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n. 11
novembre 2011
Altri articoli
disponibili
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Italiano
Introduction to Bioethics
Fundamental Principles
edited by
MASSIMO
PETRINI
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In 1970, an oncologist, Van Rensslaer Potter publishes in the journal
Perspectives in Biology and Medicine an article titled "Bioethics.
The Science of Survival": the next year this is the first chapter of
his book Bioethics. Bridge to the Future.
The rise of bioethics
Thus it was born the term bioethics to define a new discipline: the root
bio represents the biological knowledge, the term ethical
indicates the knowledge of the systems of human values. In his view,
Potter was convinced that, for human survival, it is necessary to
consider together the scientific and humanistic knowledge, since reading
the scientific-technological progress as a threat to humanity and to the
survival of life on earth. In fact, he refers to the bioethics as the
science of survival, Science of Survival of the title of his
article. Of course, the danger was not the progress, fully taken into
account but the distortions that could arise from a misuse use of the
new potential that the man had at his disposal.
The only solution would be to make a bridge (Bridge) between two
cultures, scientific and moral; a bioethics that in view of Potter
should consider the appropriateness of any scientific intervention on
life in general. This requirement urged a Dutch origin famous
obstetrician Andrè Hellegers who founded the Kennedy Institute of
Ethics of Human Reproduction and Bioethics, in 1971, at Georgetown
University in Washington, to create a dialogue between medicine,
philosophy, ethics. Thus the term bioethics enters into the university
world.
This view of bioethics, as a discipline applied to the biomedical
sciences, influences the definition of the term that appeared in 1978
edition of Encyclopedia of Bioethics, published by the
Kennedy Institute, where it appears as "systematic study of human
conduct in the field of life and health sciences, as examined in the
light of values
and
moral principles."
In Italy, Msgr. Elio Sgreccia publics in 1988, Manuale di Bioetica
(Handbook of Bioethics), republished several times, which still retains
all its validity. In 1985 was established the Center for Bioethics,
which will be joined in 1992 the Institute of Bioethics, Faculty of
Medicine and Surgery, Catholic University of Sacred Heart. Together with
the journal Medicina e Morale, whose director is the same
Sgreccia, these initiatives and subsequent publications, which will
extend their importance and influence in the international arena,
significantly contributing to the debate on bioethics in Italy.
The object of study
You can define the object of study of bioethics, in its aspects
of human life, in the words of John Paul II's Encyclical Letter
Evangelium vitae. The Pope insists that -along with threats of life
such as murder, genocide, abortion, euthanasia and other historical
forms of aggression against the human dignity- "the same medicine, which
by its calling is directed to the defense and care of human life, in
some sectors lends itself more widely to make acts against the person
and thus deforms its face, contradicts itself and demeans the dignity of
those who practice it"(EV 4).
These threats to human life arising from scientific progress that
enables man to manipulate the arising of life. As reported by the
Carta degli Operatori Sanitari (Letter to Health Care
Workers) of the Pontifical Council for Pastoral Assistance to Health
Care Workers, which states: "The more extensive knowledge of the genetic
human inheritance (genome), identification and mapping of genes in
action, with the possibility of transferring, modifying or replacing
them, opens new perspectives in medicine and simultaneously it poses new
and delicate ethical problems"(No. 12).
New problems, however, are not just about birth, but the respect for
human life at every stage and situation. Next to the scientific progress
should also emphasize a different cultural ethos that gives less
value on human life in terms of disability and old age; in the terminal
phase of illness, to bring up the life as a "good stock" given to the
personal will. Consequently, no less serious threats hang over the
incurably ill and the dying in a social and cultural context which makes
it more difficult to face and accept suffering, heightens the temptation
to solve the problem of suffering by eliminating the root, by hastening
death at the moment considered most suitable.
This is the context of bioethics, which reflects on meaning and value of
human life and is itself as a discipline that aims to establish the
basic criteria, because the interventions on human life are always
attuned to man himself. According to John Paul II bioethics must be a
precise and vigorous reaffirmation of the value of human life and its
inviolability, an appeal in the name of God to respect, protect, love
and serve life, every human life (cf. EV 5).
Some principles
Of course, in making ethical judgments, is a basic matter the reference
to a system of principles on which to base arguments. Here we will refer
to the most common systems: the system of American principles and the
personalist
bioethics.
When we speak of the principles’ system we are referring to T. L.
Beauchamp and F.F. Childress, authors of the book Principles of
Biomedical Ethics. These Authors propose the use of three principles
-autonomy, beneficence / no-maleficence, justice- to resolve ethical
controversies in practical situations.
The principle of autonomy emphasizes the freedom of the sick
person who must be able to make an independent and informed consent,
choosing a medical treatment based on personal values. We can just
think to the conscious rejection of care, communicating the truth about
the real clinical conditions, the expression of requests for suspension
of any treatment. Of course some objections may be if you think that
there can be unlimited autonomy and, more importantly, if you think the
impossibility of being able to express their choice in situations of
non-awareness.
The principle of beneficence/no-maleficence is
rooted in the Hippocratic tradition, for which the physician agrees not
to do anything harming his patient, but, through the beneficence, to
prevent suffering and having to act for the patient’s good.
No-maleficence calls clinical situations as aggressive treatment, ie the
case of excessive therapy in now unrecoverable clinical situation of the
sick person, and the beneficence recalls situations such as pain therapy
and organ donation. The main difficulty is that this principle underlies
the definition of good and evil in the absence of an ethical theory of
reference, which is why you can create a conflict with the principle of
autonomy when the idea of
the
good doctor's care does not coincide with that of the patient.
The principle of justice, finally, on consideration of similar
cases in the same way, streamlining operations in order to ensure
medical care to each patient. Again you may object either on the
possibility of clinical cases to assess or the same lack of an objective
criterion which allows to determine the minimum of care and to ensure
the priorities for the allocation of resources, often limited.
What Anthropology?
The criticism that move to these principles is that they are purely
formal, because it is never said what we should strive virtually to
autonomy and justice, or what is good or harm for the person. This was
even more evident by the lack of a clear hierarchy among them, that
enables to resolve conflict situations, for the absence of an
anthropology of reference.
As part of the personalist model, found in the work of E. Sgreccia, the
reference to the principles is within the unified theoric framework of
the ontologically founded personalism, in which the center of the
ethical choice is the unitary vision of the person. The principle is
thus a key to read the individual real situations and the reference to
the totality of the person determines a hierarchy of principles to avoid
conflict situations.
Personalism sees a unity in the person, a unitotality of body and spirit
that is its objective value. In front of each reflection, the person
appears as a reference point, an aim and not a means, transcendent
reality for society, economy, law. The Christian revelation, with the
truth of creation, then gives to this personalist view a widening of
horizons and values
that
touches the divine.
The personalist bioethics analyzes, in determining the lawfulness of an
action on man, three different components: biomedical data analysis in
its scientifically checked foundation; anthropological and philosophical
depth, ie the set of values
related
to life, integrity and dignity of the person; solving the ethical
problem, ie finding the values
to
be protected and resources to be respected in relation to the person’s
centrality and the hierarchy of values
in
it harmonized. From the moment of conception until death, in every
situation of suffering or health, the person must be a reference point
and measure between the permissible and not permissible.
One other point: today the Ethics Committee, constituted of
multi-disciplinary team of experts are called to solve the ethical
problems that may arise in certain contexts (institutional care,
research institutes, laboratories, etc.).
Massimo Petrini
Università Cattolica Gemelli – Roma
petrinimassimo.m@libero.it
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