"Therefore Choose Life": Reconciling Medical and Environmental Bioethics

"THEREFORE CHOOSE LIFE": RECONCILING MEDICAL AND ENVIRONMENTAL BIOETHICS COLLEEN D. CLEMENTS* "On the way back they sang a number of tuneful and reflective songs on the subjects ofpeace, justice, morality, culture, sport, family life and the obliteration of all other lifeforms." [Douglas Adams, Life, the Universe and Everything] Introduction There are two critical issues in the division of bioethics into medical bioethics and environmental bioethics, as proposed by Van Rensselaer Potter and illustrated in his figure in "Bioethics and the Human Prospect " [I]. These same two problems underlie E. O. Wilson's questioning analysis in "The Conservation Ethic" [2]. The present paper proposes a framework for asking the right questions in order to increase our chances of arriving at workable solutions. The identification ofthese two problem areas for discussion is the first step: 1. Granting that a healthy ecosystem is essential for the survival of the human species, does it make any sense to talk about an environmental bioethics, especially in terms of obligations to future generations, or stewardship of the ecosystem to pass on to future persons, or responsibility for future survival of our species, or duty to respect the rights of other life forms? Can such a bioethics work, conceptually or practically? 2.What is the relationship between environmental and medical bioethics, and, particularly, is it a dichotomous or a systems relationship? Is Potter's figure closer to a dichotomy representation or a systems Editor's Note.—Dr. Clements was invited to prepare this essay, a commentary on Professor Potter's "Bioethics and the Human Prospect" [I]. A friendly exchange of views ensued, culminating in Dr. Potter's "Environmental Bioethics: A Call for Controlled Human Fertility in a Healthy Ecosystem" (this issue). The author thanks Van Rensselaer Potter for his views on environmental bioethics, E. O. Wilson for thought sharing, and Norman J. Pointer for a clinician's viewpoint. *Departmerit of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, New York 14642.© 1985 by The University of Chicago. All rights reserved. 003 1-5982/85/2803-0432$0 1 .00 Perspectives in Biology and Medicine 28, 3 ¦ Spring 1985 \ 407 ENVIRONMENTAL BIOETHICS HEALTHY ECOSYSTEM ACCEPTABLE SURVIVAL The Basic Bioethic: Humility Responsibility Competence Affluent Populations Miserable Populations Future Generations MEDICAL BIOETHICS DEGRADED and DEPLETED ECOSYSTEM MISERABLE SURVIVAL Fig. 1.—The human prospect seen as dependent on the maintenance of a healthy ecosystem. The vertical arrows represent competing options. The horizontal arrows represent factors affecting the balance between the options. A healthy ecosystem is essential for survival of future generations but is under attack from both affluent and miserable populations . If medical bioethics concentrates on death control without achieving adequate birth control, the result can lead to an expansion of miserable populations, to a degraded and depleted ecosystem, and to future populations condemned to a miserable survival. Environmental bioethics is proposed as a multidisciplinary approach for individuals concerned with global problems. Reprinted with permission [I]. hierarchy model, and what difference would this make in efforts to reconcile the ethical goals of medical and environmental bioethics? We will find ourselves talking, in very broad terms, about either the real-life importance of conceptual tools or their trivial status relevant to practical action. A most down-to-earth colleague suggests such a conservation -ethics analysis may be as unimportant as arguing over the difference between using 80- or 85-octane gasoline in a lawn mower. The question about the usefulness of quibbling over rights and duties to future persons versus the capacity of human beings for interest in the future is more than a question of which octane gas to use in the mower. More probably, it is a question of trying to fill the mower with either a gas/oil mixture or gas and oil separately. It is crucial to know what sort of mower you have, because putting a gas/oil mixture into a machine designed to take them separately, or vice versa, will result in a nonworking machine. It is necessary to know what sort of human organism we have and to know what sort of ethical and value theory makes sense before trying ethical interventions, if we hope for some success. My practical colleague's standard...