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The Bioethics of the “Crazy Ape

The Bioethics of the “Crazy Ape”  

Ed. Oguz Kelemen, Gergely Tari 

ISBN 978-615-81222-8-3 (print)
ISBN 978-615-81222-9-0 (online)

Volume 2 (April 2019)

Pages: 1-345

The Bioethics of the “Crazy Ape”
collects a wide range of bioethical topics. Bioethical questions are eternal by nature, although our technologized times transform old issues in forms never before experienced. Just like the famous scientist Albert Szent-Györgyi believed in his time, we also believe that all the contributing authors recognised their moral responsibility in adding new approaches to the continuum of each debate. Although this responsibility has became increasingly complex, we must avoid to become barriers of the scientific development. Bioethics as an applied field of philosophy should always try to establish a framework for a sustainable world: in daily clinical practice, in cases of human experiments, and (not least) in the natural environment.

Oguz Kelemen, Gergely Tari

Part I.  Ethical Challenges in Enhancement Technologies

The Dignity of Apes, Humans, and AI
Author(s): Stefan Lorenz Sorgner

Only humans used to be granted personhood. Given this understanding of personhood, human embryos, who possess neither a brain nor a nervous system and consequently cannot even suffer, deserve more respect than adult chimpanzees who possess self-consciousness and sentience. This is not plausible. A new foundation for personhood is needed. My counter-suggestion is that we need an empirical way of analysing the intensity of suffering of various entities. These reflections also show reasons why a certain type of suffering, namely non-conscious cognitive pain, can also be attributed to a sufficiently developed AI, which is not yet presently available.

Human Dignity in Genetic Engineering (With Some Hungarian Examples)
Author(s): Vivien Szútor

The achievements of genetic engineering are rapidly expanding in everyday medical practice, as they offer solutions for diseases which have been incurable so far. However, genetic engineering also has disadvantages as it questions everything thought about humans until now, thus transforming the concept of the right of human dignity. This study searches for legal answers to the following questions: (1) how human dignity manifested? (2) in what cases may genetic engineering be harmful?

Part II.  Bioethics, Anthropology, Psychology, and Philosophy

Please geben vôtre consentimiento!  Informed Decision-Making in Intercultural Context
Author(s): Attila Dobos

The present study places the well-discussed problem of reaching informed consent in medical treatments into an intercultural perspective. In doing so, it sheds light on some features of the term ‘cultural context’ in the twenty-first century, as it may be seen through the lenses of philosophical hermeneutics, interpretive anthropology, and intercultural discourses. These findings will be used to support the achievements of the anthropological turn in bioethics. The theoretical considerations will be followed by instances from empirical knowledge to highlight the cultural aspects of the already explored difficulties of attaining informed consent. Some of the value differences from Hofstede’s cultural dimension theory, and the importance of the nativeness of the langue used in moral decision-making will be discussed.

Can Kant’s Position Be Guessed in a Debate on Access to New Technical Advances in Medicine?
Author(s): Daniela Reisz, Alexandra Anghel

Neuro-ethics arises as a new field of debate in bioethics, respectively in medical ethics. The term was coined by Safire in 2002 and covers aspects linked to fundamental value questions such as what is life, when does life start, when does an embryo become human. Other subjects include questions on what the mind is; the self and the psyche; brain research; consent; brain as a source of ethics; wellbeing; eugenics; the relationship between new technologies and humans. Several pillars sustain the common theoretical background of all of these ethical enquiries. One of them is the philosophy of Immanuel Kant. MRI (Magnetic Resonance Imaging) is a fascinating tool for diagnosis but it cannot substitute the specific activity of the doctors. Even so, from the beginning, the request for MRI investigation surpassed its availability and led to the enforcement of access criteria. Who will benefit from the new technology and who will not? Sometimes the information supplied by MRI can make the difference between life and death or disability, and the selection of beneficiaries requires a strong ethical ground. The question we are trying to answer is: what would Immanuel Kant`s position be in this debate?

