BIOETHICS COURSEBOOK

INTRODUCTION

On October 19th 2005, the 33rd Session of the General Conference of UNESCO adopted the Universal Declaration on Bioethics and Human Rights (here we shall refer to it as the Declaration). The Declaration embodies a set of bioethical principles that has been agreed upon by 191 Member States of UNESCO after an intense elaboration and consultation process involving independent and governmental experts from all regions of the world. This set of bioethical principles provides a common global platform by which bioethics can be introduced and strengthened within each Member State, and UNESCO is mandated to promote, disseminate and elaborate these principles for practical purposes. The UNESCO Bioethics Core Curriculum sets out to introduce the bioethical principles of the Universal Declaration on Bioethics and Human Rights to university students. Bioethics teaching has not been introduced in many universities in many countries. The UNESCO Bioethics Core Curriculum can provide an incentive to start introducing such teaching. Its contents are based on the principles adopted in UNESCO. It therefore does not impose a particular model or specific view of bioethics, but articulates ethical principles that are shared by scientific experts, policy-makers and health professionals from various countries with different cultural, historical and religious backgrounds. UNIT 1 UNIT 2 UNIT 3 UNIT 4 UNIT 5 UNIT 6 UNIT 7 UNIT 8 UNIT 9 UNIT 10 UNIT 11 UNIT 12 UNIT 13 UNIT 14 UNIT 15 UNIT 16 UNIT 17 What is ethics? What is bioethics? Human dignity and human rights (Article 3) Benefit and harm (Article 4) Autonomy and individual responsibility (Article 5) Consent (Article 6) Persons without the capacity to consent (Article 7) Respect for human vulnerability and personal integrity (Article 8) Privacy and confidentiality (Article 9) Equality, justice and equity (Article 10) Non-discrimination and non-stigmatization (Article 11) Respect for cultural diversity and pluralism (Article 12) Solidarity and cooperation (Article 13) Social responsibility and health (Article 14) Sharing of benefits (Article 15) Protecting future generations (Article 16) Protection of the environment, the biosphere and biodiversity (Article 17)

The current course-book has been prepared from three major sources which are: 1- Bioethics Core Curriculum, by Division of Ethics of Science & Technology, UNESCO 2- A cross-cultural introduction to bioethics, by Darryl Macer, Eubios Ethics Institute, 2006. This is a list of the contributing authors to the afore-mentioned book: Morgan Pollard (Australia), Susannah Tye (Australia), Irina Pollard, PhD (Australia), Dena Hsin-Chen Hsin, PhD (Taiwan), Lindsey Conner, PhD (New Zealand), Alireza Bagheri, MD, PhD (Iran), Michael Anjello Jothi Rajan, PhD (India), Mary Ann Chen Ng (the Philippines/USA), Richard S. J. Weisburd, PhD (USA/Japan), Margaret SleeboomFaulkner, PhD (the Netherlands), M. Selvanayagam, PhD (India), and Gursatej Gandhi, MD, PhD (India).
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3- Case studies for bioethics, by Anna Shimpo & Atsushi Asai, UNESCO Asia Pacific Regional Office, Bangkok. Student learning evaluations will take place throughout the course to assess whether the teaching of the course has resulted in the accomplishment of the objectives in each student; the evaluation is therefore focused on assessing the impact of the course in individual students. The general objectives of teaching bioethics to university students include: Students should be able to identify ethical issues in medicine, health care and life sciences. Students should be able to provide rational justification for ethical decisions. Students should be able to apply the ethical principles of the Universal Declaration on Bioethics and Human Rights.

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UNIT 1: What is ethics?

Learning Objectives: Students should be able to recognize and distinguish an ethical issue from other issues. Students should be able to reason about ethical issues.

Ethics (Latin ethicus or Greek ethikos pertaining to "ethos" or character) is a system of moral principles or standards governing conduct. Ethics is: 1. A system of principles by which human actions and proposals may be judged good or bad, right or wrong; 2. A set of rules or a standard governing the conduct of a particular class of human action or profession; 3. Any set of moral principles or values recognized by a particular religion, belief or philosophy; 4. The principles of right conduct of an individual. Ethical behavior requires the ability to reason, to understand the consequences and to make choices about ones actions

Case 1-1: The Lifeboat You are now on two-week cruise holiday with your friends. The ship carries 3,000 passengers and people enjoy their time on board by enjoying meals at restaurants, shopping, watching movies at theaters, tanning by the swimming pool and enjoying a number of parties and events the cruise company organizes. On your 8th day on board, the disaster happens. A fire breaks out in the ship and fireworks in the basement catch fire. Immediately an explosion occurs and the emergency bell sounds. The ship begins to sink, and panicked people dash to the deck where they can get into a lifeboat. Fortunately you are standing at the gate when the accident happens, so you can get into the lifeboat immediately. Now your lifeboat is away from the ship with 11 people and you are helping the sailor to pick up some people from the sea. The capacity of this lifeboat is 20 people but you can still see many people around the lifeboat. Now you see your friend is swimming toward the boat. The boat seems to be full. Questions Q1. Faced with the danger of capsizing the boat, should more people be picked up and rescued? Q2. What would you do in this situation? Q3. What would be ethical behavior(s) in this situation? Q4. Do you think it is possible to be ethical in this situation?

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The term moral means: 1. Of or concerned with the judgment of the goodness or badness of human actions and character; that is, the discernment of good and evil. 2. The lesson or principle contained in or taught by a fable, story, or event. 3. Rules or habits of conduct, especially sexual, with reference to standards of right and wrong.

Moral philosophy is designed to teach goodness or correctness of character and behavior; that is, to instruct what is good and bad according to an established code of behavior. Morality is the generally accepted standards of right and wrong conduct. Morality is a unique feature of the life of human beings. It is deeply influenced by several cultural factors, such as history, traditions, education, religious beliefs, etc. The intellectual analysis of this human dimension in all of its complexity is the goal of the discipline called Ethics. Ethics does not create morality or moral behavior. The goal of ethics is much more modest: to explore the nature of moral experience, its universality and its diversity. Ethics and morality are generally taken as synonyms, because they originally had the same meaning: the study of the disposition, character, or attitude of a specific person, group of people or culture, and ways of promoting or perfecting it. Ethics was traditionally divided into meta-ethics and substantive ethics. Meta-ethics is the study of the nature of morality, such as the question whether moral principles are relative to cultures or whether they apply to everyone everywhere. Substantive ethics seeks to answer questions about the nature of right or wrong, whether right and wrong are expressions of our feelings, and whether they are objective, and how we discover our ideas about morality. Substantive ethics deals with "what are the rules?" and includes the utilitarian and Kantianism concepts; often both agree on practical applications. In Kantianism actions must subscribe other people as "ends in themselves" and not as means to the ends of others, or for self-gratification. In utilitarianism actions are assessed on the basis of their anticipated consequences (good actions maximize happiness or minimize unhappiness). One distinction between theories of ethics through history is whether they focus on the action, the consequences, or the motives. Action based theories are also called deontological theories, which examine the concepts of rights and duties. However, consequence-based theories are teleological ones which are based on effects and consequences. If we use the image of walking along the path of life, a teleologist tries to look where decisions lead, whereas a deontologist follows a planned direction. When faced with seemingly complex moral choices to analyze, it is necessary to break down ethical dilemmas to manageable problems. For example, if we give a person dying of cancer the drug marijuana to ease the pain, we can focus upon these three aspects, the action of giving the drug (which in most countries is illegal), the consequences that the pain may be eased while using the drug (though there is scientific uncertainty on the effects), or the motive that we want to help. However, we can also focus on any of three aspects with a different view, for example, the action to give a drug that is not fully understood (if any are!), the consequence that others in the room may not like the smell, or the motive to respect the persons choice. The theories below focus on different parts of the total ethical equation needed to approach bioethics. In other words despite the presence of different ethical theories, in reality most of us use a mixture of these when attempting to solve moral dilemmas. Most religion based theories of ethics are deontological because they follow religious principles or laws. Despite the scientific world view that is prevalent among academics, sociological research shows that close to 90% of the people in the world find religions to be a much more important source of guidance in life than science. In questions of ethics, often people refer to religious or deontological ethical norms and values. Any theory of bioethics that will be applied to peoples of the world must be acceptable to the common trends of major religious thought, and must also be tolerant of differences. Moral theories which focus on the act rather than consequences, consider moral rules. There are different types of rules. Instrumental rules are those that prescribe an action believed to contribute to the attainment of a goal, for example, make sure you wash the vegetables well before eating them (so you do not get sick). When

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it comes to a restaurant however, the restaurant has to follow some instrumental rules prescribed by authority, for example, the toilet should not be in the kitchen. The problem is to decide which rules should be followed, as some rules do not bring benefit to anyone. Utilitarianism is one consequentialist ethical theory that makes us think about the greatest good (pleasure) for the greatest number, and the least harm (pain) for the least number. However, sometimes it is very difficult to assign values to these pains and pleasures for different people. How do we balance protecting one person's autonomy or interests with protecting everyone else's autonomy or interests? Aristotle in Nicomachean Ethics wrote that morality is the pursuit of a final good or supreme good. This may be accepted, but the question remains as to how to define what the final good is? The final good was often interpreted as happiness, which leads us to one of the main teleological theories, utilitarianism. Utilitarianism looks at the consequences of an action, and is based on the work of Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873). There are historical similarities to other scholars in different cultures, for example what Mo Tzu had taught in China in the 6th century B.C. The principle of utility asserts that we ought always to produce the maximal balance of happiness/pleasure over pain, or good over harm, or positive value over disvalue. Initially philosophers who followed this way of thinking focused on the value of happiness; however, recently other intrinsic values including friendship, knowledge, health, beauty, autonomy, achievement and success, understanding, enjoyment and deep personal relationships have been included. Utilitarianism may appear cold and calculating, but it has been said by its founders and others to be an expression of brotherly love. Utilitarianism is internally coherent, simple and comprehensive and can resolve dilemmas. We can also argue for the happiness of potential people, thus applying it to questions of human reproduction However, there are probably no pure consequentialists. If there is little difference in consequences, most people would consider it wrong to break a promise, and would decide based on that commitment. All societies accept some type of property rights, and most do not accept stealing from the rich to give to the poor, even though this would help more people. However, many societies accept differential tax scales, taxing the higher income earners increasingly more. Most people appreciate good motives over bad ones, although the consequences may be the same. Also consequentialist thinking might allow violations of human rights, and could excessively limit autonomy. Another ethical problem of utilitarianism is that the interests of the majority outweigh the interests of a minority, because utility should be maximized. In this way it is consistent with democracy, and the system of referendums to decide public policy and law. Making most people happy most of the time is more important, even though a few persons or organisms may be unhappy. However, to make people happy is one of the central goals of love. Virtue ethics implies that the moral decision is judged by the intentions of the person, for example, the intention of jumping in the river to save the drowning person was a good intention. If unfortunately both persons died, it would be a consequence of that. Another consequence could be that both were saved, or the attempt did not work. Confucius (c.551-479 BCE) was a philosopher of ancient China. The teachings of Confucius were recorded by his students, especially in the book known as Lun Yu (or in English: Analects). Confucius stressed the importance of acquiring virtue and acting according to proper moral behavior. His teaching places special emphasis on the importance of family, and on filial obligations towards parents. The father-son relationship is one of the Five Relationships. The five relationships are: relationship between a father and son, ruler and minister, husband and wife, elder brother and younger brother, friend and friend. This framework defined by Confucius had profound impact upon the countries and cultures of East Asia.
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Buddha is the title of Gautama Shakyamuni, born in Nepal, approx 6th century BCE. Gautama was born to a wealthy family, and at first his parents shielded him from the unpleasantness of the outside world. However,

eventually Gautama was faced with real-life examples of sickness, poverty, old age and suffering. These things troubled him, and he set out to examine the problem of suffering in the world and how to eliminate it. A key point in his teaching is that if an individual is unable to break free from the cycle of suffering in this lifetime, that individual is reborn to continue the quest for the release from suffering (Karma). Buddha's teachings focus on the problem of suffering, its causes, and ways to reduce and eliminate it. In a more general sense, the term "Buddha" is applied to other individuals who have managed to achieve the release from the cycle of suffering. The two major branches of Buddhism are Theravada (school of the Elders) and Mahayana (lit. "Great Vehicle").Buddhist ethics is very influential in East Asia. There are other religious texts on ethics or morals such as the ten commandments of Judaism, five pillars of Islam and Buddha's Eight-fold path to wisdom. An alternative theory of ethics is based on obligations and is shaped from the work of Immanuel Kant (17241804). Although he wrote from a Christian background, like utilitarianism, he used secular arguments which are widely applicable. Kant argued in the Critique of Practical Reason that morality is grounded in pure reason, not in tradition, intuition, conscience, emotion or attitudes such as sympathy. We could see this as following the tradition of Francis Bacon, in Of Love, where he wrote It is impossible to love and be wise. Kant regarded human beings as creatures with rational powers to resist desire, the freedom to resist desire, and the capacity to act by rational considerations. He said we must act for the sake of obligation and made categorical imperatives, one being I ought never to act except in such a way that I can also will that my maxim become a universal law. However, Kant has a problem with conflicting obligations, for example, between two promises if both are absolute. Another famous imperative of Kant is "One must act to treat every person as an end and never as a means only". In Doctrine of Virtue he restricts respect to a refusal to abase any other person as a mere means to my ends, and construes love as making anothers ends my own. However, if someone agrees to do something for someone else, as in work, it is ethically acceptable if the person is treated with respect. Kant considered beneficence more rational than love, and in Foundations of the Metaphysics of Morals, he wrote, ...love as an inclination cannot be commanded. But beneficence from duty, even when it is opposed by a natural and unconquerable aversion, is practical love, not pathological love; it resides in the will and not in the propensities of feeling, in principles of action and not in tender sympathy; and it alone can be commanded. Autonomy Autonomy is a word that comes from the Greek for self-rule, and it was first used to apply to the autonomy of city-states nearly 3,000 years ago. Today it is usually applied to individuals. Why would we have self-rule? Q1. Look around the class and see something you, and each other person has done to make them look different to other persons? What have you and others done to look the same? It is easy to see that people are different, if we look at our faces, sizes and the clothes that we wear. This is also true of the personal choices that we make. We may decide to play soccer, read a book, or watch television. We may be pressured by people around us to behave in one way, but ultimately it is our choice. There is a duty to let people make their own choices, and also corresponding responsibilities of individuals towards society. The challenge of respecting people as equal persons with their own set of values is a challenge for us all. Autonomy is also expressed in the language of rights, by recognizing the right of individuals to make choices. One of the assumptions of modern ethics is that all human beings have equal rights. In 1948 the Universal Declaration on Human Rights was agreed at the United Nations, and following that it has been used in International Conventions on different expressions of human rights, and in the laws and constitutions of many countries. It states that there are universal human rights, which should be protected, and recognized. We can argue for the foundation of human rights from secular philosophy or religion. This is different from saying everyone is of equal use to the world. The concept of human rights tries to separate human beings from the concept of how useful a person is.

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Q2. If you visit a doctor do you make treatment decisions on your own or in discussion with other family members, and the doctor? Q3. What are the limits to personal choice? Q4. What factors could we use to make such decisions in our daily lives? Q5. When we make decisions for ourselves do we also have responsibility for what happens? Q6. When is the legal age of responsibility in your country?

Justice Our own autonomy is limited by balancing our desires with respect for the autonomy of other individuals in society, and in our world. With every increase in rights comes a proportionate increase in responsibilities (duties to use that right or power in a responsible manner). Those who claim that individual autonomy comes above societal interests need to remember that a major reason for protecting society is that it involves many lives. We should give every member in society equal and fair opportunities in life: this is justice. John Rawl's book "A Theory of Justice" proposes that a just world would be organized in a way that people would not be so disadvantaged no matter which position they were born in, socially and genetically. The ethical principle of social justice and legal justice may be different because legal justice has to define the minimum common norms to stop the abuse of people. We may be ethically expected to do better than that. Different people have different goals and can have different values. Diversity is part of what we call being human. We should not expect all people to balance the same values in the same way all the time. Diversity of attitudes and characters of human individuals are represented in any one society. It is a paradox that although not everyone has the same opinion, we are in fact not that different. A failing of human thought is that people view their society as being different from another, with sweeping generalizations. Such thinking is often tied to discrimination. Future generations are also an essential part of society. People's well-being should be promoted, and their values and choices respected but at the same time, limits must be placed on the pursuit of individual autonomy. This is called intergenerational justice or equity. Q7. All human beings have equal rights. Do you agree or disagree with this statement? What is the difference between the theory, the laws on human rights, and the description of the real world? Q8. What things can you see that your grandchildren might not be able to see in the world when they live? Q9. What can you do to make the situation in the world better for others, now and in the future? Benefits Many medical and industrial technologies are challenging because they involve technology with both benefits and risks. A fundamental way of reasoning that people have is to balance doing good against a risk of doing harm. Risk assessment and cost-benefit analysis are tools commonly used in environmental science, economics and medicine. Most people believe human beings are spiritual beings, sharing emotions such as love and hate, greed and generosity. One of the philosophical ideas of society is to pursue progress. This is a powerful argument for further research into ways of improving health and agriculture, and living standards. To attempt to do good is called the principle of beneficence.

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Benefits may be promoted by those marketing a technology, but there are usually possible risks that there could be some harm. A beneficial technology should be made to overcome a problem in a better way than now. We always have to ask who benefits and who is at risk of harm. Q10. Think of cases where we need to balance the benefits of some action that restricts the autonomy of persons to make free choices? Q11. Choose one example of a technological advancement, and in a class group, identify the benefits and risks of this new technology. Have different people say one benefit and one risk, going around the class. How many can you think of? Are the benefits and risks similar for different technologies?

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UNIT 2: What is bioethics?

Learning Objectives Students should be able to explain the difference between medical ethics and bioethics. Students should be able to differentiate bioethics, law, culture, and religion. Students should be able to explain the principles of bioethics and how to balance these principles in practice.

Bioethics can be defined as the study of ethical issues and decision-making associated with the use of living organisms. Bioethics is learning how to balance different benefits, risks and duties. Concepts of bioethics can be seen in literature, art, music, culture, philosophy, and religion, throughout history. Every culture has developed bioethics. Please note that bioethics is not about thinking that we can always find one correct solution to ethical problems. There can be different choices made after ethical reflection. Bioethics is learning how to balance different benefits, risks and duties. Fundamental ethical principles can aid decision-making.

Case 2-1: Prenatal diagnosis and abortion A 39 year-old Japanese woman, Naoko, who was in her 12th week of pregnancy, found out through prenatal diagnosis that her baby had Downs syndrome. She was told by her doctor to decide if she still would give birth or take an abortion. She had to make a decision by the 22nd week of her pregnancy when is the time limit she can take an abortion. The doctor also explained that if she gave birth, the baby would have a high risk of heart disease and might not live long. Her husband is against having the baby because he is afraid of raising a disabled child and the discrimination by others to his other two children (7 and 4 years old) because they have a disabled sibling, while Naoko does not think about abortion at all especially because she has experienced stillbirth 3 years before. Abortion for a babys disability or disease is not specifically legal in Japan; however it is allowed for reasons of financial status and the physical condition of the mother. Overcoming the hard time of decision making, they decided to have their baby. Unfortunately the baby passed away 12 days after she was born due to severe heart disease. However, Naoko felt more appreciation to her baby who was born with a severe disease. With the development of medical skill and technology, it is possible to know about more conditions of a fetus in the womb. Some people think that prenatal diagnosis helps parents by giving them more time to accept their babys conditions and prepare for when the baby is born. Other people relate prenatal diagnosis with selective abortion. Prenatal diagnosis is becoming a more common practice. Questions Q1. Do you agree with Naokos decision? What will you do if you were in Naokos situation? Q2.What ethical issues exist if Naoko decided to have an abortion? Q3. How is prenatal diagnosis useful? Is prenatal diagnosis always necessary for expected mothers? Q4. Should the hospital tell all the results including congenital disorders they find through prenatal diagnosis to the parents? Q5. Do you agree with abortion in general for certain reasons?
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Ethical principles and issues need to be balanced. Many people already attempt to do so unconsciously. The balance varies more between two persons within any one culture than between any two. A mature society is one that has developed some of the social and behavioral tools to balance these bioethical principles, and apply them to new situations raised by technology. Bioethics includes both medical ethics and environmental ethics. In order to have a sustainable future, we need to promote bioethical maturity. We could call the bioethical maturity of a society the ability to balance the benefits and risks of applications of biological or medical technology. It is also reflected in the extent to which public views are incorporated into policy-making while respecting the duties of society to ensure individual's informed choice. Awareness of concerns and risks should be maintained, and debated, for it may lessen the possibility of misuse of these technologies. Other important ideals of bioethics such as autonomy and justice need to be protected and included when balancing benefits and risks. Society is facing many important dilemmas about the use of science and technology. These decisions affect the environment, human health, society and international policy. In order to resolve these issues and to develop principles for decision making, we need to involve wisdom from many fields such as anthropology, sociology, biology, medicine, religion, psychology, philosophy, environmental sciences and economics. Science and technology occurs in the context of societies that have different philosophical and religious values. The term bioethics reminds us of the words biology and ethics. New technology can be a catalyst for us to think about life issues. Some examples include environmental pollution, organ transplantation, genetic engineering, and assisted reproductive technologies. These have stimulated research into bioethics in the last few decades. We cannot avoid making decisions about these issues due to the rapid development of science and technology as well as the increasing deterioration of our environment. These decisions must be made by everyone regardless of their social or economic status in life. The more possibilities we have, the more decisions we have to make. An extensive education is no guarantee that we can make better decisions. We often do not use what we have learned in textbooks in real life. It is also important to look at how we can find some balance when faced with conflicting ideals. Global and Local Ethics A popular phrase in the environmental movement is "Think Globally, Act Locally". There are large and small issues that we can apply ethical analysis to. We can think of problems that involve a single person. We can think of global problems. One example is the depletion of the ozone layer. This results in increased UV radiation which affects all living organisms. This problem could be solved by individual action to stop using ozone-depleting chemicals, if alternatives are available to consumers. However, global action was needed in order to control the problem, and still is. The Montreal Protocol, an international convention to stop the production of many ozone-depleting chemicals is one of the examples of applying universal environmental ethics. Another problem is greenhouse warming, which results mainly from energy use. Although we can urge governments and industries to make better policies to reduce greenhouse gas emission, this problem can only be solved by individual action to reduce energy use. We could do this by consuming less, turning off lights, building more energy efficient buildings and shutting doors. These are all simple actions that everyone must do if we are concerned about the future of our planet. At present, energy consumption could be reduced by 5080% through lifestyle change. New technology may help, but lifestyle change can have a more immediate effect. Global citizens should be conscious about how they use resources. Sometimes if we perform some action, we will find it easier to perform another. There is the idea of a slippery slope. This expression envisages a slope where once footing is lost it cannot be regained. While we may not do any direct harm with the application we have now, once we accept doing one thing and drawing a line from another, later on we may find an inability to draw a line. Consider the boundary between treating short persons to become average height and making people tall to play basketball more easily. Historical theories of bioethics Bioethics is both a word and a concept. The word comes to us only from 1970 when first used in English by Van R. Potter in a book called Bioethics: A Bridge to the Future, yet the concept comes from a human heritage

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thousands of years old. This heritage can be seen in all cultures and religions, and in ancient writings from around the world. We in fact cannot trace the origin of bioethics back to their beginning, as the relationships between human beings within their society, within the biological community, and with nature and God, are formed at an earlier stage than our history can tell us. There are at least three ways to view bioethics: 1. Descriptive bioethics is observations and descriptive interpretations of the way people view life, their moral interactions and responsibilities with living organisms in their life. 2. Prescriptive bioethics is to inform or try to tell others what is ethically good or bad, and what principles are most important in making such decisions. It may also be to say that someone or something has rights, and that others have duties to them. 3. Interactive bioethics is discussion and debate about 1 and 2 above between people, groups within society, and communities. Developing and clarifying prescriptive bioethics allows us to make better choices, and choices that we can live with, improving our life and society. The choices that need to be made in the modern biotechnological and genetic age are many, extending from before conception to after death - all of life. The timing of reproduction, contraception, and marriage choice are not new. Euthanasia, a good death, is also an old choice, forced upon us by our mortality. In order to inform our prescriptive bioethics we need to describe the bioethics that people have been following and the bioethics that they have today, i.e. to have Bioethics for the People by the People. We can find various definitions of bioethics. The simplest one is consideration of the ethical issues raised by questions involving life (bio). We could include all issues of environmental ethics and medical ethics, as well as questions I face each day, like What food should I eat?, How is the food grown?, Where should I live and how much disturbance of nature should I make?, What relationships should I have with fellow organisms including human beings?, How do I balance the quality of my life with development of love of my life, others lives and the community?, and so many more you can think of. The history of bioethical reasoning is influenced by both our genes, and the environmental and social forces that shaped and continue to shape these genes into the people, society and cultures that we have. We now have the power to change not only our own genes, but the genes of every organism, and the power to remodel whole ecosystems of the planet, which has made many focus on biotechnology applications; however, the key questions are more basic. We have been destroying ecosystems with some technologies. New technology has nevertheless been a catalyst for our thinking about bioethics, which have been stimuli for research into bioethics in the last few decades. In the past many of these questions would be simply called ethics, but in popular debates today the term bioethics is broad. Love and ethics The love of life is the simplest and most all encompassing definition of bioethics, and it is universal among all peoples of the world. Love is the biological heritage given to us by our genes, the capacity that evolved in us to allow us to overcome selfishness that destroys harmony within a community. Our social heritage also gives us love, as the society tries to pursue harmony between individuals and communities. Love is the message of our spiritual heritage; across each culture they say God is love. Ethics is the concept of love, balancing benefits and risks of choices and decisions. The balancing of principles, self-love (related to the principle of self-rule, autonomy), love of others (justice), loving life (do no harm) and loving good (beneficence) can provide us with a vehicle to express our values according to the desire to love life. However, in the end, we are left with a simple fact of life, there are often no clear black and white answers to our dilemmas. Rarely can most real life situations be seen in simple balck and white. As a society we need to understand the diversity which is universal, and tolerate with love what we can. There comes a time for protection of others, but we can remember the spirit of love which says do not judge.

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Empedocles (who lived in Sicily, 5th century B.C.) assumed that in nature there are positive forces which he called, Love and Hate, or Harmony and Discord. These forces are what cause the four elements (earth, air, fire and water) to intermingle and later to separate. Love causes the elements to be attracted to each other and to build up in some particular form or person. The 1997 movie The Fifth Element, took up this theme, with the fifth and essential element to the universe being love. Empedocles considered that love was a governing principle which held things in unity. Quotations on Love: There have been more books written about the subject of love than any other subject. A selection of quotations about love is presented in the appendix below, suggesting that love of others as a principle of ethics in literature is universal in scope. Confucius, Analects (China, 6th Century B.C.) To love a thing means wanting it to live. Can there be a love which does not make demands on those who are the objects of love? Erich Fromm, The Art of Loving (Germany, 1956) If I truly love one person, I love all persons, I love the world, & I love life. If I can say to somebody else, I love you, I must be able to say I love in you everybody, I love through you the world, I love in you also myself. Mo Tzu (China, 6th Century B.C.) The way of universal love and mutual benefit... is to regard other peoples countries as ones own. Regard other peoples families as ones own. Regard other peoples person as ones own. Consequently, when feudal lords love one another, they will not fight in the fields. When heads of families love one another, they will not usurp one another. When individuals love one another, they will not injure one another. When ruler and minister love each other, they will be kind and loyal. When father and son love each other, they will be affectionate and filial. When brothers love one another, they will be peaceful and harmonious. When all people in the world love one another, the strong will not overcome the weak, the many will not oppress the few, the rich will not insult the poor, the honored will not despise the humble, and the cunning will not deceive the ignorant. Because of universal love, all the calamities, usurpations, hatred, and animosity in the world will be prevented. Mahatma Gandhi (India, 1927) Love is the strongest force the world possesses and yet it is the humblest imaginable. The more efficient a force is the more silent and subtle it is. Love is the subtlest force in the world. ...To see the universal and all-pervading Spirit of Truth face to face one must be able to love the meanest of creation as oneself. ...The path of self-purification is hard and steep. To attain to perfect purity one has to become absolutely passion-free in thought, speech and action; to rise above the opposing currents of love and hatred, attachment and revulsion. Pierre Teilhard de Chardin, The Phenomenon of Man (France, 1959) Love alone is capable of uniting living beings in such a way as to complete and fulfill them, for it alone takes them and joins them by what is deepest in themselves. Lao Tsu, Tao Te Ching (China, 6th century B.C.) The source of a mans strength lies not in himself but in his relation to other people. No matter how close to them he may be, if his center of gravity depends on them, he is inevitably tossed to and fro between joy and sorrow. Rejoicing to high heaven, then sad unto death, is the fate of those who depend upon an inner accord with other persons whom they love. Here we have only the statement of the law that this is so. Whether this condition is felt to be an affliction or the supreme happiness of love, is left to the subjective verdict of the person concerned.

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Charles Darwin, The Descent of Man (England, 1875) It is certain that associated animals have a feeling of love for each other, which is not felt by non-social adult animals. How far in most cases they actually sympathize in the pains and pleasures of others, is more doubtful, especially with respect to pleasures. John Stuart Mill, Utilitarianism (England, 1861) In the golden rule of Jesus of Nazareth, we read the complete spirit of the ethics of utility. To do as you would be done by, and to love your neighbor as yourself, constitute the ideal perfection of utilitarian morality. Confucius, Analects (China, 6th Century B.C.) Zigong asked: Is there a single word such that one could practice it throughout ones life? The Master said Reciprocity perhaps? Do not inflict on others what you yourself would not wish done to you? Tzu-kung said, What I do not want others to do to me, I do not want to do to them. Confucius said, Ah Tzu! That is beyond you.

Hillel, The Babylonian Talmud (Seder Moed) (Persia, 30 A.D.) What is hateful to you, do not to your neighbor that is the whole Torah, while the rest is the commentary thereof; go and learn it. Jesus Christ, Gospel according to St. John 15: 12-13 (Palestine, c. 27 A.D.) My commandment is this: love one another, just as I love you. The greatest love a person can have for his friends is to give his life for them. Martin Luther King, Jr. (USA, 1961) Agape is more than romantic love, agape is more than friendship. Agape is understanding, creative, redemptive, good will to all men. It is an overflowing love which seeks nothing in return. Theologians would say that it is the love of God operating in the human heart. So that when one rises to love on this level, he loves men not because he likes them, not because their ways appeal to him, but he loves every man because God loves him. And he rises to the point of loving the person who does an evil deed while hating the deed that the person does. I think this is what Jesus meant when he said love your enemies. Im very happy that he didnt say like your enemies, because it is pretty difficult to like some people. Like is sentimental and it is pretty difficult to like someone bombing your home; it is pretty difficult to like somebody threatening your children; it is difficult to like congressman who spend all of their time trying to defeat civil rights. But Jesus says love them, and love is greater than like. Soren Kierkegaard, Works of Love (Denmark, 1847) Erotic love is determined by the object; friendship is determined by the object; only love to ones neighbor is determined by love. Since ones neighbor is every man, unconditionally every man, all distinctions are indeed removed from the object. The category neighbor is just like the category human being. Every one of us is a human being and at the same time the heterogeneous individual which he is by particularity; but being a human being is the fundamental qualification. Boethus, The Consolation of Philosophy 3 (Rome, 524 A.D.) Who would give a law to lovers? Love is unto itself a higher law. Fyodor Dostoyevsky, Notes from Underground 2.4. (Russia, 1864) With love one can live even without happiness. Victor Hugo, Les Miserables (France, 1862) The supreme happiness of life is the conviction that we are loved.

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Aristotle, Nicomachean Ethics (Greece, 4th century B.C.) Those who love because of utility love because of what is good for themselves, and those who love because of pleasure do so because of what is pleasant to themselves, and not in so far as the person is the man he is, but in so far as he is useful or pleasant. And thus these friendships are only incidental; for it is not as being the man he is that the loved person is loved, but as providing some good or pleasure. (VIII, 3.1156a14-19) Perfect friendship is the friendship of men who are good, and alike in virtue; for these wish well alike to each other qua good, and they are good in themselves. Now those who wish well to their friends for their sake are most truly friends; for they are so disposed by reason of the friends themselves, and not incidentally. (1156b711) Maharishi (India, 1970) All love is directed to the self...The purpose of love is the expansion of the self. Euripides, Alcestis (Greece, 5th century B.C.) You love your life; but then, so do all men! St. Paul, Paul's First Letter to the Corinthians 13:1, 4-7 (Turkey, 53 A.D.) I may be able to speak the languages of men and even of angels, but if I have no love, my speech is no more than a noisy gong or a clanging bell. (1) Love is patient and kind; it is not jealous or conceited or proud; love is not ill-mannered or selfish or irritable; love does not keep a record of wrongs; love is not happy with evil, but is happy with the truth. Love never gives us; and its faith, hope and patience never fail. (4-7) Paul Tillich, The Eternal Now (USA, 1963) One cannot be strong without love. For love is not an irrelevant emotion; it is the blood of life, the power of reunion of the separated. Sophocles, Oedipus at Colonus (Greece, 401 B.C.) One word frees us of all the weight and pain of life: That word is love. St. John, First Letter of St. John 4: 7-8, 12 (Palestine, 1st century A.D.) Dear friends, let us love one another, because love comes from God. Whoever loves is a child of God and knows God. Whoever does not love does not know God, for God is love. Dalai Lama XIV, The Power of Compassion (Tibet, 1995) The basic aim of my explanation is to show that by nature we are compassionate, that compassion is something very necessary and something which we can develop. It is important to know the exact meaning of compassion. Different philosophies and traditions have different interpretations of the meaning of love and compassion. Some of my Christian friends believe that love cannot develop without Gods grace; in other words, to develop love and compassion is based on a clear acceptance or recognition that others, like oneself, want happiness and have the right to overcome suffering. On that basis one develops some kind of concern about the welfare of others, irrespective of ones attitude to oneself. That is compassion. Han Yu (China, 8th century, A.D.) Universal love is called humanity. To practice this in the proper manner is called righteousness. To proceed according to these is called the Way. To be sufficient in oneself without depending on anything outside is called virtue. Humanity and righteousness are definite values, whereas the Way and virtue have no substance in themselves. Dante Alighieri, Purgatorio (Italy, 13th century) Neither creator nor creature, my son, was ever without natural or rational love.

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Joseph Fletcher, Situation Ethics (USA, 1966) Love is freedom to put human need before anything else. Buddha, Gradual Sayings A.iii.443 (India, 6-4th century B.C.) (A description of six praiseworthy results that inspire a monk to develop the perception of suffering with regard to all conditioned phenomena): 1. the perception of nirvana will become established among all conditioned phenomena, 2. the mind will turn away from all realms, 3. the monk will see the peace which is nirvana, 4. inherent tendencies [to defilements and rebirth] will be destroyed, 5. the monk will have completed his tasks, and 6. the monk will have served the teacher with acts of love. Friedrich Nietzsche, Thus Spoke Zarathustra (Germany, 1883-92) We love life, not because we are used to living but because we are used to loving.

Moral Agents
In this part we shall explain what a moral agent is, and why it is important to determine moral agents. Differences between individuals All people are members of Homo sapiens, one of the millions of species alive on Earth. There is a long history of coexistence of different species together on the earth, in a variety of ecological systems. When it comes to moral issues, fundamentally we should ask whether humans are a special form of life. Are humans different from other living creatures? By comparing humans with other species, we may be able to understand both the differences and similarities between living organisms.

Q1. Do you think you have a responsibility towards animals? Plants? Bacteria? Fungi? Rocks? What does responsibility mean?

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Capacity to feel pain In most people's minds there are some differences between animals and plants. One significant difference between some animals and plants is the capacity to feel pain as we know it. Beyond the motivations behind what we are doing, another important criteria we use in judging the use of animals is avoiding the infliction of pain. Pain is more than simple sensation of the environment. While plants do send ionic potential signals in response to harm, similar in some ways to action potentials in animal nerves, the difference is in the processing of those signals to become the perception of pain. Some distinguish pain from "suffering", but they are both departures from the ideal of avoiding harm. Suffering can be defined as prolonged pain of a certain intensity, and it is claimed that no individual can suffer who is incapable of experiencing pain. The capacity for suffering and/or enjoyment has been described as a prerequisite for having any moral interests. Judging pain is subjective, and there are parallels in the way animals and humans respond. Many of the neurotransmitters are similar between higher animals and humans. It is possible that animals do have a different quality of "pain", as the frontal region of the cerebral cortex of humans is thought to be involved in feelings of anxiety, apprehension, suffering and other components of pain. This region is much smaller in animals, and if surgically treated in humans it can make them indifferent to pain. There are differences seen in the types of pain receptors; some respond to mechanical stimuli, some to noxious or irritant chemicals, and some to severe cold or heat.

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Q2. What animals feel pain (are sentient)? Q3. Is pain always bad? Is causing pain bad Q4. Do different people feel the same amount of pain? Q5. If we anesthetize a mouse so it does not feel pain, do you think we can do whatever we like to that mouse? What are some of the other factors that are important in deciding how we think it is ethical to treat animals? Can animals think? It is accepted that humans possess unique moral wills, and most want to exercise choice and their autonomy. People have been conducting psychological experiments and observing animal behaviour in attempts to answer whether animals also have some capacity for free moral judgment. Based on animal research, it has been discovered that some animals are clearly self-aware such as higher apes, and some whales and dolphins. Chimpanzees have been taught to communicate in human languages, for example sign language or computer symbols. Some mothers also taught their babies how to talk to humans. This has given us a new way of looking at other species. Behaviour is determined by genes, environment, and moral choices. In 1993 a book called "The Great Ape Project" <http://www.greatapeproject.org/> was published calling for equal rights for chimpanzees, gorillas, and orangutans with human beings (who are also a higher primate species). It is claimed that these four species of higher primates form a more natural group to confer ethical duties on, rather than humans as the only species having rights. Q6. Discuss the Great Ape Project in class. Can you think of any reasons to think that we have more duties to human beings than other primates? Q7. In almost all societies a moral rule is we do not eat humans. What about for other species? Q8. Do you think we should eat whales? How much do you think dolphins and whales can think? How does intelligence depend on the environment?

Genome Comparison of Chimps and Humans We can compare the genetic differences between human beings and other animals. Our closest genetic relation is the chimpanzee followed by the gorilla. Also, the origins of our selfish and altruistic behavior are fundamental to how we behave, and these behaviors are seen among all living organisms to different degrees. On 1 September, 2005, the first comprehensive comparison of the genetic blueprints of humans (Homo sapiens) and chimpanzees (Pan troglodytes) showed that our closest living relatives share perfect identity with 96 percent of our DNA sequence, was reported by an international research consortium (the Chimpanzee Sequencing and Analysis Consortium) in the journal Nature. The chimp sequence draft represents the first nonhuman primate genome and the fourth mammalian genome described in a major scientific publication. A draft of the human genome sequence was published in February 2001, a draft of the mouse genome sequence was published in December 2002 and a draft of the rat sequence was published in March 2004. The essentially complete human sequence was published in October 2004. "As our closest living evolutionary relatives, chimpanzees are especially suited to teach us about ourselves," said the studys senior author, Robert Waterston, MD, PhD, chair of the Department of Genome Sciences of the University of Washington, School of Medicine in Seattle. "We still do not have in our hands the answer to a

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most fundamental question: What makes us human? But this genomic comparison dramatically narrows the search for the key biological differences between the species." The 67 researchers who took part in the Chimp Sequencing and Analysis Consortium share authorship of the Nature paper. The DNA used to sequence the chimp genome came from the blood of a male chimpanzee named Clint at theYerkes National Primate Research Center in Atlanta. Clint died in 2004 from heart failure at the relatively young age of 24 (most chimps live closer to 40-50 years old), but two cell lines from the primate have been preserved at the Coriell Institute for Medical Research in Camden, N.J. The consortium found that the chimp and human genomes are very similar and encode very similar proteins. The DNA sequence that can be directly compared between the two genomes is almost 99 percent identical. When DNA insertions and deletions are taken into account, humans and chimps still share 96 percent of their sequence. At the protein level, 29 percent of genes code for the same amino sequences in chimps and humans. In fact, the typical human protein has accumulated just one unique change since chimps and humans diverged from a common ancestor about 6 million years ago. To put this into perspective, the number of genetic differences between humans and chimps is approximately 60 times less than that seen between human and mouse and about 10 times less than between the mouse and rat. On the other hand, the number of genetic differences between a human and a chimp is about 10 times more than between any two humans. The researchers discovered that a few classes of genes are changing unusually quickly in both humans and chimpanzees compared with other mammals. These classes include genes involved in perception of sound, transmission of nerve signals, production of sperm and cellular transport of electrically charged molecules called ions. Researchers suspect the rapid evolution of these genes may have contributed to the special characteristics of primates, but further studies are needed to explore the possibilities. The genomic analyses also showed that humans and chimps appear to have accumulated more potentially deleterious mutations in their genomes over the course of evolution than have mice, rats and other rodents. While such mutations can cause diseases that may erode a species overall fitness, they may have also made primates more adaptable to rapid environmental changes and enabled them to achieve unique evolutionary adaptations, researchers said. Despite the many similarities found between human and chimp genomes, the researchers emphasized that important differences exist between the two species. About 35 million DNA base pairs differ between the shared portions of the two genomes, each of which, like most mammalian genomes, contains about 3 billion base pairs. In addition, there are another 5 million sites that differ because of an insertion or deletion in one of the lineages, along with a much smaller number of chromosomal rearrangements. Most of these differences lie in what is believed to be DNA of little or no function. However, as many as 3 million of the differences may lie in crucial protein-coding genes or other functional areas of the genome. A small number of other genes have undergone even more dramatic changes. More than 50 genes present in the human genome are missing or partially deleted from the chimp genome. The corresponding number of gene deletions in the human genome is not yet precisely known. For genes with known functions, potential implications of these changes can already be discerned. For example, the researchers found that three key genes involved in inflammation appear to be deleted from a common ancestor of humans and chimps in the chimp genome, possibly explaining some of the known differences between chimps and humans in respect to immune and inflammatory response. On the other hand, humans appear to have lost the function of the caspase-12 gene, which produces an enzyme that may help protect other animals against Alzheimers disease. The researchers found six regions in the human genome that have strong signatures of selective evolutionary changes over the past 250,000 years. One region contains more than 50 genes, while another contains no known

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genes and lies in an area that scientists refer to as a "gene desert." Intriguingly, this gene desert may contain elements regulating the expression of a nearby protocadherin gene, which has been implicated in patterning of the nervous system. A seventh region with moderately strong signals contains the FOXP2 and CFTR genes. FOXP2 has been implicated in the acquisition of speech in humans. CFTR, which codes for a protein involved in ion transport and, if mutated, can cause the fatal disease cystic fibrosis, is thought to be the target of positive genetic selection in European populations (i.e. it was favored because if you have only one copy of the mutated allele you have resistance to certain infectious diseases). The chimp and human genome sequences, along with those of a wide range of other organisms such as mouse, honey bee, roundworm and yeast, can be accessed through the following public genome browsers on the Internet: (GenBank) at NIH's National Center for Biotechnology Information (NCBI); the UCSC Genome Browser (www.genome.ucsc.edu) at the University of California at Santa Cruz; the Ensembl Genome Browser (www.ensembl.org) at the Wellcome Trust Sanger Institute and the EMBL-European Bioinformatics Institute; the DNA Data Bank of Japan (www.ddbj.nig.ac.jp); and EMBL-Bank (www.ebi.ac.uk/embl/index.html) at the European Molecular Biology Laboratory's Nucleotide Sequence Database.

Q9. Does it change your opinion of chimpanzees to know there are less than 100 genes different between them and humans? Q10. How much do you think behavior is genetically, socially and/or environmentally influenced, and how can we study this?

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UNIT 3: Human dignity and human rights

Learning objectives: Students should be able to explain and apply the concepts of human dignity and human rights. Students should understand the relevance of these concepts in the context of bioethics.

Human Rights and Responsibilities

Human rights allow people the necessities for quality of life and wellbeing. Human rights come with proportional human responsibilities to use new powers and freedoms ethically. Here we shall first introduce the Universal Declaration of Human Rights discuss the relationship between rights and responsibilities, compare individual and collective rights and responsibilities, and assess humanitys attempts at establishing International Humanitarian Law.

Film: My sisters keeper (2009) Synopsis of the Story: An eleven year old Anna seeks a successful lawyer and tries to hire him to earn medical emancipation from her mother Sara that wants Anna to donate her kidney to her sister. She tells the lawyer the story of her family after the discovery was made that her elder sister Kate had leukemia, and how she was conceived by in vitro fertilization to become a matching donor; and the medical procedures she has been submitted to since she was five years old to donate to her sister. Questions Q1. Should it be possible to have a baby as a donor for his/ her sibling? Q2. Who should be able to decide how and when the donor children contribute to their sibling? Q3. If the donor child had a disease, should it be accepted to have another donor child for her or him?

Human Rights and Freedoms

The Universal Declaration of Human Rights (Table 1) was the first constitutional document for global humanity, inspired by the genocidal horrors of WWII and declared in 1948. The Universal Declaration has been the catalyst in creating common threads and benchmarks in the pursuit of a universal ethic of human rights. It is central to the evolution of International Law as well as many National Constitutions and the United Nations Charter. Human rights as outlined by the Universal Declaration include that all people are born free and equal in dignity and rights irrespective of race, religion, politics, sex or any other social status. Human rights include the rights to life, liberty, security, nationality, ownership of property, recognition by the law, work, social security, rest and leisure, and adequate standards of living, healthcare and elementary education. Human freedoms in the Universal Declaration include freedoms of thought, expression, conscience and worship, and freedom of assembly, movement and access to information from independent media. Human rights enable people to support their familys basic needs and necessities to allow at least a moderately good quality of life and wellbeing. Basic needs include food, water, shelter, warmth, security and access to

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information, education, healthcare, social support and other opportunities. There should also exist an international social order able to realize these minimal basic rights and freedoms. Unfortunately, such constitutional statements do not always carry through into national practice. International politics and economics have often created an environment in which the realization of these goals in many cases seems more fantasy than reality. Table 1: Summary of the 1948 Universal Declaration of Human Rights 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. All humans are born free and equal in dignity and rights. Entitlement to rights without distinctions of race, colour, sex, language, religion, politics, nationality, property, birth or other status. Right to life, liberty and security of all persons. Prohibition of slavery and servitude. Prohibition of torture and inhuman treatment. Right of recognition before the law. Equality before the law. Right to an effective legal remedy. Prohibition of arbitrary arrest, detention or exile. Right to an impartial tribunal hearing. Presumption of innocence until proven guilty. Protection against arbitrary interference with privacy, family, home, correspondence, honour or reputation. Freedom of national and international movement. Right to foreign asylum from political persecution. Right to a nationality. Right to consenting marriage and protection of the family unit. Right to own property. Right to freedom of thought and conscience, choice of religion and freedom to teach, practice and worship. Right to freedom of opinion and expression and right to seek, receive and impart information through any media. Right to freedom of peaceful assembly and association. Access to government, public service and genuine elections expressing the will of the people. Right to social security. Right to work, free choice of employment, equal pay for equal work and trade union membership. Right to rest and leisure. Standards of living adequate for health, wellbeing, security and child protection. Free elementary education and access to higher education on the basis of merit. Right to participate in the arts, science and cultural life, protection of author interests. Right to an international social order able to realize these rights and freedoms. Everyone has duties to their community and is subject to laws which respect general welfare and the rights and freedoms of others. Discouragement of any act aimed at the destruction of these rights and freedoms.

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Human Responsibilities and Duties With human rights also come human responsibilities. The Universal Declaration mentions duties to community and the law, to ensure the rights and general welfare of others. Rights confer new powers and freedoms, and therefore must be exercised responsibly with due respect for issues of ethics and justice. It is the responsibility of those with freedom and power to stand up for those who dont have freedom, and thus cant stand up for themselves. This is an example of duty of care. This important point has sometimes been overlooked in the debate about human rights. The typical emphasis in Western nations has been on rights and freedoms for the individual (the philosophy of individualism), sometimes to the detriment of the community or the environment (e.g. the right to bear arms). On the other hand, in many Eastern nations there has been excessive emphasis on duties and responsibilities to society and the State (the philosophy of collectivism), often at the expense of individual human rights. Each value system can learn and benefit from the other, to reach a common middle ground which does not sideline either individual human rights or collective human responsibilities. Human responsibilities at the global level include concepts of social justice an economic issue, and ecological stewardship an environmental issue. Stronger human rights, global justice and environmental movements are gathering momentum in support of the spread of human rights and democracy. These exist both as independent citizens movements (in both the developed and developing worlds including workers unions, social workers, ethicists, environmentalists, advocates of fair trade and forgiveness of third world debt, and the peace, antiglobalization and green movements), as well as through international political channels (e.g. the United Nations High Commissioner for Human Rights, or UNHCR) and legal channels (e.g. the International Criminal Courts, or ICC). Economic imperatives often override well-meant attempts to establish the practice of human rights and responsibilities. Traditional hard technologies often involve difficult labour conditions and dangerous applications of science, as well as typically being wasteful in terms of resource use, energy consumption and pollution. Less developed countries cannot afford to follow the dirty industrial paths taken by wealthier countries, because the global ecology is over-reaching sustainable limits. Fortunately, new opportunities and soft technologies provide more productive paths for international development to move directly into clean modern technologies (e.g. Bangalore in India as an international centre of information technology). Soft technologies include education, media, health, management, environmental sciences, services, information industries and relief work. Sustainable development is the concept of collective responsibilities for the current generation to guarantee the human rights of upcoming future generations.

Q1:

Identify relationships and comparisons between the interconnected concepts of a) Human Rights, and b) Human Responsibilities.

Q2:

Discuss the problem of some short term national interests competing with and compromising the common good of long term local interests and global interests.

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Revisiting the Body

Here we shall present an overview of the different theories about the body, introduce the concepts of authenticity and commodification, and explain the ethical implications of medical enhancement by describing the case of cosmetic surgery.

Introduction
Many advances in biotechnology and medicine such as growth hormones, plastic surgery, genetic therapies, mood-altering drugs and the like have brought into focus how we perceive, feel and look at our bodies. Because of these new developments, we can now make physical changes in our bodies or choose how we want to feel. We also have more options in how we live our lives. At the same time, these changes have also made us question our traditional beliefs about the body such as its relationship with the spirit and the self. Q3. How would you define your views about yourself and your body? Which of the following statements do you agree or disagree with? Why or why not? I am my body My soul matters more than my body I own my body My body is a machine Q4. Think about the meaning of what these famous people have said about the body. How would you relate this with your answer to question one? Plato: We are bound to our bodies like an oyster to its shell. Martha Graham: The body never lies. A Tamil text: The body is but a lie, a bag of wind. Avril Lavigne: I rejected some gorgeous publicity shots because they just didnt look like me. I wont wear skanky clothes that show off my booty, my belly or boobs. I have a great body. I could be Britney. I could be better than Britney. Arnold Schwarzenegger: I know a lot of athletes and models are written off as just bodies. I never felt used for my body.

What is the Body?

The relationship of the body, the spirit and the self has been part of philosophical inquiry since ancient times. So what makes the present argument different? It can be said that characteristics of our present time such as the increasing influence of the state, secularization and advances in science and medicine have brought about a situation where the power of individuals to define themselves has contributed to the tendency of people to put greater value on the body as an expression of identity. In other words, how we physically look like plays a significant factor in how we live our lives, how we see ourselves and how others relate to us. This then brings us to the question of how can we define the body in a society where the body is valuable to the point of obsession. In short, what is the body anyway? If we were asked to describe ourselves, we probably would first think of the obvious features of our physical bodies. We could start by describing our height, weight, skin color and facial features. And we could then go on to describe our personalities and other abstract characteristics. Traditionally, this is how others have viewed the body--a collection of flesh, skin and bones that contains the inner self. This is often referred to as the Cartesian dualism view of the mind/body. It is still the basis and ideology of biology and medicine---the body is compared to a machine composed of parts. We can see this in how lessons on the body are taught in class, where the body is described using different levels of organization (molecules, cells, tissues, organs, and organism). In medicine, this is reflected in the philosophy behind medical treatment wherein treatment is geared towards fixing or curing some abnormal phenomenon in the body. We can also see this model in how medicine

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itself is organized. For example, there are different specialists for different parts of the body and its corresponding functions. In our present time, there are other ways of thinking about the body besides the mind/body model. Although these may seem contradictory, altogether they help us make sense of what it means when we talk about the body. Chris Shilling describes these perspectives of the body as falling under naturalistic, social-constructionist, feminist and contemporary theories of the body. Naturalistic theories perceive the body as a biological entity that possesses characteristics specific to human beings. A clearly defined concept of nature forms a biological body from which society comes from. Naturalists think that the body is inherited from tradition. The Cartesian dualism model falls under this category. Social-constructionist theories view the body as being socially-constructed. Society defines and gives meaning to the body. Social constructionists seek to answer questions about the socially-constructed body and its relationship to power, social inequality, social identity and symbols. Feminist theories of the body focus on dominant concepts of gender that affect images of the body and gendered practices which can lead to physical changes that distinguish the gendered body. It addresses the question of how exclusive gender identities are based on the exaggeration of bodily differences and the suppression of bodily similarities. Contemporary theorists view the body as both a biological and social phenomenon. The corporal body is given importance in experiencing the world and expressing self-identity in a society that values the body in economic, cultural and social ways. The unfinished project of the body becomes the lifetime goal of individuals. Q5. How would you describe your body? From your description, what kind of theory do you think you connect with the most? What sounds true to you? Can you think of other ways to describe your body?

The Authentic Body What kind of body do we value? What goals do we seek to achieve in our lifetime project of the body? If we are to agree with the relevance of the body in defining self-identity, the question of the body then becomes linked to that of the self. To ask what kind of self we value helps us understand what body we value. In many contemporary societies, the ethic of achieving ones true self has become an ideal for both the individual and the group. We can see this searching for or being true to ones authentic self expressed by people living in different parts of the world. The journey to the true self is often related to the issue of self-fulfillment. In other words, in this ethic of authenticity, the closer we are to our true selves the closer we are to being fulfilled as human beings. The opposite of this statement also rings true to our twenty first century ears; that is, if we arent being true to ourselves, the farther we are from becoming fulfilled. The idea of authenticity is not recent. It goes back to Ancient Greek times when Socrates was concerned with self knowledge in order to achieve ones true self. In modern thought, authenticity is associated with existentialist philosophers such as Kierkegaard, Nietzsche, Heidegger and Sartre. In this ideal, the individual consciously chooses to become his unique and true self in order to rise above the herd and not merely go along with the crowd (3). It is thus ironic that one of the problems associated with the pursuit of the authentic embodied self in contemporary life is that the current notion of a good and authentic body often conforms with social norms, some of which may be unjust and oppressive. In the current debate about enhancement technologies, Erik Parens posits that both proponents and critics share the moral ideal of being authentic to oneself (4) and that these opposing definitions of authenticity stem from two different ethical frameworks. On the one hand are the critics of enhancement who argue that by altering our bodies through these products and techniques of modern medicine, we alienate or separate ourselves from our authentic selves and reality. This is rooted in what Parens speculatively calls as a gratitude

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framework---a viewpoint based on the idea that we human beings are mere creations of a creator, blessed with the gift of life that we are responsible for. On the other side of the debate are the proponents of enhancement who advocate the use of these technologies for an empowering journey towards self discovery and selfcreation. Within this creativity framework, we human beings are asked to go beyond being grateful and to transform ourselves to the best that we can be. Q6: It can be argued that it is only mainly in Western societies that importance is given to the questions of individualism, the project of the body and the desire to achieve ones authentic self. What are your personal thoughts about this?

Commodification of the Body What does commodification of the body mean? Let us look at the meaning of the verb commodify. This is usually defined as the action of placing an economic value to what was once considered as not something that could be bought, sold or traded. It is generally accepted that the current increase in demand for body parts was brought about by advances in the transplant, reproductive and genetic technologies. In the case of organ transplants, the organs needed for such medical technologies are acquired from donations from the living and the dead. In most societies, the human body is not considered as an object that can be exchanged. Thus in most countries, it is illegal and immoral to buy or to sell the human body or body parts. Human organs can only legally be given as a gift of life (5) from a donor to a patient. Unfortunately, there are more people in need of organs than people who donate. For example, there are 87,000 people waiting for organs yearly; while only 25,000 receive transplants in the U.S.A. (6). It is not then surprising that despite legal and ethical prohibitions; there is a thriving international blackmarket for body parts. Proponents for the legal commercialization of body parts argue that it is the right of autonomous individuals whether they want to sell parts of their body or not. However, the situation becomes more complex when we take into consideration the question of property rights. Legally, the traditional approach is that once organs and tissues are extracted from the body, these are considered as res nullius---no ones property (7). A famous case that illustrates this is John Moores claim of ownership over the tissues that were taken from him by doctors at UCLA Medical Center as part of his treatment for hairy cell leukemia. The Supreme Court of California ruled that he had no property rights to the tissues once they were extracted from his body. Furthermore, the Court ruled that the doctors had patent rights over the cell lines developed from Moores tissues because these were now products of their labor. However, they ruled that Moores doctors violated the duty to inform their patient about their personal motives in extracting his tissues (8). The present trend of looking at the body in terms of its parts is thought of as a reflection of a viewpoint that the physical body is the vessel that contains the rational self. Certain body parts tend to be viewed as not as integral to the self than other integral body parts. For instance, there is not much of an outcry in the sales of wigs made out of human hair or in the use of feces as fertilizer. But there is a different reaction that occurs when it comes to integral organs such as kidney, liver, heart, lungs and brain. The situation is also different when it comes to the way cartilage, tendon, cornea, sperm, eggs and blood are handled. What then is the problem with buying and selling body parts? Why does it bring feelings of revulsion to most people? One strong reason is that the human body is considered as having inherent value. This means that it is valued for itself and not for what it can be used for. The human body must be respected and not be objectified. Putting a price to the body is mostly thought of as an act of exploitation and a dehumanizing affront to human dignity (9). If we are also to consider the body as the embodied self, the act of division becomes a threat to body integrity and serves to alienate the body from the self. Although most people would agree that commodifying human persons, human bodies and body parts is ethically unacceptable, others have pointed out that the arguments tend to be abstract and do not reflect the complexity of real situations. In the case of poor living donors from developing countries, De Castro

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challenges people to consider the historical context involved in prohibiting unrelated living donors to receive money for their altruistic contributions to others. He argues that there are cases wherein compensation for donors is not necessarily equated with commodification, objectification, exploitation and loss of human dignity. In the United Kingdom, Dickenson illustrates the case of egg donors where womens role in altruistically donating their eggs is not acknowledged in a system where everyone else profits. In donating eggs, women need only sign an informed consent form and agree not to benefit from potential commercial uses of their eggs. Superovulation and egg extraction are not considered as work or labor. The result is that researchers and biotechnology firms benefit from womens altruistic donations. There is also a potential for the exploitation of women donors from developing countries where there are minimal or no regulations at all. In this sense, the insistence on the gift relationship as a way to avoid commodification effaces the contribution of women. It can further be argued that it also ignores the subjectivity and personhood of women. The Gendered Body The previous discussion on the authentic embodied self and the inherent value of the body seem to be quixotic in the harsh reality of living in societies that put premium value on young, thin and beautiful bodies. The pressure of attaining and maintaining an attractive physical appearance is a problem that predominantly affects females due to societal expectations of what being female should be. Most women are not happy with their bodies. As a result, the majority of the persons who diet, develop anorexia nervosa and bulimia, undergo cosmetic surgery, attend fitness gyms and weight loss clinics are female. One of the criticisms against the prevailing dominant Cartesian view of the body is that there exists a mind and body dichotomy that is gendered. The autonomous subject lies in a rational and masculine mind; while feminine attributes are given to the emotional and animalistic body. This is projected in society in the creation of a gendered division of labor that associates feminine values to the home and masculine values to the public sphere. In contrast, Bordo elucidates how a feminist/cultural model of the body can relocate disorders such as anorexia nervosa and bulimia from the realm of the pathologic in which it is usually classified in relation to the normal. The relentless pursuit of excessive thinness is an attempt to embody certain values, to create a body that will speak for the self in a meaningful and powerful way. The anorexic or bulimic seeks to reach the tantalizing ideal of a perfectly managed and regulated self, within a consumer culture which has made the actual management of hunger and desire problematic. What does it mean to be a woman in a male constructed society? From the moment of birth, girls learn to experience how to see their bodies and how to live in a body that is not male. As (future) women, we are encouraged in a lively sense of our own vulnerability and that of other sentient creatures; we find out that approval will not be withheld if we show timidity, and will be given if we are seen as physically pleasing; we gather, if only implicitly, that all this has something to do with the biological function of bearing and rearing children. What this means is that female identity is bound with reproductive body-based experiences menstruation, fertility, abortion, pregnancy, childbirth, breastfeeding, infertility, and menopause. And what makes this more complicated is that these experiences are lived by women in a culture organized and dominated by the Cartesian dualistic model of the gendered body. The Enhanced Body In 2004, the American Society of Plastic Surgeons projected that the total expenditure on cosmetic surgery in the United States was $8,403,557,322. This amount covered both cosmetic surgical procedures and minimallyinvasive cosmetic treatments like botox injections. Since cosmetic surgery is elective, it is not covered by insurance. People personally shell out an average of $2,223 for liposuction, $4,822 for a facelift, $3,373 for breast augmentation and $428 for laser hair removal. Many popular reality shows feature men and women go through multiple surgical procedures on national t.v. Infomercials feature celebrities endorsing products

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ranging from anti-acne lotion to yoga and pilates DVDs. Is it then an understatement to say that we are now living in a culture of enhancement? We have heard these lines before Want a new and beautiful body? Call 1-800-NEW-BODY Try our new age defying moisturizer for more vibrant and radiant skin Its all about bringing out the beautiful woman in you Its not about vanity. Its about loving your body. Im 100% plastic and I am perfect.

