Biology versus Ethics and Law. Technical advances and bioethical reflection in biomedicine.

Gonzalo Herranz, Bioethics work group , University of Navarra, Spain
dissertation in the presentation the book coordinated by Prof. Caballero Harriet
San Sebastian, 1988.

Logically, the first thing I must do is to thank Prof. Caballero Harriet for his invitation to say a few words at this presentation the book "Biology versus Ethics and Law", which compiles the lectures given here during last year's Summer Course. It is very flattering to be entrusted with this kind of sponsorship, which carries with it the opportunity to spend a few hours in Donostia, enjoying the friendly and convivial conversation, in which those of you here are masters.

My purpose this afternoon is very simple. I want to help sell the book, planting in the minds of those who listen to me an idea: that there is no room for neutrality in bioethics. The topics of bioethics today are of direct concern to each one of us. We cannot avoid them if we really want to lead a moral life. We must think sincerely about the ethical significance of scientific advances, particularly those in medicine, because they touch us very closely. It seems to me that I am not exaggerating when I say that anyone who refuses to take a permanent interest in bioethical questions is abdicating a serious moral duty.

I know that this introduction may seem demanding and alarmist. We all have a logical favorable, even enthusiastic, predisposition towards scientific progress. It makes us live very well and constantly gives us new reasons to be amazed: when someone sample us a new model of computer staff, whose almost unbelievable performance makes us rub our eyes. Or when we read about the revolution that is being prepared thanks to the continuous discoveries about superconductors, a revolution that keeps researchers and business captains alike awake at night; or when we hear about the design of new vaccines through Genetics engineering, so astutely applied that, if you had nothing else to do, you could smile in admiration for hours on end, amazed at how human ingenuity has managed to find a way around lymphocytes and is taming them. All these things make us vibrate and feel fortunate to have been born in time to witness them. One of the reasons for wanting to continue living and to lose our fear of old age is the conviction that, just around the corner of the time in which we live, we will find new wonders and marvels that science, the fairy godmother of our time, will have brought forth with her magic wand. There are very few who still have the nostalgia for the past. It's been years since I've heard anyone talk about "pre-war things". There is a vast majority of us who look confidently ahead and live with that typically optimistic attitude of hoping that everything will be better, that the future reservation many good things in reservation us.

But we also know that there are some reasons to think that not everything is rosy. That same progress, so effective and surprising, gives us some scares. We are shaken from time to time by news that undermines our usual justified confidence in scientific progress. One day we learn that neurosurgeons in many places have started to transplant embryonic nerve cells into the brains of human beings, without this decision having a solidly proven scientific basis. The protagonists of these advances, the reporters who interview them and the general public do not hide their jubilation and do not seem to be much affected when someone reports that the cells transplanted into a laboratory animal have given rise to masses of tissue that grow uncontrollably and seriously threaten the life of the recipient. Another day, we learn that, faced with the need to do whatever it takes to alleviate the anguish caused by the fatal evolution of AIDS, some governments or public agencies have waived the safety requirements that are required for drugs or vaccines before they are administered to humans, thereby incurring risks that could not have been calculated. News like this can be read every week in scientific journals. And the newspapers we all read also tell us about the unsafety of certain types of nuclear power plants, or about the contamination of food by additives and preservatives that damage our cells or cause cancer, or about the criticisms that, from environmentalist sectors, remind us that the problems of environmental degradation continue to overshadow any more active use of natural resources.

There is, in all this, in the incalculable benefits and the inevitable risks, sufficient reason for permanent interest and also for reasonable concern. For this reason, I would like to invite everyone this afternoon to take a serene and critical attitude towards biomedical progress, not a suspicious one, but a serene and critical one.

The reason is this: Biomedicine has become incredibly powerful. Doctors today have a power that we are not fully aware of. I am not only referring to doctors working in world-famous centers, where the most daring and audacious technologies are applied. Here and now, in any rural doctor's enquiry , in any Social Security clinic, in any emergency department, doctors have a fabulous power.

It is curious the propensity we have to think that Bioethics has to do only with the spectacular and innovative, with what we hear on television and in the press thirsty for sensationalism when they tell us about the magic of transplants, or about the capacity of doctors to produce human beings in the laboratory to destine them to live, to sacrifice them for the sake of research or to select them through the application of gene probes. But they do not tell us that an outpatient physician attending a simulator can act in very different ways: He or she can give him or her a philippic lecture and humiliate him or her, dismissing him or her with a loud bang, because he or she thinks that this is all that a social parasite deserves; he or she can play along and order him or her to be admitted to hospital, because he or she is convinced that, faced with these unfortunates, there is no other attitude than that of becoming an accomplice in their weakness, since it is useless to try to cure them; Or, finally, he can take an interest in the personal, family or social causes of the simulator's atypical behavior and, with infinite patience, mobilize medical and non-medical resources to try to remedy them. It is clear: the physician can do a lot. It does not take much thought to imagine how different types of society would result from systematically applying the behavior of these three physicians, how different the moral courage of the men would be.

