Why do we need Bioethics?

Hello all,

Namaste! I want to let my blog readers know about my new website-swaroopa.net. Very simple id, not the complicated blog id address. Now to the post.

Last week, we discussed about how a whole community was getting treated. We also discussed the spiritual as well as the ethical or moral aspect of how every one should be treated under the spiritual as and social laws. Why don't we go a bit further this week and explore the field called Bioethics. What is Bioethics? According to Wikipedia, "Bioethics is the study of the ethical issues emerging from advances in biology and medicine. It is also moral discernment as it relates to medical policy and practice. Bioethics are concerned with the ethical questions that arise in the relationships among life sciences, biotechnology, medicine and medical ethics, politics, law, theology and philosophy."

Look at the areas that comes under its charge, so many, which we discuss here in this blog. As we are in the middle of a pandemic, which touches upon this area, it becomes worthwhile to explore what is bioethics and the history behind it. It also encroaches upon the African American community in one another way as well. So, let us delve into it.

The insult of Queen Draupadi!
Image credits - Mackenzie, Donald Alexander,
1873-1936; Goble, Warwick / Public domain

We are going through unprecedented times of a pandemic. It has become imperative to invent a vaccine, so that humans can be safe. In previous 'supposedly normal times' development of a vaccine would have taken at least 6-8 years. But as of now, we don't have that amount of relaxed time as the pandemic is vigorously taking human lives. This brings a host of bio-ethical issues. Discussing bioethics would be a precursor to that discussion next week.

History of ethics: Ethics or Dharma was part of philosophy long before the origin of bioethics itself. In Hinduism, the Bhagavad Gita as a whole is a treatise to Dharma- the proper way to lead a human life and control the mind. In Mahabharata, it is discussed again and again- the effects of Dharma, or ethics is subtle. There, scenario after scenario is brought and the question is asked- Is this act aligned with Dharma? Morality is from a societal perspective, how one should act in a society.

With Dharma, the action is from the heart or perspective of the truth. Personal truth. That is why in Mahabharata, Draupadi, the queen famously asked the people of the court, where she was dragged by her hair- "Did

Yudhishtira pawned me before he pawned himself?" Because, she was the wife of Yudhishtira. His Dharma, or personal ethics was to protect her at any cost. But in those days, wife was considered the wealth of the husband. (I stand against that concept, because a wife has her own mind and intelligence. She is her own person. But this was during the days of the Mahabharata). So, here first of all Yudhishtira was supposed to protect his wife. But he could pawn her as well, as she was his wealth. Above this, he had pawned himself first and had no right to pawn her later. He was already a slave to Kauravas.

So, even in the age old ancient books ethics and Dharma was always discussed. In Greek philosophy, the tenets of morality and ethics were discussed far and wide. In ancient Greek 'ethos' meant-pertaining to one's character or deep, true nature. So, from within the deep folds of a person's true nature, acting from it becomes ethics. Above this, a social layer of morality also arises. So, ethics or Dharma was there long before bioethics came along.

Modern medicine took shape as a profession of treatment and healing from the days of Hippocrates (460-370 BC) - who is considered the 'Father of medicine' according to the Allopathic field. Every doctor who wants to practice Medicine takes the Hippocratic oath - "First, do no harm". The ethics and morality are deeply woven into the fabric of the practice of medicine itself. A patient when he/she is undergoing treatment, surgery or getting medicines, he/she is deeply trusting another human being- a physician.

Hippocratic Oath in Greek!
Image credits - Creator:Hippocrates
/ Public domain

This is same as trusting another person with their life. For a treatment to totally work, the patient should have trust in the doctor, that they would do the best possible treatment available at that time, for the best possible outcome for the patient. This is about medical ethics. Now, about Science. In the last 400 years, Science really started to come up in the world. Along with Medicine, scientists also started pursuing research and studies to understand the biological nature of the body and the associated systems.

Dark days of History: When Science took off, people who pursued Science many times crossed the boundaries of ethics, morality and justice. Those days of dark history led to the development of this individual field called the bioethics. Let us look a bit on those dark days.

a. Nazi human experiments: During the early 1940s, the Nazi regime was loading people into freight trains and sending to concentration camps of Aushwitz and Birkenau. Suddenly, the Nazi doctors had tonnes of people on whom they could do experiments. They just had to get permission from the Nazi elite. For that they used the support of the field called Eugenics. Eugenics was the field where desirable characters of the humans were tried to be propagated and increased. In the name of eugenics, thousands of people were being experimented on.

Jews were injected or gassed with poison to see how it effected the human body. The poison included Mustard gas, and Sulfonamides. They were deliberately injected bacteria and other micro-organisms to see how the diseases like Tuberculosis or Malaria progressed to its full length. One group was given the medicine and the other group was given no medicine to compare. People were sterilized and watched how they would emotionally respond. There was also efforts to bring out a superior race called Aryans, which the Nazis considered themselves to be.

