Bioethics: fantasies on the topic
Studies on bioethicsPeter Starokadomsky, "Biomolecule"
All students of biological and medical specialties are familiar with the discipline "Bioethics".
In the curriculum, it stands somewhere between civil defense and labor protection - that is, in the list of the most boring subjects. Meanwhile, one has only to go beyond the clerical definitions of this subject, monotonously read out by the lecturer in front of a half-asleep audience, one finds oneself in a very complex area, woven from biological and philosophical knowledge, as well as bioethics itself. In this article, we tried to raise three questions that can be called studies on the topic of bioethics.
The tragic experience of the past centuries — the Nazi death camps, Hiroshima and much more — has clearly shown that technological progress without ethical control and understanding of its possible consequences can be evil. From the awareness of the need for such control, modern bioethics emerged, which is positioned as a dialogue between society and natural sciences.
What is bioethics? To begin with, let's take the definitions from the site, which is called — bioethics.ru . So:
"Bioethics is a complex cultural phenomenon that arose as a response to threats to the moral and physical well—being of a person generated by the rapid progress of biomedical science and practice. The protection of the fundamental moral values that define human existence is a condition for the survival of humanity in the current situation.
In 1971, in the book Bioethics: A Bridge to the Future, American oncologist Van Rensselaer Potter wrote: "The science of survival should be not just a science, but a new wisdom that would combine the two most important and extremely necessary elements — biological knowledge and universal values. Based on this, I propose a term for its designation — bioethics ...“.
.. The following problems can be attributed to the main ones in bioethics:
- protection of the rights of patients (including HIV-infected, psychiatric patients, children and other patients with limited competence);
equity in healthcare; - relationships with wildlife (ecological aspects of the development of biomedical technologies);
- abortion, contraception and new reproductive technologies (artificial insemination, in vitro fertilization with subsequent implantation of the embryo into the uterus, surrogacy);
- conducting experiments on humans and animals;
- development of criteria for the diagnosis of death;
- transplantology;
- modern genetics (gene diagnostics, gene therapy and engineering);
- manipulations with stem cells;
- cloning (therapeutic and reproductive);
- assistance to dying patients (hospices and palliative care organizations);
- suicide and euthanasia (passive or active, voluntary or violent)...".
Etc...
Now let's move away from strict definitions and axioms and try to fantasize a little bit on the topic "ethical - not ethical". Let's call these exercises sketches, emphasizing that we are not discovering truths, but only trying to invite you to think about them in a new way. So:
Sketch 1. Where is this world going?Our knowledge of the living is already quite deep and systematized.
And although disputes like: "Is Darwin right, and was there evolution?" are still very far from completion, gradually they all go to the level of idle chatter of illiterate amateurs (we will also include the church's attempts to curb science, observed all over the world). Healthy people do not reject the "seditious" idea that humanity is also part of nature, and has a common ancestor with its biological relatives — monkeys. Science states this similarity at all levels — from genetic and molecular to social. This means that all the laws of nature established for other organisms must also be valid for human populations. What follows from this?
Let's take an abstract example: any specialist dealing with the cultivation of biomass (no matter whether it is bacteria in a laboratory flask or cows on a farm) knows a simple thing — overgrowth threatens the appearance of diseased organisms and the risk of gradual extinction of the population. The simplest and most effective way to keep the population healthy is periodic elimination of its part (in other words, from time to time it is necessary to slaughter part of the herd or pour into the sink with subsequent dilution of a part of the suspension of bacteria). Otherwise, the death of the entire community of organisms is inevitable.
Unfortunately, this pattern is inherent in all populations, including human ones. There's just one critical "but". Humans are the only kind of living organisms in which the life of absolutely every individual is considered the main value. And this "disables" one of the most important ways to preserve the viability of the species — a constant, incessant selection of the strongest for a moment. The selection is simple — the weakest are "wiped off" from the main resources by more adapted tribesmen, and are gradually eliminated (die). This principle was introduced by Darwin, and descendants have only confirmed its validity. Most often, the weakest are sick and elderly members of society, as well as cubs. However, the latter are taken care of by their parents, which gives them time to grow up and gain strength, while the first two types are ruthlessly eliminated.
