Global Bioethics: Building on the Leopold Legacy

GLOBAL BIOETHICS Building on tbe Leopold Legacy

by Van Rensselaer Potter

!'¥1ichlgan State University Press

1988

Cupyright © 1988 Van Rensselaer Potter Prlntf:d in the Uoited Stares of America All Ivllchigan State University Press books :ue prouuced on paper which Ineen; the requircll1cnts of American National Standard for InfurmiJtion Sciences Permanelce of paper for primed m3teriais ANSI 239.'18-

i984

Production, Julie L. Loehr Editing, Ellen M. Link Cover Design: Lynne A. Brown 'ltxt Design: C:oletU A Perry 'Py;)ography: the Copy fitters, Ltd, Edward Bracher>, Inc.'

Potter, Van Rensselaer, 1911 Global bioelhics.

~vledk:JI

179.1

ethics.

Lisa,

"labs, Eleanora, Joshua, Jeremy, and and all other grandchildren who wi1l inherit the 21 st century.

Michigan Stare Cniversily Press East L:H1s1ng, Michigan 4882,3~5202

Bibliography, p. Includes index:. L 13iocthlcs, 2. r"S2"~.P68 19i1il ISBN 0-87013-264-4

This bonk is dedlcal.ecl to Vivian. our grandchildren.

L Titlt: 88-42901

CONTENTS

FOREWORD PREFACE

vii

xiii

INTRODUCTTON KnoUlied,ge ofAdap!ation is J.Veeded for Wisdom

THE LEOPOLD LEGACY Neu.' PersjJectives en the h't)jJcld Legacy

0

13

Aldo LeojJ()ld:~' Ne,qtected LegaL}'

A LeojJGld Primer

2 HUMAN SURVIVAL The Cancer Anabgv

31

Hartb as Organism 0 The jssue of Sunrival Suroival Cannot Be Assumed 0 The Meaning oJ Suruiml 0

Kinds of Survit)ai

3 DILEMMAS IN ECOLOGICAL BIOETHICS From Knowledge to Wisdom

0

Tbe l)Ollar Dilemma

" TWO KINDS OF BIOETHICS Tbe illatter of Nomenclature L:-Ihics in a /'y'eu' Phase

u

0

.U "'

71

TeaclJing EriJics in Higher Education

Gloha! Bfoethlcs and the Feminine ViewjJoint

s

DILEMMAS IN MEDICAL BIOETHICS

'leenage Pregnancy

0

J!andimpped Nel{'borns

Futhanasia

L.l

95

Organ 71nnsplantation

The Secular Vision

0

6 THE CONT'HOL OF HUMAN FERTILITY '111'0 Kinds

(~r People

CJ

129

FOREWORD

The San Antonio Connection

Oinical Application.~: Ir!terlility c Norl:";UI:~ical Methods Q!" Contrucej.ltion Conrraceptive Research 0 Pregnancy Termiru:ltion Planned IntcrL'eniiol1 in Population Change D Ferlilily-Reguluiing Methuds Social c! ReligiGUS Correlates of FeJ'tifiry

7 GLOBAL BTOETHICS DEFINED iii/man fieaitIJ as tbe Gfobalflioerhic

0

151

Medica! Bioethlcs in Perspecliue

Ecological Biuctbics in Perspl!cli[l(J

Appmdix 1 185

THE LEOPOLD HERITAGE The Leopold Fawi!J Heritage'

[-I

The Leopold illtcUrctual Herita,ge

AppC~Kil.x

2

193

A BJOETHlCAL CREED FOR INDIVIDUALS

INDEX

197

IDEAS HAVE A LIFE AND POWEll of their own. An idea can shape or reshape the ways in which we understand and expenence reality Encountering a fruitful idea, we say, Ah-ha! and see the world anew amI cannot imagine it otherwise. The ideas that shape our vision of ourselves and our reality structure the very tak"n-for-grantecl character of everyday life. The same at limes happens with new words. A new word often allows liS to name elements of reality in a way that conveys new control over our Cu1tm21 environment. JUs oftennot the precision of aword thatisthe sourceof its power ,md usefulness. In tact, it is often the imprecision, ih~]ack Of clarity, that allows us to name and bring together at on" time many areas of interest. An apt word can assemble a rich set of images and meanings and thus help us to see rdations between dements of reality that were previously separated in our vision and thought of only as disparate. Snch ;1 word has a fertile or strategic ambiguity. This has been the case with "bioethics."

viii

CLOLiAL LilOhJ111CS

In the 1960s there was a growing concern to understand and master our rapidly developing sciences and technologies. The aSpif
i3uifdinp, on Ibe Leopold Legacy

IX

Moreover, when applied sciences Of technologies are as expensive and as intrusive (lS those of medicine, questions of proper procedures for individual and societal choice and authorization b"come c"ntral. Such, in fact, has been recognized to be the case. Bv the close of the 1960s, there was an interest in u?iderstarlding th" values and images of human wellbeing that underlie the practices of medicine, musing, and al1ied health sciences. There was alrcady a realization that, in the future, we will be able to engage in genetic engineering and develop technologies with radically new implications. Thus, the focus waS also on the b:1Sic biomedical SCiences. which would or could in the end lead to developments that would change mcdicine and ourselves. The old terms medical ethics or nursing ethicsappeared too mrrow or parochial to identify this wide-ranging cluster of interests and concerns. Even the-term "biomedical ethics" appeared too Ilarrciw. In the midst o fall this, in 1971, as the first centers for bioethics were being formed, Van Rensselaer Potter published Bioethics; nridge to the Future. Theterm l1rougllt together a wide range of interests. It was like a nidus dropped in a supersaturated solution. At once, a whole range (If concerns crystallized. The word "bioelhics" did brilliant service ;n bringing together a wide cluster of important cultural concerns. The term was proj(lUndly hcuristic .. But P wfcssor Potter had intended to address an even broader range of issues. Using the term biocthics, he wanted to investigate concerns that focused on the issue of human survival. lJe hoped to bring attention to the ways in which science can help bcttef j()rmulatc our understanding of humanity and tile world. He suggested ways in which we could conduct ourselves more responsibly and better achieve a life of quality. Bioethics was proposed by Potter as a term for a diSCipline that could provide a

x

Hldldirl[!, UN fhl:: Leop'.Jid Lega.'.},

science for survival and aid in securing happier and more productive lives. Potter's focus remains broader than that of most contemporary bioethicists. He offers a global perspective with an ecologi cal focus on how we as humans will guide our adap-

in OUf relationship to nature if we arc to secure our continued survival in a way that will accord with our views of ou r own well-being. In the future, we will be able explicitly to control the adaptation of our species to the world, Our expanding scientific and technological base allows us to change not only the character of our environment but the character of our human natme as well. We have been changing the character of the earth at least since the development of agriculture, We have altered ourselves through immunizations, which allow mOte children to grow to reproductive age and more people to live together in crowded cities, We have orclle,'trated our human nattlre through contraception and steriliLation, which allow us willfully to direct our reproduction, In the futl1re. l,owever distant, adaptation will surely take place through our ever more fundamental and self-conscious shaping and reshaping of our hUlmlil nature. Even the very modest short-ternl promises of genetic engineering suggest a long-term future in which we will make ourselves the objects of our own manipulations, The: moral and public policy chal .. lenge now confronts us of understanding what we should do when and why, ancl who has the authority to decide, Global Fiioethics: Building on lbe Leopold Legacy provides us with a particular land ethic for one of the most important areas of public policy discus sion. But lIlore generally, Poller shows again wby the term bioethics can usefully sustain his original broader intent. Within the compass of bioethics broadly construed, we will need to understand what kinds of values concerning the environment impose what kinds of obligations, Gi ven the long history of species extinction, need we be concerned with the survival of all species or only some species, and if some, which? In attempting to protect the environrnent, \Ve must choose among ways in

tation to our environn1ent,

Since the publication of his book, iJioethics, the term has devdoped its own history with little regard to Potter's original intentions, It is like a child who left home, renouncing the disciplines of its father but with substantial talents and capacities of its own, It has willfully chartered its own successful but narrower destiny by spawning an F1'lcyclopedia of Hioelhies and a large number of volumes and essays on bioethic,\ as well as a journal by tilat name, For the most part, the term biocthics has been taken to identify the diSCiplined analysis of the moral and conceptual assumptions of medicine, the biomedical SCiences, and the allied health professiems, As such, it has become a special area of phi· losophy or ethics, even though all of its practitioners have not been formally trained in either area, The field of bioethics has succeeded in identifying the need of the sciences and arts of health care for the humanities. The field has also given the humanities-philosophy and ethics in partieularan opportunity to discharge one of the traditional obligations of the liberal arts: to protect our freedom as persons by helping us to understand our condition and circumstances better. In all of thiS, the more general meaning of Potter's term has been overshadowed by the great success it has had in bringing issues together for examination in the area of hea.lth care, In this volume Potter is reminding us once more of the more general promise of the term "bioethics." lie is again recalling us to the concerns of his 1971 publication: we must retlect on the values ingredient

