Bioethics formation should be considered as a logic prolongation
of medical ethics history. On the other hand, bioethics itself
isn’t the final stage of development of ethic thought applied
to medico-and-biological theory and practice. Moreover, there
are some signs of bioethics transition into qualitatively other
level of existence as a science. Reaching this level requires
terminological assessments on the basis of historical precondition
analysis, ideological fundamentals and philosophic aspects of
medical ethics and bioethics development.
We consider the discussion on the problem whether it’s possible
and expedient to use the terms “biomedical ethics”
and “bioethics” as synonyms or these terms are interchangeable
to be significant. It occurs frequently and everywhere in real
life. If one regards these terms to be synonyms, then “bioethics”
and “biomedical ethics” will have double meaning and
the semantic load will be uncertain and not in the full form.
On the one hand, bioethics (and biomedical ethics) should be considered
as words having the same meaning of the stage of the professional
medical ethics development. On the other hand, according to V.
Potter’s idea (1970) who was the founder of the given subject,
-
bioethics is “ a bridge”, “a connecting link”
for the integral combination of biology and ethics, which are
essentially different phenomena. According to V. Potter, bioethics
is not only a bridge between different subjects but it is “a
bridge to the future”, which is necessary for the connecting
“medical ethics and environmental ethics on the worldwide
scale to ensure man’s survival”. Thus, there is a
double meaning in the definition of bioethics which should be
overcome by more exact use of terminology.
 |
Biomedical ethics
From our viewpoint it is expedient to regard the terms “biomedical
ethics” and “bioethics” to be synonyms. It is
appropriate to use the term “biomedical ethics” while
analyzing the ethic problems being associated with practical medicine.
In this case practical medicine should be meant in the wide sense
and must include the professional activity of not only the doctors
but also the activity of other specialists of public health. On
the one hand, biomedical (or clinical ethics in the above-mentioned
meaning is regarded as the next stage of medical ethics development
and foundation for forming scientifically based balance between
the newest medico-and-biological engineering and the human rights,
principles of humanism, social progress - on the other hand. In
such a case, bioethics may be defined in the primary meaning of
“a bridge to the future”, life ethics, which deals
with ethics problems not only of man but also of all living organisms
as well as the problems of preserving the environment. Initially
the distinct difference of biomedical ethics and ethics was not
of great importance and such expediency was determined only in
connection with the expansion of the object of the ethic analysis
from human to all living organisms and ecology on the whole.
Biomedical ethics as a subject originated from several stages
of the medical ethics development. “Biomedical ethics”
in its turn became the base for the formation of global bioethics,
which is now transforming into new quality that we suggest to
define terminologically as “nooethics”. Expediency
of introduction of the new term is determined by historical succession
between medical ethics, biomedical ethics and global bioethics.
Biomedical ethics originated
from three stages of medical ethics development:
I -
the stage of the formation of ethics and principles of
medical ethics;
II - the stage of the formation of corporative
medical ethics;
III - the deontological stage.
|
The first stage
The first stage of the formation of ethics and principles of medical
ethics originated from the primitive ethics and formation of medicine
in the family community, which began to produce foodstuffs. The
first stage contains the works of the great classical Greek philosophers
- Socrates, Platone, Aristotel as well as the way of medical ethics
from the ancient shamanism, the precepts of the Egyptian healer
Imhotep, the code of the ruler Hammurapi up to the ethic works
of Hippocrates’s school.
