 32
[26] Ibid. P. 34-35
[29] Global
Bioethics Inquiry, Vol. 1, Ed. Prof.
Harischandra Gambheera, Dr. Princy
Louis “End of life issues – The triangular
viewpoint in decision making” Jan 2015, P.41
[30] Ibid. P. 42
[31] Ibid. P. 42
[32] Ibid. P.43
[33] Volume 1, 2, 3 and 4
[34] It can be human health or environmental
health.
[35] Allyn L. Taylor, “Governing the Globalization of
Public Health”, Journal of Law, Medicine & Ethics, NO: 32(3) 2004, p. 500-508.
[36] The
mandate of UNESCO includes contributing “to peace and security by promoting
scientific collaboration
among nations” (Constitution of UNESCO of 1945, Article 1).
[41] Christian Byk, “A Map to a New Treasure
Island: The Human Genome and the Concept of Common Heritage”, Journal of
Medicine and Philosophy, (1998), p. 235.
[42] See Roberto Andorno, “Global bioethics at UNESCO: in
defense of the Universal Declaration on Bioethics and Human Rights”, Journal of Medical Ethics, 2007,
p. 150-154.
[43] James
Nickel, Making Sense of Human Rights: Philosophical Reflections on the
Universal Declaration of Human Rights, Berkeley: University of California
Press, 1987, p. 561.
[44] Cf. Global
Bioethics Enquiry, Volume 2, P. 41,
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