By Zubeida Mustafa
ON January 21-22, the Centre for Biomedical Ethics and Culture (Cbec) of SIUT held a joint conference with Unesco in Karachi on “bioethics education” that should provide food for thought for educationists as well as parents. When doctors speak about bioethics, we tend to conjure up images of a moral code that health professionals are supposed to observe in the practice of medicine.
The Hippocratic Oath promptly comes to mind. Hence the workshop on the first day of the conference to design a biomedical ethics curriculum for medical students seemed plausible. But was there anything to sensitize school teachers about as was the idea of the second day’s programme?
After listening to Dr Farhat Moazzam, the chairperson of Cbec, I changed my mind. The time has come to broaden the horizons. Whatever ethical issues come within the purview of the medical community have a direct bearing on society and, therefore, must be conveyed to everyone. What better time can there be to educate the people about these issues than in their childhood when they are imbibing social and moral values and learning to differentiate right from wrong? The underlying principle that science and medicine affect society and, therefore, there should be an on-going dialogue on medical/scientific issues within society itself has been recognized by Unesco. It has been incorporated in the universal declaration on bioethics which was adopted in October 2005 by Unesco’s General Conference.
Bioethics education, as Dr Darryl Macer, Unesco’s regional adviser for social and human sciences, informed the audience in his lucid presentation, basically attempts to inculcate respect for life in everyone, teach them the skill to balance the benefits and risks of technology and develop an understanding of diversity. This has a direct bearing on our lives — unless of course we have become so used to someone in authority taking decisions on our behalf that we don’t care — for thus we can make informed choices.
With the emergence of the concept of bioethics, the social equation between the layperson and the professional is changing. Giving the example of the doctor-patient interaction, Dr Macer said that initially it was one of paternalism with the doctor telling the patient what he should do. It then moved on to one of informed consent which involved a measure of equality between the two sides. Finally came the stage of informed choices made by the patient who now takes the initiative.
These equations are in the process of change in every society as the citizens acquire bioethical maturity. According to Dr Macer, the key factors which determine the pace of change are the existence of a civil rights movement in a society, the level of education among the people, their access to information, the willingness and motivation of individual members to assert themselves and the presence of institutions to support bioethics traditions.
It is a positive move that Cbec has taken the initiative to spread this awareness among the public and that too at the school level which is the ideal stage to start the process of change in attitudes in any society. Our traditions — socially and culturally — are geared towards paternalism with children being advised not to question their elders, juniors being asked to respect their seniors by accepting their views in silence and so on. But this has got to change because it is now accepted that for any decision to be implemented effectively it must have been through a participatory process with the stakeholders involved in the decision-making.
The teaching of bioethics should not be dismissed as something for which our society is still not ready. First of all, respect for life is a badly missing element in our midst and the sooner we begin to work towards inculcating it in our people the better. We accept the loss of life and human dignity with equanimity probably because that is how it has always been. But isn’t it time to change? Let us now develop the sensitivity in ourselves and in our children that life — be it human, animal or plant — is a gift that must be cherished, valued and preserved. Without this sensitivity, the rights to life, human dignity and liberty recognized by all human rights instruments become meaningless.
It is also imperative that scientific knowledge be made an integral part of life. Not only must every student be taught a basic course in science even if his area of specialization is humanities. Science must also be popularized among the lay public by imparting scientific knowledge in an interesting and easily comprehensible manner. Once upon a time PTV was doing this through a programme conducted by Mr Laeeq Ahmad who was not a scientist and probably that is why succeeded in making science so non-technical and attractive for the layperson. This paper had Azim Kidwai writing a weekly science
Why can’t we have more of such programmes? Some of the television channels do a superb job in this respect and science journalism has caught on. But more needs to be done to create an understanding of scientific phenomena without which people cannot make informed choices in respect of their health and medicine related matters. In the context of the application of the principles of bioethics, two key issues of great importance in our society come to mind. One is the social evil of the sale of human organs for transplantation and the other is manufacture and use of nuclear weapons. These issues have to be analysed in terms of their impact on human life and dignity. It is also important to weigh the benefits and risks of the technology used and then make a choice in respect of what should be acceptable to us.
Take the example of the transplantation of organs. Since the medical technology of transplantation has developed to such an extent, it has become possible to take a healthy organ from one person and transplant it in another to save his life. When the donor is a close relative, one can presume that only consideration of love and fellow feeling would have prompted him to gift his organ to another person who needs it. Since the risk to the donor is so minimal and the advantage to the recipient so great, organ transplantation is now widely accepted as an ethical procedure.
But should the misuse of transplantation technology to promote commercialization and fuel an organ trade be acceptable? We find that with the cooperation of medical professionals, affluent patients suffering from kidney failure are paying a lucrative price to middlemen to procure organs from impoverished donors who receive only a fraction of the financial transaction. Since the whole procedure is unethical and done in haste, many cases are spoilt and people’s health suffers while the donors remain as poor as ever. The loss of human dignity involved is another sad aspect of the matter.
One can imagine the dilemma of a patient suffering from endstage organ failure. He has no related donor with a tissue match. There is no cadaveric organ donation law to provide for the farming of organs from cadaver. He can, however, pay a poor person and get his organ. But then that is considered to be unethical. What does he do? The answer should be found in the light of bioethics.
Similar bioethical principles can be applied to decide the pros and cons of nuclear weapons. There is no denying that weapons of mass destruction, as their name indicates, destroy human life or mutilate people. Can they under any circumstances, howsoever distressing, be accepted as a weapon for defence? The devastation unleashed at Hiroshima and Nagasaki has left such an imprint on human memory and one that is difficult to erase. It would be impossible to find a plausible justification for it, however convincing may be the claims for security and national defence.
These are just two examples. There are many other vital decisions which we face in our day to day life to which bioethical principles should be applied to enable people to understand the implications of various phenomena and make informed choices where they are required to.