xi

xU

GLOl3A! BJOETH!CS

which we can conceive of an ideal preservation of nature. Must we in the end preserve nature ~s one would clevelop and manicure a park! Is It possible at all to imagine main taining any or many large tracLS of land in their "natural" state. unaltered or untouched by man' Does one .. m;lintain" indigenous humans living a traditional tile original ecological balance? To these possibilities is to choose among ditlerem visions of man's relationship to nature and among different visions of (he value and importance of nature. Potter poims out, such choices will themselves depend on particular population policies. In aU of thiS, we will need to ask whether anyone or any government has the authority to select a particular vision or set of visions and impose it uniformlv on the world. Here, questions concerning the character or limits of human incli vidual and commufi'll authority rise to challenge us. And if we can identify the proper goals to be pursued and have author· ity to pursue them, are they best pursued under gove rnmental or private auspices'! Potter makes a rich and important contnbuuon to the kinds of dlscussions and explorations we will need to undertake. The scope of bioethics is as as he suspected in 1971 and larger than most have acknowledged. Whether or not one agrees with the particular vision Potter us. one will need to acknowledge (hal the genre of issues he addresses is inescapable. As with his contrihulion of the term bioethics, he is again making a contribution that reaches beyond the particularity of his statement to a general philosophical an~1 mora! chaJlenge that we will all need to confront. -IT. TRISTRAM ENGELHARDT, TR Center/or Ethics, ivledicil1e, and Public Iss;ies Houston, 7exas

~~~~-

......-

....

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PREFACE

TODAY WE CAN no longer write abollt the erhics for human suryivJ.l without reference to our intellectual ancestors, There is little doubt that Aldo Leopold was one of thme ancestors. With his name cited in 27 of 96 articles In the first eighteen Issues of the journal, Erl1lironmental Rthics, he stronglv influenced the development of what we sha!J describe as ecological bioethics. His book, A Sand County Almanac, comalns no bibliography, and the original paper entitled "The Conservarion EthiC," published in The Journal of Forestry 1 also contained no bibliography. When this essav was revised and enlarged for inclt;sion in the Alm;'llac as "The Land Ethic," no references had been added. As thc first person to couple and det1ne the words "land" and "ethic" in ecological terms, Leopold was unCjuestionably the first bioerhicist: he was l1rst to envision a new ethical basis for human conduct. nrst to develop an ecological ethic (which he called the land ethic), and first to explain clearly why it is

xiii

(iLORAL m( )ETHICS

needed. In these he had no need of, and no avenue of approach that acknowledged, a progenitor. We who follow Aldo Leopold are obligated to note not only his pioneering efforts bUI also the publications of thc new brecd of concerned biologists, ecologists, and people of many disciplines who are concerned with the problem of acceptable survival for the human species. The issue, in plain Englisb, is "What We Mus! Do," to USe rhe title of a 1969 article by John Platt, published in Science2 Others who must be recognized in the development ecological hioclhics are Rachel Carson, Lewis Mumford, Eugene P. Odum, Carrett Hardin, Paul Ehrlich, Barry Commoner, Lester K Brown, Richard "ark, and P~l1l Shepard Bllt there are n13nv others who cannot he cited in the present account, 'Fortunately, a 1985 book entitled Deep Ecology' (utilizing the phrase coined by Arne Naess in 1973), which traces the basic concepts back to Aldo Leopold, attempted to cite just about all tbe relevant views and to quote them at length. Tbe authors define deep ecology as an attempt "to articu .. late a comprehensive religious and philosophical worldview" that "goes beyond a Iimlted piecemeal shallow approach to environmental problems" (Devall and Sessions, 65). Thus, the phrase deep ogy can be understood as essentially synonymous wlth what I would call "biocthical ecology," but the work insists that bioethical medicine is a necessary component of the deep ecology effort to "ask what kind of a society would be best for maintaining a particular ecosystem" (65). The myriad questions raised by modern medical tcchnology are not discussed bv the :lmhors of Dpep Hcology, but their effort is an excellent complement to the present effort to develop a glob~ll bioethic that deals with the medical dilemmas.

fHiflrif}!g on the Lrwpold Legacy

A recem annotated bibliography by Mary Angle .. meyer and Eleanor R. Seagraves contains 857 entries that pertain to attitudes and values relevant to The Natural Environment:' They cannot all be cited in the pages to follow, but where a source is recognized it will be cited. I am indehted to the IinlversiLy of Chicago Press for permiSSion to reproduce most of my article from Perspectives in filoiogy and Medicine (Winter 1l)ti7) entitled "Two Kinds o[ Bioethics; Aldo Leopold's Land EthiC Revisited"; to the University of Wisconsin Press for permission to quote from Aldo leopold. !Ii s Lire and Ui()t'R (1988) hy Curt Meine, and to Curt Meine for providing me with helpful pages from his manuscript prior to its publication; to the Oxl()[d University Press for permission to quote from A Sand County ,limanac Commemora . live Hditiol! hy Aldo Leopold and from Tbe rOllndatiun" Of Bioethics (1986) H. Tristram Engelhardt, Jr.; to Rochelle :--l. Shain for permission to quote at length from sections of Fertility Control, which she edited with J. Pauerstein; to the American Association for Cancer Research for permission to reproduce figure .) from my article in Cancer Research' and to Nina Leopold Br:ldley and Charles Bradley for their invitation to participate in the 1987 Summer Seminar Series held outdoors in the dooryard or the Leopold "Shack," ami to present a' lecture on Leopold's :'>eglccted Legacy, he!'''' reproduced in part in chapter 1. Especially appreciated is tbe accurate typing of the manuscript by Mary ,10 Markham, and the critical editing by Ellen Link of the Michigan State University Press. I also thank mv daughter, Karin Pollel' Simon, and Professor James E. Trosko for helpful suggestions. Aldo Leopold criticized academic professors and their specializations and commented, using a

GLOLlAL EJlOF7Hf(."S

xv:

musical metaphor, that all scientists "are restrained by an ironbound tahoo which decrees that the con· struction of instruments is the domain of science, while the detection of harmony is the domain of poets." There is much evidence that he preferred to advocate his intuitive hy means of poetic prose rather than by or charts. He had as much need for a hihliography as would a poem hy T S. Eliot or W. H. Auden, or a symphony by MOLalt.' Fifty years we cannot rest the case on poetry alone; but I urge ttle reader to return to A Sand County Almanac and savor the romantic as well as the philosophic passages in that memorahle volume.

1. A:cto Leorold, "The Conserv<1l1on ErhiC'," Journal of For" est,.)' 31 (1933) 1. John PlAtt, "\vhat \X/e Must Do," SCience 166 (1969): 1l15~

2L 3. Ell! Devall :md George Deep Pcology (Salt Lake City: 4Pereg.rine Smith Bo,}k~, 198'1), Excellent coverage of pasr nonk\ and artkles, Unfortunately lacks author or subjecL indexes. 4, Mary AngkrrHyer _ and El~nor R. Seagraves, 1118 Natural Erwiromnent. An Annotafed l1ibtiography on Attitudes and Vhiues (Washington: D,C,; Smithsonian TnsrJtution

Press, 1984). 5. Vall Rensselaer Potter, "Humility with Responsibility-A Bioethic for " Preside;)tlal Addreti.", Cancer Research :15 (1975); 22.97-7.'11'16 6. Although Leopold formally 3ck:nowleJged no antecedents in composing "The Land Ethic," I hasten to point out thm in building his monumental textbook Game !Uanagement he urevv on many sources, f1is book has tables, charlS, pholograpr:.s, an extensive glossa:-}', an index, ;:lIld.a hlbllography containing 427 c:tations by my coum, It W-;1S the first book of irs kinz.1: it created a ne"" profession,

INTROD1JCTION '~---"""-""'~---

Ii':

1971 A IJAsrc TEi':ET OF HI(lETH1CS was that ethical biological facts.' At values cannot be separated about the same time that hook Hioetbics, Hridge to tl1e Future appeared. hiocthies as an outgrowth of medical ethics was being developed at George· town University and at the Hastings Institute. For many it came to mean exelusively rhe ethiCS of how far ro exercise the medical options that are techni· cally possible, sueh as organ rr,msplams, the use of :.!rtiticial organs, abortion, sterilization, atlirici;]! contraception, chemotherapy, informed consent by the patient, freedom of choice in procreation or abortion. fertilization in vitro, surrogate pregnancy, ,md future developments in genetic engineering. These issucs in general have short term, immedi· ately visible consequences and all have to do with the maintenance and prolongation of individual livcs. With the focus on medical options, the fact that bloethics had proposed to combine human values with ecological facts was forgotten by

GLOBAL BJOETinCS

many: the ethics of how Ltr to exercise technological options in the exploitation of the environment was not associated with the term bioethics, The time has COIlle to recognize that we can no longer examine medical options without considering ecological science amI the larger problems of society on a globed scale, 11.11 example of an issue in global bioethics involves the medical options concerning human fertility in confrontation with the ecological need to limit the exponential increase in the human population, Regardless of the advances in health care-not to mention those in agricultural production, conservation of natural resources, and preservation of the natural enVlr0111nent-llo program can hope to succeed without the acceptance of controlled human fertility as a basic ethical imperative for the human species, Yet :lEy ethical framework that accepts this premise will obviously run counter to some of the ethical positions taken by several of the most powerful religious and political groups that exist today \1Vllcn I coined the worcl "hioethics" in 1970, I was influenced by C, H, Waddington perhaps more than by any other individuaL Born in 1905, he served as professor of animal genetics in Ecltnburgh from 1946, gaining expertise in embryology, genet ies, and evolution, He became essentially a bioethicist before the word was invented, a man concerned with the need to develop ethical theory in the light of biological knowledge, an aim similar to my own, "What is demanded of each generation is a theory of ethics which is neither a mere rationalization of prejudices, nor a philosophical discourse so abstract as to be irrelevant to the practica.! problems with which mankind is hccd at that time,'" He was aware of the philosophers' claim that it is iogicaJ1y impossihle to pass from "is" to "ought" and that to make such an attempt is to commit the" naturalistic fallacy" He said first,

Building on the Leopold Legui.y

\\le can with perfect logical consistency, conceive of an aim Of ' principle of policy which, while not in itself in its essence an ethical rule, would enable us to judge between different ethical rules. It is for such a principle that [ am searching, and which I claim to be discoverable in the notion which I h:we referred to as 'btological wisdom.'

.. To a theory

which attempted to discover a criterion for judging between ethical systems the refut.ation uf the naturalistic hUaey would be largely beside the pOint. (50-'59)

Earlier he had said, II'!. the lifetime of anv humarl individual these three types of activity-l;ecoming an ethicizing being, formulating one particular .sy.stem of ethical heliefs, anu criticizing lhose heliefs by ~Oille supra-ethical criterion of wisdom-are not clearly .st~parated in time hut certainly overlap \vith one anOlher.

Here he defined the supra-ethical criterion as "the general good," "the ethical system of general validity," or as "biological wisdom" (26-27), I insist that survival is an even more basic supra-ethical criterion, I was also influenced by an article by Margaret Mead asserting, "We need in our universities Chairs of the Future,'" which inspired me to assume the role if not the title; and an article by Theodosius Dobzhansky" provided the linchpin for the whole structure of bioethics in my mind, It was only after reading these three authors that I belatedly discovered Aldo Leopold, who had said so much so simply J dedicated my book to him, although it contained no text-references to his work, hence my present emphasis on his views, I decided that biological wisdom (indeed, all wisdom) is a form of knowledge-"the knowledge of how to use knowledge for the social good"-and that "the search for wisdom should be organized and promoted in

GLORIL fllOEmrCl

terms of the survival and improvement of the human '" This, then, was the supra-ethical criterion called for by Waddington and it becmne the original biocthic, based on the idea that the imperative, Search for Wisdom' is an ethic in itself. Theodosius Dobzhansky was a professor of zoology at Columbia University and had served as president of the American society of Naturalists in 1951.6 His 1956 book on The Biological Hasis of Human Freet/om' was listed by Waddington, but his 1958 article CEvolution at Work") and its conclu sions were not utilized, In 1958 Dobzhanskv made three important points that influenced all of mv sub sequent thinking: (I) no biological law can be relied on to insure that our species will continue to prosper, or Indeed that it wlll cominue to exist; (2) the human species is the sole product of evolution that knows it has evolved and will continue to evolve', and (3) it is up to our collective wisdom to supply program for "evolutionary developments that nature has failed to provide," The final proposal WaddIngton's supra-ethical criterion bnt it might well have been more modest My own biocthlc cans merely for a11 acceptable survival that would permit further evolution and development in view [)obzhansky's claim that natural selection does not even guarantee that the species will endure; most biological species of the past have iJecome extinct, without issue, and yet their evolution was controlled by natural selection, Their extinction hecause "selection promotes what is immediately useful, even if the change may be fatal in the long run" (Dobzhansky 1958), If Dobzhansky's first two points are accepted as " then "what ought to be" is a bioethic that survival of generation after generation, idea of acceptable survival (see chapter 2) is merely a

5

KNOWLEDGE ADAPTATION IS NEEDED FOR WISDOM

The idea survival is not a philosophic con cept invented by ethicists. The bridge between knowledge of and the wisdom of the "ought" is the built·in program inc"ery biological entity that makes it slrlvefofsurvival beyond the existing' generaticlll, The m'eehanism for s~rvival is based on the abillty of a to adapt to its environment, This is true even where humans modify the environment to their short-range needs, Adapt"'lion is of three kinds, Individual members of a spe cies, including humans, possess the property of j)hysi%gical at/aptation., Although bacteria and plants possess the property, it has not been documented for every species, and it may be that specialization to the exclusion of an adequate physiological adaptation is the first on the road to extinction, Physiological adaptation occurs continually over minutes, hours, days or months in the lifetime of individual member> of a without change in their genetic makeup, For cX:dInplc, adaptation to high altitude, which I have and studied in the I1igh Andes of Peru, occurs in several physiological systems with different time scales, Best known is the increase in hemoglobin and red cells in the blood, In all examplcs, built·in biocybernetic systems programmed by the DNA in the genetic apparatus constantly read molecular and physical environments (for eX:lmple, the percent of oxygen in the air) and feed back information to the machinery for genetic changing the physiology of the individual in a seemingly purposeful (i.e tclconomic) to become :as successful as possible in reproducing its into the nex1: generation !f

[-,vitding rm tbe Ll!opcJd l.ega,y

6

H1'()lutionm), adaptation is a property of a pop

uhtion. It occurs over a succession of generations by a gradual Ol' sometimes rapid change in tbe genetic information stored in DNA as one generation succeeds anotber. The changes can be looked upon as copy-errors that arc dth"l' spontaneous and infrequent or brought about more frequently by chemical or physical agents in the environment. Agents that cause copy-errors an:: usually damaging to individuals, causing cancer and other "bnormalities a[ low concentra[ions and death at higher concentrations. Evolutionary ad;aptation may be: seen as a mechanism for changing the cap"city of a species 10 achieve descendents with improved physiological adaptation to a new environment or to the existing environment. It succeeds whcn changes in lhe environment ate nO! too rapid. If we attempt to the "ought" from all this we find that every organism "knows" what is bad and what is good for the present. Anything that causes death witbout adequate species reproduction Is bad. Anything that changes the genome in a way that diminishes the capacity for physiological adaptation to the range of environmental variations extant is bact Anything [hat increa.ses the capacity for physiological adaptation to the existing environment is good. But no organism is equipped to prepare in advance for a future altered environment (Dobzhansky 1958). N evenhclcss, the Imman spe dcs may come closest to thal possibility on the basis of its superior capacity for physiological and cultural adaptation. With cultural adaptatlon the possibility to extinction exists but cannot guaranteed, even if an adequate overall biocthic could be adopted. Cultural adaptation in humans and in a few species occurs both in individuals and in popul3 [ions. It is limited by the two biological pro('esses of

adaptation, but it is speeded up tremendously by all the recent developments that can be lumped under the headings of communication and irl/ormat/(m storage and relrieval. It is possible that there are disadvantages to cultural adapmtion that may comparable to those in biological adaptation. That is, there is a fatal flaw in the combined biological mechanism sucb that, when a species becomes bettef and better adapted to a given steady-state envi· ronment, it may become totally incapable of sllrviving in an environment that has been drastically changed over a relatively sbort time period. So it may bave been with the dinosaurs, as many believe. As noled earlier, most species that have cvc:r existed have become exlinct because of this fatal flaw in their genetic makeup. Until recently; the human species waS no diffcrem from mher species in the f:Jilnrc to sec fatal flaw. the human species now contains a few individuals an: :l\vare of the significance of the fatal t1aw. The propOSi[ions stated by Dobzhansky an: less than thirty years old and to my knowledge have not been challenged, In fact, they would be regarded as truisms by most scientists who are knowledgeable in the field of evolution, even though they take no action in the matter. Of course, the creationists and "11\' OIbcrs who doubt that evolution is " fact of life a~c oblivious to the implications of the "fatal flaw." Any ethiC for the human species has to be based on the "Is" of possible extinction and the fact that each of us has a bullt-in species-memory that tell;, us how we "ought" to live. We ought to live in such a way as to avoid the fate of most olher species We ought to listen to those Ii:w who have thc knowledge that can contribute to the prevention or delay of extinction. We ought to ckvelop interdiSciplinary groups that can question those components of our ptesent culmre that are hastening the clestruction of

CfDRAL RfORTHfCS

the natural environment. We ought to read Aldo Leopold and C. H. Waddington and consider whethcr our special knowledge can contrihute to survival and amelioration of the human condition. In this book I describe some of the urgent ethi· cal problems that face society today. Dilemmas arise when decisions are demanded in the area covered hy medical hioethics "when life takes precedence over health." The issue is hasically one of deciding whether to adhere to the "sanctity of life" concept at all costs, or whethcr to raise the question of "quality of life" or "meaningful life." Medical lech· nology has achieved miracles, yet in many cases the v ictory has been the thwartlllg of death but not thc restoration of health. In other words, the new techllologies frequently lead to dccisions in which life maintenance has t<Jken precedence over the restura· tion of a meaningful existence. In the field of ecological bioethics then: arc also dilemmas tl1m in some respects parallel the medical problems. The ambivakncc of medical hiocthics is mirrored in the powerlessness of ecological bioeth· ies. For example, depletion and degradation of our water resources is the ecological cquivalent of the neglect of the bioethical problem of teenage preg· naltey by the medical profession. In hoth cases ethical theories abound but society has been unable to reach a consensus on what is to be done. Just as there arc somc medical bioethicists who argue the mailltellJnce of life no matter how miserable it may be, there are ecological bioethicists wbo argue Ihat economic growth and full cmploytJl(:nt should have top priority, even at the cost of air and water pollmion and acederated depletion of nonrenew'lble resources. There is also a parallel between those who are arguing for meaningful life and those w 110 are arguing for the preservation of the natural environment. Ecological bioetllics must support Ihe

I,"·

Buildin,R

01'1

fhe Leopold IegrJcv

9

prevention of air and waler pollution as well as the conservation of both renewable ane! nonrenewable resources. In essence, the issue is whether the quality of life concept is ethically similar to quality of the environment and whether the sanctity of life position has its counterpart in the sanctity of the dollar. Ale!o Leopold recognized the latter position when he said, it of course goes wlthout saying that economic feasibility limits the lelher of what can or unnot he Joue for ianlt It always has and it always will, The faliacy the economic delerminists have tled around our collective neck, and which we now need to cast off, is the helief thal econornics determines at! land use. This is sirnply not truc.9

Kenneth Boulding put it neatly when he said, Ecology's uneconomic, But with anotl,er kind of logic Economy's unecologic. 1o

Obviollsly we must seek a halance het ween ecological hioethics and economic domination just as we need to tind a balance between sanctity of life ,md meaningful life. "Ibday it is apparent thar many features of society, seen on J worldwide basis, arc incompatible with acceprahk survival or, to use Lester Brown's term, a "sustainable society" (sec chap. 2). For m'lny parts of the world, qualit y of life is a meaningless term; mere survival has hecome unplectsant and dif. ficult. It is recognized that rhe goal of worldwide controlled human fertility on an equitable basis and within a healthy ecosystem may be impossible to achieve in a world with multiple ethnic and religious groups wllo orrlOse artificial means of birth control. However, without progress toward

G'IDIL:L Blf)EiHICS

the achievement of the twin goals of birth control and environmentJI protectioll, the linure could be bleak indeed, We must therei()re tI,e present efforts in biocthics, particularly as they relate to medicine, to a recognition that the ethical behavior of human, kind must be cohercnr with ecological realities, This exploration is an extension of ideas first formulated by AIda Leopold, Only through the evolution of a third-and completely interdisciplinarv and global-bioethics,n ,combining a reexamined 'medtcal hioethies with a responsibility-oriented ecological biocthics, can the future of humankind be seen as anything other than that t(lrCSeen bv Roberr Heilbroner in his introduction to An I"q~iry into the Human Prospect: "The answer to whether we can conceive of the future other thall "8 a continuatiOll of the darkness, cruelty, and disorder of the past seems to be no; ;md to the qllestion of whether worse inlpcnds) yes." 12

L Van RensSdaer Potter, BridR€ to the Future (Englewood Cliff" NJ, Pl'emkt",Hall, 1971), Charier 1 "\V:]5 entitled <'f)ioethk0, The Se-ience of Surviv;J!/' dl3.p~ ter 13 "Survival
lJui!djrjf{ un tht: Leupold Legacy

S. POfter, "SUfYlval as a Goal [or

II

., chapter 13 in

Bioetbics, Bridge to the Future.

6. Theodosius Dobzhan,:;ky, in Genetics i"n tbe 20th LenturV, eeL L C Dunn (New York: Macn:illan, 19'51). 7. Theodosilts Dobzhansky, Tbe Biological Basis of Humun Freedom (New York: Columbl;l Uni.versit y'

Press 1 1~S6). 8. Van Rens.selaer Potter, "Physio!oglcal Adapl3tion at the;;'loJecuJar Level; The Frontier Wht:rt: Ht:search on Differentjation and Meet," l'er:.1H!Ctiv(!S in Ht"olog)) and /vfedicfne (Summer 1981): 525-42. 1 proposed thal "the m()st significant aspect of the gcnetic program for dlffef<:miarlon is the development of a whole of 'physiological adaptation' ., T th::lt research on physiological ~1dap~::l[ion_ rh2t combines thr holistic and the red:tct:onist approachc-s is the to understanding diffefemi-arion and and to my knOWledge t:lis point has not been previously m3de, alth01!gh it is implicit in much current research which descrihes wbat happens y>,,7jthout commenting on u}hy it hapr'ens." 9. Aldo Leopold) A Sand COtlJl(V Almanac (New York: Oxford l!niver!"iitv Pre~s, 194(), 19(i(); reprint ed., New York: 5ieHa Clllb;13alI3ntine Books, 19(0), 262. lO, Kenneth Bou1Jlng, in Future F:nviron;nents in Nortb ,1meriCct, ed. F [r35(,1' Darling
c7ff)I1A '" RfORT!1ICS

12. Hobert L. Heilbrone:[) An Inquiry into !be Hunwn Pr<)st'eCf (:New York: W, we. ~onon, 1974). The author examlned "[he ecological aspect" and the probJem of "populatiun overload" v,rirhin a broad framework. Pedups the single most irnportant, conch.;e, recent book.

THE LEOPOLD LEGACY

"The Land Ethic," published in 1948 but developed over a number of years, he expressed a concern which is still applicable today: "Perhaps the most serious obstacle impeding the evolution of a land ethic is the fact that our educational and economic system is headed away from, rather than toward, an intense consciousness of land,'" By lind, he meant "not merely soli; it is a fountain of energy flowing through a circuit of soils, plants, and animals" (2IG), This book is, in part, an attempt to reaftIrm and promote precepts and values such as these which were the Sl1m and substance of Leopold's land ethic. Aldo Leopold hegan his highly motivated and creative career as a professional forester, His interests continually widened as he became a conservationist, ecologist, administrator, lecturer, writer, philosopher. and poetic spirit, In her work on the life and accomplishments of Leopold "and the evolution of an ecological attitude toward deer, wolves WHEN ALDO LEOPOLD WROTE

14

GLOBAl" RJOi:'J'H1CS

:md t(}fests," Susan Flader traces the evolution and adaplation of Leopold from his earl y experiences as a forester to his final position at the University of \X7isconsin in Madison." ' No Sooner had Leopold received his I1rst job as a forester in the Southwest (Arizona and ",ew Mexico. ill 19(9) than he began to break out of the forestry specialty ancl to propose a new discipline comb in ing forestry with what he called "game management." He felt impeUed, somewhat as Martin Luther did, to announCe his convictions by nailing them to the cathedral door, in this case the Journal Foreslrr In 1918 he wrotc an arlicle emitled "For· estry :md Game Conservation" in which he made his position clear: "In conclusion, the writer Is sen· sible of the fact that in armigrdng the profession of forestry for a passive atlilude toward the game problem. he speaks from the slandpoint of a game conservation enthusiast" (italiCS added)} Whlk he spoke of the "game problem" and of game conservation, he Immediately followed by asking, "But why. indeed, should not more foresters likewise be enthusiasts on this question' They should-in fact, they must be, if they are to act as leaders in launch· ing the netl) science

liuflrJing

OJ!- tbl:'

With

15

Leopold Lega.cy

the puhlicatioll in

J93:'> of Game

Management, Leopold might have become trapped

in a process of revision that never ends for most authors as long as the later editions find readers. i\ot so with Leopolcl. His book was reprimed but not revised, because he turned his creative writing talents to the wider meaning of conservation. As ill the case of his criticism of specialized forestry, he now critici;:ed academic specialization, even thOllgll he himself had created a new specialty. Leopold called the reductionist approach used by speCialists in the uni versltv system "dismemberment:' criticizing professors f(Jr "examining the construction of the plants, Jmmals, and soils which are the instruments of the great orchestra" witl1()Ut ever 100k1l1g the "harm(ll1Y" (Almanac, Leopold's expanding vision called for an understanding of the whole field of ecology, a specialty combining all bic)!ogical spe, cialties; but he wamed to go even further. He C011, cluded with the somewhat hitter remark that the scientist, like the otter playing tag in the pools and rifl1es of the Gavilan, "has no doubts about his own design for living. iIe a"umcs that for him tlie Gavllan will sing forever" (

{!,tune rrtanage1l1enf" (italiCS

added). In 193'1 Leopold published his epic text· book Game lvIanagement, 4 which "is still regarded as a basic sPJlement of the science, art, and profes· sion of wildlife management" and which "has been contmuously in print since '1933" (Flader, 23). While this auriloril'-ltive textbook, which created the new sctence of game management, integrated details from 427 sources by my count, only seven were from the Journal Of F'orestl:V and three of those were by Leopold himself. Interestingly enol1gh, he did nO! refer to his 1918 proposal th:u foresters muSt act as leaders ill the neW science.

NEW PERSPECTIVES ON THE LEOPOLD LEGACY

The most illuminating picture of Aldo Leopold and a magnificent monument to him is the thoroughly researched and authoritative biography Aldo Leopold. Ilis Life (lwi 1l>,)rA" published bv Curt Meine in t98H.' Meine spent over three years working with hundreds of letters, as well as the original notes and iournals of l.eopold preserved in the Leopold ,uchives at the LniverSity of Wisconsin, along with personal interviews, publishecl ~lld unpuhlished manuscripts, and other historlcal

lei

GlOBAL R10l!iH1CS

sources to uS the first comprehensive biography of Aldo Leopold. Not the Ie",t useful ponion of the coverage is the complete list of the" Published Writings of Aldo Leopold" {603-201 COvering the years 1911 to 1948, for which Meine gives Susan Flader "principal credit for compilation" From this list we leal'll that during the years 1933 to 1.948, when Leopold was compiling th", essays which evcmually gave birth to "The Land Ethic," he was issl:ing a barrage of short papers on a bewildering vanety 01 subjects in a plethora of communication channels, each message articulating a particular aspeCl of rHS many-t;lCcled world views. For example, In 1940, when he first published "Song of the Gavilan" (later included in the ALmanac), he publIshed twemy-three other items on various topics in sixreen cllfferent media channels. of which Wisconsin Agriculturist and Farmer ;:ontained six and Journal of Wildlife Management contained five, while the others contained one or two by my count. A similar tally for the entire period of 1911':" 1948, with an attempt to categorize the topics covered, would only begin to plumb the dimensions of tbe Leopold legacy. The many citations from his cady letters to his mother and father also reveal a new insight into Leopold's lifelong love of nature. In short, the "1elne book contains encyclopedic Coverage of the Leopold legacy, induding reference to earlier books On Leopold, On a much smaller scale than Meine's is another book Ibm tbe University of WisconSin entitled Companion to A Sand County Almanac.' Edited by J. Baird Caificort, Jt contains thirteen by ten authors to provide well organized coverage. The 1986-88 harvest included additional insights by Wisconsin professors Ion 0i Moline' and RObert A. :>'fcCabe, , a studcnt Aid, Leopold.

of

1!ulJding On the J.e()f;oJd LeYf,tJc)'

From such a wealth of material it is my impression that Leopold contnbuted so much to so many aspects of conservation that his underlying con~crn for the future of the human species was overlooked. His views on the overconsumption of renewable and nonrencwa ble resources by an cxponentially increasing human population were neglected, while Ilis love of nature was a comfortable aspect of his life for others to asslmilate. Yet Lcopold did worry about consumption of material goods and, indeed, was the firs! to enunciate the concept of zeropopulatioJ1 growth (ZPG). In a minor publication (Condor) in 1932, he responded to some criticism in a rwo-page commentary on all of his admitted personal depletions the natural environment;

of

"Nav w.ort;?, when l1ather more tban tu;o cbildrt111 am ~rcatjr:g an insatiable need for morc primjr~g press(".'), more (0\\'&, more coffee, more oil, and morc rubhcr, to supply \vhid: tll0re buds, more

trees, and more tlowc;rs, ~vm cithej:" be, killed, or wllAtt is just as destructive; ev:cted from theIr cnvi~ [Onment6," (Meine, 290. tt2liCS added)

ALDO LEOPOLD'S NEGLECTED LEGACY

AJdo Leopold saw that human survival depended on the maintenance of a h~althy ecosystem and the control of human fertility-at a timc when neither of these ideas was widely understood. I believe he was able to define right ;md wrong ultimately in terms of hum,m survival and t11e prcsen~l­ rion of the biosphere. "A thIng is right when It tends to preserve the integrit)', stability, and beamy of the biotic community. It is wrong when it tends otherwise" (Almanac, 224).

18

G[O&L fJ/O£Tl1ICi

Leopold laid out a cohercnt and logical sequcnce of propositions that contains much morc than that simple statement, which has been taken bv manv to encompass the Leopold philosophy. It 5c';'n;, justiliable to conclllde that he was indeed concerned with rhe relation between increases in tbe human population and the "permanence" or survival of society. He fell that the hllman species Can survive only if (1) the ecosystem as a whole is capable of recovering and sllrvlving tbe "v iolencc" exercised by the human species in the course of economic exploitation; and (2) the number of human beings is held within tile boundaries set by the limitations of the eCOsystem. If these conclusions were apparent to an ecoiogist in 1933, what should ecologists of the 1980$ conc1utle? Perhaps a review of Leopold's views could open the discussion. From Leopold's "Land Ethic" (Almanac, 20126), we can distill a series of statements that could be regarded as axiom a tic and self-eVident by anyone who has had sufficknt experience in the t1eJd of ecology and who is concerned with the survival of humarlkind in a healthy ecosystem. [ will refer to these statements collectively as "A Leopold Primer:' I do not believe that a comparable synoptic view of "The Land Ethic" is ;wailahle. I have quoted directly or paraphrased twenty-four Leopold statements under three headings: Land, EthiCS, and SurvivaL Each statement in the first two instances is based on a sentence in which Leopold used the word land or the word etlJie In the third instance 1 have inferred that SUYVilmi was in Leopold's minel It is not Implied that the statements, either in the original form or as paraphrased, arc statements of fact; the v arc value judgments from Leopold, a man witil a deep and profound ecological conscience. It is recommended that readers cxamille the original context.

Building ()n ,tho l copofd r cgacy

i9

A LEOPOLD PRIMER L Lanel I, The basic concept of ecology is that land is a community. (Pataphraseu from 204) 2, "Land then, is (l()t merely soil; it is a fountain of energy flowing through a circuit of soils, waTer, plams, and :=inimals [and ba~k] to the soiL" (216) 3. Land, collectively, Is J biotiC mec":1anjsm, (ParaphrJ.sed from 211j 4. "Many historical evenLS I hi\heriO explained solely in rums of human enterprise: were actually biotic intelactions bet~veen people and land." (205) 11. Ethics

5, "An t'lhic ecologically, is J Hmit3J~on on freedom of action it) the struggk for existence." (202) 6. '~>\n ethic, philosophically. is a differentiation of social from anti-socia1 conduct," (202) ! "There is as yet no ethic ceaHng wIth Hun's relation to land and to the animals and plants which grow upon iL" {2(3) 8. "The extension of erhics LO [land] is an evol~).Hon;n y pO-':1S1hility anu -an ecol()gjc~l nece'i~~ty rfl1f human

survival]."

(203)

9, '~J\ll etbiC's so fa;: evolved rest upon a single premise: that the individual l;:; a member Df a comllll.mity of imer:..iepc:ndenl parts," (203) Ifl "A land ethlc changes the role of Numo sapiens from conQueror of lhe land-community to plain memher :ll;d cir17.cn of iL" (20:+) 11. "lA land ethic! implies respect :'by l:UIT1;JIl indiv~d~ uals for their feJlow lH.1IT1'lns] and :11S0 respecr ror the [biotk! community as such," (204) 12. '~\ land ethic .. " reflects the existence of an ecological conscience." (221) B. ''An ethic to supplement and guide the economic

relationShip to land presupposes the existeuce of 50r)",(' rnerital image of lane: a..., a biotIc mechanifirn." (214)

20

GLORA 1: BIOETH!CS

11. ".we can :?c ~,hica] only jn relation to something we

ed,n Sec, !ee~, understand, love, or othe(wise have faith in." (214) 15. "Ir:-drvidual ttliJ1kers, since the day,:, of Ezekiel :mcl IS~llah, ha:1 e 3sserrcd Ulat the despoliation of l:md is nor only mexpedient but wrong." (203) tIt SurVival

16, "".M~I?~~~jde changes [in the land-communityl arc of a dIfferent order thai) evolutionary changes. anu hav:~ effects mort:' com t l[chcl1sjve than IS Int~nded or fOreseen." (218) 17, "Th(' less vioknt the man~madc change'), the ~reater tJ:c probabiHty of su(,c(~6-sful rcadjusul1ent" lin the bHHIC community], (220) 18, "Violence lto the blork COfi1n'lUDltYl varies with hUm?D popUlation density; :l dense population req'tl1res 4 more viofent conversion." (220)

19, "~onh

America has a better chance for [survival I than Europe if she can COntrrve to limit her popUlation denSity." (220) 20. "EC?logy knows of no population density relatlO~ship that holds for indefinitely wide limit~. A,lI ?,:m~ from den~ity are subjccl to a law uf dall1D1 shmg returns." (220) perm~nence

21. "Mar:-Y hiotas ., have already exceeded their ~ustall1ed carrying capacity, ,~'lost of South America [5 overpopu14lted in this sense." (219) 22. Dc~ent land lIse requires decisJOfLferreu reactions, !h:H rhe path of social expediency is OOt disccrnible to the ;1Vcrage individuaL" (203) 24. ."A ~ _th j,n,~LJs Jig~t w_he~l it tends to pl'C'iCrH:' the !J1tegnty,. sl.lb.Hity, and beauty ot tht' ;;iOlic co~rnuDlty. It JS wrong when it lend<.; oth"!"'''''''''' (22~5J •••

lJuildirlg on fbi:' Lt:opotd Legac),

The final statemcut (No. 24) may weil be the most famous and most discussed quotation from Leopold. One of his daughters, Nina Leopold Bradley, has commented on how this ethic affected Leopold's whole family! The statement has heen called "the categorical imperative or prl.nelpal precepl of the hInd ethic" hy Callicott lO r have referred to it as "the Leopold Imperative. H Call1cott has also remarked that Leopold's land ethic "has become a modern classic and may be txeated as the standard example-the paradigm case, as il were-of what an environmental ethic is" (54). C:lllicolt then extrapolates from Leopold's slatement into a discllssion of animal liberation, animal rights, plant rights, landscape rights, and all of the literature of that genre, without considering the issue of the survival of the human species in acceptable form, which I have r,lken to be the thrust of Leopold's entire message if we consider all of the statcmellls presented above. Callicott concludes, "In every case the effect upon ecological systems is the decisive factor ill the determination of the ethical quality actions" (61). He seems to aSSUllle that Leopold was more concerned with plant and animal rights than with human intereSls, Citing many of the romantic passages from Leopold's writings. These passages help us to understand Leopold the natUralist, but in my opinion the land ethic W:lS not an either/or choice of human rights ver"" plant and animal rights. Rather. it expressed the bdiefthat the human species cannot survive without capacIty to see, feel, understand, love, or otherwise have faith" in the land community (No. 14). Like Carol Gilligan (see chapter 4), Leopold was concerned more with responsibiliries than With rights. When Leopold rderred to carrying capacity (No. 21), surely he had in mind carrying capacily for people, plants, and animals. Leopold was concerned

22

(;/J)JJAL BrCWTHIC5

abom the violence to the biotIC communitv and the disastrous effects of populatio~ density ('10. 18). Jt scems inappropriate to equate Leopold's land ethic with romantic Outside the section bearing that name. In Almanac and in The Quality of Landscape we see how much Leopold loved Nature, while in "The Land Ethic" we see how Leopold came at last to sce that unless what he loved could be protccted, !;lte of humankind would be in doubL years before Silent Spring, he wisely noted that"man-made changes ... have effects more comprehensive than is intended or foreseen" (;\;0. 16) Hence, "an ethic may be regardcd as a mode of guidance for meeting ecological situations so new or intricate, or involv. ing such deferred reactions, that the path of social cxpcc!iency for humankind's survival is not discernihle to the average individual" (No. 23). There is nothing illogical about pladng value on a healthy ecosystem for two reasons: for its intrinsic value, if we have sufficient experience and insight or If we can be taught to see and for its instrumental value, as the homc in which humankind has evolved and in which the species must continue to live. I insist that when LcopolC! speaks of obligations over anc! above self-interest he to the :selfinterest of individuals, corporations, and governments here and now, while obligations to the "land" are obligaHems and responSibilities to fll ture generations of the human species, obligations that can be fulfilled only when suffiCient numbers of humans here and now can learn to "see, feel, understand, love, or oth. erwise have faith in" the land, whether thev love it for instrumentJl or noninstrumental reas·ons. 'A land ethic implies respecr by human individuals for their fellow humans and also respect for the hiotic community as such" (1\0. 11).

RUilding on the Leopold Legacy

23

Aldo Leopold beheved that the human is and always w!1i be dependent On the mals that in turn depend on the water natural environment. He also nelle vcu natura! environment could not maintained in a condition compatible with the health anti survival of the human species if the human populalion increased its numbers indefinitely, Leopold had observed the effect of overpopulation eleer in the Southwest, which led to his essay "Thinking Like a Mountain" (Almanac 129-33). Leopold used the actual term- "overpopulation" in an anicle published in 19'17 in the Journal 0/ lVildli/e Management: 'A Survey of Overpopulated Deer Ranges in the United States." He foresaw the time when overgrazing anti c!ctorestation would lead to "the flood that one dav will scour the bank into the Pacific" (Almanac, 15'4). It is this side of Leopol(l which 1 believe has been neglected. In eadv 1987 mv wife and I happened to see a of william Vogt's Road /0 Survival" at a used book sale and bought it for 50 cents It was still in its original dust jacket, and what should! see on the back cover, listed among "What advance readers have said," but a testimonial from Aldo Leopold: ALDO LEOPOLD-

"This' huok is the most lucid analysis Of human

f'cclcgy and land use tbat I hatd~ yet encountered it is as dramatic mia as absorbing ~) any j)iece Of fiction and lobat is more it is written hy a keen·

minded scientist who knows bt'sfacis !hOrougb(v. I hope ez:ery thoughtful mar! and troman in this atomic age u/'itJ read

it. "

I thought, how poignant: Leopold praisc:d the book but lost his life in a tragic fire just as Vogt's book w-as released in 1948 and heir)re his own hook was off the press.

(;L(JBAI EJOE'njjCS

I wondered if Vog! ami Leopold had been acquainted. Where to look? I though! of Curt Meine, whose biography of Aldo Leopold was then in press. I called him and he obligingly sent me xerox copies relevant from his manuscript, here cited from the book. Heading from his epic work, I found the "VogtLeopold Connection." Meine noted that i()llowing the end of the war, people began to conslder the rath 'I head He wrote; Leopold particip:J:tcd in a number of these di3C:ISStOnS, Among his rnany constant conespCHlth:l1ts at this time, the nlO.st slgnlr1cdnt was Bill VogL Vogt h3d spent the war years in wHo /\n)t~rica as Chief of the Conserv::Hion Section of the twenty~onc-nalioe P;w American Union. In lhat capacity he surveyed the natural resource,') and wartime ,1ocial conditions across Latin AmeriGI. \'?har he saw-the c1u,<-;rcr of ur!conscionable p(lVcrry, n::SOl!:U: exploit::Hlofl, burgeoning popllJ3Uons, uOH'::,<,ponsive oligarchies, and ar.. lmyiekHng Roman CHtholic stance on t)lnh cOI1trol~tran,<;formed him from an already briHiant ornithologist and \,vritcr to ;] conservarionist wilh :a rnission. By C'3:-1y he was layjng lhe groundwork for an "jnter"Amerlcan ConserV8.tion Congress," Vogt ;md Leopold h;ic] known one another lOr a decade, and for a time V()gt p:anned to stud)" under Lc')p()ld at V;:!jsconsin [he was about twelve years }"OlmHcr~ btl t the fell thruugh. A: 3Ilother point, Vogt fried La Leopold south on a le('~ ture tour. "The importance of introducing ecology into the S\)uth American picture is so obvious that it needs no comment;' Vogt wrote to him in 19·12. "From what 1 kno\v of Latin America, their prob~en1s (~uldl you and your approach to sllch problems, 1 cannot 11elp feeling that such a journey would result in extremely imponam accompHsh. mentK, both in lhe fidd of hemisphere science and its relations to strategic problems:' A!do \1r
A[;:n the wa:', Vogt was dcrc::.-:nined to bring his dire message to the public. ki envisioned, the In~er­ American Conserv;.1~ion was to be lhe flfst IJrgc,sc:1lc forum or'. Latif'. AnwricJI1 enVrrOnlTl(,Dtal condilions <mel \Yould rcqui:e heveral years to orga· I)i7,\::, fnJaf.u:lry 1')),.;j6, Yogt sent to Leopold an e:;I!; Qu:,jine of tile proposeu conference, Leopold s respor'.sc was gloomy: '"The on!")' thin.g YOll have left o.ut i~ \1,' l~et~er lh~ phLusophy u[ tnd'~(stri;u cultures IS n.ot, :n 1~:\ ~ltr­ male development, jrrcconcihlble wllh ecologlC'
conscrvJrlD[), I thInk it IS. "I has len LO add, that the term industrial· ism camWt he used as an absolute. Uke 'tt'mperatlJ[~:' and 'velocivv' it is a quc,:1rlon of degree, Througr:Ol1t ecology, a:'l truth is relative: a thl()g becomes good at one deg:.-ee dnd ccase.;'; to be 50 at ,mother. .' Indl1st6aiism rflight theoretically be conSe:valive if there were an ethic lim:ting its application to what does not imp~lir (a) permanence and stability of the land, (b) beauty (if trle land. But 1l1ere is no such ~tl1t(j nOr Hkely to be, ,. "Bill vour outline is exceaent. That the sHuatlon is hopele~5'shouJc: not prevent (1') from dOi:1g our best.:' Even Vog:. who could h;J:dly be caJed an ?pt:mj~t, found Leopold's fo(('c'Jsr "somewhat dtSm~1i but rnuch appreciated." Vogt could not dC'IlY Leopold's rnain polnL "YOll :arc, of course, COffect in what you say about industrialism. I don't know how vou would define cth!c, but [ am hopeful tha~ horse· sense may sornc:day reph:ce il as ~llill1jting fa<.."· tor to preserve' the perm:U'lel'l('e and 5t3blHty of t:?e even lllOugh there seems to he Uttk hope for its beaU",," Leopold was no uouht depressed hv the trend o{ "\lurId events, but, as in the past, he a(wavs surfaced with his thoughts polnted to,:vard the iururc:, lIe wrote to Vogt :J \\Ceek lmer; "It IS ~o i.r:1possihle to write J letter ;lbollt. such :J hig questio.n that I :;un 3fra~d this alone dep:'esses anyone trying to make an answer," . . . , There were other reflections of (he broadenmg conservation nloVerY)(~nt in Lcopotd'~ life through~ out 19,1G, He served th~!t year as chaii'ma:::l of a ncw

16 Building on the Leopold Legacy

Committee on Foreign Relations \vilhin the \Vildlife In his [jrst draft resolution to the Commii.:tee members, Leopold stated that "rhis Committee wlsheii to ~ssetr flatly i[s belief tk1t provincialism L" as: dangerous in the wildlife field as In any other:" (477-·80)

1urning now ro Bill Vbgt's book we read his reference to Leopold's study of overpopulation among deer: Tn ~he Karbab fore·;t on the north rim of the Grand Canyon, thoroughgoing governnlem prcd;rtor COlltrol Wd.,S foHowed by an :ncreatie in the mule deer poplllation from four thousand ll) onc hundred thousand in jI:;urteen years. Consumption of 311 bn?wse within reach was fo:lowec:, in (""va years, by a ()O pCfcenr reducrion 1n the herd through starvatlon rReferencC' to Lel)pold, Journal of" W'ildfife lvlanagemenl. 1947). (Vogt, 90)

.

-

Under "The Rewards of Understanding" we read: The sheer intellectual and emotlonal satisfactiun to' he had [rom understanding-redly seeing-the countryside is a privilege within reach of ~tnyone" By failing to show us the way to it, our school.:: deprive us not only Of;1 great and lifelong grntJfication rna ofrhe co!nprehcnsfol1lhar shouldgulJe all our rclarions to our environment, The fortunate people who have been afidd with such a teacher as Homer L Shantz, A1t:o leopold, or Isaiah BOv;'lT:an nor only arc going to nod e.xdtement and satisfaction in Hving; they arc going to be much mote use. ful cilizt'fL,,> in J world rh:H desperately needs t:.lCl1L Dnlcss we mpidly adjust our demands and USC's to the complex of land limitations and potentialities. t:!1e human mce is going to suffer such travaU as il has never known. (Vogt·, 95)

Finally, opening chapler 7 "The Lane[ on Edge" we read:

All Latin Amer!can count1'1es except three or four are ovcrpnpuImed. They :Jrt: able to feed and shetter their citizens, and Bupply water for their many [leeds, only hy a progressive and ucceler;Hlng destruction of natural resources; biological bank· ruptcy hangs ovet rhdr heaus like -a shaking ava~ lanche ... , L"nless there is a profound modification in its treatment of the land. the greater part of \
Now we know how it was thar Leopold came to his conclusion on the overpopUlation of South America (No. 2J)

r hope it will become apparent that a common thread exists among Vogt, Leopold, and others like Gregg and Berrill whom I will mention larer. This common thread is a concern about human survival, and it is what constitutes the Leopold connection to the twenty-first century. Although Leopold's C011cern with human surviwl seems dear enough from his writing, it is not this aspect of his land cthic that is emphasized. Even in the most [eccnt publications the emphasis is on his personhood and his love of nature. Onlv Wallace Stegner mentions the population problem in terms of the consequences: "Less green, less space, less freedom, less health; a longer and longer stretching of a ruhherhand not indefi nicely stretchable."" Yet even he does not reach the conclusion that the end result of overpopulation is miserable survival and death, as Leopold witnessed for the deer in New Mexico. This book, rooted in the philosophy of Aldo Leopold, will explore the urgency its relevance to the dilemmas of our time.

GLOHAL BlOET11fC>;

1. AIel" Leopold, "The Land Ethic," /1 Sancl County Almanac (t\ew York: Oxford t:niversitv Press Inc~

1949, 1966; reprint. New York: Sierra Ciub!Ba1iantin~ Books, 1970, with eight essays from Round Rilyr; reis· sued in a special Commemorative EdWon bv Oxford 1987), 223. 'Inc page references herein are' fro~ th~ 1987 edition. 2, Susan Hader, 'fbinking Like a /v[oun!ain. Aldo LeOpold {md tbe Jo,,'voiutiun of an Ecological Attitude 'l1)1J)(zrd Deer; lftlhes, and FOrests (Lincoln: University of

Kebr4ska Press, 1978).

-

-'

3. AJdo Leopold, "[
ScrlbncfR, 1933), ), Curt !>leine, Alclo Leopold, His !.ife ancl WI"k (\Iadison,

LIniven.;ity of Wisconsin Press, 1988), 529 pages of rext and photOgraphs plus 105 pages of bibliographies, nOles, and index. 6, J Baird Callicott) cd.; Companion to A S'and CQuntv Almanac (Madison: Colverslty of Wiscollsin Press, 19R7).

'

7, Jon N MoUne, ':AIda Leopold and the Mora! Commlmity," JJrwironmental Ethics 8 (Summer 1986): 99-120,

McCabe, Aldo Leopold, The Professor (Macli son: Rusty Rock Press, 1987). 9, Nina Leopold llraclley, letter to the amhor 3 March 1988, 'An aenon policy To help guide his own children was Leopold's restoration of his worn out sand county farm. \Vith enthusiasm from hIS v,"ife and five children (later in hfs life he spoke of the Impropriety of siring mort than two children) the 'amily k"rncd a good deal about the land organism as they tried to rebuild 'integrity; stabHlty and hcauty' into it. The simpHdty of the 'Shack;' the hard work with shovel and axe, the camardderie. the love of hmd, brought us to a wider understand11~g of each other, of the, natural system, and our place in it." 10. ]. Baird CaHicotl, 'Ammal Liberatlon: A Triangular Affair;' 8, 110bert A,

in Ethlcs and tbe Environment, ed. D, f;cherer and '1'.

Mtig(Englcwood Cliffs, N,J,: Prcntlcc,HaU, 198,0),

29

lL V R Potter, "Bioethic~ aad the Iluman PrOlsrcct," jn Swdie.'; in SCi(!11CC' and Cuiturp, v~}L 1, 'fbe Culture Of Biomedicine, cd. n H, Brook (Cranbury, N.J.: As:-,o" dalton or Cniversity Presses, inc. 1981), 124-3 7 ,

U. "W'illiam Vogr, Road to SUl"viv{'{1 (New York: William S!oane AssociateS, Inc., 1948). 13, ~Tallace Stegner, "The Legacy of AIda Leopold," in Callicott, Compatlion, 2:,,9.

. . ._-- 2 -_ . . . . . . . .~. . . . HUMAN SURVIVAL

THE CANCER ANALOGY

O:-l TlECE~!BER 28, 1954; the Americm Association the Advancement of Science held a symposium on "Population Problems," at which Dr, At:m Gregg, vice'president of the Rockdeller Foundation (1951came up with a startling idea: the thought that the human specks is to the planet Earth what a can, cer is to an individual human being. As a cancer spe, cialist T was aware of the many eontributing lines of thought and so was not altogether surprised to note the same idea proposed by another eminent biolo, gist, Professor Norman J, Bcrrill of McGill Cniversity, in his superb book iVlan's Emerging ,}fina, l It WaS publlshed same year that ("",~~'c symposium paper appeared in Science.2 The remarks by these two men of science suggest that the effect of an ever,expanding human population 011 the carrying· capacity of the planet Earth bear" examination, We do wouid well to examine their words.

02

EARTH AS ORGANISM

Gregg esroused an idea that W8S cleady enunclated in 1949 by Aldo Leopold, who referree! to "land the collective organism" :mel stated, "Land. then, is not merely soU; il is a founr;lin of energy llowing through a circuit of soils, rlants, and animals. Food chains an: the living channels \vhich condllct energy upward; cleatll anti decay return it to the soll."3 Leopold also amicipaled Gregg a1ld l3etrill whc:n he remarke(!, "This almost worldwide display of disorganization in the land seems to be SImilar to disease in an animal excC'pL Ihat it never clllminates in complete disorganization or death. The land recovers, but at some reduced level of complexity, ami with a reduced carrying capacity li)r people, phmts, and animals" (Almanac, 297). Alan Gregg proposed similar ideas in his aforementioned symposium paper: ''If we regard the different forms of plant and animal life in the world as being so closely related to and dependent on one another thallhcy resemble different types of celLs in a total organism, Ihen we may, for the sake of a hypotheSiS, consider the living world as an organi.sm." lie went on to What wOd!d 'VcT' think if II became ~Vtdcnt thal within a very brit.:' period in the history of the

world some 0012 lype of its forms of Hk had increased greaHy at the expense or utlIer types of life? In ~hor1, I suggest, as a way of lool{lng at lhc popub~ior: problern, [hat rhere are some interesting 'cen the growth of the human population of the worid and the increase of cells ohservabk jn ncop!-asrns, To say that t:'c world has (.~ancer, and lhaL lhe CJ(1(:er cell 15 man has neil her experimental proof nor the validation of predictive acclI· racy; bm I see no rcason that instantly forhlds MfCh a SpLCu];1t:on. Cann:;:rous growths demand food; out, .so far as r know, they h:l'n::: never bc-en

cured hy getting it. '" How nearly the slums of our grc:m eities resemble the necrusis of tumors ~3iscs the whimsic:ll query: which is (he more offertSl vl: to decencv and bca:Jty, sJunls Of tIle fctid detritus of a gf(}\ving t"dIYtOr? ,If Copernicus helped a~tl·on· omv bv challenging the geocentric interpretatIon of th,/unlverse, might it not hdp biology to chalienge the anthropocentric interpret3tiOn of nature?

'lorman llerrill '\\'d5 in complete agreement with teopold and Gregg. In "The Human Crop;' ch~rtcr 17 of Man's Emerging Mind, he discussed the Issue ~t length: Directlv or iodin.:ctlv there has been a monu-

me~[J: an;1 inc!'C'::lsingly "extensive conver;;inn of the

:)lanet's living potenliJl from the diverse many to the aUMconsilming one_ 1n terms 010<;'[ comp;:,rison, the Ylrgin prairie with its stablc mixture of gr'd..')'''C'3 and nowers has become alrnoSl enri~cly corn, with a few weeds and some blowing U'.lSL All thaf can be transformed into human pro!Opl:as;~ Ls being transformed, and :lnyth:ng that :itlnds in the way is pushed against the wa!!. ." So f2X at:; tbe rest ofl1ar~ ure- is concerned we are hke a cancer whose strange cells nn:ltiply without (c;;;rrdint, t'uthlcssly demand" ing the fl\YJxishmcc.t thJl all of the ~)ody has need of. Tl".f: analogy is not far-fetched for cancer cd Is no 1110r.: than whole organisms kno'\-v when 10 SlOp multiplying, and sooner or later the body or the comnll:llily Is starved ofsllppnrl and dies, (,209-,lO)

1krrill saw three posslhle responses to the problem of overropulation. One is t:lat we can increase our resources indefi' nitely to keep pace with the increasing !X)pulatinr~, which I have trkd to show i;; imposs~bk. Anothel' is lhat we employ our colkcrlvc intelligence and keep m:r numbers ~"'ilh:n reasonable bounds, while the

eLORA!. 1l10ETfllC,

lhird is the pcssimist:c one that human beil1gE are not intelligent enough as a whok lO cor.trol their own ferti!1:y and win al way:- prc:,:; ha::d the ragged fringe of SUStenance that t"l':e more ferrite Of lhe more prolific haman slr:dn,s or rarcs Vvill ol::brccd the res!; that population comro1 by any group S0011er or later ,::cals It~ own dOOITL with those who rerain an l~ncomrolbblc breeding instinct taking its (220-21)

The analogy that sees Earth as an organism with ali Hving species as cells in that organism is not complete in det"U because the variolls species exist by and large by consuming tht: bodies, living or (\Lad, of Other species, In contrast, the celts that form an organism in the human hod v do not live by con suming other cells in the C()~munity, although the total human organism does depend on the intake of plant and animal species as food, Nevenheless, the proliferation of cell types within a human organism is exquisitely regulated by feedb:1Ck mechanisms great complexity, and the "ame can he said for the proliferation oflivlng species on the planet Eanh, In either case, when" some one type of its forms life had increased greatly at the expense of other lypes of life," to use Gr<:gg's words, we must conclude thal the natural feedback mechanisms, evolved Over millions of years, have broken down, II becomes clear that in either ease the result is brought ahout bv a great excess of binhs over the number of deaths in a given time interval, If the human species is to survive and prosper, it is essential that we must control not only nuclear armaments hut also human krtilitv and the tendencv to crowd OUt or destroy other forms of life, This statement of "what we mu~t do" is merdy an extension of the concluding Leopold Patadigm: thing Ireferring to decent land use] is right when it tends to preserve the

iJuild;ng

(in

f/;)I;'

Leopold 1egw.)'

integrity, stabilitv, and beauty of the biotic CO~l:nU­ nity It is wrong when it tends to do otherWise ,see chapter I), THE ISSUE OF SURVIVAL It was perhaps Garrett Hardin more than any other who independently developed the equivalent of the Leopold paradigms and re;111zed that this led directly to the issue of fertility control for the human populalton, In 1968 he wrote "'['he Tragedy of the Commons" in which he concluded that "freedom to breed is 1I1toler'lble,"1 ln 1972 he went beyond Leopold wilen he wrote, "With the flowering of concern for environmental qualil y and the growth of theory in ecology the time is now ripe, I think, for a concened attack on rhe populal1onenvironment-quality complex, 1 think it is almosl time to grasp the nettle of population control, which we sometime must, if we arc to survive with dignity'" With that statement he began w:hat I propose to continue, thm is, the adOpt1011 01 the cmerion of smvlv:!l as a guide for action, and the discussion of what kind of survival we should advocate, Like Garrell Hardin, Eugene P OdUffi, co-amhor of Fundamentals of Ecology, was concerned with the relation between population and survival. Quoting extensIvely from Leopold's views on the need to extend ethics to the rdation of man to the nalural environment, Odum wrote: "We can also present strong scientific and technologieal reasons for the proposition that sueh a major extension of the general theory of cthics is now necessary for human survivaL"" Like Gregg and Berrill he noted the cancer analogy: "Growth beyond the optimum becomes cancer, Canccl' is an ever-presem threat to any mature system and must constantly be guarded

