Ethics in Embryology, Neonatology and Nursing Values: Commentary on Ersoy & Altun, Tomoeda & Matsuda, Aksoy and Hasadsri

- Frank J. Leavitt, Ph.D.
Jakobovits Centre for Jewish Medical Bioethics
Faculty of Health Sciences, Ben Gurion University of the Negev,
Beer Sheva, ISRAEL (Home Tel/FAX: +972-2-9963048)
(Email: yeruham@bgumail.bgu.ac.il)

Eubios Journal of Asian and International Bioethics 8 (1998), 83.

When Darryl asked me to comment on four papers in one editorial commentary I took it as a challenge to find a unifying theme among a number of articles which don't at first seem to have much to do with one another. But then I found it interesting to read Aksoy's paper together with Ersoy & Altun because their approaches are so radically different. Aksoy seeks bioethical truth in ancient prophetic texts while Ersoy & Altun are doing more of a sociological survey, what Darryl often calls descriptive bioethics, in trying to determine the values of Turkish nurses. I also find it interesting to reflect on the fact that although there is a Hebrew word for value, EREK, which can be used in modern Hebrew to mean what Ersoy & Altun seem to mean by value the word never appears in the Bible with quite this sense. Indeed I think that the modern use of the word (like attitudes) was made up by quantitative behavioral scientists in order that they might have something to measure precisely, so that their disciplines should appear as scientific as physics. I have to apologize if my statement looks flippant but there is a background to it. I was educated in the philosophical tradition of Berkeley, Hume, Russell, Carnap and Quine. (I have been pleasantly surprised to learn that quite a few other Asian bioethicists my age were educated in the same tradition.) This philosophical tradition taught me to be skeptical about abstract nouns, especially when they are new ones or new usages, not sanctified by thousands of years of linguistic tradition. Such words might just be empty sounds not signifying anything which really exists. In the case of nurses values or attitudes, I think that what really exist are their actions, their feelings, their thoughts and especially their behavior in the wards. In-depth open interviews might be a better way to study these realities.

There is in my humble opinion a shortage of high-quality literature on Islamic bioethics. Sahin's masterful article will help remedy this situation and I hope to make it required reading in a number of my courses. Like Ibn Sina and Ibn Roshd (Avicenna and Averroes) he is both a learned physician and an Islamic scholar. A point on which I very much agree with Sahin is the importance of prophesy as a source for bioethics. Philosophy and science are important but not enough. I would even go further than Sahin because I believe that philosophy itself, in spite of its pretensions at logic and rationality, really got its basic ideas from prophesy and mystical tradition. Look for example at how many times Socrates talks about the daemons who guide his ethical thinking, or at Aristotle's remark (Metaphysics XII, 9, 1074 b) about the ancient mystical tradition from which he developed his spiritual astronomy.

But returning to the subject of Aksoy's paper I have to admit I am in a quandary, because I don't know how much embryology can really be learned from ancient texts. I am not learned enough in Islam or embryology to know whether the texts which Aksoy chooses from the Koran are open to alternative interpretations. But so far as my own Israeli tradition is concerned I have to admit that I no longer think our ancient texts can teach us very much about the ethics of embryology. The very same texts from the Bible, the Mishna, the Talmud and Maimonides can be used (and have been used by great rabbis) to teach diametrically opposed doctrines, either a very liberal one or a very strict, almost Roman Catholic one, about the ethics of abortion. Perhaps ancient spiritual texts are losing some of their value now that bio-medical technology is turning the world upside-down. Perhaps new prophesy is needed in this new age. Also, although we have been taught to distinguish is from ought, scientific fact from ethical value, perhaps some scientific discoveries should be sufficient in themselves to teach us some bioethics. If we learn that a prenate at some stage or other has thoughts and feelings, wouldn't this be enough to make us feel a little more strongly against abortion ? I am aware that my opinion has changed from some things I wrote in the past. But don't we all learn as we grow ?

Linda Hasadsri's paper also has to do with the moral status of the prenate. I don't know whether I am in favor of or against preimplantation genetic testing (PGT), but a logical error has to be cleared up. She writes about improving the quality of individual lives while seeming almost not to acknowledge that when one prenate is killed and another implanted and borne, these are two different entities and not one individual life whose quality will be improved. She says that striving to eliminate genetic based disease is no different than striving to eliminate infectious disease. But there is a difference. When an infectious disease is prevented, many of the people who are consequently healthy are the same people as those who were sick or were in danger of being sick. But when genetic disease is prevented by aborting in-vivo or discarding in-vitro prenates (as opposed to other methods of preventing genetic disease like pre-marital testing or reducing clastogenic environmental factors) then we are helping some to live and be healthy by killing others. I am not saying that this is always or ever morally wrong. Nor am I saying that it isn't. I have already admitted a quandary about embryology ethics, and in any case I don't like to judge people, especially not the women and couples who have to make these extremely distressful decisions. But I want to be blunt and honest about the facts.

A fine continuum runs from the ethics of embryology to that of pediatrics because both deal with the rights, if such their be, of those who cannot speak for themselves. For this reason pediatric ethics is also full of dilemmas. So Tomoeda & Matsuda's Guidelines on Mass Screening are an important step towards clarity and I hope to discuss them in the classroom, especially in courses attended by experienced physicians and nurses. But let us be blunt and honest here too. In neonatology there is no such thing as a voluntary decision, patient autonomy or informed consent. Some people are always making decisions for another person, because the patient cannot participate in the discussion. Parents, physicians and nurses are often quite right to make decisions for babies, especially when their lives or health are already at stake. But I am not sure what moral principle allows one to give consent to use information about a baby for the purposes of scientific research. Nor am I convinced yet that mass neonate genetic screening is really for the good of the babies concerned. But this will be discussed at greater length in a paper by Dina Pilpel and myself in the forthcoming proceedings of the 1997 WHO Satellite Symposium on Genetic Screening in Fukui, Japan (Bioethics in Asia, Eubios Ethics Institute, 1998 - in Press).

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