Why talk about cosmetic surgery? Who cares about such a trivial topic? What has it got to do with bioethics? Shouldnt it be relegated to the realm of talk shows and celebrity gossip columns? It is this seemingly fluffy exterior that tends to hide very deep and existential questions about both the goals of medicine and the goals of society. Medicine for what purpose and for whom? In a recent news article, celebrity dermatologists who market cosmeceuticals were criticized by Art Caplan, an American bioethicist, of being more like entrepreneurs than medical doctors (26). This criticism of the marriage of marketing and medical professionals engaged in the business of enhancement is rooted in the question of what should be the goals of medicine. Should medicine be exclusively for treatment and not for enhancement? Are doctors who perform cosmetic surgery and other enhancement procedures going against the goals of medicine? Bioethicists frame this argument in terms of using a heuristic distinction between treatment and enhancement. The discussion revolves around the problems encountered in the ambiguity of the terms involved and the difficulty in deciding which practices should be considered as treatment and which ones should fall under enhancement. In the case of treatment, to begin with, there is no agreement on what health means. At present there are two opposing camps, one is the World Health Organization (WHO) definition, which is a state of complete physical, mental and social well-being. The other one is commonly referred to as the normal function modeldisease and disability are seen as departures from species-typical normal functional organization or functioning the central purpose of health care is to maintain, restore or compensate for the restricted opportunity and loss of function caused by disease and disability. Successful health care restores people to the range of opportunities they would have had without the pathological condition or prevents further deterioration (29). In terms of enhancement, this generally refers to the interventions designed to improve human form or functioning beyond what is necessary to sustain or restore good health (30). One of the problems with this distinction is that there are many situations where there is ambiguity in deciding whether a particular procedure is necessary for a persons health or not. For instance, one of the arguments made by doctors who perform cosmetic surgery is that they are alleviating suffering that people experience as a result of the way their bodies look like and that by doing so, they are contributing to the health and well-being of the person.
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Deciding which procedure should be classified as treatment or enhancement especially becomes problematic when it comes to considering whether it could be covered by health insurance or not. More often than not cosmetic surgery is considered as elective and therefore is not covered by insurance. People basically pay for

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these procedures out of pocket. In this sense, cosmetic surgery reinforces the market system which favors those who could afford to pay over those who couldnt. This then leads to arguments about distributive justice, particularly in poor countries where basic health services are not available to the majority of citizens and where cosmetic surgery is another factor that advances the interests of the rich. In short, should medicine be involved in enhancement when people are dying from lack of basic medical care? The answers to the issues raised by cosmetic surgery in medicine are difficult. But it becomes more complex and nuanced when it comes to expanding the discussion to the level of society. A Cosmetic Society The classic philosophical question of does the end justify the means is also played out in the realm of cosmetic surgery. We can take as an example that of the pursuit of a better and flatter tummy. Is there any difference between exercising and liposuction in order to achieve a smaller waistline? Exercising takes a lot of time and effort, while liposuction can be done during ones lunch hour. However, achieving that size 10 body through months or years of working out at the gym gives people a feeling of satisfaction and accomplishment that isnt the same as cosmetic procedures. We can see this reflected in the saying that it isnt all about winning but how we play the game that matters. There is, after all, a glory and a dignity in human accomplishment attained the old-fashioned way, through sweat and struggle, sometimes against great oddsTechnology, precisely because of its power and efficiency, seems to cheat us of the experience of accomplishment, which is something valued in distinction from the achievement of the endThe significance of this argument lies in its calling attention to the value that lies in certain means, over and above the value found in the end considered by itself. Different means have different moral values. Why does looking at Michael Jackson bring out weird feelings in most people? And were not talking about his activities here. Looking at his pictures when he was young, you wouldnt be able to think that this child with African American features is the same person as the very white adult Michael. Michael Jackson is an extreme example of how cosmetic surgery valorizes racial values of beauty. When people undergo cosmetic surgery, they choose features that are considered as attractive in their societies. And what is attractive in society is a reflection of what types of people have more value in that society. In many countries, the image of beauty echoes that of race. And in more instances than not, the classic white and blonde Western beauty is the paradigm which is desired. Cosmetic procedures such as skin whitening, nose lift and eyelid surgery aim to make people look more like Malibu Barbie than Pocahontas. For women, looking beautiful becomes an issue of looking beautiful for whom? Do women try to look beautiful for themselves or for men? Are womens concepts of beauty pure from societys ideals of feminine beauty? Kathy Davis argues that cosmetic surgery is one of the primary ways womens bodies are constructed as ugly, deficient and in constant need of improvementcosmetic surgery belongs to the practices and technologies of the feminine beauty systema system which is one of the primary sites for the exercise of gender/power in contemporary Western cultures. On a practical side, society is not going to change overnight. Women who know that the ideal is far from perfect, also can choose to empower themselves by using the situation to make their lives better. Madame Noel, one of the earlier practitioners of cosmetic surgery in France was convinced that cosmetic surgery alleviated suffering and was a useful tool for helping womento be sure, affluent, professional womento achieve financial independence and social recognition. Are medical professionals who perform cosmetic surgeries that conform to racial and gendered ideals of beauty responsible for reinforcing unjust social norms. Or are they merely helping people alleviate the suffering caused by these norms and level out these differences in society via cosmetic surgery? Medicine and surgeons must beware the extent to which their participation in cosmetic surgeries involving such norms ends up contributing to broad and unjust system of constraining pressures and forces.

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Q7. Discuss in class whether you would like to change your body or not? Q8. Are there gender differences? Q9. Where is the line between trying to look neat and tidy, to look nice, to look handsome or beautiful, and merely to cater to other persons images of what we should look like?

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UNIT 4: Benefit and harm

Learning Objectives: Students should be able to identify harms and benefits in health care settings. Students should be able to evaluate harms and benefit in health care settings. Students should be able to justify decisions taking harms and benefits into account.

Benefits Many medical and industrial technologies are challenging because they involve technology with both benefits and risks. A fundamental way of reasoning that people have is to balance doing good against a risk of doing harm. Risk assessment and cost-benefit analysis are tools commonly used in environmental science, economics and medicine. Most people believe human beings are spiritual beings, sharing emotions such as love and hate, greed and generosity. One of the philosophical ideas of society is to pursue progress. This is a powerful argument for further research into ways of improving health and agriculture, and living standards. To attempt to do good is called the principle of beneficence. Benefits may be promoted by those marketing a technology, but there are usually possible risks that there could be some harm. A beneficial technology should be made to overcome a problem in a better way than now. We always have to ask who benefits and who is at risk of harm.

Case 4-1: Cosmetic surgery A 37 year-old woman has been worried that her body shape is not what she desires. She has tried so many diets by searching on the internet and bought low calorie diet meals but nothing worked well for her desire to lose weight. Her shape is not slim but in the normal range as a woman in her 30s, having a good balance of weight and height. Even though she is healthy, she believes she has a bit too much fat and always wants to reduce them. One day, she went to have counseling with a cosmetic surgeon, and finally she decided to take liposuction. The operation went smoothly and it did not seem to cause any problems. However, after the operation she noticed a strange spotted appearance on her skin surface, caused by the damage of cannula on tissue beneath the skin, which showed up. Now she is in a lawsuit over this problem but one thing clear is that there is hardly a way to cure her spotted skin. Questions Q1. What are the benefits and harms of cosmetic surgery? Q2. Do you agree with cosmetic surgery; why/why not, and in what occasion? Q3. What are the differences between cosmetic surgery and other medical surgery? Q4. Do you think the happiness provided to persons by cosmetic surgery is part of the definition of health for human beings?

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Risks and Precaution The precise outcome of what we do in nature or medicine is not always certain. This uncertainty can be called a risk of failure or chance of success. Ignorance of the consequences should make us act with caution in using new techniques. In our actions we try to minimize or avoid doing harm. Balancing the benefits and risks of scientific technology are not always easy, but a first step is to identify the possible benefits and risks to different people and parts of our world. Many of the things we do today have not been used for many years, like driving cars, taking chemical drugs, or even going to school. The precautionary principle has been defined in various ways, but a working definition suggested by UNESCO is: When human activities may lead to morally unacceptable harm that is scientifically plausible but uncertain, actions shall be taken to avoid or diminish that harm. Morally unacceptable refers to harm to humans or the environment that is threatening to human life or health, or serious and effectively irreversible, or inequitable to present or future generations, or imposed without adequate consideration of the human rights of those affected. The judgment of plausibility should be grounded in scientific analysis. Analysis should be ongoing so that chosen actions are subject to review. Uncertainty may apply to, but need not be limited to, casualty or the bounds of the possible harm. Actions are interventions that are undertaken before harm occurs that seek to avoid or diminish the harm. Actions should be chosen that are proportional to the seriousness of the potential harm, with consideration of their positive and negative consequences, and with an assessment of the moral implications of both action and inaction. The choice of action should be the result of a participatory process. There is a risk of harm from not using new technology also, if we do nothing new and just continue the current ways. A failure to attempt to do good is a form of doing harm. Q1. Choose one example of a technological advancement, and in a class group, identify the benefits and risks of this new technology. How many can you think of? Are the benefits and risks similar for different technologies? Q2. Can you think of a technology that you believe is too risky to be used now? If you can, think about the current technologies we use in that area for that goal. Looking back, do you think the current technology causes harms also? How can we assess technology? Ethics and Nanotechnology Here we shall define nanotechnology, provide some idea of spending on nanotechnology by developed and developing nations, and an look at potential effects of nanotechnology on relations between humans & with the environment. Nanoparticles, Nanoscience and Nanotechnology Recently a tiny technology termed Nanotechnology has created a fevered pitch for many scientists and technologists around the world. There is a fantastic long history of advancements in science and technology. Like radio transmitters, computer transistors and genetic modification, nanotechnology has quite astounding potential to revolutionise our way of life on Earth, possibly to a greater extent than any technology which has come before it. Nano- refers to one-billionth for example, 1 nanometre = 10-9 metres, or one-billionth of a metre the tiny scale of atoms and molecules. A nanoparticle (Figure 1) is a very tiny state of matter which has dimensions in the range less than 100 x 10-9 metres, or 100 nanometres. Organic molecules with different electrical and mechanical properties and which are amenable to manipulation at this scale are known as fullerenes, named after poet and inventor Buckminster Fuller. Examples include carbon nanotubes and buckminsterfullerene (C60), a soccer ball shaped arrangement of carbon atoms. Nanoscience is the study of phenomena and manipulation of such materials at atomic, molecular, and macromolecular sizes, a scale at which the properties of matter are significantly different. The great physicist Richard Feynmans 1960 talk Theres Plenty of Room

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at the Bottom was the first to hypothesise that atoms and molecular systems could be potentially manipulated into useful structures and devices. Nanotechnology is therefore the design, characterization, production and application of structures, devices and systems at the scale of atoms and molecules, by controlling the shape and arrangement of nano-scale configurations dependent upon their technological utility. The term was defined in detail by Eric Drexler in his 1986 philosophical work Engines of Creation: The Coming Era of Nanotechnology. The concepts and potentials he outlines are truly mind-boggling, including an end to most human labour and the instant manufacture of any materials from computerised input of the component elements. Funding for Nanotechnology Nanotechnologies are attracting increased investment from governments and industry around the world. Total global spending is thought to be around $6.25 billion at present, but this is set to rise. The USAs 21st century Nanotechnology Research and Development Act (2003) allocated almost $3.7 billion to fund nanotechnologies during 2005-2008. This compares with just $750 million spent in 2003. Between 2001 and 2003, the Japanese Government doubled its nanotechnology funding to $800 million. Within Europe, about $1.25 billion is currently spent on nanotechnology research and development per annum, and the UK has allocated about $81.9 million per year from 2003 to 2009. Developing countries have also ventured into huge budgeting for nanotechnology research. On one hand it increases their market economy, but the budget of a country should not be at the expense of the poor or the basic needs of common humans. At this juncture in the progress of nanotechnology, there is a need for public awareness and dialogue in each country with development and venture investment into nanotechnologies. The good fruits of science and technology should reach all the people of the world irrespective of caste, creed, class, religion or region. The application of these materials in the industrial, biomedical and environmental fields are yet to be studied in detail, but immediate promise is being shown in field of medical diagnostics and therapeutics (BioNanotechnology). The classic theoretical example is the injection of nanoparticles into the bloodstream to sweep the arteries clear of cholesterol. The other major development attracting massive research is a branch of the technology known as molecular electronics the construction of miniature networked computers from arrangements of organic molecules including fullerenes, DNA, pieces of micro-organisms and other microscopic electrochemical analogues of circuits, gears, logic gates, diodes, resistors, switches and transistors. The existence of life and the DNA storage of information imply that the physics and chemistry can be made to work if only we could more efficiently manipulate the components. Molecular computers will eliminate the coming bottleneck in the miniaturisation of microchips, but the power of such machines may also remove some of the existing barriers to the evolution of artificial intelligence. This is a global project with great uncertainties, and may well involve ethical risks to humanity proportional only to the potential benefits. Molecular Assemblers Presently more nanomaterials are synthesized by top down chemical and physical methods. But Drexlers original vision was of the bottom-up approach to engineering at the nano scale. He envisaged self-replicating molecular assemblers. Similar to recent attempts at creating artificial life, this approach tries to incorporate biological and evolutionary characteristics such as replication, heredity, learning, adaptation and selforganisation. The potential future engineering of molecular assemblers is great cause for ethical concern, because of the risks of them running out of control by accident or terrorism. The potential applications of nanotechnology to warfare and weapons of mass destruction are discussed in detail in the Peace and Peacekeeping section. Endowing technologies with the characteristics of life is inviting them to enter into competition with other forms of life such as ecosystems and human biology. Nanotechnology has been the first technology to ignite fears of an end to all carbon-based life on Earth, with the theoretical gray goo catastrophe in which replicating molecular assemblers dismantle all of the carbon molecules they come into contact with to make more and more of themselves in an open-ended chain reaction.

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Balancing the Ethics of Nanotechnology As ethicists our concern is to investigate the potential benefits of new technologies with the risks and potential consequences. Legitimate concerns have recently been explored, but the precautionary principle must investigate the potential benefits as well as the risks that nanotechnology poses. Benefits for developing countries have not been clearly defined by the developed nations, threatening to derail the development of this field in low-and middle income countries as was the case with genetically modified crops. This consequence can be avoided by increasing public awareness of the risks and benefits of nanotechnology and by encouraging governments in the developing world, in consultation with their people, to balance the risks and benefits of nanotechnology for themselves. It must be remembered however that it is very difficult to unlink scientific discovery from subsequent technological use of that information. Scientists and engineers should be bound by ethical considerations and codes of professional conduct (such as the Hippocratic Oath in medicine) which deter some of the potential negative impacts of their research. Barriers to the development of technology include whether to do the science (research and development stage), whether to publish the information (academic journals and media editors), and the ethics of engineers (design, engineering and production stages). Some potential benefits: Will Nanotechnologies help in developing renewable energy sources? Will Nanotechnology reduce hunger in the developing Countries? Will Nanotechnology promote good health (free from TB, HIV/AIDS etc.)? Will Nanotechnology improve water and sanitation conditions in the world? Will Nanotechnology eradicate child labour? Some potential consequences: Are there risks of accidents when dealing with replicating molecular assemblers? Will nanotechnology be used in military technologies or terrorist situations? Will nanotechnology cause harm to ecological systems? Will nanotechnology be harmful when breathed in? How will nanotechnology impact human labour markets? Q3. Describe the nano scale. Are there tiny particles smaller than nanoparticles? Q4. Are you for or against huge funding for nanotechnology in developing countries? Why? Q5. Think that you are a nanotechnology researcher. If an ordinary person comes to you and asks about your work will you tell the facts about the technology or will you like to convince him of the advantages of that technology? Q6. List the major research laboratories and scientists in your country where nanoscience and technology research are in progress.

Ethics of Genetic Engineering

Genetic engineering has acted as a catalyst for discussion of ethical issues related to the modification of nature, and has been politically contentious because of the economic importance of the food industry. Here we shall introduce the basics of genetic engineering, and give some examples of genetically modified organisms (GMOs) and the purposes for which they are made.

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What are genetic engineering and GMOs? With many years of research, scientists have now discovered to some extent which genes do what functions in building organisms. With the help of this knowledge and new developments in scientific technologies, they are able to modify the genetic constitution of organisms for various purposes through genetic engineering. Genetic engineering or genetic modification is an all-inclusive term to cover all laboratory and industrial techniques used to alter the genetic constitution of the organisms by mixing the DNA of different genes and species together. Genetic engineering or genetic modification is the process of recombining DNA. The living organisms made with altered DNA are called Genetically Modified Organisms (GMOs). However, the process is not so simple as precisely cutting out one gene and putting it into another place in the DNA, since genes are surrounded by other sequences in the DNA that determine whether or not a gene from one organism can function in another organism. So a careful study of the GMO is needed to be sure of its safety. Genetic engineering can be used for good causes. However, it can also potentially be misused. Genetic engineering is considered special because often the techniques involve manipulating genes in a way that is not expected to occur ordinarily in nature, allowing characters to be changed, not just between the species but also between kingdoms. Technology is rapid and new ways of manipulation and experimentation are being made. Also it can be applied to the human species (see the section on gene therapy).

Q7. Can you describe any examples of genetic engineering you have heard of? Q8. Give examples where you think the environment can influence the functions of the genes and the behavior of organisms. Q9. Find the institutes in your area doing genetic engineering. In which areas are they researching and why? Examples of genetic engineering in medicine Many human proteins are now being commercially manufactured by the use of gene transfer to microrganisms such as bacteria or yeast, including blood clotting factors, interferons, lymphokines, growth hormone, erythropoietin, insulin and various growth factors, all of which have medical uses. One of the most common proteins in use is human insulin for diabetics, which has been licensed for many countries to use since 1982. Recombinant DNA techniques are also being used to produce human vaccines, for example to produce cheap, easily stored vaccines against major childhood diseases. The logistics of the world-wide immunisation programmes are influenced more by transport, storage and delivery than production. Edible vaccines have also been made as foods, such as hepatitis B vaccine in lettuce or banana (or Plantain), which may avoid the need for medical staff to administer the vaccine, and make the plants cheap enough for third world countries. The degree of expression is not yet high enough for effective use, but is being improved. A genetically engineered vaccine against cattle ticks is being mass produced in Australia, that should help control tick infestation. The tick is an external parasite, but ingests blood, and the vaccine is a modified version of a tick protein from the gut cells, which produces an immune response in the cattle which in turn prevents reproduction of the tick. Modified proteins can also be made, using genetic engineering to alter the catalytic properties of natural enzymes, a process known as protein engineering. Many pharmaceutical products can potentially be made. The medical importance of these recombinant DNA protein products is growing, and the availability of these products makes therapies for a lot of previously untreated or uncured diseases possible.

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Already there are successful attempts to transfer human genes which incorporate useful proteins into sheep and cows milk, so that they produce, for instance, the blood clotting agent factor IX to treat hemophilia or alpha-1antitrypsin to treat cystic fibrosis and other lung conditions, also naturally occurring polyclonal antibodies for which at present there are only human donors. Genetic engineering in medicine has been long researched for transplantation purposes, for example, to make organs or body parts like valves for the heart from pigs. There are still safety concerns about large organ transfer from other species (xenotransplants). The most controversial form of genetic engineering in medicine is the use of cloning technology to create organs for transplantation purposes so that they are immunologically compatible. Q10. Do you know anyone who has diabetes? If you had a type of diabetes that could be treated by a daily injection of human insulin made by genetic engineering what sorts of side effects might happen from the treatment? Q11. What do you think of genetically engineered vaccines taken through food rather than by injections? Q12. Should we use cloning for organ transplantation?

Euthanasia
Euthanasia literally means 'good death' and generally aims to hasten the death of people who suffer severely without any hope of recovery. The Netherlands was the first country in the modern world to make euthanasia not a crime. We shall discuss the conditions under which assisting the death of a terminally ill patient may be ethical, as many countries face this policy question. Another word for euthanasia is mercy killing. Euthanasia has been a very controversial subject at periods over the past 3,000 years. Some people regard it as a morally objectionable form of killing. In some forms of Buddhism, euthanasia is rejected because ending life is thought to be wrong at any time. Many Christians oppose euthanasia because the Bible regards human life as sacred and as belonging to God. According to this view, euthanasia is wrong, as it is not up to humans to decide over life and death. But different people interpret their religious traditions in different ways. The act of euthanasia is today understood as termination of life on request. But it has not always been a voluntary choice. The decision to terminate life has been misused during human history, especially between 1933 and 1945 during the German Nazi regime in Europe. This criminal regime murdered millions of people because they were disabled, ill, old, or of different ethnic group. Murders committed for these reasons were also called euthanasia. The Nazi regime excused their criminal deeds as termination of worthless lives. Such an excuse is against the humane nature of love and compassion. The crimes committed in the past are one of the reasons why euthanasia, also understood as termination of life on request, is a criminal act in almost all States of the world. The Netherlands has made euthanasia legal, though it is still controversial there, and in this chapter some of those debates will be used to explain euthanasia. Q13. Do acceptable forms of killing humans exist?

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Though the practice of euthanasia is much older, the Dutch euthanasia law has a history of legal development and contention since the 19th century. The euthanasia law in the Netherlands must be seen in its historical background of attempts at protecting physicians that act in the spirit of the law and in the interests of the patient. Before 1990, physicians risked prosecution, but then the Royal Dutch Medical Association and the Ministry of Justice agreed upon the procedure of notification. This meant that prosecution became unlikely if a physician followed the guidelines set out in the non-prosecution agreement between the physician and the patient. The concept of euthanasia According to the authoritative 1991 study in the Remmelink report, euthanasia is defined in the Netherlands as follows: 'deliberately terminating the life of another person at his or her request'. It differs from other categories used in Dutch health care institutions: Assisted suicide is defined as 'deliberately assisting a person in a life-terminating act at his or her explicit request'. It is different from voluntary euthanasia which does not support every purpose in the act of self-destruction; A life-terminating act without an explicit request is defined as 'deliberately terminating the life of a person without his or her explicit request'. It is different from voluntary euthanasia in that it is not based on a well-considered, persistent and explicit request from the patient; Active euthanasia without an explicit request from the patient differs from voluntary euthanasia as it is not based on a well-considered, persistent and explicit request from the patient; Indirect euthanasia is known as 'Death resulting from the administration of opiates and other painkillers in large doses'; Passive euthanasia or abstention is defined as 'Death resulting from the withholding or withdrawal of potentially life prolonging treatment'. In the official definition, the termination of life at the request of the patient is central to the decision to terminate life in the case of voluntary euthanasia. The above definitions are similar to those used internationally in bioethics. The decriminalization of euthanasia In the Netherlands voluntary euthanasia has been decriminalized. The decriminalization of euthanasia made the Netherlands the first country in the world to formally sanction "mercy killing". In the new law euthanasia is administered only to patients who are in a state of continuous, unbearable and incurable suffering. There are other requirements as well: - A second opinion from an external physician; - The patient must be judged to be of sound mind; and, - A request to die must be made voluntarily, independently and persistently. The patient must be terminally ill with physical suffering. However, the physicians are not supposed to suggest it as an option. Both an oral and written request legitimize the physician to accede to the request, however, the physician is not obliged to do so. He or she may only accede to the request while taking into account the due care-requirements mentioned in the bill. In each case the doctor must be convinced that the patient is facing interminable and unendurable suffering. If he or she believes that this is not so, the physician may not accede to the request for euthanasia, no matter what the declaration of will states. It is important to note that euthanasia and assisted suicide continue to be criminal offences, but are decriminalised in certain circumstances. The Dutch Penal Code (in Articles 293 and 294) now includes that provision. It stipulates that the termination of life on request and assistance with suicide are not treated as criminal offences when carried out by a physician and if criteria of due care are observed. Therefore the view that euthanasia and assisted suicide are no longer punishable does not reflect the substance of the bill correctly. Q14. What is the meaning of decriminalization? Is euthanasia in the Netherlands legalized?

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Q15. Under what conditions is euthanasia practiced in the Netherlands?

Q16. What are the legal requirements?

Three Case-studies
The following discussion of court cases illustrates the centrality of the meaning of the defense of necessity in the developments that led to the decriminalization of euthanasia in certain cases. Read the three cases below and think of arguments for and against the view that the physician acted rightly. 1. The case of Geertruida Postma In 1971, Dr Geertruida Postma injected her mother with morphine and curare, resulting in the patient's death. On a number of occasions the patient had asked her daughter to end her life. She had suffered a brain hemorrhage after which she could hardly speak, hear, and sit up. Dr Postma was charged under Article 293 of the Dutch Penal Code. In 1973, the Leeuwarden criminal court found Dr Postma guilty but only ordered a one-week suspended sentence and one year's probation. The court indicated that the physician could administer pain-relieving drugs leading to the death of the patient in certain circumstances, provided the goal of treatment was the relief of physical or psychological pain arising from an incurable terminal illness. In this case, however, Dr Postma's primary goal was to cause the death of the patient. In the same year, the Royal Dutch Medical Association (KNMG) issued a statement supporting the retention of Article 293 but arguing that the administration of pain relieving drugs and the withholding or withdrawal or futile treatment could be justified even if death resulted. 2. The case of Mrs Schoonheim The 1984 Alkmaar ruling by the Dutch Supreme Court concerns Mrs Schoonheim, a 95-year old, bedridden patient, who had been unable to eat or drink and had temporarily lost consciousness shortly before her death. The patient requested euthanasia from her doctor, who consulted with another physician who agreed that the patient was unlikely to regain her health. The point here is that the patient was suffering from a chronic and not a terminal illness. The doctor in charge was convicted by a lower court and the Court of Appeals of an offence under Article 293 of the Dutch Penal Code, although no punishment was imposed. On appeal, the Supreme Court overturned the conviction, holding that the doctor was entitled to succeed in the defense of necessity under Article 40. The Court decided that the doctor had properly resolved the conflict of interests involved. 3. The Chabot case The so-called Chabot case led to a breakthrough in relation to the defense of necessity. A fifty-year old patient, Mrs Netty Boomsma, had a long history of depression, a violent marriage and her two sons had died, one by suicide and one of cancer. Her suffering was mainly psychological. Upon the death of the second son she decided to commit suicide and approached the Dutch Federation for Voluntary Euthanasia, who referred her to Dr Boudewijn Chabot. Dr Chabot diagnosed her as suffering from severe and intractable mental suffering. He consulted a number of his colleagues, though none of them examined Mrs Boomsma in person. In September 1991, Dr Chabot assisted Mrs Boomsma to commit suicide by prescribing a lethal dose of drugs. He reported her death to the public coroner.

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Dr Chabot was prosecuted under Article 294 of the Dutch Penal Code. He sought to invoke the defense of necessity. Importantly, the Supreme Court held that there was no reason in principle why the defense of necessity could not apply where the cause of a patient's suffering is psychological. However, the court held that for the defense to apply the patient must be examined by an independent medical expert. Dr Chabot had sought medical opinions from seven colleagues but none had actually seen Mrs Boomsma. Accordingly, the defense of necessity failed. In June 1994, Dr Chabot was found guilty of an offence under Article 294. The Supreme Court declined to impose a penalty, although in February 1995 Dr Chabot received a reprimand from a Medical Disciplinary Tribunal.

Social and political issues concerning euthanasia A wide range of critical views have been and are still expressed against euthanasia and assisted suicide. Euthanasia is applied only when we can speak of unbearable and hopeless suffering. Is a death wish voluntary under circumstances of unbearable and hopeless suffering? Some critics argue that instead of killing the patient, the patient should be made to feel better. Requests for euthanasia may be a result of depression and confusion, a feeling of worthlessness, or due to persuasion of interested parties with ulterior motives. Prompted by the Chabot case, a group of Dutch authors wrote a pamphlet named Scared to Death by Life. The authors argued that human freedom is regulated not only by rational thought, but also by emotions and unconscious motives. The authors doubt that the physician-patient relationship is always characterized by free and rational decision-making in end-of-life matters. One must take into account the patient's feelings of guilt, anger and inadequacy, and the possible motives of the physician, such as hunger for power, and rescue fantasies. Moreover, social determinants such as prevailing regulations, the public debate and the availability of palliative care in hospitals and homes for the elderly, also put to question the meaning of 'voluntary' in end-of-life decision-making. According to critics of euthanasia legislation, euthanasia and assisted suicide are not about giving rights to the person who dies but about changing public policy so that doctors or others can directly and intentionally end or participate in ending another person's life. Opponents fear that an increasingly lenient legal definition of mercy killing could make euthanasia commonplace, and render it inappropriate to deny euthanasia of babies or the mentally incapacitated. The notion that the decriminalization of euthanasia leads to more acts of life termination must be dealt with seriously. Examples of such practices include the administration of lethal drugs to shorten the life of persons unable to request it, and the assistance with suicide in the cases of psychiatric patients and elderly persons who currently are not suffering at all but who do not wish to continue living. This so-called slippery-slope effect is feared to lower the threshold at which human life is valued, and to make it easier for physicians and society at large to give up the life of the patient. This fear alone, it could be argued, even if not grounded on facts, may cause grave harm to the mental well being of the Dutch elderly and society as a whole. Nevertheless, the opposite argument, that an increased openness and awareness about euthanasia and practices of life-termination could give an enhanced sense of control-over-life to the fearful, would imply an increase in the sense of wellbeing of society as a whole. Q17. Should euthanasia and assisted suicide be regarded as a private or as a public matter? Q18. Do you think that the slippery-slope effect applies to the Netherlands? Would it apply in your country?
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Unit 5 Autonomy and individual responsibility

Learning Objectives: Students should be able to explain the concepts of autonomy and individual responsibility and to understand their significance for the health care provider-patient relationship. Students should understand the relationship between autonomy and individual responsibility.

Cars and the Ethics of Costs and Benefits While most people have used cars few have considered the full economic, environmental and ethical impact of personal automobiles. Here we shall encourage students to broaden their thinking about ethical issues to look comprehensively at both direct and indirect costs and benefits, and challenge students to critically reconsider one of the most pervasive and hyped products of the modern era. Q1. Do you want your own car?

Case 5-1: Doctors concern A 75 year-old-man had been suffering from heart failure, secondary to cardiomyopathy, and the effects of treatment were getting weaker. One day he told his doctor that he did not want to have an active therapy if he had another bout of heart failure next time, and also that it was written on his living will. After a while the heart failure quickly became worse because of an infection, and the patient had impaired consciousness. He was hospitalized immediately and had heavy use of medicine to cause dieresis but it did not work at all. His doctor wondered if there would be any legal problem if he respected the advance directive of the patients.

Questions Q1. Are advance directives respected in your country? Q2. Who should the doctor talk to with respect the advance directive? Q3. Would you regard the advance directive made by the 75year old man when he was 75 years old differently to an advance directive he made when he was 25 years old?

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Costs and benefits of car use for local transport

In life, everything we make or do has costs, benefits, or often both (e.g. benefits to the individuals and costs to society). Evolution by natural selection removes traits that have greater costs than benefits. People have developed many behaviors and technologies. Just like biological traits, these human behaviors and technologies have both costs and benefits. Self interest demands that we use technologies and behave in ways that either individually or collectively have greater benefits than costs. Evolution makes this choice for biological traits, with those individuals and species having advantageous traits leaving more offspring. However, we do not always make rational choices and some costs are difficult to see or unpleasant to look at. This chapter challenges you to consider all the costs and benefits of personal car use for local travel. During the past century, the car has drastically transformed both human life and the surface and atmosphere of the Earth. The automobile has given people mobility, convenience, and independence that could not even be dreamed of in earlier times. The automotive industry is one of the dominant sectors of the largest industrial economies; it provides jobs, economic power, and even military might. Most of the world's richest countries produce cars and all of them rely on cars for a major proportion of transportation needs. Cars are seen as symbols of wealth and status. Today, it seems that most people in the world either have cars or want them. Cars are a mixed blessing. Along with the great benefits that cars provide come costs, many of which are difficult to quantify or unpleasant to consider. In this chapter, challenge yourself to quantify some of the costs and benefits of personal car use. Calculate the costs and benefits Worksheet IStart by adding up the costs of car purchase and use; calculate how much you would have to pay (or your family does pay) for each kilometer you or your family drive. If your family has its own car, use your family's actual expenses for the calculations; if not, then do a hypothetical analysis of what it would cost for your family to buy and use a car. Car dealers should be happy to provide you with cost estimates for a car purchase; they might also be able to help with estimates of the other required expenses like maintenance, insurance, and taxes. Below is a sample calculation for Japan. This sample spreadsheet can be modified to fit your local situation and perform the calculations for you. The costs should all be expressed on an annual basis; in your locality, the costs may exclude some of the items in the spreadsheet and the table below or include others. In Japan, the average car is used for only 7.3 years. The sample calculation for Japan, is done for a family sedan with an 1.8 L engine and automatic transmission. Including all taxes and fees that are paid for the original purchase only, the price of this new car is 2,132,545 yen. The sample calculation uses the car catalog specified fuel efficiency for 10/15 mode driving (a standard urban driving sequence), but you can easily measure the fuel efficiency of a car yourself by filling the gas tank, measuring the distance until the next refueling, and then recording how much gas is needed for the refueling: divide distance traveled by fuel needed to refill the tank (km/L). The fuel efficiency you measure will probably be less than the value listed in the car catalog. Worksheet I shows the annual costs for using this car.

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Example - Worksheet I item Purchase of 1800 cc family sedan Maintenance and parts, yen Road tax, yen Inspection (shaken), yen Insurance, yen Parking, yen Total fixed costs, yen Distance driven, km Annual fixed cost, yen/km Fuel efficiency, km/L Fuel price, yen/L Fuel cost, yen/km Total cost, yen/km

calculation 2,132,545 Yen/7.3 years

Annual basis 292129 30,000 35,000 41407 80,267 (1) 60000 538803 10,000 (2)

538803 yen/10000 km

54 16 95

95 yen/L x (10000 km/16 km/L) 54 + 6 yen/km

6 60

Q2. Can you think of some ways to reduce the costs or increase the benefits of personal car use? Q3. Do you still want to buy and use your own personal car? Q4. Look at magazines, television and find images of fast cars. Is that an image you would like to portray?

How fast do you travel? The primary benefit of owning and operating your own car is the freedom to travel quickly wherever you want. Speed is distance divided by time. Most cars can be driven faster than 120 km/h; however, in urban conditions, the actual speed is far less than the maximum speed. If your family has a car, then measure the distance and time taken for several typical local drives. The speed for each trip will be much less than the maximum speed because the driver must stop at red lights and stop signs, etc. Most cities and towns also have periods with heavy traffic; during such rush hours, travel speed is low. For example, the average driving speed in Bangkok, Thailand for all hours of the day and night is about 15 km/h. The average speeds of several courses measured in morning, noon, and evening were 19.2 km/h in Tokyo and 34.3 km/h in Tsukuba (3), a town about 60 km northeast of Tokyo. In fact, most drivers do not realize how low the actual average speed of their local car trips is. Worksheet IICalculate the average speed of some drives in your town. Express your results in units of km/h. Then divide this result into 1 to get hours/km traveled; for Tsukuba, the average speed of 34.3 km/h is equal to (1/34.3) = 0.0292 h/km.

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Worksheet II drive course a b c average Examples: average speed, km/h hours/km Tsukuba 34.3 0.0292 Tokyo 19.2 0.0521 distance time speed

speed including time to earn the money to pay for the car and car use total h/km average km/h 0.0490 20.4 0.0719 13.9

Q5. How does the speed of local driving you calculated for your family differ from that for the Japanese example? Q6. Compare how much time it would take for you to travel by foot, bicycle, car and public transport for some of your local trips.

How hard do you have to work to own a car? Cars are expensive. Car owners must spend a substantial part of their working time earning money to pay for their cars. In a sense, this time spent earning money to pay for the car could be considered part of the travel time. Q7. Do you want to work harder to buy a good car?

Worksheet IIIEstimate how much time the providers in your family spend or would spend to earn the money needed for each km of travel in a family car. Start from the after-tax income and divide by hours worked: this will give income per hour. If sharing the real information with your classmates and teacher is against your value of privacy, then use some typical values for your community. The average after-tax annual income for salaried employees in Japan in 2001 was 5576676 yen for 1848 hours of work, or 3018 yen/h. Divide the cost/km traveled you calculated in Worksheet I by the income per hour; this gives hours worked to pay for each kilometer driven. For Japan, 60 yen/km divided by 3018 yen/h gives 0.0198 h of work to pay for each km the car is driven. Add this number to the average speed of local trips from Worksheet II (also in units of hours per kilometer) to get another estimate of average speed: for Tsukuba, the sum of 0.0198 + 0.0292 = 0.0490 h/km. To convert the sum back into units of km/h, divide it into 1. For the

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example calculated for Tsukuba, when we include the time required to earn the cost of car ownership and use, then the average speed of local driving is reduced from about 34.3 to 20.4 km/h, equivalent to vigorous bicycling speed. Traveling by car does not provide an exercise benefit that is provided by walking or cycling.

Worksheet III monthly after-tax income (mean for salaried workers) annual disposable income hours worked/year yen/h hours of work to pay for each km of car travel minutes of work to pay for each km of car travel 464723 5576676 1848 3018 0.0198 1.2

Can we quantify ethics? Some other costs of car use are more difficult to quantify. Cars release much of the carbon dioxide, causing the greenhouse effect, which is now causing climate change and warming the Earth. In Japan, 8326 people were killed in traffic accidents in 2002. Cars cause much of the air pollution. Every year air pollution kills about 2.7 to 3 million people, about 6% of all deaths. Even for people who are not killed, air pollution damages health causing much sickness and disability. Health care for people sickened by air pollution represents a cost of car use not included in the calculations above. Cars require networks of paved roads. These roads are built with taxes we pay to the government; road construction and maintenance are costs of car use not included in the calculations above. Paving reduces the land's ability to absorb water; as paving increases, the flooding and destruction caused by heavy rains also increases. Roads fragment natural habitats, interrupting migration pathways; cars also kill many animals on roads. Structuring our cities and towns to favor car use also makes them less friendly to pedestrians and cyclists. While traveling in a car, the local environment is the car; cars cut people of from experiencing natural environments and from interactions with other people. Q8. Can we or should we try to express this loss of lives in monetary terms? Has anyone you love been killed or injured in a traffic accident Q9. Can you think of some other costs and benefits of local car use that are excluded from the calculations? How can we compare and balance costs and benefits that have different units? Q10. Can you think of some other technologies that are causing large changes in ecosystems or in the way people live? If so, what are some of the costs and benefits of these other technologies? Q11. Should all technologies be used? Can any technologies be stopped?

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Environmental Science Environmental Science is the study and implementation of systems, methods and tools for predicting, analysing, solving and preventing large-scale ecological and social problems.

Environment is a) influences and conditions external to the genes; b) the physical surroundings of a living organism; c) natural ecosystems which surround humans; d) the total biophysical world including humans and our systems; e) the total biophysical world and its connected sphere of knowledge and information; f) all of the above, including emotion, behaviour, culture and consciousness of life.

Q2.

Which of the above definitions of 'Environment' do you think is most useful? Are there benefits to looking at the answer in different ways?

Science is . . . Science is a rational method for discovering whether the behaviour of the world conforms to certain theoretical ideas. The scientific method begins with a theory or hypothesis, which proposes some solution to a specific question or problem, and then uses logical analysis and systematic measurement to find evidence in the form of data to either falsify or help support the hypothesis. The experiment is a series of controlled observations which can be quantified and replicated. Further scientific principles include objectivity (a value-neutral position), reductionism (analysis of the parts), simplicity (elegance), parsimony (minimised assumptions), quantification (statistical measurement), testability, predictive and explanatory power, logical consistency, and (usually) general agreement with existing knowledge. Even after all this, an exposed new theory must still survive critical inspection of its methods, results and assumptions - by a scientific community pervasively in a sceptical and analytical mood. Ideas that are open to all these tests and survive them are more likely to be true.

Q3.

Should scientific information be the major driver of environmental decisions over competing shortterm political or economic objectives?

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Environmental Science Solutions: tools and techniques Tools and Techniques #1: Measurement Statistics ensure that data are quantified for interpretation, a fundamental requirement of science. Data by themselves (numbers, raw facts) are meaningless until they can be organised into information (patterns, statistics) which can be graphed and analysed. Statistics may be either descriptive or inferential (inference is the assumption that measures of a sample set can be extrapolated to the whole set). Precision is how closely the measurement is made, and accuracy refers to how correctly it is made. Examples of basic descriptive statistics are measures of central tendency (estimating the middle of data) including mean (average), median and mode, and measures of dispersion (estimating the spread of data) including variance, standard error, standard deviation and range. Dont worry, so long as you know the basic statistical principles of what youre trying to find in data and how the data are arranged, a computer can do the hard maths for you! Tools and Techniques #2: Models are simplified representations of the real-world systems of the environment. They make things clearer by cutting away the non-relevant parts to better illustrate fundamental structures, functions, processes and connections. These things are represented by specific icons representing inputs, outputs, material flows, options, decisions etc. A map is a model of the landscape, a graph is a scientific model, and an engineers blueprint is a technological model. Models are powerful tools and can be used to describe, explain, predict, prescribe or evaluate. The problem to watch out for with models is in the assumptions needed to reduce their complexity, where important parts can be left out for example economic models which dont include environmental impacts. Many of the tools and techniques on following pages are types of model. Tools and Techniques #3: Indicators are the broadly representative and easily monitored measures of the environment used to imply additional information about the system as a whole. For example, the abundance of an indicator species can be measured as a signal of the health of the whole ecosystem. A variety of environmental indicators should be used to plot comparisons between locations and across time, including physical, chemical, biological, social and economic indicators.

Tools and Techniques #4: Index refers to a measure made from the combination of many different variables, creating a much broader type of indicator. For example, the United Nations Development Programme publishes indications of the progress of nations called the Human Freedom Index and the Human Development Index.

Q4.

How do data, information, theory and knowledge differ from each other? How do we differentiate facts from opinions?

Tools and Techniques #5: Problem-solving models (e.g. Figure 1b) identify stages in the process of defining, analysing and solving a specific problem. You must identify the goal or desired objective, identify obstacles to progress towards the objective, formulate options or alternative courses of action, choose between them, and plan actions to implement the decision.
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Tools and Techniques #6: Decision-Making models (e.g. Figure 1a) are part of the problem-solving process and help you to decide between a number of alternative courses of action (including the no action option). Simple decisions with a single goal can be dealt with using a decision tree which identifies stages of the process and the risks associated with different options. Harder decisions may require multi-criteria decision analysis. The process of making a decision usually requires optimisation, or calculating the overall best and safest (optimal) alternative. Tools and Techniques #7: Expert Systems are decision support software which mimics the reasoning of a human expert. They consist of a set of logical rules about systems behaviour, combined with the input of expertise from a particular domain of knowledge. Expert systems are a practical application of artificial intelligence. Tools and Techniques #8: Environmental Impact Assessment (EIA) is a systematic process to assess the consequences of any major infrastructure development. First developed in the 1970s by the US Geological Survey (see Leopold matrix, Figure 1a), it has become widely used and compulsory by regulation in many countries. An EIA typically includes an initial scoping study to identify boundaries of concern, descriptions of the proposed development, predictions of the magnitude and importance of probable environmental impacts, comparison of alternatives, and suggested mitigation measures. Public consultation is required throughout the process, and the final report is called an Environmental Impact Statement (EIS) which must include a nontechnical summary and recommendations. Environmental monitoring is important, beforehand to know the environmental baseline, and afterwards to audit outcomes and inform future EIA. Tools and Techniques #9: Social Impact Assessment (SIA) is a systematic process along the same lines as Environmental Impact Assessment, but focusing on the consequences to society, culture, community and wellbeing. Tools and Techniques #10: Strategic Environmental Assessment (SEA) also uses similar principles to Environmental Impact Assessment, but focusing on alternative policies, plans or programmes at an earlier, more strategic phase of development.

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Figure 1: Historical Models of Decision-Making and Problem-Solving Processes a) Small sample of original Leopold Matrix used for Environmental Impact Assessment; proposed actions which may cause impact tabulated against existing characteristics of the environment. (US Geological Survey 1971) b) (overlaid) Jackson, Keith F. (1975) The Art of Problem Solving

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Tools and Techniques #11: Life-cycle Assessment (LCA) analyses material and energy flows by following the complete lifecycle of a product through the processes of resource extraction, transport, manufacturing, marketing, consumption and disposal. Tools and Techniques #12: Pressure / State / Response Models follow the causal relationship from pressures on the environment (e.g. economic demands, energy use, fisheries, industrial developments), through the state or condition of the environment (e.g. impacts upon atmosphere, water, biodiversity, ecology, heritage and human settlements), to the responses (institutional, legislative and economic instruments, environmental management practices etc.). Pressure/State/Response models are required for OECD member countries to inform national State of the Environment (SoE) reporting. Tools and Techniques #13: Before/After Control/Impact (BACI) Studies are used for definitive experimental proof beyond reasonable doubt that an environmental impact has occurred as the result of some sort of development. Monitoring of the site both before and after the development process identifies the impacts, and simultaneous monitoring of one or more closely similar non-impacted control sites demonstrates that the resulting changes only occurred at the developed site. Tools and Techniques #14: Geographic Information Systems (GIS) are the use of computerised overlay maps, often from satellite remote sensing, to combine social and/or environmental data sets. The resulting composite maps are useful to find new patterns of information and optimise strategic decision-making.

Tools and Techniques #15: Risk Assessment is a systematic method for estimating and analysing the probability, potential frequency, range, severity and social acceptability of hazards and other adverse consequences. Tools and Techniques #16: Cost-Benefit Analysis (often called benefit-cost analysis in the US) is systematic assessment of the advantages/benefits and disadvantages/costs of any decision, so as to obtain the greatest net social benefit (i.e. benefits minus costs significantly greater than zero). Problems with cost-benefit analysis arise when it (too commonly) ignores non-monetary values, and secondly when it only measures benefits to a particular small group (e.g. corporate shareholders) rather than true social and ecological benefits.

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Tools and Techniques #17: Systems Analysis is the use of information technology to discover the nature and requirements of systems. Systems engineering is the creation of new arrangements. Today typically used in software design and business management, systems analysis should also play an increased role in the environmental sciences. Tools and Techniques #18: Software Engineering and new Internet architectures, which can be based around environmental or democratic principles, have the potential to make a significant impact on human activity and the information-gathering practices of future researchers from anywhere in the world. Tools and Techniques #19: Best Practice refers to knowing about and using current advances in environmental management or technology, and incorporation of Best Available Information. Regulatory approaches are called in the US Best Available Control Technology, and in the UK Best Practicable Means or Best Available Technology Not Entailing Excessive Cost. Tools and Techniques #20: Principles of Bioethics and Sustainability should be the central guidelines and objectives for any new models or management tools you may create if you perhaps decide to choose a career in environmental science or in environmental economics. Student Activity Use the basic principles of decision-making used in EIA (similar to Figure 1a) to solve your own problem in any area of interest (e.g. some major life decision). 1) list alternative courses of action (options) as columns (e.g. career choices). 2) list aspects of wellbeing (elements) as rows (e.g. health and happiness of self and others). 3) estimate the importance of each element from 0 (not important) to 10 (most important) [x, y and z in figure]. 4) in the upper-left corner of each intersecting square of the matrix, estimate the magnitude of impact (of each option on each element) between -10 (worst negative impact) and +10 (best positive impact) [a, b and c in figure]. 5), multiply each importance estimate by the magnitude estimate and enter these scores into the lower-right corner of each square [xa, yb and zc in figure]. 6) Add up these lower-right scores to determine the total for each option. Which option does the matrix say is best? 7) Does the answer 'feel right' according to your original instincts?
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Environmental Economics Economics is the measurement of wealth and well-being. Here we shall: 1. Prioritise environmental problems and their causes. 2. Illustrate links between economics and ecology. 3. Describe ecological limits and social justice. 4. Characterise components of wellbeing. 5. Discuss the ethics of environmental economics.

The Big Problem We currently seem to be experiencing a human-driven mass extinction event. Human activity has now reached a level of collective impact often matching or exceeding that of some natural global biogeographical processes which shape and organise ecosystems and their critical ecological life-support services. Many of the systems we have created (for example economic, political or institutional systems), once-removed from individual human control, are having a devastating impact upon the global abundance and distribution of life. Habitat destruction, ecosystem fragmentation, introduced species, pollution, global warming and at the same time squandering scarce resources on weapons of war (destruction) and dubious entertainments (distraction). This is a source of depression for permanent loss of biodiversity, and a cause for anxiety over our human future. Ecosystems and biodiversity function like organs of the global body to maintain stable planetary conditions for life. Usually taken for granted, ecosystem services are provided free by ecosystems, but end up costing heavily in life and money if damaged. As extinction progressively degrades or destroys links and nodes of ecological systems, critical thresholds may be reached whereby large-scale properties of the global system may switch to a different and unfavourable stable state. It's not guaranteed that the majority of humans will be able to adapt to unexpected non-linear dynamics in large-scale systems upon which we depend. It seems pertinent to address the question of major causes as soon as possible. By its own definition, priority of objectives is of the utmost importance in human activity. Historically, immediate reasons (proximate causes) of widespread extinctions include: Proximate cause #1: most importantly, habitat destruction, such as the clearing of land to make way for human dominated environments, particularly agriculture or grazing, or as a result of large dams, logging operations, settlements etc. Proximate cause #2: habitat fragmentation into isolated segments or habitat 'islands' vulnerable to edge effects, and preventing genetic exchange and migration, for example the migration of ecosystems towards the poles to adapt to global warming. Proximate cause #3: introduced species which displace native species. For example, much of Australia's high extinction rate has been caused by introduced species out-competing (e.g. rabbits), preying upon (e.g. foxes), poisoning (e.g. cane toads), or replacing (e.g. crops, sheep, cattle) the existing native species or their habitats.

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Proximate cause #4: over-fishing / hunting / harvesting, although its theoretically possible to manage these at sustainable levels since they harvest renewable resources. A news flash for the 'big problem' might sound something like: "Mass extinction by habitat destruction threatens human survival" There must be underlying reasons behind the immediate problems so far identified. In modern times the fundamental underlying reasons (ultimate causes) include: Ultimate cause #1: Overpopulation. When were your grandparents born? Not very long ago in the 200,000year history of human evolution. Yet as recently as 1960 the human population had only just reached 3 billion. Since then, with an expansion of exponential proportions, it suddenly rose to well over 6 billion (Figure 1), possibly to double again over the current century before it is expected to stabilise. Potential costs to the Earths ecology and the resulting future human conflict are unknown. Also uncertain is whether future technology can protect humans from the fate typical of other species whose populations outgrow their resource-base. Fortunately however, human fertility rates have been slowing, especially in developed economies where children often cost more than they contribute. Better access to women's rights, education, contraception, and family planning are very important especially in developing nations.

Q1. What happens when a population outgrows its habitat or resources? Environmental Economics Further fundamental or ultimate causes are economic factors, resulting from models and systems we created and have attempted to press upon the living systems of the world. Ultimate cause #2: Over-production

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Ultimate cause #4: Over-development

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Ultimate cause #3: Over-consumption

In this view, the newspaper headline might read: "Non-living systems threaten global living systems" Why? Because the economic processes of production (supply of goods and services by firms), consumption (demand for use of goods and services), and development (growth/expansion of goods and services), are ultimately linked to ecology and are largely sourced from the environment and the labour of human society. Figure 2 illustrates the big-picture interactions, noting how the terminologies differ between the subjects of environmental science and economics. The economy is an open system reliant on three basic functions: a) supply of resources, b) assimilation of wastes, and c) provision of life-support and natural services (including spiritual). Mainstream economics, as widely practiced today, focuses almost exclusively within the boundaries of the upper section of Figure 2. In economics-speak, the non-monetary components in the lower section are known by the obscure but telling term externalities. Thus environmental losses, withdrawn from a parallel living bank account, are relegated into the background and rarely considered as costs in business policy and profit-calculations.

Q2. Identify and discuss links and flows between economy and environment.

Putting economics in its place Its useful to know that the prefix Eco- comes from the Greek root oikos, meaning house or home. Therefore Eco-logy means the science of the home (because -logy means the study of, from logos or word), and Eco-nomics means the management of the home (-nemein is to manage). The paradox is that our global home is currently being managed according to measurements and models which are basically

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ignoring the science of the home. The biological science of ecology, dealing with the distribution, abundance and interactions of Earths living systems including humans, should logically be (more to the point, must logically become) the central focus and driving force commanding the economy. "Economic models and measurement focus not ecologically rational" We must accept that economics, measurement of the distribution, abundance and interactions of money, is only a means to an end, not an end in itself. Economics, as a subset of the many non-monetary social and ecological interactions going on among and around us, is simply a means to the higher ends of widespread ecological and human wellbeing, happiness, fulfilment, satisfaction, contentment and overall spiritual/moral ease with ourselves and our environment. Unfortunately, the economy is growing too big for its boots. The production-consumption-development cycle, driven by population growth and economic growth, is now reaching or over-reaching global social and ecological limits and critical thresholds. Rather than market efficiency and economic incentives, explained in detail and promoted by mainstream media and news sources, whats really required is non-consumerism, and dematerialization, an unnecessarily unwieldy term which means the use of much less materials in production and development. In recently accepted models (Figure 3), clearly the economic sphere cannot continue to grow indefinitely without crowding out the social and ecological spheres, bounded by the limited size of the Earth. "What economics calls externalities turn out to be most important parts"

Figure 3: Putting Economics in its Place Sources: (left) John Peet 1995; (right) Ian Lowe 1998

Q3. Discuss ends and means in relation to economics.

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Limits ignored Theres not really much excuse for our economic and political leaders to claim ignorance of these things, as theres been no shortage of classic philosophical warnings about limits. Thomas Malthus warned of absolute limits to population size in Essay on the Principle of Population (1798). Ricardo warned of relative scarcity, or relative limits to growth in Principles of Political Economy and Taxation (1817). J.S. Mill in Principles of Political Economy (1857) expected the endpoint of an economy to be a desirable 'stationary state' (in modern economic terms a constant capital stock) in which there would be time for spiritual, artistic and educational pursuits. Karl Marx talked about social limits to growth and the rights of workers in Capital (1867). Kenneth Boulding introduced the concept of 'Spaceship Earth' versus 'cowboy economy' in The Economics of the Coming Spaceship Earth (1966). Paul and Ann Ehrlich foresaw catastrophic future consequences in Population Bomb (1968). Garrett Hardin warned of the depletion of open-access resources due to the self-interested actions of too many competitors for a common stock in The Tragedy of the Commons (1968). Daly (1973) promoted a nogrowth or steady-state economy in which optimum and maximum size of the economy within the greater system are taken into consideration (the scale issue). Meadows et al. wrote for the Club of Romes Project on the Predicament of Mankind: Limits to Growth (1972), which has been followed up by Beyond the Limits (1992) and Limits to Growth 30 year Update (2005). These concepts have often been met with denial, and sometimes wrongly rejected due to criticisms of the timing of specific predictions rather than of fundamental premises. Ecological limits are undeniable, and are measured in ecology by the symbol K for carrying capacity, or the maximum population density an area can sustain without causing lasting degradation. There are limits of acceptable change. The area of land required to compensate our resource consumption is known as our ecological footprint. If all people were to live the lifestyle enjoyed by the wealthiest nations, our collective ecological footprint would be more than three times the Earth's surface. Our activities have a certain forward momentum, and the resulting impacts may be positive or negative, primary (direct) or secondary (flow-on effects), may be sudden (e.g. land clearing), gradual (e.g. land degradation), or delayed (e.g. climate change), may produce feedback, act in combination (additive or multiplicative), and may be measurable or completely unknown. Attempts have been made to estimate the total environmental impact of human activity on the Earth, for example: Total impact = PF (Population x Impact per capita)

Ecological impact = PCT (Population x Consumption/affluence x Technological efficiency)

Impact damage = population x economic intensity x resource intensity x

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environmental pressure on the resource x susceptibility of the environment

Impact = PLOT (Population x Lifestyle x Organization x Technology)

Opportunities lost Economics can been divided into two major goals: efficiency and equity. Our models are very good at efficiency, which refers to maximising the amount of work done/money made (benefits), compared to the energy supplied/money spent (costs). Adam Smiths An Inquiry Into the Nature and the Wealth of Nations (1776) was the defining work on classical economic efficiency, introducing the guidance of the invisible hand of the market. John Maynard Keynes concentrated on social employment efficiency, and Joseph Schumpeter on adaptive efficiency with investment in technology and creativity. In practice, our economic models were formulated around the market efficiency objective, completely overshadowing the more ethically-important social equity objective (fairness in the distribution of wealth and equality of opportunity). Classic philosophers on the equity component of economics include Jeremy Bentham (1781) who introduced the ethical philosophy of Utilitarianism, further developed by James Mill and then his son J.S. Mill in Utilitarianism (1863), and commonly known as the 'happiness principle' or 'the greatest good for the greatest number' (economists use utility to mean wellbeing). Marshall McLuhans global village concept (1970s) highlighted wealth disparities in a comprehensible way using the metaphor of a local neighborhood. About half of the world village is in relative or extreme poverty, earning only a few dollars a day, without access to clean drinking water, modern healthcare, contraception, immunization or security. Roughly, over 80% of the worlds wealth is wrapped up by less than 20% of its people. John Rawls in A Theory of Justice (1971) proposes that a just world would be the one we would organise such that wed feel okay to be born randomly anywhere in it. This refers to social (distributive) justice rather than simply legal (retributive) justice. The other justice debate is whether to distribute wealth according to right, merit or need but any form of justice would surely do compared to the status quo of distribution by non-living market forces. A small step towards addressing the equity problem would be the application of fair trade rules in preference to free trade. Another relatively ignored and euphemistic economics term is opportunity cost, sometimes also called external costs. This refers to the fact that if you do one thing with scarce money, time and resources, theres a cost in lost opportunities towards other things you could have done instead. A brief glance at where the bulk of the worlds money is spent, shows that most often the opportunity costs are far more ethically significant than the wasteful spending choices of wealthy people and nations. Poverty, hunger, preventable disease and war have killed at least tens of thousands of children and adults every time you wake up in the morning perhaps 40 million per year, which is around one hundred thousand preventable deaths every day. Q 4: [Source of idea: Peter Unger (1996) & Peter Singer (2002) One World: the Ethics of Globalization] a) Imagine you saw that a runaway train was definitely about to kill a child playing in the railway tunnel. Would you pull a switch to divert the train to a different track, even if it meant the train would then smash up your new car parked there? b) Consider that donations of as little as US$200 can pay for enough food & medicine (including administration) to save a childs life through UNICEF or other charity organizations. Are there valid reasons to suppose any of us are in a different moral situation to the dilemma posed in a) above?

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Local children on the global scrapheap Big global problems are comprised of a mosaic of lots of small local problems. The over-developed countries (self-defined as the first world) have used global financial mechanisms to take human and natural resources from under-developed (third world) nations. Those too poor to provide prospects for profit have typically been ignored, along with other externalities like pollution. Essential human needs in the modern world include at least nutritious food, clean water, warm clothes and shelter, healthcare, education, security and access to information and opportunity. Without food on the plate, one cant much afford to consider ethical and environmental concerns. Desperation and resentment resulting from poverty also make it a security issue and root cause of war and terrorism. Nevertheless, the United Nations finds it hard to extract just the recommended 0.7% foreign aid from wealthy nations towards the needs of the desperately poor. Philosophers of ethics suggest at least 10% of income should be donated. "Ignorance of opportunity cost kills tens of thousands a day"

Figure 4: Barefoot Timorese Children Consigned to the Scrap Heap [photos: M. Pollard] Their best available opportunity is our discarded rubbish.

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Q5.

What makes us all the same? Do children everywhere have the same ability to feel love, happiness, depression and fear?

The very name of the worlds dominant economic ideology gives a hint as to its fundamental flaw. Capital refers to forms of money, and ideology (-ism) implies the elevation of something in the mind to the exclusion of all competing considerations. Therefore, power has been enthralled by the measurement of a surrogate or analogue of itself, called capital (money). Power is concentrated at the middle-scale, the scale relevant to nations and corporations, which explains why the global scale and the local scale tend to pay for, or at least miss out on, its benefits. This marginalisation of ethics in the implementation of business is known as economic realism. Should common people be driven according to financial rules constructed only by the wealthy? The study of power-relations is hardly soothing to the psychology of the faint-hearted, but cannot just be left to the cold-hearted. Power caters to itself. To this end, economics, although called the dismal science, is a master discipline of measurement (every possible cent). This skill can be used to its fullest capacity by extending the scope of measurement in economics to focus instead on ecological health, human wellbeing, and the creation of ethical outcomes (Tables 1 & 2). We must develop and implement new global financial and socioeconomic models able to synchronize the powerful driving forces of market incentives with the achievement of bioethical outcomes. If global economic models were correctly aligned to the cause of wellbeing, their collective power (a system which took us to the moon) would have been able to eliminate poverty long ago.

