In the last year, the search for ethics seemed to be everywhere. We are used to considering ethics in medicine, but we are now exploring, for example, the ethics of politics, politicians and public policy, ethics in sport, the ethics of public accountability and the ethics of research and research funding.
The search for ethics can be seen as an end-of-the-20th-century revolution in conscience and consciousness, in the sense of awareness of the need to ask the question, "Is it right?" in a wide variety of contexts.
Canada and countries like it, which are pluralistic, secular, industrialized democracies, are facing a crisis of a lack of consensus on the "shared story" - the collection of fundamental values, attitudes, beliefs and myths - that we need to buy into in order to form a society and that we use to give meaning to our communal and individual lives. This story, or societal paradigm, is the glue that holds us together as a society. In the past, much of its content was found through religious belief. Today, many people do not adhere to an institutionalized religion and, even if they do, it is often different from that of their neighbours.
In the mid-1970s we began to transfer our "collective faith" from religion to the extraordinary new science that was emerging. In particular, modern medical "miracles" held out hope, if not of immortality as most religions do, at least of delayed mortality. This new faith was first severely shaken by the advent of AIDS. At a time when we had loudly and proudly proclaimed in our public-health journals that, with the eradication of smallpox, the world would never again face a global infectious pandemic, there was little that we could do to treat young people with AIDS, who ought not to be dying. Our new faith was further shaken by the recognition that our powerful new technology carried not only the potential for great good, but also for serious harm.
We recognized this, first, in relation to the destruction of the environment of our planet, upon which we all depend for life. We had failed to ensure that in using our technologies we had engaged in respectful human-Earth relationships. More recently, we have been faced with a stunning power that no previous humans ever possessed: the potential to alter, through the use of a combination of genetic and new reproductive technologies, the very basis of human life and its mode of transmission. The new possibilities include cloning human embryos; cloning our adult selves; using ova from aborted fetuses to produce children whose "mother" was never born; and designing our progeny in ways that range from choosing certain physical characteristics - such as height, eye or hair colour - to dramatically augmenting their intelligence through a so-called "smart gene." Most recently, xenotransplantation is challenging us with unprecedented ethical issues. This technology involves transferring human genes to animals, most often pigs (which raises ethical issues about creating animal-human hybrids); treating these animals in ways that make them as germ-free as possible (which raises profound ethical issues about our treatment of animals); then using their organs for transplantation into humans (which raises unprecedented ethical issues concerning risks to humans' safety, even to the human race itself). There is a possibility - no one knows how likely - that we could allow an occult or hidden infective agent that is harmless in the pig, to cross the species barrier to humans where it could, in a worst-case scenario, wipe us out. Moreover, this infective agent could be of a type we have never before identified, as prions - the cause of "mad cow" disease - showed us.
Such possibilities have shocked us into recognizing that we do not have consensus on the values that we need to address the immense ethical issues they raise. Moreover, these issues must be accommodated within our general societal paradigm; we would deal with them in isolation at our peril. The search for ethics is part of this accommodation process.
We have also been focusing on the other end of the human life span in the last year. Probably, again, because of the change from a religious to a secular base for society, we have seen the age-old questions of euthanasia and physician-assisted suicide, and the ethical issues that surround these, erupt in the public forum (usually television).
This dual focus on the beginning and end of human life is not surprising; indeed, it is to be expected. We humans have always sought to give meaning to our societal and individual lives through searching for meaning in the context of human birth and human death. Moreover, the general level of respect for human life that permeates our society is largely determined in these contexts.
The factors that are influencing the current debates about the meaning that we will give to human birth, life and death, and through this, the nature of the society that we will create, are multiple and complex, exist at many different levels (individual, institutional, societal and even global), and cross a wide spectrum of domains (ethics, science, health care, economics, education, law, religion, media, industry, etc.).
They include, for example, intense individualism, the view that the rights of the individual always predominate no matter what the costs to society. This view has tended to emphasize individual rights without, until recently, a companion emphasis on individual responsibilities. Modern media augment the impact of intense individualism. On television, a focus on an individual makes a much more powerful and convincing visual image than one on the more intangible realities that we also need to take into account. It is easy, for example, to empathize with a courageous person with some dreadful disease who pleads for euthanasia. It is difficult to visualize the harm to society that legalizing euthanasia would cause.