Human civilization was able to get out of the rigid framework of this selection. First of all, this was facilitated by the appearance of a second signaling system, which has significantly developed only in humans. As you know, biologists distinguish two signaling systems: the first is visual, auditory and other "raw" signals of the senses; the second is verbal, in which a word acts as a conditional stimulus, which in itself has no real "physical" content, but is a symbol of objects and phenomena of the material world. At this level of development of society (population), the oldest, biologically no longer competitive members of communities bring significant benefits — they become carriers of experience that can be fully transmitted to the next generations. So gradually the value of the life of a particular individual came to the fore. This disabled the first, basic, criterion of natural selection. It is worth noting that as a result of this, our entire civilization exists now. However, biologically speaking, mutations should rapidly accumulate in such a population, which is expressed in an increase in the frequency of hereditary defects and a weakening of the entire species. So far, this is not noticeable, since the growing influence of drugs masks hidden problems for the time being [World health statistics 2009], but all the experience gained on populations of other organisms indicates that this should be feared in the first place.
By itself, the mutational load is the second way of regulating an overgrown population, a fuse inside the body itself. But people are already struggling with this. Increasingly bold experiments on gene therapy and cloning indicate that soon we will be able to fix genetic mutations in life, and thus we will win this way of regulating the size of populations. Also, mutations will no longer be able to limit fertility — artificial insemination makes it possible to pass on even those hidden mutations that in nature would give infertile organisms.
In principle, to regulate the number of such populations resistant to internal constraints, there is a third, external way — epidemics. The accumulation of organisms of the same species in a small area sooner or later leads to the emergence of new pathogenic viruses or bacteria that will be fatal for most of the population. However, humanity has learned to bypass this obstacle at the expense of science and medicine, which in the last century have managed to fight back against the main "regulators": the most famous victory of medicine in this area is the destruction of the natural virus, or smallpox.
The Black Death
Smallpox is caused by a virus of the Poxviridae family. Of all animals, only humans suffer from smallpox; mortality averaged 20-40%. The worst pandemics in Europe were recorded in 531-589 (the plague of Justinian), 1346-1382. (the black death pandemic"), 1440-1530, 1545-1683, 1710-1840, 1945-1947 (in Manchuria, the last plague pandemic — see "The Black Death". To the riddles of the plague pandemic of 1346-1351"). In the second half of the last century, WHO undertook a worldwide vaccination of the population unprecedented at that time. WHO reported on the complete destruction of the smallpox virus in 1980. We can proudly say that the decisive word here remains with the successors of Russian bacteriology and epidemiology.
What is written above is not a special revelation. In any case, any biologist knows and understands the simplest concepts of population biology. However, if you compare the theoretical data with real life, there is a twofold feeling. Every biologist is a professional who knows the whole theory, and a person who has family, friends, and relatives. And he wants to prolong his own life as much as possible. And here we enter into an insoluble conflict. From the point of view of science, humanity must be "cleaned", like any other population of living organisms — in order to save the species itself, it is necessary to sacrifice individuals, leaving only the best. However, from a human point of view, this path is unacceptable under any circumstances, because the entire progress of society is based precisely on the highest value and inviolability of the individual (although attempts at "purges" were, — eugenics is an example of this). Interestingly, during the period of wars, ideology automatically shifts towards natural mechanisms, i.e. the existence of a certain population to the detriment of the individual becomes the main value again. In simple words, from the point of view of the high command, it would be absurd to allow each individual soldier to discuss the expediency of carrying out this or that order, even despite individual individual tragedies. A nation that allows ordinary people such a luxury is likely to lose the war and be absorbed by a rival. However, wars cannot be considered a harmonious regulator of the number of people, even in the form of delirium.