A doctor's enquiry , any doctor's enquiry , is a place where decisions of enormous staff importance are taken, where human beings can be encouraged to assume their responsibilities or their conscience can be numbed by means of psychotropic drugs, capable of extinguishing anxiety and overly vivid emotions at the cost of reducing inner life to an almost vegetative level.

The power of the physician increases with progress, but progress itself, despite its name, is ambiguous. Why is what we call progress ambiguous? Last year, at a medical congress held in a Scandinavian country, a Lutheran theologian was invited to offer the attending neurosurgeons some ethical considerations on the prenatal treatment of fetuses with anomalies of nervous system development . He began his lecture by recalling the words of President Kennedy: "If anyone asks why we want to go to the moon, the answer is simple: because we can. No other answer is needed. These words, in the eyes of our theologian, represent the culmination of a process begun 300 years earlier, when Francis Bacon declared that, thanks to the new logic, human reason had come of age. Reason was emancipated to undertake on its own the improvement of the world and the deployment of its power over nature. For Bacon, the fall of Adam had entailed the loss of both his original state of innocence and his dominion over creation. The life of mankind since then, thought the chancellor of James I of England, is the story of attempts to repair these two tremendous losses: that of innocence through religion, that of mastery of the world through the financial aid of science and craft.

But Bacon's optimistic forecasts have result have failed. There is ample proof of this: just consider the subordination of science to the powerful of this world, how science has placed in the hands of a few an immense power, for example, nuclear energy. There is nothing wrong with scientists having achieved the liberation of atomic energy. What is worrying is that they have cooperated in a plan that has made only a few the masters of status. And although these days those few are showing signs of good will and have agreed to dismantle part of the nuclear arsenal, it is still true that the vast majority of people prefer, in order to live in peace, to forget the magnitude of the threat of the nuclear holocaust that weighs on all of us. Science has become an accomplice of the powerful and is thus in constant danger of betraying its vocation of innocence.

In my opinion, to give an explanation of the blindness of scientific progress for moral values we can start from the phrase of Bacon quoted above. He speaks of the double loss of Paradise: the loss of innocence and the loss of dominion over nature. Each has its specific remedy: one, religion and the other, science. But it is evident that Bacon and those who succeeded him in the cultivation and application of the sciences were concerned almost exclusively with regaining mastery over things. So absorbed have the scientists been in their work of dismantling, analyzing and recombining that they have had no time left to cooperate in the recovery of innocence. In other words, by neglecting the primary task of learning to do no harm, which is what innocence means, the capacity for moral judgment of many cultivators of science has atrophied. But then, in direct proportion to this neglect, the adventure of mastering nature ceases to be a univocal advantage and becomes ambiguous, a tree that bears both sweet and bitter fruit.

It is not easy to convince very intelligent colleagues that the natural sciences without the guide of ethics are adrift, drifting aimlessly, because it is impossible for anyone to sail anywhere if he is guide by the prow of his own boat. There are not many scientists who insistently ask themselves about the ultimate meaning of the things they do and apply, who have become accustomed to having a sincere inner dialogue about the meaning of their enterprises, or who seek the company of those who can infect them with the necessary uneasiness to keep their conscience awake and sharp. More are those who declare that their creed is science, but, apparently, their faith is no more enlightened than that of the charcoal burner. They are elementally and naively persuaded that, in the twentieth century, science has won the day over religion in all the fields in which they have confronted each other. If it is a matter of working miracles, they tell us, there are so many diseases that have been conquered; there is the genuine multiplication of the loaves of bread that is the green revolution; there is the marvel of information technology. If the purpose of religion, they say, was to bring all men together in a communion and fuse them into a unity, there are, among so many products of progress, the news or travel agencies that have turned the world into a handkerchief, or Coca-Cola or the hundreds of millions of television viewers who have their eyes fixed on the small screen right now, watching the European Football Championship matches.

His arguments are irrefutable. And yet, what is really important is to know if science is better than religion in preparing us to lead a human life, that is, a moral life, more intense and abundant, not relegated to the back of the mind, but present in all our relationships with things or with people.

Fortunately, things have been changing for the better in recent years. Ethics - at the hands of scientists seriously concerned about their moral responsibilities, and also of some theologians, some philosophers and some jurists - has managed to sneak into the laboratories of Universities and the research Departments of Industries, in hospitals and Sociology offices, in Ministries and in the Foundations that finance research.

But the dialogue between one and the other does not seem easy. Few scientists and few theologians, philosophers and jurists are concerned about the discussion of bioethical problems. Let us look at a very recent and revealing example.

From time to time, the last page of the British Medical Journal features an article in the Scientifically Speaking series signature Bernard Dixon. In the last one I read, Dixon commented on what happened at an International Symposium held in Zurich on Biosafety. The Symposium brought together scientists and philosophers to study together some issues of public interest, the kind that too easily escape the attention of narrow-minded experts.

