Concepts
The term bioethics was first coined by the biologist Van Rensselaer Potter in his book Bioethics, Science of Survival (1970). The term is taken from two Greek words: bios, the Greek word for “life,” and ethics, which has its roots in the noun ethos, meaning “custom. “Van Rensselaer used it for ethical questions concerning survival and quality of life. This terminology never became widely established. Instead, bioethics is sometimes used in a broad sense to refer to the whole terrain of moral problems of the life sciences encompassing not only medical ethics but also important aspects of environmental ethics. Mostly, however, bioethics refers to old and new ethical questions arising in the field of medicine and medicine-linked biotechnology. It is bioethics in this latter sense that the present article takes as a conceptual basis.
The term anthropology is taken from two Greek words: anthropos and logos, which can be translated as “human being” and “word,” respectively. As a combined word, it can be understood as the rational inquiry into the human being. Nowadays, there are further subdisciplines of anthropology as a science.
Biological anthropology deals with questions such as evolution, modern human populations, and human biodiversity. Archeology, in a certain way, is a link between biological anthropology and cultural anthropology. Cultural anthropology, which in Europe is often labeled social anthropology or ethnology, aims at studying different cultures. Questions of whether different cultures follow different bioethical standards and whether or not we should accept a bioethical relativism are part of the more comprehensive topic, ethics and anthropology. Philosophical anthropology deals with questions such as the mind-body problem and the difference between human beings and nonhuman beings. These questions are also addressed in theological anthropology with the important adjunct of mankind created by God.
The Importance of an Exchange Between the Different Anthropologies and Bioethics
It is of great importance that bioethics is in touch with the results of the different anthropologies. Philosophical and theological anthropologies have an impact on the bioethical framework, especially the questions of whether human beings are special beings (the question of human dignity and human autonomy) not allowed to be killed (sacredness of life). Biological anthropology is of great importance for ethical questions concerning the beginning and the end of life, which are central in contemporary bioethical debate. It is not possible to answer the question of whether harvest of human embryonic stem cells should be allowed without knowing the current state of the art of embryology. Social and cultural anthropology help us to understand how new possibilities in reproductive medicine are going to change the traditional concepts of mother, father, and children and raise the question of which kind of society we desire. Reflections on organ transplantation have to take into account the different cultures and different ways of reflecting the transition from life to death and the different forms of family structures. Anthropologists, therefore, play an important role in broadening the bioethical reflection.
On the other hand, ethical reflections also have an impact on the different anthropologies, for example, the prohibition of killing human beings, the declaration of human rights, and the importance of human autonomy.
Sacredness of the Human Life, Human Dignity, and Autonomy
The prohibition of killing has a central place in almost any morality around the world, even if in most societies there are exceptions, such as voluntary abortion. The religious conviction that human life is sacred and belongs to God plays a special role in this context.
The experiences of the cruelties during and after World War II led to the Charta (1945) and the Universal Declaration of Human Rights (1948) of the United Nations. Both documents affirm the importance of human dignity and the right to live, but they do not affirm a sacredness of life and they do not use any foundations of human dignity besides the historical experiences, conscience and reason. The focus of the documents is to declare humiliation and killing of human beings against their will as morally unacceptable (exceptions may be self-defense or some forms of abortion) and to create a framework in order to abolish wars, one of the worst sources of humiliation and killing. On the one hand, these documents were and are of great help. It is no coincidence that in 1947, the Nuremberg Code officially introduced the informed consent into the bioethical discussion and the medical research practice. In the following years, the paternalistic paradigm of the Hippocratic tradition has given way to a principle-based approach in clinical ethics, especially in the United States. Nowadays, the principle of autonomy of the patient is a fundamental cornerstone in the relationship between physician and patient.
On the other hand, the Charta and the Declaration are only of partial help for concrete bioethical problems concerning the beginning and end of life. Although in some cases, clear moral decisions can be drawn from them, there are cases where a lack of precision leaves us with unsolved moral problems. For example, they show the common conviction that active involuntary euthanasia cannot be a morally acceptable option. Still, they cannot be of help, however, to the evaluation of certain ethical conflicts at the beginning of human life and at its end. That is because the Declaration speaks about born human beings and does not deal with the specific bioethical questions of what kind of moral status human zygotes, morulas, blastocysts, embryos, or fetuses have. According to biological taxonomy, a human zygote is a human being consisting of two cells; a morula is a human being approximately 3 days after fertilization; and a blastocyst is a human being after the division in an inner cell mass, called embryoblast, and the outer cell mass, called trophoblast. The concept “pre-embryo” is used for all these forms of human beings. Following this use of language, an embryo is a human being from the time of implantation until the end of the organogenesis, and a fetus is a human being from the end of organogenesis until birth.