GW1H[ RIOET}lJCS

agaimt.'·' In proposing "The Emergence of Ecology as a New Integrative Discipline" in 1977,' he quoted Alex l\ovikoff on reductionism and holism: "Equally essential for the purposes of sdentific analysis arc both the isolation of parts of a whole and their integtation into the stmcture of the whole .. , , The considerdtion of one to the exclusion of the other acts to retard the development of biological and sociological sciences:" Odum concluded: "To achieve a truly holistic Or ecosystematic approach, not only ecology but other disciplines in the natural, social, and political sciences as well must emerge to new hitherto unrecogniLed and unresearchecllevcls of thinking and action" (" Emergence of Ecology," 1291), echoing Hardin's plea for "3 concerted attack on tile popuiationenvironment· quality complex." When Richard Falk of Princeton Universitv wrote TNs Endangered Planet: Prospects and Proposals for l-luman SunH1Jal (1971), he discussed the four dimenSions of planetary danger as: (1) the war system; (2) populmion pressure; ell insufficiency of resources; and (4) environmental overload. Following Paul Shepard, who in turn had paid tribute to Rachel Carson and Aldo Leopold, Palk reflected OdutTI's views when he wrotc: Suet a posture of cr)flccrn and position rnakcs or hnman ecology a kind of ethics of snrvlval. It is a science that relics on careful proccdutc;s of inqu:ry, data collectio:l, and detailed Obser>larion as :hc basis of inference, <::xp!;umtion, 3r:d predtctjo(l, nUL it aiso involves a mor;;.L commitment to survival and l0 lhe enh3flcc".ment of the natural habitat of man, l()

All of the above ambors have seell
survival. They have in general not conSidered what kind of survival, although Hardin spoke of surviv:llg "with dignity" and Bcrrill visualized hnmanklIld always pressing hard against "the ragged fringe of sustenance," Unlike the vast majority of the buman species, tbey ,11'e aware that humankind bas no guarantee of survival, that surviv"l cannot be assumed.

SURVIVAL CANNOT BE ASSlJMED

In 1967-70, I was a mer:lber of a group of uni versity professors in an Interdisciplinary Studies Committee on the Future of Man. We published a report on the "Purpose and Fllnction of the University;' subtitkd "University scllOlars haw a major respo[1sibilit y for survival and quality of life in the future,"ll In this report we stated, \X!e aft1rm the views- Lhat the survival of civilized

man 15 not smnerhlng to he uken for grJ.nted. that governments tluonghoul [hI? world ar~ experic~c~ ing grear. difficulty !n planni::lg for rhe tulUI'k: while tryi ng to cope with the present, and £lnaHy: that r,he

univctsitv :s one of the in')~imrions that has a ma)!Jf rcspon.;;;,itility [or th(' survival and improvement of Ek for civUi:ted marL

Mv book, moelhies, llridge to tbe Future, 12 comr';enred on the need for a new synthesis: ~lankjnd lb urge ntly in need of nt'W "wi~,,9<2~~ [hat wHl provide the "kcowkdgc of ho~v to usc kn;;J~:l­ edge" for man's survival and for impwvc:neIH"I11 the· quality or life, This cOGcept of '\""isdorn as a guide for :lction-thc knowledge: of how :0 ll'5e Imowkdgc for [he :.. oela] good~ -might be \;aUcd Scit'-1t(f; of SurtJiNli, :mrdy Ihe prerequisite to improvemel1t In the quality of life. I mke the position that the science of survival must he huilt on the

CUJRAI BI()J;'T'111C';

science of bjology :A nd enlarged beyond the traditional boundaries to l.r1clude the mOst eSbcntial e!clY,enLs of the s(JciaI science:s and the hll manities with emphasis on philosophy til tte 5trin sense, meaning ";ove of wJsdoIn." A sclcnce of survival must be moce than science al()l~t\ and T therefore prOp05t~ the term Bioethics in order to "emphasize the t"Wo mos[ iIIlporrant ingredlcnts l!13ch1eving [he ne,v wisdom that is so desperately needed: biological hnowlec1ge and hilman v-alucs, In rh!s age of speeializatio!1 "We seem lO have 10M contact wjrJ'l the daily rernindets. rhat must have driven home the truth "to Ollr ancestors: man cannot livc without harvesting phnts or killIng anirn;,l1s. If plants vdthcr and die and animal,., fail to reproduce nlan will sicken and die and fail to mailluin hi~ kind. As individuals we CJrlnot afford to kaye Ottr de&lillY 111 the hands of sciemis[s, engineers, techno!ogiSls, and politicians who have forgotten or who never knc"\v these simple truths, In ;-)Ur modern .world we have botanists who StLld)f :1iams a;-'ld zoologists who study anirnJls, but most of [hem arc specialists who do nor deal with tr.e ramii1cations of their limited know'ledge, Tbcav we need biologlsrs who respect the fragile web of life and wll0 can bmackn rheir knowledge to include fhc nal<.ile of man anLi his ;'ctalion [0 lhe bio;ogicaJ and physi~ cal worlet:" We need biologistS "vho can tell llS what we can and musr do t() survive and what we cannot and must nor do if we hope to maintain and irnprove the qua til y (If Hie du::ng the fleXL three Ih{! fale ql the f,lJorJd rests on the integra-

presen)atioJ1., and e,1:tensiort (~l the knowledge that 1'S possessed fly fl reid/he/v small number Of'.I peoplu who ClrC' on~v just beginning to realize holl' Inaa'pqua'il tbt!ir strength, how enOrmous tbe task [italic,"" ;1(1dedl Every coUege student owes it to soci. ery to leam 3S rnuch as possible of ".vhat these leaders have to offer, to challenge thern, to meld b101ogil.'2f kno,>v!edge with whatever additionaL ingredient they are :lblc to IHaster, and to become, if their t3ients are the ne"" leaders of tomorrot\', from such a pOOling: of knowledge and v31ues may tiOII,

Building on the! 2(l,t>0i4 ICgCICV

come a eew kind of scholar Cit sta:esmae \v 110 has masteted '\vhat I have referred to as Rioerhks, No incHviuual could possibly masLer all of the compo nenlS of this branch of kilowlectge l just :lS no one roday knows all ofzooJogy or;all of chemisu"j/. What. is needed is 3. new discipline to provide models ot [if~: styles for people who L:an cnnullunicate wIth each other ;md propose Jnd explain rl1e new public polIcIes that could provide a ;'hridge to the future,'· The new disciplines will be forged in (he beal of tod~Jy's crJsis prohlem~, all of '''hkh require some kind of a mix bel ween bask biology, s(ieial sciences, ;md the humanities. Blol!Jgy is more than botany and ~oology rt is the fOU!1liation on which we b'Jild ecology, which is the relation among platlt~, at!imalf.., mao, and the phvsicaJ environr:H':nL Biology includes the s5ier1ce of 'genetics, which has to do with all aspect,s of heredity, and physiology, waich deals ~vitI1 the function of individuals. For thousands of years men have Uved on lhis earth with no generally disseminated knowledge of their chemica! nml1re. l."lan's dependence upon tis natural elvironment w,-tS wideiv understood. hur Nature'S hounty v;t"'dS COD· sidere'd ru be limitless and Namre's to recover frOI11 {~pl()iclrlon V1'71S to be ample. Eventually it """as realized tll.'1t [Dan was exploiting the earth to an cxtent rh~lf the ut.e 01 more and more science and ,,1S the richcst sourcc!) of iron and copper, for ,:xamp[,::, were used up, From the biologkal srandpoinlman has progressively taken over the resource" by decn::',;iSing the numbers
other consumables, . From many uninformed \ve nov.' hear demands fOT a morarorium on when what we need is more :lnd better science. W'e need to combine biology \vith humanistic from diverse sources and forge a science of f.,arvlval that wiIl be able to set a SVSlen1 of priorities, ~'e need to start action in the art:as where kEowledgL' 1:' already

Hili/ding eil fbe J,eojJpjd Legacy

,10

availahle, and we need to reorient our research effort to get the nt:-cessJry knowledge if it is nm availahle. The age-olel ques lions about the nature of m8nlcf. 'I'roskoJl 3 and his relatinn to the world becolne increasingly importanl as we approach Lhe remaining tbree' dCLades in Lhis ccntery, \vl!cn po!it~ :cal decisions made in ignorance of biological kno:,,"lcdgc, (lr in defiance of it, may jeopardize :na~l s future an.d indeed the [umcc of earth'!' hidIog~ !C3, resources tor ht:man needs. AS individuals \ve speak. oC the "instinct fDr SUrVi\l:1~," bal the sam total of aJl OUI indi\'-iduaJ in.st~nct.s for sUfv,val is not Enough to guarantee the survival of the human race in a fOfm that any of us wouid \vil~ingly acce:;n, An insitnct for ~urvival i;.; not cnoug:h. We must dC"velop the science of survival, and il m;;Sl 5lart with a new kind of ethic,...-----hio~thici". (1

Having agreed with all those who expressed concern for human survival, anel having concluded that ecological bioethics is a key ingredient in attempts to ensure survival, we must now consider what we mean by survivaL TIlE rvIEANT"\G OF SURVIVAL

Until recently it has alwavs been assumed thai survival of the human speci~s could be taken for granted; ! he question of w herher survival is somc'~ thing to be desired was accordinglv nOl an issue, When Charles Darwin w rotc Tbe O;tgin of Species 111 1859, he was optimistic aboul the furure of humankind, He: wfOte in his penultimate paragraph, AS all the living forms of life arc the lineal dc,';cctidanrs or those which lived long before [he Cambrian epoch, WL" may feel cert~ln that thc

ordinarv sLlccessicm bv S!,cne:ul[ion has never once heen b:oken, and that J~O c3t:Jciysm 112,'-; desobtcu the whole world, Hence we may tonk with some confidence to a sect!r(- fmr;rc of gre;l[ Icngth. 14

In recent years Walter Alvarez and others have pro~ dm:ed evidence that Darwin may have been wrong about the possibility of worldwide cataclysms, It appens that the extinction of the dinosaurs 65 mil~ lion years ago may have been caused by a major impact from an eX1:raterrestrial bollv, followed by severe climatic changes, Such changes have been recently postulated as a result of the use of nuclear weapons15 The danger of producing a "nuclear wimer" is now being seriously studied," With the explosion of the first atomic bomb on July 16~, 1915, near Alamogordo, "lew :-'lexico, the survival of the human species became a worrisome issue, alrhollgh many now realize that survival can~ not be assumed even in the absence of nuclear war. Jonathan ScheU emphasized the ecosystem in lion ro nuclear war when he wrote in 1982, The primary question is not how many people wouid be lnJdialCd, burned, or crushed to d(:~atb by the lmmeuiatc effects of tbe bombs but how well Ihe ecosphere, regarded as a single living on il,:hich 211 forrn,<.; of life depend for UlC:l[ contini.ied cxlslence, would hold up. The L'>Slle is the lL1bit1bU~ ity of the eanb, and it is in this conlext :lOt in the cunleXl of the dhcG slaughter of hundreds of mn~ lions of people by the !ocal effects, lhal the question of hUI:1an 5urv!v
He noted that of all the "rnodesl hopt:s of ham an beings;' the hope that mankind will survIve is lllc most moue'sl, since it only brlngs us to the threshold of aU other

CLOBAL WOETHICS

hopes. In entertaining iL we: do f10t ;/et ask for justice, or for freedom, or for happiness t or for anv of ::he other things that we may want in lik, \'(iC do 'not even necessarily ask for Our personal survjv:tl; we ask only that we be SW"}!iH?d. \ve ask for aSSurance that \vhen we die as jndividuals, as we know we must, mankind wi!! Hvc on, . , , LJfe without the' hope for human survjval is a life of despair (184)

Schell eited Socrates for the principle that the highest good is not life survival-but the moral life (130). This brings us to the question of w hat we mean by survival. Much has written on the subject, as seen by book titles alone. We find Values for SUrD/val (Mumford 1946)" Road to Survival {Vogl 1948)'9 Science and Survival (Commoner 19(6)'" 'lhe Crisis qf Survival (editors of Ihe Progressi~e 1970)" Exploring New Ethics for Survival (Hardin 1972)" The Comedy of Survival (Meeker 1972)" The ryranny of Suruival (CaJf3han 1973)" and Challenge to Survit'al (Williams 1977}.'5 Some of the issues raised by these authors will be COnsidered later in this boo'k, But first we mmt consider what is meant when the word "survival" i;; used without qualification. In contemplating the term "survival" it should be pointed out that slItvi val begins today. None of us knows whether or not we will be alive tomorrow. On the other hand, the possibility of survival lilr at least some members of species may extend into the future tor as long as any form of lHe exists on the planet. But what kind of survival? We can think of the kim\s of survival that occur in terms of life-styles and behavior today as well as the kinds of survival that can be projected into tile futufe. We can think of the survival of individuals: our children and grand-children and future generations down

''{uifditiE; on tbe Leopold l,agm.y

through time. Bur present behavior and future exislence in terms of the kinds of survival I shall describe not only to individuals but also to tribes, communities, corporations, and governments. \Vh,H kinds of survival can be descrihed in the fewest possible categories? KINDS OF SURVIVAL .

proposed that the word "sur vival;' used without a qualifying adjective, is inadequate for in the context of ecological bioethics. I suggested categories based on quali, fying adjectives; mere, miserable, idealistic, irresponsible, and ttcceptable.'6 :HERE SURVIVAL

Mere survival is a term used scornfully by people who dislike talk about survival. Mere sur, vival implies food and shelter but no libraries, no \vrltten historYI no engineering) no science, no hos~ pirals, no chllrches, n() television, and, presumably, no artificial contraceptives: in other words. a hunt iag and gathering culrure, which incidentally is the only cuiture that has demonstrated that it can survive for tens of llllllenia, as in Australia and the Kalahari Desert of southern Africa. In the distant past it may not have been too difficult, but conract with white man changed all that. 27 ;';IISEi(AllLE

SURVH~1L

A below mere survival is miserable survival Some of Africans on the verge of starvation, wi th many actually starving to death, and suffering from Widespread malnutrition, dlarrhea, respiratory

44

Building on the Leopold IcgaCj'

disease and parasitic infestations, and now AIDS, provide a ghastly picture of how miserable survival can be much worse than mere survival. Yet both exist today in many parts of the world, and it is a matter of serious debate as to how much the white man's entry into Africa and disruption of the nativc cultures has contribllted to converting mere sur vi val to present-day miserable survivaL In their hook Natural Disasters.' Acts of God or ,lets or JV1an?" Lloyd Timberlake, editori;d director of the London· based group Earthscan, and Anders \1(Tijkman, secretary gene tal of the Sweclish Red Cross, said that some disasters, including t1oods, drought, and fam inc, are caused more by environmental and resource management than by too much or too little rain, while the effects of natural disasters such as earthquakes, volcanic eruptions, anel hurricanes arc magnified by unWIse huma n actions. At a press conference in Washington, Timberlake called for refocusing disaster relief which, he said. was often a band aid on a massive wound. '9 The amhors echoed the views of Aldo LeopOld in 1933 (sec chapter I) when they saId overcultivation, deforestation. and overgraZing tend to reduce the abiliry of S(;n to absorb and retain water, making it susceptible to drought and flooding. Population growth and inadequate housing in L"Xposed shantytowns often contribute to larger death tolls from natural disas· ters, Timberlake said. He noted that In Ethiopia, where famine is threatening millions of people, "the highlands have always been overpopulated and overcuILivated."

each person has a private nOtion of what Utopia would be. However, people can have idealistic survival at manv economiC levels and in many cuitures. Idealistic sl~rvival would occur when· sufficient numbers of people in a sodety have the economic sccuritv. the information, and the ethical concern to becom'~ motivated to think personally abom professor Falk's four planetary dangers, and in particular to think about long-term survival and the amelioration of existing pockets of miserable survivaL People cannot agree on the components of ideal smvival, but they can universally agree on the undesirability of preventable disease. No culture or religion, primitive or modern, has ever placed a premium on or aspired to starvation, malnutrition, diarrhea, intestinal worms, or other parasitiC infestations. So the desirability of eliminating these scourges is something that all can agree upon as a component of idcaUstic survival. Small pox was one of humankind's s('()u:rg'Cb decimated populations from time to time. with typhus. typhoid fever, and many other and bacterial infections. But now, international lie health efforts have apparently been SU(:c",ssl:ul the total elimination of smallpox from the This was possible because the disease was r.ra:nsmltted from person to person with no intermediate vectors such as mosquitoes, licks, snails, or other life forms. In the case of smallpox, the last person to have it was prevented from passing It on to anyone else, idealistic survival would unite people who would seek to eliminate the remaining great miseries that afiliet humankind: sexuallytransmilted infeCtions, parasitic diseases such as malaria, Bellis tosomiasis and sleeping sickness, intestinal worms of all sorts, and all the other preventable diseases that plague great numbers of the human species.

IDEALISTIC SURVlVAL

At the upper end of the spectrum is Idealistic survivaL I shall nOt discuss ideal surv! val because that is something we shall never sec, and lx:sldes,

GLOBAl RlOPTHfC5

An example of idealistic survival is the announcement concerning a grant by the MacArthur Founda!ion for $20 million to fight parasites that cause disease in three billion people around the world. Dr, Jonas Salk, known for his development of a vaccine against polio and now chairman of the foundation's health committee, announced the grant He said, Diseases caused by p-arJ.sires afflict more than haif the world'!') people. Even when not seriously iH; pr;;ople who have pa,msitic disease arc: chronically sick------wcakcr, less competr;;I1t, tess productive. and les.s content than t~ey waD Id be othef\vf~e. 300

"

Twelve medical research groups in live states and three foreign nations will participate in the program, which will establisb tbe ,vlac;\'rrhur Found.tion as the largest private sponsor of parasitology according to foundation ptesident John Corbally At the same time tllat we praise the MacArthur Foundation for this ex.'lmple of idealistic survival, we must ask what would be the long-range effects of even partial success of the program on the conti· nent of Africa? Can any program tllat decreases infant mort:.dity ~nd thereby increases the demands on (he ecosystem, without the cOllcomitant educational measures that would protect the ecosystem and promote the idea of zero populatioll growth, be anything but a disaster in the long run? The question is, how bad is a good idea? How can the people of the industrialized nations help people in the Third World, not with piecemeal efforts or bandaids, as noted by Lloyd Timberlake, but with balanced programs or multi-pronged coordinated programs, when they are unable to control their own unemployment, intlation. environmental pollUtion,

Buildinf!, on tbe Leopold Lf:Muc:y

47

soil erosion, and budget deficits? How can they cope with the dilemma posed by Norman Herrlll "that alwavs the more fertile or the more prolific human Mr:~ins or races will outbreed the rest, that population control by any group sooner or later seals its own doom, with those who retain an uncontrollable hreeding instinct taking its place"? The only answer provided by an idealistic surviva-, list would seem to be that the diBsemination 01 information and motivation for population comrol, along with public health measures policies emulating the etbics of Aldo Leopold, is the only sane ",-av to deal witb the social dilemma, Roth at home and abroad, Idealistic survival leads us to Leopold, who said, ',\n ethic to supplement and guide the economic relation to land presupposes the existence of some mental image of land as a biotic mechanism" (Almanac, 214), And at the end of his he wrote: "I have purposely presented the land as a po:oduct of sodal evolution, ,I think it is a truism that as the ethical frontier advances from the individual to the community, its intellectual content increases" (225), Idealistic sur' vival surelv is an interdisciplinary exercise in democracy 'It reqUires that we listen to the views of both the 111inority and the majority, and thar we try to ascertain the facts, For as Leopold conduded in his essay, mechanism of operation is the same right actions: for anv ethic: soeial approbation (225), social disapproval for wrong IRRESPOl'lSIBLE SURVIVAL

Irresponsible survival, my fourth category. is in a sense tbe inverse of idealistic survival. Irresponsible survival is doing all the things that run counter to the aspirations of idealistic survivalists, Whereas proponents of idealistiC survival to promote

DLOBAL B!OETH1(;:::;

ze[() Of negaLive population growth for the immed,ate future and a healthy ecosystem with concern for future generations, those who are categorLzed as imcsponsibk recognize noohligation to the fumre, proceed entirely. in terms of self-interest , have no desire or willingness to control their own reproduc' tive powers or interest in helping others to do so, and do nothing to a healthy ecosystem. Of course, there arc few who comhine all these charac· teristics. Among the interesting contemporary phenomena are the organizations that are desperately trying to preserve a healthy ecosystem in terms of heaches, tidal basins, wilderness, wildlife preserves, redwood forests. groundwater. clean air, or other elemems in the environment, while ignoring the fact that it is population pressure that underlies all of these problems. A sense of ecological morality will always retreat in the face of economic demands brought about by the growth of loeal and world populations. As noted earlier in general terms, irresponsible surviva! can be discussed in terms of individuals local ('omn1unities, corpOratiOns, or governments. I~ can be discussed in rerms of agriculture, industry, science and technology, medicine, the military complex, or toreign aflairs. Examples are too numerous [0 be compiled in detaiL In the field of agriculture it is irresponsible to use farming praetlces that aeederate soil erosion, or to use deep-well pumping techniques that progressively the water table. According to the 1983 C.S. Geological Survey's J\ational Water Summary, the combined agricultural, industrial, and residential usage exceeds the rate of replenishment in thirty-five of the forty-eight contiguous states. n In particular, the states in the Southwest, whose population increased 6-12 percent as a group between 1980 and 1983. have thirtvone percent of U.S. water usage but on'ly 6 percel~t

BuUdmg or, tJJe Leopold Legacy

of the nation's renewahle water supply. Water is being "mined" by deeper deeper wells that must eventually fail to keep with demand, State and federal g(wernmcnts are being pressured to implement huge-seale projects (0 import water from somewhere to meet the increased demand caused by population growth. As Leopold said, "Violence (to the land) varies with human population density; a dense population requires a more violent conversion" (see chapter 1). In the case of chemical herbicides and pesti' cides "pplled to tlle soil, kinds and quantities produced in ever increasing amounts ex("eeu the ability of the Environmental Protection Agency to keep abreast of practices. The problems caused hy the avalancbe of new products and product combinations have resulted in a vast increase in regulatory legislation and a huge bureaucracy faced with an almost superhum:lIl task. That the chemical intermediates and products arc basically lethal to many forms of life W,lS dramatically demonstrated on December 3, 1984. in Bhopal, India, when a pesticide intermediate, methyl isocyanate. leaked from a storage tank and killed at least 2,000 residents in the vicinity and !njmed abour 20(),OOO. The justifiea tion fClr the usc of toxic chemicals is always a t wofold argument~that increased crop yields show a favorable costibenefit ratio in economic terms, and that increased yields are nece$sary to feed a hungry and expanding world population·. The Environmental Fund is on record as believing "that every major facing the United St:ltcs as a nation and humanitv as a whole becomes more difficult to solve as population increases."·" Their supporters would have to be classified in the present context as idealistic survivalists, pursuing the twin goals of a healthy ecosystem and a stabilized healthy population with a balance between

C/LOHA

51

r BJOt'f'H.JCS

hirths and deaths. Their posltlon, supported bv many Catholics as well as by non-Catholics. would appear to be on a collision c;mrse with the r~peated admonitions of Pope John Paul II against artificial contraception and sterilization which, the POl1li1f said, are "always seriously illicit.";; In the opinion of many, tbe Pope would appear [0 be advocating a course irrevocably committed to irresponsible arKI, indeed, miserable surVival, in terms of net results." Only by eontinned dialogue between religious leaders and dedicated idealistic survivalists, and between medical ctbiclsts anel ecological bloetbicists, can some kind of agreement on priorities be reached. Another example of seemingly irresponsible behaVior with respect to future generations and of tbe effect of economic pressure on priorities is the eaSe of the tobacco industry The American Cancer Society has for some years poin ted to the connection bet ween cigarette smoking and lung cancer. Recently they have publicized dangers to the of[spring of mothers who smoke during pregnancy. Cigarette smoking has been credited with causing 30 percent of the total cancer incidence in America. Now tile )lational Advisory Council on Drug Abuse has in effect said that it is irresponsible to promOte the sale o[cigarettes bvadvel·tis· ing in newspapers, magazines, and billlx;ards, and they have proposed a tot.:11 ban on such :ldvertising." Cigaretle advertising on television bro;J.dcasts was banned fourteen years ago. LloydJohnston, chairman of the council's subcommittee on prevcntion, said that cig;u-erres arc the most widely advertised product in America, with the industry spencling :lome $1.5 bil, lion a year on advertising. The Federal Trade Commissi on has esIimated tbat half of all billboards in America advertise cigarettes. Now the economic losses to the industry and to the advertising media will have to be weighed against the filet that smoking i5

estimated to kill about 350,000 Americans (';Jell year, according to the council. Hut of all the forms of irresponsible survival with respect to future generations, ignorance, super, stilion, and illiteracy are the greatest barriers to a hopeful future for our descendants. It has always been said that om children are the hope of the future; hut unless they cm read ami develop skills and an ethical understanding of the natural world, they cannot develop into or select leaders who can plan for tomorrow's world. Leopold said, "Perhaps the most serious obstacle impeding the evolution of a land ethic is the fact that Ollr educational and eco· nomic system is headed away from, rather than toward, an intense consciousness of land:' ACCRPTABLE SURVm4L

Aldo Leopold was concerned with the concept of "carrying-capacity" of the physical environment for the plants, animals, and hunlans that occupied :l given space. We can judge that he was thinking about stffvival when he wrote in "Tht: J.
53

But'lding on tJJe U!o)Jold Legacy

52

And it is in the foreword to the Almanac tha I we find the comment But wherever the truth may lie, this much is crystai· dear: our bigt.,ter-ar1(j~bett.er sOdety is now like a hypochor:.ufiac, so obsessed with irs Owr.. eco~ nomic health as to have los[ the capacity to remain beailhy. . Nothing coulcl be morc salutary at this stage than a Hule healthy conlernpt [or a pJethora or materia] blessings. (Ix)

In more recent times Le:ster R, fJrown, president and director of The Worlllwatch Institute, Washington, DoC, has done the m,,,t to urge thought and action to preserve what we Can of the natural world in interests of acceptable survival, or, in his terms, ;a "sust::iimlble socicty" In a series of books and brochures from the institute: we find a wealth of well-documented material, ,)11 of which is relevant to the concept of acceptabk survjv~1. including Losing Ground: EnFirrmmental Stress and Wbrld Food Pmspects by Erik E Eckholm_ 36 In a powerful eft()rt entiti<"d Building a Sustainable Society (1981 ),37 Brown describes "The Shape of a Sustainable Society" ~which to me is a first attempt to describe acceptable survival-as well as "The Means of Tr:msition," "The Institutional Challenge," and "Changing Values and Shifting Prioritieso" Summing up the present Situation, he s'lid, "\Ve have nOt inherited the earth from our fathers, we are borrowing it from our children" (359)0 It is interesting to note that although he seems unfamiliar wilh Aldo Leopold, he speaks like a true diSCiple when comments, '~A world that now has over four billion human inh;lbitants desperately needs a land ethic, a new reverence for lanli, amI a better understanding of tile need to lise carefully a resource tlUI is too often taken for granted" (352)0

1. Norman J, BerriJI) 11[an's Emerging lvJind (Nc\,v York: Doud :VIeau aIlU Coo, 1955)0 2, ALm IGregg, "A Medical Asp.ect of the Population Problem," Science 12J (1955), oSI--H20 0

3. Leopold, Sand County Almanac, 1987 :d';:r2~Q, !he page references hereJn are from the 19K! e lUon l.5ce cilant<:'[ 1, n, 1). " 4, Ga~retl Hardin, "The Tragedy of the Commons, Science 162 (J968), 1243-41L This essay has been reprinted in countless f'Ubbeqtlent publtc
_

0

j

!lu/ldfng

14. Ch;1rles Darwio, Tbe Or{gfH of 5;pecies, 6th ('<1, (London'

John Murray, 1872), 428. 15. W. Alvarez tL a~., "The End of the Cret,lCeous: Sharp Boundary or Gradtla, Trdnsitiol1," Science 223 (1984): 11R3-85, See also \'V Alv:1rez et 31., "Impact Theorv of M::;ss Extinctions and the !nvcrtebl'fUe Fossil l{ccl.,:;'rd."

Sciew.'e 223 (19R4)e l\'\S-41. 16. R. P. Turco el a1., "NUClear 'X"inler: Glnha! Conse~ qw!'nces of Multiple Nuckar Explosions," SCience 22:2 098:1): 1~H)~92. See also P It Ehrlich el al., "Long:U:nn Riological Consequences of r-;uc1ear 'W'ar," Seier/co 222 (198.'I)e 129:\-130(),

17. Jonathan Schel!, The Fate oj tbe flarth (New York: Knopf, 198,,),21, J30. 184, 18, Lewis Mumford, Values for Sur",,)al (~ew Yorke Har, court, Blacc, 1946). I';), Vogt, Road to ,'-·,'urvit;ai. The a:Jthor later published People: Cballenge to Survival (New York: \v. Sloane Associates, 19(0)" 20. Darry ComrnoneI, Science and SI,ui'iFal (Kew York: Viking Press, 19(6). 21, n,e Progressive, The Crisis of SUrD/lml (Glenview, Ke Scott, ForesnnlI1, 1970)" 22. Garrett HardIn, E:x.:ploring /'few Rthic~;;Jor Sunival, (;-..;y Viking 1972),75. 2,), Joseph \\I'. ~iccker, The Cornedv of 5·urvival )brk:

Chades Scribner.;. Sons., 1(72).24. Dan:e[ Callahan, The l.l'ram·-lY oj Survival {New York: ~'v1aemillan,

1973).

2'), Leonard Williams, Challenge tu ,)'unival (:'\ew York:

Harpe::: Colophon Books, Harper and Row, 1977), "I3ioethics and the I-luman Prospect," in 26. V R. St:wYes i,''i :\'cience and Culture; vol. 1, The Culture oj lJt0rnedtClne, cd, D. H, Brock (CranburY N.l.: A'-;l')ocLHlon of l:niver;.;.ity Presses; - :984)) 124-37. 27 John YeHen. "Bushmen," Science 85, May ';5'85, 40---48 Dr. '1:'ellen is (lirector of the ar:rhropology progmm al the Xalional Science FoundatiDn

iJN

{be LtJOt';old Legacy

55

28 Llovd Timberlake and Anders W'ljkman, Natural nis~st.ers: Ads of God ()r Acts of Alan (\xras~il1glon, D,C Earttlscan, 198-,), 29. "f\;'dLural Disasters Said Man~Made," Wh5consin State Journal, l5 November 19tH, 30. '\¥r'i:sconsin ,Slate Juurnal, 17 Octobc:r 19H4, Dr. Jor:as Salk "";IS quoted 31. The EnVironmental Fund, "\Xl:Her Avalhtbilily and Pop'J.lation Grow7h," TEv Data, ~o. 16, OctOber 19tH, The fepon was bascd on (lata from rhc ItS. Geological Survey, l'v'atiortal \faler S'urnmary (198::',), and Burea;1 of rhe Census, Estimates of tbe Pnjntla.tio"{l, of Ule States, July" 1, 1981 ~o 1983, 2, 32. Stated on most literature from The Environmental Fund, e.g" TEf Data I\o. October 1984, cited ir. n. 31.

33,

J~~'ll~~.u'l;~;~ ci~~;:tS;h \I~:;~~~n~;:a:~~~tev:~~1;~~~;: ~; 'januarv 1985,

34, ~Lc::;ter' Drown, Building a Susrainttble Society (New York: W. W. NO!Ton, 1981),330. Brown commented, "A~

for population is:-;ues i fcw reHgiou's orgJnizations have beee at the forefront of social ~1Ctivism and somcamong 'them the Catholic Church and the more fundamentalist Muslim sects-can only be couoted as det.errems to progress." , National ADvisory Council on DfUg Abuse, reported In iXfisconsin State Juurnal, 27 January 1985. Erik P. Eckholm, [,QsiJJg Ground: Envirmrrnental ~)'tre!;)s ami Wbrld li'ood Prospects (New York: W. W. NortoH,

1976).

nui{din,~ a Sustai-nclble S()cieiy, This book is by iar the most aut110ritative and best dOcu::H:nted wlth respecl to The many issues involved in population, resources, and human survival in tbe long lerrtL

37, Hrow-n,

DILEMMAS IN ECOLOGICAL BIOETHICS

WrlEN ,\LDO LEOPOLD completed h10 textbook on Gume Murtagemenl and began the work that would

culminate in possibly his greatest contrihution, he drew on his extensive hackground to produce two axiorm that deserve (lUr attention tOday First, he established a baseline for all future dbclissions: "An ethic, ecologically, is a limitation on freedom of action in the struggle for existence." Second, he justified his entire argucment t()r a land crhic Oll the 1'01Jowing b:lsis: '~IUl [ecological] ethic maybe regarded as a mode of guidance for meeting ecological situalions w new or intricate, or in volving such deferred reacrions, that the path of soci~j expediency is not discernible lo the average individual" (see chapter 1) The genius of the man was evident in his abHity LO f(xcsee that mt.'re would be situations so new and intricate or with such deferred consequences that exceptional insight would be reqUired LO plan in the public interest. HIC could t()f(:sec ,he dangers in lampering with nature even jf he could not imagine tbe specific dilemmas that today confront governmental agencies charged with the protection of the "average

'59

(;r ORAl RJOFTJ/lC:::.

individmd." He could not foresee the probkms connected with the disposal of the waste products from nuclear power plants or with the disposal of the byproducts of chemical industries. I Ie could nor foresee the deliberate dissemination of thousands tons of pcsticides and herbicides on agticultural land. He could not foresee the possibility of a "nuclear winter" that could result from opening exchanges or nrst-use strikes with nuclear weapons. What he saw was humankind's uttcr dependence in the long term 011 the natural environment, which he saw being depicted and degraded even in his ownlifelime. What he saw was lhat drastic changes in the natural envlronmcnt can destroy its ability to support the human enterprise. Hc maintaincd that violence t.o the natural environment varies with human population densitv. 'A dense population requires a more violent eonve~­ sion." Thus Leopold was the forerunnl'r of the so called modern prophets of c\oom, who proclaim that the human species is on a collision course with disas· tel' unless we as a species can make drastic changes in om ethical behavior toward each other, the planet Earth, and Its biosphere. FROM KNO'.VLEDGE TO WISDOM

The deflllition of an optimum environment and the vallle judgments that iustify our position consti tute the task of ecological hloethics, It is not a task for scientists alone or for humanitists' alone. Il is a *The \.vord "hu:naniriSi" was not coineu by me, Allllough I !,",lVC; lost the 5~JUfCC, the word was coineJ to refer to peop:c whose diSciplines an: in one of IT;e hd:1lanltie5, Humanis~ is often used to describe "hlln:anitist3," and 10 exdLl\.~e sc:enti5t:," Humar:ism 15 defined tIS .my system or :nodc of tllOt~glH or m:Hon:o whJch hwnan imerest5 pn:do~ninate.

task for broad-based humanbts who can comhine biological and other scienlific knowledge with knowledge from the humanities and modify or adapt traditional moral principles on the of Leopold's two hasic axioms, listed <,arlier. [n1971 I ontlined seven properlks that might he found in an optimum environment ' These were seen favorahly by George H. Kieffer, who repl'Oduced them in his 1979 hook, with an extended discussion of "Future Ethics."2 \Vhen we think of environment we quickly come to realize that. the environment in which we live today is largely determined by the culture of the locality into which \'1e arc born. The natural features our environment may seem relatively unim· porr:dnt to Leopold's "average individual," especially if born and brought to maturity in an urb~n milieu. However, for those who think about the future, consideration of the role of the natural env;· ronment cannot be avoided. Understanding the "is" of the natural environment leads to value judgments of the "ought" for the hnman sp,:cies, that Is, to an "cologieal bioethic. As concerned humans we "ought" to consider the "is" earth's carrying capacity and how it can be enhanced and preserved. My de!1nitlon of an optimum environment went beyond the natural environment and inevilablv included some aspects of the cultural environment. However, it can be emphasized that medical knowledge, including that of my own backgroundphysiology, nutrition, and cancer researchprovides a fairly good consensus on wh~t constitutes normal function as opposed to pathological aberrations. As such we can regard my tlrst twO points as basically a description of "whal is." It was proposed that an optimum environment:

of

GLOlJ/1L WORTlffeS

I. Should provide basic needs that can be satisfied 11): effort: food. shelter, clothing, space, privacy, l<.:lsure, and education (both moral and intellectual). 2. Should provide freedom from tOXIC chemicals unnecessary rraum'l, and preventable diseas~: Trauma includes unintended exposure to damaging radiation. (POlter, Bioethics, 13,,\-118) This is not the occasion to present In detail all of the current dilemmas in c'cologlcai biocthics, but it is clear that hioethical problems are arising from our inability to stem the flood of new hazards, to dispme of them safely, and to heal the hi ological dam. .once set .in motion. \1(1e are presenrly losing our ahlltty to mamtaln an environment that is healthful for the human population worldwide, and we are produci~lg many environments lhat can no longer be conslciered healthy in terms of the plants, ani~ ats , and humans that must reproduce and develop In a nontoxfc enVlW1llUem.

:n

TIlE DOLLAR DILEMMA

DEPLETION & DEGRADm'JON OF WATER RESOURGES ~

\'?h~rever we look, we sec a shocking disregard

for [he tuture water supply. Marc Reisner has docu' mented, in detail the depiction of water supplies, Willie Samuel Epstein, Lester Brown (mentioned earlier), and Carl Pope have dealt with the degradatIOn ot the warer supply by c<)ntamination with hazardous herbicicks, pesticides. In his book, Gi./dillac Desert,3 Reisner discusses the two major ways hy which American cities and American agriCUlture obtain water The first is bv the erection of dams ;Jnel reservoirs with diversion of

61

the water to wherever it is needed for domestic or industrial use or for irrigation. The second is hy pumping wmer out of the ground from 3 watcr~ bearing stratum called an aquifer in whaT is essen~ tiallya mining operation, sincc the water is pumped out at rates far exceeding replenishment by natural rainfall. Pumping groundwater did not begin to approach calamitous rates until the Invcnl10n of the centrifugal pump shortly after World \Var I. Either by building dams or by pumping from a subterranean aquifer, the decisions were always based on the dollar dilemma-whether to consider the present or the future. As Reisner st:HCS, ,; In the West, It Is said, water flow~ uphill toward money" (to Los Angeles, Phoenix and Palm Springs) (13). Reisner documents the chronology and history of dam~ building in the West, noting the parallel activiries and competition by the Bureau of Reclamation anel the l:.S. Army Corps of Engineers in a highly critical wav. He notes that as immediate solutions prove ina'dequate, proposals become more and more fantastic. In the San Joaquin Valley, pumping now exceeds natural repkni<;hment by more than half a trl1iion g'JHons a year ,it is one reason 'yOu hear talk about redirecting the Eel -:md the Kbmath

~md

rht:

Columbia and, somcuay, lhe Yukur: R:l!ec (10)

(A proposal released in the early 1960-" called the North American Water and Power Alliance or NAWPA, would divert water from the Canadian Yukon and Tanana rivers 2,000 miles to the American Southwest.) The Colo~'ado,

grou ndwater in lcxa\ I<..lr:sas, Ok13homa, New :"1exico, and Nehranka IS

-all part of the Ogalalla Aquifer, which holds two distinctions: one of being the 13rgcst Jiscre,r('. aquifer in

62

GUJRAT BfOETIll(S

the worki) the 0iller of being the ra.s;(;Sl . disappe::n{fig aquifer in the world, . , , The Slates knew the groundwater cou:dn t bsr forever (even jf the farn:ers thuught it vyould), so, ltke t!lc Saudis \v-tth their 011, had to decide how long to [nake it" bSL A rea,,,;onablc period, the>., <.kcidcc, was twer:.ty-flve to fitly y'ea:fL (lo-ll) , The opporrur,ity for economic s:--a!>iHty offered :TY the world's large~t aquifer \vas squandered ror itmnediatc spin. The \Hlly ir>fcrcnce one em draw 1S thm the :itarcs felt eoniklenl thar when they ran out of water, the feSt of the COLU1t:T would be willing to rescue them.

RuUtlmR Or) tht' Leopold Iv;jrfcv

rrom shallow wells, Grounc\w3rer accounts for almost 50 percent of the naUon's public water supplies, Several major cities, slich as Memphis and Miami, are entirely dependent on groundwater, ,mel the US, Geologic Survey est imates that 9'5 percent of all rural Americ3ns obtain their drinking water from wells (300), The major so:..;.n:cs of groundwater conG:lmin~ti.on incl~(de

iandflUs, surface impoundments, ITIlnmg

:dl.."'tivirit:s, oil and gas explnr3tion. """"Jstc>:njection

pesticide 3nd iextilizer usc, underground stor,· larks, and septiC tank>_ Additloc;d secondary s~urces of grOv.r:.dwClter contamination include agricultural feed lots. road de-icing ::;;1Irs, JcJky ,"'ewers, spills, land~sprcadlng of wasrc~, awl salt W-J~cr cncroachmenL (302)

(l()C

The dilemmas connected with the use of water resourCeS concern not only the depletion of readily . available sources but their contamination with ardous chemicals, according to Epstein, Brown, and Pf;pe in Hazardous l¥Ylste in America:' Deep aqui[ike the OgaJaIJa contain water that has moved slowly through the earth since being charged by the runoff from the disappearing glaciers during the Ice Ages thousands of ycars ago, The aquifer constitutes a source of high quality water uncontaminated by local halardous wastes, HowevCf, as soon as it is charged above ground it is vulnerable to all rhe toxic products in the Vicinity, Moreover, the dispo6al of hazardous was res by "deep-well injection" to depths of a few hundred to over 10,000 feet at up to 70,000 sites has raised the question as to whether the aqUifers can be confidently protected against contamination, Since the deep-well injection technique is economically attractive, the number of new wells is increasing about 20 percent each year. "In practice, the secmity of deep-well disposal has proven illusory" (327), While some drinking water in metropolitan areas comes from deep and uncontaminated aqui fer5, rural areas are generally served by groundwater

The dollar dilemma is everywhere apparent; the conflict between present gain and future health is clearly a bioethical problem whose solution demands access to biological knowledge, HAZARDOUS W::4S'i'P FORM,1110N & DiSPOSAL

Senator Albert Gore, ]r. is one or the nation's leaders who recognizes the magnitude of the bioetliical problem and of the dollar dilemma, In the foreword to lIazardou.s Waste in America, he summanzes the situation and the need: More than 80 trillion pounds of roxie waste ;uc dUl1:PCJ in the Cnired Smtes each and every year, -and [he volume is ::;teadHy growing. lv1oreover, several thou;:;and abandoned ::-;:tes cuesed by the indiscrimin:alc acr1011tl of past durnpeS'i h;,hfC alreJdy been identified. The economic lnten:Sl 0: inclllsuies inconven[cncec: by remedl;JJ efforts have often ourwcighcJ the public ictereM v/l".en the criti('a! decisions were ITI;;rdc.

" Yel the pro?Iem nut only persists, it is growing. since the end of World W'aJ 1I, the producoon of organ:c chemicals io the: United SLates ha<.; grown from o[\r billion poun(i<.; annuaL\' to lnore than 30f} hllPon pounds anr:uallv. AH~l of course rhc volume of chemintl wa.'m: ha" grown proponiomlldy. Ox) . l"or~xar;;plc,

Senator Gore SlItllS up his own views In words that are strikingly congruem with Aldo Leopold's views and with the present demand for a global bloethic: Our growlng numbers and our grcJ\vlng ni:astcrv of n:Htlre'S subtle pnxc:,:,;sC'.s Jrc forcing us to ,fi:}'rgL' a ne!J' ethic Of "steu'ardsbij)" ·an ethic u'IJic/.1 insists tba! we fores(;,e and {u;count for the fUir!re consequences of out {)f'(?st?Jlt aL"tiuu s. " italic:; added)

In exhorting leadership to foresee and account for future cons,xlucnces, the senator is not demanding the impossible, While the future cannot be pre dlc~ed m de t'111 , It docs not require exceptional hiologlcal knowledge to know when poison Is poison and that certain suhstances can produce delayed effects lIke cancer, birth and subtle pathology at remarkably low concentrations" The problem of regulation is complicated by an aval;mchc caeh year of new chemicals that the world has never seen in the namral environment, To assume thaI human population will evolve physiological adaptation to these hnrgeoning insults is sheerest folly, and to assume that medical skills will be able to correct everv is equally mad" Presenting the issues in much broader terms than embraced by Rd,ner, Epstein et ai, or Senatnr Gore, are Richard J), Lamm, threc-time governor CoJorado, and Michael McCarthy, in a book that arouses all the best instincts of a Leopold disciple, Far more than a parochial plea, The /jllgl~)! West, A

Vulnerable Laud and Its Future speaks for all those who live In contact \'lith the natural envirorllllenL Although the openiug are pejorative anel partly anticipatory, they set the stage for a swceptng set of assertions: Em~rgy combines, unleashed by Ihe govcrnmen::; iuyade the West. Seeking profiL unconcerned with local fears, ignore: ~Oci
After describing a winter landscape in words reminiscent of Leopold's Sand County Almanac, Lamm and McCarthy conclude a,s Leopold mighl have: Even in winter, 01, a day like thi~, the bod b fined with life, On the land, life begins. Here il is and here, too, it ends. T~e land, Ir is the sum roral of aU the WeSl i.;; or evel WJS, if it is JO"t, it is loSt forever .. , the dark :rider:.; :ue 3t tl:c gates. (324)

None of the previous writers cited in this chapter have dealt with a problem that goes beyond local concerns, Air-borne pollurion that falls tc) earth hundreds of miles from its source has commonly been referred to as "acid-rain," The U.s. Congress Office of 'Jechnology emphaslze:s the dollar dilemma: "Our -"ation's laws and policies must strike a balance hetween tile economic benefits anu environmental

ti;

CLOlJAL lJJOEIH1C,}

risks of fuel combustion and other pollution· producing activities."6 Sandra Postel has described eXlensive damage in Germany's Black Forest and in other forests in Europe and the United States.' L 13 Parker has described how the emissions from power plants burning fossil fuel call controlled" Bibhographies like the one by Stopp" are available which cover the hundreds of pubUcatlOns on the subjeeL tbat bas been sard dilemmas in ecological bioethics was synthesized and extrapolated by Governor Richard Lamm of Colorado in his 1985 book Megalraumas, A'merica at {be lear 2000,10 a st:mling vision of where we might be in the year :WOO unless drastic changes in government oolides are made, Nor does he neglect the dilcmm;s in medical hioethics. Few authors, olher lhan the present have covered the combined issues of ~edjCal bioethics and ecological bioeti1ics in a single hterary effort, but Lamm does it with imagination and with documentation. Building on the anger of The Aligry' Wi:st, he goes on to challenge st:ltus quo of the whole world. As John Baden once said, "We're traveling on the Titanic and all We do is argue about how to place the deck chairs." 11 Lamm describes dikmma after dilemma in bOlh medical ancl ecological areas. He wrole !lotIo predict what inevitablv must be but as a warning of whar might and b35ed it on much of what is, In words remindful of Aldo Leopold. h<; commented, "The greatest mlsperccption that -western man has ever entertained is that he is separate from nature and that he call control and exploit it for his material well-helng. Human dommion over the ear!~ means all living things will inevitably end in tragedy (1S0). Here he clearly means dominion with in,bt"is and wilhout humility. In his epilogue he reminds us thar .

The United SlateS 15 fun o( poHtlcial1S ,'.:ho hide the truth from the public and often from then:sdvcs. We break the rules of history, eco!1ol:1ics. and the socia. sciences ;led h1:}pe lhJt, for die [irs':. time in we Sh:1U not havt2 to pay lhe prlct' . , . It is my prayer that someone is listening. (2 '14-45)

Daniel E, Koshland,Jr, a member of the Nalional Academy of Sciences and presently editor of the official AAAS iournal, Science, commented in a recent editorial on "Inexorable Laws and the Ecos,ystern' With the pnJblem oulHr!ed in glob:::llerms, 1t ·is dear thaI a ret:linking of pl'tOfitief' is neccs;';ilry. The popu hdon explosion has ~o lI1cwe to top prlorlty. There 1s no way that the problems from C;1rs, chemicals, bad Ltnd lise, Jnd:-;o on, \Vili not accelerate if rhe populalion keeps incrcar;ing , .. Perhaps the politically fca~ ~lble line is a negotiated t'4llality of ~acrifice, .. it is l:I11e to mke ~ global look at the polldes aed priorities thac afe our ecosys::efi1. 11

Pope John Paul in a remarkable encyclical letter entitled Social Concerns of the Church," took almost exactlv the same view that Koshland expressed, with one exception: he seemed tot~lIy obliviolls to any problem arising from the exponential increase in human populations. Commenting on tile dangers of overconsumpt ion, he stated: A :;];...i ve mccha:njstic optimism h15 net'l1 rep laced by a well-founded anxiety for the fate oChumar:ily

At the same time, however, the "economk" con cept itself, linked to the word has entered into crisJs. in tact, there is a understanding today that the nIt'ce accu.nlulation (If guods ",lild services, even lor the henefit of the nlaiorlty, is nOt enough for tlH~ realization

or human

happi~

ness, . Unless all the considef:3b!e body of resources at man's disposal is guideu by ;an oricma· lion toward the true good of the hum'd!.i race, it easily HlfnS <)g:lir~st man 10 oppress l-:im ..

CLOiL1L EIUET11!O;;

1. Van

W'e rind ourseh'"cs up again5l a form of sw)ercleve~opmenr , .. 'which cOllsist~ in an excessive avaHabil· 1:,)', . kind of m:Jferi.;)t goods [or thL benefit of ~;~::am SOC1~j g,~'oups, l.~tl easily makes peopJe slaves 0" possessIOH and ot1mmedhttegr~tjfjc3t{Oll, with no other horizon than the multiplic3tion (~f the things aire-a.ely owned with olhcrs 5tH! hette'. _ . , A tr~e con{~cpt of development cannot ignore the nse Of. the dement'; of nature, the renc\vabHH, of :e~our~e: a.r:d ~he consequences of haph:17ard 111dllsLmll1zat10n,~three cOIlsltiemtions whier! alert

our consciences to the moral dinH::nslons of development, J ~

. While Pope John Paul is moving in the direction of a global bioethic, he [,ils to recognize that there <~~c :~(~,r:r~~1e~vahle resources! that the continuing teneW,lDlhly of other, cannot be :l55Umed, and lmally, that the human capacity to reproduce is at present as much out of control as are the processes of "superde:elopmenL"". When Leopold spoke of the far-reachmg cHecls of rnan,made changes and of "Yiolence" to the environment increasing along with tb.: human population, he w:lS plainlv concerned with the possibilit)' that the human sp~cies, with its ~ast technological power, might have malignant ,efteets ,more comprehensive than is intended or i:>rcseen ' which might in lime destroy irs host, an E:mh no longer "Mother," .. A synthesis of the Yle,,:s of Koshlanc1 and Pope ,Tulm Paul II seems to call lor a global bioethic that can transcend the dichotomies bet ween science and religion, 1n my opinion, such a synthesis cannot do betl.(:r thal1 10 build on the foundation begun bv Aldo Leopold when he articulated "The Land Ethic:"

Rensselaer Pouer, "How LS an Optimum Environment Defined?" in BioetiJics, Bridge to the Futur~. eeL V R. Potter (Englewood C[lfffi, PrenticeHali, Inc, 1971), j33-4R 2, George 11, Kieffer, "An Ethic of N(lwrc," in !3ioelhics, A Textl1oo-k of Issues (Rc'aJing, Mas;.;,: Addison-Wesley, 1979), 3 7()~ 71; and "Ohlig3tiont~ to r"'uture GE!lcratlons," 345. Kleffer argued thai there 1s a dose llnk between images of thc lulure and ethlc~, ":Ethics deals ,v~th the re;11m of what nugiJt to he ~{nd Ihis autoI113tica'uy prestip, POH:S a picture of the future in:-1 way rh:Jt cootrast"} with the prc!;;enl. F:~hlcai de,ci"ions arc nOrInally conclusions for gui
3. Marc Reisner, Cadillac Desert. '(be American- West ({nd It;;; Dl.sClP1H}dring \Fater (!4cw Yorlc vik:ng Penguin Lac., 198()).

-4 Samuel S, Epsteln, Lester lC Brown, and Carl Pope, I fauudous \tasfe in Am(5rica (SaH Francisco: Sierra Club Books, 19H2). Hundreds of bOOKS, and g:()ve!:n~ mcnt reports are convenkntly assimilated into :,95

pages, a In'8.ssive appendix of 172 bly dClailC'd an thor' and ~ubject


'5. RkharJ D. Lamm and "'vtich't!e1 McCarthy) 'j'lJe Ang}~'j West, A Fu.!nerable Land and its Future (Boston: Houghton Mifflill, 1982)j 5,

6, Office of 'fl'chnology Assessment, "The Policy Dilemm3," iuAcid Rain and 'Jransported Air pufluiants: fmplicatious fur Public HJUcy (\Vt.k~h;,ngton, D.C,: CoS

Cc,ng,re,',sOTA-O-krH, 1')84).26-37 .., S:munl Postel, Air Po/fution, /k:id Rr:-lin, and fIx: Futnre (~r Forests, Wodciw2tcb Pap\,:( :-":0. ')8 (\~!shingt()n, D.C.: W'orldwatch Institwc, 198/1''1, See also Edwin Kiestcr1 "Death in the Black Forcbt," ,)'mithsmtt'c/H 16 21l-30 8. L B, Parker, AJitip,ating Acid [{(J-in t.pith Technology (\XJashmglon, llc'; Govcrmnenr Printing Ofi1ee, 19!{-)). 9. G. H, Slorp,JL. Acid Rain: A HibliograjJhy Research (Metuchen, Scarecrow Pre-ss) 1985).

7U

GLOBAL Bl0ETHlr:S

10. Hicliard D. Lamm, lIJr:j!,atraumas.' America at the l't'ar 2000 (Boston, HOdghten Mlftli:l, 1985). 11, Attributed tOJohn Baden who made ('ssentiaj!v this st;jte~ ment m a lecture in :\!atiison, \,\li5con5io, lJl:t c"ocumentation nl)t here sec'Jred. The allcgori(:±l st:.ttcn1C'nt is, bow~ ever, documented by], Baden and R, L Stroup. eds" Dureaucrac.v us FnvirolltJU'nt,· 1DP Fn!)ironmenta/ Costs ofBureaucratic Got)erncwce (Arm Arbor: The t I nivers!(v of ~,tichlgan Press, 11)::3"!), The editors seek [he (k:~velol;~

mer:l of private: institutions and remodeling of public in:.,tltutlons to foster efficient 2nd non coercive stewardship of n.HurJl resources. 12. Daniel E. Kc·sh!;md, "Inexorable Laws and the ECt).'}yskm," Science 237 (1988): 9, 13. Pope John Paul Ii, "SulicitUdo Hei Socj~Jjs" ("The SOciai Concerns of lhe Church"), 19 february 1988, E.xcerp:s reprinted in New hwk rlmes 20 :Fcbruary 1988, 14. Nicholas Polunin, ed., hGrOWlh W'ithout Ecodisave his world bur still shuv,rs rn:Jdcquatc ,:-igns of act~

TWO KINDS OF BIOETHICS

j

ing in rime:'

If SEEMS WORTHWHILE at this point to note the hio-

torical development and ongoing evolution of the global bioethics concept. Aide Leopold laid the framework for an ecological and population· oriented bioctbic5 of survival In 1'0)49 in his seminal

essay "1'hL Land Ethic" as well as in earlier eSS:lys. Con-tinulng Leopold's line of thought, in 1970 I coined tbe tCfm "bioethics" to describe the ,umt1gamalion of ethical values and bioioglcal facts, and in 1971 published Bioethics, Bridge to the Future. This

concept of bioethks was formalized il!-'!)lgure published in 197'), here reproduced as'tigure f; However, an independent movemcIll had begun at Georgetown !JniversitY which utilized the word "bioerhlc&" anci applied- it exclUSively to medical problems in a newly-created Center for fliocthics. Its cireetof, LeRoy Walters, stated, "llioelhics is the branch of applie-c ethics which studies practices and developments in the biomedical fjelds.'" !t was

/

I I I

~£9_'2tL t1,OtTH,CS

~

i;cOb9S~ ~!S~:::.,ICJ~.

l.H\:fAAN CAPAalu~-IE5

LE'iVIROf.:MCNTAL (;4PA31~ TiES

2. Hi;MJP>I FRAiL TJ:::5

2, ENv/ROill'AENT A ~ FRAILTIES

"

INDiViDUAL PROBLEMS

/'

SC::fETAl PR09 .. EMS

implicit that the focus was on the ethics of individuals in relation to other individuals ami not on Aldo Leopold's "third step in a sequence." Evidence for the exclusion of ecological and population prot !ems is abundantly clear from the collection of eighty-seven essays in the 1978 book Contemporary Issues in Hioelhtcs, edited hy 10m L. Beauch~mlp of the Kennedy Institute and LeRoy Walters from the Center for f\ioethics :n Georgetown Cniversityc They highlighted their point of view in the prel'dce: Recent develormenls in the biomedical Held:, have icd to considerable :noraf per;·;lcxify about tht' rights :md dutic<., of p;)ticnL<), lH:altL professionals, !:cscarch subjects,
C01:1P;CX

eth:cal

iSSlles

raised

thC8C

uevdoJ'Jmcms.

Alelo Leopold's land ethic w~s overlooked as were events such as Earth Day (April 1970), which initiated environnlel1Wi tcach·-ins un nearly every cmnpus In the country. It is not clear why the ethical issues embedded In this entire matter--I.e .. the exponentbI Incr(;:I5<:: In the human population and the impact 01 thiS uncontrolled growth on human survival-should not be considered basic to the contributors' discussion of the role of the medical profession In r.he modern world. Nor is it clear why issues in hioctll· ks should be focused un the moral problems facing the physician who must confront the Celt nced for performing abortions without discussing the avoidance of pregnancy by means of artil1cial comracep tives such as conuoms (see chapter 5)

74

More recently, the separate paths taken by medical bioethics an~1 ,,,,cologieal bioethics were noted as shown in Jigure i.',The further evolution into a global bioetl'i1cs;;i5_proposed in the present effort, is shown in .J1gurc It may be seen that healthy individuals and-;iTlealthy environment arc given top priority. Controlled human fertility and a worlel population stabilized at lower levels than seem to be inevitable in the tenure are considered to he ahsolute requirements for the twin goals of human health and environmental health.

l:~~~::~~:~J:~::~J~ii-:~;~: -iTH;-C-;- CANNOT

!

2J

The general tcrm "biocthics" has to be qualificd by mentioning the major areas under discussion. From the outset it has been clear that bioethics must be built on an interdisciplinary or mullidisciplinary base. I have proposed two major areas with interests that appear to be separate but which need each other: medical bioethics and ecological bioethics,' Medical biocthics and ecological biocthics are nonoverlapping in the sense lhat medical bioethics is chiefly concerned with short-Ie'rm views: the options open to individuals anel their physicians in their attempts to prolong life through the use of organ transplants, ,mificial organs, experimental chemotherapy, and all the newer developments in the field of medicine. Ecological bioethics clearly has a longlcrm view that is concerned with what we must do to presenle the ecosystem in a form that is compatible with the continued existence of the human species.' However, these two branches of bioethics should properly overlap ill the matter of individual human health, the control of human

ECQLQ(;ICJll BIOl rHICS

1

LO"G-T[~1.t

/c~ [COS)'oTEM flEGlECTED

;;"~UE Pl~Gfu ON INnIVIDUA~ ~UR~;;;AI..

I DEQRA~~U,

i~~:~\'8T/F-~~ ~

~NCONTROl

LtD

FERT'LITY

rxOANDING

WO~li)

PO~UlATIO~

----------------------....

BIOLDGIC,~~!~~.=.~J

lNVIRO"M[~TAl ET~ICS ENVI~ONMEMHl-l 8ICEH
ME'DICAI, [TI,'CS ME~,G4~ BIO(T'H:S BIOPI,,9'C4l UHIC~

j' I---THE MATTER OF NOMENCLATURE

BE SEPARATED rRDlH

)

VIEW

~~

W.lUE Pl,'CE.O ON ,PEc,n SURVIVAl

VALUE PLAC~D ON H[!lLTHY [CO$Y5TtM

CON rf
~IMI1ED

POF<JLAT,()N - - _

CROW:

~

_-_

HFAlTH~

FC05~STEM

IT'S ALL A MATTER OF BALANCING THE OPTIONS! Fig. 2.-The hypothetical consequence::; of the dive,'gent value priorities established by medical ethiciStS and environmental bioethici::;ts. It is not iIllencleci to imply thal the dichotomy is absolute, since inuividual ethieis:s will pbee varying e:nphast's on specific l,)ng-lerm and short-term vie"l.VS. The concept of "acceprahle survival" as oppo::;ed W "miserable surviv~d" is discussed in chapter 2. Much has he en wriuen about environrnental ethic::; without mendoning tbe need for controlled fertility, while muclI has heen written about the rightfi of individuals wit~10Ul discussing the need to preserve a healthy ecosystem. In Lhis ch:Jn the dual needs for controlled fertility :.tad a he:Jlthy ceo·· svsrem arc seen as essenLi:11s for 3n 3cceptable. survival for the h"llman specks, Uncontrolled fertility is seen -as the result of ':m ernpha::;is on incliviciual survival or of dealh control without tin 3uequare emph3""is on birth control by artifici31 COnlGICepLion; COlllfoHeci fertillty is not seen as incompatible with inciividll(l] ~urvivaJ and rna'v in fau enh-allce it. The chart is irllended t.o er-nphasi:zc the n~ed for resolving the dlchoromy inlo 3 anified global bioel:tics.

76

Building on the Leopold lega(v MEDiCAL RIQETr-'CS

ECOLOG C,'>.,.. 8iOETf- CS