Q6. Why do you think economics has for so long been called the dismal science? How could we make it more cheerful? Consider economics a puzzle and a challenge to save species and lives.

Unfortunately many people assume that we can solve the big global problems facing us if we recycle our garbage, develop energy efficient devices and better pollution control etc., while we retain an economy that continues to be driven by market forces, the profit motive and growth. This is a totally mistaken assumption. There is no possibility whatsoever of achieving a sustainable society while we have anything like the present economic system. Our present economy is the essential cause of our serious global problems and these problems can only rapidly worsen so long as we retain this economy. The problems are primarily due to over-production, over-consumption and over-development and it is our economic system which inevitably leads to these outcomes. p.74, and we have an economy that constantly has to increase levels of production and consumption. We must change to a very different economy, one which makes it possible to produce only as much as we need for a high quality of life, and to implement ways of reducing resource use, production, work, investment, trade and living standards as conventionally defined. (This does not imply any reduction in technical innovation, standards, cultural or scientific achievement or the quality of life.) p.79-80 Ted Trainer (1995) The Conserver Society: Alternatives for Sustainability. Dost thou not know, my son, with what little wisdom the world is governed? Count Oxenstierna (letter to his son 1648)

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Q7. Why on Earth would our most commonly-used prescriptive models focus on growth and efficiency, at the cost of trampling ecological limits and ethical principles of equity and social justice?

Table 1: Measures of National Progress and Development Gross National Product (GNP) and Gross Domestic Product (GDP) overused annual indicators based only on economic measures, they do not measure sustainable development or wellbeing because they include any monetary activity even if environmentally destructive or non-sustainable. Genuine Progress Indicator (GPI) an economic measure comparable to the GNP, but including estimates of 24 elements of social wellbeing like income distribution, leisure time, crime rate, environmental damage and volunteer work. This index is declining in many Western (overdeveloped) countries. Human Development Index United Nations Development Programme quality of life indicator which combines economic output, life expectancy, literacy rate and education enrolment. Human Freedom Index United Nations Development Programme index of 40 rights and freedoms, like freedom of speech, gender equality, homosexual rights and freedom from torture. Index of Social Health developed by the Fordham Institute, this index includes measures such as infant mortality, teenage suicide, homicides, unemployment, health access and child poverty. State of the Environment (SoE) Reporting environmental reviews used to monitor the progress of environmental protection in OECD countries.

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Economic development of course alleviates the suffering of poverty, conflict and crime; and increases human wellbeing, family planning, and the luxury of environmental protection. These are vitally important paths for those with less. Economic growth and globalisation (opening up to the world economy) are certainly necessary to relieve the suffering of the poorest people and under-developed countries. But for those with more, there is new scientific evidence that wealth increases happiness only to a point (a social and ecological limit). The health and wellbeing of current wealthy generations is hardly helped by the constant fuelling of material desires by advertising, trying to keep up with the neighbour, working too hard in stressful occupations, no time to spend on leisure or family, over-consumption of food, morally dubious goods and services, or subconscious feelings of guilt. The so-called trickle-down effect, where wealth is said to trickle down from rich to poor, is actually a cleverly inverted metaphor in free market capitalism money flows towards existing money like water down a valley. If there were fairer globalisation of health, wealth and education rather than just capital, people would place more trust in the process. Real globalisation of free trade would include the free movement of capital, production, consumption and labour (e.g. the European model). It would make policy based not on measures of money, but of happiness (e.g. in Bhutan). The ethical and sustainable corporation works to enhance the workplace, environment and society. This is known as Corporate Social Responsibility and is measured by triple bottom line accounting (the addition of social outcomes and environmental impacts to the traditional bottom line of profits). Ethical investments will have nothing to do with guns, gambling, tobacco, uranium or habitat destruction. But moral argument is only one tool for protecting the environment; other possibly more powerful/effective tools may be economic arguments. Old-style business, which treats workers, community and environment like resources to be exploited, will eventually suffer the consequences of public cynicism and alienation, environmental activism, and industrial relations conflict. New-style companies, driven not by profits but by vision and principle, will increase their effectiveness and staying-power by inspiring worker and public satisfaction, autonomy, innovation and teamwork towards new niches and green markets opened up by progress towards our sustainable future. Ecological networks can be emulated in economic models and organisational architectures, and efficient use and recycling of energy and materials can cut costs. Regulatory command and control measures can be supplemented with market-based economic incentives such as environmental valuation, green labelling, subsidies, permits, carbon credits and pollution taxes. Environmental valuation has traditionally been based around use (instrumental value), but nature is increasingly recognised as having additional nonuse values such as the option value of potential future use, bequest value to future generations, existence value and ultimately intrinsic value. Ecological economics is a sub-discipline of environmental economics, and ecologism is a new sub-discipline of environmentalism. These two branches of their respective fields reflect rejection of the assumption that problems can be solved from within the constraints of the current dominant paradigm, and perceive solutions from an ecocentric perspective reaching beyond current debates.

Q8.

Do you think animals, plants and ecosystems have intrinsic value, or is the value of nature only in its utility to humans?

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Solutions are at hand. Much information is finally coming out which outlines a humane basis for our economic future. Recent popular examples include Paul Hawkens Ecology of Commerce (1993) and Natural Capitalism (1999), Weizsacker Lovins Factor Four: Doubling Wealth, Halving Resource Use (1998), Charles Handys The Hungry Spirit (1998), Suzuki & Dressels Good News for a Change (2002), Clive Hamiltons Growth

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Fetish (2003), Doug Cocks Deep Futures (2003), George Monbiots Age of Consent (2003), John Cavanagh & Jerry Manders Alternatives to Economic Globalization (2004), Jeffrey Sachs The End of Poverty (2005), and just about any book with Sustainability in its title. With all these solutions proposed by ethical philosophers, ecologists and environmental economists for so long, why havent we solved, or even seriously addressed, the big problems yet? There seems a significant gap between the theory and the practice. A new contender for the crown of biggest problem is one of psychology. How will the greedy be weaned off their addiction? How do we deal with peoples desires, motivations, beliefs, fears of change? One answer is soft power, the persuasive power of moral authority and ethically superior value-systems. The successful marketing of important ideas involves putting them into a form which combines a sound philosophical and scientific basis with simplicity, clarity, accessibility, usefulness, attractiveness and fun. A message to current and future leaders: would you want to be frowned upon by our wiser future descendants as one of the old-style leaders, or are you a true leader for the history books? What have some of our true leaders said about economic issues? Jesus said that it is easier for a camel to pass through the eye of a needle than for a rich man to get into heaven. Buddha said that the path to contentment does not lie in material things. Mohammed emphasized the virtue of charity, as one of the five pillars of Islam. Hospitality and generosity are surely one of the key solutions to social disorder, crime and conflict. Gandhi said there is enough for all of our needs, but not for all of our wants. And finally John Lennon said give peace a chance.

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Unit 6 Consent
Learning Objectives Students should be able to explain the meaning of consent, informed, and informed consent; they should be able to define the principle of informed consent. Students should be able to explain what the process of informed consent requires. Students should be able to explain how the principle of consent is applied in different interventions, research, and teaching. Students should be able to explain how exceptions to the principle can be justified.

Informed Consent and Informed Choice

The relationships between health professionals and patients are changing in all societies to give more voice to patients. The same is true in other social relationships between those in power and consumers or citizens. Here we shall introduce the concept of informed consent & informed choice, & discuss the transitions in decisionmaking that are taking place in different societies.

Case 6-1: Defensive medicine, Caesarean section A 47-year-old obstetrician is working for a general hospital in middle size city. He delivers 11 babies a day on average via caesarean section mostly, the rate of which has been increasing. He personally believes that natural birth is an ideal way of giving birth for both mothers and babies but its been becoming a minor way. There are several reasons for this, such as increasing maternal age, safety and ease, parents schedule preferences, and preferences for doctors office hour delivery. A significant reason, in particular for the hospital, is to avoid risk and accident related lawsuits. Recently the obstetricians former colleague who is an obstetrician in another hospital was accused of not carrying out a caesarean section because the mother lost one of triplets after delivery. These facts make doctors and hospitals nervous and lead to defensive medicine more and more. Although he realizes this is not a healthy situation in medicine, he has no choice except for taking caesarean section in many deliveries once he finds any small possibilities of danger for the mother and/or her baby to have unexpected accidents. Questions Q1. What do you know about caesarean section? Q2. Do you agree with caesarean section in general and why/ why not? Q3. Is caesarean section acceptable as a part of defensive medicine? Q4. What kind of information should be shared by physicians and patients to take caesarean sections? Q5. Today, the percentage of caesarean section has been increasing in some countries, which often leads to premature birth. Should caesarean section be taken if the parents agreed with the possibility of prematurity?

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Informed Consent An animal surgeon could treat a dog with a tumor on its leg without the dog's agreement. However, people are different; humans have been given special rights to protect them against others. People have life values that are important to them that doctors should not ignore. There is no reason to treat patients as uneducated, and unable to understand. A good doctor can explain the situation to the patient. For every procedure the patient should be offered an explanation of the problem and possible solutions, and then their consent asked. This is called informed consent. The doctrine of informed consent, simply stated, is that before a patient is asked to consent to any treatment or procedure that has risks, alternatives, or low success rates, the patient must be provided with certain information. This information includes at least the following, which must of course, be presented in language the patient can understand: 1. A description of the recommended treatment or procedure(s) 2. A description of the risks and benefits of the recommended procedure, with special emphasis on risks of death or serious bodily disability 3. A description of the alternatives, including other treatments or procedures, together with the risks and benefits of these alternatives 4. The likely results of no treatment 5. The probability of success, and what the physician means by success 6. The major problems anticipated in recuperation, and the time period during which the patient will not be able to resume his or her normal activities 7. Any other information generally provided to patients in this situation by other qualified physicians. Many people would like to accept this responsibility. There are a few who may not, but this should be an exception rather than the rule, and is no reason not to apply the rule of informed consent. Even if someone does not think informed consent is necessary and says to a dentist or doctor you should do what you think is best, it still does not mean the health care professional should not talk to the patient about it. In modern medicine there are often many alternative therapies, which present the doctor with such dilemmas. The patient may not realize that there is such a variety of choices, but the doctor is still obliged to attempt to explain something of these techniques to form in their own mind which therapy is most suitable respecting this individuals life values. There are also scientific studies to show that effective doctor-patient communication has a positive influence on health outcomes. From the patient side, responsibility may be a burden, but we need to take it otherwise autonomy and democracy will break down. We should make decisions even if they are a bit complicated. Healthcare workers need to let patients make decisions; we must find the best way to do this. It will involve some time, which is a limiting factor in many healthcare systems. Health care workers should have good counseling skills. Healthcare workers should be decision facilitators; the patients should make the decisions. Some healthcare professionals may also consider that the family knows the patient better than they, and share the responsibility of consultation with family members, so-called familial autonomy. There are some families in all societies who function as one, and other families which function as relationships between individuals. Transitions from Paternalism to Informed Choice While medical ethics was developed in ancient times, as seen in the survival of the Hippocratic Oath of the 35th century BC, it did not mention consent. The traditional model until the 1950s in mainstream medicine in most countries was called paternalism, which means the doctor behaved like a father to a child. The figure below shows three different models of the relationship between doctor and patient.

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Level of Participants in Relationships e.g. Visit to a doctor to seek treatment Doctor Doctor Patient Paternalism Informed Consent Patient Doctor Informed Choice Patient

e.g. Visit to a supermarket to buy food Shop Shop Consumer Paternalism Informed Consent Consumer Shop Informed Choice Consumer

Compared to a few years before the modern response is to reject paternalism and over-dominant health care professionals who make decisions for patient's treatment without adequate respect for their voices and values. In the past many more health care professionals, and especially physicians, thought it was not in a patients best interest to be told. Whether past doctors were less or more competent to explain and counsel the patient is unknown though if we could compare the times for average consultations between patient and physician it would give us some part of the indication. It remains a challenge.

Telling the Truth about Terminal Cancer Most people want to know if they have terminal cancer, but many people are not willing to tell family members the bad news. The attitudes towards truth-telling are changing in every society even now, as they have over the past few decades. Here we shall describe a typical case of a terminal cancer patient, explain ways people come to know about their illness, and apply ethical principles to answer the question of whether people have a right to know the truth or not. A Case of Terminal Cancer Recently, cancer has been the leading cause of death in many developed countries. In cases of terminal cancer, both family and health professionals are faced with the problem of whether or not to tell the truth about the gravity of the situation to the patient. In clinical practice, the question goes beyond whether but also includes when, how and how much to tell patients about their diagnosis, treatment choices and possible prognosis. These questions have troubled doctors especially when they try to apply the principle of doing good to their patients. Most people agree that terminal patients have a right to be well informed about their situation. Moreover, most agree that these patients have the autonomy to make decisions for themselves about medical treatment and other issues involving the end-of-life. Nevertheless; a value commitment toward openness has not been achieved in the general population. The most common reason for not telling the truth is the intention to protect

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dying persons from being harmed by knowing. But in order to address the real interests of terminally-ill cancer patients, we need to clarify various issues and to find a balance between doing good and do no harm.

The Case of Mr. G Mr. G, a mentally competent 70 year-old man, was diagnosed with invasive bilateral lung cancer with pleural effusion and bony metastasis a few days after he was sent to the hospital. The doctor gave the diagnosis and explained Mr. Gs situation to his family. According to the doctor, Mr. G had about six to twelve months more left to live. Since Mr. G was already in the late stages of his cancer, the doctor did not recommend surgery. Due to the request of the family, the doctor prescribed chemotherapy even though it had very little chance of succeeding. Furthermore, due to the insistence of the family, Mr. G was kept unaware of his condition. Mr. G was a little bit nervous about his condition, while everyone in contact with him was warned not to tell him the truth and to avoid any conversation concerning his condition...

Q1: How would you feel if you were Mr. G?

Awareness of dying In the hospital, we can see four different levels of awareness as first described by Glaser and Strauss (1965), by which patients with life-threatening illness perceive their situation. Closed awareness nurses, doctors and family try to hide the truth and engage in conversations that avoid disclosure. They keep conversations to the minimum and steer away from talking about the future, especially when the patient is in the very advanced stages of cancer. Nevertheless, the patient may become suspicious or even become fully aware of the situation at a later stage. Suspicion awareness a situation where the patient begins to suspect the seriousness of his or her condition. The patient may attempt to confirm his suspicion by direct or indirect measures, such as sneaking a look at medical records, or making direct requests from hospital staff or family. Such behavior thus makes families and hospital staff adopt different strategies in response. As a result, relationships among the patient, the staff and the family become strained. Mutual pretence this happens at a later stage when everyone (staff, families, even the patient), knows that the patient is dying, but chooses to pretend that the patient is going to be all right. The dramas between them could last for a long time; as a consequence the patient will die without ever knowing the truth from family or medical staff, although they may have full awareness of their condition. Open awareness this results from when staff, families and patient know and choose to acknowledge in their actions that the patient is dying. This situation is by no means an easy one; however, it is an essential requisite to achieve the patient's 'appropriate dying' expectation especially when their expectation is ambiguous and uncertain. Looking at the four levels of awareness in a dying patient gives us much insight on how people communicate and interact with the dying. In Mr. Gs case, the hospital staff followed the request of the family to hide the truth from him. He may constantly stay in closed awareness before he dies. But more likely, he would move to either suspicion awareness or to full open awareness of his diagnosis at the latter stage. The question of whether he should have been told or not and the question of how he faces his growing awareness of his approaching death are just some of the ethical and social issues that can be seen in this case.

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Q2. Would you like to know if you had terminal cancer? Would you tell your mother or father if they had terminal cancer? What will happen if we continuously withhold the truth? Lets look at Mr. G again. First, to be deceived into believing that he is all right, Mr. G will never have a chance to make choices about his medical treatment and care. Second, with limited conversation and interaction, Mr. G may feel that he is being isolated or even being abandoned. He may have sensed his physical decline and felt distress but could not share his fears and anxieties with others. Third, it will be impossible for him to accomplish what he wants before he dies. Finally, there will be a serious breach of trust, which challenges the relationship between health care professionals and patients. Mr. G. will probably either be suspicious or fully aware that people "lied" to him. He may choose to pretend he does not know just to go along with what his family wishes. He may feel more distressed from the kind intentions of his family than if he had been told the truth in the first place.

Q3. How would you feel if you found out on the last day of your life that your family had not been telling the truth to you about your disease? Q4. How would you spend the last week of your life on earth? What would you do? Where would you go? Who would you see?

The Pros and Cons - consequences of awareness According to research, compared with people in closed awareness, people dying in a stage of full awareness are more able to plan their dying process. Thus they and their family are more satisfied with their choice of the nature and place of death. Those who know are less likely to die alone and are more likely to die in their own homes surrounded by family. Pros: If death is certain in the near future, quality of life (QOL) should be the most important concern for the dying. Awareness of dying enables the patient to plan and to fix his affairs during the last stages of his life. It also offers an opportunity for him to control the manner and timing of his death. Fully informed, Mr. G can make his own choices about how he wants to be treated or cared for and who should administer the treatment or care. He may decide that chemotherapy is futile and he may also decide to refuse aggressive or life sustaining therapy. Instead, he may opt for palliative therapies to maintain the quality of his life and die in dignity. Mr. G can also try his best to accomplish his remaining goals in life. To avoid legal complications, he can also make arrangements on what to do at the end of his life as well as what happens to his body after death. Cons: It is possible that telling the truth will destroy hope and lead to irreversible depression. After being told the truth, Mr. G may experience shock, denial, anger, bargaining or depression. He may probably need a lot of guidance, support and companionship before he can reach the stage of acceptance. He might have serious issues with the fact that his family insisted on not taking the risk of telling the truth at the beginning if told mid-way through the disease. Some people believe requests for euthanasia and the desire to die sooner are associated with awareness of the truth. In reality, those dying patients who are aware of their condition are more likely to choose hospice care and are less likely to ask for euthanasia. The desire for death is mostly related to the levels of suffering and dependency experienced by the dying patient. These can be addressed and managed properly by modern palliative medicine like hospice care. If we believe that open discussion and rational decision making are key factors in achieving benefit from telling the truth; discussing the possibility of euthanasia should never be regarded as a negative effect of telling the truth.

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To Know or not to Know- Prevalence of dying awareness Nowadays, more people have an open attitude towards life and death. The preference for open awareness of dying is being established in modern medical settings and among the general population. The rationale is that when a patient is aware of impending death, then he becomes free and exerts his right to autonomy to be able to decide what he wants from medical care and what to do with the rest of his remaining life. However, this attitude of open awareness towards death varies in different areas and different situations. In many traditional oriental cultures, more people say that they prefer to stay unaware. In these countries, the family traditionally plays a more primary role in making medical choices for terminally ill patients. They feel more secure to give the right of decision making to a traditional source of authority like doctors or families. This attitude is different from modern western approaches where individual liberty is valued. This means that patients have a right to make choices about their medical treatment or care. There is also a difference when we try to look at how people from different social classes engage in planning for their death. Physical realities are other important variables, and people with a condition of medical uncertainty or tending to have mental disturbance should consider very carefully disclosure of the "truth". In a medical situation such as this, the truth is often a percentage risk, which most people cannot fully calculate. We then have to realistically admit that it is not always possible for individuals to become aware that they are soon expected to die. Even when the prevailing attitude valued by most contemporary societies is to be honest to patients, open awareness of dying is still hard to achieve in practice. However, in order to respect the principle of autonomy, both family and health professionals would need to agree that the patient both has a right not to know and a right to know about the truth of his own condition. This is not an easy dilemma to resolve and requires careful consideration.

End-of-life medicine and truth telling

To accomplish the goal of a more peaceful end-of-life, modern palliative medicine has established the hospice model where the medical team shifts the goal of medical management of terminal patients from combating the disease to controlling symptoms, and improving QOL. In a hospice, while the patient may be dying they are always important and they will never be abandoned by the health care staff and their families. However, it in the patients best interests that they know they are dying in order to receive hospice care. Openness, honesty and hope are necessary to be able to have a peaceful dying process. Thus a prior commitment to openness and honesty is essential for nurses and doctors to offer hopeful palliative care. The biggest challenge for nurses and doctors facing palliative care is how to break the bad news and at the same time not leave the patient in despair. The health professionals communication skills and interaction with the dying patient then becomes crucial in carrying out the doctrine of truth telling. We should not have any doubts about the justification of telling the truth to terminal patients. Telling the truth is also in line with a holistic and humanistic viewpoint that values the individuals right to know. Not telling the truth not only brings sorrow and regret, but it also does not respect the principle of autonomy. However, we should be careful about how we tell the truth. Carelessly done, it could cause more damage. This goes against the principles of do-no-harm and doing good. Effective communication, sufficient support systems and good relationships among the dying, the family and health care providers are needed if we are to progress as a society that values truth telling as a necessary element for a good dying process. Q5. Try to write a living will or advance directive (a document which says how you would like to be treated when dying). Q6. Do you think you can make plans to negotiate your dying process only if you are fully informed of your terminal condition?

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Q7. After reading the above chapter, can you discuss the benefits versus the risks of disclosure? Q8. Does attitude towards telling the truth about terminal illnesses depend on culture? How about in your culture? Q9. Is there such a thing as good dying process and peaceful death? How would you describe it? Is it something that individuals should strive for? How should society deal with this? Q10. Should there be a consensus towards truth telling? Should there be universal standards (applicable to all countries) for truth telling? Who should decide these standards? Who could administer it? Q11. What is death with dignity? Why is that valued in present society?

An Introduction to Hospice Care

Hospice is a concept of care designed to provide comfort and support to patients and their families when a life limiting illness no longer responds to cure-oriented treatments. The first Hospice began in the early 1960's when a British physician, Dr. Cicely Saunders, created St. Christopher's Hospice near London. With special emphasis on pain management and other symptom control, hospice care can reach the goal of peaceful end of life by offering comfort and dignity to the dying patient. Hospice care is usually provided by a team of specially trained professionals like nurses, doctors, social workers, dieticians and religious priests or counselors. Volunteers and family members are also very important in hospice care. Everyone works together as a team to provide physical, emotional, psychological and spiritual care to the dying patients and their families. Since hospice focuses on caring, not curing, hospice care services are usually provided in the patient's home or care facilities other than the acute hospital setting. One consequence of hospice care is a reduction in health care costs. In general, a patient can only enter a hospice program if he is certified by a physician to have a limited life expectancy, usually six months or less. However, to respect the patient's autonomy, health care professionals will need to agree with the patients desire for a resumption of traditional care at any stage in time. Furthermore, an individual's needs must be continually assessed and treatment options should be explored and evaluated in the context of the individual's values and symptoms. With all these descriptions of the palliative medicine model of hospice, we may come to realize that the basis of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so. In accordance with this, it is obvious that to offer ideal hospice care without a prior commitment to openness and honesty is not possible. What can hospice care provide? Management of the patient's pain and symptoms Assistance in the emotional, psychosocial and spiritual aspects of dying Provision of needed drugs, medical supplies, and equipment Coaching the family on how to care for the patient Special services like speech and physical therapy when needed

Short-term in-patient care when pain or symptoms become too difficult to manage at home, or when caregivers need time-off

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Counseling and care to surviving family and friends

Unit 7 Persons without the capacity to consent

Learning Objectives Students should be able to explain the meaning of capacity of consent. Students should be able to explain the criteria of capacity of consent. Students should be able to explain how the criteria for consent are applied in different circumstances of treatment and research.

Brain Death
Modern life sustaining technology sometimes leaves persons in the state of brain death, which has required societies to reconsider the definition of death and ways to diagnose it. Here we shall explain what brain death is, and how the diagnosis of brain death may be understood by different members of the public. The brain consists of two parts: the higher brain and the lower brain. The higher brain includes two hemispheres and the Cerebral Cortex. It is responsible for several higher functions, including intellectual function, speech and emotion. The lower brain includes the brain stem, which is the final pathway between cerebral structures and the spinal cord. It is responsible for a variety of automatic functions, such as control of respiration, heart rate and temperature. In brain death, brain cells, the cortex as well as the brain stem, are dead and have no function. Therefore, a brain dead patient can neither move nor talk, & even respiration is dependent on the ventilator. If we turn the ventilator off, the heart will stop too. However the heart is pumping and the body is warm. There are a variety of opinions and each country has its own regulations to deal with brain dead patients.
Case 7-1: Doctor suggests removal from ventilator for brain dead patient An 80-year-old man suffered pulmonary aspiration during a meal and was taken to the hospital. He was already apneic and suffering cardiopulmonary arrest on arrival. His heartbeat recovered but he was not able to breathe on his own so he was connected to a ventilator. The doctor suspected brain death due to papillary enlargement and the extended breathlessness. There was no change in his condition during the next 48 hours. Before explaining the situation to the patients family, the doctor read several medical ethics text books, the latest medical ethics related documents, and clinical ethics check lists, and then considered what would be the most proper treatment ethically. At last he suggested to the family that the ventilator be removed from the patient. Questions Q1. What is brain death? Q2. Should brain dead persons remain connected to a ventilator? Q3. What system should be used to help families accept brain death of their loved ones?

Q1. How would you respond if a close friend or relative became brain dead?

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Q2. Brain death is one of the ways to recognize death. In most countries people would just be told their loved one was dead. Is brain death a confusing term?

Brain death is defined as the irreversible loss of all functions of the brain. Although diagnosis of this condition varies country to country in general it can be determined in several ways. First - no electrical activity in the brain; this is determined by an EEG. Second - no blood flow to the brain; this is determined by blood flow studies. Third - absence of function of all parts of the brain - as determined by clinical assessment (no movement, no response to stimulation, no breathing, no brain reflexes.) The criteria may be legally applied in some conditions, with exclusions for persons who are very young, in drug overdose, or whose bodies are very cold, because of the reliability of the criteria. There are also other conditions, like locked in syndrome, persistent vegetative state or coma which is distinct from brain death, because the persons in those states are alive. Sometimes writers and the media get confused. There are several ways in which a person can become brain dead, these include: - Anoxia caused by drowning, respiratory diseases, or drug overdose. - Ischemia - Blockage of an artery leading to the brain or in the brain, heart attack (stoppage of the heart for a period of time), bleeding in the brain. - Intra-cranial hematoma - caused by a head injury (a blow to the head) or a ruptured aneurism. - A gunshot wound to the head - causes destruction of brain tissue and swelling of the brain. - Intra-cranial Aneurysm - the ballooning of a blood vessel supplying the brain - can cut off blood supply or rupture. - Brain tumors - can destroy brain tissue and increase pressure within the brain. When any of the above occur, they cause swelling of the brain. Because the brain is enclosed in the skull, it does not have room to swell, thus pressure within the skull increases (this is "intra-cranial pressure"). This can stop blood flow to the brain, killing brain cells and causes herniation of the brain (pushing the brain outside of its normal space). When brain cells die, they do not grow back, thus any damage caused is permanent and irreversible. A persons' heart can still be beating because of the ventilator and medications helping to keep the blood pressure normal. In most countries of the world a person who is declared brain dead is legally dead. Japan is one exception, and leaves the decision up to the persons prior expression on the organ donor card, with their family's agreement.

Q3. If you could transplant brains between two bodies would you call that a brain transplant or a body transplant? In other words, does your personality rest inside your brain or in your body? Q4. Discuss the function of the brain and central nervous system. Look at a picture of the brain, and identify the different regions along with their functions.

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Death definition and brain death diagnosis In many countries death is defined as the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brain stem. Brain death is defined as the irreversible cessation of the whole brain functions. In India (The Transplantation of Human Organ Act 1994) the law recognizes brain stem death as human death and it is defined based on irreversible cessation of brain stem functions. Japanese law introduces two alternative definitions for human death and gives opportunity to the individuals to choose the definition of death either traditional definition or brain-based definition based on their own views.

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In many countries the law requires establishment of a Brain death determination committee to confirm the diagnosis of brain death. The members of the diagnosis committee should not be a member of transplant team.

Picture of the human brain

Q5. Consider your own understanding of "Life" and "Death", and discuss these in small groups.

Organ Donation The transplant of tissues and organs between persons has developed since the 1960s, and in many countries organ donation is a question asked routinely when individuals apply for a driver's license. Here we shall introduce the types of laws used to regulate organ donation, the ethical issues associated with organ transplants, the type of counseling given to the donors' family regarding organ donation from a brain dead body, and ask whether recipients should be able to know the donors' family. A Review of Organ Transplantation Laws Legal tools are a necessity in organ procurement to allow transplant surgeons to remove organs from potential donors. Uses of new life-saving technologies vary across cultural and socioeconomic backgrounds. Therefore a variety of capacities exist in terms of expertise, legislation, access to sophisticated transplant facilities and the economic affordability of organ replacement therapy.

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In Asia different cultural and religious backgrounds which influence social acceptance of transplant technology draw a different picture. In some countries the organ transplantation law did not increase the organ retrieval rate but actually decreased the number of transplantation cases. For example, in Korea before the enforcement of the current law (Organ Transplantation Law 2000), 162 cases were diagnosed as brain dead in the year before, but only 43 cases were diagnosed in 2003. Unlike most Western countries, in many Asian countries there is an age limitation for organ donation after death. For example while organ removal is prohibited from children under fifteen years old in Japan, this age is sixteen years old in Korea. In India, Turkey, Saudi Arabia and the Philippines the ages are eighteen years old and in Singapore is twenty one years old. Although there is an age limitation for organ removal from children, in order to save other children lives who need to receive an organ, in many countries (except Japan) the law allows parents to get permission for organ donation based on the best interest of their beloved ones. Q6. What do you think about children who need to receive an organ, while the law prohibits organ removal from children even based on their parents consent? Q7. In your country what is the minimum age that people can donate their organs?

The issue of consent In some countries regulations for organ transplants are different. Donor consent has been recognized as a necessary for organ donation in all these laws. In many countries if there is no document to show deceased willingness for organ donation, the family can permit organ removal based on their beloved ones interest. Donor card and living will are documents to show donors willingness for donation. Individual who wants to be an organ donor after her/his death can sign such document. In Singapore (Human Organ Transplant Act, 1987/2004) an opting out system has been applied which means the designated officer (a medical practitioner) of a hospital may authorize, in writing, the removal of any organ from the body of a person who has died in the hospital for the purpose of the transplantation except from an individual who has during his lifetime registered his objection to the removal of the organ from his body after his death. In other words an individual who wont be a donor after his death should fill out an objection form. (Singaporean Muslims are exempted from opting out system). In Japan a donor card signed by individual as well as her/his family has validity for organ removal (a double signed card), and individuals can choose not to donate at the back of the donor card. In other countries although the attempt should be made to obtain the family agreement, donor consent alone is legally enough. In Iran (Organ Transplantation Act, 2000) oral consent confirmed by one of the family member in writing is accepted. In Turkey also oral consent is accepted. Surrogate decision making In Asian countries, family surrogate decision making by the family when an individual has not left any document, either willingness for organ donation after death or any objection, has been recognized. The Japanese organ transplantation law (The Law Concerning Human Organ Transplants, 1997) is an exception to this. In other words Japanese parents can not be as surrogate decision maker for their children in case of organ donation. In some countries like, the Philippines, India, and Saudi Arabia in case of unclaimed body after forty eight hours failing to locate a family member, surrogate decision making has extended to the official authority. It should be noted that in organ transplantation laws in many countries, it is not clear that within a family, who has authority to give permission for organ donation.

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Organ removal from living donors In some countries living donation can be performed only if the recipient is a near relative. In Singapore as for living organ donation, written authorization of the transplant ethics committee of the hospital and donor consent in writing for the removal of the specified organ from his body are necessary. In Saudi Arabia (Regulations of organ transplantation, 1994), and Malaysia, living organ donation is limited to genetically relatives. While in Malaysia, organ donation to spouse is accepted, in Saudi Arabia, before performing living related transplantation the relationships between donor and recipient should be attested by an official organization. In some countries if recipient is not a near relative, human organ can be removed and transplanted with the prior approval of the authorization committee. In Iran in order to prevent organ trade, in case of living donation, donor and recipient should be compatriot. In case of living donation in Turkey, (Turkish Organ and Tissue Transplantation, 1979) doctors are obliged to inform the donors spouse as well. In many countries if donor and recipient are not relatives their name should not be disclosed. Only in the Philippines (Organ Donation Act of 1991), there is an international sharing of human organs and tissues. Sharing of human organs or tissues shall be made only through exchange programs duly approved by the Department of Health, provided, that foreign organ or tissue bank storage facilities and similar establishments grant reciprocal rights to their Philippine counterparts to draw organs or tissues at any time. In some countries there is a guideline to select the recipients. For instance in Singapore there is a priority setting for selection of the proposed recipients which a person who has not registered any objection for organ donation with respect to that organ, shall have priority over a person who has registered an objection. Q8. Did anyone you know ever receive a blood transfusion, or donate blood? (Blood is a renewable organ, which makes it different to many organs). Incentives for organ donation In Japan there was an initiative by a leading transplant surgeon as Thank you fund to provide payment to the families of organ donors. This initiative has been criticized by other doctors and no longer practiced. In Iran a non-governmental organization (NGO) is responsible to present a certain amount of money as a social gift to the kidney donors. In Singapore an organ donor has priority to receive an organ if s/he becomes a case in need for an organ. It can be consider an indirect incentive for organ donation. Q9. Do you think that organ donors should be rewarded? Q10. Do you think organ transplant recipients should be able to thank the donor's family? Can you think of any problems of doing so? Imagine a situation where the doctor has already informed you that after an accident involving a relative of yours, the brain has lost its function and breathing is now controlled by a respirator, a machine. In such circumstances a patient is in a brain dead state. Unfortunately, we can do nothing now and he will never recover. But there is a possibility of saving other lives by donating some organs from him to transplant to some patients and to give them a chance to stay alive. In some countries according to the law for organ removal, a Donor Card or a patient's prior declaration to organ donation is needed. There may be no written paper to show the brain dead persons agreement or disagreement. The law does allow the family to make a decision on behalf of their beloved ones based on his or

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her best interest. Indeed, the family is the closest and the one guaranteed to be the surrogate decision maker in this very important matter.

The Heart Transplant My name is Tom. Now, I am 12 years old and am a 6th grade pupil of an elementary school in New York City, USA. Last year at this time I was in poor health and had a weak body. I had been a very fragile boy since birth because I had a heart valve disease. So I could not do any exercises in the school. Dr. Smith, my family doctor, thought that I would not be able to grow up to be a man because I would die soon. One day Dr. Smith said, "Tom, I have very good news for your health. The surgeon at the City Hospital told me that your health will become good by a heart transplant if we can get a donor for you." A few weeks later, Dr. Smith called my parents and said to them to bring me to the hospital as soon as possible. We went to the hospital with my parents by a taxi. Dr. Smith said very seriously to me, "Tom, we found a donor for you at last." After listening to the possible benefits and risks, considering that I might soon die and had always been sick, we all thought I should have the operation. With my parent's consent, I underwent the heart transplant operation by the surgeon. My postoperative recovery was good and speedy. Today, I am in good health and I enjoy jogging for 3 miles, every morning.

Q11. Do you think that heart transplants are useful for medical treatment? Why?

Q12. Do you think that you would like to donate your heart if you suddenly die, or receive a new heart if it will save your life? Why?

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Ethical Principles for Medical Research Involving Human Subjects, by the World Medical Association Declaration of Helsinki Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended by the 29th WMA General Assembly, Tokyo, Japan, October 1975 35th WMA General Assembly, Venice, Italy, October 1983 41st WMA General Assembly, Hong Kong, September 1989 48th WMA General Assembly, Somerset West, Republic of South Africa, October 1996 and the 52nd WMA General Assembly, Edinburgh, Scotland, October 2000 Note of Clarification on Paragraph 29 added by the WMA General Assembly, Washington 2002 Note of Clarification on Paragraph 30 added by the WMA General Assembly, Tokyo 2004 INTRODUCTION 1 The World Medical Association has developed the Declaration of Helsinki as a statement of ethical principles to provide guidance to physicians and other participants in medical research involving human subjects. Medical research involving human subjects includes research on identifiable human material or identifiable data. 2 It is the duty of the physician to promote and safeguard the health of the people. The physician's knowledge and conscience are dedicated to the fulfillment of this duty. 3 The Declaration of Geneva of the World Medical Association binds the physician with the words, "The health of my patient will be my first consideration," and the International Code of Medical Ethics declares that, "A physician shall act only in the patient's interest when providing medical care which might have the effect of weakening the physical and mental condition of the patient." 4 Medical progress is based on research which ultimately must rest in part on experimentation involving human subjects. 5 In medical research on human subjects, considerations related to the well-being of the human subject should take precedence over the interests of science and society. 6 The primary purpose of medical research involving human subjects is to improve prophylactic, diagnostic and therapeutic procedures and the understanding of the aetiology and pathogenesis of disease. Even the best proven prophylactic, diagnostic, and therapeutic methods must continuously be challenged through research for their effectiveness, efficiency, accessibility and quality. 7 In current medical practice and in medical research, most prophylactic, diagnostic and therapeutic procedures involve risks and burdens. 8 Medical research is subject to ethical standards that promote respect for all human beings and protect their health and rights. Some research populations are vulnerable and need special protection. The particular needs of the economically and medically disadvantaged must be recognized. Special attention is also required for those who cannot give or refuse consent for themselves, for those who may be subject to giving consent under duress, for those who will not benefit personally from the research and for those for whom the research is combined with care. 9 Research Investigators should be aware of the ethical, legal and regulatory requirements for research on human subjects in their own countries as well as applicable international requirements. No national ethical, legal or regulatory requirement should be allowed to reduce or eliminate any of the protections for human subjects set forth in this Declaration.

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BASIC PRINCIPLES FOR ALL MEDICAL RESEARCH 10 It is the duty of the physician in medical research to protect the life, health, privacy, and dignity of the human subject. 11 Medical research involving human subjects must conform to generally accepted scientific principles, be based on a thorough knowledge of the scientific literature, other relevant sources of information, and on adequate laboratory and, where appropriate, animal experimentation. Appropriate caution must be exercised in the conduct of research which may affect the environment, and the welfare of animals used for research must be respected. The design and performance of each experimental procedure involving human subjects should be clearly formulated in an experimental protocol. This protocol should be submitted for consideration, comment, guidance, and where appropriate, approval to a specially appointed ethical review committee, which must be independent of the investigator, the sponsor or any other kind of undue influence. This independent committee should be in conformity with the laws and regulations of the country in which the research experiment is performed. The committee has the right to monitor ongoing trials. The researcher has the obligation to provide monitoring information to the committee, especially any serious adverse events. The researcher should also submit to the committee, for review, information regarding funding, sponsors, institutional affiliations, other potential conflicts of interest and incentives for subjects. The research protocol should always contain a statement of the ethical considerations involved and should indicate that there is compliance with the principles enunciated in this Declaration. Medical research involving human subjects should be conducted only by scientifically qualified persons and under the supervision of a clinically competent medical person. The responsibility for the human subject must always rest with a medically qualified person and never rest on the subject of the research, even though the subject has given consent. Every medical research project involving human subjects should be preceded by careful assessment of predictable risks and burdens in comparison with foreseeable benefits to the subject or to others. This does not preclude the participation of healthy volunteers in medical research. The design of all studies should be publicly available. Physicians should abstain from engaging in research projects involving human subjects unless they are confident that the risks involved have been adequately assessed and can be satisfactorily managed. Physicians should cease any investigation if the risks are found to outweigh the potential benefits or if there is conclusive proof of positive and beneficial results. Medical research involving human subjects should only be conducted if the importance of the objective outweighs the inherent risks and burdens to the subject. This is especially important when the human subjects are healthy volunteers. Medical research is only justified if there is a reasonable likelihood that the populations in which the research is carried out stand to benefit from the results of the research. The subjects must be volunteers and informed participants in the research project. The right of research subjects to safeguard their integrity must always be respected. Every precaution should be taken to respect the privacy of the subject, the confidentiality of the patient's information and to minimize the impact of the study on the subject's physical and mental integrity and on the personality of the subject. In any research on human beings, each potential subject must be adequately informed of the aims, methods, sources of funding, any possible conflicts of interest, institutional affiliations of the researcher,

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the anticipated benefits and potential risks of the study and the discomfort it may entail. The subject should be informed of the right to abstain from participation in the study or to withdraw consent to participate at any time without reprisal. After ensuring that the subject has understood the information, the physician should then obtain the subject's freely-given informed consent, preferably in writing. If the consent cannot be obtained in writing, the non-written consent must be formally documented and witnessed. 23 When obtaining informed consent for the research project the physician should be particularly cautious if the subject is in a dependent relationship with the physician or may consent under duress. In that case the informed consent should be obtained by a well-informed physician who is not engaged in the investigation and who is completely independent of this relationship. For a research subject who is legally incompetent, physically or mentally incapable of giving consent or is a legally incompetent minor, the investigator must obtain informed consent from the legally authorized representative in accordance with applicable law. These groups should not be included in research unless the research is necessary to promote the health of the population represented and this research cannot instead be performed on legally competent persons. When a subject deemed legally incompetent, such as a minor child, is able to give assent to decisions about participation in research, the investigator must obtain that assent in addition to the consent of the legally authorized representative. Research on individuals from whom it is not possible to obtain consent, including proxy or advance consent, should be done only if the physical/mental condition that prevents obtaining informed consent is a necessary characteristic of the research population. The specific reasons for involving research subjects with a condition that renders them unable to give informed consent should be stated in the experimental protocol for consideration and approval of the review committee. The protocol should state that consent to remain in the research should be obtained as soon as possible from the individual or a legally authorized surrogate. Both authors and publishers have ethical obligations. In publication of the results of research, the investigators are obliged to preserve the accuracy of the results. Negative as well as positive results should be published or otherwise publicly available. Sources of funding, institutional affiliations and any possible conflicts of interest should be declared in the publication. Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication.

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ADDITIONAL PRINCIPLES FOR MEDICAL RESEARCH COMBINED WITH MEDICAL CARE 28 The physician may combine medical research with medical care, only to the extent that the research is justified by its potential prophylactic, diagnostic or therapeutic value. When medical research is combined with medical care, additional standards apply to protect the patients who are research subjects. 29 The benefits, risks, burdens and effectiveness of a new method should be tested against those of the best current prophylactic, diagnostic, and therapeutic methods. This does not exclude the use of placebo, or no treatment, in studies where no proven prophylactic, diagnostic or therapeutic method exists. At the conclusion of the study, every patient entered into the study should be assured of access to the best proven prophylactic, diagnostic and therapeutic methods identified by the study. See footnote

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In the treatment of a patient, where proven prophylactic, diagnostic and therapeutic methods do not exist or have been ineffective, the physician, with informed consent from the patient, must be free to use

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The physician should fully inform the patient which aspects of the care are related to the research. The refusal of a patient to participate in a study must never interfere with the patient-physician relationship.

unproven or new prophylactic, diagnostic and therapeutic measures, if in the physician's judgement it offers hope of saving life, re-establishing health or alleviating suffering. Where possible, these measures should be made the object of research, designed to evaluate their safety and efficacy. In all cases, new information should be recorded and, where appropriate, published. The other relevant guidelines of this Declaration should be followed. Note: Note of clarification on paragraph 29 of the WMA Declaration of Helsinki The WMA hereby reaffirms its position that extreme care must be taken in making use of a placebo-controlled trial and that in general this methodology should only be used in the absence of existing proven therapy. However, a placebo-controlled trial may be ethically acceptable, even if proven therapy is available, under the following circumstances: - Where for compelling and scientifically sound methodological reasons its use is necessary to determine the efficacy or safety of a prophylactic, diagnostic or therapeutic method; or - Where a prophylactic, diagnostic or therapeutic method is being investigated for a minor condition and the patients who receive placebo will not be subject to any additional risk of serious or irreversible harm. All other provisions of the Declaration of Helsinki must be adhered to, especially the need for appropriate ethical and scientific review. Note: Note of clarification on paragraph 30 of the WMA Declaration of Helsinki The WMA hereby reaffirms its position that it is necessary during the study planning process to identify posttrial access by study participants to prophylactic, diagnostic and therapeutic procedures identified as beneficial in the study or access to other appropriate care. Post-trial access arrangements or other care must be described in the study protocol so the ethical review committee may consider such arrangements during its review. The Declaration of Helsinki (Document 17.C) is an official policy document of the World Medical Association, the global representative body for physicians. It was first adopted in 1964 (Helsinki, Finland) and revised in 1975 (Tokyo, Japan), 1983 (Venice, Italy), 1989 (Hong Kong), 1996 (Somerset-West, South Africa) and 2000 (Edinburgh, Scotland). Note of clarification on Paragraph 29 added by the WMA General Assembly, Washington 2002. Version of 9.10.2004

Q13. This is a statement accepted by most medical associations in the world to guide ethical conduct of research. Are there any articles you disagree with? Q14. How would you feel as a research subject? How would you feel as a researcher?

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Unit 8 Respect for human vulnerability and personal integrity

Learning Objectives Students should be able to explain the principle of respect for human vulnerability. Students should be able to analyze the interrelationship between present day scientific medicine and human vulnerability and to illustrate the difficulties in this relationship with example. Students should be able to specify the connections of the principle of respect for human vulnerability with the notion of personal integrity and with care ethics.

Fading Memory: Alzheimer's disease As we age our ability to store and recall memories often deteriorates and many older people experience minor forgetfulness due to degenerative changes that occur in areas of their brain involved in memory processes - the cortex and hippocampus. Yet, the memory loss and neuronal changes that occur in Alzheimer's disease are far more severe. Alzheimer's disease is memory disorder that starts with minor forgetfulness, but progresses to serious memory loss, often leaving the individual suffering from confusion, delusions, depression, restlessness, sleeplessness and loss of appetite. Alzheimer's disease typically occurs in older aged people, but can occasionally strike those in their 30's. The occurrence of Alzheimer's disease becomes more common with age, affecting almost 5% of people between 65-70 years, and almost 50% of people over 85 years of age in the US.

Case 8-2: Is the decision of family for the patient? A 77 year-old-man has been in treatment ward for Alzheimers disease. His abilities of memory, orientation, and judgment were continually decreasing, and he had problems of wandering, delirium, paranoia, and insomnia. He had neither gait disorder nor deglutition disorder. One day he fell down and could not stand up. He claimed pain in his leg and his doctor found a femoral fracture through the X-ray. The doctor explained this to the family, and suggested his family take him to see an orthopedic specialist. He judged that the patient needed to have surgery since both bone adhesion and pain relief were difficult to be cured through conservative therapy. However, his family denied him the treatment. Two days after falling down, he could not make postural changes because of pain, and then had bedsores in the sacral region. Questions Q1. Have you ever broken a bone? Q2. Is there any reason that persons with Alzheimers disease might receive different treatment from other persons for any condition? Q3. What should the medical team do now?

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Environmental and genetic factors influence our susceptibility for developing Alzheimer's disease. For example, environmental toxins can increase the occurrence of this disease. The first clue to the genetics of Alzheimer's came from observations that people with Down syndrome, a disorder caused by having an extra copy of chromosome 21, almost invariably suffered from Alzheimer's if they survived until middle age. A gene on chromosome 21 is now known to be involved in early onset Alzheimer's and more recent research has demonstrated that certain variations of genes found on chromosomes 1, 14, and 19 are also involved in the development of this disease. Each of these genes is involved in the production of a normal protein in the brain the amyloid protein. In most people the amyloid protein does not have a negative effect on brain function, however the version found in Alzheimer's brains (a slightly larger protein) cannot be broken down as easily and so it deposits in the brain to impair, and ultimately, destroy neuronal cells. Modern understanding of the genetics of Alzheimer's, particularly those genes involved in the early onset of this disease, commands serious ethical consideration. Inevitably, parents with a history of Alzheimer's disease in their family will have the opportunity to screen for this disorder in the early stages of a pregnancy. But if the results return positive, should they then consider terminating the pregnancy in an attempt to prevent any suffering that their children may experience later in life? Research into the treatment of this disease is constantly expanding and so the opportunities available to those suffering from Alzheimers disease in the future are certainly not going to be as limited as they are at present. Stem cell research offers exciting possibilities for the treatment of neurodegenerative disorders such as Parkinson's disease, and this research also holds much potential for the treatment of Alzheimer's, yet it remains limited by the ethical debate which surrounds it. Other treatments, such as the development of new pharmaceutical drugs also hold much promise for future Alzheimer's treatments. For instance, memory enhancing drugs may be beneficial in revitalizing the activity of healthy neurons in the Alzheimer's brain, to improve memory and other mental functions in patients. Alternatively, other drugs could be developed which can prevent the accumulation of amyloid proteins in the brain tissue which are at least partly responsible for the neuronal damage that occurs in Alzheimer's. In addition to these drug treatments, researchers are currently investigating ways in which they can help a person's own body fight Alzheimer's disease. In this case, genetic screening for the genes involved in Alzheimer's disease may become particularly important if effective preventative treatments are developed. Recent research in mice with a genetic tendency to overproduce the damaging amyloid protein has pointed towards an intriguing new avenue for investigation and eventual treatment. If young mice genetically prone to develop the symptoms of Alzheimer's are given a small injection of the amyloid protein, their immune system will destroy it and they, in turn, develop immunity to it. Once immunized, these mice are able to destroy the protein over the course of their lives, preventing its aggregation in the older brain, along with the associated symptoms of Alzheimer's disease. Q1. Recent improvements in the medical field have enhanced people's life expectancy across the globe, particularly in developed countries. Yet, while we have extended the life of our bodies, we have not yet managed to prevent, or even adequately treat, the degenerative disorders of the brain such as Alzheimers disease. What ethical implications can you see in this trend? Q2. Should parents use genetic pregnancy tests to screen for genes involved in the early onset of Alzheimer's? What ethical issues may arise from a positive finding? Q3. If an individual partakes in genetic screening and receives a positive result for Alzheimer's genes, what right do they have to privacy of information? Do health insurance companies have a right to know that this individual is at high risk of developing Alzheimer's disease?

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Advances in Neuroscience & Neuroethics As our knowledge of the brain increases we are able to alter its function; therefore, it becomes important to integrate neuroscience and neuroethics into the foundations of learning. Here we shall introduce the nervous system, point to a diversity of neuroethics issues, draw attention to the revolutionary nature of current research, and discuss Parkinsons disease to highlight major issues of ethics in neuroscience.

The Human Nervous System Neuroscience is the study of the nervous system. The nervous system is made up of the central nervous system (CNS) and the peripheral nervous system (PNS). The central nervous system consists of the brain and spinal column; the peripheral nervous system includes the cranial and spinal nerves and an extensive network of motor and sensory nerve cells or neurons interconnecting all parts of the body (see Figure). The brain functions as the main coordinating centre for nervous activity and so controls, directs and integrates all nerve impulses of the human body. It controls physical functions like movement, balance and breathing, and mental functions like our behaviors, emotions and intelligence. The CNS, therefore, is the physical substance that provides us with genetically determined ways of behaving and also ways of changing this behaviour. The brain is really the enlarged anterior part of the vertebrate CNS, which is enclosed within the cranium of the skull. It is composed of billions of interconnected neurons that transmit information to one another and to peripheral neurons throughout the body by means of chemical and electrical signals (see Chapter F2). In short, the nervous system receives, interprets and integrates information from the outside world, or from within the body, and then formulates appropriate responses for target organs such as muscles and glands. Appropriate, graduated responses in the target organs are produced as follows: the more neurons that are involved in signaling a muscle to contract in your arm for example, the larger the contraction will be. If the arm is involved in lifting a weight, the heavier the weight the more nerve fibres are activated to enable the muscle to lift the greater load. While many neurons are excitatory in nature, that is, they enhance responsiveness of their target, others are inhibitory. The inhibitory neurons reduce the responsiveness at their target in order to prevent a buildup of stimulating signals. For instance, to smoothly pull your hand towards your shoulder both inhibitory and excitatory responses are needed so that some muscles are inhibited while others are excited. The brain is always active therefore it requires a large percentage of the bodys oxygen supply and oxygendelivering blood circulates through at an average flow of 650-700 ml per minute. A disruption of the oxygenated blood supply (ischemia) to specific areas of the brain may bring on a stroke and consequent dysfunction of the damaged brain tissue. With new technologies, it has become possible to understand healthy brain function and its dysfunction in disease. Neuroscience is an area of scientific investigation that includes many specializations concerned with growth, development, and function of the nervous system. Consequently, neuroscientists have to be knowledgeable in a range of subjects including anatomy, physiology, biochemistry, molecular biology, pharmacology, computer science and neuroethics.

The nervous system viewed from behind; The nervous system is composed of the central nervous system or brain and spinal cord, and the peripheral nervous system. The peripheral nervous system is a series of pathways that transmit impulses between the central nervous system and the other body tissues

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Body or Mind Where is the Difference? Our environments (internal and external) are being monitored continuously by the sense organs. The sense organs (e.g., eye, ear, nose, taste bud) collect information and convert it into nerve impulses. Only when impulses reach the central nervous system are they interpreted and sensed as light, sound, smell, taste and so on. Different parts of the brain are responsible for interpreting different impulses. For example, you may see stars from a blow to the head simply indicating that the light interpreting region of the brain has been stimulated. Meditation Exercise: Close your eyes and concentrate on the space inside your head for a while. Visualize a lemon, visualize cutting it into segments, visualize slowly sucking on the segments one by one ... What sensations are you experiencing? Concentrate on taste, saliva flow, colors and shapes please write them down after the exercise. Did your mind create physical changes in your body? Do you feel that your mind is separate from your body? Can you imagine measuring love or anger in the same way as you can tastes, heart beat or breathing? The more doctors and scientists learn about the inner workings of the mind, the more they realize that there is no mind-body dualism mind and body are inseparable. Thoughts and emotions are the result of complex electrochemical interactions within and between nerve cells which, in turn, communicate with the rest of the body. For example, the disembodied voices of schizophrenia and the low-self esteem of depression are generated by distortions in brain chemistry. Mental states and physical wellbeing are intimately connected. An unhealthy body can lead to an unhealthy mind, and an illness of the mind can trigger or worsen diseases in the body. Researchers are learning how these distortions arise, how to lessen their severity and, in some cases, how to correct them. Q4: Scientists believe that the human ability to be ethical has evolved over hundreds of thousand of years. Do you agree or disagree?

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Neuroethics Neuroethics is a new field that deals with the pros and cons of research conducted on the brain as well as the social, legal and ethical implications of treating or manipulating the mind. Neuroethicists propose that we consider the ethics now rather than wait until new technologies have been developed and are being used. Access to information is an important consideration but there are also wide implications for the rights of the individual. Brain scans can identify early signs of brain disease and risk factors for mental health. New advances in brain scans use blood flow, and tend to focus on basic brain processes. Interestingly, scientists are expanding on traditional research into general brain functions, organization and evolution to explore the more subtle functions which make us individuals. For example, advances in neuroimaging technology may improve our ability to make predictions about an individuals future. Scientists will learn how different patterns of brain images, taken under varying circumstances, strongly correlate with different future behaviors or conditions. Advances in neuroimaging will provide access to the mental processes involved in recalling a memory, whether true or fabricated, and assist neurologists to differentiate between the two (see Chapter F2). Future neuroimaging will provide insights into individual traits such as intelligence, cognitive abilities, personality characteristics such as violence and addiction, and mental illness. Specific neuroimages may also predict the onset of particular neurodegenerative diseases such as Alzheimers and Parkinsons. Prediction of the onset of a particular disease potentially could lead to prevention of onset or early treatment. However, there are many ethical concerns that must be considered before the potential is exploited.

Q5. Accurate predictions could lead to useful preventative interventions but what if those predictions are wrong or misleading? Q6. Should you feel guilty for a crime you might commit? Q7. What happens if the information about your potential to commit a crime or become ill gets into the wrong hands such as private businesses and insurance companies?

We now know that the prefrontal cortex of the cerebral cortex is responsible for cognition, emotional regulation, control of impulsive behavior and moral reasoning. Should the prefrontal cortex be damaged or its function impaired by risk factors such as alcohol or stress, an individual may be unable to appropriately regulate his/her behavior despite knowing right from wrong.

Q8. Are criminals whose prefrontal cortex is damaged responsible for their criminal behavior? Q9. Should they be punished or rehabilitated? Q10. If scientists can read your thoughts, do you think that they can also change them? Note of Interest: Gifted children use their brains in completely different ways to most of us. Their brains are far more active and they generate many more connections compared with the average ability brain. Finger-Printing - Can Machines Read Your Mind? As technology continues to develop, there is the potential that machines could be created that are capable of reading an individuals thoughts and memories. Presently, the polygraph is used to detect lying. Detection is done by recording involuntary responses such as heart rate, blood pressure and sweating. But can a machine

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that measures brain activity accurately detect lying? More sophisticated brain fingerprinting techniques are being developed that can reveal a persons knowledge of an event or incident (see section F2.1). If a device could accurately measure hidden knowledge, how should it be used? Do the benefits of this technology as in detecting criminals or terrorists or company employees who cannot be trusted outweigh the possible harms? If this technology is forced on an individual, or done without consent, what happens to their right of privacy against mental intrusion? Modern neuroscience poses many dilemmas because the brain is who we are its our personality, consciousness, behavior, ideas and spirituality. How and what we think, feel and act is very personal and often we choose not to reveal every aspect of ourselves. Is modern neuroscience opening up a Pandoras Box?

Q11. If brain machines manage to interpret the very secrets of the brain, what uses will it be put to and who will have the controls? Q12. Who should have the right to the information in your brain? Lawyers, doctors, family members, employers, insurance companies, marketing agencies, government intelligence organizations?

Parkinsons Disease Parkinsons disease is a neurodegenerative disorder caused by damaged or dead dopamine cells in the region of the brain that controls balance and coordinates muscle movement. Dopamine is an inhibitory neurotransmitter that is responsible for ensuring that signals between the brain and muscles are coordinated to allow for smooth and fluid movements. As dopamine neurons begin to die, the line of communication between the brain and the muscles cannot be regulated effectively, and the brain is no longer able to control muscle movement. Symptoms include tremors in the hands, face and legs; stiffness of the limbs and trunk; slowed movement and speech; and impaired balance and coordination. It is well established that the loss of dopamine cells resulting in Parkinsons has genetic as well as environmental causes. With current technology, it is possible to screen for one specific Parkinsons gene but the process is complicated and costly. At the moment, the test is only useful for those who are likely to exhibit early onset of the disease; that is, showing symptoms at about 30 years of age. Research may soon lead to similar tests that can effectively screen for those people susceptible to the disease, regardless of time of onset and it may even be possible to screen for the disease prenatally. This could reduce the incidence of the disease by selectively screening fetuses and carrying to term only those who do not carry the gene. Embryologists continue in their efforts to develop safer and more reliable screening methods for severe genetic disorders, but for many conditions having a certain gene, or gene combination, merely means that the carrier has a heightened risk of developing that genetic illness. This especially holds true for the lifestyle diseases such as heart disease and cancer, where risk of expression will have to be evaluated in an environmental context. Chapter F3 section F3.4 details how health and wellbeing interact among genes, living conditions and behavioural habits. Intracerebral Grafting of Fetal Stem Cells for Parkinsons Another important challenge to neuroscience is the application of stem cells to repair neurological damage particularly important in Parkinsons disease. Stem cells are cells that have the potential to grow and develop into specialized cell types, such as neurons. There are two main sources of stem cells embryonic stem cells and adult stem cells. Recently scientists were able to take a special type of stem cell from rat embryos and successfully treat a Parkinsons-like disease in rats. Neural stem cells that can develop into nervous tissue were injected into rats which showed about a 75% improvement in motor function 80 days after treatment. Can we as a society ignore the potential benefits of this kind of research?

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A prominent ethical topic is the use of aborted fetal brain tissue containing the required stem cells. Several nations have provided ethical guidelines for the use of embryos and fetuses in clinical and experimental research. These guidelines advocate that the decision to abort a fetus should be wholly independent from the decision to use that fetus in research. This guideline is designed to reduce the chance of a fetus being aborted solely for the purpose of providing organs. Under these guidelines organ donation from an aborted fetus is considered no different from donation from a deceased child or adult. Q13. A number of the potential therapies for the treatment of Parkinsons disease are quite controversial. For example, stem cell treatment would require large numbers of aborted embryos. Is it ethical to pursue such research when the condition may be managed with drugs? Q14. If neuroscience could provide a safe and accurate prenatal screening test for Parkinsons disease, is it ethical to use this information to decide whether to keep or abort a pregnancy?