Children’s Bioethics, Theory of Attachment, and P4C

Author(s): Florin Lobont

Starting with a brief analysis of the main theories of children’s rights to culture and cultural rights and their entailments in the realm of biomedical practices as culture, the study sketches a critique of these views on children as universally-dependent and separate individuals unable to make autonomous biomedical decisions for themselves. As a sound alternative, the study puts forward the ethics of care which redefines children’s rights in terms of autonomy-in-relation, socio-cultural milieu, and cultural identity. In support of this tenet, the essay brings forward reputed research results associated with the attachment theory that show how an individual’s current relational experience is deeply dependent on his/her belief systems, which are significantly shaped by the primary caretakers, and contribute essentially to the structuring of their future social interactions. Further, the study calls for the extension of this view to the socio-cultural level as a grounding for understanding society as built on relational selves, rather than on individual separate(d) subjects. The last section describes briefly the Philosophy for Children, a mind competency enhancement set of practices that significantly increases the chances to attain a more autonomous-in-relations identity in children and young people.

Implementing Purity and Combating Impurity: Biopower and Totalist Movements
Author(s): Mihai Murariu

This essay discusses the interaction between totalistic worldviews on one side and biopower and perspectives on purity and impurity, on the other side. It does so by using the concept of totalism, a system of thought defined by its pursuit of the complete reconstruction of society in accordance with its soteriological-simplifying principles. Totalistic worldviews tend to enforce the implementation of what they see as purity and the combating of what they see as impurity by enforcing their ultimate aims on their host society or beyond.

The Psy-complex: Out of the Techno-Scientific Paradigm?
Author(s): Attila Bánfalvi

In the age of modern sciences, a basic discrepancy has been raised between the ontologically-different kinds of body and psyche on the one hand, and the scientific epistemology on the other.
a. Psychology as a presumed scientific endeavor uses mainly quantitative, statistical research methods which are based on the hypothesis that the psychic phenomena are essentially measurable, quantifiable.
b. Psychotherapies are broadly equivalent in their effectiveness. It seems that the psychotherapeutic efficacy is based mostly on common, non-technical elements.
c. The two-hundred-year-old ‘pendulum’ of psychiatry which has been swinging between the somatic and psychotherapeutic-social treatment approach, is now on the way to a less technically-oriented, more humane helping attitude.

Euthanasia in the Contemporary World: What Role Does Faith Play in the Choice to Legalize Assisted Dying Practices?
Author(s): Sorin Grigore Vulcănescu

The purpose of this essay is to examine the pattern of society in the states in which euthanasia, physician-assisted suicide, and assisted suicide have been legally recognized as well as their current legal status. Moreover, this study refers to the slippery slopes that have become obvious in some cases and to the fact that euthanasia cannot be a transparent practice to be adequately controlled by law and free of abuses. An overview of the “metamorphosed” terminology, of how the teachings and morals of the Christian Church (on the basis of which these societies have developed) have been replaced by secular anthropocentric ones, the general factors leading to euthanasia, and the characteristics of pro-euthanasia laws/society constitute an attempt to identify the propulsion of this controversial subject, not an attempt to diabolize Western culture. In this sense, this essay is an approach towards understanding a fact, not a negative generalization of Western culture.

Part III. Globalization and Environmental Ethics

A Critique of the Environmental Ethical Critique of Christian Anthropocentrism
Author(s): Ferenc Hérány

The trends in environmental-ethical thinking that oppose anthropocentrism formulate criticism directed toward ideologies that have been defining the Western ethical mentality up to our days and that are, at the same time, paradigms that obstruct sustainability. Such criticism facilitates the development of an ethical system that is more likely to be able to generate a sustainable social-economic structure. With my research, I wish to contribute to this endeavour. However, there is another aspect that I consider to be of crucial importance, namely that numerous individuals in the Judeo-Christian, respectively in Antiquity-based Western civilizations are unable to identify with this type of criticism grounded in environment-ethical thinking. Consequently, the objective proposed for the ‘criticism of the criticism’ is to reveal new perspectives of interpretation which can reconcile ecologic sustainability and Western Christian ideologies that are, from certain points of view, rightfully criticized. What I propose in my essay is not to repudiate environment-ethical criticism, but to amend it in order to serve a common goal: ecologic sustainability.