The second stage is the formation of corporative
medical ethics. It is associated with appearance and distribution
of monotheistic religions such as:
Buddhism, Iudaism, Christianity, Islam. It is also associated
with the works of Paracelcium, A. Vesalius, Harvey, Malchipij,
Persifal and in future it was associated with the creation of
medical faculties and medical corporations. Independence and spreading
of the physician profession and growth of its prestige resulted
in opening of medical faculties. A physician becomes also a scientist
and a doctor in the renewed meaning of this word. Graduates from
the medical faculties give “faculty promise”, the
content of which was approximately the same as of the text of
“Hippocrate’s Oath”. The creation of medical
corporations resulted in actualization of medical ethics problems,
although corporate ethics was primarily aimed at the defense of
the interests of medical community but not of a sick person.
 |
Ye. I. Chazov,
vincitore del premio Nobel e dottore onorario dell’Odessa
State Medical University. |
The third stage (deontological) is conditionally
dated by 1834 - the time of publication of the book of the English
philosopher and lawyer J. Bentham (1748-1832) “Deontology
or the science on moral”. The significant role in the development
of classic theories of deontology belongs to such outstanding
philosophers as D. Mil, E. Cant, V. Ross. During the process of
division and extending deontological theories from the positions
of various philosophic systems the principles and postulates of
worthy doing the duty, ethic requirements and standards were substantiated.
It is interesting to note that deontology as a part of the ethic
theory covered essentially the content of the most various occupations
and specialties. However, with the course of time it started to
deal mostly with the ethic problems of medicine. As a result,
medical ethics has been more frequently termed as medical deontology
by the end of the 19-th century. It is in this connection that
the period of the intensive development of deontology beginning
from the classic works by J. Bentham was called the deontological
stage of development of medical ethics. Deontology as a doctrine
on the moral duty became a science of practical use of the principles
and standards of medical ethics in different branches of medicine.
It also became a school of medical humanism and moral professionalism.
Deontology fights against commercialization of medicine, for the
observation of patients’ interests and professional physicians’
rights.
The physicians proved to be among the first who raised their voices
against production, distribution and application of bacteriological,
chemical and nuclear weapons. One of them is academician Ye. I.
Chazov Nobel prize winner, the Honorary Doctor of Odessa State
Medical University.
The significant role in the analysis of the results of the deontological
stage of medical ethics development and the formation of philosophic-
and-analytical base of the next stage - bioethics, belongs to
the outstanding personality, one of the greatest persons of the
20-th century A. Schweitzer (1875 -1965). There is no division
into more valuable and less valuable life into the higher and
lower in his ethics of “reverence for life”. Considering
each form of life to be sacred and inviolable, A. Schweitzer criticized
anthropocentricity for narrow limits of interhuman relations and
widened the biblical commandment “don’t kill”.
He
had all rights to say: “My argument is my life’*.
A. Schweitzer was the man whose range of interests was really
great. He became famous not only as a talented physician but also
as a thinker, a humanist, a philosopher, a theologian, a priest,
a musician, a music expert, a writer, a journalist, a social worker
and a philanthropist. He was honored with the name of Nobel prize
winner. His contribution to the development of medical ethics
is great. A. Schweitzer created new thinking, which includes conception
of defense of the environment. New thinking meant recognition
of responsibility of inhabitants of our planet for preservation
and prolongation life on the Earth. Survival will be possible
if the change of mentality leaves behind the rate of technical
progress, if the gap between the poor and the rich decreases,
if expenses for arms are reduced, but economic progress is not
accompanied by destruction and degradation of the environment.
A. Schweitzer may truly be considered as the founder of the ecological
science. A. Schweitzer realized the problem, which had arisen
in front of the mankind in the middle of the 20-th century: the
exponential growth of knowledge is not accompanied by the increase
of wisdom necessary for the control of this knowledge.
A. Schweitzer’s ethics, which is characterized by universalism
and globality was aimed at overcoming this gap and finding the
way out of spiritual crisis of the 20-th century. A. Schweitzer
saw that the cause of contemporary moral crisis was in opposition
of ethics of personality and society. According to A. Schweitzer,
all variety of ethic systems and ideologies may be brought together
to two main types: ethics of self-denial and ethics of perfection.
Ethics of self-denial is of social-utilizing character and means
that each individual should sacrifice himself for the sake of
others and society on the whole. Another type of ethics is ethics
of self-perfection of a moral personality. A moral personality
is in constant dispute with the community ethics due to differences
in the assessment of humanity and he cannot obey it absolutely.
