Global Bioethics: Building on the Leopold Legacy

4. TWO KINDS OF BIOETHICS

-------4------TWO KINDS OF BIOETHICS IT SEEMS WORTHWHILE at this point to note the historical development and ongoing evolution of the global bioethics concept. Aldo Leopold laid the framework for an ecological and populationoriented bioethics of survival in 1949 in his seminal essay "The Land Ethic" as well as in earlier essays. Continuing Leopold's line of thought, in 1970 I coined the term "bioethics" to describe the amalgamation of ethical values and biological facts, and in 1971 published Bioethics, Bridge to the Future. This concept of bioethics was formalized in a figure published in 1975, here reproduced as figure 1. However, an independent movement had begun at Georgetown University which utilized the word "bioethics" and applied it exclusively to medical problems in a newly-created Center for Bioethics. Its director, LeRoy Walters, stated, "Bioethics is the branch of applied ethics which studies practices and developments in the biomedical fields."l It was 71 72 BIOLOGICAL KNOWLEDGE GLOBAL BIOETHICS KNOWLEDGE OF HUMAN VALUE SYSTEMS / IBIOETHICS I / ~ MEDICAL BIOETHICS I. HUMAN CAPABILITIES 2. HUMAN FRAILTIES ECOLOGICAL BIOETHICS I. ENVIRONMENTAL CAPABILITIES 2. ENVIRONMENTAL FRAILTI ES / INDIVIDUAL PROBLEMS /' " SOCIETAL PROBLEMS--POPULATION PROBLEMS ~------------~I I~____________~ Fig. l.-Bioethics as a system of morality based on two kinds of knowledge, and its fragmentation into two kinds of applications. From V. R. Potter, "Humility with Responsibility-A Bioethic for Oncologists: Presidential Address," Cancer Research 35 (1975): 2297-2306., with permission of the American Association for Cancer Research. The two kinds of bioethics are both needed for the solution of the interacting problems shown in the lower box, and attempts to solve these problems lead to new knowledge that feeds back to the original pools of knowledge. Building on the Leopold Legacy 73 implicit that the focus was on the ethics of individuals in relation to other individuals and not on Aldo Leopold's "third step in a sequence." Evidence for the exclusion of ecological and population problems is abundantly clear from the collection of eighty-seven essays in the 1978 book Contemporary Issues in Bioethics, edited by Tom L. Beauchamp of the Kennedy Institute and LeRoy Walters from the Center for Bioethics at Georgetown University. They highlighted their point of view in the preface: Recent developments in the biomedical fields have led to considerable moral perplexity about the rights and duties of patients, health professionals, research subjects, and researchers. Since about 1970 ... members of numerous academic disciplinesincluding biology, medicine, philosophy, religious studies, and law - have become involved in the complex ethical issues raised by these developments. Aldo Leopold's land ethic was overlooked as were events such as Earth Day (April 22, 1970), which initiated environmental teach-ins on nearly every campus in the country. It is not clear why the ethical issues embedded in this entire matter-i.e., the exponential increase in the human population and the impact of this uncontrolled growth on human survival-should not be considered basic to the contributors' discussion of the role of the medical profession in the modern world. Nor is it clear why issues in bioethics should be focused on the moral problems facing the physician who must confront the felt need for performing abortions without discussing the avoidance of pregnancy by means of artificial contraceptives such as condoms (see chapter 5). 74 GLOBAL BIOETHICS More recently, the separate paths taken by medical bioethics and ecological bioethics were noted as shown in figure 2. The further evolution into a global bioethics, as proposed in the present effort, is shown in figure 3. It may be seen that healthy individuals and a healthy environment are given top priority. Controlled human fertility and a world population stabilized at lower levels than seem to be inevitable in the future are considered to be absolute requirements for the twin goals of human health and environmental health. THE MATTER OF NOMENCLATURE The general term "bioethics" has to be qualified by mentioning the major areas under discussion. From the outset it has been clear that bioethics must be built on an interdisciplinary or multidisciplinary base. I have proposed two major areas with interests that appear to be separate but which need each other: medical bioethics and ecological bioethics.Z Medical bioethics and ecological bioethics are nonoverlapping in the sense that medical bioethics is chiefly concerned with short-term views: the options open to individuals and their physicians in their attempts to prolong life through the use of organ transplants, artificial...