Ecocentrism or the Attempt to Leave Antropocentricity
Author(s): Dejan Donev

With the emergence of industrialization as a social phenomenon, an event identifying the onset of dysfunctionality of the biotic community emerges: the issue of environmental sustainability. This question carries with it the need for expanding the views of traditional ethics that rests on anthropocentric theses. One of these approaches is ecocentrism, where the issue of the rights of individuals is crucial (whether it is just humans or people along with other living beings), stating that ecocentrism takes into account all participants in the biotic community as integral parts of the system. Logically, the mutual relations of the individuals of such a community and the consequences arising from their actions, which are the subject of research in this essay, are the main subjects of this position.

Debating Public Policy: Ethics, Politics and Economics of Wildlife Management in Southern Africa
Author(s): Matthew Crippen, John Salevurakis

Based on field research in Africa, this essay explores three claims: first, that sport hunting places economic value on wildlife and habitats; second, that this motivates conservation practices in the interest of sustaining revenue sources; and, third, that this benefits human populations. If true, then sport hunting may sometimes be justifiable on utilitarian grounds. While not dismissing objections from the likes of Singer and Regan, we suggest their views – if converted into policy in desperately impoverished places – would destroy animals and the habitats on which they depend. There are empirical verifications of this, which we discuss.

The Role of the Codex Alimentarius Commission in the Controversy over Genetically-Modified Food
Author(s): Ivica Kelam

The Codex Alimentarius Commission (Codex) is the main international body responsible for adopting food safety rules. A particular problem is the issue of genetically-modified food since this topic has been in the public attention from the first instances of sowing genetically-modified crops in the mid-1990s. Because of the importance of the recommendations in the Codex, corporations are particularly interested in adopting the recommendations which cannot affect their profits – this is particularly evident in their effort to prevent the mandatory labelling of genetically-modified foods. In this chapter, through a brief historical overview of the process of labelling genetically-modified food, we will point to the complexity of this issue, which is manifested within a twenty-year process of issuing rules on labelling genetically-modified food.

Part IV. Ethical and Legal Challenges in Medicine and Research

UDBHR: An Interpretation in the Indian Medico-legal and Bioethical Context
Author(s): Anamika Krishnan

The UDBHR is the most advanced set of guidelines ever set forth in global bioethics. Despite its ambiguity and issues in the drafting process, it provides guidance to developing and developed countries to uphold bioethical principles. India is a country with rich potential in health care, which is unfortunately distorted by bioethical issues like non-protection of surrogate mothers, pharmaceutical scams, complex questions of autonomy and consent etc. The study is made to critically appraise the UDBHR, and discover the scope and prospects of its applicability in Indian medico-legal and bioethical scenario.

An Evaluation of Faith-Based Perspectives on the Withdrawal of Life-Sustaining Treatment from Patients in a Permanent Vegetative State
Author(s): Kartina A. Choong, Mahmood Chandia

In England and Wales, when patients are diagnosed as being in a permanent vegetative state (PVS), continuation of life-sustaining treatment is considered futile. Consequently, it is legally deemed to be in their best interests for this to be withdrawn, alongside clinically assisted nutrition and hydration. This article investigates whether English Law’s stipulations on the matter align with the religious doctrines of the Abrahamic Faith traditions. Based on the findings, it highlights a number of important issues relating to the development of a religiously-sensitive decision-making framework which merits public debate.