A. Schweitzer considers that ethics of the moral personality should
be in the first place and community ethics can be moral only through
recognition of individual ethic values. A. Schweitzer thought
a statement that ethics of moral personality and community ethics
couldn’t be united in the uniform system of ethic values
to be a great error.
The International Medical Academy named after A. Schweitzer carries
out a lot of work on popularization of Schweitzer’s creative
inheritance.
 |
Albert
Schweitzer |
The fourth stage of development of medical ethics
formation of biomedical ethics has been started since 1970- the
time of publication of basic works of W. Potter. Development of
biomedical ethics was a direct consequence of practical introduction
of achievements of scientific and technological revolution under
the conditions of deep ideological crisis and increasing load
of global ecological problems.
Great progress of medical-biological sciences gave rise to numerous
complex problems of moral character. It was carried so far that
man tried to control his own evolution and claimed for not only
supporting his life but also
improving and changing his nature to his own interpretation. These
situations cause grounded discussions of ethic basis and moral
right of such actions. The subjects of intensive discussion and
analysis are ethic problems of clinical trials and experiments
on animals, gene engineering, transplantation of organs and tissues,
new reproductive technologies, euthanasia.
Biomedical ethics as a modern stage of medical ethics is directed
at energetic search for ways of humanization of medicine and medicobiological
science by comparing possibilities of medicine and biology with
human rights. The idea of „constructing a bridge”
to connect such principally different phenomena as biology and
ethics belongs to V. Potter. Since the beginning of their existence
natural sciences have been oriented at objectiveness as ideal
of spirituality, study of objective reality without subjective
experience and moral and ethic assessment of man. The essence
of the historically formed conflict between naturalism and humanism
consisted in ignoring information and knowledge beyond investigation
competence of descriptive and experimental science. According
to V. Potter, bioethics is not only a bridge between different
disciplines but also “ a bridge to the future”, which
is needed” for connection of medical ethics and ethics of
environment on the global scale to ensure man survival”.
It is global bioethics based on intuition and intellect (logics)
confirmed by empiric knowledge of all branches of science, and
especially biology” that can and must ensure” long-term
survival of the mankind as a species in normal and stable civilization”.
Ethics, which was historically anthropocentric field of knowledge
and studied the relationship of “man-toman”, also
began to consider the sphere of the live (A. Schweitzer) and then
the notion of morality involved the nature on the whole (V. Potter).
Thus, it is expedient to differentiate biomedical ethics as a
stage of development of medical ethics and bioethics as more extended
field of knowledge that makes its task to protect physical, mental
and spiritual integrity of man, its genome, protect animal and
plant world and environment. It represents a complex of measures
on systematic analysis and coordination of man’s action
in the field of medicine, biology and ecology from the point of
view of generally accepted moral values and principles.
In the 20-th century the mankind faced the disastrous consequences
of global ecological crisis. This principally new phenomenon raised
a question of physical survival, continuation of the human race
and development of civilization. The critical phase of relationships
and controversies between the society and nature is conditioned
by titanic growth of consumption of natural resources, change
of landscapes, creation of new anthropogenic medium and disturbance
of dynamic balance in the biosphere at different levels of its
organization. It is evident that solution of the problem of global
ecological crisis is associated with a solution of amalgamation
of goals of economic basis with maintenance of ecological balance
and resource stability.
 |
J. Bentham |
The global ecological crisis
First of all, the global ecological crisis has philosophic and
ideological aspects due to necessity of devising conception of
interaction. Psycho-social aspects of the problem are of great
importance, and they are reflected in necessity of psychological
and social support of the population. Medical aspects of global
ecological crisis are connected with prevention and therapy of
ecological pathology and ecological nosology.
The global ecological crisis raised a number of questions
and their solution became an immediate task of the mankind in
the 21st century.
1. Are the prognoses of disastrous development of conflict
between the mankind and environment real?