~~~

/

,

:"'OIV'[;.,JAL PROBLEMS

/'

l:'::": T:':~PPRQ8LEMS - - POPJLATION

H:'AL"'f'Ft..L ENVIRONMEN:-

I !.JD!v/DUAL HEALTH

"'/

CON-ROLLED

-

SPECIES SGR\jlYAL

ST4B~L:ZEO

'-!LIvIA'
FERTiU";'Y

~

WORLD

FO?ULATION - - _

L: C_CEP-T~A8L!ESU~RVIVAL] A

:'J.-C1obal bioer.hkE ccohjg! ...-al hioctii ic'l.

d.':'

HEALTrY i;(;8$Y$TEM

_ _-'

a unif1catlon of medica: bio<:,th:c::;

"rhe COf:o:rns of medical biocth;cs anti t'c0logicaj b;oe~hic~ a3 prc~cntcd In figure 1 ~1fld the shuft term 'l~L long-term dic!iot· omy shown in figure;: are here nsolved intO ;) unified 'set of goa"s lll,~t include;J l1f:;J.\lh2ul cnvironmct,t (for t)coplc), Lndlv:dual t:I:
reproduction, and in th.: attitude tow2n.! the significanceof an cvcH~xpanding human population. < The dnve by professors of philosophy to identify themselves in their new vocations has led to some changes in the labels given the new applica tions of ethics. Thus, medical hiocthics or hioethics has become biomedical ethics. 4 Similarly; profcswrs of philosophy bamled together to form a new iournal with the label Elwironmental Etblcs. ' In both of these instances, attention has been given to the professional background in the field of ethics. The early developments at Georgetown University led to the choice of the word biocthic5 and to the disposal of the long-standing term medical ethics, which could be traced back to the Oath of Hippocrates. Gorovitz decided ro refer to medical ethics as dealing with questions of professional etiquette, and he agreed with the evol ution of medical ethics into biocthics in conformity with the Georgetown Schoo1. 6 In 1986 Goravit?: still employed the term hioethlcs solely in the medical application,7 As described in the preceding chapter, Aldo Leopold noed the simplest possible tcrm~land ethle~but then was forced to go to great lengths ro explain h is meaning: that land is more tban soH, more than the space occupied by a shopping center; that land includes water, plants, and animals. For him, land included the whole biosphere. I believe he would go along with the term ecological bloethic, for he repeatedly indicated his emphaSiS on ecological principles, as when he stated:

"'Those who regard "overpopulallOl:" as a myth do not L"Vc:nmerit Ci1..1rlon in my opinion, They inducieJdian Simon, Ben W.'menberg, and John Tierney. Sec Rohert S, McN:an1.'tm, "Time Bomb or 1'<'1yth: The Popubtiof'l Problem," Foreign .-1ITairs 62 (1984;: 1107''',)1, for opposition to the myth proponents.

7H

GUJBAl: R1QFTHTCS

An elhic, ecoiogicaU y, is J Hm:tat:on on freedom of action 1n the struggle fur existence" , " , An ethic may be regarded as a nlode of for ll1<,etlll, ecological sitLJ:ations SO new or intricate; or involvir:.g such deferred reactions, that the path of "iodal expediency [for humankind's survival] is not dis· cernible La the aver.1ge individuaLS

I also believe that he would accept the usc of the word biocthics in place of ethics. In his discussion of the evolution of ethicS from inlerperS01l31 to the nolation of the IndiVidual to society and finally to "the third step in a sequence," be saw the extension of ethiCS to the entire biological community-the creation of a new ethic not preViously enunciatecl, in fact an ecological bioethic, At the present time it is necessary to go bcyond Leopold and beyond medical bioethics, We must recognize that over-specialization in either branch can be cOllfllerpro(lucllve to the of acceptable survival on a global scalc. two branches need to be harrnonizc<.1 and unified to :1 consensual point of view that may. weB be termed global bioethi<;5, stressing the .two meanings of the word globaL A system of ethics is global, on one hand, if it 'is unified and comprehensive, and in the more usua I sense, if it is worldwide in scope, THE MATTER OF ETHICS IN HIGHER EDlJCATION

Aceordlng to an unpublbhed smvey of hioethics teaching by Carola Mone for the """Lll,,,, Cent!:r, Clouser estimated that there were over 1SOO leges offering courses in bioelhics From an informal survey of college catalogs, Mone found practically no such courses in existence from to 1965, In a survey reponed in Jon Hendrix,lo 45 perccnt of the courses in hloethics

jJwidi'lg on the f eO/MItl LeJ-;.ury

79

were hdng taught In biology clepartments Biology professors were responding to a popular demand, which was perhaps triggered hy the celehrmion of Earth DefY on April 22, 1970, The rise in hioethics teaching in hiology cJepattments hetween 1965 and 1977 also coincides with the many adoptions of my hook Bioetbics, nril~ge {O /be i'1ltUYe. Clouser explains the narrow views of the medical profession as the inevitable result of the medical school environment: The setting (.s, j n f.ir1Cl of concc9tua: ghetto, and bcems to reflect [he setting of all professional schools, not just meJ:cine, \);r~en the san:c presupposition~, purposes, ;loti pOint" of inlerest art' shared by a cornml1nity, I;: is as though they art locked into a 2hetto. Their view of themselves, oth~ ers, lheir relationships, goals and desiderata ;ire the S
Callahan and Bok have been particularly concerned with the preservation of professional standards in the leaching of ethics in higher education They comment, \X7: 1ile ~1 conSiderable purfion of the reaching of eth· ks tai>.cs r>ace \Vilhin depJrtl1icnts of phi~(,jsophy and reUgior., ~:mght by those with docromre,<;, i:! those fields, prClb~lb]y the most sign~tlcatH devdop~

mem in the P:.iSt decade has beefl the spread of courses bcyoe.J those discipl1nary contextS. That t>nread, in turn, has p.jscd ~ignific
They also raise the question of "whether it is possible to teach such courses without engaging ill unacceptable indoctrination." On the other hand, William Bennett, former Secretary of Education in the Reagan Administration, has vigorously criticized

flO

8i

any unwiil ingness to assert that some things are right ami others wrong that their vbion of ethics entails. 1',2

THE LIMITS OF PHILOSOPHY While Callahan and Bok were concerned ahouT the qualifications and credentials of biocthics teaell cr,5, Callahan, in another connection, exprc:s.sed the vicw that "hiomedical ethic;; must now move inTO a new phase" because "only rardy Can eThical analysis and prescription lead the way in social ami CUltural change," He noted, For some dccades, especiaHy during the 405 and 50E, phJ1osophy W:I.,':; a narro\v, (j ry and tcdlnicaJ field. Only recently htl;') jt come out of its deep slumber, ~lb questior:s have beell raised abou: the purposes of pliljO'::'OPfl}'. IThtl~,] the c;'oniern, of biomedicine have pf1)vidcd both imeresting aml difficult materiaJ to test the prOposithm th;n moral philosophy CQuld, dC!3pitC' its sophisUcmeci detractors, h::rve LO say about hllman Bfe. In th.ll Sf'llSe, nOt <Jr.! y is medicine !Lsdf bdflg tcs;cd by ethiCS, bUl elhics if:>clf is bf"ing tested by medidne. B

And, we might add. ethics itself is being rested by ecological, population. and pollution all Over the world, That the competence of classical philosophy to solve bioethical problems is being questioned can· not be doubted. Bernard Williams, provost of King's College, Cambridge Liniversity, himseif trained in philosophy, has called fOf philosophers "to tran scend their self-imposec1limits :md to give full attention [0 the complexities of tile ethicai iife."" Williams is primarily concerned with the limitations of philosophy and never approaches the

concerns of medical or ecological bioethics. Even in a single case, that of deciding for or against :tbortion (U2-H), Williams does not give a solution bm uses the problem to illustrate the difficulties of reasongiving, He states that the attempt to rest the structtlre of knowledge on some favored class of statements has nov.' genef~l11y been ui.splaced in favor of a holis:ic tYflC' of model, in \vhich S'JH1C beliefs can be quesLiofled, justifled, or adjusted whlle other:; are- kept constant, bu'.. '.here is GO pro('cs,<, by whk:') thc')' can :111 be questioned at ODCe, or;111 justified in terms of (almost) nothing. In \fun Ncuf:trh's hU"TlO'JS image. we repair the ship wbEe we are on tl:c sea. (113)

A similar commentarv on the limitatiom of philm;ophv was almost sirr;ultaneously published by Profes,50r George Gale of the departmenr of Philosophy, University of ~1issouri, Kansas City Gale commented, \,?hen early twentieth-century physics expe:lenced ".vhAt (:n11 only be called revolutio~1;lry upr;c2vaJs, ~!S

lhe theory of rel:ttivily and quantum physics overthrew the classical world view. the d.a5sical1)hllosophy devc:lopcd hy Desca,tes, :,E'lhniz, :-J"ewton ~md Kant was overthrO\.vn as weB ,,[Thus,] [11(' philosophkal COl1;1cquences of lheSf two c,t:'W physical theories we re at least {l;, lmportant as the rheo rics themselves. H

Gale pointed to the growing isolation of philosophy from science in the 405, 50s, and 60s (cr. Callah'lIl, above), as philosophers were en!iced ~way from the prohlcms of interpreting science in order to i(KllS On problems .. internal to the means of interpretation rather than to the sul"rancc," Looking toward the future, Gale noteu that contemporary biology is

82

GLOL!.1L FfIOB'[J{fCS

a field .of increasing interaction between scientists and phIlosophers. However Gale, like Williams did not specifically menUon the need applied' phi 10,oph)' tIl medlcal or ecological biocthics. '" Going beyond the points raised by Callahan. \\' I111ams, or Gale regarding the limitations of classical pl1l1osophy, Fox and SW:l7.ey launched a broad attack agamst "bioethics" and "bioerhicists," terms which they employed in the .reMrictcd but Widely employed se~se that deals only with medical problel11S16 Their obJeenons centered on their conclusion that "it is pnnClp;Jlly American analytic philosophy-with its emphaSiS on theory, methOdology, and 'technique, and Its utlltt:man, KanLJan, and 'contractarian' outlooks-in which most of the philosophers Who have emered [medical] bioethics were trained" (356). Bnefly stated, their objection is that ind,ivjduaU~m in the primary valuc,complex On whiCh rhe ltllellecma! and moral edifice of [medic.alJ bioet!1ics rest;-;. IndIvidualism, in this connectlo.n, slan:;, 'with the belief in the importance. U;lJquen~ss, dignity, :J!1d sOvereig!1ty of the individ: u
~hile the indiVidualism to which they Object seems to reflect and systematically suppOrt convemion'11 rejativ~!y ,:o:,scrvative American concepts, values, an,1 behels (3,6), roxand Swazey are concerned that the restricted definition or 'persons as individuals' ;H:d of.'pcl'sons i:l rehHions> that perv'ades jmedican blOe'ttucs makes it d[fficllit to imrod un: and Jind al~ ~tppropriat;;.; pj~cc for v'a/ues ~ike decency, kindness, crnp~fhy, car1l1g, devoUon, service, generosity, aitmlslll, sa-crJfice, and love, .