The Beginning of Human Life
The decision of when human life begins is very important for bioethical evaluations of human embryonic stem cell research in determining the morality of destroying human blastocysts, not implantation of human morulae after preimplantation genetic diagnosis and voluntary abortions. If a human zygote is considered a human being with the full moral status of a born human being, then the destruction of human zygotes, morulae and blastocysts, as well as voluntary abortions, are morally unacceptable. Only two dilemmas may be accepted: (1) abortion after rape (negating the autonomy of the woman involved) and (2) abortion to save the life of the mother. If instead the pre-embryo, embryo, and fetus are not given full moral status, but some value, then a balancing of goods (e.g., therapeutic purposes, wishes of the mother involved, and so on) is ethically permissible. There would be, however, an important moral difference in evaluating the wishes of an incompetent 15-year-old girl to abort and of a 30-year-old woman who does not want to continue her pregnancy because of her wish to go on a long-planned holiday.
The question of when a human being comes into existence has a twofold meaning: Biological anthropology does not answer the question of when human life first appeared on earth (the question of anthropogenesis). It can only answer questions such as: What kind of earliest hominids have we discovered? Biological anthropology and embryology cannot answer the other question either, of whether a zygote, a morulae, a blastocyst, or an embryo with a beating heart are already human beings with the moral status of a person. What it can do is to explain when the formation of a common genetic code is completed, when twinning is no longer possible, and so on. Therefore, the decision of when an entity of human origins has to be considered a human being in the moral sense depends on various presuppositions. Decisions on the moral status are very important for the moral evaluation of embryonic stem cell research, preim-plantation genetic diagnosis (to select the pre-embryos with certain or without certain genetic traits), or voluntary abortion in its various forms.
Social and cultural anthropology tells us that the decision of when a human being is morally considered a person depends on the different cultures; for example, in ancient Rome, the father decided about the moral status. When he accepted the newborn child into the family, it gained the moral status of a person. Otherwise, it was abandoned and left to die. For Jews, the unborn in its beginnings has only value insofar as it is potential life that can fulfill the commandment of the Bible, “Be fruitful and multiply.” For most Roman Catholics, the pre-embryo in the state of a zygote is instead understood as a person with full moral status. Two main reasons for the Roman Catholic position are named: the potentiality argument, in the sense of an active potentiality of a new organism, and the precautionary principle. The active potentiality must not be understood as the potentiality of a prince to become king. It is meant as an inner active force of the new organism, which may be guaranteed by its unique soul being there at this early stage. This argument makes two important presuppositions: the inner active force at this early stage and the definition of “new organism.” Undoubtedly, a new human organism comes into being with fertilization, but one may question whether it is identical with the later-born human being. So, some argue for a number of important biological moments: the division of embryoblast and trophoblast, the end of the possibility of twinning, or when the final structure evolves by cooperation between maternal positioning and the embryo. They conclude that the new human organism after fertilization is only the predecessor of the individual organism that the ultimately born human being will be.
Even if one agrees for the sake of argument that the active potentiality of the new human being is given with fertilization, two different morally relevant problems remain. First, there are human beings who never seem to develop into “normal” human persons because their genomes are genetically altered in a way that prevents them from developing certain cognitive capacities. Their active potentiality, therefore, differs from the active potentiality of “normal” human beings. Empirically, these human beings seem to be so handicapped that the active potentiality of a normal ape genome seems to be of a higher cognitive degree. If active potentiality were a necessary and sufficient condition for moral status, then handicapped people would not be deemed worth being protected in the same way as “normal” human beings because they seemed to lack that active potentiality.