The Symposium, in Dixon's opinion, was a resounding failure. The philosophers spoke of Philosophy and failed to express themselves in a language familiar to the biologists, while the latter, with their infinite capacity for small details, spoke of the contamination of bioreactors, safety measures in laboratories experimenting with recombinant DNA and the like. However, it seems that the desired meeting with each other did not take place, nor was there a dialogue on the ethical aspects of the problem, as was the purpose that had inspired the meeting. Dixon refers to the astonishment provoked by the communication of a German group on the factors governing the virulence of Escherichia coli. In a fascinating work , they have revealed how these germs, ordinary and peaceful inhabitants of our organism and that of many other animals, become rabidly aggressive and cause very serious diseases when certain gene-mediated pathogenicity factors coincide. Researchers at the Würzburg group revealed that they had succeeded in cloning some of these genes and, thanks to the precise tools now available to molecular biologists, in converting harmless strains of E. coli into virulent ones. It seems to be working like a charm.

This finding opens the way for laboratory men to produce terribly aggressive germs and even to add deadly toxin-producing genes to them. Well, what surprised Dixon is that, in the face of this astonishing, and alarming, finding, no one in Zurich sounded the alarm. Not a word was heard in the course of the Symposium discussions, not a line was written in the published conference proceedings about the possible consequences of this research for the odious business of biological warfare. No one there seemed concerned about a threat, in comparison to which the bombs loaded with Yersinia pestis, the bubonic plague-producing agent, which the biological warfare laboratories prepared in the 1960s, are amateurishly botched.

This example sample us the alarming dissociation that exists between the ability of some Genetics manipulation wizards to dominate nature and their rudimentary concern to recover innocence, to limit their ability to do harm. This example also sample how frequent is among scientists the probably unintentional forgetfulness of ethical values.

I said at the beginning that the purpose of my words this afternoon was to invite everyone to take an interest in the ethical implications of scientific advances. This is a moral obligation, which cannot be refused. It would be much more comfortable for people - and much more irresponsible - to entrust the solution of moral problems to experts: just as we call a plumber to repair a broken faucet, we could entrust experts to solve ethical problems. But there are no experts in ethics. Some of us dedicate ourselves to read and reflect on what is written about the history of our ethical notions and their philosophical and theological foundations, or to analyze the solutions that some propose for such a complicated ethical problem or dilemma. But ethical decisions have to be made by each one of us. Bishop Escriva de Balaguer insisted that spiritual advisors, experts in moral questions, must give advice, inform and educate: but they must respect the conscience of those they are advising, they cannot usurp their freedom. "...the committee ," he said, "does not eliminate staff responsibility. It is we, each one of us, who have to decide in the end and we will have to give an account of our decisions to God" (Conversations, 96). No one can mortgage his responsibility and his capacity to make moral decisions, blindly trusting in the committee received.

Well, the same thing happens in the world of bioethics as in spiritual life. One cannot transfer one's staff responsibility to the experts. All of us, if we are truly responsible, have to go through the sometimes difficult process of taking sides, of deciding the dilemmas that present themselves to us. Each of us must be an active moral agent in the areas of ethical tension, in those that affect us directly and in the public dialogue on the issues in which the destiny of humanity is being decided day by day. To put it another way: when it comes to making moral decisions, to making ethical judgments, we are all equal, we are all equally expert, all decisively important. It is not enough to say to someone else: position my conscience and decide for me.

This is my conclusion: we should all be interested in the problems of bioethics, particularly those concerning man. We should therefore be pleased that the VI Summer Courses organized by the University of the Basque Country in San Sebastian last year included a course degree scroll "Biology in the face of Ethics and Law". And thanks to the fact that the Course Directors, Professor Ochoa Olascoaga and Professor Caballero Harriet, have managed to gather most of the lectures given in it and have had the good agreement to publish them, we are now celebrating it. I am sure that the effort it has cost them has been worthwhile. Because there is very little published on Bioethics among us, and of our own making. We are at a very late stage with respect to what is happening in other countries. The medical-ethical discussion among us is too poor and stammering. Perhaps this is due to the fact that physicians still think that rational justification of the decisions one makes is something for priests or philosophers. Perhaps many abstain for fear of violent disagreement, because we are not yet capable of practicing educated disagreement. Whatever the reasons or the lack of reason, this makes Begoña Ochoa and Fco. Javier Caballero's gesture of publishing "Biology versus Ethics and Law" all the more meritorious.

I warmly congratulate them. And my friendship with them leads me to reproach them with all my affection for not having included a synthesis of the discussions that followed the lectures. I remember that the students who participated in the course asked very pertinent questions. This would have made two things clear: that there is no lack of ethically sensitive people and that those of us who participated in the course also made our differences of opinion clear.

But, anyway, there is the book, fulfilling its good offices. It is, in addition to a good source data, an archive of ideas that will provoke adhesions or disagreements. It is also a testimony that today the University should not turn its back on biomedical ethics, a hopeful sample that the time has come to revive that very university occupation of contrasting opinions, of practicing interdisciplinary dialogue, on the problems in which the most serious decisions of our future are at stake.

Thank you very much to all of you.