Zentrum für Medizinische Ethik Hans-Martin Sass, Professor für Philosophie an der Ruhr Universität, 44780 Bochum, ist Geschäftsführer des Bochumer Zentrum für Medizinische Ethik und Senior Research Scholar am Kennedy Institute of Ethics, Georgetown University, Washington DC 20057. Die Studie ist ein Beitrag zum Teilprojekt 'Gesundheitsmündigkeit - Health Literacy' einer Forschergruppe 'Kulturübergreifende Bioethik' unter Leitung von Heiner Roetz (Bochum), gefördert durch die Deutsche Forschungsgemeinschaft. Herausgeber: Prof. Dr. med. Burkard May Prof. Dr. phil. Hans-Martin Sass Prof. Dr. med. Herbert Viefhues MEDIZINETHISCHE MATERIALIEN Zentrum für Medizinische Ethik Bochum Ruhr-Universität Gebäude GA 3/53 44780 Bochum TEL (0234) 32-22749/50 FAX +49 234 3214-598 Email: [email protected] Internet: http://www.medizinethik-bochum.de Der Inhalt der veröffentlichten Beiträge deckt sich nicht immer mit der Auffassung des Heft 151 ZENTRUMS FÜR MEDIZINISCHE ETHIK BOCHUM. Er wird allein von den Autoren verantwortet. Das Copyright liegt beim Autor. © Hans-Martin Sass AMBIGUITIES IN BIOPOLITICS OF STEM CELL RESEARCH FOR THERAPY 1. Auflage März 2004; 2. Auflage Juni 2004 Who cares for Gretchen Mueller? Schutzgebühr: € 6,00 Bankverbindung: Sparkasse Bochum Kto.Nr. 133 189 035 Hans-Martin Sass BLZ: 430 500 01 2. Auflage Juni 2004 ISBN: 3-931993-32-9 AMBIGUITIES IN BIOPOLITICS OF STEM CELL RESEARCH FOR THERAPY naturales' maxims of avoiding extremes in Western cultures [Hartmann 2003; Sass 2004A]. Who cares for Gretchen Mueller? Influential Chinese philosopher Mengzi holds, as Rousseau and others did in European Hans-Martin Sass enlightment culture, that 'being compassionate and act humanely .. is innate in everybody's heart'. But in Asian as in Western philosophy, the nature of 'good morality' is controversial. THE CASE: WHO CARES FOR GRETCHEN MUELLER? While Mengzi (391-308 BC) grounds human morality in 'human nature' without much Gretchen Mueller, 42 years old and a mother of 3, suffers from paralysis of her lower metaphysical reasoning and calls for nurturing and practicing moral deeds to further self limbs and trunk, associated with paralysis of her bladder and rectum, due to a car accident a cultivation, Wang Yangming (1472-1529) presents a model of interacting macrocosms and year ago. Her husband Carl, 48, an accountant, who had a heart attack 2 years ago resulting in microcosms, calling on humans to avoid wickedness and evil and returning to original substantial loss of left ventricular heart muscle, takes care of Gretchen and their children of 2, goodness. For Mengzi the role model is the gardener caring, nurturing and beautifying the 4 and 7, as good as he can. New research in cloning and in reprogramming of human embryonic garden, for Wang it is the cat and its innate (sometimes dormant, but never absent) nature to and somatic stem-cells might offer therapies for re-growth of injured muscle and nerve cells catch mice [Ivanhoe 2002:107f]. Controversies in European enlightment over the nature of and eventually better or heal Gretchen's and Carl's health conditions and allow for improved social contract between Rousseau, Hobbes and Locke resemble similar positions. Ratankul individual and family life. But some governments have criminalized stem cell research, others [1999, p. 19] describes it as Buddhist moral duty 'to practice morality (sila), mental discipline have put more or less severe restrictions on human cloning, cell-reprogramming, and research (samadhi) and wisdom (panna)'. on embryonic constructs, in part due to a potential transfer of new therapeutic technologies into St. Paul in his influential letter to the Romans argues that, while the Jews know what to human reproduction; they seem to care more for zygotes and morulae than for citizens in need do by revelation, the pagans have ample opportunity to learn about naturally good and bad by of better medical care and caring governments. studying the laws of nature. Religious commandments, such as fasting during Ramadan for Muslims or obeying the sanctity of Sabbath for Jews, become less demanding and actually need CARING FOR THE SICK IS A PRIME MORAL AND CULTURAL PRINCIPLE to be disregarded, whenever there is need to balance those commandments against saving life There are many differences in cultural traditions and professional cultures, representing and fighting disease: saving life and fighting disease comes first [Sass 2003; 2004]. One of the the richness of humankind's heritage and the diversity of priorities in expertise and ethics in five central requirements for a Muslim is to support generously the poor and the sick [Ilkilic professional ethics. But we rarely see much of a difference when it comes to moral obligations 2002]. The prophet Micah holds that are basically only three rules in obeying the Lord 'to do towards the sick, the poor, those who are weak, in pain, in despair, and cannot help themselves. justly, and to love mercy, and to walk humbly with your God' [Micah 6:8]. Jesus makes an even A common moral prima-facie recognition of individual and communal responsibility