2. Is the mankind capable of overcoming the global ecologic
crisis?
3. Is the ecological situation a consequence of the human
lack of fore-sight, greed and stupidity or is it a result of natural
evolution of the biosphere from the point of thermodynamic law
of increasing entropy, increasing chaos and simplification of
the system “mankind-nature”.
Answers to these questions determine strategy of the mankind
survival in the 21-st century.
Bioethics, in the broad sense of this word, became the answer
to negative consequences of introduction of the newest medical
and biological technologies and manifestations of the global ecological
crisis under the conditions of ideological insolvency of the society.
From our point of view, it is appropriate to include the notion
of “global bioethics” into terminological use (i.e.
bioethics in the broad sense). Biomedical ethics and ecoethics
should be considered as its constituents; they have arisen due
to realized striving of the mankind to survival by preserving
the biosphere based on amalgamation of modern achievements of
science and practice with moral and spirituality as well as protection
of natural control mechanisms of the biosphere.
Retrospective assessment of bioethics history gives evidence that
it concentrated its attention on advocacy of human rights in the
70s, it was aimed at the problem of life quality improvement in
the 80s and it got a character of global bioethics in the 90s.
Unfortunately, despite realization of threat of global ecological
disaster, energetic work of bioethics institutions, governments,
parliaments, governmental and nongovernmental organizations, physicians,
lawyers, teachers and ecologists, church and public at large,
negative tendencies of the biosphere degradation failed to be
overcome in the second part of the 20th century with the mankind
entered the 21st century with a growing load of unsolved problems.
 |
| Argomenti di
discussione e di analisi intensa sono i problemi etici su
prove cliniche e su esperimenti sugli animali |
Medical ethics
To our mind, medical ethics begins its next, the 5th stage of
historical development, which is stipulated by the level of irreversible
changes of relationship balance between man and nature achieved
by civilization. Philosophic and ideological principles of this
stage are determined by the conception of the academician V.I.
Vernadsky about the biosphere and its transformation resulted
from the human activities as powerful geological force into the
Noosphere.
The ethic orientation of Vernadsky’s doctrine consists in
that he connects the appearance of the Noosphere with transformation
of the mankind into the entity as powerful geological force. According
to his understanding, the thought, intellect are regarded as the
moral intellect, which is able to be embodied in science, as well
as in technology. By his expression “The truth, beauty and
good are indivisible in the Noosphere”.
It was originally supposed, that formation of a noosphere would
lead to regulating of natural and social activity, to appearance
of more modern forms of being. This process was considered by
V.I. Vernadsky and his followers as real benefit which would give
to mankind the solution of its most challenging problems. In some
aspects the noosphere was thought to be as full elimination of
evil, as a condition of general welfare and harmony.
 |
| Vladimir
Ivanovich Vernadsky |
But what is true content of processes on a planet covered with
reasonable human activity (it is in this way the philosophical
dictionary determines a noosphere)? It is quite evident, that
formation of the noosphere and development of crisis which threatens
existence of mankind occur simultaneously. The noosphere as a
reality is the artificial environment which pushes aside and oppresses
an areal of biological life. Formation of the artificial environment
has opened unprecedented opportunities to people in growth of
material well-being, comfort and safety, has risen to a new level
an opportunity for intellectual knowledge and development. At
the same time it leads to water and atmosphere pollution, a devastation
of the soil, the general degradation of the natural environment,
global ecological crisis.
Consequences of growth of the artificial environment are the phenomenon
contradictory. The artificial environment has ability to self-development.
It has features which do not correspond to the goals put by people.
Changing by the internal laws leaving the borders established
by founders, the artificial environment gets independence, becomes
alien to a person and is beyond of his control.
The Biosphere has its specific control mechanisms that are to
protect the Earth, the entire Biosphere and mankind.
 |
| “La verità,
la bellezza e il bene sono indivisibili nella noosfera”.
V. I. Vernadsky |
At present inhabitants of the Earth of the 21st century realize
that the mankind destroyed control mechanisms of the Biosphere.