The Biological Basis of Memory Our ability to learn, retain and recall information requires that it become 'hard-wired' in the neuronal circuitry of our brain. As our understanding of the biological mechanisms of memory evolves, we face new opportunities in the treatment of memory disorders, as well as in the enhancement of normal memory function. Here we shall describe short-term and long-term memory, outline the biological mechanisms of memory consolidation, and discuss the neuroethical concerns associated with artificial memory enhancement. Learning to Remember When we learn new information it does not necessarily mean that we will retain it and be able to remember it at a later date. Learning simply involves the acquisition of new knowledge, while memory enables us to store that information within the nervous system so that we can recall it sometime in the future. A part of our brain called the hippocampus plays a particularly important role in converting learned information into a memory. We can store our memories for varying lengths of time, ranging from periods of only a few seconds, to a few years, or an entire lifetime. Memories are therefore often classified according to whether they are stored for a short period of time (short-term memories), or a long period of time (long-term memories). Short-term memory is sometimes referred to as working memory because it is used during the course of intellectual reasoning, with the information being deleted from the memory banks as each stage of the problem is resolved. For example, working memory is often used when dialling a new telephone number. To do this, you would typically look the number up in a telephone directory, store that information in your short-term or working memory, dial the number (without referring back to the directory), and then conveniently forget the telephone number as you begin your conversation. Yet, if you repeat this process a number of times, you will begin to store the information more permanently in your long-term memory. Unlike short-term memory, when events or facts are stored in a person's long-term memory they are reasonably permanent, and not easily forgotten. Even if the information is seemingly lost, a long-term memory can usually be recalled with a few hints. Interestingly, memories can be modified by our perceptions, beliefs, or through suggestions made by others about a specific situation after the event has occurred. Memories are, therefore, not always accurate recollections of an event since they can be altered to become what are known as false memories. Scientific research has shown that when people who witness a particular incident are later exposed to new and misleading information about this event, their recollections can become distorted. In particular, misinformation has the potential to invade our memories when we socialize with others, when we are suggestively interrogated, when we imagine a scenario, or when we read or view media coverage about some event that we may have experienced ourselves. Over the last two decades researchers have learned a great deal about the conditions that make people susceptible to memory modification. In particular, research has shown that memories can be

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modified through suggestion and imagination, and that they are altered more easily when the passage of time has allowed the original memory to fade. Q15. Memories are fragile and can change over time, that is, memories that people believe to be true may in fact be a modified version of the actual event (a false memory). Different areas of our brain are involved in processing true and false memories and their activity can be identified using neuroimaging techniques. Should neuroimaging be used to support the testimonies of eyewitnesses to a crime when there is good evidence that their recollections may be distorted to a degree? Q16. Some mental health professionals encourage patients to imagine childhood events as a way of recovering supposedly buried or repressed memories. Since imagination is a mechanism by which false memories are instilled, what are the ethical concerns of this form of therapeutic intervention?

Making Memories The transfer of information from short-term memory to long-term memory is known as consolidation. During the process of consolidation, pathways in the brain are strengthened or hard-wired as brain cells (neurons) become more efficient in their ability to transmit information to one another. This strengthening process occurs as the spaces between neurons (synaptic junctions) develop more effective means of transmitting a chemical message (neurotransmitter) from one neuron to another (see figure). These neuronal pathways are called memory traces or memory circuits because the strengthening of the synaptic junctions is believed to hold the key to the storage of memories within the brain. Once memory traces are established they can be activated by the thinking mind (the frontal cortex) to reproduce, and sometimes modify, memories. Another form of memory, known as negative memory, actively reduces the strength of connectivity between neurons so that the brain can ignore information that is of no survival significance to the individual. This occurs because our brain is continually inundated with fresh sensory information from the outside world and if our minds attempted to remember all of this information the memory capacity of our brains would be exceeded within minutes. Thus, the brain not only strengthens certain pathways, but it also inhibits others which are processing useless information so that insignificant memory traces are not established. Information is transmitted from one neuron to another across a space called a synapse. Chemical signals, known as neurotransmitters, are released from vesicles in the presynaptic neuron. The neurotransmitters diffuse across the synapse to bind to receptors on the postsynaptic cells membrane. Changes at the synapse can either enhance or reduce the efficiency with which this neurotransmitter signal is transmitted from one neuron to another by altering the amount of neurotransmitter that is released from the presynaptic cell, or the amount of receptors present on the postsynaptic membrane.

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As a way of enhancing the consolidation of long-term memories, the brain has a natural tendency to rehearse information that catches the minds attention. The type of information that tends to be circled repeatedly through the mind is typically that which has an emotional component to it. Information that does not have significant value to the individual typically requires conscious effort to consolidate. In other words, we have to actively cycle the information through our mind. You may be familiar with this phenomenon, for example, most people find it is relatively easy to remember an emotional event such as a time when they were embarrassed in front of their friends, yet find it difficult to recall a mathematics formula that they have actively tried to store in their memory. This occurs because in circumstances where we are excited or scared, hormones such as cortisol are released within the body as part of the stress response. Cortisol is a neuroactive hormone that acts to fast track the consolidation process by enhancing synaptic changes between neurons. The bodys natural tendency to enhance the storage of emotionally laden memories has important survival value for many animals, including humans. For example, in dangerous circumstances we will typically experience emotions such as fear or anger that help us to respond appropriately to the threat (either fleeing the scene or putting up a fight). These emotions, along with the body's 'stress response' which elevates levels of cortisol, help us to remember this important event so that we are better able to respond if faced with a similar situation in the future. Thus, the brains tendency to store emotional memories is an adaptive mechanism that enhances our ability to negotiate the environment in which we live. This adaptive process has important consequences for the neuronal processes involved in addiction, which are similar to those involved in the storage of memories (see chapter F3 for a discussion of the stress response and its role in addiction). Q17. In 1999 researchers genetically engineered a mouse that outperformed regular mice on learning and memory tasks. Should this technology be used in humans to produce people with superior mental abilities?

Memory Enhancement Therapies If medications can improve memory in people with memory impairment, what will they be able do for normal healthy people? As described above, a major research effort is being directed towards the development of memory-enhancing drugs. These drugs target the molecular mechanisms involved in strengthening the synaptic junctions between neurons that are involved in the process of memory consolidation. Although this research is aimed at finding treatments for dementia, such as that which occurs in Alzheimer's disease, there is reason to believe that some of the products under development would enhance normal memory as well, particularly in middle and older age when a degree of increased forgetfulness is normal. There are three primary areas of ethical concern surrounding memory enhancement therapies. The first and foremost concern is safety. Side effects and unintended consequences are a concern with all medications and procedures, but neuroscience-based memory enhancement requires that we intervene in a highly complex system, the functioning of which is not fully understood. This complexity, combined with our lack of understanding of the risks associated with memory enhancement warrants that we precede with extreme caution. In addition to this, the drug safety testing that must be conducted prior to a drug's release onto the market does not routinely address health issues associated with long-term use, trans-generational effects if consumed while pregnant, or the consequences of consumption during periods of nervous system development, such as childhood or adolescence. Another ethical issue of concern relates to the social implications of introducing a memory enhancing drug onto the market. How will the lives of all individuals, including those who choose not to consume the drugs, be influenced by living in a society with widespread memory enhancement? In competitive situations such as examinations that determine a persons acceptance into higher education or the workforce, we may require the equivalent of the regulations used for performance-enhancing drugs at sports events. Whats more, the freedom not to enhance ones memory may be difficult to maintain in a society where at least some of the competition are using memory-enhancing drugs. While for those who do wish to consume the drug, social barriers such as cost will inevitably prevent some from doing so. This inequality could, in turn, further exacerbate the disadvantages already faced by people of low socioeconomic status in education and employment.

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The third category of ethical concern relates to our values and our sense of self. We generally view selfimprovement as an admirable goal, but does this include enhancing our capabilities with drugs? Improving our natural endowments for traits such as memory, not only incurs medical and social hazards, but also runs the risk of altering our perceptions of what we consider normal. That is, what we may have previously considered and accepted as a normal memory may in time be considered a pathology deserving of treatment. In addition to this, if it becomes commonplace to improve our productivity by taking a pill, we may also undermine the value and dignity of hard work, tinkering with the human brain as if it were merely a machine worthy of constant upgrades. This line of thinking flies in the face of many religious and philosophical ideals. There is emerging neurological evidence from work with Buddhist monks who regularly practice a variety of meditation techniques demonstrating that mental training can modify and improve the functioning of the human brain. If this is the case, should people with normal memory function be allowed to boost their memory with a quick fix drug treatment, when the brain can be modified through conscious effort? Q18. A number of pharmaceutical companies are developing new chemicals to improve memory. Would it be a good idea to take a pill to improve your memory and attention? Would a desire to perform well at school outweigh any potential side effects that you may experience, particularly if those side effects would not arise until later in life? What ethical issues can you see arising from the development of such a drug?

The Neuroscience of Pleasure, Reward and Addiction Certain areas of our brain regulate and reinforce behaviors that are pleasurable or rewarding. On the whole, this mechanism encourages us to repeat behaviors that are beneficial to our wellbeing (i.e. eating). Non-life enhancing substances, including certain drugs, can however, alter these mechanisms, which may over time ultimately lead to drug abuse and addiction. Here we shall introduce the delicate biological balance between reward and addiction, describe how drugs of abuse affect the dopamine reward pathway, and discuss lifestyle factors that influence addiction and the ethical issues associated with drug abuse.

What is Addiction? Addiction is often described as an excessive appetite for something and is characterised by an uncontrollable motivational drive to seek out the object of the addiction. Individuals are described as addicted when they can no longer control their behaviour and find it difficult, if not impossible, to refrain from consuming something (e.g. drugs), or partaking in an activity (e.g. gambling). When we think about addictions we typically think of an inability to control behaviours that are detrimental to our health or wellbeing. However, life in itself can be viewed as a series of addictions; such as addiction to air, food and water, that are needed to ensure the survival of an individual and the species. This chapter will focus on drug addiction and takes the medical perspective as defined in Mosbys Medical Dictionary Addiction: a compulsive, uncontrollable dependence on a substance, habit, or practice to such a degree that cessation causes severe emotional, mental, or physiological reactions. Drug addiction, or substance dependence, is characterised by three basic features: A compulsion to seek and consume the drug of choice. A loss of control in limiting its consumption. The experience of negative emotional states, such as sadness, anxiety or irritability, when access to the drug is prevented. Addiction does not simply relate to the positive reinforcement derived from a drug and the desire for the euphoria, or high, that it produces. Two other features also characterize addiction: tolerance and dependence. Tolerance refers to the individual's need to progressively consume increasing amounts of the drug to get the same euphoric feeling as before. Dependence refers to the negative physiological consequences of withdrawal,

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such as nausea and irritability. In this way, drug abuse is not only driven by the pleasurable and rewarding effects of the drug, but also by the desire to avoid the negative effects that withdrawal can incur. Both tolerance and dependence are believed to result from the adaptations that occur within the underlying dopamine neuronal system on which most drugs of abuse act (section F2.2). People consume drugs for a variety of reasons, some may do so purely for the pleasure, while for others it may be an attempt to cope with emotional pain arising from, for example, conflict, stress and/or anxiety. Regardless of the reasons why an individual starts to consume a potentially addictive drug, they will likely become addicted if they continue to take it for a period of time - although the amount required to induce addiction varies substantially between individuals. This variation can be due to lifestyle factors, genetic traits or both. For example, the amount of stress that an individual experiences in early life, or while taking drugs, affects their tendency to become addicted, with those exposed to higher levels of stress becoming addicted more easily (section F.3.4). While genetic traits can enable the neuronal circuits within the brain that mediate addictive states to 'hard-wire' faster and more effectively in response to drugs of abuse so that some are more prone to addiction than others. The mechanism involved in hard-wiring the neuronal circuits regulating addiction are similar to that involved in the formation of memories, whereby the connectivity between neurons in the circuitry is strengthened (Chapter F2). The goal of current neuroscience research is to understand the basic biological changes that occur within the brain that lead to the loss of behavioral control over drug seeking and drug consumption that are involved in addiction. Many recent insights in behavioral neuroscience have been gained through research conducted on animals which have enabled researchers to pinpoint the changes that occur within neuronal cells and between them (at their synapses) in the 'reward pathway' after repeated activation (as occurs with drug consumption). For example, researchers have implanted electrodes directly into the brains reward pathway of a rat and have allowed them to self-stimulate these neurons by pressing a lever which sends an electrical current through the electrode. Rats quickly find this sensation pleasurable and rewarding and will press the lever continuously until they are exhausted, going without food and water, until experimenters intervene. In other behavioral neuroscience experiments researchers have inserted electrodes into the reward pathway of the rats brain and provided electrical stimulation when the rat responds correctly to, for example, directional cues. These rats learn very quickly to turn in the correct direction to receive their mental reward. Experiments such as these have allowed scientists to gain a better understanding of the problems associated with drug addition by providing insight into the function of neuronal reward systems and the repetitive behavioral responses associated with them. However, a crucial ethical issue for debate is whether the experimental animal has lost its freedoms, in particular, the freedom to survive of its own accord and whether this loss of freedom is justified in terms of the information gained; that is, whether it will ultimately lead to the alleviation of suffering. Can we draw a parallel between the loss of self-directed choice that occurs during human addiction and the loss of the rats autonomy in these experiments where the responsibility for its wellbeing is left in the hands of the experimenter controlling it? Q19. Write a diary entry of one day in the life of a controlled rat. Pay attention to all feelings and emotions such as confusion, happiness, discomfort and so on. Do you think that experiments such as these are ethical? Dopamine: The Courier of Addiction Pleasure, which scientists call reward, is a very powerful biological force that helps to direct our survival. If you do something pleasurable, the brain is wired in such a way that you tend to do it again. Life-sustaining activities, such as eating, activate a circuit of specialised nerve cells devoted to producing and regulating pleasure. One important set of neurons involved in this circuit (situated at the very top of the brainstem in the

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ventral tegmental area) uses a chemical neurotransmitter called dopamine (see figure). These dopaminergic neurons release dopamine onto nerve cells situated in a limbic structure called the nucleus accumbens. Release of dopamine in the nucleus accumbens is involved in reinforcing behaviours, which makes an animal more likely to repeat them in the future. Other dopamine fibres make contact in relevant parts of the frontal region of the cerebral cortex to form the dopamine reward pathway. In addition to reinforcing behaviours, the activity of dopamine cells provides the sensation of pleasure through connections to other regions of the limbic system involved in regulating emotion. All drugs that are addictive activate the dopamine cells of the ventral tegmental area to enhance the amount of dopamine that is released in the nucleus accumbens. Natural rewarding activities and artificial chemical rewarding stimuli act on the same dopamine cells, but natural activities are regulated by appropriate feedback mechanisms that protectively control the magnitude of the response. No such regulating restrictions bind the brains responses to artificial stimuli. When an animal is hungry, this strongly motivates the animal to seek food because in the hungry state eating is pleasurable. But when the animal has consumed sufficient food, a satiety centre suppresses the reward system connected with feeding. Thus the seeking of pleasure by the healthy animal or human is adaptive and has survival value. Chemical addiction, along with other addictive behaviours such as gambling or eating disorders (i.e. anorexia and bulimia), can be considered as diseases of the dopamine reward system because they either directly or indirectly result from changes in its normally well-regulated activity. This deregulation of dopamine activity that occurs with addiction can have important consequences for other bodily functions as well. For instance, in addition to forming part of the brains reward system, dopamine also functions as a main neurohormone mediating neural interactions with the pituitary gland which controls metabolism, growth and reproduction. Significantly, drug-mediated deregulation of dopamine activity can have adverse effects on fertility and development through well-documented physiological mechanisms (See Chapter E1 on Lifestyle and Fertility). Over a prolonged period, drug use changes the brain in fundamental and long-lasting ways. These long-lasting changes then regulate the manifestation of addictive behaviours. It is as though there is a figurative switch in the brain that flips at some point during an individuals drug use turning what was once a choice, into a compulsion. The point at which this flip occurs varies from individual to individual, but the effect of this change is the transformation of a drug abuser to a drug addict. Q20. The idea that diseases such as alcoholism have a purely biological causation is attractive and forms the basis of some effective therapies. Morally, however, may not the biological model also be used to excuse a voluntary behaviour without assuming responsibility for the activity or its consequences? In your opinion what are the important distinctions between medical and moral models of addiction?

Prefrontal cortex

Ventral tegmental area Nucleus accumbens

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The dopamine reward pathway Dopamine cells in the ventral tegmental area project to the nucleus accumbens and prefrontal cortex of the forebrain to form the dopamine reward pathway. The release of dopamine in these brain regions regulates and reinforces reward-mediated behaviours, be they adaptive (i.e. eating) or maladaptive (i.e. drug consumption). Q21. Neuroscientists study drugs for many reasons. What are some of the reasons that neuroscientists may have for studying and developing new drugs? Q22. Is there any difference between 'good drugs' and 'bad drugs', and if so, what are they?

The Biology of Drug Addiction The word drug, when used in ordinary speech often denotes a substance whose use is forbidden by law. However, nicotine and alcohol are as much drugs as are opiates, amphetamines and cannabis. In general terms a drug is any chemical agent that affects living processes and pharmacology is the branch of science that studies these effects. As indicated above, scientists are beginning to appreciate the common neurobiological mechanisms of addiction, and how it drives compulsive behaviour. However, it should be noted that the stimulation of dopamine is not necessarily the only mechanism behind addictive behaviours. The subjective high that these drugs promote corresponds to the sudden increase of brain dopamine activity, either alone, or in combination with other neurochemicals. In cocaine use, for example, both dopamine and another neurotransmitter noradrenaline are artificially enhanced creating heightened alertness and levels of energy. The nicotine found in tobacco smoke, on the other hand, activates specific cholinergic receptors called nicotinic receptors, which are normally activated by the neurotransmitter acetylcholine. Nicotine therefore stimulates acetylcholine-mediated activities including respiration, maintenance of heart rate, memory, alertness and muscle movement. But it is through stimulation of the nicotinic receptors on the dopamine cells in the ventral tegmental area that triggers the rewarding sensation, or feeling of satisfaction, experienced by smokers. That nicotine is a highly addictive drug can clearly be seen when one considers the vast number of people who continue to use tobacco products despite their well-known harmful and even lethal effects. In fact, at least 90% of smokers would like to quit, but each year fewer than 10% who try are actually successful. Although, nicotine may produce addiction to tobacco products, it is the thousands of other chemicals in tobacco that are responsible for its many adverse health effects. Smoking either cigarettes or cigars can cause respiratory problems, lung cancer, emphysema, heart problems, and peripheral vascular disease, while chewing tobacco causes cancers of the oral cavity, pharynx, larynx, and oesophagus and damages the gums. In fact, smoking is the largest preventable cause of premature death and disability. Yet its addictive properties; that is, its ability to override the brain's dopamine feedback system, make it difficult for people to exert the self-control required to abstain because their brain has adapted to this artificial stimulation. That is, the natural transmitter acetylcholine is no longer sufficient to maintain dopamine levels because the system has fallen out of balance. Their attention and motivation are therefore directed towards keeping this system active through their consumption of nicotine. So, as levels of nicotine within the body, present from the last cigarette, begin to deteriorate, they will typically crave another cigarette to replenish them. Importantly, lifestyle factors such as stress can enhance this motivation by altering the activity of dopamine cells in the reward pathway (see F3.4). In summary, drug abuse is a complex phenomenon and a persons vulnerability to it can be influenced by a multiplicity of environmental and genetic factors. Whatever the cause, the drug of choice often serves to fix an acquired or deeply embedded need for an emotional transformation. Owing to dopamines potency and biological significance, the body protectively reacts to fake (i.e., drug-induced) stimulation by fading its response to repeated fake stimuli. Thus repeated drug-intake, while initially providing the desired rush, provokes the brain to accommodate to the continued artificial stimulation by decreasing its baseline levels of dopamine which, in turn, forces the addict to increase their drug intake in an effort to bring back previously normal working dopamine levels within the brain.

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Q23: Why would part of our brain be devoted to motivating us to repeat certain behaviours? How would this enhance the survival of a species? Lifestyle, Stress and Addiction Health, as defined in the Constitution of the World Health Organization (WHO), is a state of complete physical, mental and social wellbeing not merely the absence of disease or infirmity. In biological terms, health and ill-health are not alternative states; rather they are part of the same continuum. Without doubt our wellbeing depends on our genes, the conditions under which we live and the ways in which we behave. Drug addiction is one such lifestyle factor that has significant detrimental effects on every aspect of our wellbeing, disturbing physical, mental and social functioning. Since the brain and body communicates in both directions through the immune and the neuroendocrine systems, brain/bodily health is strongly influenced by how an individual can adaptively balance the stress of life. If we respond to change appropriately, stress is good and can be seen as the spice of life. For example, when we react to challenges and survive, we learn from the experience and mature emotionally. In evolutionary terms, if an animal were injured in a classic fight and flight response, immune function is enhanced through the actions of stress hormones, which helps the animal to fight infection and repair the wound. At the same time, stress hormones help the animal to remember the place of action and stay out of trouble in the future by enhancing memory processes within the brain (Chapter F2). Thus, an appropriate stress response is adaptive as it helps maintain physical resistance and enhances memory processes. However, when an individual is stressed for prolonged periods of time, or if the stress response is not properly turned off once the challenge has been met, it creates wear and tear on the body and mind. This wear and tear is called allostatic load. Lifestyle diseases such as heart disease, cancer, gastrointestinal disturbances, diabetes, depression or addiction are all influenced by family and community life, socioeconomic structure as well as incidents in childhood and prenatal development all of which contribute to allostatic load. It is the sense of being in command over our lives that promotes wellbeing more powerfully than an appropriate control of behaviors such as smoking, diet and exercise. Being at the bottom of the social scale, for example, whether provoked by poverty (lower income, lower education, poorer medical care, poorer housing), or advanced by harmful lifestyle (drug dependence, social disengagement, poor diet, lack of exercise), adds to a persons allostatic load, which in turn affects their health. In short, stress, which results in a high allostatic load is a good predictor of declining physical health, declining cognitive function and declining memory. Conversely, the allostatic load score is typically lower in people with higher education and income and, importantly, in people who have more social ties and networks. We are a social animal so social interaction and support is as important as good dietary control and regular exercise in reducing allostatic load. High stress/allostatic load has significant consequences for addiction. The neuroactive hormone cortisol, for example, is elevated in individuals with high allostatic load and influences the functioning of a number of neuronal systems, including the dopamine reward system. Within this dopamine system, cortisol acts to enhance the responsiveness of dopamine cells to drugs of abuse and enhances the synaptic changes that are thought to underlie the behavioral expression of addiction. Exposure to stressful events in early life is believed to have a particularly important influence on the manifestation of addiction, as well as other health problems, in later life. Indeed, the nervous system is particularly vulnerable to the effects of stress in early life, during critical phases of growth and development. Evidence for this comes from both animal and human studies, for example, an association has been made between chemically dependent women seeking counseling for problems related to substance abuse, and their experience of childhood sexual abuse. Similarly, men are more likely to seek help for the consequences of sexual abuse (depression, alcoholism) than for the abuse itself. Current neuroscience research is exploring the mechanisms by which stress, particularly stress that is experienced during early life, functions to flip the figurative switch in the brain that effectively transforms a drug abuser into a drug addict.

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Q24: In order to develop a mature conscience capable of responsible ethical judgment, the child has to be sufficiently loved. Does that statement seem sound to you and if so, can current biological knowledge be used to enhance the value of human love? Q25: Do you see anything wrong with using drugs if they enhance our ability to focus or improve our mood? What do you think society would be like if drug enhancement became the norm?

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Unit 9 Privacy and confidentiality

Learning objectives Students should be able to why patient privacy and confidentiality should be respected. Students should be able to recognize legitimate exceptions to confidentiality.

Genetic Privacy and Information The issue of genetic privacy has been becoming more important in debates about genetic testing. Genetic information may come from many sources, including a persons family medical history, a clinical examination or a scientific test. Here we shall explain what human genetic information is, and how we can learn about our genetic information, and discuss the privacy concerns raised by that information.

Case 9-1: Health insurance and privacy A 21 year-old Japanese woman who is a university student has been considering going to see a psychiatrist. Since she has national health insurance, she has to pay the hospital only 30% of the total medical cost, which she thinks she can afford. What makes her pause, however, is that if she uses the national health insurance her hospital visits will be reported to her father through the company he is working for, which she does not want to happen. Details of treatment or prescribed medicines are not reported but because the name of hospital/clinic she attends will be reported her family can guess her condition. This means she cannot hide the fact that she sees a psychiatrist and that will make them worry. This is because she is a dependent family member of her father in the national health insurance system until she starts to work after graduating from the university. Another option is that she pays all the cost by herself without using the national health insurance but then this is too costly and she cannot go to see a psychiatrist. She has been wondering what to do but she really does not want to let her family know about this and be worried about her. Questions Q1. What are possible options she can consider?

Q2. Should all the hospital visits of family member be reported to the household when they use health insurance?

Q3. This situation could happen for anyone who has any kind of health insurance when they have the insurance as a family. Is there any way of keeping the patients privacy, or should family share all the health conditions that family members have?

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Genetic information Genes largely determine who we take after in our family, and usually we can see a mixture of our father and mother, and someone new. Human cells have 46 chromosomes, 23 from each parent. Each chromosome is composed of a very large single deoxyribonucleic acid (DNA) molecule. A DNA molecule consists of two strands that wrap around each other in a twisted ladder conformation called a double helix. Each ladder rung consists of a pair of chemicals called bases, either A (adenine) and T (thymine) or C (cytosine) and G (guanine). There are over three billion of these base pairs of DNA making up the human genome. Genes are made of DNA. They code the directions for building all of the proteins that make our body function. Except for identical twins, every person has a different genetic sequence. Variation of this sequence, and the responses to environmental factors, accounts for human diversity. There are different types of genetic information. The genotype of a person is all the DNA they have. It provides details, at the fundamental level of DNA or protein sequence. Phenotype is the observable outcome in terms of physical characteristics. In many cases the phenotype is a result of the interaction between genotype and environmental factors, for example, our body weight. Information about a persons physical features and gene-inherited diseases are part of the individuals genetic information. Q1.What genetic factors determine whether we are man or woman? Q2. Think about what characters are determined by genetics and which are determined by the environment. Q3. Would you like to know your genes? What does genetic testing tell us? A genetic test is a laboratory analysis of DNA, RNA, or chromosomal abnormalities that cause or are likely to cause a specific disease or condition, for example, Down syndrome. Tests can also analyze proteins or chemicals that are products of particular genes. Different types of genetic testing can be used to identify carriers of genetic disease, screen newborn babies for disease, predict risks of disease, establish clinical diagnoses and determine direct treatment. Prenatal testing of embryos and fetuses is also widely conducted in some countries, while in other countries it is not permitted if it is linked to abortion (see later chapters). Predictive testing estimates the likelihood that a healthy individual with or without a family history of a certain disease might develop that disease. For example, women who carry the mutated BRCA 1 or BRCA 2 (for BReast CAncer) gene are more likely to develop breast cancer and ovarian cancer than other people. Information about a genetic predisposition can be beneficial to individuals. It can make them seek medical advice and receive therapy for the disease at the earlier stage, so that they can try to avoid environmental factors. However, in the case of single-gene diseases like Huntington's Disease (HD), which has no effective treatment and is invariably fatal; some people may choose not to know the result of the tests. Moreover, a great deal of sensitive personal information can be derived from genetic testing with ethical, legal, and social implications (ELSI) for individuals, families and others. Q4. Can you get a genetic test in your country? If yes, for what diseases? Q5. Should genetic testing be performed when no treatment is available? Give reasons for your answers and discuss. Q6. Should genetic testing be used for children? Why? At what stage in life would you undergo genetic testing? Q7. What do you think are some ethical, legal and social implications of genetic testing?
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Who should know your genetic information? The issue of genetic privacy has been becoming more important in debates about genetic testing. Some genetic information, such as the color of our eyes and hair is easy to see, and cannot be kept secret. But other personal genetic information, such as risk for developing a health disorder late in life, may have a much more private character. People do not expect such information to be disclosed because they feel that this type of information is too personal. Who owns and controls personal genetic information? Who has a right to know the results of a genetic test? The ethical principle of privacy has set limits on who can have access to personal genetic information, and how should it be used. Respect for an individuals genetic privacy requires us to be sensitive to the special role that genetic identity has come to play in their lives. The effects on a person of being informed that he or she would suffer a genetic disorder can be seriously harmful. It may change their ways of thinking of themselves, and change decisions about matters such as marriage, childbearing, and other lifestyle choices. Moreover, genetic information is not only about an individual, but also involves that individuals family and the community in which they live.

Q8. What does privacy mean to you? What things belong to your definition of personal space? Do you think that privacy is individually or culturally determined? Q9. Does your school have your medical records? Who can access them? If not, where are your medical records located? Q10. Do you have a right to know the results of your aunts, cousins, brothers, sisters, or parents genetic test? Why or why not? Employment and Life Insurance Genetic testing not only has the potential to improve the diagnosis, prevention and treatment of diseases, but it can also reveal details of a persons current health as well as information about their susceptibility to disease. It also opens up the possibility of identifying a group of people who may be regarded as socially undesirable, perhaps leading to prejudice or discrimination. An important question facing us is to what extent, if any, genetic traits, conditions, or predispositions should provide a basis for determining access to certain social goods, such as employment and insurance. While individuals may be sure about what they do not want employers to know, employers may believe they have a number of reasons why they should know about medical and genetic information likely to affect the health and performance of employees. Employers have a legitimate interest in ensuring that an employee will be able to perform the requirements of the job, especially with regard to safety issues. An employee with a susceptibility to a genetic disorder has the potential to productivity losses and costs associated with the disease. Employers also have the potential legal liability for injuries to employees. (See the movie guide for the film GATTACA, which illustrates how genetic testing does not determine a persons ability to contribute to a company). The use of genetic information by employers raises a number of ethical issues for workers, such as issues of privacy and discrimination. Employees may also be concerned about discrimination by third parties, such as other employers, if the genetic information is disclosed to them. We should ask whether employers have a right to ask applicants to take a test as a condition of employment. Quite apart from the issues of employment, individuals who are found to be at risk for some genetic disorders may find they can get only very expensive life insurance, if they can get any at all. Insurers may attempt to use genetic information as a condition of insurability. This is because certain kinds of genetic information may

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reveal significant information about a persons future health. Insurers may ask applicants to disclose genetic information derived from a genetic test or from family medical history. Q11. Are the results of genetic tests different to what people can determine from your family history of disease? Q12. Would you take a genetic test if a family member asked you to? What about if your school asked you? Or an employer or insurer asked you? Who has rights to know the results of your test? Q13. Are individuals entitled to keep exclusive information about their genes? Is an insurance company entitled to know what risk they are taking before insuring an applicant? Q14. For what purposes should other persons ("third parties") use this information?

Testing for Cancer Gene Susceptibility Breast cancer kills more women than it does men, but it is a question that faces all in society. Here we shall explain genetic testing using the example of breast cancer, the risks and benefits of genetic testing, and limitations of genetic testing.

Testing for cancer gene susceptibility Genetic testing is based on knowing the genetic code of cells in our bodies. This genetic code, in the form of the chemical DNA, determines everything from hair colour to the way we digest food. Mutations, or changes to the structure of DNA, can make us more susceptible to some diseases or disabilities. Even if you have a mutation, it may not mean you will get the disease, but just that you are more likely to get it. The link between having the mutation and the possibility of getting the disease is not well understood. For example, some genetic mutations interact with factors like a persons lifestyle or other environmental factors such as chemicals or sunlight. The technology for testing for some mutations is now available. Imagine that a simple blood test could tell you if you have a mutated gene that makes you susceptible to getting cancer. There may be the possibility that you could pass this mutation on to your unborn children. Genetic testing provides some opportunities to find out about possible health problems that may not happen for many years. Knowing whether you are more susceptible to a disease gives you the opportunity to minimize the risks, for example, making lifestyle changes. Information from genetic testing is powerful knowledge which raises important questions: Do we want to know what could go wrong with our health in the future? How accurately does it predict the future? Who should be informed and when? Could this knowledge be used against someone? Should people be told if they do not want to know? Q15. If your sister tests positive for the BRCA1 gene, would you recommend to her that she have her breasts or ovaries removed as a preventative measure? BRCA testing Changes to the gene BRCA1 have been linked with breast and ovarian cancer. BRCA1 is a tumour suppressor gene. Tumour suppressors are genes that control cell growth. When enough cells in an area have grown, the tumour suppressors tell the cells to stop growing. When these genes dont work properly, as in the case of

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mutated BRCA1 genes, the signal to stop growing is not always given, growth continues out of control, and tumours result. To test for a BRCA1 mutation, a blood sample is taken, and a specific change on chromosome 17q21 is searched for. Only 5% of women with breast cancer are thought to have this particular mutation. Genetic testing can lead to early detection that could help to prolong and save lives. The information could cause havoc if it was misused or misunderstood. When a woman is told that she carries the gene, she has the following options. She could simply monitor her health. In the case of ovarian cancer this may not be enough as often symptoms do not appear until it is too late. She could choose to have a preventative mastectomy (surgery to remove her breasts) or hysterectomy (surgery to remove either just the ovaries or the uterus and the ovaries). Making the decision and having an operation can cause stress. People deal with stress in different ways. Some people become devastated. This may lead to anxiety attacks, depression or even heart disease. Some people, even if they cannot change their future, find information of this sort beneficial.... the more they know, the more their anxiety level goes down. But there are others who cope by avoiding, who would rather stay hopeful and optimistic and not have difficult questions answered. Some people feel they would have more control over their health if they knew they had inherited a defective gene. Some women might choose to have their children early in life and then proceed with a hysterectomy. And others feel they simply could not adjust to a positive test result. This type of testing can have enormous implications on future employment or health and life insurance eligibility. Suppose a person learns that they have a predisposition to cancer; would they be forced to inform their employers and insurers about the test results? Potential employers may hold this information against them and not offer them the job. If insurance companies were given this information, premiums would increase for those at risk and life insurance may be denied. There are also implications should a person test negative, as this result may lead to people feeling that will not get cancer (complacency). A woman might decide not to monitor her health carefully, neglecting the early detection practices such as self- exam and mammography feeling that she is safe from this cancer. Complacency would be especially harmful if the test results are actually a false negative. It is estimated that less than one in ten cases of cancer results from inherited gene mutations. Most cancers are not the result of inherited factors. Even if a mutation in a gene for a particular cancer is inherited, for example the BRCA1 gene for breast cancer, the cancer will not always develop. Also, both men and women without the gene can also develop breast cancer. Q16. If your sister tests positive for the BRCA1 gene, would you recommend to her that she have her breasts or ovaries removed as a preventative measure? Q17. What information does the article give to help you answer each question? Q18. What additional information do you need? Q19. Is it illegal in your country to use a blood sample for genetic testing even though the sample was taken for another reason? Q20. Write a list of risks and limitations of genetic testing.

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Unit 10 Equality, justice, and equity

Learning Objectives Students should be able to identify and deal with the ethical issues involved in allocating scarce health care resources. Students should be able to recognize conflicts between the health care professionals obligations to patients and to society and identify the reasons for the conflicts.

SARS (Severe Acute Respiratory Syndrome) SARS (Severe Acute Respiratory Syndrome) will go into the medical records as the first new panic disease that has swept international society in the 21st century. Although the number of persons who died from the disease is currently less than a thousand (see the www.who.org website), it affected the lives of millions of persons in 2003.

Case 10-1: Triage A 12year-old boy, accompanied by his mother, came to the hospital with high fever, headache and diarrhea. Since it was January in winter in Mongolia, with cold and dry weather, and the influenza epidemic had already started in the area, the doctor immediately suspected that the boy was infected by influenza. He was acutely ill, so the doctor judged it was necessity for him to receive ventilation support. Then, however, they found out that all the 5 ventilators that the department had were in use for another 11 year-old girl with influenza and 4 elderly people in chronic care. This 11 year-old girl just came yesterday and seemed to start recovering, but her doctors want her to be ventilated for one more night at least. Also, the 4 elderly people cannot live without a ventilator. Moreover, the epidemic of influenza is expected to get more serious within a week or so, and it is expected that the hospital would be full of patients infected with influenza, and some of them, especially elderly people and young children would need a ventilator.

Questions Q1.What are the conflicts and problems in this case? Q2. What ethical issues do you see in this case? Q3. Do you think one of 5 ventilators in use should be connected to the boy? If yes, in what occasion or with what reason will it happen? If no, what are the reasons and should those reasons be based on ethics, rational thinking or something else?

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The focus on SARS was so high in the media that news of SARS overshadowed the outbreak of another panic disease, Ebola virus, that killed more than 100 persons in March 2003 in Congo. SARS is the latest of more than 35 new or reemerged infectious diseases over the last 30 years. The difference was that most people in the world, especially in safe and secure social settings felt protected from Ebola virus of Africa, and even the global pandemic of HIV seems distant from most people who donned masks to avoid SARS. SARS infected and killed young and old, healthy and unhealthy, making everyone seem vulnerable. In Beijing, Toronto, Taiwan, and some other places, hospitals were sealed as an emergency. Patients and staff were all locked up inside the hospital building to isolate them from outside, to stop the spread of the disease. The quarantine orders were announced without little warning and preparation, which caused a massive panic. Similar quarantine emergencies used to be common with diseases like tuberculosis and smallpox in the past. They are a public health measure to protect society from infectious diseases. Those health care workers who were placed in working quarantine experienced fear, depression, anxiety, anger and frustration. During the international battle against SARS one of the features was the high proportion of frontline health care workers who were infected and who died. According to the data compiled from the WHO until the 7 August 2003, 20% of all persons affected with SARS were health care workers (1725/8422). In the early stages of the outbreak, they had all unknowingly treated patients with SARS. Even for the latter stages in the outbreak in the first half of 2003, there were several who became ill with SARS in spite of "full" precautions.

Q1. Did you wear a mask during the SARS panic in early 2003? Q2. How did you feel when someone coughed a lot? Q3. Each person infected with SARS was a victim of another, but do you think people regarded each person as being dangerous and somehow bad? Q4. Every person of any profession has their personal role in a family to be a father, mother, spouse, and child, in addition to their professional roles. Should we respect the health workers autonomy to take a break from intensive work to fight SARS? Do you expect health care workers to die for protecting the public health?

AIDS and Ethics AIDS is killing millions of persons every year, and has reduced the average life expectancy of persons in many African countries by decades. As a sexually transmitted disease it has raised many ethical issues. Here we shall explain the methods of infection with HIV and having AIDS, then consider the global burden of AIDS, and the ethical issues of AIDS including discrimination and fear of persons with HIV. What is HIV/AIDS? HIV is an abbreviation for Human Immunodeficiency Virus. AIDS is caused by getting infected with this virus. When the virus enters the human body, it attacks the immune system. The human immune system protects the body from foreign matters like viruses and bacteria. When the immunity gets very weak, the body cannot fight against even minor infections. Therefore, a sequence of diseases becomes apparent. This stage is called AIDS (Acquired Immune Deficiency Syndrome). There is no one single disease called AIDS. AIDS is the condition in which the body is attacked by multiple diseases due to low immunity. Usually there are no symptoms even after being infected by HIV. This period is called the incubation period. After a long incubation period, as the immune system gets weaker, symptoms such as fever, loss of weight, and

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diarrhea appear. As the immunity gets weaker, the body cannot fight against diseases that we normally dont unity get, such as tumor. This is the symptom of AIDS. At the moment, there is no fundamental cure for AIDS. During all the above period until death, the virus can be spread to other persons. Therefore, it is important to prevent HIV infection. er Q5. What is the difference between HIV and AIDS? . Q6. What are three ways to get infected by HIV? . How do you get infected? There are only three ways to get infected by the virus: virus 1. Sexual intercourse 2. Blood serum contact e.g. blood transfusion, sharing needles by drug users 3. From mother to fetus (vertical transmission) This means that in daily life, if you avoid unsafe sex, there is very little chance to get infected by the virus, unless you are infected by blood. AIDS is a dangerous disease, but it can be prevented! The World Situation (Dec. 2002)
Estimated number of persons infected with HIV/AIDS Total: 42 million

Adults

Children under

Estimated number of deaths due to HIV/AIDS during 2002 Total: 3.1 million

Children under 15 20%

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Adults 92%

Children under 15

Adults

Children under 15
Adults 80%

Activity 1 Fill in the missing cells Write the corresponding letter next to the five items to complete the table. 29,400,000 East Asia & Pacific 1,500,000 Australia & New Zealand 700,000 Country HIV infected persons Newly infected persons per year North Africa Middle East & 550,000 A 570,000 83,000 3,500,000 30,000 250,000 270,000 C 500 45,000 60,000 150,000 Deaths per year 37,000 2,400,000 8,000 25,000 45,000 440,000 <100 15,000 42,000 60,000

Sub-Saharan Africa Western Europe

Eastern Europe & 1,200,000 Central Asia B 1,200,000

South & South-East 6,000,000 Asia D North America Caribbean Latin America 15,000 980,000 440,000 E

The data table is based on the WHO and UNAIDS research on AIDS epidemic update. Accurate statistics are difficult concerning HIV/AIDS, just like other data for any disease. The study on distribution and collecting information about a specific disease is called epidemiology. This study is more difficult for HIV/AIDS because of the long incubation period. Many cases may not be detected unless an individual voluntarily takes blood tests. In poorer countries, it is even more difficult just to take the test. The outbreak of AIDS is most serious in countries inside sub-Saharan Africa, where the average life span of the persons in the country decreased because of such deaths. Still evidence from Ethiopia and South Africa shows that prevention work is beginning to pay off for young women, with HIV prevalence rates dropping among pregnant teenagers (UNAIDS epidemic update 2002) which shows that learning about HIV/AIDS decreases the chance of getting infected by it. Q7. When do you go to the hospital? Do you go there by yourself? Write down how you felt when you went to the hospital, or when you were sick.

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Ethical concerns of AIDS What is different about AIDS from other diseases? When the first AIDS case was reported in the early 1980s, the news terrified many people. Various prejudices caused difficult situations for patients. There were rumors that homosexuals were spreading a fatal disease. Incorrect information increased inequality. Some patients were refused by hospitals, many lost their jobs, and friends rejected each other. This phenomenon is not only seen in the case of HIV/AIDS. The society tends to discriminate patients with infectious disease. A recent example would be SARS. In China where the outbreak was most serious, many people were isolated. In the past, persons having diseases such as Cholera, Leprosy, and Tuberculosis were isolated from society. Many, died in despair. Why were they discriminated? Why did they have to live such a harsh life? Reasons to fear? At present, there is no fundamental cure for AIDS. This means that once you are infected with the virus, it is most likely that you will have to live with it. Still, the AIDS virus is less infectious compared to the influenza virus, for example. The big difference between these two viruses is that a person with influenza has typical symptoms that can be identified both by the persons themselves and by others, where as in the case of HIV, many people may spend years without noticing that they are infected. It may be scary to think that someone around you might have an unnoticed disease. Reasons to discriminate? The main route of HIV infection is through sexual intercourse. The virus can be easily spread in society through one infected person having unprotected sex with multiple partners. On the other hand, it can be avoided by not having sex, or by having protected safe sex with a specific partner. In many countries, it is a taboo to talk about sex in public. The existences of sex workers are seen as immoral by many, but have been present since ancient history. This issue itself contains many ethical debates. Still, can we leave those who are sick because they were involved with prostitution? Lets look at some comments that people gave towards AIDS patients, and think whether you can agree or disagree to each of them. Q8. Why do you think people get sick? Can you blame somebody? Can you avoid it?

Q9. Have you seen any movies or TV dramas discussing AIDS? Have you read any books on AIDS? How did you feel before and after watching it?

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Activity 2. Voices Read each of the following comments. Which comment do you agree with the most? Which do you disagree with? Why?

I will avoid them. God did not give them a second chance.

I doubt their morality but want to help for their recovery.

I have sympathy for those infected by transfusion or those infected by spouse, but dislike the ones who had bad behavior.

I am plain scared of them.

I feel sorry for the ones who get it from blood. Not so sorry for the gay people.

Depends on how they contract the disease. No sympathy for those who use drugs.

I love everyone!

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Activity 3: Role Play Make a group of 4~5 persons and write a scenario where one person doubts that he/she might be infected with AIDS and then decides to take a blood test. Decide among the group members what role you would like to play. Use your imagination! What is the background of the person who wants to take the blood test? Would he/she talk to the family? To a friend? Who are the people surrounding her situation? How would they react? Think how you would act according to your role.

Female Infanticide In some parts of the world still today, families kill girl children when born are killed within 24 to 48 hours of their birth. Here we shall introduce the concept and history of female infanticide, and discuss the case study of female infanticide in India, the causes for female infanticide, and how to prevent female infanticide around the world. Generally Female Infanticide is the act of killing a new born girl baby within 24 to 48 hours of birth. This doesnt happen to male infants. Is this not a grave concern for humanity? Among the creatures in the world there is a tendency of the strongest one to dominate over the weakest one. This is true with human beings also. Although we can find female infanticide in various forms and ways in different countries, most of the countries stopped this cruel method by the middle of the late 19th century. However in certain countries like India, female infanticide still prevails to some degree. The people of Duma sacrifice a child every year to please their deity. The Romans were also accused of this type of practice, and it is said that this practice prevailed in northern Europe also. The Suevi and Scandinavians held it as a fixed principle that their happiness and security could be obtained only at the expense of the lives of others. The Pagan Arabs buried their daughters alive. Female Infanticide in India In India female infanticide prevails to a significant extent, even after the 19th century attempts to stop it. In India the customs of female infanticide originated as a sacrifice to the god in some parts of Bengal. In some parts of Orissa when a couple had no children for a long time they took a vow to the goddess Ganga that if she bestowed upon them children, they would offer the first born to her. If they were blessed with children the eldest was reared for three or four years and on an auspicious day, it was a given a holy bath in the river; the child was encouraged to go further and further into the water till it was carried away by the stream. This kind of offering is still practiced in some parts of Orissa. In Tamil Nadu the horrible fact of killing female children has been reduced but has not stopped yet. There are several causes for female infanticide in India today. The poor economic status of the family plays a major role. The raising of girls is said to be inauspicious with the Dowry System still prevailing as an incentive to avoid financial costs of marrying daughters. Other factors include illiteracy of the parents, and negative influence of some neighbors and society. Why Should Female Infanticide be stopped? Female infanticide affects the immediate society as well as the larger society. When the mother, the father and the siblings are affected by killing a child in the family, the larger community feels ashamed. Female infanticide results in psychological shocks. Therefore they keep the fact as a secret even though the practice is

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very common in the community. The bioethical immaturity of the family should be exposed and proper counseling should be given to the members of the family. To prevent female infanticide around the world, parents should be educated. A baby of any gender should be considered to be the greatest gift of God. In the process of procreation nothing can happen without the presence of the female. Female infanticide is a social injustice to women.

Drama Groups of students can play out this skit in the presence of the teachers. First Family A baby boy is born. The whole family is very happy and all members of the family distribute sweets to their neighbors on this occasion. Neighboring Family A baby girl is born and the whole family seems to be sad and the neighbors come and complain to the mother for giving birth to a baby girl. This hurts the mother acutely and she takes the new born away to a distant place to kill the child. As she is snatching the child, the grandmother of the newborn baby watches this and follows her child. After walking for a distance she asked her daughter why she had taken her new born daughter to a distant place. The mother replies that the agony of giving birth to a girl child has been pricking her mind and so she has made up her mind to kill the newborn. The grandmother politely says to the newborns mother if she had killed her when she was born as a female child, what would have been the plight of the family. The grandmother advises her child and the mother repents for her act and immediately falls down at the feet of her mother and asks for her pardon. Now the newborn baby, her mother and her grandmother return home and give sweets to all the neighboring houses and celebrated the birth of the new girl child. Q10. What is Female Infanticide? Q11. Can we allow Female Infanticide? Who can be blamed? Q12. What is your action plan if you happen to see an incident of attempted female infanticide? Lifestyle and Fertility Some students are just considering about their fertility and others will not yet be considering whether to have children. Our lifestyle now affects our future health and fertility. There are some lifestyle choices everyone can make. Here we shall consider the influences of lifestyle, environment and social development on personal empowerment and reproductive health, and discuss the divide between fertility and infertility, and common causes of infertility. Reproduction and Fertility The capability to bear healthy children depends on our genes, the conditions under which we live and the ways in which we behave. Many environmental and behavioral factors, including nutrition, exercise, poverty and drug abuse, contribute to ill health and poor fertility. Therefore fertility may be a good indicator of an individuals overall health status in certain circumstances. About 15% of couples in developed countries are involuntarily infertile, with a much higher percentage in developing countries (30-40% of women in parts of tropical Africa). The main causes of infertility in developing countries are sexually transmitted diseases (principally gonorrhea and chlamydia) and repeated

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pregnancies coupled with poor hygiene at the time of childbirth, abortion or miscarriage causing secondary infertility. Pregnancy is the best way to judge a couples fertility. A couple is considered infertile if no conception has been achieved after 12 months or more of unprotected sex of average frequency. Fertility problems are equally likely to be caused by a disorder on the mans side or on the womans side. Occasionally there is a problem on both sides, and in about 25% of cases the cause cannot be identified. Unexplained infertility characterizes childless couples where a thorough examination of both partners fails to reveal a specific cause of infertility. By their mid-thirties about one in four couples is infertile. The decline in fertility has several causes including more frequent failure of ovulation, decreasing sperm counts and sperm quality, and an increased likelihood of spontaneous abortion early in pregnancy. A womans menstrual cycles may become irregular in her early or mid-forties. This is the onset of the climacteric - the period of transition from fertility to infertility and may last as long as 10 years. The final termination of menstrual cycles, or menopause, occurs at an average age of 50-52. A healthy postmenopausal woman can become pregnant with the aid of reproductive technology; donated oocytes can be fertilized in vitro and the embryo transferred to her womb or uterus. The pregnancy must be supported with hormone treatments. Q13. Do you want to have children? How many? Fertility Declines with Age Female infertility is normally age dependent and increases from 30 years of age to the menopause; while agerelated rise in male infertility is more gradual. Children who are born to older parents, especially older mothers, also stand a greater risk of having chromosomal abnormalities. One of these is Downss syndrome, caused by an extra copy of chromosome 21. Chromosomal abnormalities increase with maternal age because the mothers oocytes, or eggs, remain frozen in their first meiotic division from early in her fetal life. Increasing paternal age also raises the chances that a child will have certain medical problems. Genetic anomalies in a mans sperm also increase over his lifetime because the sperm precursor cell stocks (immature spermatogonia) are constantly dividing to produce new sperm. Thus, an older mans sperm are the product of a greater total number of cell divisions, and each round of DNA replication carries a chance of introducing a harmful mutation. Of pregnancies that proceed far enough to be detected clinically, about 15-20% are subsequently lost by spontaneous abortion or miscarriage, usually during the first three months or trimester. The majority of all spontaneously aborted embryos and fetuses have chromosomal abnormalities. This contrasts markedly with a 5% chromosome abnormality rate found in stillbirths, clearly illustrating the natural in utero selection processes that eliminate 95% of chromosomal damaged conceptions.

50 - 60% Unknown Etiology 20 - 25% Multifactorial Inheritance 7 - 10% Environmental Agents 7 - 8% Mutant Genes

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Figure 1: Causes of Human Congenital Abnormalities at Birth

6 - 7% Chromosomal Abnormalities

Many Conceptuses Do Not Survive More than half of all human conceptuses are genetically abnormal and have little or no chance of giving rise to a baby. It is generally recognized that human fecundity rate (= the probability of achieving a clinical recognized pregnancy within any given menstrual cycle) is about 25% and high levels of fertilization failures or early developmental death, are the norm at conception. Most abnormal conceptuses are lost at very early stages, failing to implant or implanting so briefly before they die so that menstruation proceeds regularly and the mother is never aware of their existence. In some cases, environmental factors such as alcohol consumption, general anesthesia, or X-ray exposure around the time of ovulation or fertilization may trigger chromosomal abnormalities. Spontaneous abortion is one of natures way to counter negative environmental factors. The causes of most human congenital anomalies at birth are unknown because the majority of common disorders, such as heart disease, diabetes and cancer, are caused by a combination of genetic and environmental factors. If there are many factors we say that the cause is multifactorial in origin (Figure 1). Reproductive health depends upon the smooth succession of physical, physiological, behavioral, intellectual, emotional and spiritual change through which each individual passes from conception to death. Q14. Can you think of anything you do now which might affect your fertility? Q15. Make a list of factors which people think affect your fertility in positive and negative ways. Q16. Do you think that everyone has a right to have a child? Maximizing Health and Fertility This section describes some of the factors that affect fertility. Think about what you can do. (i) Nutrition and Reproduction Food restriction and abnormal eating behavior (as in obesity and anorexia nervosa) lower normal fertility levels. Good nutrition is also vital during pregnancy. Underweight women risk producing an underweight child who will be more likely to suffer a variety of medical problems. Being either underweight or overweight increases the likelihood of premature birth, which is bad for both mother and baby. Besides enough calories, a pregnant woman needs to consume adequate amounts of other nutrients, especially protein, calcium, iron, vitamin A and folic acid (folate). Women who are overweight face an additional increased risk of certain serious disorders during pregnancy including diabetes and hypertension. Under normal conditions the fetus is adept at taking these nutrients from its mother and does not usually suffer any deficiency, but the mother may do so. (ii) Exercise and Reproduction There is a positive correlation between exercise, improved fitness and enhanced sexuality and bearing a healthy child. Traditionally, pregnant women were thought of as fragile creatures who needed to avoid exercise. Its now clear that, except in the case of certain problem pregnancies, exercise has a positive value in maintaining the womans health and sense of wellbeing. Therefore pregnant women should engage in moderate, low-impact forms of exercise, such as brisk walking and swimming, but should avoid exercises that significantly raise the body temperature. Thats because high maternal temperatures may increase the likelihood of fetal abnormalities and may also cause dehydration, which can overstress the mother and her fetus. As well as consuming the right foods and maintaining physical fitness, a couple wishing to make a baby has to avoid a number of agents that can harm the fetus. Alcohol and tobacco heads this list. Fetal Alcohol Syndrome (FAS) has a specific cluster of symptoms. It is not clear whether moderate drinking, like one or two drinks per day, is harmful but several studies have reported that two drinks a day does have ill effects, including reduced

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intelligence, on genetically vulnerable fetuses. The average IQ of the FAS children is about 70 with the severity of intellectual disability being related to the degree of alcohol exposure in utero. (iii) Substance Abuse and Reproduction Heavy alcohol consumption during fertilization and pregnancy increases the likelihood of birth defects and infant death. Drinking whilst pregnant is also associated with Fetal Alcohol Syndrome (FAS). FAS children have characteristic facial appearance and other physical anomalies, are intellectually disabled and may have behavioral problems such as attention-deficit hyperactivity disorder (ADHD). Since no safe level of alcohol intake has been established, women should abstain completely from drinking whilst attempting to conceive as well as during pregnancy. One of the most harmful practices a couple can engage in whilst planning to become pregnant and during pregnancy is smoking. It is testimony to the addictive power of tobacco that, even though its ill effects on fetal health are widely known, only about 20% of female smokers in the US actually quit during pregnancy. Smoking by either the father or mother increases the likelihood of spontaneous abortion, premature birth, low birth weight, congenital malformations and childhood cancer. Smoking's ill effects continue after a child is born where 25-40% of all cases of sudden infant death syndrome can be attributed to the mothers smoking during pregnancy, and babies whose mothers smoke during pregnancy have a 59% higher chance of dying during infancy than those born to nonsmokers. Fetal exposure to addictive drugs such as cocaine, heroin and nicotine cause the baby to be born in an addicted state, as well as having the other harmful effects listed above. Lifestyle of both mother and father influences the health of the reproductive cells (sperm and eggs or gametes) and the baby. Drugs such as nicotine, alcohol, certain recreational drugs and narcotics including marijuana, cocaine, heroin and amphetamines, transmit their effects by increasing the frequency of abnormal sperm, and reducing sperm number, motility and fertilization ability. Self-induced infertility in fathers is a major concern not least because it increases the demand for assisted reproductive technology and associated risks. Q17. Do alcohol and tobacco have warnings for pregnancy written on them? What do the warnings say? Do you think people should smoke? (iv) Other causes of male infertility and the environment There are many possible causes for insufficient or defective sperm. Overheating of the testes by prolonged strenuous exercise or wearing too-tight clothing can also cause a transient reduction in sperm count. More serious, however, are chemical and physical toxins introduced into the environment by human activity that may affect fertility rates in all animals including humans. The average sperm counts in a number of Western societies have dropped by nearly one-half (from 113 to 66 million sperm per milliliter of semen) between 1940 and 1990. During this period the prevalence of certain male reproductive disorders such as undescended testicles (called cryptorchidism) and testicular cancer, have significantly increased. Endocrine disruptors disturb sex hormone function regulating adult fertility by mimicking or antagonizing sex hormone activity. These hormone disruptors include agricultural pesticides and a variety of industrial chemicals such as the polychlorinated biphenyls (PCBs). Agricultural workers experience a decline in their sperm number proportional to the degree of pesticide exposure. Whether endocrine disruptors are also responsible for the observed sperm decline in the general population is not clear. However, if this steady decline continues then male fertility would be severely reduced within a few generations. Undescended testicles, sex chromosome anomalies, infections that cause blockage of the reproductive tract and chemotherapy can all cause irreversible reduction or failure of spermatogenesis.

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Environmental toxins that contribute to reducing male fertility are made more severe in individuals with preexisting genetic or behavioral risk factors. There are many environmental concerns that may be explored in this context just one is given because it provides a good example illustrating the interconnectedness of all biological systems. Many factors may contribute to falling sperm counts and associated anomalies but most attention has been focused on a specific class of environmental pollutants. (v) Immunological Factors in Human Infertility Immunological factors in human infertility are now easily bypassed by in vitro fertilization techniques such as intracytoplasmic sperm injection or ICSI (see the chapter on assisted reproductive technology). However, immunological factors are important in the understanding of infertility treatments because the presence of antisperm antibodies in the serum of the female partner may explain persistent infertility and IVF failure. (vi) Poverty, Population and Development Today in the industrialized countries the prospects for pregnant women and their fetuses are far better than they were in the past. For example, in the USA 80% of all established pregnancies culminate in the delivery of a live child, and once a child is born it has 99.3% chance for surviving infancy. Further, less than one in 10,000 pregnancies now leads to the death of the mother. However, certain social/ethnic minority groups are significantly disadvantaged compared to the general population. Indigenous people in Australia and the United States, for example, experience various forms of difficulties simultaneously, including social discrimination, which can be recognized by the high level of low birth weight infants and excessive neonatal mortality. Good health is a basic human right, especially among poor people afflicted with disease who are isolated, forgotten, ignored, and often without hope. Just to know that someone cares about them can not only ease their physical pain but also remove an element of alienation and anger that can lead to hatred and violence. Former U.S. President Jimmy Carter http://www.cartercenter.org/healthprograms

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Too often indigenous people live on a lower average family income, have a lower level of education, suffer a greater level of unemployment and are relegated to unacceptable overcrowded housing and poor sanitation. As a result many of the persistent health problems relate to alcoholism, other drug dependencies and depression, which then becomes the legacy for the next and subsequent generations. The relationships among environment, poverty and social development are complex and varied; however in the spirit of reconciliation major inequities are increasingly being addressed and it is hoped that this lesson will accelerate the process. In general terms there is broad agreement that personal empowerment and reproductive health is part of an essential package of health care and education. Reproductive health includes ensuring that individuals and couples can make their own choices about family size, spacing of their children and have confidence in a healthy outcome. Q6. Does every child in your society have an equal chance to grow up healthy? Assisted Reproduction There are many ways that we use medicine to improve our health. Reproduction is also part of human health, and there are ways to assist persons who are infertile. More and more technologies are being developed which change the roles of different persons involved in reproduction, including genetic and social parents. Here we shall describe some assisted reproductive technologies, highlight major bioethical concerns, and consider which technologies each person may choose. Assisted Reproductive Technology (ART) Since the first 'test-tube baby' Louise Brown was born in Britain in 1978, more than a million children have been born through assisted reproductive technology (ART). The original IVF technology involved mixing eggs and sperm in a laboratory dish (in vitro fertilization or IVF) and then implanting the resulting embryos (embryo transfer or ET) into the womb or uterus. The technique was developed to help women with blocked fallopian tubes and apart from their blocked tubes there were no additional fertility problems. Since early studies suggested that the new technology was without additional risk to mother and baby, IVF soon became widely accepted and modified developments for the treatment of complex types of infertility became available.

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Q1. Look at the names of assisted reproductive technologies (ART) in Box 1, and list the ones you have heard of before. In this chapter most but not all of these techniques will be introduced and discussed.