8.l

They object when vdlue:; like these, that center on the hond;.; hetweec self and otbers and on comrr:unity, and lhat inch:dc oOlh 'strangers' and 'brothers' and future as weH as present gencrdtioH.•,) in their orbit, are categoriz.cd in [mccicalJ bioethics as sociological, theological, Or religiOUS rather them as ethical or niora!. (355)

Emphasizing the bipolar choices thal the basic indi~ vidualistic position of (medical) bioethics produces, the authors include "self versus others," "rights ver' sus responsibilities," and "independence versus dependence," among others (355). In a subsequent section I will disellss "responsibility" as a key COil, cept in the proposed globai bioethics, and here not( that the points made bv fox and Swazev are quite in agreement with my recent characteriz,ltion of medi, cal bioethics as bein!? primarily concerned with individual survival in a shorr,term time frame (see Potter, "Response to Clements" Chapter 4, n,3). The arrlcle by Fox and SwaLey has not gone unnoticeci, In a recent paper entitled "Baiting Biocrhics," GOfOvitz assembles all the complaints against (medkal) biocthics but focuses his rebuttal on Fox and Swazey in particu1irf. He assens rhat they h'l\~e misrcpresemed some of his own views as parr their case "that individualism and 3u!Onomy have an illegitimate hegemony in [medical! bioethlcal thought." Concluding that "Fox and Swney have not made their case," he adds, "but despite my criti~ cism of their complaints, I have a lingering sense that their attack on [medicalj bioethics would nOt have been so eloquent Of SO impassioned were there not a grain of [ruth in what they say" (Gorovitz, 3(7).

(;[Ol:dL BJOETJ11CS

Clements attacks medical bioethtciSLs from a different angle." She criticizes all th()se~and EngelhardT" in particular- who believe that medical biocthics should be concerned with procedure and the proper functioning of the (medical) bio('[hical bureaucracy rather than with content.

ETH ICS I]\i A l\T\'V PHA,sE In the same vein as Fox and Swazey, Clements and Ciccone, professors of psychiatry at the University of Rochester, specifIcally and succinctly challenged the philosophic viewpoint as presented by Levine and Lyon-Levine." They noted that these anthors assumed lbat the problem of patient advo. cacy (the patient's best interest) can best be understood in rhe classical ethical prinCiples of autonomy and beneficence (medical paternalism), which Clemems and Ciccone lumped under the term "universal principles." They expressed the opinion that "most articles on medical ethics routinely reject the inductive method and accept the use of principles" to support the Idea, for example, of patient autonomy. They list the arguments and rebuttals as follows; Thi~ posillon stHes th;n
1. If,1oi"al lrtfuitlOll.

Pbil()sOf;I~r 93~-9J,)

:;, Faith, Ce1'lain univer;;aJ ethIcal prilldpk!'i ~ire parr of <1 helkf sy'stcrn, The ht:,'ief system wiU work if one accepts the: partkuh~r rheology or t:1ith involved_ It mll~t fail fOt secular er hies,

Clements and Ciccone concluded that the attempt to apply universal principles em lead t~ t1;c installation of taboo .systems "valldaled by rhc_l}~: anny of numbers or the tyran~y of preJudKes They argued that treatment deCISIOns bcba:ed o~ e::mminarion of the leal world of consequences, the individual situation, and what we know about PUt

pose and funCTions-in

ot~er \vor:ls~

?n

~X:lnll~a~

tion of accumulating expcnence With Mlllliar ca .. e5 i1.ldged against the background of ,llorma: ~evch)p­ mem and function (Clements and CICcone, Apphed Clinical EthicS'} They are in fact calling for a new phase in applied ethics, a new phase that IS yet to. be enunciated in detail, but which can alrcadv be VIOU: 'Ilized as a methOdology for dcvclopmg a tmly global bioethics that embraces the wcll-belIlg of both the individual and the speeles.

GU)11t1l R!Ol!j'HU:S

GLOBAL BlOETHICS AND THE FEM ININE VIEWPOINT Classical ethics h;cs ,11ways been the ethics of lodividuals, the first two sL1ges mentioned by Aklo Leopold (Almanac, 237~64), The emphasis on the ethics of individuals has heen clearly mak dominated. Leopold advanced the biologizing of ethics in an ecological framework that cmpha,i7ed the connections between all forms of life, While he was not thinking in terms of the female role in nat· nre or in society, the current trends in the modern studies on feminine psychology are more congruent with Leopold and ecological bioetllics th:m with classical ethics and current medical bioetllics, Indeed, global bioethies is tbe logical outcome of the impact uf tlx/eminine uteupoint UPOIl medical bfoethies and ecological btoetbies, Women who ,lfe imerested in supporting women's reproductive rights mig!1t be expected to suppOrt global bioethics as well as birth control, free choke in the m,lllct of abortion, ,md preservatIon of a healthy ecosystem, H Nearly all will oppose violence, war, and tbe nuclear armaments race, while many will oppose the dom!· nation of political and economic systems by male patterns of thinking. Carol Gilligan has begun a seriolls study of psy· cho!ogical theory and its relationship to women's development from chIldhood to maturity Her slUd· ies are dearly concerneci with the concepts ,level· oped by ethicists. In reviewing effons from Freud to Kohlberg, ,he stresses again and again how women have been excluded from the critical theory·building studies in psychological research. She builds on the six stages rhal describe the devel~ opment of moral judgment from childhood to adulthood as elaborated by Lawn:nce Kohlberg, but notes that his studies and tilose of numerous others

Buildiu{:;

Uti

the !.f3(Jpo'irt rcgacy

were based on males. As sllch, she believes thal they arc inadequate for present SOCIety and ar,c inapplicable to a proper undcrstandmg of wo~~:n s behavior in society. In her VIew, wInch 1,~el1e,c um be coupled with Leopold's outlook, tb,,} n.WY«/ problem «rises .lImn conflicting respo:~slbtltUe~ ratiJel' tban from competmg ngbts (It«IICS added)." She adds lhat it requires for its rcsoluti,~n:1 mode of:hin~ln~,th~t-.iS cor:tcxtua! and na::ral1ve l':1.ther [h(;.\1 tOrJ],al ,:\1.d abstract. This conception of fnor;J,lHy as concc:rncd wirh the acdvitv of carc centers moral development a1o'Jnd the lll~dcrsrAqJ.lng of responsibi~iry. and re13tionshjp~, jusl as the conception of Ir.orailty as fail ness ties ::nOlal dc\'c!opment t.:, th:: llnde.l'st;;'l:d. ing of right;; 'and rules, , . , Thc mOf";{.hty (~f 1'lghts [~ male concept] differs from the mo::ahcy ot tcspons:bilitv in its emphasis en se9~Hation rather Iha:1 CO?neCtiOn, i:;:l its C()J)s~dcra:-!on of Ihe: indl vidual, [malE' V1C w J raIhe:: than the rd'Jt1onshlp as pnrmuy Ilemale view]:' (19j

Agl'eeing with Miller,

H

Gilligan notes,

\VOlTIcn not or..Jy define therEsclves i:l a conre~! of human n:]ali0l15hip bm abo .jtHlge lh~msdves :n terms of their :abElty to e~lre. \Xiomen 5 11131.(; ~r.

rr:an'slife

has been that of ::tUfWfer, carc:aker,

:1nd helpmare, th~ weaver?f those w=:,\VOrkS ot :~~_~ tionships on whtcb she in tun: rehe~. But W:ll;t: women have thUF; taken care o[ men, rnell luvc_. ~!1 their rheorks

or

psychological dcvcioprnenL as m ~hdr economic arrangc-mt.::r:ts, tended, to ~S~tlmC, ~r

devalue thar care. \Vhen the focus on mdlVl.duatwtl and individu;il achicveH:Cf:.t extends-inw adulthood 'and lwhe;]I maturity is eCF:ated ,with p~er5o~al -aUlOllOlfiV, concern with rdanon:'i1ups appears as a weakncs~ (If women rather than as :a hurr::H'l strength. (Gilligan, 1.7)

8.8

CfLUHA1, lJI0FTtfJr:S

In Gilligan's differentiation of women from men, which depicts women as concerned with ,hips and care and men as concerned with individua, tion, individual achievement, and personal autonomy, w;,: can see a paralle! with Leopold's reference to the "biotk arrogance of homo jlmericaullS." \X!ith human ethical theory dominated hy males detennincd to conlJuer and exploit nature, tl1ere has heen little chance for Leopold's land ethic to he extended to twc;nty·tlrst cenmry issues and to include "an intelli, gent hnmility tOward man's place ill nature,"" If is correct in her analysis of women's ego development as fune:tion of ;matomy and destiny,'" and in her enlphasis on tl1<.' differences in ego development in men and women as parlly bio. logical and partly cultural, there may he a hasis for hoping thm the women's civil rights movement could be recognized as the: foundation for a new phase of women's contribution to human progn'''', Instead of being limited to an Earth Mother fertility image worshipped as an end in itself," the modern W')man demands the right to control her own reproducriv(' choices, Fcom that beachhead, women could express a feeling for life and l;md in the sense envisioned by A/do l.eopold. They could e:xtend tile basic female outlook of clring, respOl]>!. bHity, anel networking into an omlook that would *1 agree with Uillig:!n: anatOlrlY becmse only W(l'men :are uDique!y equipped to carry, clcl:w r, and hreast~fced a ch:td; destiny beC2wic ~'C)f man y :i girl Of even z.n older fertjle

\Von);]!":

the fu"urc lnclcdes the possii-::IJity th;;t she

wm face ::In unintended pregnancy, anc!

bec:wse hUnl:1n cuJ~

tun:,,) have emphasized tbat ehHd·b<:'<1dng is Lhe normal rune rion, while childlessness j,.., nruw,tllr:1L Sm3li \vonder toat l!H.:.TC

m;,~y he diiTcre1Ce..., in ego deveJopment between

:inti wo:nCl1!

1:::;,<:11

li1citdfn{!, on (IX U!{lptJld Legca:')!

R9

include the entire ecosystem and humankind, and c"pcciaUy the women and children of the future. According to Gilligan, \\?hereas rile rjgJlis COI1.ccption of ~nor:.]li.Ly ... is "cared tp arriviltg al an objectively fair or Just reso· fUlion LO moral lliJcrnrnas npon WI.llch ;'l~l r~l!io!la~ persons could agree fthe universahty pnfx'.~ple ,OJ ethicisLS], the respofisib:liiy conceptlon ic:cuses instc3d on the llndalions of any paIticl1Ja,r rcs~h:­ tim: and de-scribes the cont1icrs th:-lt H::::m:-un, (GIllig,in, :2i -22; cL fox and Swazey)

Here in tile responsibility concepllon we have the basis of a global bioethic, an outlOOK that would modify the medical emphasis on individual sur~l;al and fOoter peace and ecosystem preservation, I he evolution of global bioethics emerges as a develop menl thar parallels Gilligan's final comment: Through thIS in perspective, we c.'ln begin to cnvL"jon how a mmriage between adult ~cvclop­ Inent asH is currently portrayed anc. wometrS development ;l,""1t hegins to be seen could lead to a changed understanding of hUlllan development an? J. !Dore genera rive view of hurnan life. (Gilligan, 174,1

The assumption that male and female hUl11,:n development arc biologically ' . t(:,~e.dij: ferent in thelr Hnal ethleal outlook 15 not nCCCSS,lry, although this wdl be the case, w~r is Impo,r~ lant is a further exploration of rhe lUSlghts dc.\·doped by Gilligan and other prokssionals who have been led hv their study of mora I development m girls and w~men to visualize two mudds of moral· ity. TIle "rights" conceplion 01 moraitty: I:ke ~uch of the thought in current meatcal blOethlcs, focu,ses on the individual and can be explored further wHhOut necessarily labeling it «male." Similarly, the "responsibility" conccpt, focusing on relattonshlps,

91

can he developed further without labeling It "female<" As icxcseen by Leopold, our ethic~l concepts can be broadened to include his third stage in ethics, in which survival of the species and the SUf< vival of a human Iife<supporting ecosyslem is bal< anced against the «rights" of individuals< Thus, the "responsibility" concept need not be labeled female or embraced by women alone Indeed, as it is expanded intO a globaJ bioethlc, the rcsponsibil< fty motif becomes a beachhead for further efforts by both male and female scientists and mora! phi< losophers who hope to promote the wdfare and survival of the human species, The global hioethic mllst be based on a combination of rights 31Kl responsibilities in which masculin, ity and femininity arc no longer viewed as mutually exclusive dimen;;iol1s of a bipolar continuum, The concept ofpsycho!ogical androgyny, the endorsing of certain tr<1clition:11 attributes of both males and females, and the rejection of certain others. can reorgani%e traditional perspectives on sex roles.''' The greatest barrier to the widespread accept< anee of a glohal hioethie is the "macllO" mor:
tive role; dominance over nature; and conflict with other m;l!cs< This macho morality is in part the source for the belief that a technological fix can be found for any tech nological disaster and for the belief that religious Holy Wars arc manlv< In contrast, perh:1ps the greatest hope for acceptance of a global bioethic is the womcn's movement for reproductive freedom, followed by the 'changed understanding of human development and a more gcneralive view of human life" as imagined by Gilligan,

L 10m L. B<::mchamp and LeRoy wfalt~;>d(;ontet'ln, r'~)9r:.:~{ issues {11 fJioelJ.Jics (Belmont, Cali ,: ""4 ~W()i" ,', ' ,i.,~; LeRoy Walters discusses "Dioethics aB J. Fjeld at EthKs,


Plena{11 Press 1976), . c: d ,- " , l (Sprlnv 19 7 91' 1 Denne '1 itS S _ Fnt'irurunentt:a, ,:,tmcs Ci" "an in[e[di.~dplin;Jry journai de(ilcltcd to ,t,l':e P1l,: 0: sophical ~tSpcc(s of environmental proble~ls. o~ I,.lgt 1 the- editor comments, "The !Ollrna! wlH not :~av~ a spedfic point of view nor will it ~dvocale anYlh,Il:"g, , i e ' "z "Bioethics ~md SO(,la1 ResponSihlUry, 6. San1uC' TOlOYh, . >' __ ,,_/ . • d T 1 Beauin (~orztemp(l1'ar_'/ Issues U1 hWt:< )f~",~, . • , , ch~lmp and l" 'X/alters (Belmont, calIf.: W;adsworth, lq~H) 'j?-60 ".,.~' « 'h«1(5,"F'l'h's96\'l,)H6)< 7 Samuel Gonwit7, ,'Banmg Bwet .• ) _., <

j

f

,"

,

T')

<

356- ~1<

< "< A,

8, _l\ldo Leopold, "The Land EthiC)

l"'h'

d C-un'y

Ian 1 u Abtl-t.:mac. 1987 edition, 202-3. See C Dp. 11. . J

<

~.

j

K. D~mf1er CIOllscf, '{be Tcaching of HrJJlcs .voL 4, 9. Teacbing Bioethics: SUrlteuies, Pr~blem5, ~md ReSDurces (Hastings,on-Hudscill, ~.Y,: I he Hastings Centcr, L980), 48-4-9· ,.' ,'~ ;-. 10. Jon R. Hendrix, 'A Survey ot nlO~thlcs <:O~:lSes, ~~.s. j

::1

Colleges and Universities," Arnertct:l,17 BIO{vf}.'V 1t.acher ;'9 (February 1977): HS ff, cited by ClOc.K~r, q~, ~ 1 b. Callahan and S I3ok, flti;)icS lcac~trlg ;~ Hi?ber 1, Educatio1l (Ne\v York.: Plenum Press, ]980)1 XlV-Xv. _ 12~ Wi1liam Dennett, "Getting Ethics," Commentary ;0 (1980) 62<<)5

.

,

3 Daniel Callaha~, "Sh3ttuck Lectnre-contempor~rl 1 Ui01l1edic:II EthicS," New Englar1d Journal oj ,liedtemp :,02 (1980), lnR33, <'

14,

Bernard WHHalns, Eth[cs and tht' LinI!!>: c:ll'btlosophv (Cambridge, Mass.: Harvard Univcrsi~y Pres}:, 1985). " George Galc; "Science Jnd the PhHosoplltrs:' Nature 112 (6 December -'£92-95. CO:l',prehcnsive brief ' ' an(i eaSIer to re:aJ tl1an WH!iams' book, Publish.cd ~lbstract: "To s.cJentiSl;;, the philosophy of ::,cknct; ;)C(~ms ~m irrelevance, as d(X'5 the e1'n1'ln(81 prac-::iC'e ;j[ SCIcGCe to pl:HsoPherfl., preoccupied as they 3ft' ';t/ith the {ogle;}l conSIStency o1lhelr methods, The gulf hecweef:' Ute ph], lusophy of sCience', whkh has ltfi roOl~ in the g:'owth of POSHivis::::1 in the 1a1"C nineteenth cenrury, impovedshes bo[h. But there 1S He)W hope that the gu1f wUi. be brIdged by the evolution of pfliloSdp!1Y im:n tr:eory of scienc(:~." 16. Rer:l:c G Fox and]l:l!ith P. Swazey, "Medlc8f MnraH'tv is Not I3ioerhlcs-:\1cdical Ethics in China and the Uni~ed ~tatt's," Perspeaitx:s ill Ri!)iDgV and iHedicine 27 (I')K',}): .')~)G-6n,

c. D. Clements, "Til(: Bureau of 5j()cth~cs: Form Without COl1lent IS Meaningless," Persjlectires itt DiotogJ' and 111!?dicine 26 ~ 1982): 04-78. 19 C(:ll~en 1,>, ~-=1emcnts ;:md J, Richard Ckconc. 'Applied ClmJGll Ettucs Or linlvltTsai l)/inc1ple,')," lIo;:;pital and COmrtluni~yP~yclJiat!:v36(1985): 121 .\4. L. Ll"vine and .tvt Lyon~Lt'vjne, "'Etlli(:al Con1Hcts At the Interface of Aclvoc:KY ~,nd Psychiat:-y," flosJ)llal and Communi!}' Psycbiatr,'': 35 (198--1): 66:;·,-66, ' 20. v. R Potter, "Hnmllity with Responsibility." Intuitions wt:rc dhcusscd in ('onneUlor. \vit!: "The hurek:.. Experience," 8 sudden intuition that cannol be wiHec or predicted, Experknce: has :;hown that an in~llition tLat pn:dkts :he outc,)P1e of J decision may bc correct or incorrect and ll'.e in (orren lnnlition may produce just :is much euphoria as a ('effect one. In erhics as in ,',ciellcc, the vaIid~ty of:i prcdiction can only be tested by experience, However, In ~h(:' cnc, alihovgt the deci1)10115 t',lilorcd to e2ch partlcuJ:u cal)C are preferable to bure:mcratk dictation ofuniversaJ principles, su~h dcci:'t:on \\.'iH ;~lv~l ve rcason-giving thar falls back O~l expcr;.. ence In 51InH:Jr ,-'Jses. Hu: the evaluation 0;' the past exp:~r~em:c, .in eth~cs as in scitC:Hce will lean hc:ndi.y on the JOJF:t e!lorts 01 motivared and qualified partic:pJJlL5,

The conc~usion rJ'..;.cu.ssion of the tht;me that "cbc suc(es.') of present ~tnt>.1bortj()n politics wO'Jici ... cXlend the c.ubious nloral reaUty of fcm;;t1e subjugation and mate suprem3cy," 5ti 22. Carol GiLigan, In a D~l.jerellt Hiice. PsychologiutJ Tbeol)l and Wbmel1';,: De!.!etopmeYli (Carnbridge, :\-1;:v:.'): Harvard Cniversity Press, 1982;. Sec ::lIs() 1,. Kohlherg, Tbe Pbilosop}:1! of ;HoraJ Del'eioprnent (San Francisco:

,

"

~:;,

Harper Jnd Ro\. . ., 19tH). Jean Baker Millef. 1()ward a/,/{!u' P5)'cbology of Wcnnen (Boston: Hcaco:1 Press, 1976),

:-\ldo Leopold, "\\fhy lhe Wilderness Soricly?" A 1955 comment reprintecl In l.Vflderness, \Vinter 1984, ,22: \ff>bster:'i Tbird New International Dlctionar.v (Sprmg· ftekL Mass.: G. C. Merriam (z)rnp::my, :96':;). "Eant. Moth<:;~: The e:,w for full personality dcvdopnlent. Men frequemly have ocen able to I,);ocr'eale children whlk ;1volding the rcsp(H:sibiliry flJf that choict'. Women em now rnak;: the choice and can demand shared responsibllltks Ii)!' fcpn)duCllve choices. Wor::'.cn are saying that fertility is a male/female probkn, rerliEty :l1ou](:, be viewed as a tOL11 process of nurturing anel paymg ohll.ga" Lions, or maintaining !lfe'-s b-asic Pfoces:.eS in a rcsponsi~ hie way. Leopo!d c,:dW this total pn)CCSs as g(:dng beyond, the ml{'rOGUHnl of thc individual tl.) the macrocosm 01

GI:OEAL Jjf()PTl-il('S

~he emir:: biosphere, Together rncn and Won1en can lIltegralE'In each the etfljcs of lights -and respo~lsibiJjtk'>s and extend the intcofat1O!l " o!ob'l .. n ' .. •'I) "" D' <_ b'lOt:,,". ,d(-S_ 26. \'. 0, ,LO!1g, "RebUoflShir Of Masculinitv to Selft':sreenl andd SeJr-l\cceptaoce ' in Femak Pro[r'>':;~j'()nal' ('011'I;:gl. S ,-", , < ,- ~LI. entH, Cliems, :lr:d Victims of Dorr.estk Vioicncc ,; Journal Of CGunselins and Clinicul Psvcbolog" '1'4 (1986), 32)-27. . '. " 0.

-,

.-.- ~---- ~---- 5--·---------DILEMMAS IN MEDICAL BIOETHICS --~'-"--

EARLIER I PROPOSED that medical bioethkists and medical practitioners are primarily concerned with the short-term view of saving individual lives, with patient autonomy, and with "rights to life," This was seen as frequently in conflict with what I conceived as the ecological bioethic, which pursues the longterm view of accept:lble surviI'al for the hllman species in a healthful biosphere as its goal. In the present ch~pter I will mention some of the problems that confront medical bioethics and society when life takes precedence over health, The issue is whether "sanctity ofliIe" takes priority over "meaningfullifc." Ecological biocthics can help the field of medicine in promoting community and societal health, emphasizing responsibilities more than rights, The field of medical bioethics cannot be looked upon to provide a set of guidelines Ii)! the medical profession. Just as the practitioner is faced with dilemmas on every hand and at a time when help is

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most sorcly needed, the sources of help arc unable to agree on what to do, In the end, economics may tell the physician whether or not he is permitted ti)

do all that tec!mo10gical advances might permit him to do,' Mcamvhile, the ethica 1 turf is in dispute and the atmosphere is one of crisis' On the one hand, the secular ethicists approach medical dilemmas the claSSical philosophical search lilr while on the other the religiously oriented rule givers take the posirion that all [he rules have alrcady been laid down, Ne\v, comers to the field are the hiologists and clinicians, who may haVe either a secular or a religious orienta, lion,' All who express opinions are likely to have a cryptic bias thai reflects their religious upbringing and practices or lack tllereof. For ethicists to exclude available knowledge regarding the structure and fun('lion of human beings and other living orga nisms in the biosphere' would he as inappropriate as the presently-occurring exclusion of the available facts on Darwinian evolution from the biology courses taught of our high schoo is and some of our colleges, The creatiomst point of view with its unchanging blueprint for eternity seems a poor foundation [or solving the interacting bioelhi cal problems in either healtll care deliver;' or bio, sphere protection, Leopold's land ethic' suggests th~t the hum;\t1 species is responsible for the preser, vation of the natural environment and for holding the human population within the carrying capacity of the planet Earth, o

TEENAGE PREGNAKCY A recent publication opened with a statcment rhar the environmelltal problems of technocraticindustrial sodeties are beginning to be seen as

manifestations of a continuing environmental crisis thaI is coming to underslood as a crisis of character and of culture, '10 meet this crisis, the author' offer an exposition of the new term "deep ccology.'" Ilowever, iu presenting the dominant world view and deep ecology alternative (69), the authors r,lil to mention individual male ;lUtonomy to reproduce without responsibility and with' out societal restrictions, For the deep ecology alter nalive 10 omit mention of the need for the prevenfion of unwanted pregnancies and umvamed births, with all the under! ying issues of abortion and teenage pregnancy, seems almost hypocritical. The matter of teenage pregnancy is an example of a problem that by almosr any criterion that might be applied, has reached crisis proportions, But It is a problem tl!',H all [00 frequently is ex:lmined in isolaIs a panoramic perspective that tion, What is seeks to address the directly rdated issues of abor, tion, seleclive Jlontreatl1lem of handicapped new, borns, use of cigarettes, drugs, and alcohol ])y pregnant teenagers (,md women), causes and consequences of premature hirth, the use of Neonatal Intensive Care Cnits (NICUs), and the provisions rhe varions welfare laws along with interprerations of the impact of these !:two, The ethical dilemma, stated in starkest terms, is whether to promote or forbid aborl.ions, in particular for teenagers, A caseby-case approach seems called for. The problem is even more complicated than the heacl-to-head confl'ont3tion hetween so-called pro-life (or antichoice) and pro-choice factions, For adult women [wentv or older, pro-choice is presently a matter decision, But can a fifte('~nyeaT-old caught in an ullin tended nancy make 'w informed decision under the cumstances which usually accompany such C2se~<' How can the society help teenagers to avoid

GI0111L BIOE7J1f('S

the need j(ll' an ahorlion or make an informed deci~ sion once pregnancy has occurred when the soeielv is torn between opposing view,,> ' TIl}? NUMBERS

For ra",;, data on teenagc pregnancy, the 597~page Reporlof lhe Seleel Cumlllittee on Cbildren. KJUtb and Families is a useful compendium,. Th~ c()m~

mitlee concluded, "There is no focused approach to solving the complex problems of teen pregnancy at any level of government. The efforts that do exist arc toO few, [are] llncoordinated, and lack significant supp()n~ In short, the system is broken" (ix)~ The cnrrent sill1alion fOf the United Statcs on an anm,"l basis (1'o)82) is reported in round numbers for lOA million adolescents ages fifteen LO nineteen: over one million teen,lgc pregnancies resulted in 400,000 abortions, over 100,000 miscarriages, and SOQ,OOO births~ Fifty~five percent of these births 3re to unmarried teens, w hose infants are at far greater risk of low birth Weight, and therd()[c infant mortality. (Details regarding premature births, birth defects, ami mental retardation appear to be unavailable.) Thc bll'ths to teens accounted [or almost 14 percent of ,Ill births, and "most tccn'lge pregnancies m the United States arc unintended" (2)~ But, significantly, one~thlrd of teenage mothers will have;i second pregnancy while still in their teens (2)~ While the pregnancy rate increased between 1970 and 198::\, the actual number of births and the birth rate declined due to the increased rate of abortions (3, 20 ftlg. 1j), Meanwhile, t.he percentage of t.eenage mothers who were unmarried rose: from 1960 to 1983 tile number of unmarrIed teens giving birth rose from 15 percent ro 54 percent. Births to unmarried teellS accounted for ne;lrly 40 percent of all

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births to unmarried women (4)~ The data do not show how many of the "unmarried women" were unmarried teen mothers when their first child was bort). Debate as to the role played hy legislative assistance to un-r/eu mOthers continues. Birth rateS varv for white and minority teens~ The ratc is much t{ighcr for black adolescents (9S~ 5 per 1000 in 1983) than for white adolescents (4::\:6 per 1000 in 1'0)83), '~Blacl' adolescems ~Iso b~gl11 childbearing at younger than wllnes, l11erea,mg the Jjkelih()~)d of subsequent births during the teenage years" (4, [Table 2])~ Bur the correlation is with poverty. "Families headed by young mothers are seven times more likely to be living below the poverty level than other families" ([/j)~ "Children of teen parel1ls lend to be less healthy on the average than Olher children, and to exhibit learning difficulties more frequently in school. They also are likely to become teen par"nts thermel~ ves" (17). "Low birth Weight, whicl1 is strongly associated with infant mortality, remains high among infants born to teens~ 1eenage mothers typically account for about 1 in 5 low birthweight infants In 1983. there were ,+7,500 low birlhweight infants born to teens under 20, almost 20 percent 01 all births to teens" (12)~ These facts may suggest thm the adoption of a teenager's offspring may inv01v,e a risk~ Data show tl1at in 1971,2 percent of unmarned black teenagers and 18 percent of umnarned white teenagers who gave birth placed theIr dl!ldren lor a(loption, By 1976 the figure for whites had dropped to 7 percent and the black r3te had dropped to zero. Again, the a'~,lllability of welfare ffi3Y h,}ve affected the number of infants offered tor adoption. ~ ~ The impact of low birth weight on medICal bl0~ ethics has been reflected in a recent art ide by Hack

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and Fanaroff,' In the report, 98 infants born at a gestation;]! age of twenty to thirty weeks had birth weights between 260 and 740 grams, 1\venty Infants sllCVlved but all required active respiratory Slipport, prolonged intensive ene, and hospimlization, The developmental Olltcome rellccts a handicap rate approaching one,third of all survivors. "When weighing the final outcome, the enormous ongoing medical, financial. and social costs must be considered, . , ' The poor previous reproductive historv of the majonty of the mothers, , ' indicates a need' for preventing or treating the causes of the immature births, rather than expending resources On pro, longed neonatal intenSive care, The implic:ttions and cost,benefit ratios of extending the trend whereby intensive care is applied to progressively smaller immature infants must he seriouslv considered in order jor definitive guidelines to he dwz:md" (italics added), The authors did not comment on the number of teenage moth("rs in the group of 90 rnOlhen;, but 52 were unmarried. Since the number of unmarried teenage mothers is incr("asillg and since thelr infants are frequently underweight, the lack of ethical guideHnes for treating premature infants is certlinly part of the teenage pregnancy i"ue. THE INCREASE IN ONE-PARENT FA:'YfILlES II was noted above that the number of unmarried teen mothers b'15 increased rapidly ,mel that births ro unmarriecl teens accounted for 40 percent of all births to unmarried women. But how many of the post-teen unmarried mothers began Childbearing as unmarried teenagers' The share of births to single parents tilat is attributable to teenage pregnancy may actually be much greater than 40 percent. Senator Daniel Moynihan lUi> been especially

cognlz:lnt of the impact of the increasing number of single·parent t'amilies on society, in tcrms 01 school performance, poverty. and crime In. his book Family (lnd Natiun S he cites ~llan11111g fmdmgs In one studv school performance VI'as reported; :lITIong ali two-parent children, 30 percent were fanl(ed as high achievers, compared to only 1 per cent of one-parent children. At the low end, only 2 [Jercent of two,parent children were low achievers while 40 percent of one-parent chIldren fell 111 that category (929:'», As for poverty, in 1984 there were 33,700,000 Americans living helow the poverty line, Of these, 16,4-iO,OOO lived in female-headed families (96). Moynihan implied that the home life of children of unprepared teenage mothers ,n female-headed households is likely to have tures that make for crimi1l3lity" (98), Looking to the future, it was projected that in the period 19802000, the number of female-headed families will increase at more than five times the rate husbandwife families ([47), Whatever the effects of teen;lge pregnancy and female, headed families-a~d none appear to he favorable-the phenomenon IS on ille increase, THE ABORTION ISSUE