Is it possible to resolve this conflict without changing psychology, i.e. remaining human? I would like to wish that bioethics prevailed over other methodologies in this field. Because applied biology and medicine try not to mention the global consequences of their work — their task is to find a way to get rid of the main diseases and prolong the existence of an individual even to the detriment of the interests of the population. Today, applied research in the field of combating AIDS, cancer, pathologies of the immune and nervous systems are the most funded areas. Bioethics itself is not yet able to offer an acceptable solution to this conflict — the very conditions of the problem are set in such a way that there is no solution. And even the dreams of science fiction writers on space exploration do not offer a solution to the problem — they only postpone it.
In the meantime, everything goes on as usual — thousands of people in laboratories and hospitals are fighting for every life, although we know that in the future this will lead to the extinction of the entire species of Homo sapiens — unless Sapiens evolves into a more advanced civilization that will still be able to resolve these issues. We hope that this will also be the merit of bioethics, which, perhaps, will grow to a fundamental discipline and push applied sciences aside.
Etude 2. Disappointed expectationsA significant share of lectures on bioethics among physicians is occupied by the question — is it possible to lie to a patient, hiding from him the details of his illness or treatment?
In fact, it seems to me that this is a pure cabinet dispute. Such a question is put in advance so as not to be solved. Is the doctor smart? Is the patient strong? How incurable is his case? What century and what country, city or village?
The tension of all mental strength and special delicacy requires a conversation with a patient whose oncological disease is diagnosed at the very late stage, when it is practically impossible to help him with anything other than some palliative aids, anesthesia, and even, perhaps... kind words. In these cases, according to our deepest conviction, "soldier's directness" is categorically contraindicated. We need a well-thought-out, artfully formulated "legend", a half-truth that would not contradict the patient's subjective feelings and his ideas about his own illness. It is natural for a person to seek hope for recovery to the highest degree! We must try to maintain this hope. This "lie for comfort" is nothing but a variant of the holy lie "for salvation". Just in such desperate critical situations, a sick person easily meets the doctor, suggests the necessary hypotheses and words himself. There is a concept of "protective inhibition" in psychology. It often becomes the last saving refuge of incurable patients.
From the journal <url>Often medical care is not limited only to the diagnosis of the disease and the selection of chemical compounds that will eliminate it.
Often, the doctor can comfort or just talk to relieve the patient from the oppression of bad forebodings that worsen his well-being by themselves. It all depends on the wisdom of the doctor — on how far-sighted he is, both as a doctor and as a psychologist.
The potential for self-healing of the body is huge, and often consciously or unconsciously a person can mobilize all forces to fight the disease. Sometimes it just needs a push from the outside, which can be either a supportive doctor's advice or a placebo — a dummy drug. It has been shown that pills that do not contain drugs can improve the patient's condition (for a short time), and this is most effective in the treatment of pain (see "International Medical Journal" No. 1/2002). That is why the trials of new drugs are always monitored by studies of the placebo effect, in order to determine the real effect of the drug, taking into account the influence of the patient's own consciousness. By the way, for the same reason, there may be an illusion of the effectiveness of homeopathic preparations containing an equal amount of active substance with a placebo — that is, zero molecules.
However, the struggle for patient awareness here does a disservice (as does any struggle of energetic amateurs with overworked professionals). For example, as a consequence of the lawyers' attack on medicine in the United States, doctors, in accordance with bureaucratic requirements, must make notes about the absence of a drug in the drug in the reports available to the patient, which, of course, negates the desired effect. Perhaps the success of homeopathy, which has filled its teeth, can be explained by the fact that, unlike ordinary doctors, homeopaths are still allowed to use fake medicines - although under loud incomprehensible names. And the complete harmlessness of its preparations in comparison with other methods (for example, bloodletting in the Middle Ages) went to the reputation of homeopathy only for the benefit.