While redoing the nature and environment man changed the life
conditions on the planet by his intellect, results of the intellectual
work and created his Noosphere that in contrast to the Biosphere,
did not have its own control mechanisms. Under such conditions
the influence of the living beings is accomplished not only directly
but also indirectly, i.e. via the transformed Biosphere. This
influence may be realized but it is unrealized in most cases.
Man made very complicated technical equipment; and at present
he tests new forms of dependency: dependence on computer, TV programmes,
Internet. He created virtual reality that is able to effect human
behavior. At present elements of artificial intellect have been
developed and investigations are in progress. Being aids computers
become equal participants of communication and will be able to
make decisions in the future. The living beings cross the life
frontiers into the virtual reality. Culture is substituted for
a system of rationalistic constructions. Spirituality is reduced
to the intellect, and values are changed by specific aims. Principles
of profit, liberalism and benefit are dominated. There is noted
a transfer of the mankind to development deadlock when reproduction
is substituted for cloning, teaching- for coaching and work -
for automated mechanisms.
Undoubtedly, modern society is in Noospheric crisis, its destructive
consequences are enormous and the outcome is unpredictable. The
Noospheric crisis consists in increased chaos, simplification
of the system “mankind -nature”, and may be characterized
as a direct consequence of the thermodynamic law of growing entropy.
The Noosphere is mortal as all alive and a man with his political
and social constructions, economic technologies and psychological
characteristics is not only an instrument for completing the cycle
“birth-development-aging-death” of the Noosphere.
This conception of ethics means that limitation of negative features
of a personality (shortsightedness, selfishness, greed, stupidity)
and enhancement of spirituality and humanism becomes the most
important way of overcoming the noospheric crisis.
 |
| La formazione
e lo sviluppo della nooetica possono sia contribuire all’evoluzione
della scienza biologica sia modificare l’attività
umana, tenendo conto delle priorità della noosfera,
della biosfera e a lungo termine dell’uomo in specifico.
Quindi la nooetica entra nell’etica dell’umanità
come la fase più alta dello sviluppo della bioetica,
diventando una parte integrale e significativa di essa. |
Unfortunately, former bioethics principles, methods and theories
won’t be adequate and effective enough in new reality. Under
the conditions of the realized Noosphere the increasing interaction
of an individual or the entire mankind with the objects of animate
and unanimated nature takes place both by direct and indirect
way through the modified Biosphere.
If the human activity in the Noosphere does not begin to be regulated
with new ethic principles, the consequences of modern noospherical
crisis may have global and disastrous character. For the maintenance
of all living, for all nature and ecosystem on the whole, this
new ethics has to become Nooethics, i.e. to become the rules of
behavior in the Noosphere, which would promote the global interests
of all Noosphere components such as: the Planet, mankind and Biosphere,
transformed by it. Nooethics is meant to become one of the numerous
control mechanisms of the Noosphere, which have to provide its
stable existence and development. The creation of Nooethics may
be regarded as the strategy of ethics development and provision
of the mankind survival at the modern stage of its existence.
Nooethics as the highest stage of Bioethics development has to
enter the ethics as a part of Philosophy, and become an integral
and very important part of it. Nooethics will promote the further
development of Medicine and medicobiological science that permits
to name the modern stage of medical ethics nooethic one.
The global mankind responsibility for the life on the Planet (in
the Noosphere, according to V.L.Vernadsky) probably makes up the
deep destination of man, his life, according to the moral principles
of good, mercy and compassion in the harmony with himself and
the world surrounding him.
Formation and development of Nooethics can contribute to the evolution
of biological science and modify the human activity, taking into
account the priorities of the Noosphere, Biosphere and in the
long run, the specific man. Therefore “Nooethics”
as the highest stage of Bioethics development enters the mankind
ethics and becomes as an integral and very important part of it.
Professor Zaporozhan V.N.
Rector of Odessa State Medical University
Ukraine