The matter of abortion may be examined in sev eral ways, First, what are the facts, and second, what are the consequences uneler pre,;enr conditions Of in the future if the percentages increase or decrease? Moynihan reports succinctly tbat each year 60 of everv 1000 American women under age elghteen have" 01)ortioI15, In Canada the rate is 18 per 1000, and in The ::-Ietherlamls only 7 of every 1000, Put another way, fully 40 percent of all pregnancies in American teenagers end in aborlion (171), What would be the consequences if the practice were

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encouraged to approach 100 percent? We know tbat making the practice illegal would not reduce the fig~ ure to zero percent ~ This is an issue that has aroused more ethical disagreement than any other in recent times, The goal of preserving the two~parent family and In,crcasing the quality and financial indepen'dence of the children who will become the citizens of the future is at stake, The iSsue is one in which secular ethicists, biologists, and clinicians are confronted by the New Right coalitions of religious Conserva~ tlves who oppose ahottion categorically, Moynihan quoted the obvious when he cited the Ne~1 york Times: "Teenagers need help to avoid pregllilrrcy, and to aVOle! abonion," He then asked "Should IlOI there be a nalional effort to protect children from both?" He noted that in New York City in 198') 1,292 girls under the age of fifteen be';ame pn:g: nant, followed by abortions for 988 (172-73'), It seems inconceivable that any ethical approach to the problem could advocate an end to abonions without agreeing with Moynihan that every effort should be, m,adc to help teenagers avoid pregnancy Yet thiS IS precisely where the ethical crisis is lW)st poignant, Those who oppose abortion most VIolently cannot agree on how teen:1gers shOUld be helped [0 avoid pregnancy, They rend to oppose sex education and increased availability of contra~ cepUves, the two most likely explanations for the low rate of abortions in The Netherlands. On the other hand,. if no help in aVOiding pregnancy is g;Yen, and ;1 abortion is outlawed, will these poli~ (le,s be Willingly coupled with new welfare policies that would help the unmarried teenage mother to complete her education and become employed and able to provide a suitable home thr her of.fspring? Agall1 we turn to Moynihan, who remarks, "The national poliCies we have affecting pr~gnant

teenagers, and those at risk of becoming so, are tIlled with contradictions,., ,We subsidize family planning services for teenagers while encouraging them not to seek them" (172), In noting Ihe para~ doxes in the AFDC program (Aid For Dependent Children), he notes that [here arc few solutions that can be imt in piace as regulations: case~by~case social work is required, In other words, the categor~ leal rules of the religious consefl'
lC5

(iLOlJAL BJOHTlllCS

10-4

The final conclusion is on the whole despairing, but the one optimistic notc seems to he that "tbe needs of bmilies might be the means for bringing liberals and conservatives togelher on matters of policy" (188). Meanwhile, the polarization between antichOICe and pro-choice factions appears to be increaSing, while the pregnant teenager living in poverty and the conscicmiOtls legislator who woull' like 10 llelp arc caught in the cross tire. THE 1985 WISCONSIN LHGISL1TION

During 1985 a "Special Committee on Pregnancy Options" was set up the Wisconsin State Asscmbly under the cil3irmanship of Assemhlyman Marlin Schneider.' The committee included deven puhlic memhers who personally held extreme pm-choice or anti-choice/antiabortion views, Despite the divergence in views. they had some commun goals that they were able to ',lddress. Tile title of the act finaUy p:lssed was the" ':'\.bortion Prevention and Family Responsibility Act of 1985." It sl~ted: The high n::mber

();:un~nteIliJed

or

Uf1\VdDtCG

preg-

nancies -and the reSllltant high numhcr of alHJrJlo'1S Ls a tragic and unde~ir:10k COfL.')cquence of complex societal proh1crns, Strong dfor:s IT.U~t he made ro t"osure that unintendet1 p:egnancies Cd not be('om~" unv.rJnted prcgnancie~ .. , It is dear that among


responsiblHty (italiC's :lGcied),

What may he a novel aspect of the legislation is that the hill makes grandparents responsible for the support of a child of one of their dependent minor dlildrelL Cnder the bi!l, rhe parents of the minor

mother would assume such responsibility UPO,rl the birth of the child; the parents of the minor lalher would assume that responsibility only after he has been determined to he the father. Each set of grandparents has an egual responsibilityt,o suppmt the newhorn child, but their responsll1!1tty ends when their own child reaches age eighteen. . Onlv future experience wi!! make it po,slblc to determi'ne whether the gr8ndpareming sections .of the bill will have the effect of decreasing un1Otended pregnancies or of increasing the number of ahortiuns. The bill repealed previous stme laws restricting the sale of nonprescription contraceptives and a separate hill was subsequently passed permitting the sale of condoms 1ll venthng machines. The bill also repealed a WlSCOllS1'~ Cf1l~"i nal law on abortion LO contonn to the 19! '\ U.S. Supreme Court decision on abortion.. ..' Siuce the effeet of the law on the aHltudes of the parents of adolescents who may become pre g l.13,nt or who have become pregnant cannot bepJedlcted, the Department of Health and Social SerVices IS mandated by the law to submit hy 1 January 1989 a report 10 the presiding officer of each house or the lcgislatnrc concernlng the impact of the reqUIrements for grandparents' support of clllldren or thel! minor children, DILEMMAS 1"< THE CASE OF HANDICAPPED NEWBORNS Recent developments in medical technology and instnllTICnC,1t1on have occurred in ~ ,1111hcu 111 which the goal of the medic:!1 pfaCtlt!oner. has alwavs been the preserval10n and extenSIOn of hie 111 the individual patient. Until recently, phySICians have heen asked to assume that all Iife-.. no matter

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how miserable, or extended [or however brief a time, or at what cost~is preferable r.o death . .\1edical practitioner, have not individuallv or collectively sought to pass judgment on the o~erall consequences of their increased power to aid individuals. On the other hand, the word "dilenuna" has appeared everywhere in discussions of the problems tmsed by the new technologics. Tn his fatseemg "Shattuck Lecture 011 Contemporarv Biomedical Ethics," Daniel Callahan speaks of" difficult moral dilemmas" and "moral dilemmas gener. ated by emergent technologies."" After a thorough analysls of the problems, he concludes that "biomedical ethics must now move into a new phase, one tbat wlll torce a rethinking of its rok, its methodology, and its relalion to other disciplines and institutions:'. My present eft(m sees this Ilew phase as one 1Il whleh meciical bioerhicists must examine. with the help of medical doctors, ecologists, demogra. phers, and others, the significance of Aldo Leopold's land ethic. They mList consider how the practice of medicine can evolve guicielines that can lead to societal as well ~s to individual 11"alth and well-being. However, it would be tragic indeed if the practice of medicine came to be domitl3ted by purely political considerations. As mentioned earlier, the word "dilemma" is the only one that can describe the present situation in many areas of medical practice. The term b eA1)
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I,

Neonatal Medicine" by Robert F. Weie All of th",e studies are recommencled for in-depth coverage and will be re!erred to below. In addition, there is the outstanding book by Jeff Lyon, Playitlg God itl the Nurser]!, h a title that certainly suggests tbat dilemmas arise whenever human individu;rls have to make decisions to preserve or to end the lite of another, SELECTIVE NON TREATMENT

Nine years before the "Baby Doc" incidem (see Lyon, 21-58), [)uff and Campbell noted that between 1940 and 1970 tbere was a 58 percent (\ecrease in the inf3nt death rate in the United States, which they attributed to the 111stal1at10n of infant intenSive c'are units (NICes). While some survivors from the NICU may be bealthy, others continue to suffer from such conditions as chronic cardiopul· monary disease, short-bowel svndrome, or various manifestations ,;fbrain damage: they noted that others arc severely handicapped by myriad congc:niL~l malformatiOns that in previous times would have resulted in early death. Their summary stated, Of 299 conseCutive dc:aths occurting in
multiple anomalies, eight with (nsomy, eight with cardiopulrnon2ry disease, seven with mcningomyc~ loce1e, three with other central-nervous-systcm dis* ordt'r~, and tv-'o with short*bowel syndrome.

In each GL'
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"playing God" was accepted. Yet the authors were firm in staling, "The issue has to he faced, for not to deCide is an atbitrary and pOtentially devaStating decision of default." The authors commented that "many pediatricians and others arc distressed with the long-term results of pressing on and on to save life at all costs and in all circumstances." Thev quoted Eliot Slater approvingly, who said, "If this i~ one of the consequences of the Mlnclitv-otClife ethk, perhaps our formulation of the p~inciple should be revised:' 15 This view was also advanced by M. Harry Jennison, executive director of the Arne rjean Academy of Pediatrics. in his foreword to Lyon's hook: "In spite of modern technology, there are hmlls to ,,:hat we ought to feel obliged to impose on dYll1g pallents and on those whose futures are overmastered by fu tilitr." In a Similar vein, Landau and GUSi:llfson, in a commentary titled "Death is Not the Enemy," wrote. "The development of technologies with the prime aim of prolonging life should be .~eriously questioned if the ultimate result is destined to be a grotesque, fragmented, Of inordinately expenSlve eXlblence: -16 Yct the ultimate result is frequently concealed, and today parents are being pressured to believe that their defective infant is salvageable bv medical science. ' . Robert Weir, a professor of religious studies at OklJhoma State University, surveyed the situation in 19R4 not long 'ltier the Baby Doe C3se had captured public attention. 17 Hb book and that of Lyons supplement each other to a remarkable decrree Both describe tlle chronology of the legal man~uv~rs and administrative rulings that followed. )'1ore recentlyit has been "eponed that federal efforts to lav (jow~ hospital rules regarcling cases of handi~appcd mlants have been struck down by lower couns and the U.S. Supreme Court"" Earlier it was reported that the American Jewish Congress and the Pro-Life

lJuilding on IDC Leopr.dd legacy

1Of;

CommiLlee of the National Conference of Catholic Bishops have issued a consensus statement in which they stated, "Handicaps, in and of themselves, do not justify withholding tre.atment;' but intervention is not required when it would be "clearly futile and would do no more than bridly prolong the act of dying." 19 Their position appears to avoid the issue of qualil y of life. However, if medical experts disagree, the p3rems arC Obligated to decide in their child's "best interest." The dilemma remains, but parental discretion appears to be emerging as a key formula. Weir adopted a comprehensive method of documentation, with a deSCription or handicapped infant syndromes, case hismrics, legal cases, and historical records of society's views on infantiCide which could be regarded as equivalent to or in some cases preferable to Withholding treatment. Weir pre· sented the views of seven pediatricians, who included Duff, Shaw (both mentioned earlier), and C. Everett Kcmp, Surgeon General of the United States. All have different and opposing vie\Vs and in several cases are critical of each other. Koop reported with pride the case of an infant who went through thirty-seven operations, of which Koop performed twenty-two. Clearly the dilemma for physicians and parents rem:lins. Weir ~lso surveyed tile views of seven attOrneys and ~gain, differing and opposing views were held. fohn Robertson, one of the attorneys, clearly advo· 'cated the vicw that, with few exceptions, the appli, cation of crimimlliability to withholding care may be "both (iesirah!e and morally compelled." For Robertson, even though the wards for retarded chi!dn.:n in state institutions are often "an apt description of hell." the rermination of parental rights In a custody hearing and assignment of a child to an Instimtion not clearly a worse alternative than

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death" for the child. Weir noted that the federal moves to rcstrict parental and physician discretion, advocated by Koop, were subject to the criticism that they frequently I'li! to distinguish between handicaps that can be corrected and those which cannot. When ethicists were survcved divergent views were again highlighted. While' 50;ne believe in the sanctity of life, no matter what, others, especially Michael '1ootey, reject that principle and argue that the morality of abortion and infanticide-including withholding medical treatment-hang on the con· ccpmal issue of "personhood."20 Engelhardt has taken a Similar view. Zl In particular, the plight of par· ents is conSidered. The basic view is that withhold· ing treatment or deciding to abort a fetus is primar· ilya matter of parental discretion. Weir comments (178) that one of the problems common to the ethical literature is the minimal Jttemion given to the medical realities and the range of cases that actually characterize the NICUs. In addition, there ls the vagueness of terminology used by elhicists--for example, the meanings of "sanctity of life," "quality of life,," "harm," "meaningful life," "human," and "person." RESPONSIBILITY M[lST BE ACG'EPTED

Elsewhere I have argued that the keynote here as in other cases is responsibility. 22 The issue of tem· age pregnaucy is iuextrieably interwoven with decisions involving abortion, nontreatmcnt of handicapped newborns, and even infantiCide. Tl,e alternatives of chOOSing abortion, infanti· cide, or nontrcatment for a handicapped newborn arc classic examples of the controversies surround· ing the concept of nOn treatment in the absence of prospects tbr meaningful life. The present state of affairs seems to encourage nondecisions by both

BuUding

Uri /(1e

L('ojlotej Lr:gacy

111

parents and pediatricians. The parents have been encouraged to indulge in nondccisions by ]aws that require the "maintenance" of defective surviving infants in state·supported facilities it the parents are umble to undertake the burden. What would be the: situation if parents were given accurate information about the infant's rondition and prospects after "ueatmem" and wcre told that its maintenance was their responsibility? What if they were lold that for the type of defect at hand, rhe very lK"Xt pregnancy would probably yield a normal child? l[rhe parents and the physician shared the responSibIlity for the decision and the parems had to bear the major responsibility for the outcome, the commonsense delineation of meaningful life would not be delayed for long. Moreover, in the ease of many handicapped newborns, the condition is hereditary In such cases the parents should be told when thclr SitUation is the type that can be readily diagl;osed bOt h in rhe parents and in the felus in utero. I hey should be told when, despite the occurrence of or~e homozygous defective fetus Of newborn,. theIr chances of a nonsymptomatic llt"whorn mtant 10 the next pregnancy are tbree out or fOllr I~ should be expbined that a homozygous normal 10tant may oceur in one out of four pregnancies, and that a homozygous d~fectil'e infant may occur a second time, also with a probability of one out of four, In which case thev could abort and try again. III such cases, how many parents would elect treatment for a handicapped newborn tbat they wo~ld have, to maintain lor the rest of their Jives, and In addJtloll possibly forego the option of havin~ a nOfllla! child? They should be told whether treatment would produce a normal child, since in most cases it does not. Going back to the 1973 repoft (Duff and Campbell) in \.".h1c11 43 (1'i percent) of" 100ai 299

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Building on f/:;e leopold l,egacy

deaths were to nontrcatrm:nt, 256 (86 percent) resulted trom pachology thm prevaiJed despite the IreaI1nent gir'erl, Of these, 66 percent were the result of respiratory problems or complications associated with extreme prematurity (birth weight under 1000 g), From the standpoint of applied bioethics, the problem is not the 299 newborns that died but the defective newborns that were treated and survived, e,scaping any deCision to withhold treatment. \XThat kind of survival was given them? While mortality in hospitals that have a NIClJ is about half that reported for hospitals lacking such unIts, an unreported number of tn:ated survivln o infants arc handicapped by "a myriad congenital malformations that in previmis would have resulted in earlier death" (Duff anel Campbell). Various manifestations of brain dam2lge also persist. At present these cases can be abandoned hy their parents, who may have broughl on extreme prematurity or defects by the llse of hul, cigarettes, or drugs. Would it nOt be belter to put less emphasis on maintaining premature and defective infalllS ill NICUs at famastic cost, with possible abandonment and miserable survival, and instead stress the knowledge that could bring about a normal birth? Wbuld it not be better to abort a defective fetus than to give birth LO a permanently h,mdicapped infant? It is time to reach a consensus on the criteria as to which defens ('
01'

failure to treat a handicapped newborn, suit can also be brought for to advise a patient of the options involving amniocentesis and possible aborUon.23 The bottom line, in all of the cases involving issues of meaningfltllife, is responsibility. Decisions made on behalf of or newborn infants should be sbared by physicians and by parems who have been properly informed as to the biological facts in the individual case. When public faCilities afe ayailable to relieve parents of the responsibility of maintaining a defective child for life, the parents should be fully informed as to the possibilities for meaningful life for their chilli in the available institUtiOH, where it is widely agreed th3t life for a severelv defective child comes close to "3 definition of hell'; as noted earlier.24 Again; the parents should bear the responsibility for their deCision or nondeciSlOn and should informed of possible contingencies during prenatal care, while their physician should bear the responsibility for advising them of their present and futnre oprJOl1s. ORGAN TRANSPLAN'rATION

Organ transplantation has been performed in adults for many especially in the case of kidnev failure and more recently, in the cases of hean;; and livers.' Humans twO kidneys and can survive, leading a normal life, with only one kidney Thus a donor Can onc kidney to an appropriate recipient and go on living. Not so in the case of hearts and livers, Since of these we have but one, In these cases donors must be victims of automobile accidents or gunshot wounds, which are in plentiful supply in Lhh; country. The donors must be incapable of sustaining meaningful life and

! 14 GLOBAL JJl0/fTIliC;'l'

their permission must be supplied by a responsible parent or spOuse. More recently, organ transplants young ha;,e been carried Out in newborns or l.nia!:ts, ,the ~~ndlCapped new horns who might be subjected to selectlve nontreatment" as discussed 111 the preceding two sections. TRANSPL:1NTS INVOLVING HANf)IC4PPED NEWBORNS

. Rapidly advancing medical tcchnology has again

~:[ced dlle~l1nas Upon medical biocthicists. In prevIOUS tuncs a handlcappccl ncwborn with fatal pathology m the hrain, heart, or liver presented no p~rtJcular ethical problems Death would supervene wah whatever treatmcnt. In tbe earliest attempts, treatment, by means of organ transplantation from an m[ant fatally dllmaged in an automobile accident was attempted and probably undocumented. In the past few years heart and liver transplants in infantS have been carried out successfully in a number of hospitals and widely reported in the media. More recently a new possibility has emerged. A handicapped newborn may have fatal pathology in heart, or bram but not in all three. This creates the technologIcal opporrunity to salvage a viahle organ from one delectlve newhorn and replace the correspondmg nonviahle organ in a second defective newborn, thus sacrificing (killing?) the hrain-dead donor. The cholee may he offens; ve but it is ratIonal, in a limited sense, if the donor has essen. ually no hrain function but a normal heart.25 Such an mfam could be maintained alive with heroic effons for extended P~[iods but its lite would not :'meaningful:' Many attorneys, pediatricians, and ~th;~lsts hllVe argued, in terms of the "sanctilv of hIe, that such a life callnot be "terminated." 'But

)lI(tdiflf!,

Gri

{be Leopold L::gac.l'

11-;

lOW they are confronted by a new alternative. The )raindeficicnt newborn can contribute its good ,eart to a heartdefeetivc newborn who would oth~rwise surely uk. ::\ot only does this alternative but the brain-defective infant could be kept llivc untll a heart-defective infam came along. or cl1l!il a Iiver-ddcctive infant came along, or until the :wo defective infants became available What is the "thieai decision now? How bad is ,1 good thing' The jescribed c1ilemma is not theoretical: it recently came to pass in California and was Widely reported in the media. A neonate with a severe heart c1efect was born to an unwed minor. A 16-day-old neona[c with a defective brain vvas used to obtain a viable heart, with permission granted by its parents, whose child was many miles from the planned recipient. The transplan \ was reported as successful. " TRAl'v'SPLt4NTS llvllOLVING ADULTS

The demand for liver tr;msplants is increasing exponentially Dr Thomas E. Starzl of the University of Pittsburgh School of Medicine, who pioneered the operation, said that the number at his location increaseu from 14 in 198010 an estimated 250 this year." He said that many who could be helped die for lack of a donor liver. To increase the sllpply of organs he recommended relaxing the requirements as to when a patient is conSidered brain-dead and available as a donor; removing donor age limits; developing teams in emergency rooms that would be available to remove donor organs from people who arc dead on arrival; and changing laws on org,m donation to Jtreswned consent, meaning doctors would be free 10 remove organs from a dead person unless he or she objected beJorelJand, thereby creating new ethical prohlems.

116

CLOBAL B10E111](..:'s

A comprehensive report on the issue of who

gets the organ transpJams was recemly described." The l!lsk Force on Organ Transplantation said the l;nited States should expand access to organ trans· of their wealth plams for its own or insurance coverage, but limit access for aliens who come 10 this country seeking trans·· plants. They tecommended that aliens who come to the United States for surgery should receive no more than 10 percent of the kidney transplants at any hospital. Heart and liver transplants should be reserved for American citiloens and permanent resi· dents wherever possible. The pand noted that organs are donated by rich and poor ;llike hut that poor people often cannot afford transplants or maintenance therapy. Organ transplants are increasing in part because of a new drug, cyclosporin, that suppresses the ten· dency of the body's immune system to reject for· eign organs and tissues. present cost of treat· ment is about $500 per month and must be continued for life. number of kidney trans· plants rose from 4,886 in to 7,800 in 1985; heart transplants rose from 62 to 719 and liver trans· same period. The plants rose from 26 to 602 in increases were made possible because unmatched donors could be used in conjunction with cyc1os· potin treatment. A member of the panel, Roger W. Evans, a medi· cal sociologist at the Battelle Uuman Affairs Research Centers in Seattle, Washington, estimated the average first·year cost for a kidney transplant at $35,000, for a heart tr;lllsplant at $95,000, and for a liver transplant at 5135,00, The panel said the selection of transplant patients must be based solely on objective medical and the probabilcriteria such ,lS the p~tient's ity of a successful transplanL They thus by·passed

BuildinfJ, or! the Leopold Legacy

J17

the ethical dilemma of deciding whether the Jjfe of one patient is more important (to society) than the life of another patient, when a choice must be made. The panel condemned thc lion of organ transplants" that is now occurring in the case of kidney transplants since, as noted aboye, a donor can sell one kidney and survive with only one remaining. However, a year·old federal law makes it illegal to buy, sell, or profiteer in human organs for transplant in the United ~tlItes. Now that the beating heart of a bmln-dead newborn infant has been transplanted to the body of ~ newborn with hypoplastic left-heart syndrome, one can imagine the possible use of a heart from a hospi· tal patient who has survived without a respirator for months or vears in a veget.ltive stale hut who is not totallY brain·dead, as i~ the case of Karen Quinlan (Engelhardt, Foundations, 211). Such a person con· trasts with the victims of automobilc accidents or gunshot wounds who may not be capable of sus· tained existence. But it may be revolting to utilize heart of a Karen Quinlan, who was once a per· son. in contrast to the permi»sible use of the heart of :i vegetative-state newborn \VhO in the minds of many people was never a person and never could be.

ARTIFlClAL ORGANS

The alternative to a kidney transplant is an.ificiai dialYSis, which can be done in a hospital or under a patient's own management. The numbers and prob· lems will not be documented here, but it is clear that although a meaningful life can still occur, it becomes increa$ingly hurdensome and difficult. Nevertheless, the procedure is widespread.

llH

Gr.cWAI lJlO1:.THErs

Completely experimental, and (hw; far tried in only a few patients, is the plastic pump unplanted in the chest as an artificial hean and powered by an external source, I feel that the device overlooks the fact that the, heart is much more tl1;m a pump, It has a speClal OXidative llJetabolism, the details of which differ from all other organs, '9 and in addition duees a special hormone," There seems to be no justification for assumini\ that this mechanical devi::c could ever replace a hUllJan heart," The only JusntlcatlOn for continuing its development miaht be its possible use fot a few days until a suitable donor of an actual human heart could be found hut as pointed out earlier in the case of handicapped newborns, the transplantation of human hearts raises new ethical problems, ECTHANASIA For cemuries people have argued about whether to facilitate the death of a fellow human who wishes

to be helped to die Of who It is presumed would wish to die if capahle of making the decision. Euthanas!:l, taken literally, means normal death, implying that nature has heen let to t3k" its coutse, Reccnrly it has been taken to mean good ot easy death and to mean a "mercy killing," the bringing ~;b()ut of such a death for:l person by a friend or family mcmher or by the health care system Tn a hospital or nursing home D, KR. stands for "Do l\ot Resuscitate"-a label for patients whose lives are not to be saved should respiration Or heartbeat faiL The label is sur' rcpticious because of the absence of laws or guide c lines that specify when it is legitimate to let nature take over, Thus we see another dilemma for medical Dioethics-the need for policy clarification on ;{ subject that brings deeply divided opinions, The

Liuildfr
Leopold L1?gacy

119

New York State 'Jask Foree on Ufe and the Law recentlv recommended legislation that would set guicleli';'es for D,N,R, orders" 11 was proposed that the D,N.R. orlier would be lei\al only if the patient's prior consent had been secured or if a variety of alternatives had been followed, James Rachels, a professor of philosophy at the l'nlvcrsi!y, of Alabama at Birmingham, has traced the hrstoneal roots of the current debate, He suggests that for a mercv killing, the accused should be able to show as rlgor;)llS a defense as would be req llired in the case of killing in self-defense," THE SECl)LAR VISION

The material covered in this and the preceding chapter is intended to document the fact that medic bioethics bas been preoccupied with a narrow and constricted vie", of individual interests that oftentimes does 00l function in the best interests of either individuals or society, 11 is also clear that the prohlems are so overwhelming and the dilemmas '0 deep-rooted that a reluctance to consIder ecological or survival issues may be understood if not excused, A great number of L'isues in medical bioethics involve a balancing of the individual autonomy 01 the patient with the needs ami desires of his physic cian, the hospital, and the health care system, Some of the dilemmas might be bettcr resolved If the broader needs of society and future individuals could also be weighed in the balance, The further evolution of a medical bioerhics program has been vigorously prufHoted by Engelhardt (l~)undatiorzs), After conclucl1ng that we inevitablv must live in 3 society of secular and reh" giOllS ph;ralism, he expresses the hope that this can be a peaceable evolution,

121

120

GLOB/,L BIOET! l1C~'i

In particular, we will need to learn to dcHver health (3re In a come:xt of a pluf3lilY of moral V!t"Wpoi;lts, where there 1~ !imited moral authority to impo~e one understandmg on all w!ttout their consent. In undcr<;tmding the limils of reason and lthc limit:> ()~ 111(Hal authority to usc we wil1 corne to learn much abollt the human condition" (ix)

Engelhardt presents a "morality of mulual respect" and demands "a commitment to a secular pluralist ethic" (385) He offers arguments for abortion on demand as well as for infanticide and euthanaSia under a variety of circumstances, Tn so doing he argues that such views "are intellectually unavoidable even for the most committed Christian, Jew, BuddhISt, or Communist who does not wisiJ to use Jorce to resolve moral disputes" (:185, italics added). (Curiously enough, Islam and the committed Moslem were neglected throughout the volume,) Engelhardt does not :ldvocate the abandonment of the moral traditions of established religion by {b(,lr comrmtted aduocales; what he stresses is thal the advocates must at the same time accept rhe proposItlons of a secular pluralist morality in thar "there is no rational warrant for the use of force in imposing anyone particular view of the good life on others" (Foundations, 385), This deknse of the principle of personal autonomy (85) travels on rather thin icc even within the health care system that is the province of medical bioethiCi" dnci is quite different from the concept of "mutual coercion mutually agreed upon" advocated by Garrett Hardin in his classic essav "The '!l:agcdy of the Commons,"" However, the latter view is flawed in that there b ]jttte hope that a pluralist society can mutually agree to force compliance with a particular moral view, e,g" absolute prohihitlon of abortion, Crowe has emphasizect the improbability that Hardin's theorctical solution can succeed in p~actice

because all of the needed components are myths that time has seriously eroded: the myth a common value systc.:m, d;e myth of a mntual! y agreed upon monopoly of coercive foree, and the myt;; that admlnislr:ltors can rcgula.re the commons _. Crowe concluded sadly that the major problems of overpopulation, nuclear war, and enviromnemal degradation have neither technical nor political solutions, while extenSIOns in morallly arc not likely His only hope was the enlistment of SClentisl, in tbe search for solutions. Unlortunatc:ly, Engelhardt's excellent Siltvcy of where we stand iJl rhe phllosophic issues involved in health care dellv ery and the vision of a secular plurahsl moralIty without the application of force did not extend to the essays by Hardin and by Crowe or to Leopold's land etlilc. Engelhardt's commendable visi,m of a peaceful, secular, pluralist society needs to be extended hevond the issues of health care for mchviduals, beyond the conl1icttng value differences ,of traditional religions, and into the biological reahues that shaped "The Land Ethic"

L Linda Hugl1cy Holt, "DRGs (Dlagllo;:tic Related Groups)' T~e Doc10rs' Dile!uma," PerspecUues in BiOlOgy and A1udicinc 29 (1986): 219-:-26, "The bind

from a health care-planning point of VIC\V is that costs will nest be CQntained by direct dlsincc:nllVC to overut\· lizalion of services liy physicianS; bill the moral imperativ<',s of the physician's oath are vjolated by direct c"lsinccntives. Phvsici-ans are c:omfortJble either dojng t:venrthing tl~-at can pO$s~bly he done [or patients or (with) sending lhe patknis (() another source of care Iskj; conscielllious physicians may Anu it impo;;;slble 10 fum':llon U11der a system in whieh they arc e,,,pectcd to serve :ruly as gatekeepers for the rationing of rncdical ca rc:."

122

G1 GEAr BIOET'UICS

2. Joserh H. Kjrsner, "The Changing Medical Scene (1929~ 1985): A Personal Perspective," Perspectiues in Iltology and /j,1ediclne 29 (1986); 227-42. Some titles referred to include "Medicine on the Brink: The Dilemma of a Learned Profession"; ''The Academic Medical Center: A Stressed American Institution"; "The Young Physjcian~Uving with Uncertain tv" ; and many others. 5. Clements and Ciccone, ':A.ppliez"t Clinical E-tbl('s or Cnivcrsal Principles," 121-23, Their point of view is dis-

cussed in my chapter 'L -i. Trosko, "Scientific Views of Ilulnan 0"3.ture,"

70~97.

5. Devall and Sessions, Deep Ecolopy. 6. U.S. Congress, House, A Report oj the Select Committee on Children routb, and FamiUes, 99th Cong., 1st scss.) 1985, lx, Subsequent statistics are taken from thls report, 7, Maureen Haek and Avroy A. Fanaroff, "Changes in the Delivery RO\)ffi Care of the Extremelv Small Infant « 750 g): Effects on Morbidity and Outcome," New England Journal of Medicine 314 (1986), 660~64, "Since pessimism prevails in the fe\\' reports on later Qutcomes among these very 5 mall and immature infants. the indiscriminate initiation of intensive care raise~ many philosophical, and economic questions references). Dcspite many reviev.rs with titles such aN Small is Too Small," "What Is the Lower Limit of Viabilltyt" and "Whcre and How to Draw the no clear guidelines dictate the initial delivery room care of the extremely immarure infant « 750 g)" (HalleI' added). 8. Daniel P. !>1oynihan, Famll), and Nation (New York: Harcourt, Brace, Jovanovich, 1986). Loaded with data j,{nd tart I reasonabie inferences. 9. Abortlon Prevention and Fa:nily RespoDsibWty Wisconsin ACt 56, 12 November 1985, 10, Callahan, "Shattuck Lecture." Sce chapter 1, nOle 13, 11. R. S Duff and A. G. ,',1. Campbell, ",\Ioral mel Ethica' Dilemmas in the Special-Care ~ursery," Neu! Rnglanc. journal of Medicirle 289 (1973): 890-94. J2. Anthony Sha~ "Dilemmas of 'Informed Consent' if Children," New Rngland journal Of Medicine 28' (1975): 885~90. l

BuitdinA on the Leopold '"glU_Y

123

13., Robert F. 'X'eir, Select/ue Nontreatrnenr Of Handicapped Newborns. ~Horal Dilemmas in Neonatat lrledicine

(New York: Oxford llnivershy Press, 1984). 14.

jeff Lyon, Playing God in tbe NurseTY

York,

London: W W Norton, 1985). The Baby incident (pp, 21~58) involved a six'pound baby boy born in BloomingtOll, indiana, on 9 April 1982 with multipic defects that would require surgical correction and other ;:1bnormalities that would remain. The decision was whether to act quickly with considerable uncertainty as to the ultimate nulcomc or to do nothjng (withhold treatment), in which case the baby would die. The parems had twO healthy children and had looked forward to the birth of a third child. After hearing the possible optJons from three physicians, the parent..'> chose to have tl'catrnent withheld, :1 deciSiOn that was not unanimously -approvcd by the three physicians. following legal action initiated by the hospit'JJ lawyer. -a hearing WAS held anti a judge ruled th'at since medical opinions were divergent) the parents had the right to make the decision. After rcpeated hearings ::tnd appeals all the way to the Indiana Supreme Cc,urt, ,,,lith the media finally alerted and with the special-care nurses protesting the action) Baby Doe finally died six days after his birth, The publicity attending thifi case, in contrast to the forty-three cases reported in a mcdic~l Jour· nal (Duff and Campbell, Q, 11 above) nine years carlier, set off -a series of actIons by the Reagan administration in response to further C:1sel' and protests by organized citizenI" groups. 15. Elliot Slater, "Health Service or Sickness Service," British loJedlcal journal 4 (1971): ; 734~36. 16. R'chard L Landa" and James ,',1. Gustafsotl, "Commentary: Death is ~ot the Enemy," Journal of tbe American Medical Associatiort 252 (1984): ·2458, Dr, Landau is editor-in-chief of Perspectives in and lHedicine.

17. See \~'eir. "Seiective NontreatmenL" 18, Stuart Tavlor, Jr., "High Court Upset;; US, Intervention on Infants' Lives," New York Times 10 June 1986, lSL A.,'.;socialed Press, "Catholics, JCVvTS Reach Accord ou Treating Disabled InfantS," \Visconsln State]ournal! 27 July 1985,

124

GrOBAL B10HTHICS

20, Michael Tooley) Abortion and Infanticide (New York: Oxford Lniversity Pre'js, 1983). See my chapter 7) n. 10_

2L II. Tristram Engelhardt, JL, The Foundations of Rioethies (New York, OxfOrd University Press, i986) 22, V, R Potte~ 'Applied llioethics and tile Crisis in Health

23

24.

