Sezione Medicina

from Leadership Medica n. 9/2000

There is no denying that the results of scientific research put a strain on our conscience every day with questions which always appear so absurd as to make the elderly whisper:"Where shall we end up, at this rate?", "What sort of world will our grandchildren live in?"and so on. We do not get a moment's respite. The ethical problems which we have kept lying in a drawer for years as an unconfortable bunch of prohibitions come back again with the eternal question:"is it right?", "Is it wrong?". And, linked to our ethics by means of a thin, transparent but strong and unbreakable thread, philosophy resurfaces. The only branch of learning which "serves no purpose", but which gives purpose to everything. The philosophy of " why is this right and why is this wrong".That which provides us with our coordinates for thinking, researching, deciding and living. Yes, because humanity, the evolved part of humanity which no longer has struggle against starvation and bad weather, is just like a young boy who, having spent centuries learning how to make a bonfire, and centuries trying to understand how to make a wheel turn, has suddenly realised that by "working hard"he can achieve more and has started studying seriously, but without perseverance, with many mistakes, to make up for lost time. Let us then set out in search of thease rules along the path of bioethics, with the humble attitude of one who knows that the route can only be mapped out on the way, to clarify in a competent way the terms of the debate taking place within the scientific community. But since you cannot play the doctor, the scientist or the philosopher, we have asked Prof. Adriano Pessina, who has been active for years in the field of bioethics, to introduce us to this laboratory-like world.
Luisa Miccoli

Bioethics is in fashion nowadays; however it is not a fashion.
Even though many debates still exist in connection with the determination of its epistemological status, that is the specific features of bioethics (a new form of ethics? a public form of ethics? a development of medical deontology?), the problems it has to come to terms with are real and tangible, and they pose radical questions.
Still, bioethics represents an important landmark in the recent history of western culture: it has laid emphasis on the fact we can no longer rely on the nineteenth-century image of science as a morally neutral discipline, only leading to progress and emancipation; it has started to question, although with different results, the theoretical models of development, trying to better understand the ethical and social consequences of the changes taking place in medicine; in brief it has questioned the meaning of technological civilization and of its impact on the actual and symbolic forms of life.
Today, we tend to evoke bioethics when we discuss in-vitro fertilization, organ transplantation, biotechnologies which alter vegetables and animals: we are frightened, or we exult, when faced with the possibility of cloning or of genetic control, but deep down we tend to think that, in any case, these are problems which only relate to a specific aspect of technology and science, and are confident that, after all, these are problems which do not concern everybody.
Indeed, there is an increasing tendency to approve the switch from frontier bioethics to Everyday Bioethics, as stated in the title of a book which has just been published by Giovanni Berlinguer, present chairman of the National Bioethics Committee. Of course, there are issues which directly concern a greater number of people than those involved in the practice of organ transplantation, intensive care and in-vitro fertilization.
However, it would be wrong to assume that the theories stimulated by reflecting on "extreme cases" remain of limited interest and do not, on the contrary, end up by influencing everyday mentality and practice. By exerting a critical function, one is not denying the value of scientific research, undervaluing the contribution which the advancement of technology and the development of medicine as an art and branch of knowledge have made to well-being: all it means, in fact, is refraining from immediately equating development and progress;it means not undervaluing the nature of the image of man and of reality which is being asserted once the barriers fall between what is ethically right and what is not; it means being aware that the system of scientific research and medical practice interacts with the system of economy and of the researcher's Weltanschauung; it means keeping in mind that not all the boundaries which are met on the experimental plane may be coolly regarded as pure obstacles which only need to be overcome; it means being aware that we are all involved, in different ways, in the practical and theoretical choices a few people make for the "good" of so-called humanity.
When faced with extreme cases, with border-line cases, we console ourselves in fact with the thought that these are exceptions and seek, each one of us within his own territory, an authority who is in a position to reassure us, whether the peace of mind we are looking for coincides with the absolution or the condemnation of the technique.
When faced with the possibility of generating in a laboratory a human being in embryo, of storing it at low temperatures, of investigating it, manipulating it, altering it, allowing it to grow in the womb of a woman who need not be the biological mother, we query the issue by employing the same conceptual tools with which we have considered abortion; we debate on the notions of paternity and maternity by employing the traditional concepts of desire, love and right, and we do not appear to acknowledge the epoch-making event generated by such a radical transformation in human generation.
But does not the irruption of zootechnics into gynaecology radically transform our own way of thinking and talking about the human being? Does not the possibility of transplanting organs, tissues and limbs, by taking them from living people or from corpses, cause us to question the boundaries and the meaning of this experienced corporeity which is so familiar that deep down it is almost unknown to us? Is not the already precarious limit between normal and pathologic, between life and death, shaken by the technological processes which enable us to prolong life in conditions which appear to be of non-life, such as that which slumbers latently in a test tube?
Life, death, distress and pain remain: but they remain within a human condition which, with the expansion of possibilities, cannot express itself in full. Man is becoming his own experiment, within a framework of rationalisation of the possible behavioural systems which leaves unresolved the crucial question related to what being a man means.
Bioethics is not a fashion, because we are all in the same boat, taking part in this history of man which is technological civilisation.
Bioethics will not become a fashion provided we manage not to assimilate it within the worn Manichean system which polarises and simplifies every debate in terms of progressive and conservative, libertarian and reactionary, atheists and believers. The acceleration in researches, also pushed by economic requirements, demands fast choices, and there are also biologists and doctors, scientists and jurists, philosophers and politicians, who go as far as suggesting formulas: but the time required for thinking is not the same time needed for action and the complexity of what our civilisation plans, requires and imposes an effort of the mind which may compare favourably with our scientific attainments.
If bioethics does not want to be only a fashion, it needs to allow itself, and demand, more time for thinking: time when philosophical reflection may become again res publica; time to rediscover principles capable of reconciling the good of the individual with that of the whole community; time to build a civilisation in which no one finds himself to be a moral foreigner; time which will prevent us from loading the new generations with the weight of out daring and of our fears.

But do we still have time?

Adriano Pessina
Docente di filosofia morale e di bioetica Università Cattolica di Milano