Above this, twins were another important group the physicians gave importance to. As the twins came as two, one twin could be the guinea pig and the other twin could be kept as the placebo. Placebo is a control, scientist use, where the patient or person is given sugar pill as medicine instead of the medicine to compare the effect of giving medicine and no medicine. Placebo has no therapeutic value. There has been stories after stories where twins were murdered or subjected to inhumane scientific human experiments. These stories can be read more here.

b. Tuskegee syphilis experiments: In the US as well, there had been dark days of human experimentation. In between 1932 and 1972, the US Public Service conducted a clinical study on African American males, that came to be known as Tuskegee syphilis study. It was to observe the natural progression of the disease. Some 600 men participated in the study, with 399 already having the disease. The patients, who were poor, African American sharecroppers, were not told they had syphilis and were asked to take part in the study that US Public Service was having in collaboration with Tuskegee University of Alabama. They were remunerated for the same.

Tuskegee syphilis study!
Image credits - National Archives Atlanta, GA (U.S. government)
/ Public domain

The men were told they were being treated for "Bad blood" and were never given medicine to stop the disease or to intervene with it's progression. Even though they were told it would be for just six months, the study was continued for 40 years until 1972. ( This also becomes a dark chapter in the history of African Americans. As this related to bioethics, I felt it would be more appropriate here than last with with the history of racial marginalization.) Even though Penicillin, the antibiotic had become standard treatment for syphilis in 1947, the patients were never given the medicine to stop the disease. Many died from the disease.

c. Institutionalization: This is yet another dark chapter in the psyche of the world history. In the early days of 20th century from 1850s to 1960s, people who were mentally challenged or unstable were committed to mental asylums, which were run by state whether in the US or in the United Kingdom. Even though the intention with which it was started was good, there has been many dark stories where atrocious and painful episodes have happened to the residents. Many movies have been taken to showcase the stories of people, who were never able to lead a dignified life outside the institution.  Unfortunately even today, in many other countries, it is still the practice.

Nuremberg code and Belmont report: These cases and many other similar episodes depicts the difficulty many times humans have, to self-regulate. The Nazi human experiment brought this fact to the front and center after the Second World War and the collapse of Nazi regime. The famous Nuremberg trials were military tribunals held by the Allied forces (US, France, United Kingdom and other allied countries) against the war crimes of Nazi regime under the International law and laws of war.

In those trails, the Nuremberg code was drawn, which proposed how to treat human subjects during clinical trials and ethical principles of research for human experimentation. The Nuremberg trials also led to the development of principles of international law against war crimes, crimes against humanity and wars of aggression.

Panel of judges at the Nuremberg trials (1945)!
Image credits - United States Army Signal Corps photographer /
Public domain

Nuremberg Code became the Bible on how to conduct clinical trials and what all points should be taken care of. The code made it mandatory to inform the patient and never keep them in the dark about what would be done with their body; their intentional consent needed. This is what was not practised in the Tuskegee experiments. It also made sure the scientists and physicians should act within the law and do experiments within the protocol for that specific consent. This made sure, irrational scientists don't perform rogue experiments on patients. It also made sure at any point, if the patient wants to stop the experiment they could dissent the consent and withdraw from the experiments.

Now, the Belmont Report was issued on 30th September, 1978 in the US by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research after the Tuskegee experiments came to light in the early 1970s. It became part of the Code of Federal Regulations (CFR) - 45 CFR Part 46. While the Nuremberg code is to take care of International code of ethics for the clinical trials and human subject experiments, the Belmont Report is solely for the US rule of regulations for human subjects.

The Belmont Report deals with three objectives. Respect for persons- people who participate in the experiments should be treated with respect. The patients should participate only after Informed Consent and the researchers should not be deceptive. Beneficence- The rule should always be 'Do no harm' and it should have minimal risks to the subjects. The third point is Justice. The patients should be treated justly, should be remunerated with no exploitation and fair dispensation of cost and benefits to the patients.

Why do we need it? First of all why am I writing a blog post on bioethics? At the present time, we are in the middle of a pandemic. If I have to discuss  the ethical perspectives concerned with the clinical trials associated with the pandemic, I need to first elaborate on the area of bioethics and how it came about. Hence this attempt. Now, why do we need bioethics?

Code of Federal Regulations at the Mid-Manhattan library!
Image credits - Kaihsu Tai / Public domain

Yes, there are a lot of good, ethical and honest scientists. But there are also a lot of rogue, selfish, "my research should go on at any cost" scientists as well. This is about the human body as well as the life and health of a person. Here all the safety measures have to be put into place so that the human, the human values as well as the moral codes are protected. Other aspects also come under bioethics, in which many raging debates are going on.

For example, the practice of Euthanasia or assisted death when a patient is suffering incurable, painful disease or in a coma, is be laden with controversy and there are strong advocates on both sides. Same way, the practice of abortion is a hot potato issue. Both of these come under medical ethics, though. In the case of bioethics, gene therapy as well as the use of stem cells from embryos for research are highly controversial and explosive in nature. Same way there are people who are for  and against vaccination.

In this current health climate, this debate takes even more importance. Do we need to vaccinate against Covid-19 or not? How soon should we develop the vaccines. What all should be the criteria to be taken care of? How much resources should be spent towards it? How much should be the cost compared to the benefit? We will try to look into this further next week, as per my perspectives. So, having such bio-ethical rules and regulations would make sure we are doing the clinical trials and human experiments within the moral and ethical codes. Hence these rules are important as well as the field of bioethics.

Next week, we would explore bioethics from the stand point of a pandemic and what could be the consequences, that are apparent and as well as hidden. That is for the next week.

I wish you a good and safe weekend, and I'll see you next Friday!😉
  
Next week: Bioethics of a pandemic!
Image Credits:  Wikimedia Commons