toward stronger appeal, suggesting God's appearance and image in the sick, the suffering and the poor: the sick and the poor seems to be strongly supported by religious teaching, philosophical 'inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto argumentation, and cultural tradition everywhere. me' [Math 25:40]. Schueller SJ defines two 'golden rules' for Christians 'as God has loved us, 'Love your neighbor' is a basic commandment in most cultural and religious traditions we should love one another; as God has forgiven us in Christ, so we should forgive one another [Sass 1986; 2003A]. We find the Golden Rule 'do not do to others what you do not want to be (Eph 4:32)'[1980, p. 212]; he calls this a general orientational model a norma normata, which done to yourself' in Confucian teaching, in Jewish and Christian religion, in Kantian ethics [Qiu needs to be differentiated by 'requirements of morality', as the norma normans, a decisionist 1988:298; Sass 2003A], even in extreme anarchist reasoning such as in Kropotkin's 'Mutual position [Schueller 1980, p. 230] quite close to St. Thomas Aquinas insight that assessment and Aid' [1902]. Avoiding extremes and helping others in doing so and in finding harmony and justification of moral acts and those acts themselves need to be close to the situation: 'actiones re-balancing mental and physical disorders is an essential insight in religions and philosophies humanae secundum circumstantias sunt bone vel male' [S.Th.8I,II,q18,3]. Ivanhoe summarizes of individual and social harmony, of harmonious interactions of microcosms and macrocosms, a similar minimalistic view of applying general doctrines or principles to singular cases in and of supporting the sick and the weak in spiritual and medical healing. Asian cultures of situational ethics 'Mengzi vigorously attacked all attempts to ground morality in any "external" orientation in harmony find responding cultures of the 'meson', the Golden rule and the 'res non standard. No "teaching" or "doctrine" (yan) could ever replace the properly cultivated "heart 3 4 and mind" (xin) as one's guide to moral action' [2002:35]. Asian cultures resemble the two different models of certainty and insight. Confucian notion of the larger family as the role model for moral obligations and rights, in A-priori moral intuition based visions and principles allow for individual or particular towards and of those members in need; from a Western point of view they probably moral-community based personalized concepts of differences between good and evil. Those would favor minimal-metaphysics Aristotelian reasoning over heavy-metaphysics Platonism. sometimes different convictions and attitudes towards moral mid-level principles and their Judaic and Muslim teachings have strong foundations in prioritizing the care for life and implementation in day-to-day moral decision making depend on personal interpretation and health over other religious commands. Christian theologians and churches have accepted application of individually and culturally shaped values and visions. A-priori based scientific cadaveric and life organ transplantation, blood donation, 'immortalization' of human cell lines, experience allows for empirical scientific knowledge which can be verified by everyone using cell-reprogramming of lung cells for the development and ongoing use of vaccination for human rationality for scientific inquiry, independent of individually shaped prescientific measles-mumps-rubella vaccination from aborted fetuses. As far as the acceptance of these understandings or visions of the nature of nature. practices by the Roman Catholic church is concerned, Kevin Fitzgerald SJ, priest and geneticist The final system of reference for a-priori intuition is the individual conscience, taught argues that benefits 'significantly outweighed the drawbacks of using aborted fetal cells' and refined by parents, priest, and neighbors of a specific culture and its internal confirming or [Argetsinger; Goldstein 2004]. critical forces in the implementation and development of moral culture and moral action and Book-based Judaic, Christian, and Muslim religions, also non-book based systems of interaction. A review of historical and contemporary moral positions towards helping fellow reference such as Confucian, Daoist, Hindi, and Buddhists worldviews display quite variety humans sick and poor on one side, and on issues such as moral duties towards unborn forms of and flexibility in the history of ideas in their different branches and in bioethical positions on human life, organ or blood exchange, merci-killing, demonstrate a widely shared common and crucial issues today [ Nationaler Ethikrat 2003; Roetz 2004; Sass 2003A], but none of them universal moral obligation for the former, but reasoned controversies among morally competent does have any elasticity to disregard or actively violate the 'love your fellow-human', the people on the latter; both positions are based on a-priori moral intuition, would not be possible 'solidarity' principle, in particular with the sick, the suffering and the poor.