So should I allow a doctor to prescribe pills to a patient under the guise of aspirin? The trouble is that people can suffer or even lose their lives due to both untimely and improper treatment. And not every doctor will be able to immediately determine whether the disease is imaginary or not. First of all, the professionalism of the doctor and the patient's abilities play a role here. However, their relationship is already beginning to be harmed by overly scrupulous adherence to the rights and freedoms of the patient, which are carefully protected by ethical committees and public institutions (see, for example, the Charter of Patients' Rights).
Etude 3. Don't train on catsAnimal experiments are one of the most popular media topics.
As a rule, it occupies the minds of idle citizens who are concerned about the need to do something in their lives. Protecting your neighbor is quite difficult, costly and not always convenient. Picking up one particular dog and then taking care of it — day after day — is also a thankless way. Gnawed slippers and a wake—up call every day for a walk at seven in the morning - this will discourage anyone from rescuing animals. And protecting animals in general, all together, is much more comfortable. Especially since (as they write in the newspapers) — scientists brutally mock everything that can move.
Indeed, when the research process is presented in a caricature form, where scientists torture laboratory rats without anesthesia, and in moments of depression melancholically chop off the heads of mice with nothing to do — there is something to be horrified about! Bioethics focuses on the need for humane treatment of laboratory animals, and also regulates experiments on volunteers. And, it should be noted, all the requirements here are fair and logical — that's why they are observed all over the world. Although, on the other hand, not everything is so clear here either.
We will not even consider the question of the need to work on animals: before thousands of patients take it, any medicine must be tested for efficacy and safety on animals whose lives are a priori lower than the value of human life (may animal rights defenders forgive us this cynicism). To begin with, let's consider why it is important to observe humanity in working with animals. Probably, it will be unusual for many to hear this, but scientists are trying to make the fate of experimental animals as easy as possible. And it's not just about compassion. As you know, stress dramatically changes the state of the body, starting from molecular processes and ending with behavior. Anyone who works with animals knows well: the slightest difference in the method of killing an animal — and the results of the experiment are unlikely to repeat the previous ones. And this means the loss of time and money to repeat the experiment. Therefore, it turns out that the most accurate and reproducible results will be obtained if the animal is killed without stress at all — ideally, if in a dream; this is what they do in most cases.
Now about how animals feel in cages, knowing that tomorrow they will be killed. My personal opinion is nothing. The antelope escapes from the claws of the tiger, and after a minute it quietly grazes on. In the wild, death for a mouse or rat can come from any direction at any second. Therefore, the situation of the vivarium can cause latent fear only in humans, but it is unlikely that animals worry much, living in such greenhouse conditions. The very fear of death was "invented" by people, and they live under the fear of it all their lives. Plus, they also wrap themselves in other horrors — all together this is called existential fears.
Existential fears are a special group of fears associated not with any specific life events of a certain individual, but with the very essence of a person. Therefore, these fears have a number of features:
- They are more or less inherent in all people;
- They are hidden in the depths of the subconscious and therefore are not always realized by a person;
- Because of their depth and lack of specificity, they cannot be completely eradicated.
Many people revel in the feeling of fear — from this horror films and stories about death attract thousands of idle minds. This, by the way, has been noted for a long time, and scenes of violence now serve simply as advertising, and extremely violent videos become hits on the Internet. Therefore, animal welfare activists mentally imagine how terrible experimental animals must feel, attributing their fears and fantasies to them. In fact, they are protesting against what they come up with themselves. Therefore, bioethics, having taught scientists, is most likely powerless to explain to the masses that their fears are invented by themselves. And her efforts are directed (or should be directed) to ensure that the experimenters themselves correctly understand the essence of the experience with animals! Due to the fact that bioethics has been lost in a far corner, even among biologists, clowns of various educations sometimes come out into the light, who begin to sue universities because of the cruelty that they invented themselves.
Above are three arbitrary plots that came to my mind as soon as I started reading a boring bioethics textbook. And above, I just tried to discuss some aspects of these problems, without pretending to study these issues in depth. Any of the topics can be continued, and I leave it to the reader.
And, you must agree, bioethics is extremely interesting.
Portal "Eternal youth" http://vechnayamolodost.ru31.08.2009