Second, even if the active potentiality explains why this early human being should be protected, does it give sufficient reason to protect its life in the same way the life of an already-born human being is protected? Following the Roman Catholic precautionary principle, it is safer to strictly protect the pre-embryo as long as we cannot be sure of its moral status. Even highly respected theologians such as Thomas Aquinas (1224-1274) or Karl Rahner (1904-1984) doubted this position. Rahner argued that if there are serious positive doubts about the moral status of pre-embryos, there might be good reasons to allow certain forms of research. “Serious positive doubt” means that the probability that the pre-embryo is not a human being in the same sense as a born human being is very high. So precaution is exaggerated. How problematic a precautionary principle without limits can be becomes obvious when looking at the position of traducianism 1,500 years ago. It was claimed that the male sperm already represents a human being (homunculus); similar to a plant, it is the male semen that carries the whole active potential. For many people, this caused a moral dilemma, as every waste of sperm must be considered killing a human being. It was Thomas Aquinas who rejected this position. His doubts were based on philosophical reasoning rather than medical or scientific findings, as the latter were not yet at his disposal. Coming back to the contemporary debate, one is faced with the question: Is there a moral difference (not an ontological one) between destroying the nucleus of the sperm and the nucleus of the egg at the moment when the genetic material of the sperm is in the egg but not yet united with the genetic material of the egg, or destroying the fertilized egg at the moment after fertilization? If the answer is no, and if we do not protect this juxtaposition of egg and sperm in the process of uniting, then it would be cautious to protect the pre-embryo the same way we protect born human beings. This is especially the case when other goods are at stake, for example, the development of new therapies by the means of embryonic stem cell research.
The End of Human Life
It was and is widely accepted that (biological) human death means the irreversible cessation of the integrated functioning of the human organism. But it is an open question of whether or not death is the irreversible loss of function of the whole organism (or cell), that is, of every one of its component parts, or whether it is the irreversible loss of function of the organism as a whole, that is, as a meaningful and independent biological unit. For a long time, there was no need for this distinction. Irreversible cessation of cardiopulmonary functioning was accepted as the criterion of death. However, this criterion is not accurate. Technologies developed during the last century have resuscitated many patients whose respiration and heartbeat had already ceased. Today’s medicine can determine the death of essential parts of the brain as leading to the loss of the capacity for consciousness and to a persistent vegetative state. It is possible to determine the death of the brain as a whole or the cortical death. Physicians can describe that the death of the brain results in the irreversible cessation of the integrated functioning of the human organism as a whole, leading to a complete disintegration of the whole organism after some days. Important questions, however, remain open: Is the death of essential parts of the brain, that is, the death of the higher brain, in particular the cerebral cortex, where consciousness and mental activity are realized, the death of the human being—or does the death of the brain mean the death of the human being, that is, the loss of the functioning of the higher and lower brain, consisting mainly of the brainstem, where the various somatic functions of the organism are coordinated? Or is only the result of the death of the brain, namely the death of the whole organism after some days, the death of the human being?
The establishment of the right criterion of death is very important for bioethical questions about the end of life, especially for organ transplantation and the cessation of therapies. If, on the one hand, the death of the higher brain is the death of the human being, then organ transplantation is permissible at this moment. It would not only be permissible but also obligatory if the person has given the permission before death and if there are people in need for the respective organs. Following this presupposition, it would be good medical practice not to keep someone on life support machines if the human being were declared dead after higher brain failure. In consequence, there is no human person in a persistent vegetative state, but only a thing with human origins. If, on the other hand, someone were considered dead when the whole organism was dead, our current practice of organ transplantation would represent a form of active euthanasia, killing a dying person who voluntarily has accepted this form of dying. There is, however, a very good reason not to accept the position that someone is dead only when the whole organism is dead: A photograph of a public decapitation in a Bangkok square in the mid-1930s shows a decapitated victim. Jets of blood from the carotid and vertebral arteries in the neck illustrate, however, that the heart is still beating. This picture illustrates why someone should be considered dead whose brain is dead, even if there is a heart beating. In this case not the whole organism, but the organism as a whole is dead. Therefore, whoever demands as the criterion of death the death of the whole organism demands too much.
The Unknown Territory
Bioethical reflections and anthropological studies will gain further importance. Genetic engineering and nanotechnology will soon press the questions harder: Do we want to change our nature in an irreversible way, and if so, to what extent? Only if scientists and ethicists work together, open to listening carefully to one another, will human welfare best be served.
References:
- Callahan, D. (1995). Bioethics. In W. T. Reich (Ed.), Encyclopedia of bioethics (Rev. ed., Vol. 2, pp. 247-256). New York: Macmillan Library Reference.
- Koenig, B., & Marshall, P. (2004). Anthropology and bioethics. In S. G. Post (Ed.), Encyclopedia of bioethics (3rd ed., Vol. 1, pp. 215-225). New York: Macmillan Reference.
- Kuhse, H., & Singer, P. (2001). (Ed.). A companion to bioethics. Oxford: Blackwell.