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Box 1: Major Assisted Reproductive Technologies (ART) Artificial insemination by donor or by husband (AID; AIH) In vitro fertilization and embryo transfer (IVF-ET) Direct intra-peritoneal insemination (DIPI) Gamete intra-fallopian transfer (GIFT) Zygote intra-fallopian transfer (ZIFT) Intracytoplasmic sperm injection (ICSI) Sperm collection by way of microsurgery Embryo and sperm cryopreservation and storage Cytoplasmic transfer Preimplantation genetic diagnosis (PGD) Karyotyping and genetic manipulation Tissue banking Ovulation induction Laparoscopy and hysteroscopy Laser laparoscopy Hystero-sonography Ultrasound scanning Egg and embryo donation; posthumous gamete donation Flow cytometry Surrogacy Cloning technology

Male-Factor Infertility In this section some factors that affect male fertility are discussed. (i) Standard Semen Parameters A variety of factors (parameters = a factor we can measure) can indicate poor quality semen that reduces male fertility. These are sperm count (number), sperm motility (movement), sperm morphology (shape) and sperm fertilizability (joining of sperm with the egg). Sperm counts are easy to perform, so it is often used to assess fertility. Sperm morphology is one of the best indicators of fertility; however, examination with the light microscope can provide only limited information on their internal structure. The most common group of conditions affecting fertility is characterized by insufficient or poor-quality sperm in the mans semen (see the Chapter on infertility for lifestyle/social factors). The usual rule of thumb is that a man is likely to be subfertile if there are fewer than 20 million sperm per milliliter of semen or if the fraction of the sperm that has normal motility is less than 50%. Q2. Do you know where in your city there are frozen sperm collections? (ii) Artificial insemination If sperm numbers are too low, semen can be collected over a period of time and frozen. Then the entire collected amount can be placed in the womans vagina or directly into her uterus at a time coinciding with ovulation. Partner insemination is usually called artificial insemination by the husband (AIH). It has been also used in cases of forced separation of couples (e.g., prisoners on long-term sentences). The procedure can also be done proactively where men with normal sperm counts may store their own sperm in advance of medical procedures that could affect their fertility; such as chemotherapy, radiation treatment and surgery on the testes or reproductive tract including sterilization. If the male partner is completely sterile or the couple does not want to use his sperm as, for example, when he carries a gene for a serious genetic disease, women can use artificial insemination by donor or AID. Donor

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insemination (DI) is also employed for single women who want to become pregnant, or for women who are partnered by other women. Internationally recognized insemination centers restrict donor recruitment to men who are healthy, free from transmissible genetic disorders and sexually-transmitted disease and have semen with a high fertilization potential. Information about potential donors physical appearance, profession and other interests is usually available to potential recipients. Donor insemination is more successful than partner insemination, does not carry an increased risk of spontaneous abortion or congenital anomalies, and has advantages over adoption in that the child is genetically related to the mother and the couple can experience conception, pregnancy and delivery. It is, therefore, one of the major treatments for male infertility (see also the section on Sperm, Egg and Embryo Donation). Q3. Do you think there should be restrictions on who can use donor insemination? What sorts of restrictions? (iii) Intracytoplasmic sperm injection (ICSI) Intracytoplasmic sperm injection or ICSI, in conjunction with IVF technology, has given hope to men with severe infertility problems. This technique involves the injection, via a micropipette, of a single sperm directly into the cytoplasm of the oocyte (egg) and can be used for non-motile or otherwise damaged sperm. Even a man who produces no mature sperm at all may be able to father a child. Immature spermatids (sperm precursor cells) can be harvested by needle aspiration of the mans testis and used to fertilize the egg. Soon after the development of the ICSI technology it became the standard treatment for severe male-factor infertility but there remain unanswered questions relating to unidentified risks in the children conceived by this procedure. Debate is also continuing as to its use when the male has normal semen parameters. In the presence of normal semen parameters, fertilization by ICSI does not show an advantage over conventional IVF treatment, however, some centers use ICSI for all cases of IVF in order to protect against the possibility of fertilization failure.

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Female-Factor Infertility About 20% of female infertility is caused by abnormalities of the reproductive tract with the commonest being abnormal fallopian tubes. They can become scarred, obstructed, or denuded of cilia as a consequence of pelvic inflammatory disease a general term for infections of the uterus or oviducts, usually caused by sexually transmitted organisms such as chlamydia or gonorrhea. Another condition that can interfere with fertility is endometriosis, a condition where endometrial (uterine) tissue grows at unusual locations such as on the ovaries or oviducts. Although surgery can sometimes restore fertility in such conditions, it often fails to do so. In such

cases it is possible to bypass the fallopian tubes by performing IVF and placing the resulting embryos directly into the uterus. Another 20% or so of infertility cases are caused by failure to ovulate. These conditions can be caused by a variety of physical and psychological stresses (see the Chapter on Fertility). Menstrual irregularity may be caused by, for example, excessive weight loss, strenuous athletic training, anxiety, grief, depression and certain drugs. Q4. Do you think the government should fund ways to help people have children if their infertility was the result of their unhealthy lifestyle during their younger days? In Vitro Fertilization (IVF) Technology In vitro fertilization can circumvent many sperm problems. In vitro means in glass short for in a petri dish. In the standard IVF procedure the woman is given hormones to promote the development of a batch of follicles on a precisely timed schedule. When the follicles are nearly ready to ovulate, a fine needle is passed into each one under ultrasound control, and the oocyte is flushed out. As many as twenty oocytes can be harvested in a single procedure. The collected oocytes are placed in a Petri dish, and the partners sperm are then added. Regardless of the exact IVF procedure used, the artificially fertilized oocytes now embryos - are kept in tissue culture for several days, during which time they divide several times. It is possible at this stage to remove a cell or two from the conceptuses without harming them; the sex and genetic makeup of the removed cells can then be determined. This preimplantation genetic screening procedure is useful if one of the parents carries a disease-causing gene and the couple wants to ensure that their child does not inherit it. One or two embryos are placed in the womans uterus at the same time in order to maximize the chances that at least one will implant. If several embryos are transferred and all implant, the woman may be offered the opportunity to have the number reduced by a fetal reduction abortion. This practice presents ethical problems. High-number or multiple pregnancies such as triplets or quadruplets are associated with all kinds of serious risks to the fetuses and to the mother. Serious outcomes are still births, birth defects and other disabilities, including intellectual, evident by the age of 2 years. A more common problem, however, is not multiple fetuses, but having no fetuses. About a quarter of the attempts achieve pregnancy and birth. The prospects are particularly poor for women over 40 years of age where only about 8% will achieve a successful pregnancy after a single IVF attempt. Q5. How many times would you try IVF in order to have a child? Preimplantation Genetic Diagnosis (PGD) The risk of genetic disorders is a major problem for many couples when thinking about pregnancy. Special tests can detect fetal abnormalities and congenital disorders. These tests include ultrasound scans, amniocentesis, chorionic villus sampling and preimplantation genetic diagnosis. These procedures can also be used to determine the fetus's sex. Preimplantation genetic diagnosis is now considered a valuable approach, which in combination with IVF techniques, enables the screening for genetic disorders before the corresponding embryo is transferred to the expectant mother. Reasons for preimplantation genetic diagnosis include: for carriers of single gene diseases such as cystic fibrosis that is especially frequent in infertile male populations; for carriers of thalassemias that are endemic in the Mediterranean area; for sex-linked diseases; to prevent the transfer of chromosomally abnormal embryos obtained from 'at risk' groups such as older women.

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Sperm, Egg and Embryo Donation There may be surplus embryos generated during IVF treatment that are not transferred into the uterus. Before treatment begins, the couple is required to write their wish regarding the fate of surplus IVF embryos, should there be any. Spare embryos may be discarded, stored frozen for later use, donated to infertile couples or donated to research. If a woman's oocytes cannot be used, oocytes can also be obtained from donors. Obtaining oocytes from female donors is more complex and expensive than sperm donation because the donor must undergo hormone treatment followed by oocyte aspiration (see IVF section). There are certain risks for the donor, including the risk of injury or infection associated with the procedure itself, the risk of unwanted pregnancy (because the donor cannot use oral contraceptives during the period before the donation), the risk of psychological trauma, and a small chance of negative effect on future fertility. Still many women altruistically become donors. Reproductive technologies such as IVF and ICSI are increasingly used by couples experiencing infertility. In many countries they have become standard procedures and the number of children born with their help is increasing annually (even in Japan alone more than 11,000 IVF babies were born in the year 2000). Many parents feel unsure about how, if at all, to communicate the method of their child's conception with their child and significant others. Sharing of information is especially significant when donor material has been used since failure to do so denies the child access to its identifying heritage. Knowing one's origins provides emotional security in terms of identity and belonging and in terms of medical history, as genetic knowledge is sometimes indispensable. It is for this reason that access issues are a major aspect of prenatal ART counseling services. By way of protecting children's best interests, parents are now expected to tell the truth about their conception at some point, preferably before they reach the age of consent. The importance of access to information applies equally whether the child is the result of adoption, donor gametes, donor embryos, some variant of surrogacy or just technological support. Q6. If you were born from donated eggs or sperm, or were an adopted baby, do you think your parents should tell you who your genetic parents are? Summary The main difficulty in evaluating new technology for effectiveness is that we have no good way of seeing how they all work together with each other. It would be wrong to look upon assisted reproduction as the panacea for all causes of childlessness. Instead the technologies are assessed one by one, as if they exist in isolation when what is needed is to assess the impact of ART innovation as a whole. Thus, when forced to choose among several ART possibilities, the logical clinical protocol is to integrate the best available evidence from the literature with clinical expertise and tailor it to the individual situation. Certainly there is also the responsibility for researchers to assess the risks posed by assisted reproduction. This requires epidemiological follow-up studies to determine whether the ART created children bear any cellular or molecular abnormalities beyond the expected in the population at large. Some recent studies have started to raise doubts about the safety of IVF, but for most children born they are merely grateful for the means for their creation. For the sake of future generations of assisted reproduction children, research on human embryos should be encouraged. Finally, taking into consideration new scientific insights, we may be able to retain what is biologically relevant and adaptive, and modify what is not. Surrogacy Surrogacy is when someone does something in place of another person. Some women get pregnant for another woman.

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Gay male couples who wish to have children may also ask a surrogate mother since they cannot get pregnant. In genetic or partial surrogacy the surrogate mother agrees to be artificially inseminated using the sperm from the partner of the woman, and she then carries any resulting fetus or fetuses to term. If the woman who cannot sustain a pregnancy can nevertheless produce healthy oocytes, those oocytes can be fertilized with the partners sperm by IVF and then implanted into the surrogates uterus. This procedure is called gestational or total surrogacy. Either way, when the child is born, the surrogate gives it up for adoption by the couple. Modern surrogacy challenges traditional assumptions about parenthood because assisted reproduction procedures make it possible to separate out the various phases of the reproductive process. It is now possible for a child to be subject to multiple parenting with two men (genetic and adoptee) fulfilling the functions of father and up to three women (genetic, gestational and adoptee) fulfilling the differing functions of mother. The birth of such children also holds wider kin implications for grandparents or other relatives.

Q1. Do you think surrogate mothers should be paid? Q2. Would you consider being a surrogate mother as a part-time job? Q3. In some countries only married women who already have children are allowed to be surrogates. Why do you think that law was made?

Choosing Your Childrens Sex and Designer Children There is a long history of discrimination against females in many cultures. In some cultures there is a lower number of females compared to males that indicates there is sex selection against females. Here we shall describe sex selection, discuss some of the ethical issues associated with its practice, and consider the question of designer children. Sex Selection Some people would prefer their child to be of one particular sex. Sometimes their preference has specific medical reasons; for example, in instances of sex-linked genetic disorders the couple may want a child of the other sex. This usually means a girl, because most sex-linked disorders affect boys. Another reason why couples would prefer a child of a particular sex is for specific social or even religious reasons. The presence of both the sex chromosomes, X and Y, generally results in the birth of a male child while the presence of two X chromosomes leads to the birth of a female. A sperm can either carry the X or the Y chromosome along with the halved number of other chromosomes (22), the autosomes, which do not play a very important role in sex determination. The ova are of the same type with 22 autosomes and one X chromosome. This XX-XY sex determination mechanism in nature presents an equal chance of conceiving a female or a male child.

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Box 1: Some Definitions Sex selection: To prefer to continue/terminate a pregnancy as per the desired sex of the unborn child. Sex determination: The endeavour to know the sex of the unborn child for medical/genetic reasons or for sex selection. Family spacing: To terminate a pregnancy in case there are already very young children in the family. Family planning: To terminate a pregnancy in case the child is not wanted by the couple. Sex ratio: The number of females per thousand males. Embryo: (Greek word meaning to swell) term given to a human conceptus from conception until 8 weeks gestation. Fetus: (Latin word meaning little one, young one or offspring) term given to the human conceptus from 8 weeks gestation until birth.

Q1. Would you like to have a girl or a boy? If you already had 3 boys would you like to have the next child be a girl?

Pregnancy Termination Abortion or the deliberate termination of termination is a medical procedure in which a fetus is not allowed to develop fully to term but is forced out of the mothers womb. The process can be unsafe for the mother and can cause complications and even her death, especially in countries where access to experienced and safe medical clinics is restricted for economic or legal reasons. There are rarely grave medical conditions in which such a procedure is the only means to safeguard the health of the mother. Many a times however, the simplicity of the procedure and the failure in upholding the life of the unborn has led to its misuse in various regions. Ultrasonography (the use of sound waves to form an image visible on a monitor) and a number of medical genetic techniques have made it easier to identify the sex of a child prenatally (before birth) thereby facilitating its use for sex selection, sex determination, family spacing and family planning (See Box 1). The issue of abortion raises a number of issues pertaining to the ethical (right and wrong actions), social and legal implications. It has become a matter for even greater societal concern in the wake of the falling sex ratios, i.e. the birth of unequal number of girls and boys, which are seen in some states in India, Korea and China. There are laws against abortion for reasons of gender selection in many Asian countries, but the practice still occurs. Advances in instrumentation and technology meant for diagnosis of diseased conditions can reveal the sex of an unborn child, sometimes associated with a genetic disorder (See chapter on Prenatal Diagnosis). However, this technology has been misused in many parts of the world to terminate a pregnancy for non-medical reasons (and there will always be an ethical debate over termination in the case of a fetus having a genetic disease). The vast majority of abortions are for normal fetuses not wanted by the parents at that time or because there are too many children already in the family.

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Q2. What will an embryo or a fetus develop into? What is the chances of a fetus at 12 weeks being born if left to the natural course of pregnancy? Q3. Is it right to terminate a pregnancy because the parents do not want a child? How about if it is because it is a girl child?

Designer Children In societies where males are preferred for family succession and females shunned, or for economic factors, for example, because of the dowry system in India, such practices have mushroomed being misconstrued and misused both by the medical professional and the people. This has resulted in less number of girls as compared to boys. The situation has long term consequences when there will be scarcity of brides in a particular society; men will quarrel over brides, killing each other and especially targeting married men to marry their widows, or seek brides outside their caste and social set-up. This will lead to insecurity of married life with detrimental effects for the children also. The problems with pregnancy termination hence raise ethical queries into the status and rights of the unborn child, of the girl child, pregnancy termination as a family planning and spacing method, failure of medical ethics and legislation formulation and implementation. Some of the long-term consequences include social and marital implications, insecurity for married men and their children, lack of brides, etc. Assisted reproductive technology (ART) can also be used for designer children. This means to design the characters in children before they are born or conceived. Preimplantation diagnosis (See chapter E2) can allow embryo selection at 3 days of age when an 8-cell embryo, and parents can then choose which embryo to implant. Most individuals who donate gametes (eggs or sperm) are motivated principally by the desire to help infertile couples and do it for free or a modest fee. However, the question arises whether the ARTs should be available to all to try to improve selected qualities in their children which are unrelated to health. Athletic achievement, beauty, brains, social skills come immediately to mind. It is a fact that some wealthy couples, in the hope of having gifted or attractive children, are willing to pay large sums of money to donors they feel produce gametes of outstanding genetic quality. This demand has led, particularly in the US, to the development of competitive markets for superior sperm and oocytes dubbed ber-eggs raising disconcerting echoes of eugenics (selective breeding programs) and related fears. The commercialization of oocyte donation, for instance, may coerce women to ignore the possible risks of IVF procedures or to conceal undesirable aspects of their and their familys medical history (payment for organ donations is widely prohibited for this reason). An additional concern is whether extraordinary payments for gametes converts the child into a mere commodity. Q4. List both short term and long term consequences of an act where sex ratio is deliberately altered. Q5. Would you like to choose gametes from famous persons? From clever persons? From strong persons? Or just from the person you love?

Prenatal Diagnosis of Genetic Disease Genetic disease affects many persons, and in cases where it is severe, some families decide not to have children. For many parents they only realize this after the birth of the first affected child. Prenatal diagnosis allows the conditions of the embryo or fetus to be checked prior to birth, which presents several options to parents. Here we shall describe methods for prenatal diagnosis and highlight major bioethical concerns

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associated with the choices that can be made while we emphasize that the state should never force selective abortions because of prenatal diagnosis, and discuss the ethical limits of parental choice. Prenatal screening Prenatal diagnosis or screening has become associated with normal prenatal care in most industrialized countries. There are some important non-genetic screening programs. For example, if a woman is not immune to rubella, she should be immunized before becoming pregnant. Recombinant DNA techniques were first used for prenatal selection of sickle cell disease in 1982. However the most common screening used in most countries is based on protein screening because for many diseases it is the lack of functional enzyme that is important, it may not matter what allele you have as long as some protein can be made (see the earlier example of PKU). For a growing number of known genetic diseases, methods have been developed to detect the genetic defect early in fetal life (For methods of genetic screening see the Chapter on Genetic Technology). These methods rely on removing a sample from the fetal material and analyzing it. There are different stages at which fetuses can be screened for genetic disease or abnormalities. As far as the ethics and the distress and the health risk to the mother are concerned, the earlier it is, the better. Fetal sampling is laborious so that currently only a small proportion of the population, can be screened even if it is considered desirable. Ultrasound is routinely used, and has the advantage of being non-invasive. Different methods may be combined, for instance the first screening may be maternal blood sampling, and if the level of certain proteins (e.g. alpha-fetoprotein) is abnormal, there is greater risk that the fetus may have some problem such as spina bifida or a chromosomal problem, like Down's syndrome. Then further testing is needed to check the result of a blood protein test, as still in most cases with an unusual protein level the fetus is normal. Samples of placenta or fetal tissue may be taken from those fetuses considered at high risk, i.e. those of older mothers or parents who have a history of genetic disease. The older technique used is amniocentesis, where cells from the amniotic fluid are removed and grown in the laboratory for analysis. No harm is done to the fetus as the fetus is surrounded by discarded cells in the amniotic fluid which are no longer needed for further growth. The fetal samples can be taken at 11-16 weeks. It is now possible using very sensitive genetic probes to take a sample of the chorionic villi (membranes around the fetus) at 6-9 weeks and analyze the fetal DNA directly to determine whether it has a specific genetic defect, with the technique of chorionic villi sampling. Like amniocentesis there is a 1-2% risk of miscarriage after the sampling due to the procedure, which is why they are not general. We are still unable economically, ethically, or socially, to screen every fetus for so many diseases, with these techniques. Currently efforts and resources are focused on parents with higher risk, however, the latest screening techniques allow hundreds of samples to be tested with over ten thousand different probes simultaneously, which allows low cost routine screening, which could enter widespread use. In the mid-1990s mail order companies in the UK conducted cystic fibrosis tests. In the future it will be possible to routinely use the technique where the few fetal cells that can be found in the mother's blood are isolated, and analyzed. It is already possible to use preimplantation diagnosis to look at an embryo before implanting it in the mother, when IVF is used. However, IVF is not an option for general use in developing countries at present as medical resources are limited. It may be an option for those parents who refuse abortion of a fetus, but have a high risk of passing on a genetic disease. Q1. Would you be interested to know the genetic profile of your embryo/fetus before birth? Why?

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Therapy or abortion after prenatal diagnosis? The general aim of prenatal diagnosis is to reassure mother's who are worried that their fetus has some disease. They may avoid pregnancy without the possibility of such reassurance that the fetus did not inherit some disease, or abort because they worried about some ill effect from a drug used before the mother knew she was pregnant. Prenatal diagnosis does not always mean an affected fetus will be aborted. In fact, medically it should be separated. There are a number of advantages for the parents who want to bear a child regardless of the fetus's condition. The first is that some therapy may be possible to solve the problem, or even to lessen the seriousness of the condition. There are even cases of surgery being performed on a fetus and the fetus being returned to the mother's womb. Another benefit is knowledge, to be informed before birth and emotionally prepared. Human procreation is associated with a high degree of error, because when genetic elements rearrange there are often mistakes. The number of fertilized embryos with genetic abnormalities may be about 70%. Most of the genetically abnormal embryos are never implanted, or are spontaneously abort in early pregnancy. But some babies are born and will die later; some have a painful life, while others do not. Q2. Is it right to terminate a pregnancy if the unborn child has a genetic/medical defect which cannot be treated? Is it right to terminate a pregnancy if the unborn child has a genetic/medical defect which can be treated? Ethical issues of prenatal diagnosis If a fetus has a serious genetic impairment, with a consequence of serious mental deficiency, some people might say that the fetus does not, and will not in the future, have a "life" as "normal" humans have a life. While the potentiality is different, it is impossible to define what is a normal human life, and it is discriminatory to claim that some human beings do not have a life worth living. One of the achievements of the twentieth century has been to fight for the rights of all persons, and to not allow some people to claim other people are inferior. There are quality of life issues, but can we deny the potential for spiritual relationship between God and the most diseased forms of human life? Severely retarded individuals may not appear spiritually aware - but can people judge? Many religions would argue there are no "worthless" lives. We should build a society to prevent discrimination, and make life easier for those with disability, whether or not we accept using prenatal screening. The ethical issues that remain are questions of whether mothers can choice to follow up diagnostic tests of the embryo or fetus, which can provide useful information for preventative action, with choices for abortion. This controversial issue will remain a divided question in the following centuries the same as it has for millennia in writings about the ethical issues of abortion. Different countries have contrasting approaches to these questions. This book chapter does not take a position on this topic, except an observation that it is a difficult moral dilemma and each culture has different ways to cope with the lack of consensus that is universal on the morality of these questions. Whose choice? We can take the viewpoint of the child to be, the mother, or the family, and all views are important in cultures which are family-centered. Once we start to take societys broader view, there are more ethical questions about interference in reproductive rights of persons. Although we will continue to see ethical division over the morality of prenatal genetic screening, with some people continuing to reject it, ethically we need a system to respect the informed choice of families. They must decide their responsibility to present dependents and future children, and think firstly of the children's quality of

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life. The correct decision is not to say do not abort or abort, but it may be the decision made by the informed mother. Society may put limits on the extent of this choice, e.g. maybe for sex selection, and maybe for fears of misuse. Q3. Imagine you are the government minister in a resource-poor country with a large population. What policy options to govern health services related to prenatal diagnosis would you offer? Child Labor In the Developing Countries of the world it is reported that two in three children are illiterate and go to work to support their families. Here we shall help you understand what child labor is and how we could help in the eradication of child labor. Meaning of Child Labor Normally, persons above the age of twenty one go to work in order to support themselves and their families. In the present world scenario we can see children on the streets between the ages of four and adulthood doing all sorts of work that should be done by adults. Child labor can be defined as the work done by a premature child below the age of the official end of school in public or private organizations. No one should be allowed to work at such young ages to support himself, herself or their family.

Look at the Following Pictures which show children who are working as Child Labor

The world is a global village where all are born equal. The reasons for child labor include poverty, being disinterested in studies, a selfish attitude of the parents, interest in earning, conventions and customs. Socioeconomic factors might influence a child to go to hazardous work to earn a living. This should be eradicated by giving proper education to the parents as well as the children. Each one has a duty to prevent child labor in a positive way. Child Labor is against human rights, and also against bioethics. According to the UN every child has equal rights to be educated from the beginning age stipulated by the state. If any individual or group violates this constitutional law then it becomes a crime. Q1. There may be many other reasons for Child Labor. Can you list some of the reasons which you have encountered in your locality? Q2. Think about who can eradicate Child Labor? Q3. List some suggestions to eradicate Child Labor Q4. Find a reference to show the wages, hours and conditions that children who are used as child labor today encounter. What was the situation in your country 200 years before for children and labor or education?

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Unit 11 Non-discrimination and non-stigmatization

Learning Objectives: Students should be able to explain the concepts of discrimination and stigmatization in the context of bioethics. Students should be able to identify different contexts and bases of discrimination and stigmatization and their implications. Students should be able to identify and deal with situations where exceptions to the principle can be justified.

Eugenics For millennia there have been attempts to improve hereditary qualities through selective breeding. Eugenics can be defined "as any effort to interfere with individuals' procreative choices in order to attain a societal goal". The word means "good breeding" from the Greek names Eugene and Eugenia expressing the notion of "well born" which was a celebration of parents belief that their offspring are especially blessed.

Case 11-1: Reporting an HIV test result to a couple Alisa, 34 years old and Kenji, 32 years old, are a Japanese couple having been together for 9 years. They are not married but have been living together and sharing a household. They are thinking to have a baby in the near future but neither of them thinks about getting married because they believe it is not necessary to start a family. One day they go to a local health care center which provides free HIV tests. They do not have any concern that either of them would have a problem but think it is a good opportunity for them before having baby and also because they have never taken the test in the past. While waiting for the results after test, they fill in some information about their age, gender, marital status, health information, diet and other questions. This is not for identifying who takes the test, so they need not tell their name or address, nor other personal information that can identify the person later. When their names are called to tell the results, they are led to different rooms separately. It is a small surprise for them because they thought they would be told the results together, so Alisa asks about that to the staff. Then the staff tell them that they do not inform the results to anyone except the person who took the test and his/her spouse, even if the person who takes the test agrees to have his/her partner hear the result. If they want to know the results of their partners, they can tell each other what they are told in the center. Eventually they follow the centers rule and hear each result separately. However this makes them confused in the sense that they have to be married to hear the results of HIV tests and also they dont understand why the health care center has different attitudes towards married couples and unmarried couples. Questions Q1. What is behind the different attitudes of the health care centre to married and unmarried couples when the health care centers tell the results of these tests? Q2. Should there be any policy that results of certain disease or medical tests should be informed only to the first person or limited family member(s), even though the first person agrees or wants to have the third party with her or him? Q3. Some couples choose not to marry but stay together just like married couples, or recently many young couples start living together before they marry. Also same gender couples are not allowed to marry by law in some places, though they want to. When people are in this situation, what considerations should apply in medical treatment?

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The term "eugenics" was coined by Sir Francis Galton, an English scientist (1822-1911), based on studies of hereditary and Mendelian genetics. The eugenic idea has been abused in the past; for example, by the Nazis in the 1930s and early 1940s. Some countries have implemented social policies to promote eugenic population selection even today, including immigration policies and reproductive technology, but generally modern eugenics is based on eliminating genetic disorders. Several forms include: Eugenics of normalcy: Policies and programs intended to ensure that each individual has at least a minimum number of normal genes. Negative eugenics: Policies and programs intended to reduce the occurrence of genetically determined disease. Many countries sterilized persons to stop them having children in the twentieth century. Positive eugenics: The achievement of systematic or planned genetic changes to improve individuals or their offspring. This includes selection of healthy genes, and use of gametes from people thought to be superior in intelligence or physical characters. When abused it has been developed into genocide and "ethnic cleansing". Ethnic cleansing is the mass expulsion or extermination of people from a minority ethnic or religious group within a certain area and who, in many instances, had lived in harmony for generations prior to the outbreak of national hostilities. Well publicized examples include ethnic atrocities experienced in the former Yugoslavia. War violates fundamental human decency but is at its worst when actions are taken against civilian populations subjected to atrocities such as rape, assassinations, massacres, torture and ethnic cleansing. Q1. What is a bad gene? What is a good gene? Is there any such thing? Q2. How different are other persons perceptions of bad and good? How much desire could parents have for certain characters, e.g. eye color, height, obesity, of their children? Q3. What did the Nazi eugenics policy in Germany in the 1930s-1945 lead to? Q4. Does anyone want to have sick children? How much should we try to have children without disease?

Genetics, DNA and Mutations There are numerous ethical issues raised by genetic technology, so some background knowledge of DNA and genetics is needed to discuss the issues. Here we shall introduce the basics of genetics, what mutation is and how it can cause genetic disease. Why do humans make humans, and birds make birds? Organisms do not pass their replica to the next generation but rather genetic material containing information needed to construct a progeny (offspring). In almost all organisms DNA is the genetic material, except for some viruses where it is RNA instead. The genetic constitution of an organism is called its genotype. Interaction of this genetic constitution with the environment results in the physical appearance and other characteristics of an organism which is called its phenotype. DNA works as a database or store of information needed to make an organism. It exists in the form of sequence of four nucleic acids A (adenine) T (thymine) G (guanine) and C (cytosine). When two strands of DNA are together, A binds with T and G binds with C, and these are called base pairs. There are approximately 3 billion

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base pairs in the human DNA. Genes are coding regions of the DNA that carry necessary information needed to make proteins, which are structures present and operating in the cells and organs. Genes are passed from one generation to the next during reproduction and are called the units of heredity. Variations in the sequence of DNA make each organism different. Genes express and function differently in all species, which makes each species and even each organism unique. Although almost all organisms have DNA (and a few viruses have their genetic information encoded as RNA), the expression of genes determine what we look like in general. Several genes get switched on or switched off during development and determine our phenotype. Environmental interactions also can determine diseases and behavior. The genetic code of all living organisms is made up of DNA.

Q5. Think about the closest organisms that are similar to human beings? Q6. What do you think if all organisms look alike? Q7. How many genetic diseases do you know? How many mutations do you have? How many fatal recessive alleles do you carry in your genome? Mechanism of genetic diseases and mutations Every person has a different genetic sequence except for identical twins. The genes are made of DNA. DNA is a long chain of units, called bases, and there are only four kinds of base (ATCG). Each position of the DNA can be one of the four bases, and the genetic sequence is the order of these bases. In the same way the sequence of this sentence determines what we understand in reading it, the sequence of DNA determines what happens in living organisms. There are only four possible characters for each position, but even a short sequence of 20 positions could have many possible combinations of sequence. DNA is a long chain of these units, which forms a spiral geometrical structure called a double helix. Functional lengths of DNA are called genes. Each gene may be involved in defining one particular function or character at the phenotypic level. There are many new genes discovered every week. Our genes are in long linear strings, called chromosomes. Humans possess 23 different pairs of chromosomes, a total of 46. While every human has the same set of chromosomes and thus types of genes in the same order, each gene has variant types which are called alleles. Alleles differ in their exact sequence of DNA but they should generally perform the same function. We can have many different alleles, for example there are at least 46 distinct alleles of the gene phenylalanine hydroxylase (e.g., a mutated allele of this gene is responsible for the disease PKU). There are mutations found in each of these alleles, which would make total genetic screening for PKU impracticable, but a simple cheap enzyme test can be performed. Mutations are changes in the nucleotide base sequence, and are quite common. Mutations can be caused by random chance, by chemicals or radiation, and most commonly are caused by reactive chemicals (free radicals) formed in the ordinary process of metabolism. Specific mutations are often seen as a response to ultraviolet (UV) light or smoking. The DNA repair enzymes can repair most of these, others may escape repair and can result in abnormalities, such as cancer. If the mutation occurs in the zygote, or reproductive (germ) cells, the new offspring may carry the mutation. Somatic mutations play a role in the development of most cancers, being steps in the process. Only some mutations actually cause harm, others may make no harm (see Fig. 1). This complex system is in delicate balance, and it only requires a defect in a single gene to disrupt this balance, the effect sometimes being lethal.

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Figure 1: Mutations alter Amino Acid Sequences The original and the mutated DNA sequences may give rise to the same amino acid, a different amino acid, or stop translation. A frameshift mutation completely alters the amino acid sequence resulting in a nonsense message. DNA Sequence Original AACTAATTGCGTA Neutral Mutation AACTAGTTGCGTA Single amino acid change AACTACTTGCGTA Deletion, frameshift AACT/ATTGCGTA Insertion, frameshift AACTAGATTGCGTA Protein Sequence Leu-Ile-Asp-Ala-

Leu-Ile-Asp-Ala-

Leu-Met-Asp-Ala-

Leu-Ile-Thr-His-

Leu-Ile-STOP

The cause of many genetic diseases is a simple nucleotide substitution, which occurs at a low frequency during the duplication of DNA. The effect of this nucleotide alteration is summarised in Fig 1. The effect does not always depend on the size of the deletion, but more on whether the resulting sequence has shifted in the reading frame for protein translation. This is summarised in Fig. 2. For example, in patients with muscular dystrophy, part of a gene for a protein dystrophin is deleted. The severity of the disease depends on whether it is out of frame, rather than how much is missing. As long as some type of protein can be made the muscle cells may still be able to function. Figure 2: Effect of frameshift mutation Original THIS LINE CAN BE READ WELL Single letter deletion (frameshift) THIS LINC ANB ER EADW ELL Whole word deletion (not a frameshift) THIS LINE BE READ WELL There are also more major mutations, where large fragments of DNA can be translocated to a different chromosome. Abnormal chromosome numbers can also occur, so instead of two copies there may be three copies. Because this alters the number of alleles of genes for certain proteins, this can have major affects, usually resulting in death. Trisomy 21, where there are three copies of chromosome number 21 results in Down's syndrome, and is an example where death may not necessarily be the result. In most other chromosome trisomies, death occurs during fetal growth, and/or as a result of spontaneous abortion. Often only one of each pair of alleles of each gene is needed for normal function. Some of the alleles may be so different in their sequence from normal that the protein or enzyme they produce is nonfunctional. If this is the case then the individual will use the other functional allele of the pair and this will normally allow a completely normal life or phenotype. Sometimes one of the alleles produces an abnormal but functional product; again the individual will probably live normally. But if the individual possesses two nonfunctional, or misfunctional alleles for any gene then the effect will be a genetic disease. Normally the defective allele is not used if there is

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a normal, functional alternative allele, and the allele would be called recessive because of this. A recessive allele/gene is therefore one which does not get used to create the phenotype. The allele which is used is called the dominant allele/gene. People may carry a recessive disease-causing allele without it having any effect on them, but it is possible that it will be passed on to their offspring. In some cases the defective allele is dominant which means even an individual with one normal and one defective gene will suffer from the disease. Dominant and X-linked mutations often cause severe disease and interfere with reproduction so would not last many generations. Recessive mutations have the greatest chance of being maintained in the population, no mutations would be eliminated in the first generation, as each individual would only be a carrier, and if there is only one copy, then there is no effect. They would be present for generations, for example, the most common mutation in cystic fibrosis is thought to have originated about 50,000 years ago. Genetic disease is not usually lethal and some abnormalities have little effect. About 3-4% of children suffer from some type of genetic disease at birth. Every human possesses a specific genotype, consisting of many units called genes; each gene directs the manufacture in our body of a specific component, these components are usually proteins of which the most important class for genetic studies are enzymes. Every person has new mutations, and carry alleles which could cause disease. We all carry about twenty recessive alleles for lethal characteristics, but because these occur at low frequency the incidence of a child being born with two recessive alleles is low. Some mutations are found in the reproductive cells (ova and sperm) and others in the body (somatic) cells. Both types of mutation have the potential to cause cancer.

Genetic screening DNA is normally found in double-stranded form (the double helix). The four bases are given the symbols, A, T, G, and C. The base A binds with T, and the base G binds with C, between these long chains, as is shown below: ---ATTCCGAAGCTGACTGA--- parent chain ---TAAGGCTTCGACTGACT--- complementary Genetic screening involves the use of this complementary binding. A sample of DNA is taken from a cell, and then the DNA is split into single chains. The bases in this single-stranded DNA will bind to the pairing bases. To make it easier to test, this single-stranded DNA may be fixed to a plastic filter. We can test for the presence of a certain sequence in this fixed DNA by adding a solution of single-stranded probe DNA, a short sequence of synthetically made DNA with a label on it, like a fluorescent dye. After mixing the probe with the sample, the probe that is not bound to the complementary sequence is washed away. If there are copies of the sequence in the sample, we will be able to see the probe when we hold the filter under ultraviolet light, because the probe is fluorescent. If there is no complementary sequence in the sample to the probe, then we will not see any fluorescence. In this way, many samples can be tested, with many probes, and this is known as genetic screening. We screen for the presence or absence of particular DNA sequences that represent different genes. This screening can be used to detect a mutation, for example to tell that a fetus has a mutation that will cause a genetic disease (prenatal diagnosis). It can also be used to detect which types of bacteria may be present in a food sample, or for medical diagnosis of a patient. Information about whether an individual has a particular DNA sequence and gene can be very powerful, especially in the diagnosis of genetic disease. There are many ethical and legal issues that result from this technology, as discussed in following sections on genetic privacy and information. For example, presymptomatic screening means testing for a late-onset genetic disease, like Huntington's disease, before the person is sick. Such predictive power may require psychological counseling. It is very important that privacy is

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respected, because the information in a person's genes identifies risk factors for disease that medical insurance companies and employers could use to discriminate against people. There are already cases of discrimination against individuals after genetic testing in North America. Many genetic diseases (such as diabetes or cancer) are caused by the effects of multiple genes, and the relationship between the environment and genes. Genetic susceptibility means that a particular gene is only one determinant for the development of a complex disorder. For example to have an allele called Apo E4 (that about 10% of Caucasians and Asians have) increases the risk of developing Alzheimer's disease, and confers a very strong susceptibility at younger age if you have two alleles. Alternatively, another allele for this gene, Apo E2, seems to be protective against Alzheimer's. Q8. Is there any advantage to having presymptomatic screening for Alzheimer's disease when you are 20 years old? What about when you are 60 years old? Q9. If you check on the Internet for keywords like gene array or gene test, you can find many examples of genetic tests. Find some examples and write about the advantages and disadvantages of genetic screening.

Genetic Privacy and Information The issue of genetic privacy has become more important in debates about genetic testing. Genetic information may come from many sources, including a persons family medical history, a clinical examination or a scientific test. Here we shall explain what human genetic information is, and how we can learn about our genetic information, and discuss privacy concerns raised by that information. Genetic information Genes largely determine who we take after in our family, and usually we can see a mixture of our father and mother, and someone new. Human cells have 46 chromosomes, 23 from each parent. Each chromosome is composed of a very large single deoxyribonucleic acid (DNA) molecule. A DNA molecule consists of two strands that wrap around each other in a twisted ladder conformation called a double helix. Each ladder rung consists of a pair of chemicals called bases, either A (adenine) and T (thymine) or C (cytosine) and G (guanine). There are over three billion of these base pairs of DNA making up the human genome. Genes are made of DNA. They code the directions for building all of the proteins that make our body function. Except for identical twins, every person has a different genetic sequence. Variation of this sequence, and the responses to environmental factors, accounts for human diversity. There are different types of genetic information. The genotype of a person is all the DNA they have. It provides details, at the fundamental level of DNA or protein sequence. Phenotype is the observable outcome in terms of physical characteristics. In many cases the phenotype is a result of the interaction between genotype and environmental factors, for example, our body weight. Information about a persons physical features and gene-inherited diseases are part of the individuals genetic information. Q10. What genetic factors determine whether we are man or woman? Q11. Think about what characters are determined by genetics and which are determined by the environment. Q12. Would you like to know your genes? What does genetic testing tell us? A genetic test is a laboratory analysis of DNA, RNA, or chromosomal abnormalities that cause or are likely to cause a specific disease or condition, for example, Down syndrome. Tests can also analyze proteins or chemicals that are products of particular genes. Different types of genetic testing can be used to identify carriers of genetic disease, screen newborn babies for disease, predict risks of disease, establish clinical diagnoses and

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determine direct treatment. Prenatal testing of embryos and fetuses is also widely conducted in some countries, while in other countries it is not permitted if it is linked to abortion (see later chapters). Predictive testing estimates the likelihood that a healthy individual with or without a family history of a certain disease might develop that disease. For example, women who carry the mutated BRCA 1 or BRCA 2 (for BReast CAncer) gene are more likely to develop breast cancer and ovarian cancer than other people. Information about a genetic predisposition can be beneficial to individuals. It can make them seek medical advice and receive therapy for the disease at the earlier stage, so that they can try to avoid environmental factors. However, in the case of single-gene diseases like Huntington's Disease (HD), which has no effective treatment and is invariably fatal; some people may choose not to know the result of the tests. Moreover, a great deal of sensitive personal information can be derived from genetic testing with ethical, legal, and social implications (ELSI) for individuals, families and others. Q13. Can you get a genetic test in your country? If yes, for what diseases? Q14. Should genetic testing be performed when no treatment is available? Give reasons for your answers and discuss. Q15. Should genetic testing be used for children? Why? At what stage in life would you undergo genetic testing? Q16. What do you think are some ethical, legal and social implications of genetic testing? Who should know your genetic information? The issue of genetic privacy has been becoming more important in debates about genetic testing. Some genetic information, such as the color of our eyes and hair is easy to see, and cannot be kept secret. But other personal genetic information, such as risk for developing a health disorder late in life, may have a much more private character. People do not expect such information to be disclosed because they feel that this type of information is too personal. Who owns and controls personal genetic information? Who has a right to know the results of a genetic test? The ethical principle of privacy has set limits on who can have access to personal genetic information, and how should it be used. Respect for an individuals genetic privacy requires us to be sensitive to the special role that genetic identity has come to play in their lives. The effects on a person of being informed that he or she would suffer a genetic disorder can be seriously harmful. It may change their ways of thinking of themselves, and change decisions about matters such as marriage, childbearing, and other lifestyle choices. Moreover, genetic information is not only about an individual, but also involves that individuals family and the community in which they live. Q17. What does privacy mean to you? What things belong to your definition of personal space? Do you think that privacy is individually or culturally determined? Q18. Does your school have your medical records? Who can access them? If not, where are your medical records located? Q19. Do you have a right to know the results of your aunts, cousins, brothers, sisters, or parents genetic test? Why or why not?

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Employment and Life Insurance Genetic testing not only has the potential to improve the diagnosis, prevention and treatment of diseases, but it can also reveal details of a persons current health as well as information about their susceptibility to disease. It also opens up the possibility of identifying a group of people who may be regarded as socially undesirable, perhaps leading to prejudice or discrimination. An important question facing us is to what extent, if any, genetic traits, conditions, or predispositions should provide a basis for determining access to certain social goods, such as employment and insurance. While individuals may be sure about what they do not want employers to know, employers may believe they have a number of reasons why they should know about medical and genetic information likely to affect the health and performance of employees. Employers have a legitimate interest in ensuring that an employee will be able to perform the requirements of the job, especially with regard to safety issues. An employee with a susceptibility to a genetic disorder has the potential to productivity losses and costs associated with the disease. Employers also have the potential legal liability for injuries to employees. (See the movie guide for the film GATTACA, which illustrates how genetic testing does not determine a persons ability to contribute to a company). The use of genetic information by employers raises a number of ethical issues for workers, such as issues of privacy and discrimination. Employees may also be concerned about discrimination by third parties, such as other employers, if the genetic information is disclosed to them. We should ask whether employers have a right to ask applicants to take a test as a condition of employment. Quite apart from the issues of employment, individuals who are found to be at risk for some genetic disorders may find they can get only very expensive life insurance, if they can get any at all. Insurers may attempt to use genetic information as a condition of insurability. This is because certain kinds of genetic information may reveal significant information about a persons future health. Insurers may ask applicants to disclose genetic information derived from a genetic test or from family medical history. Q20. Are the results of genetic tests different to what people can determine from your family history of disease? Q21. Would you take a genetic test if a family member asked you to? What about if your school asked you? Or an employer or insurer asked you? Who has rights to know the results of your test? Q22. Are individuals entitled to keep exclusive information about their genes? Is an insurance company entitled to know what risk they are taking before insuring an applicant? Q23. For what purposes should other persons ("third parties") use this information?

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Unit 12 Respect for cultural diversity and pluralism

Learning Objectives: Students should be able to explain the meaning of culture and why it is important to respect cultural diversity. Students should be able to explain the meaning of pluralism and why it is important in the field of bioethics. Students should be able to deal with cultural diversity and take into consideration cultural specificities (appropriate approach, positive inputs and limits) with respect to the fundamental principles of bioethics and human rights. Genetically Modified Foods Since 1995 people in the U.S.A have routinely eaten food made from plants that have been modified by genetic engineering. The economic importance of the food industry is one of the reasons why some other countries have placed limits on import of genetically modified (GM) food, as well as health concerns to the public. Here we shall discuss some issues related to genetically modified food, including the ethical issues of labeling genetically modified food.

Case 12-1: Baby with intersex condition A baby of a couple was born as their third child two weeks ago. The baby has intersex condition and the doctor told the parents that the baby needs a surgery, which means that it is required to choose one of two sexes. Since the condition does not cause physical suffering to the health or life of the person, the surgery can be taken in the future when the baby grows up and knows what sexual identity she or he has. Although the parents understand the importance of respecting the childs will, they worry that the child would be confused with their condition and may not be able to suit to the society, which could cause a number of serious problems. Also they may face discrimination from others and that they cannot expect what kind of difficulties they would have were another concern. The parents thought that even if they decide the sex for the child and get the surgery done, the child does not need to know this condition, and can grow up just like other children. Questions Q1. What do you know about intersex condition? What are differences between the Intersex and the Gender Identity Disorder? Q2. What are benefits and harms of taking the surgery early? Should surgery be delayed until when the child can decide? Q3. What would you do if you are a parent of the baby? Q4. Do you think there should be a choice of not taking surgery forever, if the person does not want to? Q5. What kind of difficulties do you imagine for people with intersex condition in society? How could it be solved?

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Genetic engineering and Food Genetic engineering or genetic modification alters the genetic constitution of organisms by mixing the DNA of different genes and species together. The living organisms made with altered DNA are called Genetically Modified Organisms (GMOs). Genetic engineering is considered special because often the techniques involves manipulating genes in a way that is not expected to occur ordinarily in nature, that characters can be changed between species. Many kinds of GMOs have been developed for environmental purposes and for health and medicine. Genetic engineering has been particularly successfully used and applied in food and agriculture to produce genetically modified (GM) foods. Use of genetic engineering technologies in food and agriculture to produce GM food has been very controversial. Genetic engineering has been used to produce transgenic plants that carry several enhanced characteristics by inserting genes from various organisms, for example, plants with increased yield, disease resistance, and pest resistance with inserted Bacillus thuriengensis (Bt) insecticidal protein genes which selectively kill pests that eat crops. There have also been fruits and vegetables modified for long term storage or delayed ripening that remain fresh for a long time, which is also useful during transportation to the market. Over 15 countries of the world used GM crops for general food production by 2004. Better Foods? In 1996 a new tomato variety was sold in the U.S.A. made by a technology involving use of antisense RNA sequences to bind to the mRNAs of undesired proteins. The concentration of an enzyme (poly-galacturonase), which is produced by ripening tomatoes causing softening of the tomato, was reduced by up to 99%. This enzyme degrades the cell wall in the tomato, so its absence leaves the fruit firmer longer. These tomatoes have been developed to improve shelf life (about 300% longer) and taste since growers can leave the tomatoes on the plant longer. It is also useful to transport to the market, especially in developing tropical countries where it is very hot. The so-called tasty tomato, Flavr Savr (Flavour Savour), was not however very commercially successful when sold in supermarkets in the USA. The second wave of GM plants includes those with high nutritional content and improved food quality like golden rice, or plants that can tolerate high salt levels in the land or are modified so that they can grow in harsh conditions like drought. Some GM food such as golden rice or bananas with vaccines are being developed for health purposes. Golden rice has increased levels of beta-carotene, considered to be especially beneficial for people with vitamin A deficiency. Q1. Are there any GM foods in your country? Q2. Which food in the supermarket is not modified in some way? Q3. What other benefits can you think of from tomatoes which do not go soft quickly? What other agricultural uses of genetic engineering do you know? Q4. Do you think golden rice is a "good" GM food? What other information do you need to make a judgment? Ethical issues of GM Food Some people think that products made from GMOs are unnatural. Some call them as Franken-foods. We need to think about whether they are different from existing food varieties. It is not possible for the consumer to differentiate GM food from other conventionally grown foods since both look the same, may even taste the same, unless it is mentioned on the labels of the packets. It is difficult to say that the food is unsafe given that in some parts of the world, like in the USA, people have been eating GM food for a decade. In other parts of the

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world, especially in Europe, many people are not willing to accept GM food because of fears of health risks and other ethical concerns. We can find people with allergies to many foods, and there will always be some people who have an allergy. That is another reason why people may need to know what is in the food. In the modern supermarket however, most foods are processed containing some compounds from many different plants, especially soybeans. In the USA, the Food and Drug Administration (FDA) has said it is not necessary to label food containing products of genetic engineering. This is against the views of many public groups who argue that it is best to have more information available for the consumer and that food origin is of interest to consumers. In Europe or Saudi Arabia for example, any food with more than 1% from each GMO must be labeled, and in Australia, Japan and New Zealand it is any food with more than 5% from each GMO. As discussed in the chapter on genetic engineering we can consider these types of concerns as extrinsic ethical concerns. The people in favour of technology think that genetic modification provides a great opportunity for solving hunger, food insecurity, and malnutrition in the world since it can be made for all environmental conditions and help in increasing quantity and quality of food. It is these arguments which have led the United Nations Food and Agriculture Organization (FAO) and United Nations Development Program (UNDP) to support the selective applications of genetic engineering for food production. At the same time, there are fears raised about the safety of the food and risks to health since it is considered a new technology and people fear that some genes will be transmitted to them. Many NGOs in the world have also raised the concern that growing genetically modified crops will be harmful for the environment and genetic modification will result in "superweeds". For example, if herbicide resistance genes from canola will flow into weedy relatives to make them resistant to herbicides. Scientific studies are still being conducted to evaluate the actual risks. It is also said that GM crops are unsafe for other organisms that feed on them, for example, some people claimed Bt toxin kills Monarch butterfly larvae. Extensive scientific studies found this was not true, however, these stories are still found on the Internet and in some NGO circles. In general farmers growing Bt crops use less pesticides and less dangerous pesticides than they used to use in "conventional" agriculture. This can be beneficial to the environment, especially if GM can target specific pests more effectively than the broadly toxic pesticides which devastate many non-pest invertebrate groups. There is a fear that GM crops and foods will result in the loss of our biodiversity. Also, since the technology is new and needs lots of investment, it would be unfair to small farmers in poor countries. These are valid concerns and demand scientific investigation. However, the scientific studies have not been conclusive, and there may be benefits in some environments and societies and not in others. There have been contradictory reports both in favor of and against genetic modifications which are confusing people. Q5. Do you think GM food will be an appropriate method for eradicating hunger and malnutrition from the world? How else can we eradicate hunger and malnutrition in an ever increasing global population? Q6. What is a safe food? Would you eat GM food? Q7. How much information should be on food labels? Bring some examples to class to discuss.

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Peace and Peacekeeping Peace is more than just the absence of war, and can be achieved by various means. Here we shall discuss causes & consequences of war and peace, illustrate gradients of power and peacefulness, demonstrate methods for establishing peace, and compare future scenarios of war and peace. Peace and War Peace is the presence of calm, human unity, personal safety, sufficiency, agreement, freedom, ecological health and human wellbeing. Peace is based on love. Peace is a central issue in bioethics, which can be interpreted as love of life, and among whose central principles are beneficence, non-maleficence, autonomy and justice. Peace is in accordance with good human qualities, for example the cardinal virtues of prudence, justice, fortitude and temperance, the Ten Commandments, the Pillars of Islam and the central tenets of Buddhism. Peace is unity, a common bond of humanity for all different peoples, connected in tolerance and harmony despite a diversity of beliefs. Peace is tranquility, serenity, the presence of nature, good mood, healthy body and calm mind. Peace is good, the subject of ethics. Peace is more than just the absence of war. Peace is the absence of any violence, hostility, threats, use of force, use of power against peoples will, subterfuge, crime, civil strife, conflict, bad intentions, bad relations, disturbance or negativity. Peace results from the avoidance of sin, for example the seven deadly sins of anger, pride, lust, sloth, gluttony, covetousness and envy. Peace is never found in the presence of things considered evil and which cause harm, such as war. Similarities between languages are an illustration of shared history, brotherhood and sisterhood. Peace is salm or salaam in Arabic, used in the greeting assalm alaikum (peace be with you). Peace is shalom in Hebrew, as in shalom aleichem (peace be with you). Peace is px in Latin, pace in Italian, paz in Spanish and Portuguese, paix in French and pes in Middle English. Peace is frieden in German, vrede in Dutch, and fred in Norwegian. Peace is in Russian, and in Greek. Peace is in the Thai language. Tranquility in Japanese, in Chinese, and in Korean. is shanti in India. Peace is written

Q8. Is peace a strong element and goal in your life? What does peace mean to you? Where do you find peace? Many people believe War is inherently and altogether outside of ethical boundaries, and cannot be rationalised or excused. Despite this abhorrence, Homo sapiens still retains some of its fighting instincts as a territorial carnivorous primate. Neanderthals (debatably a subspecies Homo sapiens neanderthalensis) seem to have been more peaceful than us, and may have been driven to extinction by an extended form of genocide. African tribal wars, Roman Empire, Viking raids, the Crusades, Mongolian Empire, medieval battles with swords and pitchforks, forceful colonial takeover of Africa, North America, South America and Australia, the Great War, the era of Japanese imperialism, Jewish Holocaust in Germany (6 million dead), Hiroshima and Nagasaki experiments (over 70,000 immediate deaths from each), Rwandan genocide (800,000 dead) Human history reads like the story of war. Industrialized production-line manufacture and international sale of armaments, especially since the World Wars, has become a very profitable large-scale business for many countries. To peace activists this industry is known as the global military-industrial complex. People within it prefer to call it the Defence Industry. Nations which are the largest producers and distributors of arms tend to be those which are wealthier and less

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internally conflict-ridden. Top manufacturers and exporters are the US (e.g. M16 machine gun, ICBM missiles), Russia (AK-47, RPG-7 grenade launcher), France, Germany (G3 rifle), UK, Belgium (MAG machine gun, FAL rifle), China, Israel (Uzi machine gun), Ukraine, Italy, Spain, Bulgaria, Brazil and South Africa. Major importers are often poor countries with deplorable economic disparity. Violent conflict and direct application of force are defining features of war. War is gory, not glory. High death tolls arent just remnants of the previous century. The recent Iraq war and its aftermath have been independently estimated to have caused at least 25,000 and perhaps over 100,000 civilian casualties, deliberately not counted by the coalition of the willing. These are not just numbers, but someones brothers and sisters. Mass commercial distribution of weapons and the ensuing wars result largely from the massive economic incentives involved. Shifting international alliances and hyped-up threats in the mass-media ensure the maintenance of markets. The Stockholm International Peace Research Institute aggregate, used as an indicator for the UNDP Human Development Report, estimates US$16.231 billion of official legal conventional arms transfers globally in 2001, even after excluding the massive trade in hand-held small arms. Other reports have estimated much higher annual figures. Organized and disciplined in a stricter manner than other human institutions, the use of force permeates all levels and structures of the military. This is of course necessary to ensure that soldiers advance unflinchingly into a hail of danger. It also assuages feelings of guilt, both in the soldier who must only follow orders to commit atrocities in the field, and in the officers who didnt do it themselves. Non-questioning compliance in many spheres of occupation means loss of individual thought and freedom of action, denying you the right to your own values and set of ethical principles, and ignoring moral responsibility. Thieving of land, resources and money have been the real underlying reason for war throughout history. Unfortunately, we want to thieve from our neighbours doesnt sound like a very convincing excuse. Therefore leaders of war use other excuses to justify their actions, often indoctrinating intolerance to different religions and cultures. Excuses relating to justice are also used for violence, and bear further consideration in this chapter. Of course, the other main reason is the acquisition of power, or the ability to manipulate land, resources, money and also people.

Other people believe War is always a last resort, but can sometimes, in extreme situations, be justified as necessary to relieve a population from risk, oppression, suffering or exploitative leadership. Just war is a subjective matter of ideology; witness Holy wars, Cold War, Palestine, Vietnam, Cambodia, war on drugs, Afghanistan, Central America, Chechnya, the Balkans, East Timor, Western economic imperialism, World Trade Center, war on terror, Afghanistan again, Iraqi bombings, suicide bombings, fears of WMD (weapons of mass destruction), future wars Sometimes is a conditional word which limits when to do something, and whether it would perhaps be best not to. This introduces the ends versus means debate. Believers in Right Action suggest that we are duty-bound to behave using good means even if the resulting ends are likely to be bad. On the other hand, believers in Utilitarianism often say that duty is measured by consequences rather than right action, and means may be justified when theres a high degree of predictability that the ends achieved will produce significantly greater good. Justified violence rests on assumptions about justice. The term justice, from the philosophy of ethics, may be interpreted in different ways. Social justice, or fairness and equal opportunity for all, is known as distributive justice. The use of force by police and the criminal justice system is an example of retributive justice (although theres debate as to whether prisons are mainly for retribution, prevention or rehabilitation). Just War Theory tries to identify those conditions which justify the resort to war (jus ad bellum: justice in going to

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war), and permissible or just conduct during war (jus in bello: justice in warfare). Supposedly Just War has been characterized by the following conditions: a) just cause, such as the protection of human rights, b) right intention, which should be the establishment of peace, c) appropriate proportionality, with just ends outweighing the means, d) the defensive rather than offensive position, e) use of force only as a last resort after diplomacy and economic measures, f) competent authority and leadership, g) high probability of success in the achievement of just ends, h) limitations on the use of excessive force, i) non-use of conscripted or child soldiers, j) non-use of internationally maligned tactics or weapons, and k) careful discrimination for the prevention of innocent casualties. By freedom we mean the ability to pursue the diverse range of opportunities offered by modern life, requiring liberation from oppression by dictatorial governments. Freedom is the cry of people unbearably oppressed and disenfranchised, whose depths of pain and emotion may offer no other option but resistance. This is why one persons terrorist is anothers freedom fighter. Ernesto Che Guevara was made a martyr in South America, to become a global cultural pop icon for freedom despite his advocating and using violent guerrilla warfare. Other fighters of oppression have won freedom, autonomy and democracy for their people and become respected statesmen, such as Nelson Mandela in South Africa, and Xanana Gusmao in the worlds most newly liberated country, East Timor. Justification for actions may depend on the socio-political nature of the situation. Perhaps some advice from two past US presidents to present and future leaders is relevant here. Franklin Roosevelts peace objectives from his four freedoms speech (1941) were freedom of speech, freedom of worship, freedom from economic want and freedom from aggression, and John F. Kennedy once warned oppressive governments that Those who make peaceful revolutions impossible will make violent revolutions inevitable. Q9. Can war be rationalised or justified? Is there an ethical difference between wars based on greed and those based on grievance? Does the answer depend on whether the people advocating war have relative opportunity for wealth and wellbeing, justice from oppression and freedom from fear? Pacifism Pacifism doesnt believe violence can be justified. Violent means always provoke a violent backlash an eye for an eye leaves everybody blind. Pacifism is the ethical philosophy of non-violence, or harmlessness. Pacifism has had a long tradition in many cultures, for example including Jainism, Taoism, the original teachings of Christ, Anabaptists, Quakers, Contractarianism, International Federalism, hippie culture, green politics, civil rights and peace movements. Buddhism also seems to be one of the worlds most peaceful philosophies. It can be summarised by the four noble truths of Gautama Siddhartha (Buddha): 1. life has omnipresent suffering; 2. suffering involves a chain of causes including desire and selfishness; 3. suffering can be reduced by removal of these causes; and 4. there is a path towards this end. This path is the eightfold path, namely: 1. ethically correct viewpoint (e.g. selfless, desireless, compassionate), 2. right resolutions, 3. right speech, 4. right action, 5. right livelihood, 6. right effort, 7. proper mindfulness, and 8. regular practice of concentration (meditation). Further, Buddhas middle way is a life which does not follow extremes of pleasure on the one hand, or extreme asceticism on the other. Such inner strength requires emotional intelligence such as the following abilities: self-awareness and management of ones emotions, awareness of

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the emotions of others, empathy for the feelings of another, generation of motivation, positivity and optimism, impulse control, delay of gratification, and using both thought and feeling in decision-making. The principle of Ahimsa, proclaimed by followers of Vishnu, Mahavira and Buddha among others, is the philosophy of never harming any form of life. Another exemplary pacifist is Mohandas (Mahatma) Gandhi, revered as one of the most humane and sane leaders of the twentieth century. He led the Indian people in a successful pacifist movement against colonialists of the British Raj, by the use of mass action which overwhelmed the countrys jails and political systems. These actions stand as a good example of how large numbers of people can demand change, without using any forms of violence. The easily perceived drawback of pacifism is that a simple smile doesnt block aggressive use of fist or gun. Consider the fate of many of the worlds famous pacifists, such as Jesus Christ, Mohandas Gandhi (1948), Martin Luther King Jr. (1968) and John Lennon (1980). Assassination elevated them to become martyrs, promoting rallies of sympathy and awareness of their cause to an even more effective level. Self-martyrdom has also been used to raise awareness, but cant really be considered non-violent, as this selfless Buddhist monks protest of the Vietnam War powerfully illustrates.