25,

26,

Care," Psycbi"tric Annals 16 (1986), 399-401. The emphasis on responsibilty 1:; in Hne with "the ferrUnine viewpoint" mentioned in Chapter 4) with Leopold's ideas in general, and With (he propo,5ed evolution of a global biocthlc (chapter 7). Alan L Otten, "~/rongful Life? Parents and :-Iewborns Win New Legal Rights lO Sue for Malpraeliee," Wall Street Journal, 7 June 1985, L Associated Press, Los Angeles, "$2,2 Million :;eptuplet Suit Fifed,"' Wisc'Orlsin State Journal, 9 October 19B5, II. T, Hnp;clhanlt, Jr" "Euthanasia and Children, The InJt1l'Y of Continued Exis~ence:' j(lurrw[ of Pediatrics 8:5 (1973): 170~ 71; H" A. Spit?, "Hospitalism: An fnquiry into th(~ Genesis of Psychiatric Conditions in Eadv Childhood," Psycboanal,vtic ,')'wdy c:ttbl? Child 1 (1945): 53-74, it is Hnponant to distinguish here between two kinds of brain deficiency There is a "whole-brain" definitlon of death in which artificial respiration can mainwin a biologically alive set of orgAns. This legal Jefinition of death began in about 1970. More recently :a higherbrain~centers definition of death has been suggested. An individual might not reqUire artificial respiration but remain permanently unconscious (Engelhardt, Foundations, 203- Hi). A newborn infant with anencephaly h3.S a functioning brainstem but no higher brain function, Michael Seilcr and Harry :\C[SOl1, "Baby Je;:;sc Gets a Heart from Michigan Child," Los Angeles ifmes, 11 June 1986, 1. Jesse Dean Sepu lveda was born on ..\
on

Building on the Le0i"(Jld Legac}'

over guardianshjp, Meanwhile, Frank Edwa~d C}emenshaw, Jr'r ;,l1so born on :via:: was 10 Butterworth Hospital in Grand Rapids, Michigan, and was diagnosed as braln-dead. \Vith his fYd.re~ts~ consent, the :'lichigan infant was flown to ?\orton Alr Force Base in a prh'3.tc Jetw:ambula11Ce 2nd transferred to the Lorna Linda Medical Center in Loma Linda, California, where he arrived with a strongly beating heart. The transfer was performed on TlIesuay night, 10 June 1986, hy Dc Leonard Hailey, who had performed four prev10UA successful transpl:mra since November 1985 Dr. Baileyestimated the cOSt of the operation at :about $100)000, which V,!':.1.S borne by the hospHaL The opcmtion ·l1il3S declared a :mccess and after some days the ehild was released to his parents and gmndparents, The operatiOl1 has become possible because the recip.ients :ar~ ~rcated \'lith the anti-rejection drug Lydosponn, adnunIstered daBv for life at an annual cost of $0,000. :viorc recently an extensive article has appeared ;:,ccause of the confusion in the definition of brain dealll (Sandra lli;!kcslee. "Law ThwartS Effort to Donate infants' Organs," New lhrA~ J'imes 9 :-;cptembe~ 1986, '19-20), Ms, Blakeslee quOted Dr. Michael r:arr:soi'lj a pediatric surgeon at the University of C21i1?rn~q, San Francisco, who g'Jve :an estimfllc of ·iOO-Sl)O 111f;\nt5 needing new kidneyS, 400-500 needing h,earts. and 500-1,000 needing liver.;. annually in lhe United Stales. A colleague, Dr. Mitchelt Golbus, estimated that ahout 3)500 anencephalic ncwborns arc born In the llnited States each year enough to cover the cstim:ued neecl for organ replacement, but the law hlS been inrcrpreted to mean that an :anencephalic newborn is not bram,·dead since it is not wbole-brain dead/ and the trnnspla11l cannot legally be carried out while the Drainstem and organs arc viable. Pressure to legalize t~e U$.c ciated Press, "Organ Transplanting has i'onMedical problems," Sious Ci(yloumai, 16 "larch 1986, (All Editor's Note poinTS our {hat Dr, Star;:1 was- a native of LeMars, Iow,l. He performed the world's Hrst :'il~ccess-. (ul liver transplant in 1~67 at the University 0-1 Colorado,) "From 1981 through 1985 Statzl and other j

{][OiiA,L BJUb7'HJC,

126

surgeons at the University of PIttsburgh tr;msrl~nted livers! 768 kidneys, 198 heartt;, :i:! heatt·lung~, 16 pancreases and three single lungs, Thirty-two tlmes they rransplal1led :J heart aJld lungs simultaneously, three time, a heart and liver.... Tn 1985, 35 other ~ncdic;ll centers tr.msplanted livers, 70 centers were transplanting heart::>, 180 tra nsplanting kidneys and 20 liKing p~tn~ creases. Most of these began after the drug ~cyclosporinj became generalIy availah1e in 1983·" 28. Robert Peat, "Federal Payment for Tr
ill VlfJo," Proceedings

the Society for Experimental (195t): 41-,1(i This rderence and more recent studies (sec L. 1\1. lIall, "Preferentlal Oxidation of AcetOacetate the Perfused. HearL" Blochemiu?l and Biophysical Research Communlcations 6 [1961J: 177), suggest that in a [asring or exerdf-ing animal the' liver ffi3Y export the end prod~ lict:) of fat metabolism to surpatt the oxidative metabolism of the hearL 30. P. T. Manning et a1., "Vasopressin-Srimularcd Release of Atriopeptin: Endocrine Ant:lganisls in Fluid Homeosratis," Science 229 (198'); 395, 31. United Press Inrernatfonal t "MulripIc Strokes K.ill 'Bionic Biology and lHedicine

Bill' Schroeder," AU/waukee Sentinel, 7 August 1986, L Mr. Schroeder died on 7 At:gust. lIe received [he hnplam on 25 November 1984 and suffered strokes on

13 December 1984, Mav 1985, and on 10 November 198"5, He was the l"8st surtdving recJpient of:3 permanent implant of a plastic pump, with which he lived 620 days. The temporary llSC of the de-vice seems to be lhe direction in which the technology is mu'·/ing,

32. "Dealh Out of the Closet," ediloria!, New ibrk Times,

30 June 1986. '35, TilHles Rachels, The End q[ L(le_, Euthanasia and 'Morallly (New York, Oxford Cnivcrslry Pre"" 1986). In a recent poll of 2)000 people, 90 percent ~~pp()rte? ~he right of competellt persons to rcfus: l.ltc~.:;:JSla111.mg treatment even if their liocmfs and thelr fam1lies object (H. A. Schmeck, J1'., New }-ork TtmeJ~ 2 December 1:)(';6, I). . 34, G,Hrett Hardin, '"The Tragedy

0

I' t 11<:: C'~omrnons.-"

Science 162 (1')6Rlr 1243-8. 3'1. Ber-vl L Crowe; "The Tragedy of the C:omnlons Revisited;' Science 166 (1969) 1103-7.

THE CONTROL OF HUMAN FERTILITY

about a future involving further increases in popubtion in the Western Hemisphere, basing his v[",vs on the concept of "carrying capacity" of the land, that the soil, water, air, plants, and :mimals available to the human species. I am sure that were he living today, he would Ix: aware of the precarious future for people ill Africa, the Middle East, India, and Soutlleast Asia. Tnday, specialists in a variety of technologies arc inclined to believe that if they could be given adequate financial snpport, there is an almost unlimited extent to which they coule! expane! the carrying capacity of thc planet Earth, and therefore the ;tbility to support vast increases in the numbers of human inhabitants in this environment. Their confidence is not justifkd. ;\[0 one knows exactly when the p(lim of no return in the present trajectory will be reached, but as Leopold wisely noted, "Ecology knows of no population density rclalionship that holds for indeHnitcly Wide limits. All gains from ALDO LEOPOLD \11;:,\, APPREHbNS1VE

13U

density are subject

GLOBAl BJOETHfCS

to

a law of diminishing returns"

(Almanac, 1987, 220).

In contnlst to the conmcopian scenario. there is another that is mueh more likely and i,~ in fact already on stage. It goes somewhat in the following steps, wah one leading to the next. ;. Carrying capacity is by technology -. Populanon lllereases by medical technologv and environmental technology. ' 3. Governments and private multi-national corporatlom a~e unable to manage ethical problems of dlstnbutlOn and equity. 4. Political unrest escalmes amung competing ethnic and religious groups. . 5. Military solutions through exploitation and appropriation of science lfid technology arc sought. . 6, Development of science and technology for the common good withers of competition WIth military demands. 7. Carrying capacity relative to human needs begins to enter crash phase, 8, Widespread lowering of lifespan r".,,,,I,. 9. Ivlberdble survival remains as Outcome. Every transilion from one step to another in the above sequence could he the subject of an extended presentation of facts and opinions, pro and con. Here they provide a kind of study plan for exam inmg the onrush of daily events reported bv the media. . Aldo Leopold·s ethical concern for "the land" is not only a moral issue but a pragmatic formula for survivaL His views impinge on the very beginnings oj the ahove seem rio. (1) When technology is employed to lncrease the short-term carrying capacny of the earth, it must Simultaneouslv be used to prcservc the long-t,crm carrying capacity. (2) When

Em/(ting

0)1

ihe Jeopold

re.g(~cJ'

Ul

the popUlation increases as a result of in infant mortality and other preventahle medical technology must also be applied to the controlled fertility. The present medical purSuit of life m:tlnterlaCice without regard to the quality of life must be earefully scrutinized, While some consideration must be to the wishes and best interests of those whose lives are pointlessly prolonged, more effort should be devoted to the puhlic health measures that would make possihle productive, healthy, functioning lives for people everywhere, It is maintained that this goal cannot he achieved within an ethic that gives top priority to the principle of autonomy, especially insofar as this implics freedom to repro duee withour responsibility and without societal restrictions, or within a religious ethic that forbids artificial contraception or abortion. TWO KINDS OF PEOPLE

Using a system that has prot(lUnd consequences for fULUre of the human specics, all of the world's people can be classified into just twO groups. The separation into two groups call be made on the b~ISis of whether individual couple;; or single women (including teenagers) are controlling their o",n fertility. either by means of abstinence. artificial contraception, or abortion. Political probarise when there is a marked disparity in birthrates among ethnic or religious groups within a nation or hetween contiguous nations, In general, the extent of fenility control increases with the amount of education and the breal{ing away from religious precepts that forbid artificial contraception and abortion, When a city or a nat.ion contains factions that widely in

1;)2

rheir levels of education, income, and religious orientation, political unity may be almost impossible to achreve, and the relative proportions of those with familles to those with large families change markedly in a few decades, Thus, Norman Berrill concluded (see chapter 2) "that ' the more fertlle or the more prolific human or races will out breed the rcst, that popUlation control by any group sooner or later seals its own doom with those who retain an uncontrollable breeding instinct taking its place:' There is a tendency in the l'nited States to regard overpopulation as a nonissuc, because artificial contraception buttressed by legal abortion is so widespread, (In contrast to the off1cial Vatican ])05inon, many Catholics use artificial conll:acepl whllc those who do not are likely to use the approved natural rhythm method-which is certainly not a "natmal" method of l)irth cont1'Ol.) '\:er there IS a tragic tenden cy for the poorest and most disadvantaged members of our societ r [0 disregard contraception, The net result can be rates of teenage pregnancy; increased of (Acq:lired Immune DefiCiency Syndrome), conlJllUatlOn of the poverty cycle for sector of the population, The diSinterest in the population prOblem in the l,nired States is sheerest fOliy for another rcason. South (,)ftheborder, Mexico, with a popUlation oI 83,8 mllliOIl 10 1987, has a doubling time estimated at only 28 years.' Although Mexico is now making rcm:rrkabk progress in promoting birth control, the mothers of the future have already bet::n born, Wier widespread poverty and unemployment it is diffi cult to prevent unw'Ultcd pregnancies, The sO[Uti01 j(lr the disenfranchised is mass migratiOn across th border into the United States by legal or meg; means, Not only Mexicans but Central American

lJul1dlng on the Leopold U.lf{({9'

from fanher south can (orne in via Mexico, Caribbean popUlations like tho;,e in Haiti, Jamaica, Cuba, and Puerto Rico lend to fall into this same category and to regard the United States as a panacea, For those who, like Aldo Loopold, believe thal "North for permanence if she can contrive to popUlation density," the comroJ of human 15 a paramount requirement, With a continual influx of legal and illegal emigrants from the countr1cs south of the border and from the Caribbean countries and elsewhere, it becol1les apparent that limiting fertilit y in the United States, without Similar action in other parts of the world, would not prevent continued increases in the total population of the Nortb American continent," :::.!owhcre arc the consequences of fertility control or the lack of It more pOlitically devastating chan in the case oJ the contliel between the Israeli Jews and the Palestinian people, although strangely, the issue has little publicity, The future of israel is fundamentally hopeless insofar as the Jewish component of the state, which chooses edu cation, advanced technology, and a decent income for its people as its top priorities, operates within a secular framework that sanctions controlled fertility, Whether the Palestinians are given citizenship and illcorpor;itcd into the state or, alternatively arc contiguous territory and 8110wed ro set Ltp their own state, the demographic bahnee will inexorablv shift to a situation that will doom the Jews, Nor 'can the Jew'S solve their problem by an all-out effort to ourbrecd the Palestinians, It is too late in rhelr history for that. The Palestinians, Egyptians, the whole Moslem world-for whom anilkial contraception and abortion are strictly forbidden-are on a collision course with the r·est of us in terms of birthrates. While

('-'LU~1l1Jl0E1H1CS

Palesrinian women are encouraged to bear fiYe, six, or se:cn childrell-to c\oublc their group's popula: lion 111 a generation, the Israelis ma\' fail to even maintain their numbers except by imn~igration. This has fLlnher complicated the volatile sill;alion in the Middle East. Another example of tbis disparity in birthrates among ethniC groups within a region is in the USSR. Any data on binhrate for the USSR as a whole is meaningless, as in the case of any other country including the United States, which has widely dive;': ethnic groups. Mother Russia ane! the six Eastern European members of the USSR and its allies are, as a whole, fairly stable in terms of population. In the predominant group, the core Russian RepUblic, the 19808J increase in the population was 0.6 percent, with a doubling time of 121 Ycars. In the Ukraine, Belorussia, !vloldavia, ESI'onia, Latvia, and Lithuania, the corresponding increase ranged from 0.4 to 0.8 percent with doubling times of 93 to years. :-.lumbers of abortions per woman are extremely high' The birthrate is below rnaimenancc levels because sexual activity is COnSciously moderated very significantly by ahortions. to a lack of adequate supplies' of artificial contraceptives. In contrast are the Moslem provinces on the southern border where :tbortion and contraceptives ar.e forbIdden In the four Central Asian Republics of KtrglZtya, Tadzhikistan, Turkmenistan, and Uzbekistan, the 1980~81 increase in the respective popula!tons was 1.8 to 2.7 percent with doubling times of 26 to 39 These four republics are overwhelmingly of the Moslem In the Transcaucasus, Armenia and Azcrbaydzhan have growth rates of 1.5 perc(:nt each with projected doubling times of 48 years:' But trouble between the Christian Armenians and tbe Moslem ALcrbaydzhanis has

Ruiiding Dri tho u:opOld Leg?lc.i'

gone on for centuries, and only recently- clashes of 200,000 on the have occurred in Sumgait, a Caspian Sea.' Populations of both groups are reproducing much more rapidly than are the core RUSSians. The Azerbaydzhanis an: Shiite Moslems, the sect that holds s~ay under the Ayatollah Khomcini in iran where a 1987 population of 50.4 million is reproducing with a doubling lime of 21 (Fornos, Gai1'l1:ng People). Black Africa as a whole has a pronounced populatic)!1 problem. 'Ibday a new variable has complicated the picture. With a plague of Biblical proportions threatening, the spreading incidence of AlDS lends a sense of urgency to the neeclto halt unregulated population growth. According to Werner Fornos, president of the Population Institute, Kenya, with a population of million in 19H7, has a growth rate of 4 percent per and a doubling time of onlv \(, vears. Similarly, lanzania, and Zaire t{ave doubling times 20, and years, respectively, some of the most rapid growth ratcs in the world (Fomos, Gaining People). White South Africa, with its controlled fertility rates, undoubtedly feels threatened (politically ,md otherwise) by these trends. The incidence of AIDS is not unrelated to the unregulated activity in these areas, and perhaps the only break in the rate of incre",e wili occur if spread of AIDS is unabated. was not a global view when he proposed the land ethic, nor could he envisage the medical and dilemmas that would develop over ensuing fitly 11:)day, the issue of human fertility extends far beyond China and India. It is a global problem, and all the value.s that Leopold held dear wiil only move inexorably toward ecocatastrophe unless world leaders and their constituents can reach some

GLOBAL B!OE,711CS

measure of agreement on how to proceed, Stephen Haushenbush placed the burden of finding a solution 111 poiltlcal terms on the United States when he said, 01: t.h~ American success in achieving a mutuaHy sansfYlOg way of living, an ag:'ccmenr for (,01n(1)on progres:-; with itS own minority, which (s both underprivileged and facially different,. rnav also depend some of the world's future chances of avoiding centuries of malevolent and violent (011filet ~etwecn the wodd's dominant white minority 3n~ itS overwhelming maiorifY of yellow, brown, JUG hlack: men who are hoth underpcivlleged anc..:. ex:asperaled:'6

THE SAN ANTONIO CONNECTION It seemed entirely appropriate that the Department of Obstetrics and Gynecology at the University of Texas Health Science Center at San Antonio, only a Hule over a hundred miles from the Rio Grande, would have the vision to see the populanon problem not only as a North American prob lembut as a global problem, Under the leadership of Dr, Carl ]. Pluerstein, a five-year grant was obLlmed from the Rockefeller Foundation to set up a post-doctoral program consisting of a six-month core curriculum of didactic instruction in social science, reproductive biology, and clinical procedures, followed by individual specialization in one of these areaS, Because of the varying national, cthme and academic backgrounds of the post-doctoral fellows, the core curriculum was taught with the aid of.wrltten instructional units; the outgrowth of that ettott was the hook Fertility Control: f1iotogic and Behamorat Aspects, edited bv Rochelle N, Shain Ph.D. (anthropology) and Carl]. Pauerstein, MD,; For perhaps the first time, the authors reported a multidisciplinary effort combining (I) basic reproductive blOlogy, (2) clinical applications of

reproductive and hehavioral science (Le" control of fertility), (3) demogr;lphy, (4) anthropologic and sociologic perspectives, and (5) social sdencc methodology, Although the dlsciplim:s of medical hioethics ;md ecological hlOethics were not included, this omission is readily accomm:d for by the fact tl1m the post-doctoral fellows were being trained to become skilled in all aspects of fertility regulation, the delivery of contracepti I/e ;,ervices, and the problems involved in infertility The inclusion of items (3-5) was to hdp "prcpare them for the lIlultiple and complex problems that they wonld upon their return to thdr countries of or1g1n." The book remains a monument to the group effort; it is well worth utilizing as an objective coverage of one aspect of th<: global bioethics that is here advocated-the coupling of medica! and ecologiol bioethics. CLINICAL APPLlCATIONS: INFERTILITY

Shepard noted that approximately 15 percent of couples experience infertility,' As a rewlt widespread fertility control and more liberal altitudes toward the rearing of out-of-wedlock children, infants are available for adoption, Many advance;; in diagnosis and treatment were described as paralleling advances in the control of fertility, NONSURGICAL 2\<1ETHODS 01' CONTRi\CEPTIO:N 'Three factors have revolutionized the attitudes of society toward contraception; (I) the threat of rapidly expanding population, (2) the desire for increased personal freedom, and (3) tbe

138

GLORAIl1JOET1JJCY

development of oral cOlllraceptives,"9 Thc alternato oral contraceptives arc all less effective than "the pill"; the so-called rhythm or timechhstinence method was reporkd to be much less effeclive, posslhly hecause of indications "that women have a pe:lk of sexual clcsirc coincident with the preovulatory estrogen peak;' making ahstinence difficult ,:hen most needed (73), Out the major complication, accordmg to Sheparcl, aside from recllnenl sexual [rnsuatlon, may involve an increased of abnormal offspring and pregnancy wastage if the method faiis, EVidence was Cired to indicate that 1-1 to, percent of women per year become pregnant uSing the rhythm method compared to 1 to ,) cent using oral contraceptives (72), Allhough more studies are needed to substantiate the risk of abnor~ mal offspring due to fertilization of an ovum more than 48 hours after ovulation, the risk of genetic damage would be an excellent example of the bioethical error in sanctioning an ahnormal response to a hiologically normal function, The various methods for stcrliization of men or women were discussed by Shepard In another chap ter and need not be described here, However, it i: relevant to note at tbis point that Pope John Paul I has taken a strong religiOUS viewpoint on what i ciearly a problem in medical hioethics when h' declaredthat artifiCial contraception and steriliza t1011 are "always seriOllsly illicit." 10 Indeed, shorth after the international population conference I; Mexico City in August 1984, he repeated tradltiona church teaching that abstinence from sex during, woman's fenile period was the onlv method of lim. iting family size that conformcd to'divine plan; but he added, "the use of infertile periods for conjugal unJon can, however, be an abuse if the couple is seeking in this way to avoid children f()r unworthy

reasons."ll

1::'8

I:"lNOVATIVE APPROACHES IN CO:"lTRACEPTIVE RESEARCH

Harper and Sanford reviewed newer methoc1s under consideration,12 At the time of publication, newcr appllca\ions of the oral contraceptives were being studied as injectable synthetic progestational agents, and more recently these attempts appear to have come to fruition, In research supported in equal measure by the Ford Founc1ation, Canada's international Development Research Centre, and the Rockefeller Foundation, a new contraceptive technique with five ye:lfS protection following a single administration has been reported," The original studies by Drs, Sheldon J. Segal and Horado I3. Croxatto led to the developme-nt of a new form of reversible contraCeption, an implant ~hat relea.sed a progestrin, levonOrgeslrel, directly intO the bloodstream of women, protectlng them frOIH pregnancy for five years, .During the next several years it l$ ~xpecled that hundreds of thousand;, of women will join a~mos[ 10;000 of their ~isLers in 1-4 developz:u and developing countries-the pionecrs who participated voluntarily in clinical trials over a nineyear period··..··in using the implant) which ha., been named Norpl:rnt, (2 rcgi,slered trademark owned by the Populallon Council), j

A similar and parallel developmem with comparable results is in progress in the laboratories of the Swedish pharmaceutical company KabiVitrnm in Stockholm" The availabilitv of five~year protection from prcglUncy after J 'single ad~inistration, with ongoing research on improvement~ in the technique, would seem to offer the possibility of quieting much of the controversy surrounding the abortion issue, Despite the options, however, rhc ignor',111ce,

GLOBAL IJ!OETHft':1:

140

innocence, naivete, religious restrictions, or carcfcssncss of many couples makes pregnancy termination by abortion a second line of defense that will remain controversial for SOme time to come. PREGNANCY

TER'vlI~ATlO~

\1(!cinberg has discussed the issues smrounding abortion as well as the various procedures and their timing,15

In \'Ii'estern society, the maio)' options 'lvailablc to the woman faced with all undesired prl"gnancy are marri~ge, Single-parent rearing, ofkrlng the chile! for adoption, or pregnancy termination, Eaeh of these has advantages and draw hacks the mother in terms of physical and emotional health and social acceptability, Pregnancy termination by abortion is the most utilized option following an unwanted prl"gnancy, Although there are dara to indicate that one in four in the United States ocellr when the woman is already pregnant at th" time of marriage, there are also data showing an increased incidence of separation and divorce in such marriages, More· over, for most teenagers the marriage ",olmion" frequently means discontinuation of education and frustration of life or career goals. Following the legallLation of ahortion in 1973, there were in the United States 1.2 million abortions in 1976 and 1,3 mUlioll in 1977, with an estimated 2,) million women who desired abortion but for whom services W"fC not available. Prior to the legalization of abortion, many women in the United States were forced to lItilize extralegal practitioners, with maternal sepsis and mortality frequent sequelae, Death rales from septic abortion have declined 19 percent annually to the

present rate of only 4 per 10,000 procedures performed in the first r.rimester and 1.6 per JO,OOO 1il the second rrime"ter, Both these tlgures are lower th:m. those for term delivery in the t:nited States, Tot:d morbidity, the proportion of patients who experience injury,' disease, or other defined complications :lS a result of a surgical or medICal nnDOc dure, is reported as 5. S percent following firsttrimester abortions. The l1gure rises to percelll for second-trimester procedures. Thus a goal of termination services is to diagnose and terminate pregnancY as soon as possible. Various methods are avaiJ~ble and have become reliahle at earlier times than w"re previously availahle. . ' A variety of procednre;, for abortion arc avat!able, depending on the stage of pregnancy Current phm'maceurical indicates the future POSS1bilitv of self-administered ahortlOn techmques employing some kind of a chemicaL Among the new developments is nonsurgical pregmncy lenmt1:ltlon by means that prevent a fertilized ovum from 10 sur· receiving the chemical support that it vive. Indeed, it has been proposed that the mgcs lion of the appropriate compound once a month, without any knowledge of whether fertiJi7Ation had taken place, would constitute a method of contraception, Those opposed to ahortion arg~e thal the procedure would constitute an abortlon If fertIlization had t:1ken place In the absence of knowledge one wav or the other, they would oppose this methm,(o[ fertility control. It is cleat that nonsurgical methods of abortion, carried out privately with the use of specified types of medication, would make it e.xtremelv difficult to prevent women from terminating pregnancies i[ they so chose, One approach to the expression of opposition is the organized boycott of pharmaceutical compames thm produce the mediGttion, or orgamzed pressure

142

on the FDA to ban the product. One can foresee the development of small companies ,specializing in abortifacient chemicals or even black-market clisrrlbution, \X/einherg notes that despile legaliz;uion, abortion is stlll opposed by certain religious and SOCioeconomic groups, AS a result of this opposition, the Hyde Amendment to the Health, Education and Welfare appropriations bill w:;s p
Of cOUl'se, the termination of pregnanc), by abortion is an unsatisfaCtory solution to the problem of unwanted pregnancy, The alternatives are either total abstinence or the llse of effective contratechniq ues, Sex education in the schools may provide needed information, but parental guidance seem, most advisable, The information can he provided "after the fact:' and termination services should provide adequate counseling, education, and emotional support bc!()re, during, and after the procedme, The proviSion of contraceptive advice is essentiaL Two studies demonstrate a 93 percent contraceptive acceptance rate after abortion (Shain and Pauerstein, 118-21),

PLA INTERVENTION IN POPULATION CliANGE

According to llrowning and Poston,'" the three main population variables are fertility, mortality, and migration, "Of the three, governments have put their greatest efforts into the control of mortality Saving lives is unambiguously positive, and no govc:rnment has ever avowed vther than a policy of mortality reduction" (204), Governments have been reluctam to put their coercive powers to use for population except in such cleareut instances as the effort to control contagious Nowhere is this more evident than with respect to fertility "Only in tile last three decades has the 'population problem' with its Cassandra,like prophecie:; of impending doorn, particularly for the developing countries of the world, led governments to reluctantly acknowledge the effect of population change in the developmental process" (205), Sources of oppOSition to family planning programs have been mainly ideologicaL One author has classified different sources of opposition in Latin America into three categories, but Browning and POotOll regard his analysis as equally applicable to many parts of the Third World, First are the nationalists, who believe their country requires a large and growing popUlation, Comervatives are a separate category, often but not invariably associated with religiOUS groups (e,g" Cathoik, Muslim, and fundamentalist sects), The conservative position considers birth control programs to be contrary to natural (however defined) and yet another step the weak<:mng of the foundation of SOCiety-the family :mel kinship structure A third category is the leftists, Le., doctrinal ,'v!arxists, who have argued that in a socialist society the problem of overpopulation simply does not exist. fn chapter

145

17 Poston and Browning presentcd "Four Case Studies: Mexico, Inelia, China and the United States" (Shain and Pauersrein, 215-32), Mexico has been remarkable for the suddenness with which government policy has shifted toward birth control pro grams, President Lopez Portillo proclaimed his goal of reduction of the birth rate from to per lOOO as a target to be reached by 1982, This was nOI reached, although the crude birth rate was down to 52 by 198'1. 17

FERTILlTY-REGUL.A,TING METHODS IN PREIKDUSTRIA.L SOCIETIES

Shain and Lane have surveyed their subject from an anthropological as well as :1 historical viewpoint 1M They declare d Binh control has b(:cn utHi7.ed throughout recorded hiSTory, and in societies representing all levels of socioeconomic development. Hirth pl3nr:ing Js not an invention of modern b'Jl it is as old as mankind. Infanticide :1nd abortion have beell The most PfC...",-:1!cnt methods of effective fcrtilityregulation utilized throughom history. (244)

The enumerations of the bizarre and exotic meth· ods for inducing abortion used in various parts 0 the world attest to the conclusion hv Devereux.1' quoted by the authors, that "there is' every indic2 tion that abortion is an absolutely nniversal ph, 1l0menOll, and that it is impossible even to COl struet an imaginary social system in which n woman would ever feel at least impelled to abor' (245).

SOCIAL & RELIGIOUS CORRELATES OF FERTILITY

Hoppe has reviewed the eXlensive literature on the causes of the wide variation in fertility in varimls parts of the world'O The include edlnea· tion, urbanl,;nl, economic status, rninority status) religious orientation. Without pursuing the reasons for and tile historical development of religious opposition to fertility control, and especially the opposition to infantiCide and abortion, it was noted that considerable variability exists even within welldefined religious groups. Most empirical research on religion and fertility has dealt with differences between Roman CathOlics and other major religious groups, It is less oftcn realized that some other religious groups exhibit fertility rates which in general rar e;'
'fhe increase in the Hutterite population has little effect on the world population, but the fertility

rate of the world's Yloslem population is another matter. Aecotding to Kirk, [slam h;cs been a more q

GIORf.L R/Ot:THIC)

effective barrier to the diffusion of falllily planning th~n Catholicism" (Shain and Pauersrein, 267). The effects of IslamiC fertiliry rate,; on the future of the USSR and the Middle Ea;;t lllay constitute a serious threat to world peace. SIG:KIHCA:KCE The [()fegoing pages have not b(;gun to encapsulale the admirable feature" of the San Antonio effort, with its twenty-seven d1apters, extensive bibliogra· phies and comprehensive glossary, tables and charts, assembled by eighteen contributors, What emerges is the fact that fertility can ,md will be con[rolled by an increasingl y effective assortmem of options, ranging [rom surgical sterilization to a variety of artitkial contraceptive,; to a developing phar maceutical approach to nonsurgical abortion, As long as there is a separation of church and state, individuals will be able to limit their fertility and governments will be able to maintain freedom of choice. \\7hen church and st~te become one, as in certain Islamic nations, individual choice may he lo't and the increase in total population may have political consequences touched on only indirectly by Shain and Pauersteio, IL is nOteworthy that this discussion of fertility control has not been one of right or wrong, ethi cally acceptable or unace(;ptable, While ethicists and religious groups may debate the rights of the fertilized ovum and the morality of sex without reprodUction, rhe pharmaceutical community will continue to make iL easier to avoid both issues, In the long run the new venereal disease Acquired Immunity Deficiency Syndrome (AIDS)," not here discussed, may have a greater impact on the mores than do the dogmas.

Dldiding orl jhe ft!oP{J(ct Legacy

The subject of fertility control has been inlroat this point and the San Antonio effon highlighted to make it clear that the options are available, and lhm they are increasing, The authors were nol describing the ethical dilemmas posed, nor were they undertaking a discussion of the ecological consequences of a failure to achieve fertility control on a global scale, On the one hand we hav(; the view of Aldo Leopold and his realization that population density must be limited before earth's carrying on the other a compellmg capacity is c"Xceeded, presentation of the means and the problems COil, nected with "fertility controL" We must now proto the development of a viable world view, Overpopulation is not the world's only problenl- Equally imp0rlam is the overconsumption of nonrenewable resources by the Western world and the overconsumption of the so·called renewable resources of soil and forests by tl1e poverty-stricken, overpopulated nations of the Third World, Con trolled fertility and controlled consumption constitute a doubl~ trnek to acceptable survival for the future, Inhumane rreatment of minorities by majorities or of suppressed majorities by powerful minorities is, of COLlrse, not the solution to the need to control individual reproductive powers Health, education, and economic justice wlil do much to gain lile acceptance of constraints applicable to all, The prevention of unwanted pregnancies and unwanled births, along with eeillcation would provide an understanding of the natural and the political world, might be sufficient to stabilize world population and SlOp environmental degradation," uuceu

148

GLOBAL BJOFTHICS

L ,\i7erner Pornos, Gaining People, rasing Ground.' A BlueprinT

11

Stabilizing World Popu.1atlon puhHshed

for the Population Institute, Washington, nc, (Ephrata, Penn,; Sdencc Press, 1':)88), 2, It D, tamm and G. Imhc)ff. The Immigration Time Bomv. the FragmenttJIR of Atflericu (New York; Dut~ tOn, TI-uman Talley Books, 1985). 3, LS, Congress, Jojnt Hearings Defore Subcommittees, "The Political EconoI1lY of the Soviet Union," 98th Cong" 1st se8<.;., 26 july and 29 Seplember 19B3, RH~ 162.

lJui!d1n-g on fhe Leopold I-egm::}'

-

4. See Fornos, Gaint'ng People. 5. Philip Taubman, "Soviet Reports a Major Oil Center in Azerbaijan is Shaken hy Rio~s," New York Times, 1 ";larch ;%8, L (i Stephen Raushenbush, iHan '5 Past: }dan '5 Future, A Humanistic flistory jbr Tomorrow (::\ew York: Dela~ corte Press, 1969), The '8.uthor reviews the dfailures" of previous power structures-Greek, Roman, Church) Spanish, etc, 7, R. N. Shain and C .L Pauerstein, eds., Ferlili~}' Control; JU%gfc and Behavioral Aspects (Hagerstown, \ld.: Harper and 1))80), The book has an excellent glossary and index .me! each Chapter has a fist of sources and references cIted in the text. Permission to reproduce pflss-ages was granted Rochelle N, Shain and CuI 1. Pauerste:in, r'er[ilt'~y is defined in demography as th'c demonstrated production of children. ::\lllnericallv it is the number of bLrths per year per 1000 member:-- of the populatioH I also ter:ned CHi{, the Crude Bi:-th Rare, R Marguerite K. Shepard., "Infertility," in FerHlllJ Control: BiologiC and Bebavioral Aspects, c(l It N. Shain :md C, . P",merstdn (Hagerstown, ~·ld.: Harper and Row, 1980), 70.