Or, we can see and feel, including through the Internet, the global economic reality (although not yet a global society and, certainly, not a global community) in which we live. The fall-out from this awareness can cover a wide spectrum of responses. For instance, it can result in a feeling that the major harms and risks - such as environmental damage, the loss of employment, the threat of biological weapons and of war - are beyond our individual control and even beyond the control of our politicians, whom we see as having the responsibility to protect us. This gives rise to deep anxiety and fear, which can be converted into hostility and the search for certainty, sometimes in the form of tribalism (of which biker gangs and neo-Nazi groups are examples), which can help us to feel that we belong, a feeling we humans need to live with a certain sense of security and hope.
In contrast, we deny our global reality when we accept with equanimity that 40,000 children (100 jumbo-jet loads) die each day in our world from preventable causes; that the majority of people in developing countries have no access to even a minimal level of basic health care; or that 30 per cent of people in developing countries who die of cancer do so with no pain-relief treatment because our Western war on drugs has caused narcotics - which are highly effective and cheap pain-relief treatment - to be unavailable.
Our greatest challenge for the future, is to evolve a "shared story" that, like our common human genome, can bind us together and that will enable us to protect and respect the physical and non-physical realities that we need to be both fully human living beings and fully living human beings.
I propose that there are three world views competing as a basis for a new societal paradigm:
The first is the "pure science" view, which takes a position that science does or will be able to explain everything, including those characteristics, such as altruism and morality, that we regard as distinguishing us from other animals and most clearly identifying us as human. This is a profoundly biological view of human life, a "gene-machine" approach. It seeks meaning in human life mainly or only through science and, likewise, seeks to exercise control through this. It is intolerant of the view that there is a mystery in human existence - which often results in the negation of a sense of wonder - and within its parameters there is no recognized space for spirit.
This view is comfortable with the use of reproductive technologies and with euthanasia, seeing most decisions concerning reproduction or one's own death as personal matters involving only individual values and preferences. The "gene-machine" approach to reproduction is epitomized by a current development in Britain. A private clinic is offering women having abortions the option of storing their fetuses in liquid nitrogen so that they may later use a cell from the fetus and the cloning technique that produced Dolly to create an embryo genetically identical to the aborted fetus.
The "gene-machine" approach to euthanasia can be summed up in the words of one politician who, speaking in favour of it, said, "When we are past our best-before date, we should be disposed of as quickly, cheaply, efficiently and painlessly as possible." n In contrast, the "pure mystery" view often decries science or is expressly anti-scientific (as can be seen, for example, in the creationists' legal suits against teaching evolutionary biology in schools). This view adopts an intense sanctity-of-life stance, which can be compared to respect or reverence for life, and most importantly, with respect or reverence for death.
For instance, many people who hold this view believe that all medical treatment must be continued until no vestige of life remains. These same people could also have difficulties with providing necessary pain-relief treatment that could or would shorten life. Often, this view is derived from fundamentalist religious beliefs. It seeks meaning, and likewise control, through religion. This view does encompass a sense of wonder, but this is not elicited by the new science. The latter is seen as frightening, at best, and possibly evil.
The "science-spirit" view seeks a structure to hold both science and the human spirit. This view experiences our new science as eliciting wonder at both what we know, and, as a result of this, what we now know that we do not know - what can be called the mystery of the unknown. It seeks meaning through a combination of science and spirit, which could create a different reality from the other two views.
In short, the other two views represent opposite poles on a spectrum and as a result tend to be linear. In contrast, the tension created through seeking a combination of science and spirit might create a third dimension - a space for human spirit, one which also fosters our imagination and creativity.
This view may also be less likely to seek control than the other two views, probably because it recognizes that it is less certain - indeed, it has respect for uncertainty and acts in situations that involve this, under a precautionary ethical principle.
The science-spirit view recognizes there is more that we can do with our new science than what we ought to do, and it opens up, therefore, the debate on what we should and should not do. For instance, under this view, we could regard certain genetic interventions on a human embryo as acceptable (for instance, those aimed at therapy for that embryo). But others, for example, those involving alteration of the human germ-cell line (the fundamental genetic inheritance that is passed from generation to generation) or human cloning, we could regard as inherently wrong. Likewise, this view would accept refusals of treatment and the provision of necessary pain-relief treatment that would result in death, but reject physician-assisted suicide and euthanasia. This view requires the courage to live with the uncertainty that making such distinctions involves.
It recognizes there are many questions we must ask about any given issue, but that there may be no one right answer. Its fundamental premise is that it is only through an undivided "science-spirit" approach that it will be possible to tell a collective story - to create a societal paradigm - of sufficient depth, breadth and width to capture our collective mind, heart and imagination.
It will be the greatest challenge of the 21st century to realize the potential of this view.