Non-violent resistance There have been many other victories from nonviolent resistance. Polands Solidarnosc trade union movement and strikes led by Lech Walesa (1980) for improved workers rights, is regarded as the initial impetus for the later downfall of the Communist regime in the country. In the Yellow Revolution of the Philippines (1983), the assassination of Benigno Ninoy Aquino Jr. (pictured on the 500-peso note) sparked an end to Filipino trepidation at the use of people power, bringing his widow Corazon Aquino to the presidency and ended the Marcos dictatorship. The Singing Revolution (1988-1991) saw two million people stand hand in hand singing prohibited national songs for 600km across Estonia, Latvia and Lithuania, and led to the independence of Estonia from Soviet rule. Similarly, the Czechoslovakia Pragues Velvet Revolution (1989) saw the playwright activist Vaclav Havel become the first post-Communist president. A more recent success of non-violent revolution was the Orange Revolution in Ukraine, which saw Viktor Yushchenko come to power after being the victim of election fraud and attempted poisoning. Perhaps similar forms of people-power, under the leadership of Aung San Suu Kyi (pictured), can also eventually liberate the people of Myanmar (Burma). Non-violent political revolution inspires confidence in the nature and standing of the resulting government. Non-violence then, doesnt exclude these various other strategies of resistance, such as diplomacy, politics, public protest, marches, petitions, appeal to world opinion, creative media activism (culture jamming), civil disobedience, workers strikes, industrial action, and non-violent direct action. Direct action refers to protests outside the institutionalized framework not incorporating violence, aggression, threats, and sometimes property damage. Forms of violence undermine the moral authority of otherwise well-meant protest, and provoke a

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backlash of lost admiration and sympathy for the cause. It may be hard to practice a philosophy of nonviolence in countries with conscription (forced entry into the military). Conscientious objection is refusal by a peace-loving person to join institutions engaged in violence, and is commonly punishable by imprisonment. The speeches of charismatic American civil rights leader Martin Luther King Jr. demonstrate a fine example of passion combined with compassion. His words ring out truths about justice and equality not just for the American negro, but for Hispanics, Arabs and Jews, for black or white or any minority group, and for all countries of the world. I have a dream, that my four little children will one day live in a nation where they will not be judged by the colour of their skin, but by the content of their character. I have a dream today. Reverend Dr Martin Luther King Jr. (1963) Q10: Why is violent protest not good strategy for the Peace and Justice Movements? Conflict Resolution & Preventive Diplomacy Conflict Resolution and Preventive Diplomacy involve the early use of discussions and negotiations designed to put moral and political pressure on leaders to prevent the escalation or spread of armed conflict. More intractable than a simple dispute, a situation of conflict possesses fundamental or institutionalized elements of disagreement which allow limited flexibility of the participants. The enterprise of conflict resolution includes various peaceful methods of dealing with such problems, including conflict analysis, enquiry, negotiation, mediation, facilitation, conciliation, arbitration and judicial settlement, with the aim of getting both sides to find a middle-ground and collaborate towards a compromise or consensus decision. Often opposing sides in a conflict cant effectively communicate with one another. A mutually respected neutral third-party mediator or facilitator is then required for negotiation to take place; for example representatives from a neighbouring country or the United Nations, or a personality of international standing. Success or failure can depend on the belief systems of the mediator, so ideally several independent mediators should be employed by the process. These would include mediators friendly with each opposing party, for example from the same background or culture, who can then empathise with and accurately represent each sides point of view and enable effective trust and communication. Facilitation goes further than mediation, analysing the wider social context to help facilitate understanding of broader causes, perspectives, value systems and relationships. Certain cultural values or human needs such as identity and security may not be subject to compromise. Compromise is the settlement of differences and is conditional on concessions from both sides. Preferable to grudging compromise is a consensus position, a mutually accepted win-win situation of constructive synthesis which comes closer to the truth than either of the previous positions. Further information can be found in the UN Secretariats 1991 Handbook on the Peaceful Settlement of Disputes Between States. Successful diplomacy relies upon trust, good communication, and belief in a peaceful resolution. The statesperson who believes in these things is known colloquially as a dove. On the other hand, hard-line leaders and mistrustful strategists who believe in power, strength, deterrence and coercion in foreign relations are known as hawks. The outcome of hawkish behaviour from both sides is often the self-fulfilling prophecy of war so peace-loving democratic people tend to vote for doves. Legal initiatives for peace include the Hague Conventions, Nuremberg Code and Geneva Conventions, other multilateral agreements and conventions on disarmament and demilitarization (Table 1), and attempts to introduce international law such as the International Criminal Courts. Attempts by the United Nations and other international bodies to restrict the conduct of war have had only mixed success, the strengths and weaknesses of which are assessed in the chapter on Human Rights and Responsibilities. In addition to diplomatic and legal methods across the table, there should also be coordinated practical strategies on the ground. Peace building measures and the concept of capacity building aim to meet peoples requirements for identity, self-satisfaction and quality of life. They involve the transfer to local people of

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knowledge, technology, and other economic and political tools and information, to enable self-sufficient development and prevent further expressions of hostility or continued dependency on aid. Peace building and preventive diplomacy are best implemented well before the outbreak of armed conflict. This would avoid not only the tragedy of open conflict, but also the difficulties and dangers of deploying post-conflict peace enforcement or peacekeeping operations, such as those attempted by the United Nations (Tables 2 and 3). Table 1: Examples of International Conventions Against Weapons Proliferation Nuclear Weapons: 1970s Strategic Arms Limitation Talks (SALT I and SALT II) 1990s Strategic Arms Reduction Treaties (START I and START II) 1995 Nuclear Non-Proliferation Treaty (NPT) 1996 Comprehensive Nuclear Test Ban Treaty Chemical and Biological Weapons: 1925 Protocol for the Prohibition of the Use in War of Asphyxiating, Poisonous and Other Gases and of Bacteriological Methods of Warfare 1993 Convention on the Prohibition of the Development, Production, Stockpiling and Use of Chemical Weapons and on their Destruction Outer Space: 1967 Outer Space Treaty (prohibiting placement of nuclear weapons into orbit) Land Mines: 1997 Convention on the Prohibition of the Use, Stockpiling, Production and Transfer of AntiPersonnel Mines and on their Destruction Ballistic Missiles: 1987 Missile Technology Control Regime (an organisation established by a group of like-minded countries in the absence of any appropriate multilateral convention) 2001 International Code of Conduct against Ballistic Missile Proliferation (now called the Hague Code of Conduct) Conventional Weapons: Little or nothing despite conventional weapons causing the overwhelming majority of casualties (because of economic benefits and the right to national self-defence)

Table 2: Examples of Peace Enforcement Missions (e.g. UN Charter Ch. VII Enforcement Provisions or UN Security Council Mandate) 1950 1960 1990 1991 1992 1992 1993 1999 2001 Unified Command in Korea ONUC operation in the Congo Gulf War Coalition in response to invasion of Kuwait by Iraq UNIKOM on the Iraq/Kuwait border UNPROFOR in Croatia and Bosnia-Herzegovina UNITAF task force in Somalia UNOSOM II intervention in Somalia NATO bombing of Serbia (without direct UN mandate) US invasion of Afghanistan (debatable peace enforcement categorisation, but triggered little UN objection due to sympathy with the US after September 11 attacks)

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Table 3: Examples of United Nations Peacekeeping Missions 1948 UNTSO in Israel and Palestine (first UN peace deployment) 1949 1956 1958 1962 1963 1964 1965 1965 1973 1974 1978 1988 1988 1988 1989 1989 1991 1991 1991 1992 1992 1992 1993 1993 1993 1999 1999 1999 1999 2000 2003 2004 2004 2004 2005 UNMOGIP observer group in Kashmir (India/Pakistan) UNEF emergency force in the Sinai (Egypt/Israel) UNOGIL observation group in Lebanon UNTEA for West Papuan transition into Indonesia UNYOM observation mission in Yemen UNFICYP in Cyprus DOMREP observers in the Dominican Republic UNIPOM observation mission in India/Pakistan UNEF II emergency force in Suez Canal and Sinai UNDOF disengagement force in Golan Heights (Israel/Syria) UNIFIL interim force for withdrawal of Israel from Lebanon UNGOMAP for the Soviet withdrawal from Afghanistan UNIIMOG for the Iran/Iraq war UNAVEM in Angola UNTAG in Namibia ONUCA for Central America (Nicaragua) MINURSO for referendum in Western Sahara ONUSAL observer mission in El Salvador UNAVEM II to monitor ceasefire and elections in Angola UNTAC transitional authority in Cambodia UNOSOM operation in Somalia ONUMOZ in Mozambique UNOMUR observer mission in Uganda/Rwanda UNAMIR assistance mission in Rwanda UNOMIG observer mission in Georgia UNMIK interim administration in Kosovo INTERFET in independent East Timor UNAMSIL in Sierra Leone MONUC in the Democratic Republic of the Congo UNMEE in Ethiopia and Eritrea UNMIL mission in Liberia UNOCI in Cte dIvoire (Ivory Coast) MINUSTAH stabilisation mission in Haiti ONUB operation in Burundi UNMIS mission in the Sudan

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Q11. Sun Tzus The Art of War (4th Century BCE) is the definitive text on the traditional Chinese art of war (bing fa). One of its central principles is that ...to win one hundred victories in one hundred battles is not the acme of skill. To subdue the enemy without fighting is the supreme excellence. Discuss.

The science of war and peace International law and diplomacy will gain advantage from a more systematic approach. More systematic doesnt necessarily mean more institutionalised, rather more scientific in its consideration of systems, processes and ethical principles. Conflict resolution and peacekeeping should be based on proper humanitarian measures of the degree of suffering and the number of lives at risk. Whats required is a sort of collective epidemiology of war. This would be based in medical and bioethical principles, and involve scientific analysis of conditions leading to war and peace. For example, policies can be measured using methods from environmental science such as risk assessment, impact assessment, or cost-benefit analysis, but using casualties as the primary unit of measurement rather than dollars. War-prone states can be identified according to regional patterns, population pressure, economic disparity, social heterogeneity, polarity, election and power cycles, popular discontent, leadership style and contagion from neighbouring confrontations. Examples of empirical studies of war and peace can be found in books like Geller & Singer (1998) Nations at War A Scientific Study of International Conflict or in academic journals like Conflict Management and Peace Science. Care must be taken not to enflame any situations, for example although Samuel Huntingtons (1997) Clash of Civilizations was a useful study of ideological differences as risk factors for inter-civilizational war, it also served to promote the concept of a divided world. Generalizations shouldnt ignore the positive international effects of multiculturalism, trade, travel and human diversity. The study of war shouldnt focus too heavily on cultural differences, but rather on fundamental causes such as the relations of power, territory, resources and economics. Furthermore, looking at industrial warfare from an ecological perspective shows that it has become a lose-lose strategy for all concerned. Both sides of a conflict, regardless of who wins the war, tend to suffer devastating environmental damage as well as catastrophic loss of life because of the scale of the industrialised methods employed. Even if a country wages war from the air on the other side of the world, the globalisation of terrorism has made it impossible to prevent reprisal attacks on home soil. Taxpayers fund the war, soldiers die for the war, civilian populations suffer the physical and psychological consequences, ecological and cultural heritage becomes irretrievably damaged, and future generations must live in fear of potential reprisals. It seems that the only winners from war are the multinational corporations which make weapons and bid for lucrative contracts to clean up the mess. Subsequently, the emphasis of these industries should move towards conflict resolution, peacekeeping and the use of non-lethal force to maintain order on the streets in the protection of civilians and humanitarian workers. This would open up new industries and markets, for example in the development of non-lethal weapons designed to detect and prevent aggression without taking human life. Examples of non-lethal weaponry include rubber bullets, stun grenades, tear gas, catch-nets, sticky foam, calmative & sleep agents, infrasound, high power microwaves, metal embrittlement agents, anti-traction lubricants and polymer adhesive glue. Peacekeeper casualties can be minimised with body armour and unmanned aerial spy vehicles. In the age of peacekeeping we will not succumb to the notion that war is about killing, and power will be able to be exerted without losing the ethic of saving life. Q12. Discuss the concept of an epidemiology of war, or the process of measuring the impacts of war on human life. An age of asymmetrical warfare The face of war is changing. We seem to be fast entering an age of asymmetrical warfare requiring a so-called revolution in military affairs. This means that conflicts between nation states are reducing in number (modern democratic countries with good trade relations almost never wage war with one another), but are being replaced by the actions of small groups, such as opportunistic terrorist networks not aligned to any particular nation.

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Loose terrorist organisations such as Al-Qaeda are like the tentacles of an octopus slippery to sever using conventional military means. This implies that traditional military hardware and concepts of deterrence are no longer applicable. Massive expenditures on large-scale industrial warfare no longer provide disincentives to attack. This waste of resources can best be exemplified by the Strategic Defence Initiatives (or Star Wars antimissile shields). These projects, which have broken defence spending records, measured in hundreds of billions of $US over decades, if anything are just likely to enflame new arms races (like the development of multiple nuclear bomblets), and are anyway totally ineffective in an era where weapons of mass destruction can be delivered in a suitcase completely under the radar screen. The use of passenger planes as missiles on 11 September 2001 was horrendous and horrifying enough, but the anthrax attacks which soon followed almost had a more fearful element about them despite the very small number of victims in that case. They signify entry into a possible future world of chemical and biological weapons of mass destruction used in warfare against civilian populations innocent people held accountable for the misinformed policies of their leadership. The so-called War on Terror is a tautological concept which may simply create an inflammation of terror if not undertaken with careful sensitivity and generosity to other cultures. The most useful definition of terrorism is violence threatened or employed towards civilian targets for political purposes. This definition thus does not include non-violent protest, strikes, civil disobedience and freedom fighting which targets only military forces. Unfortunately, this is not the definition typically used by the politicians and media of more wealthy countries. This seems to be because of difficulties in coming to terms with the hypocritical paradox of state-sponsored terror inherent to the functioning of normal military establishments. But the definition is useful because it includes all threats of violence towards civilians (e.g. nuclear deterrence), not just threats posed by small groups of individuals or less well equipped fanatics without access to military high-technology. If the definition of terrorism were to include state terror, it would become a useful disincentive to state-sponsored military actions which ultimately provide the fuel (the direct motivation as well as indirectly some of the weapons used) for insane acts of ideological desperation. Terrorism thrives on the fear of death, but although the frequency and severity of attacks seems likely to increase, terrorism is still only a minor risk factor compared to other causes of death. Not only would War on Poverty save tremendously more lives per day with much less expenditure, it may even prove more effective at reducing terrorism than the War on Terror itself! Reforming those global economic systems which allow such massive inequality and restlessness would reduce the desperation and grievances against Western economic imperialism which lead to hostility and terrorism. It is known that nations left behind by modern progress can turn into what are sometimes called failed states, rogue states, and breeding grounds for terrorism. Yet much more money is allocated towards military hardware purchased from corporations, than towards foreign aid for deprived people. Perhaps it would also be rather helpful if wealthy nations stopped making and selling everybody vast amounts of weapons, motivated by profit margins.

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Empathy versus the psychology of violence Wisdom comes from the stories of those who know the true face of war, be they civilian victims or returned soldiers. They know suffering and pain, and may find it hard to relate to ordinary society because of paradoxical ethical contrasts and post-traumatic stress disorders. They know that unleashing the dogs of war means unleashing ethical chaos on people. Many innocents suffer horribly or die (taking their first-hand wisdom of war with them), and new ranks of humans and their leaders (ignorant of the truth of war) always seem ready to fight again. War unlocks the darkest reaches of the disturbed mind (e.g. hate, anger, fear, numbness, sadness, madness). Those who survive in a war-zone can still function in these mental states. Mercenaries who thrive in a war-zone are the ones with a minimum of empathy. Those who lack empathy are known in psychology as sociopaths or psychopaths. It cannot be good to glorify such situations or encourage institutionalised training towards such ends. Empathy should be taught and encouraged, rather than the emotional desensitisation of military practice and training where repeated exposure to violence decreases normal responses of shock and disgust. Violence is also made abstract by video-game training, and modern virtual reality technologies for easy killing at a distance by remote control remove any immediate awareness of

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tragic consequences. The psychology of violence is also promoted by common forms of media and entertainment. Conflict is considered the essential ingredient of drama, and violence is even central to comedy and cartoons. Nevertheless, a film can still incorporate successful drama whilst promoting ethical values if it illustrates the context and consequences of the violence it contains. News media would also be more informative if it provided better depth and balance towards solutions-based positivity instead of just parroting the loaded words of politicians (Table 8). Propaganda models have been proposed which imply that massmedia are involved in self-initiated censorship and omission of relevant facts, for the purposes of maintaining symbiotic partnership with government and big business. The language of our media is an important precedent for our actions as a culture. If sympathy is the ability to feel sorry for another person, then empathy is the further step of being able to imagine, perceive or identify with the emotions and experience of another. Sympathy and empathy are important pointers towards a culture of compassion.

Table 8: Military Euphemisms (euphemism is language employed to be suggestive of a particular connotation) Defense Industries Collateral Damage Military Intelligence Deterrence Conventional Weapon War on Terror Preventive War Pre-emptive Strike Peace Enforcement Small Arms Smart Missiles Friendly Fire Terrorist Freedom Fighter Suicide Bombing Development, manufacture and trade of offensive weapons Confounding term used to cover innocent civilian deaths and injuries Covert information used in military and security strategy Use of the threat of violence to achieve strategic objectives Common guns/missiles (causing more deaths overall than WMD) Using terrorism to justify continued policies/industries of state terror Initiation of actual war due to suspicions of potential war Early offensive or surprise attack before a threat has materialised Intervention into an existing conflict (e.g. authorised bombing raids) Machine-guns, hand-guns, etc. (statistically biggest-killing category) Bombs with autonomy, self-navigation, artificial intelligence Shooting & bombing mistakes killing personnel of same alliance Sometimes used to disparage political activists or freedom fighters Sometimes used as justification for acts of terrorism Homicide bombing has better emphasis on consequences

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Future scenario #1: technological wars Its euphemistic that we call the military-industrial sector the Defense Industry. Most of the products invented, manufactured and distributed by the defense industry are really for offence. Ballistic projectiles fired from a gun can do nothing but attack. Its darkly ironic as well, because looking forwards in time it seems possible (and increasingly probable the further forward you look) that defense technology will reach a threshold beyond which it risks driving to extinction its own creators whom its designed to defend. An article which stirred up much debate, Why the Future Doesnt Need Us (2000) by Bill Joy, founder of Sun

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Microsystems, warned that future developments and combinations in the fields of Genetics, Nanotechnology and Robotics (GNR technologies), along with easy internet access to such information by uncontrollable small groups, could place the continued existence of humans in jeopardy. Its not folly to say that some crazy and terrible things are currently being developed by scientists in secret government and military facilities around the world. There exist corporate and defense scientists, working on projects unseen by the general public, which remain unchecked by international regulation or ethical debate. Academic scientists believe in transparency, and open access to new discoveries for the benefit of humanity. The rate of scientific and technological change is accelerating towards the unknown faster than ever before in history (for example computing power, information in journals, environmental risk etc). Many technologies and scientific disciplines of the world seem to be fast-moving towards what is known as technological convergence, or the progressive combination of new technologies into unpredictable new forms. In particular, biology and biological principles are being incorporated into technology (biomimetics refers to innovations in engineering from the mimic of natural designs). The many current examples include genetic engineering, nanotechnology (e.g. molecular electronics), artificial intelligence and artificial life (e.g. artificial neural networks, evolutionary algorithms), robotics (e.g. autonomous weapons, virtual warfare), computing (quantum and DNA computers), cybernetic systems (e.g. microchip implants), micro-electro-mechanical devices (MEMs, sensor networks) and biochemical weapons etc. The aim of much of this bottom-up approach to engineering is to endow technologies with biological characteristics such as replication, heredity, learning, adaptation and self-organisation. The potential benefits, which may be magnificent, are rivalled in scale only by the potential dangers, which may be proportionately immense if weaponized into military technology. Typical responses to such warnings are disbelief and denial, but a cursory scan of scientific journals, or even just the news media as things progress, indicates definite grounds for great ethical concern. For example, scepticism about the successful development of autonomous robots, artificial intelligence and artificial life has largely been based on the slow progress of previous attempts at the top-down approach (trying to add together characteristics like problem-solving or pattern recognition, rather than allowing technology to create itself using evolutionary principles). Such doubts may become irrelevant as soon as key developments in molecular electronics and quantum computing progress to a certain point, creating new orders of magnitude in parallel processing power available for bottom-up self-evolution. Quantum computing has fundamentally different properties to ordinary digital bits and bytes, with quantum bits (or qubits) able to exponentially increase their processing power when in combination. Technological evolution is heuristically directed rather than selection among random mutations in biological evolution. This means that its incredibly fast and generally difficult to control, typically changing into complex systems with emergent properties beyond the expectations of their creators. It may seem rather fantastic, but the existence of invisible, replicating, evolving artificial life-forms (molecular computers) with swarm intelligence (wirelesslynetworked communication) may not be confined to the realms of science fiction in the relatively near future. Basic structural components have already been discovered for molecular electronics (the creation of nanotechnology computers, with nano- meaning one billionth the scale of atoms and molecules). They are made from organic chemistry (the same chemistry as life) with different mechanical and electrical properties, and include a structural base (e.g. nanomolecular layers, buckminsterfullerene), wires (e.g. carbon nanotubes, which are conductors of electricity when arranged in a line and semi-conductors when arranged in a helix), and other microscopic electrochemical analogues of circuits, gears, logic gates, diodes, resistors, switches and transistors. These trickier components can be extracted from mechanisms and structures already existing in other complex carbon-based machines such as viruses (like the T4 bacteriophage pictured). The molecular arrangements of life and the DNA storage of information imply that the physics and chemistry can be made to work if only we could more efficiently manipulate the components. Current technical difficulties in the manipulation of atoms

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for construction at this scale, and the development of molecular assemblers (mechanisms for self-assembly and replication, with the potential associated risk of uncontrollable chain reactions), are currently being investigated with huge amounts of financial backing. The prophetic vision of Richard Feynman Theres Plenty of Room at the Bottom (1960) have become a major driving force behind the current generation of research into molecular systems. Eric Drexler, the technologist and philosopher who defined in detail the term nanotechnology in Engines of Creation (1986), has seen his original definitions diluted, perhaps due to his initial emphasis on warnings of potential ethical consequences from self-replicating molecular assemblers. Ethical concerns are derided and pushed into the background by massive economic incentives. In a frightening ethical twist, Drexler argued that development of engines of destruction is virtually impossible to prevent considering the current global context of independent groups and nation states with access to funding and information. While accepting the good intentions of people who want to prevent such developments altogether, he argues that rather a benign or benevolent nation must develop the technology first to investigate the appropriate global nanotechnology defences (active shields) before the risk of misuse or accident becomes too great. The scale of potential consequences of nanotechnology seems too great to ignore, even if the probability of such things seems quite unlikely. So although the physical scale of future weapons of mass destruction may be microscopic, the scale of their potential impacts will possibly be greater than that posed by nuclear weapons. During the Cold War (19451990), the centrepiece of nuclear game theory (war strategy) was known as MAD the appropriately-named acronym for Mutually Assured Destruction. Its quite possible that MAD may become ensured rather than deterred, due to unexpected anomalies in the game theory relating to the particular details of such future WMD. Nuclear weapons (e.g. atomic, hydrogen, neutron & gamma bombs, and dirty nukes), chemical weapons (e.g. mustard gas, VX nerve agent, sarin), biological weapons (e.g. anthrax, smallpox, botulinum toxin), cyberwarfare, autonomous weapons, robotic warfare and space weapons may be less devastating than the genetically engineered or nanotechnology weapons which may be beyond the horizon. A new paradigm and era of peace and friendship among peoples and nations is clearly needed, and soon. Otherwise, large portions of the Earth may be rendered similar to other planets of our solar system, and become inhabitable only by robotic technology.

Future scenario #2: a path to peace To borrow the rallying call of the increasingly well recognised annual World Social Forum, Another World Is Possible. What would be the distinguishing characteristics of another possible world? Our world is made up of a network of interlinked systems and subsystems, some of which are cooperatively beneficial to the whole system, and others which are not, but remain competitively successful because they tend to benefit themselves. We have seen that some beneficial systems (e.g. international law) are lacking in certain important characteristics (e.g. effective global policing and enforcement mechanisms), and that some harmful systems (e.g. runaway military industries) are driven by powerful motivating forces (e.g. economic incentives). Can you envisage from this another alternative to the status quo which would lead us away from continued cycles of war and terrorism, and away from potential global catastrophe? It seems a difficult question to answer, especially if we accept that violence cannot be used even in the cause of peace (because it undermines a just cause and perpetuates further violence). Unfortunately, the just say no campaign against military industries has very little chance of success against entrenched and powerful institutions of war and the necessity for national security. But as with other kinds of harmful addictions, the principle of harm minimisation (based on the assumption that wars are an inevitable consequence of a multistate international system) using soft power, can help the industries of war to transform themselves step-bystep towards more beneficial roles in international affairs namely peacekeeping, humanitarian response, and culturally-sensitive enforcement of international law and the Universal Declaration of Human Rights. Soft power is the use of persuasion and co-option rather than coercion, diplomacy rather than force, and compromise rather than intolerance. The persuasive influence and legitimacy of soft power comes from

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promoting a higher moral ground with compelling value systems. Effective use of soft power tends to increase the influence of a country beyond its political or military capacity (e.g. the Netherlands and Scandinavian countries). Hard power on the other hand is the use of force or coercion, for example military action, threat, deterrence and economic might, and is associated with hard technology. Hard power has the unintended result of promoting resentment which only leads to hatred and vengeance. Thomas Kuhn in his Structure of Scientific Revolutions (1962) showed that the progress of science is not gradual, but is based on a series of punctuated changes in knowledge (paradigm shifts), which alter the very model and language of the previous belief system. A paradigm is a theoretical framework which supports scientific beliefs and cultural behaviours. Fundamental changes in an established viewpoint do not come easily, with initial attempts at ridicule likely to come from the collective weight of tradition, inertia and professional careers invested in maintenance of the current paradigm. Institutional resistance will persist until the models and language of the previous belief system (security through the national operation of hard power) is updated to the alternative paradigm (security through international co-operation towards peace). Q13. What non-violent soft power techniques can be employed towards the emerging paradigm shift to a more peaceful world? Moral or ethical influence alone will not remove the strong incentives which support and drive the actions of military industries, terrorism and the arms trade. Warfare and the military-industrial sector are perpetuated, among other things, by market forces. However, sustainable as well as destructive industries can obviously both generate jobs and income. Economic incentives for defence industries can still be maintained if military forces were to transfer their business focus, step-by-step over time, from existing skills and behaviours through the following phases: Step Zero War Fighting: The current paradigm has excessive tolerance to war, and acceptance of the arms trade, at the national level. These are increasingly seen as intolerable and unacceptable at the global and local levels. Step One Peace Enforcement: The UN category of peace enforcement still makes use of current military hardware and training, under enforcement provisions in Chapter VIII of the UN Charter or by mandate of the UN Security Council. The differences lie in the justification for their use, and careful discrimination to avoid unnecessary collateral damage. This is a policy of pre-emptive peace rather than pre-emptive war. National military actions already use ethical concepts of freedom and justice in an attempt to justify their actions, but many people believe this is often just empty rhetoric. Strengthening the role of international war lawyers (sometimes known as Judge Advocate Generals) would put more substance behind these claims. Professional standards of practice set criteria against which objectives and activities can be measured. The justification and conduct of war can be informed by internationallymonitored measurement scales, for example by indexes and indicators from concepts of Just War theory adapted to more culturally universal values. Its still patriotic to support your countrys military operations undertaken towards global values rather than just for national interests. Step Two Peacekeeping: National military industries and the focus of training can then transfer towards the principles of peacekeeping. Peacekeepers try to establish security and adherence to negotiated agreements, ceasefires and military withdrawals in situations of recent conflict. People who like to see action can still be involved in military operations without the resort to desensitisation and dehumanisation. Pride and self-justification are perhaps at their greatest for soldiers wearing peacekeeper blue helmets. Peacekeepers are generally limited to self-defence and a non-coercive mandate. Other professions have corporate vision statements and ethical codes of conduct (e.g. the Hippocratic Oath in medicine is an ethic of beneficence and non-maleficence, or in older terminology thou shalt not cause harm), so why not also for military industries? Non-lethal weapons, protective

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equipment, virtual and cyber-weapons will be increasingly developed and deployed to minimize the potential harm caused by peacekeepers in proper balance with the benefits of their humanitarian operations. Even non-lethal force is inappropriate for peace-observer missions. Q14. What are the ethical issues related to non-lethal weapons? In extreme circumstances is it always better to maim (e.g. the horrible example of blinding lasers) than it is to kill (e.g. aerial bombing)? How does this relate to the concept of capital punishment? Step Three Peace Building: As conflicts are reduced in number and intensity during the era of peacekeeping, the defence industry can move towards the age of peace-building. Peace building ensures that peoples cultural and psychological needs for a satisfactory life are met, as a preventative measure or prophylactic to war. There must thus be appropriate and culturally sensitive provision of a dispute resolution service well before armed conflict becomes imminent. Efforts will be directed towards prevention rather than cure, for example promotion of international economic systems which alleviate poverty, and political systems which deny the means for dictatorial oppression. Countries wont need to waste their scarce resources on armaments once protective global systems are put into place (e.g. Costa Rica has already been brave enough to give up its military forces to boost social expenditures). Reallocation of technologies from defence to other applications can be economically successful, for example the transfer of Japanese military know-how towards commercial electronic, mechanical and optical products after 1945 (the tragic lessons of Hiroshima and Nagasaki resulted in Japans SelfDefence Force becoming a good model of constitutional non-aggression). Demilitarisation also includes keeping a watchful eye on dangerous technological developments with use of the precautionary principle and an ethical duty of care. Step Four Humanitarian Relief Operations: Generous activities (e.g. the international response to the December 2004 Indian Ocean tsunami) promote thanks and respect for the risks and efforts undertaken by good-hearted people. Generous economic expenditures save lives and inspire admiration for wealthier countries rather than resentment. Expressions of power on the other hand, like military bases in other peoples countries, are the cause of terror. Change the uniforms (and the values!) into those which are welcomed more warmly by the people. Compassionate value systems undermine attempts to justify terrorism. People want their countries to be loved for their tolerance, empathy and economic generosity. Institutions like the International Red Cross and Mdicins Sans Frontires (Doctors Without Borders) are great examples of self-sacrifice and love for humanity. National armies can only dream of such admiration until they follow their example and start to utilise their overwhelming resources with practical humanity and ethical vision. Its becoming more difficult to justify brute military force in the face of an increasingly well-informed world public. Ordinary people are generally quite compassionate, but seem to believe that theyre relatively powerless to do something about ethical issues. But with increasing knowledge and awareness, moderate wealth, the spread of democratic values, and new technologies such as the internet, weve never had so much individual power to effect change. It should be possible to reach a collective critical mass which will accelerate the paradigm shift already underway. We can overthrow the dominant paradigm and strongly establish an alternative world-view. We can change destructive self-fulfilling prophesies, subconsciously created by the selective perception of mainstream media and military institutions, to replace them with positive feedback loops which allow widespread expectations of a peaceful and sustainable world. The stakes are high, but the power of collective human activity is immense, and it would certainly be worth it for our species to survive and see the twenty-second century.

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Unit 13 Solidarity and cooperation

Learning Objectives Students should be able to explain the development of the notion of solidarity in different societies. Students should be able to describe the difference between solidarity as an instrumental and a moral value. Students should be able to give examples of solidarity in the context of health care and research

The Human Genome Project The Human Genome Project was the project to sequence all human DNA and map the genes and DNA sequences that determine genetic variation. There have also been many other species as subjects of their own genome projects, which provides interesting biological information fundamental for understanding how to apply biotechnology to practical use. Here we shall introduce the human genome project and the roles of the International Human Genome Organization, and cite some examples of other genomes being sequenced.

Case 13-1: Defensive medicine, Is there a doctor on board? and Good Samaritan law I am a 38 year-old physician. 2 weeks ago I was on flight from Okinawa to Tokyo after enjoying a vacation with my family. 40 minutes after taking off, there was an announcement to ask if there was a physician on the plane because they had a medical situation onboard. Instead of telling a flight attendant that I am a physician immediately, I had something else in my mind, which was I want to know whats happening and I might be able to help that person but what if I could not do anything or nothing gets improved. People would be disappointed, the person might get angry or sue me for what I do as medical malpractice, and airlines do not take any responsibility for the results of what I do. Unlike the United States or Canada, Good Samaritan laws do not exist in Japan. There has been a lot of argument over that and some legal professionals claim that present laws are effective enough to protect physicians in case they could not save people in the emergency situation, but in reality many medical professionals are reluctant to participate in these scenes. Eventually, there was another physician in the plane and he went to see that person. After landing I knew that she had had a simple stomach problem for some stress and little sleep, which became worse onboard after having a few glasses of alcohol. Questions Q1. Have you ever had/seen these situations in transportation or other public spaces? Q2. Do you agree with my behavior or should I have said that I am a physician? Q3. What would you do in this situation if you were a physician? Q4. Should physicians always contribute to medical need situations even though it is outside their work place or own professional fields? Q5. Is a Good Samaritan Law necessary to protect medical professionals?

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The Human Genome Project The Human Genome Project (HGP) aimed to map and sequence all the DNA of human beings, known as the genome (a total of about 2.8 billion linear bases on 23 different chromosomes). There are thought to be about 30,000 genes in human beings, and most of these have been identified. However, the genes comprise only 510% of the total DNA in the human genome, the function of the rest of the DNA is unknown. While most genes have been identified, the function of most of them is still to be investigated. The Human Genome Project was conducted by a publicly financed international research effort whose goal was to decipher the human genetic code and to provide these data freely and rapidly to the public. In addition a company called Celera, and several others, also made intensive efforts to sequence the human genome. On June 26, 2000, members of the Human Genome Project announced that they had succeeded in sequencing a "working draft" of the human genome. An article published in the February 15, 2001 issue of the journal Nature outlines the strategies and methodologies used by this group to generate the draft sequence. Sequencing of the human genome represents a scientific milestone, and the data are of immediate use in many important ways. To further understand and use the information coded for in this "human blueprint", several international bodies, including the U.S. National Center for Biotechnology Information (NCBI) provide access to these data worldwide through public Web sites (http://www.ncbi.nlm.nih.gov). The Human Genome Organization (HUGO) was conceived in late April 1988, at the first meeting on genome mapping and sequencing at Cold Spring Harbor, New York state, USA. For some time, as the genome initiatives got under way in individual nations, the need for an international coordinating scientific body had been under discussion. The HGP was the natural culmination of the history of genetics research. In 1911, Alfred Sturtevant, then an undergraduate researcher in the laboratory of Thomas Hunt Morgan, realized that he could - and had to, in order to manage his data - map the locations of the fruit fly (Drosophila melanogaster) genes whose mutations the Morgan laboratory was tracking over generations. HGP researchers have deciphered the human genome in three major ways: determining the order, or "sequence", of all the bases in our genome's DNA; making maps that show the locations of genes for major sections of all our chromosomes; and producing what are called linkage maps, complex versions of the type originated in early Drosophila research, through which inherited traits (such as those for genetic disease) can be tracked over generations. This ultimate product of the HGP has given the world a resource of detailed information about the structure, organization and function of the complete set of human genes. This information can be thought of as the basic set of inheritable "instructions" for the development and function of a human being. Although the so-called full sequence was completed and published in April 2003, there are still a few portions of the genome that are not accurately sequenced because that DNA is difficult to isolate and prepare for sequencing. Q1. When did you first hear of the Human Genome Project? The Human Genome Organisation (HUGO) Mission Statement: * to investigate the nature, structure, function and interaction of the genes, genomic elements and genomes of humans and relevant pathogenic and model organisms; * to characterise the nature, distribution and evolution of genetic variation in humans and other relevant organisms; * to study the relationship between genetic variation and the environment in the origins and characteristics of human populations and the causes, diagnoses, treatments and prevention of disease;

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* to foster the interaction, coordination, and dissemination of information and technology between investigators and the global society in genomics, proteomics, bioinformatics, systems biology, and the clinical sciences by promoting quality education, comprehensive communication, and accurate, comprehensive, and accessible knowledge resources for genes, genomes and disease; and, * to sponsor factually-grounded dialogues on the social, legal, and ethical issues related to genetic and genomic information and championing the regionally-appropriate, ethical utilization of this information for the good of the individual and the society. The vast implications to individuals and society of possessing the detailed genetic information made possible by the HGP were recognized from the outset. Another major component of the HGP is devoted to the analysis of the ethical, legal and social implications (ELSI) of our newfound genetic knowledge, and the subsequent development of policy options for public consideration. Up to 5% of the money in some countries is being spent on the educational, ethical, legal and social impact. The HUGO Ethics Committee was made with the following purposes: * to promote discussion and understanding of social, legal and ethical issues as they relate to the conduct of, and the use of knowledge derived from, human genome research. This may encompass consideration of research directions, practices and results, and the issues of human diversity, privacy, and confidentiality, intellectual property rights, patents, and commercialisation, disclosure of genetic information to third parties, the non-medical use of such information, and the medical, legal and social aspects of testing, screening, accessibility, DNA banking, and genetic research; * to act as an interface between the scientific community, policy makers, educators, and the public; * to foster greater public understanding of human variation and complexity; * to collaborate with other international bodies in genetics, health, and society with the goal of disseminating information; * to deliberate about policy issues in order to provide advice to the HUGO Council and to issue statements where appropriate; * to report on its activities at least annually to the HUGO Council: and to act on any other related matter.

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Sequencing of Other Genomes The tools created through the HGP also continue to inform efforts to characterize the entire genomes of over a hundred other organisms important for medicine, agriculture and biological research, such as mice, rats, rice, chimpanzees, fruit flies, flatworms and many bacteria. These efforts support each other, because most organisms have many similar, or "homologous," genes with similar functions. Therefore, identification of the sequence or function of a gene in a model organism has the potential to explain a homologous gene in human beings, or in one of the other model organisms. Many genetic techniques have been improved including: * DNA Sequencing * The employment of Restriction Fragment-Length Polymorphisms (RFLP) * Yeast Artificial Chromosomes (YAC) * Bacterial Artificial Chromosomes (BAC) * The Polymerase Chain Reaction (PCR) * Electrophoresis

Q3. If you look on the Internet you can find the DNA sequence of many different species. How similar are different species to human beings?Do you know how similar your genome sequence is to another person? Q4. The International Haplotype Mapping (HapMap) project is looking at the variation between human populations. Did you know that between any two people there are about one million DNA base pairs difference, and 85% of the differences are within any so-called race. Therefore the concept of race used in society does not have clear genetic foundations. Q5. Do you think that it is good to map the human genetic lineage through all population and ethnic groups? Should we ask each group whether they want to know the results? How might the information be misused? Q6. Do a web search for the Genographic project and consider whether it is a good project? Would you like to trace your own personal genetic history?

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Unit 14 Social responsibility and health

Learning Objectives

Students should become acquainted with the shared responsibilities of the state and various sectors of society in regard to health and social development. Students should understand the requirements of global justice and the notion of the highest attainable standard of health care as a right. Students should be able to explain the health status is a function of social and living conditions and that attainment of the highest attainable standard of health care depends upon the attainment of minimum levels of social and living conditions. Students should be able to appreciate the urgent need to ensure that progress in science and technology facilitates access to quality health care and essential medicines as well as the improvement of living conditions and the environment, especially for marginalized segments of the population. Students should be able to analyze potentially exploitative social practices and or arrangements affecting public health and recommend possible solutions.

Case 14-1: Medical tourism A 64 year-old American man has had problems related to heart disease. One day his doctor told him that he needed to have bypass surgery; otherwise, he could die anytime in the near future. However, he has financial problems to pay for the surgery. Bypass surgery costs about US$ 40,000 in the United States, which he cannot afford. Later when he was surfing the web for bypass surgery, he found an article about a British woman who went to Thailand for cosmetic surgery. It mentioned that there were high quality and low cost medicines in developing countries. He saw advertisements on the web that said the hospitals there had doctors trained in the US, Europe or Australia, and spoke English. Then he found it cost only 25% of the US price for the bypass surgery in Thailand and made a decision to go there. Now 10 months after the operation, hes been recovering well and enjoying time with his family at home again. Questions Q1. Recently its becoming common for people in developed countries to go abroad, mainly to developing countries such as Thailand and India, for medical treatment. Do you agree with medical tourism in general? Q2. What are the benefits and harms of medical tourism? (Note: Medical care in Thailand costs a third as compared to the United States and you dont have to wait on a long list. For example, you may wait for more than a few months to get an operation in the UK but only a week in India. Do you think you would like to take this opportunity if you needed medical treatment?) Q3. Many people in developing countries still do not have access to basic medical care and every year many die from treatable diseases such as diarrhea in India. Also in Thailand, there are big gaps in quality and service depending on the financial situation; some basic medical treatment is free, but there are lower service standards, less quality and only a few minutes consultation to see a doctor in a public hospital after waiting for hours. However, some private hospitals in Bangkok provide all the detailed checking, and offer consultation with foreigners and rich local people, for a simple stomach ache. How do you consider these gaps in medical opportunity in the same country? How about the difference between foreign tourists, ordinary citizens, and the poor who are turned away from private hospitals because they cannot afford it?

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Sustainable Development Sustainable Development is about the survival and wellbeing of current and future generations of life. Here we shall introduce the concepts of sustainability and sustainable development, the political use of relevant terms, the integration of economy, society, culture and ecology, the uncertainty and the precautionary principle, and the principles of sustainable management.

The Earth from Space: Photos of the Earth as a single, fragile entity in inhospitable space have highlighted the concept of limits and inspired the search for human unity and global sustainability. (NASA Image)

The Biggest Problem in the World Sustainable Development and Sustainability deal with quite simply the problem ever faced by humanity.

LARGEST

and

most extreme

What will be the future for our species? What must we do to ensure our long-term survival? Can we control our collective destiny as inhabitants of this earth? A few leading scientists have predicted double-digit percentages for the likelihood of human extinction by the end of this century. You can always find someone with some opinion or other. But hang on a second Do they know what theyre talking about? If theres even a remote chance theyre right shouldnt we be a little more concerned?? It may not be absurd hyperbole indeed, it may not even be an overstatement to assert that the most crucial location in space and time (apart from the big bang itself) could be here and now. I think the odds are no better than fifty-fifty that our present civilisation on Earth will survive to the end of the present century without a serious setback. Martin Rees (2003) Our Final Century p.7-8 What can we do? Everything!! Modern knowledge, freedoms and strong ethical convictions can turn it around. A career in environmental science or human rights might help! But even despite the money temptation, careers in business, science, law and politics can deliver environmental and social wellbeing, sustainable technologies and ethical value systems.

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What about the kids? Sustainable Development is an objective. Its a concept, a symbol, a slogan, a word-phrase, a process, an action, a pathway, a guideline, a desire, a motivation, a mechanism, a measurement, an interpretation, a relationship, an interaction, an aim, a method, a result, an outcome, as well as many other possible interpretations. Its currently the focus of the United Nations Decade of Education for Sustainable Development 2005-2014.

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It was first mentioned in: I.U.C.N. (1980) World Conservation Strategy: Living Resources Conservation for Sustainable Development. I.U.C.N. (World Conservation Union), Gland, Switzerland. The first widely recognized definition was in The Brundtland Report: World Commission on Environment and Development (W.C.E.D.) (1987) Our Common Future. Brundtland, Gro Harlem (editor), Oxford University Press: Sustainable development is development that meets the needs of the present without compromising the ability of future generations to meet their own needs. Theres a lot more to it, and people have been redefining it, deciding on its principles and arguing over its goals ever since. This original aspect is still central, and has been shortened to the phrase: Inter-generational Equity meaning equity between present people and future generations. Since equity means fair and equal wealth, wellbeing, environment and opportunity, and since future generations are you, kids, and your children and their kids it can be simplified even further to: "What about the kids?"

Q1. Most recent definitions and principles of Sustainable Development have also included Intragenerational Equity, or equitable distribution within the current generation. Discuss some ethical and practical differences between Inter-generational equity and Intra-generational equity.

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Slippery Terminology Sustainable Development has been a slippery term to pin down, and defining it has caused much heated debate and controversy (see Table 1). But it isnt really all that confusing - if its not defined in a vague or veiled way (like putting the emphasis on economic sustainability). To sustain is to support, cause to continue, keep in existence, replenish, preferably enhance, and at least maintain at a certain standard or level. Sustainable (as well as meaning able to be sustained), refers to the level at which a resource may be used, harvested or depleted such that it is able to regenerate or replenish (sustain) itself indefinitely (e.g. the stock of a fishery, timber yield in forestry, agricultural productivity, etc). Development is any activity or progress which increases the wellbeing of humans and the environment. Too often it is accidentally or deliberately confused with concepts and growth (particularly economic growth, including consumerism, commercialism and technocentrism). But growth isnt always development, which must include things like reduction of poverty and increased quality of life, modernization, equity, health, democracy, freedom, fair trade and conservation. Sustainability is a measure of how well policy and management live up to the principles and philosophies of sustainable development. Sustainability can also be thought of as a wonderful imaginary place or ultimate objective where all good requirements are met for sustaining ecosystems and maintaining human wellbeing. Sustainable development has most commonly been used in specific reference to the sustainability of ecosystems. For example, the Australian government has incorporated the term ecologically sustainable development as an official aim of policy, although environmental groups feel some principles are missing (see Table 2), and theres still a long way to go in practice! The environment is much more than ecology and biodiversity. It also includes the human environment, including social, cultural, economic, political and informational components, all included in environmentally sustainable development. Oh, and by the way, this is one of the reasons why environmental science is such a fascinating career to choose - it includes

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the big and the small, the concrete and the abstract, humans and nature - and its never short of interesting and vitally important issues! Despite all these inclusions, sustainable development is a term still often abused and misrepresented. Its even been accused of being an oxymoron, a strange word describing a self-contradictory phrase, where seemingly opposite words combine to suddenly make sense.

Q2. Sustainable development is somewhat ambiguous - a fuzzy concept which often means different things to different people. Is the term Sustainable Development self-contradictory? Why and/or why not? Do differing interpretations help it to become a more useful and popular phrase, or do they make it less useful and practical?

Table 1: Landmarks and Defining Events Majority of human history - barbarism reigns 1948 - Universal Declaration of Human Rights 1970 - UNESCO Man and the Biosphere Program 1972 - Club of Rome The Limits to Growth 1980 - IUCN World Conservation Strategy 1987 - WCED Brundtland Commission Our Common Future 1990 - Commonwealth of Australia Ecologically Sustainable Development Working Groups 1992 - UNCED Rio Earth Summit, and Agenda 21 1992 - United Nations Commission on Sustainable Development 1993 - Commission of the European Community Fifth Environmental Action Programme 1994 - IUCN / IIED Strategies for National Sustainable Development 1994 - United Nations Conference on Population & Development 1995 - United Nations Conference on Social Development 1996 - Earth Council Making Sustainability Work strategy 1996 - Earth Network for Sustainable Development website 1997 - Rio+5 Forum and Earth Summit+5 review 1997 - Kyoto Conference on Climate Change, Kyoto Protocol 1999 - Seattle WTO Conference anti-globalization protest gathering The Millennium Earth Initiative 2000 - Time to contemplate embarking into the 21st century 2000 - Earth Charter (revised after non-adoption at 1992 Rio Earth Summit) 2001 - United Nations Millennium Ecosystem Assessment 2001 The first annual World Social Forum (Another World Is Possible) 2002 - Johannesburg World Summit on Sustainable Development 2002 - International Criminal Court 2005-2014 United Nations Decade of Education for Sustainable Development Now - time to turn all this talk into action!

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Table 2: Summary of Ecologically Sustainable Development (adapted from: Ronnie Harding, 1998, Environmental Decision-Making; p. 27-29) ECOLOGICALLY SUSTAINABLE DEVELOPMENT Principles and Objectives Recommended by Australian Environment Government Groups

1. Integration of Economic and Environmental Goals in Policy 2. Inter-Generational Equity 3. Conservation of Biodiversity and Ecological Integrity 4. Recognising the Global Dimension (Integration) 5. Caution with Risk & Irreversibility (Precautionary Principle) 6. Appropriate Valuation of Environmental Assets 7. Efficiency 8. Economic Resilience (Capacity for Environment Protection) 9. International Competitiveness and External Balance 10. 1Community Participation 11. 1Constant Natural Capital and Sustainable Income 12. 1Qualitative Development 13. 1Limits on Natural Resource Use 14. 1Intra-Generational (Social) Equity

So, what is it were trying to sustain?

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An easy to comprehend example of sustainable development in action is sustainable fishing. Sustainable yield refers to an uncertain level or threshold of harvesting at which a population or resource will not be at risk of overall long-term decline. In sustainable fishing we do not to try to maximise our catch (yield), but rather optimise it for sustainability (optimum sustainable yield) in accordance with a sustainable fishery management plan. Boats in the commercial fishing fleet may be allocated fishery property rights, sharing proportions of the annual quota (total allowable catch), or alternatively regulated by closing the fishery when total allowable catch is reached. Fishing quotas may be transferable, seasonal, area-specific, speciesspecific and/or enforceable by law. Modern fishing gear is available which avoids damage to unintended by-catch and the sea-bed habitat. Individual recreational fishers also have bag-limits, (quota), size limits, and gear restrictions. Protection of the ecosystem and large-scale habitat is often even more important than limiting exploitation of the stock. Regional systems of Marine Parks (National Parks for the sea), such as those managed by the Great Barrier Reef Marine Park Authority in Australia, allocate areas for different or multiple uses (e.g. commercial fishing, recreational fishing, tourism or conservation zones). Marine protected areas, and also conservation of breeding and nursery grounds such as coastal wetlands, reserve habitat space for fish populations to rejuvenate. Sustainable fishing is more akin to farming than to hunting, as it ensures that new cohorts of fish are helped to survive and grow for harvesting in following years.

Sustainability must be integrated, meaning that it should be broad and all-inclusive. Thats why Francesco di Castri came up with a neat metaphor: The Chair of Sustainable Development [journal Nature & Resources 31(3)]. A metaphor is a handy comparison which helps memory and understanding, and in this one the chair has four connected legs of sustainability which must all be included in sustainable policy and management. If one leg is over-emphasised, (usually the economic leg), then the chair wont be flat or comfortable. Also, this is a tall Renaissance-style chair, because the Renaissance and Enlightenment were periods of Western history when integrated thinking led to some of the best discoveries. The concern now, is that education is too specialised - and training only for a very specific career may not be equipping you with the broad multidisciplinary knowledge we need to solve inter-connected global problems.
Ecological Leg Biodiversity Ecosystems Habitats Endangered Species Keystone Species Pollution & Waste Physical Processes Natural Resources Social Leg Institutions Infrastructure Education Legal System Health & Medical Politics/Democracy Military Industries Human Resources Cultural Leg Religion & Culture Ethics & Behaviour Desires/Motivations Entertainments Freedoms/Rights Responsibilities Family Values Information/Media Economic Leg Economic Growth Natural Capital Goods & Services Corporate Practice Employment Quality of Life Efficiency Fair Trade/Equity

Q3. What difficulties and compromises do you think might arise in our attempts to measure such factors for sustainability?

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Precaution for uncertainty Uncertainty is a fact of life. But one thing's for sure Those causes cause these effects. These effects affect those because Act-contact-impact in fact Unless because of non-causal correlation of course Oh dear... These systems seem complex. That feedback sure is noisy Impacts interact. Processes produce probabilistic progress of properties huh? Actions cause impacts with interactions. Indicators illustrate. Contents index complex sets and common context connects concepts what? Welcome to uncertainty, and yes I'm confused too. What did I do with my network flow diagram? Its something to do with that systems theory. Emergent properties are part of complexity theory. Risk is where the probabilities can be guessed at. A bit risky Indeterminacy is Im afraid I dont know. Oh no. Ignorance is I dont know what it is I dont know. Uh oh Apathy is I dont really care. Thats the worst. And I dont suppose chaos will interfere this time wheres my noodles Uncertainty is one of the reasons why many environmental management and sustainability policies sometimes fail to live up to expectations. That can be dangerous, because of the risk of irreversible damage to free but easily disrupted ecosystem services which provide critical life-support functions. If we make mistakes providing for people, deaths can be the result. If we make mistakes with ecology, well youve heard the phrase extinction is forever. These are just two examples of irreversible damage. Some ways to reduce uncertainty include measurement, modelling and monitoring. These important methods make use of environmental and social indicators, selected because they also convey information about the bigger picture. But you can never totally get rid of uncertainty. Thats why they invented the

The Precautionary Principle Where there are threats of serious or irreversible environmental damage, lack of full scientific certainty should not be used as a reason for postponing measures to prevent environmental degradation. In the application of the precautionary principle, public and private decisions should be guided by: (i) careful evaluation to avoid, wherever practicable, serious or irreversible damage to the environment, and (ii) an assessment of the risk-weighted consequences of various options.(definition from Intergovernmental Agreement on the Environment, Australia, 1992)

Q4. Can you find definitions for Risk, Uncertainty, Ignorance, and Apathy, and identify the differences between them? Can you think of situations where they contribute to an ethical problem? Lean and Green Sustainable planning and sustainable management are the practical applications of sustainability to policies of government or business which affect society or the environment. They involve using principles of sustainable development in problem-solving and decision-making. In the spirit of the Chair of Sustainable Development introduced earlier, heres a new memory-aid metaphor, based on the Leaning Tower of Pisa in Italy, which also uses concepts of balance and equilibrium. This model doesnt show what is to be included in sustainability, but hints at how to do it in planning, policy and management. The Tower of PISA for Sustainable Management

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Precautionary: Caution with risk and uncertainty, and avoidance of serious or irreversible damage by using predictive impact models and the Precautionary Principle. [Be careful] Integrated: Inclusion of all aspects of sustainability (e.g. political, social, cultural, economic, ecological), with large spatial scale (whole habitats) and long time scale. [Look at the big picture] Strategic (Sustainable): Strategic means well co-ordinated and goal directed. In this case the goal is sustainability! (If this context isnt clear, Sustainable can be used in place of the term Strategic) [Have a strong ethical & scientific backbone] Adaptive: Adaptive means responsive to changing circumstances (the adaptive thinker can change her or his mind on the basis of new information). [Flexibility is the best]

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Q5. Can you come up with a new model or metaphor which helps to explain something related to bioethics of interest to you? Simplify something abstract and hard to understand by comparing it to something more concrete and well known. If thats a bit hard, maybe you can come up with a new -ism (-ism is a suffix denoting a doctrine or ideology), or a new -ology (-logy is from the Greek for study and indicates the scientific study of something). Describe and analyse your new metaphor, model, ideology or scientific discipline. Does it have ethical dangers, weaknesses and benefits?

Write an Essay The Internet is an amazing tool for information-gathering and communication. Look at the Internet Resources Directory in the file <www2.unescobkk.org/eubios/BetCD/Bet14sq.doc>. The web-sites are sorted under the following headings: Academic Literature Activism & Charities Agriculture Biotechnology Business Coastal & Marine Decision-Support Dictionaries Education Election Employment Encyclopaedias Environment Ethics Global Warming Internet Media Legal Libraries & Books Medical & Health Modelling Museums Sustainable Development Translation Web-search

a) Can you write an essay or short answer which, somewhere, uses most or all of these words? b) What ideas or conclusions have emerged from this exercise about the sustainability of: (i) humanity as a whole? (ii) your own life? c) If you have a computer linked to the internet, visit some of the web-sites listed in the directory. Which ones did you choose and why? Are they interesting or useful? Are there any drawbacks to this kind of research (e.g. do some of the sites no longer exist)? d) What has this exercise taught you about the power and future potential of information tools like the Net? Activity 2: Do the Sustainability crossword on a copy of the crossword. The soft copy of the crossword file is <www2.unescobkk.org/eubios/BetCD/Betcwd.doc> on the website.

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UNIT 15

Sharing of benefits

Learning Objectives: Students should be able to understand the need for ensuring that scientific knowledge contributes to a more equitable, prosperous and sustainable world. Students should be able to explain that scientific knowledge has become a crucial factor in the production of wealth, but at the same time has perpetuated its inequitable distribution. Students should be able to explain the reality that most of the benefits of science are unevenly distributed among countries, regions and social groups, and between the sexes. Students should be able to analyze efforts that have been undertaken at various levels to promote the sharing of the benefits of scientific knowledge and research and to explore novel initiatives that may be undertaken. Students should be able to identify and assess potentially undue or improper inducements in different research settings/situations.

Universal Declaration on the Human Genome and Human Rights UNESCO Unanimously approved this statement on 11 November, 1997 at the General Conference, after numerous drafts from the International Bioethics Committee (from 1993-1997). The United Nations General Assembly unanimously endorsed it on 9 December, 1998. Please consider the first global bioethics declaration. Do you agree with its content? The General Conference [of member countries of UNESCO], Recalling that the Preamble of UNESCO's Constitution refers to "the democratic principles of the dignity, equality and mutual respect of men", rejects any "doctrine of the inequality of men and races", stipulates "that the wide diffusion of culture, and the education of humanity for justice and liberty and peace are indispensable to the dignity of men and constitute a sacred duty which all the nations must fulfil in a spirit of mutual assistance and concern", proclaims that "peace must be founded upon the intellectual and moral solidarity of mankind", and states that the Organization seeks to advance "through the educational and scientific and cultural relations of the peoples of the world, the objectives of international peace and of the common welfare of mankind for which the United Nations Organization was established and which its Charter proclaims", Solemnly recalling its attachment to the universal principles of human rights, affirmed in particular in the Universal Declaration of Human Rights of 10 December 1948 and in the two International United Nations Covenants on Economic, Social and Cultural Rights and on Civil and Political Rights of 16 December 1966, in the United Nations Convention on the Prevention and Punishment of the Crime of Genocide of 9 December 1948, the International United Nations Convention on the Elimination of All Forms of Racial Discrimination of 21 December 1965, the United Nations Declaration on the Rights of Mentally Retarded Persons of 20 December 1971, the United Nations Declaration on the Rights of Disabled Persons of 9 December 1975, the United Nations Convention on the Elimination of All Forms of Discrimination Against Women of 18 December 1979, the United Nations Declaration of Basic Principles of Justice for Victims of Crime and Abuse of Power of 29 November 1985, the United Nations Convention on the Rights of the Child of 20 November 1989, the United Nations Standard Rules on the Equalization of Opportunities for Persons with Disabilities of 20 December 1993, the Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction of 16 December 1971, the UNESCO Convention against Discrimination in Education of 14 December 1960, the UNESCO Declaration of the

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Principles of International Cultural Co-operation of 4 November 1966, the UNESCO Recommendation on the Status of Scientific Researchers of 20 November 1974, the UNESCO Declaration on Race and Racial Prejudice of 27 November 1978, the ILO Convention (N 111) concerning Discrimination in Respect of Employment and Occupation of 25 June 1958 and the ILO Convention (N 169) concerning Indigenous and Tribal Peoples in Independent Countries of 27 June 1989, Bearing in mind, and without prejudice to, the international instruments which could have a bearing on the applications of genetics in the field of intellectual property, inter alia the Bern Convention for the Protection of Literary and Artistic Works of 9 September 1886 and the UNESCO Universal Copyright Convention of 6 September 1952, as last revised in Paris on 24 July 1971, the Paris Convention for the Protection of Industrial Property of 20 March 1883, as last revised at Stockholm on 14 July 1967, the Budapest Treaty of the WIPO on International Recognition of the Deposit of Micro-organisms for the Purposes of Patent Procedures of 28 April 1977, and the Trade Related Aspects of Intellectual Property Rights Agreement (TRIPs) annexed to the Agreement establishing the World Trade Organization, which entered into force on 1st January 1995, Bearing in mind also the United Nations Convention on Biological Diversity of 5 June 1992 and emphasizing in that connection that the recognition of the genetic diversity of humanity must not give rise to any interpretation of a social or political nature which could call into question "the inherent dignity and (...) the equal and inalienable rights of all members of the human family", in accordance with the Preamble to the Universal Declaration of Human Rights, Recalling 22 C/Resolution 13.1, 23 C/Resolution 13.1, 24 C/Resolution 13.1, 25 C/Resolutions 5.2 and 7.3, 27 C/Resolution 5.15 and 28 C/Resolutions 0.12, 2.1 and 2.2, urging UNESCO to promote and develop ethical studies, and the actions arising out of them, on the consequences of scientific and technological progress in the fields of biology and genetics, within the framework of respect for human rights and fundamental freedoms, Recognizing that research on the human genome and the resulting applications open up vast prospects for progress in improving the health of individuals and of humankind as a whole, but emphasizing that such research should fully respect human dignity, freedom and human rights, as well as the prohibition of all forms of discrimination based on genetic characteristics, Proclaims the principles that follow and adopts the present Declaration. A. HUMAN DIGNITY AND THE HUMAN GENOME 1. The human genome underlies the fundamental unity of all members of the human family, as well as the recognition of their inherent dignity and diversity. In a symbolic sense, it is the heritage of humanity. 2. a) Everyone has a right to respect for their dignity and for their rights regardless of their genetic characteristics. b) That dignity makes it imperative not to reduce individuals to their genetic characteristics and to respect their uniqueness and diversity. 3. The human genome, which by its nature evolves, is subject to mutations. It contains potentialities that are expressed differently according to each individual's natural and social environment including the individual's state of health, living conditions, nutrition and education. 4. The human genome in its natural state shall not give rise to financial gains.