Reproductive Autonomy and Genetic Technologies: Ethical and Legal Implications Related to Sex Selection
Author(s): Narine Harutyunyan

Autonomy has always been at the center of discussions on reproduction. Development of various genetic technologies, aimed at the expansion of parental reproductive choices, resulted in heated debates on the limitations of the exercise of reproductive autonomy. The aim of this research is to analyse the arguments on the content and limitations of the concept of “autonomy” and “harm” with relevance to non-medical sex selection. In particular, I focus on interpreting “the harm principle” within the context of preconception and preimplantation sex selection.

The Medicalization of Childbirth: Ethical and Legal Issues of Negative Childbirth Experience
Author(s): Gergely Tari, Csaba Hamvai

As a potentially harmful process, medicalization should be analyzed in contrast to reproductive autonomy. We argue that it is crucial to advance women’s control over reproduction, especially over childbirth, since disregarding autonomy could cause negative childbirth experience even without maternal or foetal morbidity or mortality. We present the results of a questionnaire-based research of our own regarding negative childbirth experiences among Hungarian women (n=506). We found that comprehensive medical information, active participation in medical decision making, freedom of movement during labour and delivery had positive effects, while the loss of control was correlated with negative childbirth experiences.

Prophylactic Mastectomy on Demand
Author(s): Csaba Hamvai, Gergely Tari, Melinda Csenki

This paper presents the case of a breast cancer patient who demanded prophylactic mastectomy after her contralateral breast cancer was treated. Removing the otherwise healthy organ was contraindicant according to both the surgeon and the oncologist, since the patient was neither a BRCA mutation carrier, nor did she have a strong family history with this disease. This situation resulted in the clash of ‘autonomy’ and ‘nil nocere’ bioethical principles. Besides the bioethical aspect, this piece will discuss legal and psychological issues of the case.

Truth Disclosure in the Age of Technologized Medicine
Author(s): Coralia Cotoraci, Alciona Sasu, Mircea Onel,  Cristina Ghib-Para
Truth disclosure refers to informing the patients and their families on the truth about the diagnosis and everything linked to the disease itself (prognosis, evolution, treatment). This study aims to reveal the medical students’ opinion on truth disclosure. We selected a lot of 305 medical students, from the Faculty of Medicine, “Vasile Goldis” Western University of Arad, Romania. They were given a short questionnaire containing questions on how much they agree or not with patient truth disclosure. Most students agree with truth disclosure, but there are also a category of students, mainly from non-EU countries who do not agree with truth disclosure, as well as students who agree with truth disclosure only in special circumstances.

Ethical Challenges Related to Marketing Drugs
Author(s): Miroslav Radenković, Ivana Lazarević, Marko Stojanović, Tanja Jovanović

Drugs have unquestionably become a key factor in the progress of human health and the considerable prolongation of life extent. There are numerous signs showing that the advertising of medicines can actually affect understanding, attitudes, and expectations of patients in relation to the specific drug. It is therefore crucial that the pharmaceutical industry implements the highest ethical standards of good laboratory, clinical, and manufacturing practice. The health-care and well-being of patients should be the first priority. The promotion of drugs must be done in an ethical, accurate, and balanced way, while not being misleading. The proper assessment of the risks and benefits of the product use must be ensured. Medical doctors should always consider evidence-based medical facts and medical scientific knowledge in order to avoid prescribing specific drugs uncritically and under the influence of the pharmaceutical industry.

Disclosing Research Results to Participants: Is There a Consensus?
Author(s): Adél Tóth
Traditionally, research results have not been disclosed to participants during medical research. However, recently a debate on the ethical duty of disclosing research results to participants has emerged. In this review, three positions in the debate are outlined: first, the disclosure is deemed an ethical imperative, second, a prima facie duty, and third, a consideration only. Although the notions of respect for persons, beneficence, and reciprocity can provide strong arguments for accepting disclosure as a duty, no consensus has been concluded on this issue yet. In the lack of consensus, addressing the issue of disclosure is required from every research plan.