9, Marguerite K. Shepard, "Nonsllrgical Method;; of Contract:ption," in Pertilit')' Control: Bf%!l,ic and Bebauioral.c1spect<;;. ed. R. X, Shain and C J, Pa~uerstcin (Hagerstown, ~Id,: Ha,,!,cr and Row, 19A'J), 71 ~84. 10. Neu) }brk Times and Associated Pres.s, ~Fi:iconsin State Juurnal, 27 January 19B5, reported' that in Caracas, Venezuela, Pope John Paul n issued a strong conuemna· tion of contraception, steriHzatlon, divorc~ abortion, ,lnd eutharrash,L

149

\'\'arns of Abuse in ~8tufal Birth Control," ,"rfUwaukee 5entlmd wire services ii'om Vatican City, 6

September 198(t 12, Michael 1. K Harper and Barhara A, Sanford. "Innovari~re Approaches in Contraceptive Hcsearch," in FertiliJ,v Control: Biologic and Bebat'ioral A::.pects, ed. R. N. Shain and C J, Pauerstein (Hagerstown, Md.: Harper and Row, 1980), 85-102. Lvnn Landman. "The Makings of tl New Contraccptive," til'; An Oeca:"ional Report O'tl tbe wtjrk of the Rockefeller Foundation (New York: Rockefeller Foundation, 19R'5), 9-10, 1i1. Professor L. Boltiger of K..:JbFVitrum. PO. Box 30064, st0425, Stockhoh:l, Sweden, in a tener to the author. 15. P'dul Weinberg, "'Pu:gnancy Termination," in Contn;l: Diologic ((;nd Bebovioral Aspects, t'{.L R Shain and C. J. P-,lUerstcjn (Hagerstown, Md_: Harper and Row, 19801, llH~h. 16. Harvey L. Browning and Dudley L Po;;;ton,JL, "Planned Intervention in Popultlt1on Change)" in Fertility Control: HiGlogie and Hebavioral ASjJects) ed, K ~, Shain and C. J. Pauersteln (Hagerstown. Mel: Harper and

r.,.

Row, 19HO), 204-14. 17. /98'} World POjJulation Data ,')'beet (Washington, D,C.:

Population Reference Bure:an, Inc.). cLn,7, IS. H. N, Sham and R. A, L(lht', "'Population (;rowth and Regulation fror.::l a Cross-Cultural Perspective," in FertUit)! ContruL, Biologic and Beba1!iorai Aspect$, eeL R N. Shain and C. ]. Pauerstein (Hagerstown, Md,; Harper and Row, 1980), 235~50, Rochelle Shain 1la.<J published an upd2ted review, ":\ Cross-Cultural History of Abortion," Clinics in Ohstutrit'S ana Gynecology i j (1986): 1 1/, 19, G. Devereux, '~'\ TypologIcal Studr of ,'\bortion in 350 PrimWve. Ancient and Preindustrial Societies," in AliortioH'in America, ed. ·H. Rosen (Boston: Beacon

Press, 19(7),97, 20. Sue K. Hoppe, "Social anti Sodal·,P:;ychologicaJ Corre,l:1tcs of Fertiliry," in Fertili(y Control.' Biologic and HehuvioraJ A.I,Jlcct:j·, ed, l\.. N. Shain and C J Pauerstein (Ilagerstown, yIn,: Hdrper and Row, 1980). 261 ~ 76,

:50

GL0&11 f3101:Tf11(S

2 [ R. C. G~lJo et aI, "Frequent Detection and Isolation

of Cytopathic Retroviruses ~HTLV-IlI) from P:uient5 with AIDS and ar Risk for AIDS," Scjenc~ 225 (1%4) 500~503 . /\ddltiona! reports with citations of research l1tcf
GLOBAL BIOETHICS DEFINED

I T IS SO EASY '10 APPJ,\IJD TilE DRAlI1ATlC. thollsand-

riiile-fifghl-of an anencephalic infant thl'Ough the rebuilding of its hean imo a defective newborn by a skilled surgeon, It is easy to comprehend the oneon-one relationsbip between ;1 desperately ill patient and a wise pbyslcian, the medical blocthic that sees no second choice, that can always choose life as the supreme value above all other values, l'iot so easy is the problem, How do we prevent f:Hrlirie in -Africa? How do we save the Amazonian rain for· est? How does South Africa change its present policies and go on to limit the reproduction 3nd meet the rising expectations of il:5 majority black popula tion in terms of education, land, and jobs? How do we incorporate family planning (Le., controlled fertility) and the concept of person health into an overall program of health carc that includes good nutrition, an absence of prevemable disease, and a minimal level of infant mortality in our own highly reprodnctive segments of tlle population? [low do

151

1S2

GT,ORAf~

RTOH1HlCS

We achkve health without a

increase' How do we prevent the human species from ckstroying natural environment upon which human life depends? do we obtain leadership that underst:mcls the urgency of developing a global bioethic which, like Leopold's land ethic, "is a limitation on freedom of action in the struggle for existence"? nngelhardt has remarked that "one has no intellectual problems, no philosophical problems, if one does not worry about giving re'lsons."J It must he noted that Lester Brown, Director of Worldwateh Inslitute, and his colleagues have abundantly given the reasons. It is as if the authors have assumed that if the facts can be assembled and the desirability of human species survival can be assumed, the ethics of "what we must do" will follow automalicallv. And perhaps they are right The entire output (;r Worldwdteh Institute, from its annual accounts of "the state of the world'" to a long list of relevant reports and books, embraces the issues of human survival and the necessities of both fertilitv control and cnvironmcntJl preservation,3 As suei], Lester Brown has provided a framework for globa( bioethies under the rubric of a "sustainable so,~iety:'4 too, would like to give North the world-"a better chance for permanence." Still, '" individuals we need to have a fe(:lirl~ of direction, a sense of personal identity with something above and beyond our own dailv life. A bioethic may fulfill tl,al need, if underst()()d to mean a gfobal bioethic, encompassing not lust medical bioethics but ecological bioethics as well and having as its core element the twin concepts "person health" (described below) and Leopold's land ethic. 010bal biocthics is proposed as a secular program of evolving '1 morality that calls for decisions

in health care and in the of the natural enVllonment. tt is a mor:liity of responsibility. Although described ;15 a secular program it is not to be confused with secular Immanisrn.' Global bioethics can coexist with secular humanism as long as it can be agreed upon that the natural la,"", governing the biosphere-indeed, the 11Oiverse-are not going to change according to the wishes of individuals, governments, or religiOUS preferences. In the lace of the diven;c but determined religious bias of major segments of the worid popularion, both ar home and abroad, a global bioethie cannot be based on any single religiOUS dogma; ane! even if there were no other reason, it must be secular. in an evolVing legal framework the global bioethic must recruitsupport from all mantlerof religious groups on rhe basiS of their persuasion that "quality ofHfe" a!lel "quality of the environment" are goals tbey can support without losing membership in the segregated moral communities that give them courage and divcrse religious factions must that terrorism, brntality, ,md war in support of a version of religious truth cannot rorce the acceptance of their particular moral rules by members of other religious or secular groups. Thcy must be persuaded that mutual respect and tolerance other groups is part or a viable global bioelhic BiOClhics remains what it was originally-a system' of moralily based on b[olog~c:aC l(nowledge,. and hurna'l values, with the "" Sccu~ar humanism has been C'ondernnecl on (ne h
154

CLonAL tJI0ETJ11(,'S

human species accepting responsibility for irs own survival and [()r the preservation of the natural cnvironn1cnt. The emphasis on bioethics in the hroader sense-as a system of personal morality-has an illleresling parallel with Engelhardt's discussion under the 11eading HBioethlcs and the crisis in ues." It seems to quote him at length in tigh r of the ahove Bioe:thics is an element at ct SE'CUJ3f culture ::md the greH:-g!",mdchlld of the Enlightenment. Bec'ause the 19805 have been 1:1Jrked in Iran, the tnited States. and c[sc,\vhere attempts to return to lradilional valL:es and the (c rtaintles of religious beUet's, one m"{:s.r wonder what chis augurs for bioethics in this special secular sense, However, because the world doe.') not ~1pre:ar \)!1lhe brink of embracing a particular orthodoxy, and if all orthodoxy is not imposed, as S3Y in iran or tbe SOViet l:nion. biOf'th· develop as a secular fabric of ics will ratjonality in an era of uncertainty. That is, lhe exiStence of open disc,ussion among diver· gent groups, such ab athdsts, C2tholics, Jews, Protestants, heterosexuais and homosexuals. anout public policy lssuc~ bearing cn health care wEl press unavoidably for a neutral common [angu~lge, Rioc:thics is developing as the lingua franca of a world concerned with nealrb care, but not possessing :1 common ethical viewpoint, (Engellurdt, 5)

HL:MAN IIEACrH AS THE GLOBAL BIOETHIC

At the outset it must be clear that individual human health for all world's people and not for jnst a chosen few must he a high priority for a global biocthit: that as its goai the 5u[viv'11 and improvement of the human race. Indeed, hLalth as the basis for the global bioetllie is all admirable end

in itself. If widely accepted, many other deciSions follow more easily. The adoption of a heallh ethic should be acceptable to all the diverse religious e1c' mems, for no nation, trihe, or religiOUS community has ever regarded malnutrition, parasitism, or dis, ease of an., kind as a desirable goal. Por instance, infant . is a measure of the overall of a communi tv or a nation: a decrease in infant mOT" talit y would "indicate progress toward better health.; Increases in pOSitive health for all memhers of soc!· ety would he improvement, in contrast to those technological advances in medicine that postpone mortality at the cost of an increased morbidity and that place sanctity of life ahead of quality of life. With the emphasiS on worldwide health, a large component of global bioethics is medical hioethics, which was shown in chapler 5 to bc ill a state of crisis, MEDICAL BIOETHICS IN PERSPECTIVE

Any program of global bioethin; musr attempt to develop proposals that take a position wirh re:sp
156

GLOBAt RlOr;THTCS

':"s this volume will show, there will be few serious general secular moral objections to abortion on request." He then goes on to say, "With all its defects, how-ever, a secular biocthics has numerous virtues. It promises the possibility of providing a comext for health care that can encompass in toleration health care givers and receivers wilh diverse moral perspectives" (l2). Clearly limited to the roles of health care and receivers, the book docs not mcntion problems of overpopulation or of changes in the environment. Nor does it embrace the concept of positive health for populations local or world-wide as a goal t(}r medic;,l bioethics, as is here proposed as a goal for global bioethics. On the olher hand, it remains an outstanding work that contains a wealth of background and insight that cannot be attempted here. No writing in the field of medical bioeth!cs can fail to mention it, In contrast to Engelhardt's publication, which was obviously written fill' medical bioethicists, George H. Kieffer, a biologist at the University of Illinois, was commissioned by the American Association for the Advancement of Science to write a study gUide on contemporary problem:,. He did just that,
From the standpoint of the global bioethics pro~ fessed herc, the medical and nonmedical issues af( interwoven to the extent that neither can b,

Bulldmg GJ! lilt! Leopold Legac;y

157

discussed to the exclusion of the other, and Kieffer recognizes that fact in his introduction. In addition, hc opens with a chapter on "Ethics and Evolutionary Biology" and one on "Ethical DeclsionMaking," in which he rcl:ues 10 the discipline of philosophy. It is unavoidable to conclude that the two book, are essential complements to other as a background for building the concept of global bioethics, although neither indexes Dobzhansky or ","addington introduction). THE CONCEPT OF PERSON HRALTH

As a biochemist and enzymologist in the field of cancer research, I have heen professionally con· ccrned with the concept of health for many years. 1 am convinced that the ongoing holistic research on physiological adaptarion combined with molecular genel:!c, at the reductionist level, is virtually the key to understanding health and I would like to develop a concept of human health that would go beyond vegctative or animal health. Ip£oposeto call it persoll iJealtb, that is, hcallh that is the property of a responsible, cognitive, sentient person who is active in maintaining or improving his or her own mental and physical condition. In this sense, a newborn infant does not have person health. Its health is the responsibility of its parents. The infant can be said to have health or to be healthy bur iI does not have person health. A significant part of the function of physicians, psychologists, philosophers. and basic scientists should be to join in the effort to construct a global biocthic and to inBtruct, guide, and aid the public in the attainment of person health. The global bioethic presented here is a concept that could provide a model for people-whatever sex or mcc-to begin to develop responsibility for their own health. This

BJOETHfCS

'59

means raking responsibilily for limiling lhe number of children in a familv in order to improve the qualIty of the community in a manageable qualil y enviromnent. Through family planning at many local k"Vcis a combined medical and ecological bioethlcs could extend to become an expanding global bioethics. Wtth education and guidance from the above-mentioned physicians, psychologists, philosophers, and basic scientists, knowledge could serve as a cmalyst and as a powerful antidote :lgainst the poisonous effects of greed, ignorance, and unchecked c1iscase in our world todav. Finallv healthy adults could then begin to pro~ide the;; children with the necessary mentorship that is intrinsic to worlel health and the future of a stable and productive world ecosystem. This is all in can· trast to the present system. ~ noted by Rene Dubas in "In the Umted States, the emphasis is on controlling disease rather than on living more . . The public health services ... do little to recogni7e, or measure the healthy state, let alone hypothetical conoition designated 'posit.lve health."" My concept of person health is strongly supported by the realization that pcople can do much to preserve their own health and prevenl disease, as sUtnmarized by Kieffer under the heading" Personal responsibility for health-An ethical impetative"(Kieffer, 3Yi-41). I Ie refers ro a blueprint issued by the Department of Health, Education and Welfare that seems ro respond to Dubas: "Only hy preventing disease from occurring, rather than by treating it iater, can ,ve hope to achieve any major improvement in the nation's healrh. . . todav's health problems are caused a . not susceptible to medical solutions or 10 direct intervention by tbe bealth practlti()1Zer"(i!2lics added here).' I make the point mat onlv ean

take personal responsiblliLy their own health, and 1 call attention to Engclhardt's extended and multi-faceted definition of person, particularly in his discussion of "person as moral agent" which he terms "being a person in the strict sense:'" With this view, a fetus or neonate or even a very young child would not be a person "in r.he strict sense."'"

(iL()B/~L

WHAT PERSONS

M"'VU

DO

If health is seen as people strive for, and if we have accepted widespread health as part of the global biodhic, we can begin to advise people as to what they sboule! do for themselves, recognizing that only persons as moral agents, that is, persons in the strict sense, can exercise the needed self-diSCipline to guard and improve their personal healrh. Persons who accept this responsibility arc then in a position to guide the development of their cltildren and adolescents into healthy adulthood . The guidelines thus become a matter of family morality and strength. H The following is a general of items that only individual persons in the strict sense can be responsible for.

.r1 BJOETHICAI. COMlvll1:"'IFNT FOR

PERSON

(7

E4MILY lIEALTH

1. I will avole! seltcadministcnxl elmg abuse and addiction: this includes alcohol, cigarettes, cocaine and similar illegal drugs, and even legitimate pharmaceuticals. 2 r will give proper attcntion to diel and exercise. 3. I will avoid sexually transmitted diseases resulting from sexual promiscuity and carelessness. (The current epidemic AlDS IAcquired Immune Deficiency Syndrome I is only one of the

160

4,

5.

7.

8.

GLOBAL BIOETHICS

many known diseases in this category but it is characterized by high mortality and, at present, no treatment; virgins cannot transmit or acquire the di~ea.se from another virgin and they will remain disease free if cohabiting with one another or living monogamously together, assuming both have never engaged in drug abuse and needle-sharing with infected persons.) 1 will drive carefully and legally I will avoid action that leads to unintended and unwanted pregnancy resulting from sexual carelessness and failure to use anificial contraceptives. I will avoid exposure to noxious chemicals or unnecessary radiation, (When these are present in trace amounts they may still cause eane(;t or hereditary diseases at a low probabilitv; individuals eannot always be aware of their pr~sence and can only be alert to warnings from responsible offieials, ) I will scck competent professional advice and treatmen! as early as possible when disrressing symptoms are not understood; I will seek some form of health insurance while healthy. I will support local and national g(~)Vernment officials and private organizations who provide responsible policies and decisions that facilitate the above individual actions bv means of education, economic justice, environmental prOtectiOll, and public health measures,

Il Illay here recognized that only the citizens in the developed world can begin to approach the freedom and economic resources needed to exeroptions indicated in the above lise Even in the United States vast numbers of famllies, Illany whom live below the poverty level, cannot to make decisions or take action in their own inltercst among many of the eight categories listed,

Buildiug nn tbe Leopold !.ewtlJ

In the underdeveloped world actual starvation is not unknown and parasitism exists to ,m extent uni· 11laginable in t;niled States, Fertillty control is tar from adequatc and malnutrition does not stifle C011ception. Global biocthics calls for determined gov· ernmental foreign aid plus charitable aml culturally sympathetic efforts to bring down infant mortality, malnutrition, and paraSitism willie simultaneously assisting governments to promote the birth of healthi<.:r but fewcr children. The challenge of Islam to a global bioethic remains to be examined, however.

TIlE RHSPONSIl3!LlTY OF PERSO;VS

Infants am! children are not in " pOSition to be responsible for any of the eight principles listed above, When we read about moral development in children we realize that the concepts with which are indoctrinatccL if any, fall short of most of my proposals for individual respomibility The case of the adolescent is of prime- importance in considering thc above remarks on "What PnSOllS Should Do" and on "The Responsibility of Persons," Whelhe-r one examines the of moral development as seen in and men" or in and women, as studied by ! j there does not seem to be of of responsibil· ity for health, either or others, Until now, most adolescent been with development individuation and auronomy whUe girls have been primarily concerned with caring, relationships, and responsibility to others (at the expense of individnation and autonomy), The new paradigm of global bioethics, embracing a morality emphasized GlIHgan (see chapter 4), insists that now boys should learn responsibility as well, while adolescent should

162

crORAL BI()ETH1C,

move toward achieving more personal 3Ulonomy and inclividuation, (This is in contrast to the conception of morality as fairness, in which moral development is tied to the understanding of rights and rules,) Such a step tilr adolescents would lead, in an expansive sense, toward a movement of cultural evolution and person~tl adaptation which would begln to set a better structure and ethical foundation for a worldwide bioethlcs, whcrdn people could achieve an individualion and autonomv which would no longer propped up by sex ster~­ otypes and discriminatiOn, This could lead eventually to a global bioethic extending beyond the current parochialism that would suPPOrt world health and a reasonable population ethic based on personal integrity, responsibillty, concern, and action, Since a measure of personhood is the abilitv to take responsibility one's own health, including the ability to control own sexu,ll and reproductive activities rather than following one's biological instincts, it follows that morai development in adolescents under ideal conditions is a process of reaching personhood, For this process to succeed there must be adequate resources, opportunities, and motivation, Thus, in addition to caring for their own health, people who have attained true personhood have the responsibility of helping others, rarticularly their own offspring, to gain the same slalUS, Personhood is thereby a steppingstonc to parenthood, in the best sense, Since the human species is no longer in a position to operate on the basis of instinct alone, it is important for developing adolescents to receive an education that estahlishes the meaning of person the responsibilities they owe to their It must be obvious that only a nuher small percentage of adults can be said to have achieved success in meeting the

Builti?rlp, on tlie Leopold /,(1f:!,ac)!

165

aic)rementioncd cmmdards indicated in the "Bioethi cal Commitment for Person and Family Heallh:' ,\1any manage to avoid any kind of drug abuse or sexually transmitted di,eases but [ail in degrees in the case of the otber categories, When it comes tl) the adolescent years, the Ii,t seems almost a litany of what numbers of them afC not (oncerned about, b more than the customary complaint of the older generation; the pace of cui, tural change has indeed accelerated, with respomible parenthood lacing obstacles unimagined in former YC'IfS, Tbe value system has neglected the concept of person health and a new look at medical bioethics is called [or, TEENAGE PREGl'.fANCI'

This dilemma ,,-as presented in chapter 5, Stated "in starkest terms," it was "whetber to promote or forbid abortions [pregnant] teenagers," and a case-by-case approach was called for Certain criteria should be looked for in each case, should be to prevent all unintended Of unwanted pregnancies-",indced, ail pregnancic;, in economicallv insecure and intellectuallv immature adolescent females, With pregnancy prevented, abortion would not be an issne, In contrast, the community's responsibilities for the welfare and the future Hfe of the p,-egnanl female should be given priority over any assumed rights of the fetus, Is the girl capable of accepting personal and parental responsibilities! Was the pregnancy unintended and unwanted? Was it the result of ignorance, carelessness, or Were alcohol, or illegal drugs during the firM trimester of pregnancy? Is the case still in the nrst If undesirable chemicals were present, what about the pOSitive likelihood for the production of a premature, underweight, and

164

CL(!llAL BIOlJTiIlCS

handicapped infant? Should such an infant be offered to unsuspecting or to knowledgeable couples looking for an opportunity to adopt a newborn' Wbat resources, paremal or welfare, are available? Is the involved male known? Is tile male in a position to accept responSibility? Is the pregnant female Iikdy to produce J normal infant and to nurtme it through a adolescence? Will her own adolesccnce coupled with motherhood lead to competent and morally responsible adulthood? Bioethics calls for deciSions based on answers to these questions. At the outset it must be said that, regardless of the answers to any of the above questions, the pregmmt teenage girl who was not ignorant or careless, who was fully aware of wh,lt she was doing, and who fully accepted the idea of competent, selfsupporting motherhood even as a single parent, SllOUld not be coerced or forcefully pcrsuadnl to have an abortion. If til(" pregnancy was intended and wanted she must have been aware of the possibility of abortion and have rejected the idea, But pregnancy as an entry ro welfare support should not qualify for parenthood: counseling for and against abortion should be available and the seriousness of paremhood should be discussed. In comrast to rational pregnancy, the young girl aged 13 to 16, ignorant of effective contraception, ignoranl of the responsibilltics of pcrsonal health and of parenthood and possessing no employable skills, should be made aware of the possibility of abortion and should be helped in every way to have a legal, medically competent, and cost-free abortion. The idea that abortion is murder is totally rejected by global bioethics, in my view, while emphasis is placed on the development of health in the unfortunate victim of SOciety's pressures and her own uncontrolled sexual For girls in the 17-19 age

BIiUding em ti}e Leopold Legr:rc)

group and t()r older women, the same considerations apply. The social system 3t1l1 the local community should pursue the further evolution of bioethiCS, emphasizing that females should not give birth unless the was planned and wanted and untll the female is for competent parenthood for a limited number children, hopefully with the help of a competent and 'willing male. The issue of timing is most important. Abortions shouid be performed in the first rrimester. School and parental instruction should providc knowlcdge as to the means anc1 moral choices involved in artificial contraception, bearing in mind the precepts of "person health," as well as to diagnostic signs al1cl probability estimates of pregnancy. With proper instruction, unwanted pregnancies need nOl occur, Thus abortions should not be needed but cert~linJy, if needed, should not be called for after the first trimester. With new methods of abortion and contraception on the horizon, the possibility of self· administered, completely private abortions may be very

ne~f, 14

SELRC71VE NO,WrRRATklENT OF

HA1'WICAPPED NEWBORNS

The subject and possiblc responses on this issue have been eXllJUstively discu8scd by Weir and by Lyons as reported in chapter 5, while the philosophical issues h:lve been discussed hy Engelhardt and by 'looky,15 besides being mentioned above. As in the case of the abortion killing the result of an umv:mted pregll~ney should not be considered murder according to most the secular philosophers, although it is not whether their arguments apply to nOrlnlll unwanted newborns, The present discllssion is limited to the dilemma presented by the severely handicapped newborn, and as

GLOili,L iJ}{)El11JCS

hi7

before, the malrer is one of degree and therefore case-by-case decisions, But again, the propOsed global bioethic does not every decision on the "sancWy of life" modeL Decisions must be made on the b",sis of the type of and the ability ofmeciical technology to clo more than prolong life, The kind of life in prospect for the newborn, lor existing slbhngs, and for the must be eonsicierctL Oepending on the type of defect, th" chances iflr the birth of a subsequent normal child can be caJclliated and may be as high as one in four-or higher. If [he prospects for developmenr into a Self-sufficient person are so bad that thc parents cannot accept responslbtl1ty for the care and parenting of the defective newborn hut mnst instead have the infant transferred to a public institution, tbenin consultation with their physician and available specialists they should be permitted Icgally to make the decision to lnve the life of the newborn ended in preference to the undesirable aspects of institutional care, Past deciSions to withhold care and treatment seem all unsatisfactory alternative to a quick and painless death, (Opposit~, vtews are reviewed by WeiL) The maintenance of an anen~ephalic newborn as an organ bank for a prospectIVe organ-deficient ne\vborn as described in chapter 5 seems ntore abborrent than a prompt endmg of both newborn 01~ preferably, their abor lion as soon as diagnosed, So far it has not been establisbed that the recipients can survive normallv (see belo",) , Tbe demand to save the life of every deteCtive tetus or newborn, even though it cannot he given a healthy or tolerable existence, seems inappropriate in the face of the loathesome conditions in which millions of children who are Glpable of health are forced to live, With no controls on fertility and wlth the llatural environment neglected, the numbers of [he deprived will increase while peciiatric surgeons seck miracles I()r a favored few,

Weir has discussed five different alternatives to the dilemma of the newborn, along with tbe polarized positions the varions experts, and personally chooses his flfth, whic11 is to withhold treatment not in the child's best interests, He rightly focuses on the new born's prospects but, of course, experts will disagree onlile child's best interests, In the final analySiS the parents, after consultation, should be responsible ft)f the final deCision, wbich should reflect a glohal bioethic and a consideration for the interests of prior and Subsequent offspring, ORGAN TRANSl'LANTATION

In recent years has been an explosive increase in the' number of organ transplants owing to the discovery of the new chemical designated as cyc1osporin A, which will permiltransplantation of an organ from a donor to a recipient without the necessity of having idcntical genotypes, as in identical twins, or non-ilienrical but very closely fllmcl1ing genotypes," The involved have been discussed," hut more recently a new risk has emerged, It appears lhat cyclosporin A has been shown to act as a tumor promoter ill at least one lcst system," I have previously stuciied chemical carcinogenesis involving compounds referred to as "promoters,"" It is now quite clear that certJin compounds can, directly or after biological "activation," causc mmaliol1S in the DNA of the and thereby convert normal cells to with only a single exposure, Ir is inferred that most or us have suffered such exposureS blll that, unless we are exposed over a period of lime to conditions that lead to the proliferation of the initiated cell, no canccr will result. Compounds that cansc cancer in animals previously exposed 10 an initiator are called "promoters" and cydosporin A appears to be such a

GLOli.4L RI(/ETHICS

compound. It is administered daily ar considerable expense for the of the recipient. It will be important to follow medical history of organ recipients who receive cyclosporln h~t(lre any concluSions can he drawn as to the possible complications of the cyclosporin regimen. In :mv case, the rapid increase in organ transplantation yet another example of the emphasis being given heroic inclividual health meaSures \vhile public health measures worldwide inevitably fairer. While organ transplantation for delective !lewbOf[]S can be scriollsly questioned, it can be defended for adults provided the recipient can be given an extension of life with acceptable: quality. However. merelv to postpone inevitable death at' the expense of ~ miserable life is poor utilization of medical

is

reSOlJ1'ces,

AR'f'lPICIAI,O/{GANS

The tremendous technical advances for adults who have suffered brain damage or loss of limbs in wars and in automobile or industrial accidents will not be uiscuo;;;cu cxcept to say that hettcr prevention is still to be preferred. Dialysis machines have been continually improved for kidney patients, and the hope has arisen thaI a damaged he-Jrt can replaced by a pump of mme kind, since demand for heart tr:msplants far exceeds the supply. Moreover, any decrease in honllcides and "ut~)mobi!e accidents will further shrink the supply of hearts. Up to the present, patients implanted with a plastic pump suffered undesirable complications and all have died. It has been suggested that the assumptIon lhal 1he heart can be replacedwilh a mechanical pump overlooks its metabolic functions."

BuiJdmg!)YI the j,oupold [('gary

EUTHANASiA

C'lowhere in the whole ;)rea of medical bioethics is the emphasis on the postponement death so pointless as in the ease of many of our citizens. Hesiding in nurSing homes that are more like warehouses, their only future is greater and greater helplessness until finallv the health care svstem concedes the inevilabl~. One has onlv to ~1Sit such a facility to realize that its existence ;., presently con ceived is a national embarrassmcm. Those residents who arc not helpless arC constantly reminded thai they soon will be like those whose company they avoid, unable to command, "Enough."" 'I'lle system is misled by a religiously-insplfed ethic that or other hopeless humans should not be able to exer, ciSlO choice in the maUer of how or when to die. the extent that tbis prevails, it Ls time for a secular ethic that would permit indivicual to ask for help in choosing to die and to make the decision before the ability to make the request is lost. It would be possible to make the loss of the abillt v to choose between life or death determine when -the choke [or death is to be exercised. As things now stand, individuals are not allowed to make that choice, and the declsion is irrationallv delaved until the move to take some terminating ;etl0n'is made by someone doC, without authorization by the aL)out-t()-(iil:. . As in other dilemmas in medical bioethics. the giobal biocthic profes,;ed here merel y demands· that we look al the whole picture, that we reali:.:e death is not the worst thing that can happcn in any individual's life. The ethical issue 1$ not so much Ihe question of whether aLtelltion to individual lives is oYer-emphasized as it is the questiOn of tile balance between such efforts and the expenditure of lime and money for effons that would raise the level of

GLOBAL E!OF'T'Fm:'!;

personal health worldwide by giving attention to the environment as well as to the technological advances at the medicallcvd, It is better that one million children should be healthy than that Olle miserable life should be prolonged against its own persuasion, It is better that we work toward the preservation of a healthy environment than award LUll(: for the creation of the best retrofitted human machine. Thus we come to the ecological reality foreseen by Leopold, that violence to the environment increases \vlth ropulation density, ECOLOGICAL BIOETHICS IK PERSPECTIVE

Ideally, Individu:ils who are economically secure and intellectually mature should be able to limit their own procreative powers and avoid despoiling the environment. They can even develOp their own person health and competentiy help their limited numbers of offspring to gain personhood. But meanwhile, vast numbers of poverty-Stricken, poorly-educated, ccollomicaUy insecure, or imeileetually immature females will become pregnant and again, often beginning as teenagers. Governmental Aid lo Families with Dependent Children (AFDC) will have to contribute to their support, while demands for jobs and space continue to exert pressure to mine nonrenewable resources and explott. the environment in a throwaway industrial economy. who insist that there is no popuThere arc lation problem, thal the solution will come auto maticaUy because of the so-called demographic transition theory of the three-stage shift in the balance between births and It is claimed on thc

BuUdil!/!,

WI

the! po/mid Lege-fey

l"7j

basis of some past experience that under poor social conditions, high birth rates are halanced by high death rates, As prenatal health care improves, death rates decrease but birth rates remain high and population growth is rapiel, In the tinal stage, ferrllityi.e., hirth ratc-declines and population stabilizes, according to this theory. Lester Brown has provided more coverage of the "whole picture" needed to develop a global bioethic than any other individual Of organization, His book, Bulletin? a Sustainable Society, provides a of data and conclusions. Douhting that Thitd World nations will move quickly from the: second to the third of population stabilization, he notes that the level of education is a rrlmary factor in lowering fertility. He srates, Achieving a stationary population will be painfully dlffic:llt if conl:"aceptlvc ~ervke5 3re not backed by legal abortion. With the legalization of abortion in [raly in the share of world population living in societies where abortion Is readily available rcached two-thirds, trp from unt>thlrd a decade :ago. Yet, one~thlfd of the world's WOmen::Ire ,"itilllleniect rhih basic puhlic health scrvk:e except on iliidt terms." (Brown; 1S4·..·) 5)

During the Reagan administration in the l.Jnited States, the view that there is no population problem became official policy and efforts to end or decrease the number of legal abortions at home and abroad wcre pursued, ETHICS EVOLVES INTO L4\v'

The conversion of ethical viewpOints into law applies not only to the abortion is,'llc but to every facet of medical and ecological bioethics that enters into a global bioethic, In medical bioethics the legal

I';'

GleBA!. RtoETfrrc')

detlnitiol1 or death has cvo/veel into "brain-dead" but not into "higher-centers brain-dead," The case of assisted suicide can still be interpreted as murder, and letting a newborn defective inrant die without treatment is lIlegal except under very special conditions, However, in some cases an adult may be allowed to die by non'lfeatment" or even 'With

assistance/ 3 and for the tlnw being abortion rCll1ains legalLced, In medical bioethics the decisions tend to involve a single patient or a newborn infant careci for by a single phYSician and his consultants, ope ratin conjunction with the parents, a spouse, or aciult children. Still, the decisions operate within existing law, In the case of abortion, individual decisions were revolutioniLecl by the Roe v Wade decision by the U.S, Supreme Cmlft in 1973, which legalized abortion. lbday, attempt., arc being made by militant groups to overturn that decision and even to write a cOl1stitmional amendment making abortion illegal-in other words, to make the ;aw conform to their own particular ethic. In the eonvcr,!on or ecological hioeth!cs into law, the scope of the prolJlems becomes much wider. Whether the problem is add rain abatement or the disposal of toxic waste, governments must deal in with corporaTions whose economic interests are at stake. The realization that human ingenUity has created industrial processes and new .wnthetic chemicals whose henefits find a readv and p'rofilable market, but whose dangers are re:;Uzed only hindsight, has created a recapitulation of Panciora's box,'" Ali the examples need not he recounted hut two may be mentioned without extensive documentation. When tetra-ethyl \vas invented as an antiknock additive for gasoline used in trucks and motor cars, it was hailed as a tnumph of synthetic

chemistry and its inventor w:!S congratulated and rewafllect, It took nearly hall' a centllfY for public health authorities to realize that dangerous amounts of lead were entering the environment and [Ot the "ovcrnment to restrict the use of the additive and promote lead-free gasoline, Another famolls example is the case of DDT, whose demise was hastened hy the publication of one of the mos t famous exposes of all time, Silent Spring, written by Rachel Carson in 1963-" Carson bas been bitterly criticized on the basis that she described the dangers of this powerful insecticide withoUt mentioning the millions of lives saved by the control of malaria through the cutting down of the mosquito po pula lion or anv of the other benefits, Hindsight has taught us tl;m DDT, as well ali other J11 irade chemicals such as penicillin, set in motion a present-day proof of the fact of evolution: resistant strains of insects and pathogenic bacteria can evolve and establish themselves in the altered environment, while higher forms of life can be damaged, Leopold understood lhis problem when he "An ethic may be regarded as a mode of guidance for meeting ecological situations so new or intricate, or involving such deferred reactions, that the path of social expediency is not discermble to the average individual" (see chapter I), However, Leopold did not foresee the ecological problems confront us tod