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B. RIGHTS OF THE PERSONS CONCERNED 5. a) Research, treatment or diagnosis affecting an individual's genome shall be undertaken only after rigorous and prior assessment of the potential risks and benefits pertaining thereto and in accordance with any other requirement of national law. b) In all cases, the prior, free and informed consent of the person concerned shall be obtained. If the latter is not in a position to consent, consent or authorization shall be obtained in the manner prescribed by law, guided by the person's best interest. c) The right of each individual to decide whether or not to be informed of the results of genetic examination and the resulting consequences should be respected. d) In the case of research, protocols shall, in addition, be submitted for prior review in accordance with relevant national and international research standards or guidelines. e) If according to the law a person does not have the capacity to consent, research affecting his or her genome may only be carried out for his or her direct health benefit, subject to the authorization and the protective conditions prescribed by law. Research which does not have an expected direct health benefit may only be undertaken by way of exception, with the utmost restraint, exposing the person only to a minimal risk and minimal burden and if the research is intended to contribute to the health benefit of other persons in the same age category or with the same genetic condition, subject to the conditions prescribed by law, and provided such research is compatible with the protection of the individual's human rights. 6. No one shall be subjected to discrimination based on genetic characteristics that is intended to infringe or has the effect of infringing human rights, fundamental freedoms and human dignity. 7. Genetic data associated with an identifiable person and stored or processed for the purposes of research or any other purpose must be held confidential in the conditions set by law. 8. Every individual shall have the right, according to international and national law, to just reparation for any damage sustained as a direct and determining result of an intervention affecting his or her genome. 9. In order to protect human rights and fundamental freedoms, limitations to the principles of consent and confidentiality may only be prescribed by law, for compelling reasons within the bounds of public international law and the international law of human rights. C. RESEARCH ON THE HUMAN GENOME 10. No research or research applications concerning the human genome, in particular in the fields of biology, genetics and medicine, should prevail over respect for the human rights, fundamental freedoms and human dignity of individuals or, where applicable, of groups of people. 11. Practices which are contrary to human dignity, such as reproductive cloning of human beings, shall not be permitted. States and competent international organizations are invited to co-operate in identifying such practices and in taking, at national or international level, the measures necessary to ensure that the principles set out in this Declaration are respected.

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b) Freedom of research, which is necessary for the progress of knowledge, is part of freedom of thought. The applications of research, including applications in biology, genetics and medicine, concerning the human

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12.a) Benefits from advances in biology, genetics and medicine, concerning the human genome, shall be made available to all, with due regard for the dignity and human rights of each individual.

genome, shall seek to offer relief from suffering and improve the health of individuals and humankind as a whole. D. CONDITIONS FOR THE EXERCISE OF SCIENTIFIC ACTIVITY 13. The responsibilities inherent in the activities of researchers, including meticulousness, caution, intellectual honesty and integrity in carrying out their research as well as in the presentation and utilization of their findings, should be the subject of particular attention in the framework of research on the human genome, because of its ethical and social implications. Public and private science policy-makers also have particular responsibilities in this respect. 14. States should take appropriate measures to foster the intellectual and material conditions favourable to freedom in the conduct of research on the human genome and to consider the ethical, legal, social and economic implications of such research, on the basis of the principles set out in this Declaration. 15. States should take appropriate steps to provide the framework for the free exercise of research on the human genome with due regard for the principles set out in this Declaration, in order to safeguard respect for human rights, fundamental freedoms and human dignity and to protect public health. They should seek to ensure that research results are not used for non-peaceful purposes. 16. States should recognize the value of promoting, at various levels as appropriate, the establishment of independent, multidisciplinary and pluralist ethics committees to assess the ethical, legal and social issues raised by research on the human genome and its applications. E. SOLIDARITY AND INTERNATIONAL CO-OPERATION 17. States should respect and promote the practice of solidarity towards individuals, families and population groups who are particularly vulnerable to or affected by disease or disability of a genetic character. They should foster, inter alia, research on the identification, prevention and treatment of genetically-based and geneticallyinfluenced diseases, in particular rare as well as endemic diseases which affect large numbers of the world's population. 18. States should make every effort, with due and appropriate regard for the principles set out in this Declaration, to continue fostering the international dissemination of scientific knowledge concerning the human genome, human diversity and genetic research and, in that regard, to foster scientific and cultural co-operation, particularly between industrialized and developing countries. 19. a) In the framework of international co-operation with developing countries, States should seek to encourage measures enabling: 1. assessment of the risks and benefits pertaining to research on the human genome to be carried out and abuse to be prevented; 2. the capacity of developing countries to carry out research on human biology and genetics, taking into consideration their specific problems, to be developed and strengthened; 3. developing countries to benefit from the achievements of scientific and technological research so that their use in favour of economic and social progress can be to the benefit of all; 4. the free exchange of scientific knowledge and information in the areas of biology, genetics and medicine to be promoted.

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b) Relevant international organizations should support and promote the initiatives taken by States for the abovementioned purposes. F. PROMOTION OF THE PRINCIPLES SET OUT IN THE DECLARATION 20. States should take appropriate measures to promote the principles set out in the Declaration, through education and relevant means, inter alia through the conduct of research and training in interdisciplinary fields and through the promotion of education in bioethics, at all levels, in particular for those responsible for science policies. 21. States should take appropriate measures to encourage other forms of research, training and information dissemination conducive to raising the awareness of society and all of its members of their responsibilities regarding the fundamental issues relating to the defense of human dignity which may be raised by research in biology, in genetics and in medicine, and its applications. They should also undertake to facilitate on this subject an open international discussion, ensuring the free expression of various socio-cultural, religious and philosophical opinions. G. IMPLEMENTATION OF THE DECLARATION 22. States should make every effort to promote the principles set out in this Declaration and should, by means of all appropriate measures, promote their implementation. 23. States should take appropriate measures to promote, through education, training and information dissemination, respect for the abovementioned principles and to foster their recognition and effective application. States should also encourage exchanges and networks among independent ethics committees, as they are established, to foster full collaboration. 24. The International Bioethics Committee of UNESCO should contribute to the dissemination of the principles set out in this Declaration and to the further examination of issues raised by their applications and by the evolution of the technologies in question. It should organize appropriate consultations with parties concerned, such as vulnerable groups. It should make recommendations, in accordance with UNESCO's statutory procedures, addressed to the General Conference and give advice concerning the follow-up of this Declaration, in particular regarding the identification of practices that could be contrary to human dignity, such as germ-line interventions. 25. Nothing in this Declaration may be interpreted as implying for any State, group or person any claim to engage in any activity or to perform any act contrary to human rights and fundamental freedoms, including the principles set out in this Declaration.

Ethical Principles for Medical Research Involving Human Subjects (by the World Medical Association Declaration of Helsinki) Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended by the: 29th WMA General Assembly, Tokyo, Japan, October 1975 35th WMA General Assembly, Venice, Italy, October 1983 41st WMA General Assembly, Hong Kong, September 1989 48th WMA General Assembly, Somerset West, Republic of South Africa, October 1996, and the 52nd WMA General Assembly, Edinburgh, Scotland, October 2000 Note of Clarification on Paragraph 29 added by the WMA General Assembly, Washington, 2002 Note of Clarification on Paragraph 30 added by the WMA General Assembly, Tokyo 2004

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A INTRODUCTION 1. The World Medical Association has developed the Declaration of Helsinki as a statement of ethical principles to provide guidance to physicians and other participants in medical research involving human subjects. Medical research involving human subjects includes research on identifiable human material or identifiable data. 2. It is the duty of the physician to promote and safeguard the health of the people. The physician's knowledge and conscience are dedicated to the fulfillment of this duty. 3. The Declaration of Geneva of the World Medical Association binds the physician with the words, "The health of my patient will be my first consideration," and the International Code of Medical Ethics declares that, "A physician shall act only in the patient's interest when providing medical care which might have the effect of weakening the physical and mental condition of the patient." 4. Medical progress is based on research which ultimately must rest in part on experimentation involving human subjects. 5. In medical research on human subjects, considerations related to the well-being of the human subject should take precedence over the interests of science and society. 6. The primary purpose of medical research involving human subjects is to improve prophylactic, diagnostic and therapeutic procedures and the understanding of the aetiology and pathogenesis of disease. Even the best proven prophylactic, diagnostic, and therapeutic methods must continuously be challenged through research for their effectiveness, efficiency, accessibility and quality. 7. In current medical practice and in medical research, most prophylactic, diagnostic and therapeutic procedures involve risks and burdens. 8. Medical research is subject to ethical standards that promote respect for all human beings and protect their health and rights. Some research populations are vulnerable and need special protection. The particular needs of the economically and medically disadvantaged must be recognized. Special attention is also required for those who cannot give or refuse consent for themselves, for those who may be subject to giving consent under duress, for those who will not benefit personally from the research and for those for whom the research is combined with care. 9. Research Investigators should be aware of the ethical, legal and regulatory requirements for research on human subjects in their own countries as well as applicable international requirements. No national ethical, legal or regulatory requirement should be allowed to reduce or eliminate any of the protections for human subjects set forth in this Declaration. B BASIC PRINCIPLES FOR ALL MEDICAL RESEARCH 10. It is the duty of the physician in medical research to protect the life, health, privacy, and dignity of the human subject. 11. Medical research involving human subjects must conform to generally accepted scientific principles, be based on a thorough knowledge of the scientific literature, other relevant sources of information, and on adequate laboratory and, where appropriate, animal experimentation. 12. Appropriate caution must be exercised in the conduct of research which may affect the environment, and the welfare of animals used for research must be respected. 13. The design and performance of each experimental procedure involving human subjects should be clearly formulated in an experimental protocol. This protocol should be submitted for consideration, comment, guidance, and where appropriate, approval to a specially appointed ethical review committee, which must be independent of the investigator, the sponsor or any other kind of undue influence. This independent committee should be in conformity with the laws and regulations of the country in which the research experiment is performed. The committee has the right to monitor ongoing trials. The researcher has the obligation to provide monitoring information to the committee, especially any serious adverse events. The researcher should also submit to the committee, for review, information regarding funding, sponsors, institutional affiliations, other potential conflicts of interest and incentives for subjects. 14. The research protocol should always contain a statement of the ethical considerations involved and should indicate that there is compliance with the principles enunciated in this Declaration.

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15. Medical research involving human subjects should be conducted only by scientifically qualified persons and under the supervision of a clinically competent medical person. The responsibility for the human subject must always rest with a medically qualified person and never rest on the subject of the research, even though the subject has given consent. 16. Every medical research project involving human subjects should be preceded by careful assessment of predictable risks and burdens in comparison with foreseeable benefits to the subject or to others. This does not preclude the participation of healthy volunteers in medical research. The design of all studies should be publicly available. 17. Physicians should abstain from engaging in research projects involving human subjects unless they are confident that the risks involved have been adequately assessed and can be satisfactorily managed. Physicians should cease any investigation if the risks are found to outweigh the potential benefits or if there is conclusive proof of positive and beneficial results. 18. Medical research involving human subjects should only be conducted if the importance of the objective outweighs the inherent risks and burdens to the subject. This is especially important when the human subjects are healthy volunteers. 19. Medical research is only justified if there is a reasonable likelihood that the populations in which the research is carried out stand to benefit from the results of the research. 20. The subjects must be volunteers and informed participants in the research project. 21. The right of research subjects to safeguard their integrity must always be respected. Every precaution should be taken to respect the privacy of the subject, the confidentiality of the patient's information and to minimize the impact of the study on the subject's physical and mental integrity and on the personality of the subject. 22. In any research on human beings, each potential subject must be adequately informed of the aims, methods, sources of funding, any possible conflicts of interest, institutional affiliations of the researcher, the anticipated benefits and potential risks of the study and the discomfort it may entail. The subject should be informed of the right to abstain from participation in the study or to withdraw consent to participate at any time without reprisal. After ensuring that the subject has understood the information, the physician should then obtain the subject's freely-given informed consent, preferably in writing. If the consent cannot be obtained in writing, the non-written consent must be formally documented and witnessed. 23. When obtaining informed consent for the research project the physician should be particularly cautious if the subject is in a dependent relationship with the physician or may consent under duress. In that case the informed consent should be obtained by a well-informed physician who is not engaged in the investigation and who is completely independent of this relationship. 24. For a research subject who is legally incompetent, physically or mentally incapable of giving consent or is a legally incompetent minor, the investigator must obtain informed consent from the legally authorized representative in accordance with applicable law. These groups should not be included in research unless the research is necessary to promote the health of the population represented and this research cannot instead be performed on legally competent persons. 25.When a subject deemed legally incompetent, such as a minor child, is able to give assent to decisions about participation in research, the investigator must obtain that assent in addition to the consent of the legally authorized representative. 26. Research on individuals from whom it is not possible to obtain consent, including proxy or advance consent, should be done only if the physical/mental condition that prevents obtaining informed consent is a necessary characteristic of the research population. The specific reasons for involving research subjects with a condition that renders them unable to give informed consent should be stated in the experimental protocol for consideration and approval of the review committee. The protocol should state that consent to remain in the research should be obtained as soon as possible from the individual or a legally authorized surrogate. 27. Both authors and publishers have ethical obligations. In publication of the results of research, the investigators are obliged to preserve the accuracy of the results. Negative as well as positive results should be published or otherwise publicly available. Sources of funding, institutional affiliations and any possible conflicts of interest should be declared in the publication. Reports of experimentation not in accordance with the principles laid down in this Declaration should not be accepted for publication.

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C ADDITIONAL PRINCIPLES FOR MEDICAL RESEARCH COMBINED WITH MEDICAL CARE 28. The physician may combine medical research with medical care, only to the extent that the research is justified by its potential prophylactic, diagnostic or therapeutic value. When medical research is combined with medical care, additional standards apply to protect the patients who are research subjects. 29. The benefits, risks, burdens and effectiveness of a new method should be tested against those of the best current prophylactic, diagnostic, and therapeutic methods. This does not exclude the use of placebo, or no treatment, in studies where no proven prophylactic, diagnostic or therapeutic method exists. See footnote 30. At the conclusion of the study, every patient entered into the study should be assured of access to the best proven prophylactic, diagnostic and therapeutic methods identified by the study. See footnote 31. The physician should fully inform the patient which aspects of the care are related to the research. The refusal of a patient to participate in a study must never interfere with the patient-physician relationship. 32. In the treatment of a patient, where proven prophylactic, diagnostic and therapeutic methods do not exist or have been ineffective, the physician, with informed consent from the patient, must be free to use unproven or new prophylactic, diagnostic and therapeutic measures, if in the physician's judgement it offers hope of saving life, re-establishing health or alleviating suffering. Where possible, these measures should be made the object of research, designed to evaluate their safety and efficacy. In all cases, new information should be recorded and, where appropriate, published. The other relevant guidelines of this Declaration should be followed. Note: Note of clarification on paragraph 29 of the WMA Declaration of Helsinki The WMA hereby reaffirms its position that extreme care must be taken in making use of a placebo-controlled trial and that in general this methodology should only be used in the absence of existing proven therapy. However, a placebo-controlled trial may be ethically acceptable, even if proven therapy is available, under the following circumstances: - Where for compelling and scientifically sound methodological reasons its use is necessary to determine the efficacy or safety of a prophylactic, diagnostic or therapeutic method; or - Where a prophylactic, diagnostic or therapeutic method is being investigated for a minor condition and the patients who receive placebo will not be subject to any additional risk of serious or irreversible harm. All other provisions of the Declaration of Helsinki must be adhered to, especially the need for appropriate ethical and scientific review. Note: Note of clarification on paragraph 30 of the WMA Declaration of Helsinki The WMA hereby reaffirms its position that it is necessary during the study planning process to identify posttrial access by study participants to prophylactic, diagnostic and therapeutic procedures identified as beneficial in the study or access to other appropriate care. Post-trial access arrangements or other care must be described in the study protocol so the ethical review committee may consider such arrangements during its review. The Declaration of Helsinki (Document 17.C) is an official policy document of the World Medical Association, the global representative body for physicians. It was first adopted in 1964 (Helsinki, Finland) and revised in 1975 (Tokyo, Japan), 1983 (Venice, Italy), 1989 (Hong Kong), 1996 (Somerset-West, South Africa) and 2000 (Edinburgh, Scotland). Note of clarification on Paragraph 29 added by the WMA General Assembly, Washington 2002. Version of 9.10.2004 Q1. This is a statement accepted by most medical associations in the world to guide ethical conduct of research. Are there any articles you disagree with? Q2. How would you feel as a research subject? How would you fee as a researcher?

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Unit 16 Protecting future generations

Learning Objectives: Students should be able to explain the principle of protecting future generations. Students should be able to evaluate the possibilities and difficulties in the application of the principle in practical settings.

Human Gene Therapy Gene therapy has been discussed since the 1970s but despite clinical trials since 1990 it has not yet been very successful. It is however a symbolic issue in bioethics, for it is a technology that was discussed prior to its use widely in many societies from the ethical perspective. Here we shall introduce somatic cell and germ-line gene therapy, consider the risks and benefits of gene therapy, investigate the relationship between discussion of ethics and evolution of regulation, and consider human genetic engineering. Case 16-1: Brain-enhancing drug use for adults This 47-year-old man is a successful owner and chef of an Italian restaurant in one of the largest cities in the world. He opened this restaurant 3 years ago and it has been busy and popular. Every morning his day starts at 4 am when he gets up and goes to several markets. After a long busy day, finishing dinner time and cleaning, he finally goes to bed at 1am every night, which means he has only 3 hours to sleep, but he never feels tired at his work. The reason is not simply because he loves his work and is really enjoying and happy with this situation, but he regularly uses an analeptic drug, Modafinil, which is normally prescribed for narcolepsy, shift work sleep disorder, and excessive daytime sleepiness. Since he started to use this drug 2 years ago, it has enabled him to focus on his work continually with more energy and less sleep, which led to his present success, he believes. He does not have any big problem caused by this drug at the moment and is going to keep this life style. There are different kinds of these drugs. Some drugs cause heavy tiredness or severe side effect afterwards, which prevent you from doing anything expect lying down in bed whole day. Questions Q1. What are the benefits and harms of using these drugs? Q2. What causes the use of these drugs in general? Do you agree with this man in using them constantly? Q4. Have you ever taken these drugs, other types of energy supplement/drink, or vitamin shot, such as high caffeine/taurine containing food and drink? If yes, what occasion was that and was it a good decision? Also, will you use it again in future? Q5. Should these drugs be banned strictly by law/authority, or opened more to market and made easier for people to buy? Q6. If it becomes popular to use brain-enhancing drugs among people in future, what kind of effect would there be on the individual and society? Q7. Some people warn that the use of these drugs by more people in the future will lead to the use by other people who actually do not want to use them because a higher quality of work will be required in a short time, which eventually you can manage only by having these medicines. Do you agree with this argument? Gene Therapy trials Many genetic diseases may be able to be treated by correcting the defective genes, using gene therapy. Gene therapy is a therapeutic technique in which a functioning gene is inserted into the somatic (body) cells of a

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patient to correct an inborn genetic error or to provide a new function to the cell. It means the genetic modification of DNA in body cells of an individual patient, directed to alleviating disease in that patient. There have been several hundred human gene therapy clinical trials in many countries (including USA, EU, Canada, China, Japan, New Zealand), involving over 6000 patients world-wide, for several different diseases including several cancers. Genetic engineering is altering the genetic composition of a living organism by technological means based on recombinant DNA technology (see Chapter C2). This can involve altering the gene sequence, or addition, substitution, and/or deletion of DNA. It has contributed to the understanding of genetic diversity which is useful in the conservation of plants, animals and microorganisms. Genetic intervention is a general term for the modification of inheritable characteristics of individuals or populations through various social mechanisms and/or biomedical technologies. Types of Treatment of Human Genetic Disease: After conception the genotype may be "normal" (without a genetic disease) or "abnormal" (with a genetic disease). There are several stages at which therapy could occur. Somatic cell therapy can be performed before birth or after. Symptomatic therapy (to treat the symptoms of the disease by diet or medicine for example) usually occurs after birth, but may also occur before birth in some diseases where it is possible and necessary to treat early. The questions of reproduction are more complex, as someone healthy in their life may still have problems with their fertility or pass on a genetic disease to their children. Gene transfer refers to the spread of genetic material through natural genetic mechanisms. Little is known about the frequency of genetic exchange in Nature. Human gene transfer is a term used for gene transfer when it is not expected that any therapy will result from the transferred gene, for example, the gene may only be a marker for improving other methods of therapy against the disease. It was first approved in 1989 in the USA. Somatic cell gene therapy Somatic-cell gene therapy involves injection of 'healthy genes' into the bloodstream or another target tissue of a patient to cure or treat a hereditary disease or similar illness. The DNA change is not inherited by children. For other types of gene therapy see later in the chapter. The DNA can be repaired by correction of the mutation, which may only require a few base pairs of DNA within a gene to be replaced. Not all the gene must be inserted, only what is needed. If accurate changes can be made it may be very safe. The problem is how to deliver the DNA, and how we can be sure it is changed properly. Many vectors, including modified viruses, have been developed and tested. One success already known is curing an immunodeficiency disease, adenosine deaminase (ADA) deficiency, by allowing expression of the enzyme made from a normal gene in the cells of children lacking it. ADA deficiency is a rare genetic immunodeficiency disease that is caused by lack of functional ADA enzyme. The first human gene therapy protocol began in September 1990 that successfully treated adenosine deaminase deficiency (ADA) disease. If gene therapy is more successful, it will revolutionize the medicine of the future and will have a profound impact on our moral and ethical outlook. But as of 2005 it is still experimental and in clinical trials. Q1. Do you think there are any ethical differences between gene therapy and other therapy? Q2. Does any conventional therapy also change a patient's DNA? Enzyme Deficiencies and the ADA Gene Therapy trial During the 1980s it was thought that the first patients involved in gene therapy trials would be sufferers of several rare enzyme deficiencies, all with fatal symptoms. Because many genetically determined diseases involve the bone marrow, and bone marrow transplantation techniques are effective for curing many diseases,

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there have been many preliminary animal gene therapy trials aimed at changing the pluripotent hematopoietic stem cells of the bone marrow, the "parental" cells from which all blood cells come. One of these diseases is ADA deficiency. The lack of the enzyme ADA destroys the immune system. There are up to 5 sufferers of ADA born annually in the USA. The more general name for these diseases is severe combined immunodeficiency (SCID). SCID is extremely rare, affecting about 40 children worldwide each year. About 25 percent of those with SCID suffer from ADA deficiency. ADA degrades certain products that interfere with DNA synthesis, thus killing cells, especially the T-cells of the immune system. The most effective therapy available is complete isolation of the patient so that they are not exposed to infectious agents. Some in the press have called these unfortunate children "bubble" children, because they need to live in a sterile plastic bubble. Bone marrow transplantation can be used if a suitable donor is available. To treat this, the bone marrow is removed from the patient, and then the cells are infected with a virus containing the gene for ADA. The gene then becomes part of the recipient bone marrow cells' DNA along with the carrier virus. After genetic modification in the laboratory the cells are placed back in the patient using bone marrow transplantation and the cells need to continue to produce ADA, they can cure the disease and prevent certain infant death. Up until the late 1980s there was no alternative treatment for sufferers of ADA, a reason why experimental gene therapy methods are used, since they will die if not treated. The major reason that the first trials were postponed in 1990 was that an alternative treatment was partially successful. The new conventional therapy was approved in April 1990, called PEG-ADA, and it combined the protein ADA with another molecule enabling the enzyme to survive intact longer. PEG is a nontoxic polymer. PEG-ADA is not a cure, rather it converts severe combined immunodeficiency to partial combined immunodeficiency. The patients had weekly treatments of PEG-ADA with clinical response to the drug without serious side-effects. Some have been able to go out of isolation and join their families or attend school. In April 1990, Anderson and Blaese and a group of scientists presented their proposal for gene therapy of ADA deficiency to the Human Gene Therapy subcommittee of the U.S. National Institutes of Health. It had many committees (a total of eight layers of review) to pass through before approval, but it was given approval in August 1990 for a trial of ten patients. The test removed T-lymphocytes from the patient and introduced the ADA gene into them. Lymphocytes have a limited life, so the entire procedure needs to be repeated, though they may last many years which is much more than the current life expectancy of these patients. ADA deficiency is a useful model for other diseases that affect the lymphoid system. ADA deficiency is heterogeneous, with patients retaining 0.1 to 5% of the normal level of the enzyme, but this level is still too low for normal immune function. A level of 5% normal is adequate, so the expression of the gene does not need to be great. ADA-deficient T-lymphocytes have normal ADA levels following retrovirally mediated insertion of the normal ADA gene. The presence of the ADA gene inside cells will probably provide better detoxification than the presence of extracellular PEG-ADA. For some children with ADA deficiency, gene therapy has worked as a treatment. Regulation and Safety; the Gelsinger case Gene therapy is still an experimental therapy, but if it is found to be safe and effective, it may prove to be a better approach to therapy than many current therapies, because gene therapy cures the cause of the disease rather than merely treating the symptoms. Also, many diseases are still incurable by other means, so the potential benefit is saving life. In the USA the trials must be approved by the Recombinant DNA Advisory Committee (RAC) and the FDA. The RAC meetings are open to the public, to help allay fears about genetic engineering. In Japan the trials require approval of committees of both the Ministry of Education, Culture, Sports, Science and Technology, and the Ministry of Health and Welfare. There is extra regulation for gene therapy because it involves genetic engineering, in addition to the normal ethics committee approval for any experimental medicine.

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From 1989 until September 1999 there were thousands of patients in trials and no one died because of the experiments. 18 year-old Jesse Gelsinger died at the University of Pennsylvania (USA) on 17 September 1999, four days after receiving a relatively high dose of an experimental gene therapy. His death was the result of a large immune reaction to the engineered adenovirus that researchers had infused into his liver. He died of acute respiratory distress syndrome and multiple-organ failure. There was intense review of the procedures for safety following that case. The researchers had not given all the safety data to the patient or regulatory committees. Therefore it was not proper informed consent. (The principles of bioethics and research ethics are discussed in detail in other chapters). The head researcher was also trying to make a company for gene therapy, and may not have reported bad results including deaths of monkeys in the tests because he did not want bad media publicity for the stocks of the company. It was therefore an important case in bioethics in general, and is an example of conflict of interest. The trial at the Pennsylvania Institute for Human Gene Therapy was testing in patients the safety of a possible treatment for an inherited liver disease, ornithine transcarbamylase deficiency (OTCD). OTCD causes ammonia to build up in the blood. Gelsingers illness was being partly controlled with a low-protein diet and with a chemical therapy that helps the body eliminate ammonia. The death triggered alarm at many centers that are testing gene therapy, because 30% of all such trials used adenoviruses to convey a gene into patients' cells. Wild adenoviruses can cause various illnesses, including colds, although infections are usually mild. The FDA immediately halted two other trials that involved infusing adenoviruses into patients' livers. The researchers admitted at a meeting of the RAC that they had failed to notify the FDA prior to Gelsinger's fatal reaction of the deaths of some monkeys that had been given high doses of a different modified adenovirus. The group had also omitted to tell the RAC of a change in the way the virus was to be delivered. Also patient volunteers who participated in the OTCD trial before Gelsinger who were mostly given lower doses of virus, still suffered significant liver toxicity. If that had been reported to the FDA, it would likely have put the study on hold. Gelsinger himself should not have been allowed to even join the trial because the approved protocol called for a female in his place, because females are less severely affected by OTCD than males. Furthermore, his blood ammonia level was too high for admission into the trial when it was last checked, on the day before the fatal gene treatment. Following the review of his death, the regulatory systems were made more strict. Then in 2002 there were cases of leukemia in two children in France who had gene therapy for immunodeficiency diseases. However, there was also positive news of gene therapy in some trials for other diseases. Ethically there should be some positive results from animal studies before trials should be approved. The progress since 1989 has not been as fast as many hoped. Non-inheritable (somatic cell) gene therapy to treat patients involves similar ethical issues to any other experimental therapy, and if it is safer and more effective, it should be available. Q3. When was the first trial of gene therapy in your country? What is a clinical trial? Q4. How is gene therapy regulated in your country? Q5. Discuss some of the ethical questions raised by the Gelsinger case. Germ-line gene therapy At the present the gene therapy that is done is not inheritable. Germ cells are cells connected with reproduction, found in the testis (males) and ovary (females), i.e. egg and sperm cells and the cells that give rise

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to them. Germ-line gene therapy targets the germ cells that eventually produce gametes (sperm and eggs). This type of therapy may mean injecting DNA to correct, modify or add DNA into the pronucleus of a fertilized egg. The technology requires that fertilization would occur in vitro using the usual IVF procedures (See chapter E2) of super-ovulation and fertilization of a number of egg cells prior to micromanipulation for DNA transfer and then embryo transfer to a mother after checking the embryo's chromosomes. We need to have much wider discussion about the ethical and social impact of human genetic engineering before we start inheritable gene therapy. Deliberately targeting the human germ-line is problematic from biological and ethical viewpoints, especially in view of unknown consequences passed down generations. It may also take away control from the child and person so made. It could lead to consumer children, and there may be no limit in the traits that people can choose. Because of the risk of harm to the development of the person whose genes are changed, many people question its safety as a risk we do not need to take. Other ways could help people who have a child who has a genetic disease, like genetic screening or assisted reproduction and donated gametes. However, others say it is natural for humans to take more control over their evolution. Q6: What are the ethical differences between inheritable and non-heritable gene therapy? Q7. If you suffered from a disease would you like to correct the genes so that your children do not need to have the same disease or medical therapy that you receive? Q8. If and when gene therapy becomes effective and safe, for what conditions should we allow it? Should it be used to cure a disease, enhance our immune system, or to make our bodies stronger? Q9. Make a list of things that you would not like to change about your body and a list of things you would like to change? In-utero gene therapy may be somatic or germ-line. In the 1990s scientists developed a technique in mice in which foreign DNA was transported intravenously to the developing embryo in utero. It was found that the maternal blood flow effectively transported the DNA through the placenta, opening up the way for somatic in utero gene therapy. These advances are significant because they foreshadow the use of in utero gene transfer in humans for specific target organs; such as the lung in the case of cystic fibrosis, targeted for therapy with the advantage of arresting the genetic defect before it can severely damage tissues and organs in affected children. The major hazard of somatic gene therapy, as with all experimental treatments, is that things could go wrong. However, for some diseases irreversible damage is done in utero if the disease is not fixed. The development of human fetal gene therapy, however, carries complex moral and ethical questions including the issues of deliberate or accidental targeting of the germ-line cells with physiological/psychological consequences on future generations of children. Some interesting facts The first approved gene transfer was in 1989 in USA, and it involved the use of cells which attack cancer, called tumour-infiltrating lymphocytes (TILs). They are isolated from the patient's own tumour, then grown in large number in vitro. The cells are then returned to the patient and stimulated by a naturally-occuring hormone, interleukin-2. The procedure was found to help about a half of the patients. In order to discover how this therapy works, the TILs were genetically marked to trace them in the patients. The initial trial involved ten patients, but later that number was increased following the success of the preliminary group of patients. The first country to issue a commercial license to somatic cell gene therapy was China, for a cancer treatment! There are trials in many countries, and despite discussions since the 1960s of the ethics of the techniques, it has not yet proven to be of widespread applicability. As we improve our understanding of genetics, immunology and our body, it is hoped that it will deliver on its promise. It goes to show how long it can take to conduct medical research to provide a clinically effective treatment.

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Human Cloning Cloning is the process of asexually producing a group of cells (clones), all genetically identical to the original ancestor. The word is also used in recombinant DNA manipulation procedures to produce multiple copies of a single gene or segment of DNA. It is more commonly known as the production of a cell or an organism from a somatic cell of an organism with the same nuclear genomic (genetic) characters - without fertilization. A clone is a collection of cells or organisms that are genetically identical. Some vegetables are made this way, like asparagus, or flowers like orchids.

From Scientific American November 24, 2001 (http://www.sciam.com/) Human reproductive cloning is the production of a human fetus from a single cell by asexual reproduction. In 2001 a cloned embryo was reported made by nuclear transfer, though in 1993 cloned embryos were made by splitting human embryos. Since the late 1990s reproductive cloning was used to produce clones of the adults of a number of mammalian species, including cats, dogs, cows, sheep, mice and pigs. The most famous of these was Dolly, the sheep. Many countries rushed to outlaw the possibility of reproductive cloning in humans. Most mammalian embryos can only be split into 2-4 clones, after that the cells lack the ability to start development into a human being. Therapeutic cloning is the cloning of embryos containing DNA from an individual's own cell to generate a source of embryonic stem (ES) cell-progenitor cells that can differentiate into the different cell types of the body. ES cells are capable of generating all cell types, unlike multipotent adult-derived stem cells which generate many but not all cell types. The aim is to produce healthy replacement tissue that would be readily available. Since it is from the same body it is immunocompatible so that the recipients would not have to take immunosuppressant drugs for the rest of their lives, as they do if they receive an organ from another person.

Q1. Is there a difference between identical twins made in nature or ones made by human cloning? Q2. Such clones could be born at different times and/or from different mothers? Are they still twins? Q3. Should teachers be able to clone good students, or parents clone good children? Discuss the ethical issues of cloning. United Nations Declaration on Human Cloning In order to illustrate an example of the politics surrounding human cloning below is the Declaration and the extended press release which includes the viewpoints of some countries. Consider the issues behind the Declaration, which followed several years of hot debate. United Nations Declaration on Human Cloning [59/280]
The General Assembly,

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Recalling its resolution 53/152 of 9 December 1998, by which it endorsed the Universal Declaration on the Human Genome and Human Rights, Approves the United Nations Declaration on Human Cloning annexed to the present resolution. 82nd plenary meeting, 8 March 2005 Annex: United Nations Declaration on Human Cloning The General Assembly, Guided by the purposes and principles of the Charter of the United Nations, Recalling the Universal Declaration on the Human Genome and Human Rights, adopted by the General Conference of the United Nations Educational, Scientific and Cultural Organization on 11 November 1997,1 and in particular article 11 thereof, which states that practices which are contrary to human dignity, such as the reproductive cloning of human beings, shall not be permitted, Recalling also its resolution 53/152 of 9 December 1998, by which it endorsed the Universal Declaration on the Human Genome and Human Rights, Aware of the ethical concerns that certain applications of rapidly developing life sciences may raise with regard to human dignity, human rights and the fundamental freedoms of individuals, Reaffirming that the application of life sciences should seek to offer relief from suffering and improve the health of individuals and humankind as a whole, Emphasizing that the promotion of scientific and technical progress in life sciences should be sought in a manner that safeguards respect for human rights and the benefit of all, Mindful of the serious medical, physical, psychological and social dangers that human cloning may imply for the individuals involved, and also conscious of the need to prevent the exploitation of women, Convinced of the urgency of preventing the potential dangers of human cloning to human dignity, Solemnly declares the following: (a) Member States are called upon to adopt all measures necessary to protect adequately human life in the application of life sciences; (b) Member States are called upon to prohibit all forms of human cloning inasmuch as they are incompatible with human dignity and the protection of human life; (c) Member States are further called upon to adopt the measures necessary to prohibit the application of genetic engineering techniques that may be contrary to human dignity; (d) Member States are called upon to take measures to prevent the exploitation of women in the application of life sciences; (e) Member States are also called upon to adopt and implement without delay national legislation to bring into effect paragraphs (a) to (d); (f) Member States are further called upon, in their financing of medical research, including of life sciences, to take into account the pressing global issues such as HIV/AIDS, tuberculosis and malaria, which affect in particular the developing countries.

Press Release of the United Nations Declaration on Human Cloning Press Release, 8 March 2005 GA/10333 Fifty-Ninth General Assembly Plenary 82nd Meeting (AM) GENERAL ASSEMBLY ADOPTS UNITED NATIONS DECLARATION ON HUMAN CLONING BY VOTE OF 84-34-37 The General Assembly this morning adopted the United Nations Declaration on Human Cloning, by which Member States were called on to adopt all measures necessary to prohibit all forms of human cloning inasmuch as they are incompatible with human dignity and the protection of human life.

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Acting on the recommendation of the Sixth Committee (Legal), contained in its report A/59/516/Add.1, the Assembly adopted the text by a vote of 84 in favour to 34 against, with 37 abstentions (See Annex).

human dignity; to prevent the exploitation of women in the application of life sciences; and to adopt and implement national legislation in that connection. The Declaration adopted today was the product of a Working Group established by the Assembly to finalize the text of a United Nations declaration on human cloning, which met in New York last month. Last November, the Sixth Committee averted a divisive vote on the question of an international convention against human reproductive cloning by deciding to take up the issue as a declaration. Regretting the failure to achieve consensus, several delegations said they had voted against the text today because the reference to human life could be interpreted as a call for a total ban on all forms of human cloning. The Assembly had missed an opportunity to adopt a convention prohibiting reproductive cloning, said the United Kingdom representative, because of the intransigence of those who were not prepared to recognize that other sovereign States might decide to permit strictly controlled applications of therapeutic cloning. Echoing the views of a number of speakers, he said the Declaration was a non-binding political statement, which would not affect his countrys position on the issue. Those in favour of the Declaration welcomed its adoption, saying it constituted an important step in the protection of human dignity and the promotion of human rights, as well as a stepping stone in the process towards a complete ban on human cloning. The text, noted Costa Ricas representative, sought to advance science in a clear framework of ethical norms. The text, added Ethiopias representative, sent a clear message against unethical research which made human life the object of experimentation. Explanations after Vote The representative of Mexico, speaking in explanation of position after the vote, said that those negotiating the Declaration had had to take into account uncertainty over new scientific advances, as well as its ethical, cultural and religious implications. There was a dichotomy between reproductive and therapeutic cloning and, during the entire process, Mexico had focused on seeking a consensus, first on the negotiation of a mandate and subsequently on the text itself.

Regretfully, it had not been possible to achieve a consensus that would facilitate a universal norm, he said. Despite the fact that some delegations had decided not to yield in their original positions, many of their concerns had, in fact, been included in the final text just adopted. The text had the fundamental concern of guaranteeing human dignity and it reflected a realistic form of compromise. Hopefully, the National Parliament would take the necessary action, as the letter and spirit of the Declaration were in step with Mexican legislation and jurisprudence. The representative of China, also speaking in explanation after the vote, said that different countries varied in their understanding of the texts inherent moral, ethical and religious aspects, and it was regrettable that the Declaration failed to give effect to the concerns of those countries. The prohibitions contained in the text could be misunderstood as covering all forms of cloning. Having voted against the Declaration, the Chinese Government would continue to adhere to its position against reproductive human cloning, while maintaining strict controls over therapeutic cloning. The representative of India expressed deep regret that the Sixth Committee had been unable to recommend to the plenary a text that was acceptable to all Member States on a matter of such paramount importance as an international convention against the reproductive cloning of human beings. India had voted against the political Declaration, as some of the provisions of the Declaration could be interpreted as a call for a total ban on all forms of human cloning. India remained totally opposed to reproductive cloning owing to the doubtful nature of its safety, success, utility and ethical acceptability, he said. However, the merits of therapeutic cloning were considered on a case-

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by-case basis within the bioethical guidelines laid down with the approval of the National Bioethical Committee. The Declaration voted upon today was non-binding and did not reflect agreement among the wider membership of the General Assembly. Indias approach to therapeutic cloning, thus, remained unchanged. Belgiums representative regretted that it was not possible to find agreement on a Declaration that could have found consensus in the Assembly. Todays vote reflected the wide divergence in the international community on the text. Rather than bringing States together, it had divided them. It was essential that reproductive human cloning be prohibited. However, it was reasonable to preserve, at the national level, the possibility of carrying out therapeutic cloning. The representative of the United Kingdom said he voted against the Declaration, because the reference to human life could be interpreted as a call for a total ban on all forms of human cloning. He could not accept such an ambiguous Declaration, which might sow confusion about the acceptability of that important field of research. The Assembly had missed an opportunity to adopt a convention prohibiting reproductive cloning because of the intransigence of those who were not prepared to recognize that other sovereign States might decide to permit strictly controlled applications of therapeutic cloning. The Declaration voted on today was a weak, non-binding political statement that did not reflect anything approaching consensus within the Assembly, and would not affect the United Kingdoms strong support of stem cell research. Hungarys representative said he voted in favour of the Declaration because it attached the utmost importance to sending a strong message that the birth of cloned human beings was not acceptable. Furthermore, during the conduct of life sciences, there was a need for a delicate balance between the freedom of research and the adequate protection of human life and dignity. Also, the Declaration was in line with the existing obligations of Hungary under international law. He hoped the Declaration was only one step in the consideration of human cloning, and not the final stage. Hungary was open for further discussions in the international community at the appropriate time. The representative of the Republic of Korea said his country had voted against the political Declaration, which had not achieved a political consensus. It was not binding and would not affect the Republic of Koreas future position on therapeutic cloning, which would reaffirm human dignity by relieving pain and suffering. The representative Thailand expressed regret that the General Assembly and the Sixth Committee had been unable to adopt a consensus Declaration. The Declaration just adopted was not binding and the text was ambiguous. In light of that, Thailand had voted against the Declaration and felt that it should be left to Member States to use their own interpretation as to whether or not to prohibit therapeutic cloning. The representative of Spain said that the term human life contained in the text was confusing and should be replaced by the term human being as used in scientific texts. The Declaration did not cover the well known fundamental differences between the two types of cloning. The fact that there had been no consensus on the issue after four years of discussion showed just how precarious the text was as adopted. Spain was opposed to reproductive cloning, but favoured therapeutic cloning, which was looked upon positively by the scientific community. The issue would now be passed on to the National Parliament. Japans representative said he had voted against the resolution. The Declaration was difficult to interpret and did not respect the various views of Member States. The adopted text would not affect Japans domestic legislation on the issue. The representative of Brazil regretted the lack of consensus on the text adopted, which highlighted the deep division in the international community on the issue. He also regretted that the Sixth Committee had deviated from its original mandate to elaborate an international convention on human cloning. He had voted against the text, which did not contain language consistent with his countrys position on the issue. Singapores representative said he had voted against the resolution because it did not capture the diversity of views on the issue. Four years ago, the Assembly endorsed an initiative to begin work on an international

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convention on human cloning. There was still unanimity that reproductive cloning should be banned. It was unfortunate that that initiative was hijacked, and culminated today in the adoption of a text which sought to impose a single set of regulations on States regarding all forms of human cloning. The representative of the United States, welcoming the adoption of the Declaration, recalled that his delegation had explained its position in the Sixth Committee and would not give a further explanation today. The full text of that explanation was on the web site of the Permanent Mission of the United States. The representative of Poland said his delegation had voted in favour of the Declaration and unequivocally opposed the cloning of human embryos. Any use of human stem cells should be permitted only when the stem cells or stem cell lines were obtained from supernumerary cells, or when donors had expressed their willingness to permit it. The representative of South Africa said his delegation had abstained from the vote and found that the language of the text was deliberately ambiguous so as not to infringe on the rights of those who wished to continue with research in their own jurisdictions. South Africa was against reproductive human cloning and would continue with the strict regulation of therapeutic cloning. South Africa considered therapeutic cloning to be aimed at protecting human life and, as such, it was not inconsistent with the Declaration just adopted. The representative of Canada, emphasizing that his countrys position was clear, said reproductive cloning was illegal in Canada in whatever form. The ambiguity of the Declaration might give rise to certain political and other concerns. Norways representative said that his Government opposed both reproductive human cloning and therapeutic cloning, as reflected in its domestic legislation. It had sought to contribute to the elaboration of an international convention on the issue. At the same time, it had been willing to go along with a declaration, as long as it enjoyed consensus. He had voted against the Declaration, since it did not reflect the views of all States and did not enjoy consensus. The representative of Costa Rica said the adoption of the Declaration today constituted a historic step to promote human rights and guarantee human dignity in all circumstances. The text urged the scientific community to advance, bearing in mind the value of human dignity and human life. It was impossible to reach a consensus because a small group of States had rejected all reference to human life in the text. The Declaration sought to advance science in a clear framework of ethical norms. It was of concern that some delegations had undermined the value of the Declaration, which had received majority support. Frances representative said she regretted the failure to find consensus. She was convinced that there was a clear consensus regarding the prohibition of reproductive human cloning. Also, given the threat of dangerous experimentation, it was essential to prohibit reproductive human cloning. However, she could not agree on prohibiting all forms of cloning. France had voted against the Declaration, and regretted the inability of the Assembly to send a universal message on such a vital issue. The representative of Nigeria regretted that he was not in the room when the voting took place. He was fully in favour of the Declaration. His country supported the Declaration because there was no alternative to it, for the time being. Human life was sacrosanct, and there was no reason for its violation. It was an inconceivable paradox that proponents of therapeutic cloning would sacrifice the life of one in order to serve another. He stressed that human cloning was unethical and a direct assault on human dignity. Todays Declaration was only a stepping stone in the process towards a convention on a complete ban on human cloning.

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The representative of the Russian Federation said that the question involved complex scientific and ethical issues and that his country had always been in favour of consensus. Regrettably, there had been no

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The representative of Mali said, had his delegation been present, it would have abstained from the vote, in accordance with the common position of the Organization of the Islamic Conference.

consensus. But, the Russian Federation had voted in favour of the Declaration, in order to send a message to the international community about the impermissibility of reproductive human cloning. The representative of Uganda said that her country had voted in favour of the Declaration because it opposed the destruction of human embryos and believed in the protection of human dignity. The Declaration was consistent with humanitys responsibility to protect the sanctity of human life. The representatives of the Netherlands said his country had opposed the Declaration because it could be interpreted as a total ban on all forms of cloning. There was a need for strict oversight, but not a total ban. The Declaration just adopted was not binding. The representative of Ethiopia said he had voted in favour of the Declaration, which sent a clear message against unethical research, that made human life the object of experimentation. He hoped the funding for research into human cloning could be redirected towards research and development to find cures for those affected by HIV/AIDS, tuberculosis and malaria. The representative of Antigua and Barbuda said that, had she been in the room during the vote, she would have voted in favour of the text. Kyrgyzstans representative also said that, had he been in the room, he would have voted in favour. Libyas representative congratulated the international community for adopting the Declaration, which was a step forward in the process towards a future convention to ban all forms of human cloning. The Declaration was a starting point in the protection of human dignity. He had voted in favour of the Declaration.

ANNEX Vote on Declaration on Human Cloning The United Nations Declaration on Human Cloning (document A/59/516/Add.1) was adopted by a recorded vote of 84 in favor to 34 against, with 37 abstentions, as follows: In favor: Afghanistan, Albania, Andorra, Australia, Austria, Bahrain, Bangladesh, Belize, Benin, Bolivia, Bosnia and Herzegovina, Brunei Darussalam, Burundi, Chile, Comoros, Costa Rica, Cte dIvoire, Croatia, Democratic Republic of the Congo, Djibouti, Dominican Republic, Ecuador, El Salvador, Equatorial Guinea, Eritrea, Ethiopia, Georgia, Germany, Grenada, Guatemala, Guyana, Haiti, Honduras, Hungary, Iraq, Ireland, Italy, Kazakhstan, Kenya, Kuwait, Lesotho, Liberia, Liechtenstein, Madagascar, Malta, Marshall Islands, Mauritius, Mexico, Federated States of Micronesia, Monaco, Morocco, Nicaragua, Palau, Panama, Paraguay, Philippines, Poland, Portugal, Qatar, Rwanda, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Samoa, San Marino, Sao Tome and Principe, Saudi Arabia, Sierra Leone, Slovakia, Slovenia, Solomon Islands, Sudan, Suriname, Switzerland, Tajikistan, The former Yugoslav Republic of Macedonia, Timor-Leste, Trinidad and Tobago, Uganda, United Arab Emirates, United Republic of Tanzania, United States, Uzbekistan, Zambia. Against: Belarus, Belgium, Brazil, Bulgaria, Cambodia, Canada, China, Cuba, Cyprus, Czech Republic, Democratic Peoples Republic of Korea, Denmark, Estonia, Finland, France, Gabon, Iceland, India, Jamaica, Japan, Lao Peoples Democratic Republic, Latvia, Lithuania, Luxembourg, Netherlands, New Zealand, Norway, Republic of Korea, Singapore, Spain, Sweden, Thailand, Tonga, United Kingdom. Abstain: Algeria, Angola, Argentina, Azerbaijan, Bahamas, Barbados, Burkina Faso, Cameroon, Cape Verde, Colombia, Egypt, Indonesia, Iran, Israel, Jordan, Lebanon, Malaysia, Maldives, Mongolia, Myanmar, Namibia, Nepal, Oman, Pakistan, Republic of Moldova, Romania, Serbia and Montenegro, Somalia, South Africa, Sri Lanka, Syria, Tunisia, Turkey, Ukraine, Uruguay, Yemen, Zimbabwe.

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Absent: Antigua and Barbuda, Armenia, Bhutan, Botswana, Central African Republic, Chad, Congo, Dominica, Fiji, Gambia, Ghana, Greece, Guinea, Guinea-Bissau, Kiribati, Kyrgyzstan, Libya, Malawi, Mali, Mauritania, Mozambique, Nauru, Niger, Nigeria, Papua New Guinea, Peru, Russian Federation, Senegal, Seychelles, Swaziland, Togo, Turkmenistan, Tuvalu, Vanuatu, Venezuela, Vietnam.

Energy crisis, resources & environment There are limits to the human consumption of different forms of energy and natural resources. Environmental impacts from our consumption depend upon the different forms of energy or resource, rates of use, and whether or not they are renewable. Here we shall describe the different forms of conventional and non-conventional energies, illustrate dilemmas between use of energy and preservation of the environment, and consider the conservation of different natural resources.

Energy Energy is the capacity to do work. Energy is found on our planet in a variety of forms, some of which are immediately useful, while others requires a process of transformation from one form to another which is easier to use. Energy is an important input for development of society. The energy consumption of a nation is usually considered as an index of its development. This is because almost all developmental activities are directly or indirectly dependent upon energy. We find wide disparity in per capita energy use between the developed and developing nations. Because of eminent shortages in conventional energy sources there is increasing attention to non-conventional energy sources such as solar energy, wind energy, tidal energy, geothermal energy and biomass energy. In tapping the non conventional energy sources an eco-friendly approach is essential in order to keep our environment more habitable. Energy sources can classified into conventional energy sources and non conventional energy sources. Conventional Energy Sources The conventional energy sources include, coal, oil, natural gas and biomass. Coal is the most widely used fossil fuel. Anthracite coal which is harder with low sulphur content and more than 90% carbon is considered better than the bituminous coal which is softer with 70% to 90% carbon and produces less heat than the anthracite. A coal mine is called a colliery. The major coal uses in the world are in the iron and steel industry, and generating electricity from heat in thermal power plants. In high temperature and pressure coal can be converted to coal gas, which can also be used like natural gas. Burning of coal creates environmental problems due to the production of fly ash, SO2, oxides of nitrogen, different hydrocarbons and acid rain problems. Coal dust also affects vegetation leading to coloured necrotic symptoms. Fly ash also contaminates water and leads to heavy metal pollution. Coal is the worlds single largest contributor for global warming.

Q1. Can you suggest five ways to prevent global warming? Activity 1: Group activity start planting trees in your gardens, and in places the community wants to have more trees. Q2. What is your ethical concern about air pollution? List out advantages and disadvantages of oil in daily life?

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Oil is the second major conventional energy source. This is more inflammable than coal with highest energy content per unit of fuel matter. Oil is found as organic remains within underground sedimentary deposits at different parts of the world. Crude oil is taken from the ground, refined in oil refineries and categorized into different forms based on the purity, petrol, diesel and gasoline. Kerosene and lubricating oils are also produced. Oil powered vehicles emits CO2, SO2, NO2, CO and particulate matter that are major causes of air pollution, especially in urban areas with heavy traffic density. Leaded petrol leads to neurological damages. Petrol vehicles can be run with unleaded fuel by adding catalytic converters on all the new cars but unleaded fuel contains benzene and butadiene which are known to be carcinogenic compounds (See chapter B7). Natural gas is mainly composed of methane with small amounts of propane and ethane. Natural gas deposits are mostly found along with oil deposits because they have been formed by decomposing remains of dead animals and plants buried under the earth. Natural gas is the cleanest fuel. It can be easily transported through pipelines. It has high calorific value and burns without any smoke. It is used as a domestic fuel, industrial fuel and also in power plants for generating electricity. It is also used as a source of hydrogen gas in the fertilizer industry and as a source of carbon in the tyre industry, for example. Compressed natural gas (CNG) is used as an alternative to petrol and diesel for transport of vehicles. Nowadays buses and auto-rickshaws run on this new fuel. This has greatly reduced the vehicular pollution. Synthetic natural gas (SNG) is a mixture of carbon monoxide and hydrogen. It is a connecting link between a fossil fuel and substituted natural gas. Low grade coal is initially transformed into synthetic gas by gasification followed by catalytic conversion of methane. Group activity: Visit a natural gas plant and submit a mini project report. Non conventional energy sources Non-conventional energy sources are mostly renewable, which can be generated continuously in nature and are inexhaustible. These energy sources are not yet used widely by human beings due to easy availability of conventional energy sources. Due to over-exploitation of conventional energy sources and its impact has deteriorated the quality of our environment. This has necessitated the transition towards non-conventional energy sources, which are more eco friendly and non-exhaustible. Solar energy: Solar radiation is one of the cheapest energies available throughout daytime and can be trapped through various ways. For example, consider the following cases: a. Solar thermal devices such as solar cookers, solar water heaters that concentrate solar radiation with the help of a reflector to form heat. The solar energy received by near earth space is approximately 1.4 kiljoules/second/m2, this is known as the solar constant. b. Photovoltaic (PV) silicon devices of solar cells directly convert solar radiation to electricity and are widely used to create solar lamps. Solar cells are made of thin wafers of semiconductor materials like silicon and gallium. When solar radiation falls on them a potential difference is produced which causes a flow of electrons and produces electricity. By using gallium arsenide, cadmium sulphide or boron, the efficiency of the PV cells can be improved. A group of solar cells joined together in a definite pattern form a solar panel, which can harness a large amount of solar energy and can produce enough electricity to run streetlights, irrigation water pumps. Similar cells are also used in calculators, electronic watches, and traffic signals. c. Solar cookers: solar cookers make use of solar heat by reflecting the solar radiation using mirrors directly on to a glass sheet which covers a black insulated box within which the raw food is kept. A new design of solar cooker is now available which involves a spherical reflector instead of plane mirror that has more heating and hence greater efficiency.

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Q3. Please collect data on how many houses, institutions, and industries have set up solar water heaters. Q4. List ways and means you can conserve the energy.

Wind energy was the earliest energy source used for long distance transportation, by sailing ships. Today some countries like Denmark and Germany, and the state of California in USA, have large wind turbines cooperatives, which sell electricity to the central electricity grid. Wind power is the function of wind speed and therefore the average wind speed of an area is an important determinant of economically feasible power. Wind energy is harnessed by making use of windmills. The blades of the windmills keep on rotating continuously due to the force of striking wind. During the past two decades there has been a great deal of technical progress made in the design, sitting and installation, operation and maintenance of power producing windmills. These improvements have resulted in decreased cost of electricity production. The rotational motion of the blades is converted into energy for a number of machines like water pumps, flourmills and electric generation. A large number of windmills are installed in clusters called wind forms and feed power to the utility grid and produce a large amount of electricity. These forms are ideally located in coastal regions, open grasslands or hilly regions, particularly mountain passes and ridges where the winds are strong and steady. Wind energy is very useful, as it does not cause environmental pollution, though it changes the appearance of the landscape. After initial installation cost, the wind energy is very cheap.

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Tidal energy: Tidal and oceanic waves have enormous potentiality to produce electricity as continuous rotation of turbines can be achieved to generate electricity if tidal waves are allowed to make impact on turbines continuously. Kinetic energy of tidal flow can be harnessed through two main technologies namely: a. Lift device turbine where the windmill type of technology is applied to the liquid environment. Here the propeller has speed much faster than the current speed and is considered to be most efficient device. b. Drag device water wheels technology is less efficient than the lift device and the blade speed is unable to exceed that of the current. Geothermal energy is derived from the heat present in the interior of the earth, and can be converted into heat and electricity. Three popular technologies to harness this energy are 1) Geothermal heat pumps that use shallow ground energy to heat and cool buildings; 2) directly piped hot water to warm greenhouses, of bathing; and 3) power plants that generate electricity from geothermal reservoirs like deep wells. Suitable sites for power generation from geothermal energy includes volcanic locations, geysers and hot springs, and it is used in New Zealand to generate electricity. Biogas is a mixture of methane, CO2, hydrogen and hydrogen sulphide. This gas is obtained from biological degradation of organic wastes. For example in India, gobar gas is derived from cow dung within a chamber of suitable environment the presence of water. Digestion of cattle excreta within a chamber primarily by methanogenic bacteria provides an ecofriendly technology to produce a large amount of biogas that can be used local villages for cooking. Biogas plants also produce large quantity of refuse in the form of slurry, which can be used as organic fertilizers. Biogas is non-polluting, clear and low cost fuel which is very useful for rural areas where a lot of animal waste and agricultural waste are available. You could try to setup a mini biogas plant in your house/institution. Energy from solid waste: As the population increases day by day, the amount of waste generated is also increasing. One of the important methods of solid waste management is using this waste for energy production. This waste can be burnt to produce heat that creates steam from water in the boilers. This steam can be used to rotate turbines for generating electricity. This energy is popularly known as trash power. However, the solid waste burning creates air pollution, unless it is incinerated under very careful conditions. Nuclear energy is known for its high destructive power as evidenced from nuclear weapons. The nuclear energy can be harnessed by two methods, namely nuclear fission and nuclear fusion. 1. Nuclear fission: the nuclei of certain isotopes with large mass numbers are split into higher nuclei on bombardment by neutrons and a large amount of energy is released through a chain reaction. 2. Nuclear fusion: two isotopes of light elements are forced together at extremely high temperature around 1 billion degrees Celsius until they fuse to form a heavier nucleus releasing an enormous amount of energy in the process. It is difficult to initiate the process but it releases more energy than nuclear fission. It is not yet used for energy production.

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The major problem related to nuclear energy is the disposal of nuclear waste. The management, storage and disposal of radioactive wastes resulting from the nuclear power generation are the biggest expenses of the nuclear power industry. Human errors have created disasters or accidents in nuclear power plants in the past, such as in Chernobyl in the former USSR. It will result in collapse of both living and non-living components of our ecosystems. Q5. Do you know the destructive power of nuclear energy? Can you suggest some safe disposal methods for nuclear waste.

Energy and Resource Conservation Conserving energy for the future has become a key issue in the present scenario of environmental degradation and protection. Energy saved is energy given for another day. Saving energy will cut down pollution levels and help our fossil fuel last longer. We should improve the energy efficiency of our own operation. We should use creativity in the development of new technologies to achieve greater efficiency in energy transfer. We should encourage people to use less polluting energy sources so that the damage caused to our environment will be reduced.

Q6. Give examples of eco-friendly approaches in all our activities and ways we can reduce energy use. Natural Resources are the resources, which are available in nature, which are necessary and useful for human needs in the form of matter and energy. They help to improve the quality of human life when used well. These natural resources includes air, water, soil and minerals along with the solar energy as abiotic factors, while biotic factors consist of plants, animals and microbes. Mineral resources: Minerals are naturally occurring inorganic crystalline solids having a definite chemical composition and characteristic properties. Commonly used minerals are quartz, feldspar, biotitic, dolomite, calcite, and laterite. Use metals by human beings have been extensive since the beginning of human civilization. The metals used in maximum quantity are iron, followed by manganese, copper, chromium, aluminum and nickel. Coal is a major source of energy.

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Mining includes extracting minerals from deep deposits in soil by using sub-surfacing mining, or from shallow deposits by surface mining. Open-pit mining, dredging and strip mining are forms of surface mining. The damage done to the environment from mining is enormous. It results in devegetation and defacing of landscape, subsidence of land, ground water pollution, surface water pollution, air pollution, and occupational health hazards for the workers. Hydrosphere: Water is our most abundant resource, covering about 71% of the earths surface. This precious film of water is about 97% salt water and the remainder is fresh water. Water helps maintain the earths climate and dilute the environmental pollutants. Essential to all life, water constitutes from 50% to 97% of the weight of all plants and animals and about 70% of our body. Water is also essential for agriculture, manufacturing, transportation and countless other human activities. Water is a precious commodity, and we need to think how to conserve water. Food Resources: The main food resources include wheat, rice, maize, potato, barley oats, cassava, sweet potato, sugarcane, pulses, sorghum, millet, fruits, vegetables, milk, meat, fish and seafood. Meat and milk are mainly consumed by more developed countries while rice, wheat, maize are staple foods everywhere. Deficiency or lack of nutrition often leads to malnutrition resulting in several diseases in the developing countries. In some of the developing countries, even though the production has increased considerably still there is a starvation and hunger prevails. Conserving genetic resources for food and agriculture is veryt important and the subject of international treaties. Every two seconds someone dies of hunger in the world. This is mainly due to improper distribution systems. The green revolution brought modern agriculture in terms of using more fertilizer, pesticides and new hybrid varieties but it also lead to undesirable changes in our environment. Even though the pesticides and fertilizers have increased the productivity it also became lethal to some of the useful and beneficial insects and animals. In order to increase our agricultural productivity and minimize the damage of pesticides on environment, agriculturists are encouraged to take up organic farming which is one of the traditional ways of agriculture. Organic farming refers to agricultural production system used to produce food and fibre with out chemicals namely pesticide and fertilizers. Organic farming relies on developing biological diversity in the field to disrupt habitat for pest organisms and the purposeful maintenance and replenishment of soil fertility. The maintenance

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of soil fertility relies principally on the use of legumes, crop rotations, the application of composted animal manures. Certain wild species commonly known as wildlife resources are important because of their actual and potential economic value to people. Wildlife resources that provide sport in the form of hunting and fishing are known as game species. Biological resources provide people with a wide variety of direct economic benefits as a sources of food, spices, flowering agent, soap, cocking oils, lubricating, waxes, dyes, natural insecticides, papers, fuels, fiber, leathers, natural rubber, medicines and other important materials. Aspirin, probably the worlds most widely used drug, was developed according the chemical blue print supplied by a compound extracted from the leaves of a tropical willow tree. A fungus produces penicillin. The ethical issues of animal use are discussed in chapters A3 and A4.

Q7. Please consider how to conserve natural resources? Think of ways to conserve water, conserve Energy, protect the soil, and promote sustainable agriculture. Q8. Which biological resources did you use yesterday in your daily life?

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UNIT 17

Protection of the environment, the biosphere and biodiversity

Learning Objectives: Students should be able to explain how bioethics is related to environ mental issues. Students should be able to analyse environmental issues from anthropocentric, biocentric and ecocentric ethical perspectives. Students should be able to describe sustainable development.

Ethical Limits of Animal Use There is a long history of special relationships between other animals and humans, for example, the use of animals in farming or as domestic companions. The use of animals in factory farming and scientific experiments has stimulated interest in whether animals have particular rights. Here we shall study the factors that people use to claim that animals have rights, the ways society regulates the use of animals, and the sources of the intrinsic and extrinsic value of living organisms. What are animal rights? Animals are used in many ways by people. Do animals have a right to live without pain caused by people? Do they have a right to live free? If animals have rights then human beings have corresponding duties towards them. While we would all agree that we have some duties to animals, there is disagreement about just how many and what kind of duties we have. We come across these issues every day when we eat meat, play with our pets, or use products made from, or tested by, animals. Animals which feel pain are called sentient animals. In practice one important criteria we use in judging the use of animals is how much pain is caused. Let us consider some of the factors that people use to discuss animal rights. Q1. Can you think of the ways animals are used in society? What are some examples of cruelty to animals we see in society?

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Intrinsic and extrinsic ethical factors for ethical use of animals We can think of ethical factors within an organism itself (intrinsic factors), and others that are external to it (external factors). A summary of some factors for judging animal use is in the table below. We can see there is value in something being alive when we observe the way most people protect life. Various qualities in animals increase their ethical status, including the capacity to feel pain, self-awareness, being conscious of others, and an ability to plan for the future. Intrinsic Ethical Factors - Pain - Self-awareness - Conscious of others - Ability to plan for the future - Value of being alive Extrinsic Ethical Factors - Human Necessity / Desire - Human sensitivity to animal suffering - Brutality in Humans - Effect on other animals - Religious status of animals - What is natural

Many extrinsic factors are important in deciding whether it is ethical to use animals or not. Destruction of nature and life by humans is caused by two human motives - necessity (needs) and desire (wants). It is more ethically acceptable to cause harm if there is some necessity for survival than if theres simply desire for more pleasure. If we are going to harm life, a departure from the ideal of doing no harm, or love of life, it should be for a very good reason. Such a reason might be survival, and we can see this as natural - all organisms consume and compete with others. Plants compete with each other for space to grow, animals eat plants or other animals, bacteria and fungi also compete for resources and space - sometimes killing other organisms, at other times competing without killing, and also cooperating in mutual symbiosis (see section B1.3). This distinction is required ever more as human desire continues to destroy the environment of the planet, including many endangered animal species, and even whole ecosystems. Other extrinsic factors that are important include human sensitivity to suffering, or the effects of upsetting other animals. Being cruel to animals may also lead to brutality towards people. There is debate over what is the natural way to treat animals, as it changes between culture. Certain religions give special status to some animals, for example, Hindu religion gives cows a high status so that few Hindu persons will kill cows for food. This also means that in India animals are not used in school experiments. There is a trend in all countries for less use of animals in schools for teaching, and experimentation. Q2. Do you agree or disagree that it is sometimes necessary to harm animals so that you can live? Q3. Do we need to test the safety of cosmetics and personal hygiene products using animals?(Cosmetics are used by both men and women, e.g. deodorants). Have you heard of any shops which claim not to sell cosmetics tested on animals? Q4. Who decides what is necessity and what is desire? At home? At school? In your country?

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Animal Experiments The issue of animal experiments has caused more debate than eating animals. It is a little ironic because in most countries the scale of animal use for food is much greater than it is for experimentation, and eating animals is a choice based on desire more than necessity. That desire is supported by long standing cultural traditions and cuisines. However, from a moral point of view, some animal experiments are done with the hope of directly saving human life in medical research. On the other hand, luxury products such as cosmetic testing can be said not to be necessary. In the past decade, there have been less animal experiments conducted, and we can expect more ethical alternatives to continue to be developed using alternative methods for testing product

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safety. These may also prove cheaper and more efficient. These alternatives include computer models, use of isolated cell culture, and comparisons to already existing data. Some factors used in guidelines to assess whether or not animals should be used in experiments, include: - Aim of the experiment - Species of animal - Duration of discomfort or distress - Number of animals - Available alternatives to the experiment - Realistic potential to achieve goals - Possible pain - Duration of experiment (in terms of lifespan) - Quality of animal care - Credibility of the researchers

At the practical level, the feeling of pain is the first major guiding principle for animal treatment. There is a debate about self awareness, which would be necessary for animals to express autonomy, and about whether they are capable of thinking, or a certain degree of perception and cognition. These concerns are one reason why researchers try to choose the animals lower on the evolutionary scale for experiments and product testing. Q5. What are the differences between using an animal killed accidentally and one that was grown and killed especially for an experiment? Do you think we should kill animals for experiments? Q6. It is a requirement in certain schools to dissect animals in biology class. If you dont think it is ethical to do so, do you think that you can tell your teacher that you don't want to dissect an animal because it goes against your beliefs? Would you dissect an animal just in order to pass a course? Q7. Discuss what benefits and what you learnt from any animal experiments you may have done in class? Did it change your attitude towards animals? Did it make you more or less sensitive to animals? Q8. Can you find examples of medical advances in which animal research was essential? Q9. What is the proper way to look after animals used in experiments? Are there any special treatments given to dead animals in your country? In Japan, a shrine is often made to pay respect to experimental animals, and remembrance services are held annually at many universities. Do you think that cultural practice could work in your country?

Eating meat and farming Some people choose not to eat animals. A vegetarian is a person who does not eat animals. A vegan is one who doesnt eat any animals or animal products (milk, eggs, etc.) or use animal products (e.g. leather). It can have some health advantages to eat less meat to lower the level of saturated fat, especially in middle-aged persons living in countries where people eat too much. Some choose not to eat animals for moral or religious reasons. Eating more plants also has environmental advantages as food and energy is wasted in the transfer from plants to animals. However, except for South Asia, most people today say it is natural for us to eat some meat or fish. Even if we do eat animals we should minimize the harm we cause. Many people will continue to eat animals, and practical ethics must improve the ethical treatment of all animals. One area of particular concern is whether farm animals should be kept in a field, a caged box, or a factory farm. The confinement of animals, such as veal calves, pigs and poultry in small cages has led some countries to set minimum enclosure areas for each animal. It has been illegal to use so-called "battery cages" in Switzerland for chickens since 1992, but concerned countries need to also reduce demand by restricting imports or products from such farms. Each society has to decide how much more they are prepared to pay for better treatment of animals, such as the costs of eliminating battery farming. Another example is using the protein bovine growth hormone in cows to make them produce about 10% more milk. Thus there is some cost in production of not using new animal treatments such as bovine growth hormone to produce cheaper milk or meat. It is also important to consider the

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effects of policies on the different communities involved in agriculture, as well as the rights of consumers and the animals themselves. Q10. Do you know any vegetarians? Why did they choose not to eat meat? Q11. What do you know about factory farms? What are the ethical and health advantages and disadvantages of factory farming in different environments? Do you think it is wrong to keep animals in small cages? Q12. Do you have some animal products in the supermarkets close to you that are priced because of claimed ethical advantages? Do you think organic food (food grown without the use of artificial pesticides, fertilizers or genetic modification) is better for you? What about free range eggs compared to ones made in a battery chicken farm? Q13. What are some ethical and ecological differences between obtaining food from destruction of natural habitat for the purposes of farming, and the hunting of wild animals in their natural habitat?

Zoos Another ethical question that can be asked is whether we should keep animals in zoos. Zoos and wildlife parks have value in preservation of endangered species, and in gaining public support for conservation campaigns. An understanding of life and ecology can make people appreciate animals more. There is a trend for zoos to give animals greater space and freedom which meets more of the natural requirements of animals.

Q14. Do you have local animal parks to visit? Do you think zoos and wildlife parks help to preserve endangered species? Q15. Should we capture animals for the purpose of keeping them in zoos, and under what conditions would the capture and keeping of animals be ethical? Q16. Do you think that anyone should be able to do fishing for recreation? What do you think about hunting of animals for fun, such as fox hunting or hunting deer for their antlers as a trophy? Q17. In a few places where tourism is essential for the money to keep a wildlife park, the park may allow some trophy hunting of wild animals. How would you balance the ethical issues of the individual animals versus the ecosystem-wide issue of the financial survival of the wildlife park? What are some alternatives for financial survival of the park? Ethics Activity 1. Can you think of intrinsic, and extrinsic ethical factors that could be weighed whether you should use the following animals in biology classes? Dissection of cow eyeball. a) b) Frog dissection. Keeping woodlice at school. c) Catching butterflies to bring to school. d) e) Other cases you have used in class.

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Ecology and Life Ecology is the biological science of living relationships. Here we shall introduce ecology and how life is defined, show how life is categorized and organized, and explain living systems, processes & interactions. Ecology - basic ingredients Biology is the scientific study of life. Ecology is the branch of biology which investigates living relationships the science of organization and interaction between different organisms, living systems they inhabit and their physical environments. There is much less research into the large-scale systems of ecology compared to the small-scale systems of molecular biology. As we see the fragility of our world, the future of life depends on human understanding of this subject. We need more ecologists if we are to manage the many predictions of global ecological crisis. Of particular concern are the abundance of life and the distribution of life. Three primary subjects studied by ecology are: 1. Organisms 2. Interactions 3. Communities To these traditional areas of discussion in ecology must be added a fourth major concern, since life cannot be considered in isolation from the impacts and pressures placed on it by relentless forces of global change, industrial technology and the expansion of human-dominated ecosystems: 4. Ecological ethics Q18. What other areas of knowledge do you think are important for a young ecologist to have a working knowledge of, beyond 'natural' ecosystem interactions? Q19. Are the soil, water and sky parts of the ecological community?

Ecology - the cast of characters Life is defined by science to have particular characteristics: birth, metabolism (synthesis of energy from the environment), growth, replication (capacity for reproduction), hereditary variation, adaptation (evolution by natural selection), inner program (DNA, genetics), organic (carbon-based) chemistry in an aqueous medium, systems behaviour (self-organization, feedback) and complexity (emergent properties like consciousness). Also relevant to the future of life are systems which display most of the above characteristics and behaviours, having their own ways of 'living'. These include viruses, ideas (the 'meme'), human institutions, technologies, software (e.g. 'genetic' algorithms), and possible future developments in artificial intelligence and nanotechnology. The classification of living organisms into a logical hierarchy of groups is called taxonomy. Biology subdivides life in the following manner: Kingdom, Phylum, Class, Order, Family, Genus and Species. A commonly used five-kingdom system is Animalia, Plantae, Fungi, Protista and Monera (bacteria). Communities are assemblages of species in the same habitat. Species are one of the fundamental units of biology (along with genes, organisms and communities), referring to a genetically and anatomically distinctive groups of organisms capable of breeding. Species are written down in italics with a capitalised genus name followed by the species name (e.g. the human species is Homo sapiens). Habitat is the home or environmental space in which an organism lives and grows. Examples shown in Table 1 are large-scale habitats, but boundaries typically merge. Habitats range down in size to a particular forest

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community, leaf, pond or the specific localised conditions of microhabitat. Each species has its ecological niche, or the tactics or role to play in the community as defined by its food, shelter, foraging habitat, mating season and interactions with other individuals and species. Keystone species play key roles, linking together community and ecosystem structure (e.g. the dominant vegetation type of a habitat, specialised microorganisms etc.), making them essential conservation targets. An ecosystem is the collected cast of characters, connected in a balanced performance of networked systems, subsystems, processes, flows and cycles. Conservation effort is most effectively directed at larger-scale units such as communities, habitats, ecosystems and vulnerable biodiversity hotspots (Figure 1). Biodiversity refers to the variety of life, and is studied at the scales of genetic diversity, species diversity and ecosystem diversity. There have been around 1.8 million species so far described, but the majority of invertebrates and micro-organisms remain undiscovered. Estimating the total number of species uses extrapolation from ecological models, scaling up a well known region or taxon to the global level. Most estimates range from 10 to 50 million, but perhaps even up to 100 million species alive on Earth. Around 13,000 new species are catalogued each year. There are so many kinds of insects that a young ecologist on a trip to the Amazon could easily discover and name a new species of beetle. The inventory of life is the most exotic unmapped territory remaining to science. Q20. Where does the human species fit into the above cast of characters? Table 1: Large scale communities and habitats (also called ecotypes or biomes) Polar (Arctic): Coniferous Forest: Deciduous Forest: Montane: Temperate Rainforest: Tropical Rainforest: Coral Reefs: Oceans: Riparian: Estuarine: Sclerophyll Forest: Savannah: Deserts: Polar (Antarctic): Land of the polar bear Northern cold-temperate pine forest (also called boreal forest or taiga) Distinctly seasonal forests which shed their leaves in winter High-altitude (cold-adapted) mountain ecosystems Mid-latitude moist closed-canopy evergreen forest Warm moist closed forest containing Earth's greatest biodiversity Tropical coral reef containing the greatest marine biodiversity Littoral (shallow), neritic (continental shelf) & oceanic (deepwater) Rivers, lakes and deltas, the essential fresh water habitats Intertidal bays & river mouths essential as fish nursery-grounds Mainly hard-leaved (dry-adapted) forests such as Eucalyptus Dry grasslands with widely-dispersed trees, such as the African plains Arid (low rainfall) environment with little permanent vegetation Land of the penguin

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Figure 1: Biodiversity Hotspots (known forest & heath habitats only) Source: E.O. Wilson (1992) The Diversity of Life p.250-251

Ecology - the action How do organisms and communities change and arrange, and how have the characteristics and diversity of life changed over the long term? This is the subject of evolution, and the discovery by Charles Darwin (On The Origin of Species by Means of Natural Selection, 1859) of a mechanism by which a lineage can adapt into greater complexity through a series of incremental changes to suit its environment. Natural selection is the 'survival of the fittest' idea, where evolutionary success in the struggle for life goes to those replicators (e.g. genes, organisms) best adapted to reproduce descendants in competition with other living forms. Small genetic changes which are adaptive to the environment will bestow competitive advantage, and aid the manoeuvre of the lineage into new niches. In building up civilizations, the human species has also designed its institutions around models of competition and the struggle for fitness (witness major historical activities such as warfare, economics and politics). Almost forgotten in all this competitive activity has been the more fundamental interaction exemplified by ecology: namely cooperation. Fundamentally, the functioning of ecosystems is a broadly cooperative enterprise. A base framework of cooperation must underlie competitive surface activity; for example even ruthless business competition must rely upon adherence to a cooperative framework of financial and trade regulations. Models of cooperation (e.g. open-source software, multilateral agreements) are increasingly recognised as necessary models for the future. Close cooperation between two or more species is referred to as symbiosis, or a symbiotic relationship. It's called mutualism when both species benefit from the association, commensalism when only one species gains

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advantage, and parasitism when damage is done to the host. Specialised cooperation increases dependence of one species on the evolutionary success of the other. In some sense, the whole plant and animal kingdoms are in broad mutual symbiosis, with animal respiration involving conversion of oxygen into carbon dioxide, and plant photosynthesis involving conversion of sunlight and carbon dioxide into energy and oxygen (which is why tropical rainforests are the 'lungs of the Earth'). Fungi and bacteria are decomposers, creating life after death by recycling dead nutrients into a form usable by plants. Another example of mutual symbiosis is plants and their pollinators, a delicate evolutionary dance between nectar-producing flowers and pollen-transporting insects. Q21.The human species is constantly interacting with natural ecosystems of the Earth. What kind of symbiotic relationships do we have? Does human activity generally seem to be in cooperation with, or in competition with nature?

Ecosystems - structure and function Commoners' laws of ecology ('Ecology for Beginners') a) everything is connected to everything else b) everything must go somewhere c) nature knows best d) there's no such thing as a free lunch. As the name implies, an ecosystem is a type of complex system, the structure and function of which can be described by systems theory. The difference between a system and a bundle of parts is that the elements of a system are functioning together as an interconnected whole. At its simplest, a system is a web or network, a model highlighting the intersection points (nodes) and flow routes (links). For example, a food web is a network flow diagram with a series of links between predators and their prey. Flows may be one-way or both ways along a link, and matter or energy are often transformed at a node. Analysis of how factors change with time is the study of system dynamics. System dynamics are driven by a series of operations called processes. Examples of ecological processes include chemical transformation, genetic exchange and mass transfer, and actions at such micro-scales have impacts at the scale of organisms and communities. Complexity theory is the study of natural information patterns and the predictability of systems. Just because a system is complex (which means unpredictable) doesn't imply that it's complicated (which means difficult to understand). Actually, one of the amazing things about systems is that they have common features and follow similar general rules across many different scales and levels of organisation. Knowledge of systems and complexity allows connections between many different disciplines to become apparent. Systems are composed of many subsystems 'nested' hierarchically within them. Complex interactions and cybernetic feedback (flows of changes which are self-reinforcing or self-regulating) in the subsystems result in unpredictable collective behaviours in large-scale systems called emergent properties - the emergence, at a certain level, of new order and simplicity from a sea of complexity. For example, science tries to 'explain' life as an emergent property of interacting molecular subsystems. In any case, the important thing is that when nodes or links are altered or removed, a system must find stability by rearranging itself into a new structure. The dilemma for ecology is that human rearrangement of its parts, towards and beyond unknown thresholds (breaking-points), is likely to cause life-threatening non-linear dynamics (dramatic changes or phase shifts) in the stability and habitability of the entire global ecosystem.

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Q22. Compare and contrast any two systems of your choice. Student Activity: This simple natural scene could be from your local backyard or park. Draw a quick sketch or network flow diagram showing hidden ecological interactions (e.g. predator-prey relations) and cycles (e.g. energy, matter). Involve other important nodes (e.g. micro-organisms, soil) beyond the existing sun, bird, lizard, caterpillar, and plants (represented here by Bodhi leaves).

Biodiversity and Extinction Biodiversity is genetic, taxonomic and ecosystem variety. What is the significance of species extinction? Here we shall highlight the importance of biodiversity & its loss, and discuss extinction & past/present mass extinctions. Biodiversity is the variety and richness of life on earth, measured at different levels such as the diversity of genes, species, higher taxonomic groups, and ecosystems. Genetic diversity increases reproductive fitness, allowing outbreeding and adaptation to environmental change. Species diversity is required for the effective functioning of ecological communities. Ecosystem diversity provides habitat and the highest-level richness of the world. In simple terms, biodiversity makes life more interesting. Attempts to resurrect extinct species (popularised by 'Jurassic Park') have not yet been successful. A project of the Australian Museum to resurrect the thylacine, or Tasmanian tiger, has recently been cancelled. Another project unable yet to be completed was to resurrect the mammoth from tissue samples preserved in permafrost. Mixing of genetic material with that of a host egg cell does not reproduce the pure original form. Cloning research and cryopreservation (preservation by freezing) of DNA, cells, gametes and embryos in genome resource banks, despite limited current applications, are potential investments in the future of conservation. The first successful natural breeding of cloned male and cloned female American wildcats was reported in August 2005, which offers proof of principle for efforts to clone extinct species. It will need to be tested over further generations however. Seed banks and captive breeding programmes in zoos are also very important for endangered species. However, technological breeding methods must not also breed complacency. After all, it will be technically impossible to replicate or replace the most important unit of biodiversity - viable whole ecosystems. Q23. Discuss differences between prevention and cure. Can extinction be cured?

Q24.

How are seed banks useful for conservation and agriculture?

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Biodiversity - the drama Extinction is the death, and loss for ever from the Earth, of a genetic lineage of a species. Extinction can be viewed as a tragedy, although it has happened throughout biological history. Even from a purely human centered view, ignoring any intrinsic moral value of life, extinction means we lose essential ecosystem support services, potential new information, ideas, patterns, processes, foods, chemicals, products and may impact on other economic, aesthetic and spiritual values.

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Threatened species are those at risk of extinction, indicated by rapid decline of population, limited extent of occurrence, models of ecological disturbance or fluctuation, projected habitat loss or fragmentation, and/or low absolute number of remaining individuals. Along the descending journey, threatened species pass through the categories of 'vulnerable', 'endangered', 'critically endangered' and 'extinct in the wild'. A 'ghost species' is a non-viable population, or the living dead with negligible chance of escaping extinction. What happens to an ecosystem when some of its inhabitants go extinct? Feedback interactions occur, and the fluctuations of the adjusting system put further species at risk. If a keystone species is affected, the repercussions may include rapid and dramatic unravelling of the whole community. As a well-known example, hunting of the north-eastern Pacific sea-otter for its fur allowed its sea-urchin prey to grow to excessive population size, resulting in the decline of beautiful kelp forests in favour of an exposed-seabed community with reduced biota. Similarly, if a seemingly-successful population expands beyond the limits of its food or resource-base, loss of equilibrium and catastrophic population decline typically follow, unleashing the 'Four Horsemen': conflict, famine, pestilence and death. Risk factors which make a group more susceptible to extinction include some of the following characteristics: small population size (rarity is the predominant risk factor), narrow geographic distribution, niche or habitat specificity, large body size, symbiotic dependence on other species (e.g. for pollination), narrow diet, low dispersal ability, slow reproduction, morphological ornateness, susceptibility to stress, and stenotypy (or specialized lifestyle with limited adaptability). Bad luck can perhaps also be mentioned, as there seems to be a random component to the fossil record of mass extinctions. Furthermore, weird and wonderful adaptations, seemingly beneficial over the short term, such as over-reliance on symbiosis or strange features resulting from evolutionary arms races, may in fact be detrimental to survival over the longer term, leading unwitting species down a potentially dead-end path known as an evolutionary cul-de-sac. Q25. Is it possible that the human species is in an evolutionary cul-de-sac (dead end street)? Which behaviors, seemingly adaptive over the short term, may be disadvantageous to our survival over the longer term?

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"Although the fossil evidence does not support the concept of historical mass extinctions or mass killings, there is a catastrophic extinction event occurring in contemporary time. Raven (1990) has

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Extinction Five mass extinction events of the geological record are flagged and graphed by loss of whole families in Figure 2. The big five should act as warnings. They marked the end of the Ordovician, Devonian, Permian, Triassic and Cretaceous (extinction of the dinosaurs) geological periods, and seem to have been caused at different times by combinations of climate change, comet or meteorite impact, super-volcanism, marine regression and/or broad ecological restructuring or collapse. A case in point is death by suffocation, such as when the evolutionary blossoming of photosynthesis created a (then) toxic oxygen-rich atmosphere, or during the Permian extinction with up to fifty percent less oxygen postulated for a temporary period. Mass extinctions may occur over millions of years, or may take only a few decades depending on whether the cause is gradual (uniformitarianism) or suddenly nonlinear (catastrophism). Researchers have differing opinions on the causes and history of extinction as interpreted from the fossil record. Despite vigorous debate about the past, most experts in evolution or ecology display uncanny agreement about the present. As an example in the following quote, from within a minority view - uniformitarian argument - for gradual change during past eras, we nevertheless see emerge the majority-view which is warning of catastrophism for the present era.

estimated that, by the first quarter of the 21st century, the world will have lost 2 million out of a minimal world total of 10 million animal species and about 65,000 out of 300,000 species of vascular plants. These losses, due to habitat destruction by humans, are occurring with a rapidity that is unprecedented in Phanerozoic time. Historic extinction episodes were so gradual that many lineages were able to accommodate in an evolutionary and ecological sense. The tempo of the current extinctions precludes any such adjustments." John Briggs (1994) 'Mass Extinctions: Fact or Fallacy?' p.235-6

Figure 2: History of Biodiversity Illustrating Mass Extinction Events

Q26.

Do you agree it is likely we have now entered the sixth great mass extinction?

"I will consider only species being lost by reduction in forest area I will not include overharvesting or invasion by alien organisms. I will assume a number of species living in the rain forests, 10 million (on the low side), and I will further suppose that many of the species enjoy wide geographical ranges. Even with these cautious parameters, selected in a biased manner to draw a maximally optimistic conclusion, the number of species doomed each year is 27,000. Each day it is 74, and each hour 3." E.O. Wilson (1992) 'The Diversity of Life' p. 268

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Change in global biodiversity is measured by a simple equation - number of speciations (evolutions of new species) minus number of extinctions. The average longevity of a species is 1 to 10 million years, only about half that for mammals. Estimated normal 'background' extinction has been estimated at less than one species per million per year. How are we managing the living world at this moment? As usual estimates vary, but the important thing is that detailed scientific studies agree the current extinction rate is very large. The above quote is based on decades of study and satellite imagery observations of habitat destruction and fragmentation in tropical rainforests (the most biodiverse terrestrial ecosystem) by Thomas Lovejoy and E.O. Wilson. Empirical biogeography theory indicates that a tenfold decrease in habitat area removes approximately half of existing species. The quote below reflects scientific predictions for tropical coral reefs (the most biodiverse marine

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ecosystem) in a world of global warming, susceptible to widespread death by coral bleaching, where essential symbionts of coral polyps (tiny dinoflagellates called zooxanthellae) are lost and the reef dies a barren white. Nevertheless, average biodiversity has increased over the long-term history of life (Figure 2), the rebounds partly explained by species selected for extinction resistance taking advantage of vacated niches. Unfortunately however, recovery of biodiversity is slow enough to ensure that even if Homo sapiens were to survive a mass extinction event, we would live in an impoverished world for longer than our expected natural lifespan. "Even under the best case scenario, losses of at least 50% of the [Great Barrier] Reef's living coral cover are likely to occur by 2050. How humans will be affected by these changes is still uncharted yet is enormously important." (p.1), "Projections of changes in water temperature do not bode well for coral and the reefs that they help build. Already increases in water temperature of only 0.6C since 1880 have increased the bleaching and mortality of reef-building corals across the planet These levels of change in sea temperature are unsustainable by corals growing where they are today, even under the milder scenarios in which seas only warm by 2C." (p.54), and "these temperatures will exceed the local thermal tolerances of reef-building corals on annual basis by 2030-2060. The calculated thermal stress levels rise to several-fold higher than those seen in 2002 and lead to the highly probable conclusion that reefs dominated by coral will be rare in the Great Barrier Reef region by 2050." (p.84) Hans & Ove Hoegh-Guldberg (2004) 'The Implications of Climate Change for Australia's Great Barrier Reef'

Q27.

Everyone dies. But can Homo sapiens, the human species, go extinct? How likely do you think it might be over short, medium and long time-scales? What are the alternatives to extinction?

Ecological Ethics Here we shall introduce the concepts of ecocentrism and stewardship, and encourage an awareness of ecological ethics. Ecological ethics has typically been subsumed by anthropocentric (human-centred) and individual-centric concerns (for example, the focus on individual moral choice and autonomy in recent ethics). A biocentric viewpoint is the view from an individual living organism, like a tree or a dog. Ecocentrism is to view a problem from the perspective of a whole ecosystem, and it comes from an awareness that we are only part of a larger system. Ecological ethics education can be made even more effective with understanding of actions played out at the systems level and group level. Concepts of collective wisdom and human maturity as a species are important here. Homo sapiens is a young and new species, having been around for less than 200,000 years or so. Ethical choices and consequences ought to be assessed on the scale of large groups, at the systems level, over the long term, to non-human as well as to human life and wellbeing.

Q28. Can you think of occasions when you view ethical questions ecocentrically? The Gaia Hypothesis Almost the largest relevant system and scale is the planet as a whole, also known as Gaia, named after the Greek mother goddess of the Earth. James Lovelock's hypothesis, proposed in Gaia - A New Look at Life on

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Earth (1979), views the planet as a living super-organism. As well as life adapting to its environmental conditions, it proposes that the homeostatic (or balanced and self-organising) planet, the sum of all its living interactions, in turn acts to optimise surface conditions for the maintenance of life. Q29. Do you think our planet as a whole can be classified as one living organism?

Stewardship Humans are not the only animals to feel emotions and pain (damaged ecosystems in fact exhibit widespread animal suffering), but our species has exhibited conscience and intelligence. We invented tools and civilisations, and derived management and ethical systems beyond what we know are the capabilities of other known forms of life. With such power also comes responsibility. In this case our responsibility is stewardship, or the protective guardianship of Spaceship Earth and its living systems. Should we be technocentric, placing trust in future technology to save us from the mess we make of the Earth, or should we be ecocentric and remain within known limits and principles of ecology with adequate precaution, prevention and preservation of critical life-support processes? We are probably not alone across the myriad galaxies, just as we no longer think we're at the centre of the solar system or universe. Theres a theory which says that lack of verifiable contact with extraterrestrials is because 'intelligent' life quickly tends to destroy itself with its own technology! Instead of such a gloomy prognosis, taking a different path we could yet add to Gaia's definitional features of life - like providing replication and heredity through 'terraforming', the potential future technology of seeding other planets. This would of course open up a whole new ethical debate, but will we be around long enough for our technology to progress that far? We can be, but only if we choose soon, and utilise the scientific and ecological management tools of the subject known as environmental science. Sustainable living involves not just efficient agriculture, but also minimizing our energy use and pollution. The type of research that is required for a transition to a lasting earth is of three broad types. One is the use of science to discover the workings of nature, such as elemental cycles, and developing technology for energy and resource conservation. Another is economic systems that are consistent with sustainable living. We need a fresh approach to add to the battle of protecting the environment. In the long term the most important approach is a lasting change of human attitudes to those that are compatible with sustainable life. We need lifestyle change. We cannot isolate any environmental problem from the whole crisis of modern life. The environment is influenced mainly by human behaviour, national and international development, economics and politics.

Q30. Consider the following table and where your community is in the evolution of ecological ethics? Do you think there are some differences in the evolution of these concepts in different cultures?

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Environmental Science Environment includes both natural and human systems. Here we shall study the wide range of environmental problems, introduce a basic understanding of environment, science, measurement and models, and demonstrate environmental science and management tools, techniques and solutions.

* World Scientists' Warning to Humanity * from the Union of Concerned Scientists (signed by 1600 leading scientists from 71 nations, 1992) "Human beings and the natural world are on a collision course... No more than one or a few decades remain before the chance to avert the threats we now confront will be lost and the prospects for humanity immeasurably diminished. WARNING: We the undersigned, senior members of the worlds scientific community, hereby warn all humanity of what lies ahead. A great change in our stewardship of the Earth and life on it is required, if vast human misery is to be avoided and our global home on this planet is not to be irretrievably mutilated." Environmental Problems Much attention has been focused in previous decades on problems of the environment, human nature and human governance but the current century is almost certainly the most hazardous that humans have ever entered, and may be our last unless we can shift the attention of our leaders and the global power they wield towards the solutions - and act on them! Specific problems must be identified and understood, but squishing many into Table 1 makes extra room to identify more tools and techniques from among the solutions.

Table 1: Problems War Conflict Poverty Greed Over-Population Over-Production Over-Consumption Over-Development Habitat Destruction Habitat Degradation Fragmentation Ecosystem Collapse An industrialized form of violent mass organised acquisition of power Land, money & resources the real reason (religion/culture often just an excuse) Inequality causes conflict, suffering, environmental & psychological damage Lust for kinds of power, such as money, tends to corrupt moral concerns First 200,000 years to 0CE: 0.2 billion; 1850 1 bill; 1960 3 bill; 1999 6 billion Economic system geared to constant growth, ready to supply any demand Cultural system constantly encouraging desire, consumerism & materialism Wealthy nations wasting limited resources at the expense of poor nations Land-clearing for agriculture, grazing, forestry, mining, urban sprawl etc Decline in ecological function, integrity, fertility, biodiversity, aesthetics etc Dramatic restructuring of communities due to key extinctions or changes Isolated fragments of habitat become ecologically disconnected & vulnerable

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Deforestation Desertification River Decline Overfishing Pollution Climate Change Ozone Depletion Coral Bleaching Pest Species Disease Epidemics Food Supply Water Supply Nuclear Legacy Resource Decline Loss of Biodiversity Extinction Apathy Ignorance Unhappiness Unease

Clearing or burning of forests & rainforest for timber or other land-use Previously productive land becoming infertile, arid or saline (salty) Turbidity (muddiness), eutrophication (algal blooms), eco-disruption (dams) Most fisheries have been shown to be harvested beyond sustainable limits Pesticides, fertilisers, sewage, petrochemical smog, acid rain, landfill wastes Global warming, Greenhouse Effect, El Nino, rising temperature & sea levels Loss of the atmospheric layer which protects life from harmful UV radiation Impending large-scale death of the second most biodiverse ecosystem Natives displaced by introduced species (predation, weeds, hybridisation etc) Evolution of new diseases, epidemics (extensive), pandemics (global) Preventable hunger/disease kills about 40 million people/year (~100,000/day!) Fresh water crises, waterborne disease, drought, diversion from ecosystems Nuclear waste remains toxic thousands of years longer than storage methods Non-renewable depletion, slow transfer to renewable resources & energy Ecosystems, habitats, species and local populations lost to extinction Conservative estimate (Wilson) of 74 species lost forever each new morning I dont want to know either. Dont care. The unknown & uncertain. What you dont know cant hurt you or can it? Unrealistic expectations, rising rates of depression, anxiety & youth suicide Trying to be 'normal' in a prevailing climate of fear and paradox

Q31.

Which do you think are the most urgent environmental problems in the world today, and what are their main causes?

Environmental Science is the study and implementation of systems, methods and tools for predicting, analysing, solving and preventing large-scale ecological and social problems. Environment is a) influences and conditions external to the genes; b) the physical surroundings of a living organism; c) natural ecosystems which surround humans; d) the total biophysical world including humans and our systems;

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e) the total biophysical world and its connected sphere of knowledge and information; f) all of the above, including emotion, behaviour, culture and consciousness of life.

Q32.Which of the above definitions of 'Environment' do you think is most useful? Are there benefits to looking at the answer in different ways?

Science is a rational method for discovering whether the behaviour of the world conforms to certain theoretical ideas. The scientific method begins with a theory or hypothesis, which proposes some solution to a specific question or problem, and then uses logical analysis and systematic measurement to find evidence in the form of data to either falsify or help support the hypothesis. The experiment is a series of controlled observations which can be quantified and replicated. Further scientific principles include objectivity (a value-neutral position), reductionism (analysis of the parts), simplicity (elegance), parsimony (minimised assumptions), quantification (statistical measurement), testability, predictive and explanatory power, logical consistency, and (usually) general agreement with existing knowledge. Even after all this, an exposed new theory must still survive critical inspection of its methods, results and assumptions - by a scientific community pervasively in a skeptical and analytical mood. Ideas that are open to all these tests and survive them are more likely to be true.

Q33.

Should scientific information be the major driver of environmental decisions over competing shortterm political or economic objectives?

Environmental Science Solutions: tools and techniques Tools and Techniques #1: Measurement Statistics ensure that data are quantified for interpretation, a fundamental requirement of science. Data by themselves (numbers, raw facts) are meaningless until they can be organised into information (patterns, statistics) which can be graphed and analysed. Statistics may be either descriptive or inferential (inference is the assumption that measures of a sample set can be extrapolated to the whole set). Precision is how closely the measurement is made, and accuracy refers to how correctly it is made. Examples of basic descriptive statistics are measures of central tendency (estimating the middle of data) including mean (average), median and mode, and measures of dispersion (estimating the spread of data) including variance, standard error, standard deviation and range. Dont worry, so long as you know the basic statistical principles of what youre trying to find in data and how the data are arranged, a computer can do the hard maths for you! Tools and Techniques #2: Models are simplified representations of the real-world systems of the environment. They make things clearer by cutting away the non-relevant parts to better illustrate fundamental structures, functions, processes and connections. These things are represented by specific icons representing inputs, outputs, material flows, options, decisions etc. A map is a model of the landscape, a graph is a scientific model, and an engineers blueprint is a technological model. Models are powerful tools and can be used to describe, explain, predict, prescribe or evaluate. The problem to watch out for with models is in the assumptions needed to reduce their complexity, where important parts can be left out for example economic models which dont include environmental impacts. Many of the tools and techniques on following pages are types of model.

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Tools and Techniques #3: Indicators are the broadly representative and easily monitored measures of the environment used to imply additional information about the system as a whole. For example, the abundance of an indicator species can be measured as a signal of the health of the whole ecosystem. A variety of environmental indicators should be used to plot comparisons between locations and across time, including physical, chemical, biological, social and economic indicators. Tools and Techniques #4: Index refers to a measure made from the combination of many different variables, creating a much broader type of indicator. For example, the United Nations Development Programme publishes indications of the progress of nations called the Human Freedom Index and the Human Development Index.

Q34.

How do data, information, theory and knowledge differ from each other? How do we differentiate facts from opinions?

Tools and Techniques #5: Problem-solving models (e.g. Figure 1b) identify stages in the process of defining, analysing and solving a specific problem. You must identify the goal or desired objective, identify obstacles to progress towards the objective, formulate options or alternative courses of action, choose between them, and plan actions to implement the decision. Tools and Techniques #6: Decision-Making models (e.g. Figure 1a) are part of the problem-solving process and help you to decide between a number of alternative courses of action (including the no action option). Simple decisions with a single goal can be dealt with using a decision tree which identifies stages of the process and the risks associated with different options. Harder decisions may require multi-criteria decision analysis. The process of making a decision usually requires optimisation, or calculating the overall best and safest (optimal) alternative. Tools and Techniques #7: Expert Systems are decision support software which mimics the reasoning of a human expert. They consist of a set of logical rules about systems behaviour, combined with the input of expertise from a particular domain of knowledge. Expert systems are a practical application of artificial intelligence. Tools and Techniques #8: Environmental Impact Assessment (EIA) is a systematic process to assess the consequences of any major infrastructure development. First developed in the 1970s by the US Geological Survey (see Leopold matrix, Figure 1a), it has become widely used and compulsory by regulation in many countries. An EIA typically includes an initial scoping study to identify boundaries of concern, descriptions of the proposed development, predictions of the magnitude and importance of probable environmental impacts, comparison of alternatives, and suggested mitigation measures. Public consultation is required throughout the process, and the final report is called an Environmental Impact Statement (EIS) which must include a nontechnical summary and recommendations. Environmental monitoring is important, beforehand to know the environmental baseline, and afterwards to audit outcomes and inform future EIA. Tools and Techniques #9: Social Impact Assessment (SIA) is a systematic process along the same lines as Environmental Impact Assessment, but focusing on the consequences to society, culture, community and wellbeing.

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Figure 1: Historical Models of Decision-Making and Problem-Solving Processes a) Small sample of original Leopold Matrix used for Environmental Impact Assessment; proposed actions which may cause impact tabulated against existing characteristics of the environment. (US Geological Survey 1971) b) (overlaid) Jackson, Keith F. (1975) The Art of Problem Solving

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Tools and Techniques #10: Strategic Environmental Assessment (SEA) also uses similar principles to Environmental Impact Assessment, but focusing on alternative policies, plans or programmes at an earlier, more strategic phase of development. Tools and Techniques #11: Life-cycle Assessment (LCA) analyses material and energy flows by following the complete lifecycle of a product through the processes of resource extraction, transport, manufacturing, marketing, consumption and disposal. Tools and Techniques #12: Pressure / State / Response Models follow the causal relationship from pressures on the environment (e.g. economic demands, energy use, fisheries, industrial developments), through the state or condition of the environment (e.g. impacts upon atmosphere, water, biodiversity, ecology, heritage and human settlements), to the responses (institutional, legislative and economic instruments, environmental management practices etc.). Pressure/State/Response models are required for OECD member countries to inform national State of the Environment (SoE) reporting. Tools and Techniques #13: Before/After Control/Impact (BACI) Studies are used for definitive experimental proof beyond reasonable doubt that an environmental impact has occurred as the result of some sort of development. Monitoring of the site both before and after the development process identifies the impacts, and simultaneous monitoring of one or more closely similar non-impacted control sites demonstrates that the resulting changes only occurred at the developed site. Tools and Techniques #14: Geographic Information Systems (GIS) are the use of computerized overlay maps, often from satellite remote sensing, to combine social and/or environmental data sets. The resulting composite maps are useful to find new patterns of information and optimize strategic decision-making.

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Tools and Techniques #16: Cost-Benefit Analysis (often called benefit-cost analysis in the US) is systematic assessment of the advantages/benefits and disadvantages/costs of any decision, so as to obtain the greatest net

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Tools and Techniques #15: Risk Assessment is a systematic method for estimating and analysing the probability, potential frequency, range, severity and social acceptability of hazards and other adverse consequences.

social benefit (i.e. benefits minus costs significantly greater than zero). Problems with cost-benefit analysis arise when it (too commonly) ignores non-monetary values, and secondly when it only measures benefits to a particular small group (e.g. corporate shareholders) rather than true social and ecological benefits. Tools and Techniques #17: Systems Analysis is the use of information technology to discover the nature and requirements of systems. Systems engineering is the creation of new arrangements. Today typically used in software design and business management, systems analysis should also play an increased role in the environmental sciences. Tools and Techniques #18: Software Engineering and new Internet architectures, which can be based around environmental or democratic principles, have the potential to make a significant impact on human activity and the information-gathering practices of future researchers from anywhere in the world. Tools and Techniques #19: Best Practice refers to knowing about and using current advances in environmental management or technology, and incorporation of Best Available Information. Regulatory approaches are called in the US Best Available Control Technology, and in the UK Best Practicable Means or Best Available Technology Not Entailing Excessive Cost. Tools and Techniques #20: Principles of Bioethics and Sustainability should be the central guidelines and objectives for any new models or management tools you may create if you perhaps decide to choose a career in environmental science or in environmental economics.

Student Activity Use the basic principles of decision-making used in EIA (similar to Figure 1a) to solve your own problem in any area of interest (e.g. some major life decision). 1) list alternative courses of action (options) as columns (e.g. career choices). 2) list aspects of wellbeing (elements) as rows (e.g. health and happiness of self and others). 3) estimate the importance of each element from 0 (not important) to 10 (most important) [x, y and z in figure]. 4) in the upper-left corner of each intersecting square of the matrix, estimate the magnitude of impact (of each option on each element) between 10 (worst negative impact) and +10 (best positive impact) [a, b and c in figure]. 5), multiply each importance estimate by the magnitude estimate and enter these scores into the lower-right corner of each square [xa, yb and zc in figure].

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7) Does the answer 'feel right' according to your original instincts?

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6) Add up these lower-right scores to determine the total for each option. Which option does the matrix say is best?

Environmental Economics Economics is the measurement of wealth and well-being. Here we shall first prioritize environmental problems and their causes, then illustrate links between economics and ecology, describe ecological limits and social justice, characterize components of wellbeing, and finally discuss the ethics of environmental economics. The Big Problem We currently seem to be experiencing a human-driven mass extinction event. Human activity has now reached a level of collective impact often matching or exceeding that of some natural global biogeographical processes which shape and organise ecosystems and their critical ecological life-support services. Many of the systems we have created (for example economic, political or institutional systems), once-removed from individual human control, are having a devastating impact upon the global abundance and distribution of life. Habitat destruction, ecosystem fragmentation, introduced species, pollution, global warming and at the same time squandering scarce resources on weapons of war (destruction) and dubious entertainments (distraction). This is a source of depression for permanent loss of biodiversity, and a cause for anxiety over our human future. Ecosystems and biodiversity function like organs of the global body to maintain stable planetary conditions for life. Usually taken for granted, ecosystem services are provided free by ecosystems, but end up costing heavily in life and money if damaged. As extinction progressively degrades or destroys links and nodes of ecological systems, critical thresholds may be reached whereby large-scale properties of the global system may switch to a different and unfavourable stable state. It's not guaranteed that the majority of humans will be able to adapt to unexpected non-linear dynamics in large-scale systems upon which we depend. It seems pertinent to address the question of major causes as soon as possible. By its own definition, priority of objectives is of the utmost importance in human activity. Historically, immediate reasons (proximate causes) of widespread extinctions include: Proximate cause #1: most importantly, habitat destruction, such as the clearing of land to make way for human dominated environments, particularly agriculture or grazing, or as a result of large dams, logging operations, settlements etc. Proximate cause #2: habitat fragmentation into isolated segments or habitat 'islands' vulnerable to edge effects, and preventing genetic exchange and migration, for example the migration of ecosystems towards the poles to adapt to global warming. Proximate cause #3: introduced species which displace native species. For example, much of Australia's high extinction rate has been caused by introduced species out-competing (e.g. rabbits), preying upon (e.g. foxes), poisoning (e.g. cane toads), or replacing (e.g. crops, sheep, cattle) the existing native species or their habitats. Proximate cause #4: over-fishing / hunting / harvesting, although its theoretically possible to manage these at sustainable levels since they harvest renewable resources. A news flash for the 'big problem' might sound something like "Mass extinction by habitat destruction threatens human survival". There must be underlying reasons behind the immediate problems so far identified. In modern times the fundamental underlying reasons (ultimate causes) include:

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Ultimate cause #1: Overpopulation. When were your grandparents born? Not very long ago in the 200,000-year history of human evolution. Yet as recently as 1960 the human population had only just reached 3 billion. Since then, with an expansion of exponential proportions, it suddenly rose to well over 6 billion (Figure 1), possibly to double again over the current century before it is expected to stabilise. Potential costs to the Earths ecology and the resulting future human conflict are unknown. Also uncertain is whether future technology can protect humans from the fate typical of other species whose populations outgrow their resource-base. Fortunately however, human fertility rates have been slowing, especially in developed economies where children often cost more than they contribute. Better access to women's rights, education, contraception, and family planning are very important especially in developing nations. Q35. What happens when a population outgrows its habitat or resources? Environmental Economics Further fundamental or ultimate causes are economic factors, resulting from models and systems we created and have attempted to press upon the living systems of the world. Ultimate cause #2: Over-production Ultimate cause #3: Over-consumption Ultimate cause #4: Over-development In this view, the newspaper headline might read: "Non-living systems threaten global living systems" Why? Because the economic processes of production (supply of goods and services by firms), consumption (demand for use of goods and services), and development (growth/expansion of goods and services), are ultimately linked to ecology and are largely sourced from the environment and the labour of human society. Figure 2 illustrates the big-picture interactions, noting how the terminologies differ between the subjects of environmental science and economics. The economy is an open system reliant on three basic functions: a) supply of resources, b) assimilation of wastes, and c) provision of life-support and natural services (including spiritual). Mainstream economics, as widely practiced today, focuses almost exclusively within the boundaries of the upper section of Figure 2. In economics-speak, the non-monetary components in the lower section are known by the obscure but telling term externalities. Thus environmental losses, withdrawn from a parallel living bank account, are relegated into the background and rarely considered as costs in business policy and profit-calculations.

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Q36. Identify and discuss links and flows between economy and environment.

Putting economics in its place Its useful to know that the prefix Eco- comes from the Greek root oikos, meaning house or home. Therefore Eco-logy means the science of the home (because -logy means the study of, from logos or word), and Eco-nomics means the management of the home (-nemein is to manage). The paradox is that our global home is currently being managed according to measurements and models which are basically ignoring the science of the home. The biological science of ecology, dealing with the distribution, abundance and interactions of Earths living systems including humans, should logically be (more to the point, must logically become) the central focus and driving force commanding the economy. "Economic models and measurement focus not ecologically rational" We must accept that economics, measurement of the distribution, abundance and interactions of money, is only a means to an end, not an end in itself. Economics, as a subset of the many non-monetary social and ecological interactions going on among and around us, is simply a means to the higher ends of widespread ecological and human wellbeing, happiness, fulfilment, satisfaction, contentment and overall spiritual/moral ease with ourselves and our environment. Unfortunately, the economy is growing too big for its boots. The production-consumption-development cycle, driven by population growth and economic growth, is now reaching or over-reaching global social and ecological limits and critical thresholds. Rather than market efficiency and economic incentives, explained in detail and promoted by mainstream media and news sources, whats really required is non-consumerism, and dematerialization, an unnecessarily unwieldy term which means the use of much less materials in production and development. In recently accepted models (Figure 3), clearly the economic sphere cannot continue to grow indefinitely without crowding out the social and ecological spheres, bounded by the limited size of the Earth.

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"What economics calls externalities turn out to be the most important parts" Figure 3: Putting Economics in its Place; Sources: (left) John Peet 1995; (right) Ian Lowe 1998

Q37. Discuss ends and means in relation to economics. Limits ignored Theres not really much excuse for our economic and political leaders to claim ignorance of these things, as theres been no shortage of classic philosophical warnings about limits. Thomas Malthus warned of absolute limits to population size in Essay on the Principle of Population (1798). Ricardo warned of relative scarcity, or relative limits to growth in Principles of Political Economy and Taxation (1817). J.S. Mill in Principles of Political Economy (1857) expected the endpoint of an economy to be a desirable 'stationary state' (in modern economic terms a constant capital stock) in which there would be time for spiritual, artistic and educational pursuits. Karl Marx talked about social limits to growth and the rights of workers in Capital (1867). Kenneth Boulding introduced the concept of 'Spaceship Earth' versus 'cowboy economy' in The Economics of the Coming Spaceship Earth (1966). Paul and Ann Ehrlich foresaw catastrophic future consequences in Population Bomb (1968). Garrett Hardin warned of the depletion of open-access resources due to the self-interested actions of too many competitors for a common stock in The Tragedy of the Commons (1968). Daly (1973) promoted a nogrowth or steady-state economy in which optimum and maximum size of the economy within the greater system are taken into consideration (the scale issue). Meadows et al. wrote for the Club of Romes Project on the Predicament of Mankind: Limits to Growth (1972), which has been followed up by Beyond the Limits (1992) and Limits to Growth 30 year Update (2005). These concepts have often been met with denial, and sometimes wrongly rejected due to criticisms of the timing of specific predictions rather than of fundamental premises. Ecological limits are undeniable, and are measured in ecology by the symbol K for carrying capacity, or the maximum population density an area can sustain without causing lasting degradation. There are limits of acceptable change. The area of land required to compensate our resource consumption is known as our ecological footprint. If all people were to live the lifestyle enjoyed by the wealthiest nations, our collective ecological footprint would be more than three times the Earth's surface.

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Our activities have a certain forward momentum, and the resulting impacts may be positive or negative, primary (direct) or secondary (flow-on effects), may be sudden (e.g. land clearing), gradual (e.g. land degradation), or delayed (e.g. climate change), may produce feedback, act in combination (additive or multiplicative), and may be measurable or completely unknown. Attempts have been made to estimate the total environmental impact of human activity on the Earth, for example: Total impact = PF (Population x Impact per capita) Ecological impact = PCT (Population x Consumption/affluence x Technological efficiency) Impact damage = population x economic intensity x resource intensity x environmental pressure on the resource x susceptibility of the environment Impact = PLOT (Population x Lifestyle x Organization x Technology)

Opportunities lost Economics can been divided into two major goals: efficiency and equity. Our models are very good at efficiency, which refers to maximising the amount of work done/money made (benefits), compared to the energy supplied/money spent (costs). Adam Smiths An Inquiry Into the Nature and the Wealth of Nations (1776) was the defining work on classical economic efficiency, introducing the guidance of the invisible hand of the market. John Maynard Keynes concentrated on social employment efficiency, and Joseph Schumpeter on adaptive efficiency with investment in technology and creativity. In practice, our economic models were formulated around the market efficiency objective, completely overshadowing the more ethically-important social equity objective (fairness in the distribution of wealth and equality of opportunity). Classic philosophers on the equity component of economics include Jeremy Bentham (1781) who introduced the ethical philosophy of Utilitarianism, further developed by James Mill and then his son J.S. Mill in Utilitarianism (1863), and commonly known as the 'happiness principle' or 'the greatest good for the greatest number' (economists use utility to mean wellbeing). Marshall McLuhans global village concept (1970s) highlighted wealth disparities in a comprehensible way using the metaphor of a local neighbourhood. About half of the world village is in relative or extreme poverty, earning only a few dollars a day, without access to clean drinking water, modern healthcare, contraception, immunization or security. Roughly, over 80% of the worlds wealth is wrapped up by less than 20% of its people. John Rawls in A Theory of Justice (1971) proposes that a just world would be the one we would organise such that wed feel okay to be born randomly anywhere in it. This refers to social (distributive) justice rather than simply legal (retributive) justice. The other justice debate is whether to distribute wealth according to right, merit or need but any form of justice would surely do compared to the status quo of distribution by non-living market forces. A small step towards addressing the equity problem would be the application of fair trade rules in preference to free trade. Another relatively ignored and euphemistic economics term is opportunity cost, sometimes also called external costs. This refers to the fact that if you do one thing with scarce money, time and resources, theres a cost in lost opportunities towards other things you could have done instead. A brief glance at where the bulk of the worlds money is spent, shows that most often the opportunity costs are far more ethically significant than the wasteful spending choices of wealthy people and nations. Poverty, hunger, preventable disease and war

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have killed at least tens of thousands of children and adults every time you wake up in the morning perhaps 40 million per year, which is around one hundred thousand preventable deaths every day. Q 38: [Source of idea: Peter Unger (1996) & Peter Singer (2002) One World: the Ethics of Globalization] a) Imagine you saw that a runaway train was definitely about to kill a child playing in the railway tunnel. Would you pull a switch to divert the train to a different track, even if it meant the train would then smash up your new car parked there? b) Consider that donations of as little as US$200 can pay for enough food & medicine (including administration) to save a childs life through UNICEF or other charity organizations. Are there valid reasons to suppose any of us are in a different moral situation to the dilemma posed in a) above?

Local children on the global scrapheap Big global problems are comprised of a mosaic of lots of small local problems. The over-developed countries (self-defined as the first world) have used global financial mechanisms to take human and natural resources from under-developed (third world) nations. Those too poor to provide prospects for profit have typically been ignored, along with other externalities like pollution. Essential human needs in the modern world include at least nutritious food, clean water, warm clothes and shelter, healthcare, education, security and access to information and opportunity. Without food on the plate, one cant much afford to consider ethical and environmental concerns. Desperation and resentment resulting from poverty also make it a security issue and root cause of war and terrorism. Nevertheless, the United Nations finds it hard to extract just the recommended 0.7% foreign aid from wealthy nations towards the needs of the desperately poor. Philosophers of ethics suggest at least 10% of income should be donated. "Ignorance of opportunity cost kills tens of thousands a day"

Figure 4: Barefoot Timorese Children Consigned to the Scrap Heap [photos: M. Pollard] Their best available opportunity is our discarded rubbish.

Q39. What makes us all the same? Do children everywhere have the same ability to feel love, happiness, depression and fear?

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The very name of the worlds dominant economic ideology gives a hint as to its fundamental flaw. Capital refers to forms of money, and ideology (-ism) implies the elevation of something in the mind to the exclusion of all competing considerations. Therefore, power has been enthralled by the measurement of a surrogate or analogue of itself, called capital (money). Power is concentrated at the middle-scale, the scale relevant to nations and corporations, which explains why the global scale and the local scale tend to pay for, or at least miss out on, its benefits. This marginalisation of ethics in the implementation of business is known as economic realism. Should common people be driven according to financial rules constructed only by the wealthy? The study of power-relations is hardly soothing to the psychology of the faint-hearted, but cannot just be left to the cold-hearted. Power caters to itself. To this end, economics, although called the dismal science, is a master discipline of measurement (every possible cent). This skill can be used to its fullest capacity by extending the scope of measurement in economics to focus instead on ecological health, human wellbeing, and the creation of ethical outcomes (Tables 1 & 2). We must develop and implement new global financial and socioeconomic models able to synchronize the powerful driving forces of market incentives with the achievement of bioethical outcomes. If global economic models were correctly aligned to the cause of wellbeing, their collective power (a system which took us to the moon) would have been able to eliminate poverty long ago.

Q40. Why do you think economics has for so long been called the dismal science? How could we make it more cheerful? Consider economics a puzzle and a challenge to save species and lives. Unfortunately many people assume that we can solve the big global problems facing us if we recycle our garbage, develop energy efficient devices and better pollution control etc., while we retain an economy that continues to be driven by market forces, the profit motive and growth. This is a totally mistaken assumption. There is no possibility whatsoever of achieving a sustainable society while we have anything like the present economic system. Our present economy is the essential cause of our serious global problems and these problems can only rapidly worsen so long as we retain this economy. The problems are primarily due to over-production, over-consumption and over-development and it is our economic system which inevitably leads to these outcomes. p.74, and we have an economy that constantly has to increase levels of production and consumption. We must change to a very different economy, one which makes it possible to produce only as much as we need for a high quality of life, and to implement ways of reducing resource use, production, work, investment, trade and living standards as conventionally defined. (This does not imply any reduction in technical innovation, standards, cultural or scientific achievement or the quality of life.) p.79-80 Ted Trainer (1995) The Conserver Society: Alternatives for Sustainability. Dost thou not know, my son, with what little wisdom the world is governed? Count Oxenstierna (letter to his son 1648)

Q41. Why on Earth would our most commonly-used prescriptive models focus on growth and efficiency, at the cost of trampling ecological limits and ethical principles of equity and social justice?

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Table 1: Measures of National Progress and Development Gross National Product (GNP) and Gross Domestic Product (GDP) overused annual indicators based only on economic measures, they do not measure sustainable development or wellbeing because they include any monetary activity even if environmentally destructive or non-sustainable. Genuine Progress Indicator (GPI) an economic measure comparable to the GNP, but including estimates of 24 elements of social wellbeing like income distribution, leisure time, crime rate, environmental damage and volunteer work. This index is declining in many Western (over-developed) countries. Human Development Index United Nations Development Programme quality of life indicator which combines economic output, life expectancy, literacy rate and education enrolment. Human Freedom Index United Nations Development Programme index of 40 rights and freedoms, like freedom of speech, gender equality, homosexual rights and freedom from torture. Index of Social Health developed by the Fordham Institute, this index includes measures such as infant mortality, teenage suicide, homicides, unemployment, health access and child poverty. State of the Environment (SoE) Reporting environmental reviews used to monitor the progress of environmental protection in OECD countries.

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Economic development of course alleviates the suffering of poverty, conflict and crime; and increases human wellbeing, family planning, and the luxury of environmental protection. These are vitally important paths for those with less. Economic growth and globalisation (opening up to the world economy) are certainly necessary to relieve the suffering of the poorest people and under-developed countries. But for those with more, there is new scientific evidence that wealth increases happiness only to a point (a social and ecological limit). The health and wellbeing of current wealthy generations is hardly helped by the constant fuelling of material desires by advertising, trying to keep up with the neighbour, working too hard in stressful occupations, no time to spend on leisure or family, over-consumption of food, morally dubious goods and services, or subconscious feelings of guilt. The so-called trickle-down effect, where wealth is said to trickle down from rich to poor, is actually a cleverly inverted metaphor in free market capitalism money flows towards existing money like water down a valley. If there were fairer globalisation of health, wealth and education rather than just capital, people would place more trust in the process. Real globalisation of free trade would include the free movement of capital, production, consumption and labour (e.g. the European model). It would make policy based not on measures of money, but of happiness (e.g. in Bhutan). The ethical and sustainable corporation works to enhance the workplace, environment and society. This is known as Corporate Social Responsibility and is measured by triple bottom line accounting (the addition of social outcomes and environmental impacts to the traditional bottom line of profits). Ethical investments will have nothing to do with guns, gambling, tobacco, uranium or habitat destruction. But moral argument is only one tool for protecting the environment; other possibly more powerful/effective tools may be economic arguments. Old-style business, which treats workers, community and environment like resources to be exploited, will eventually suffer the consequences of public cynicism and alienation, environmental activism, and industrial relations conflict. New-style companies, driven not by profits but by vision and principle, will increase their effectiveness and staying-power by inspiring worker and public satisfaction, autonomy, innovation and teamwork towards new niches and green markets opened up by progress towards our sustainable future. Ecological networks can be emulated in economic models and organizational architectures, and efficient use and recycling of energy and materials can cut costs. Regulatory command and control measures can be supplemented with market-based economic incentives such as environmental valuation, green labelling, subsidies, permits, carbon credits and pollution taxes. Environmental valuation has traditionally been based around use (instrumental value), but nature is increasingly recognised as having additional non-use values such as the option value of potential future use, bequest value to future generations, existence value and ultimately intrinsic value. Ecological economics is a sub-discipline of environmental economics, and ecologism is a new sub-discipline of environmentalism. These two branches of their respective fields reflect rejection of the assumption that problems can be solved from within the constraints of the current dominant paradigm, and perceive solutions from an ecocentric perspective reaching beyond current debates.

Q42. Do you think animals, plants and ecosystems have intrinsic value, or is the value of nature only in its utility to humans?

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Solutions are at hand. Much information is finally coming out which outlines a humane basis for our economic future. Recent popular examples include Paul Hawkens Ecology of Commerce (1993) and Natural Capitalism (1999), Weizsacker Lovins Factor Four: Doubling Wealth, Halving Resource Use (1998), Charles Handys

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The Hungry Spirit (1998), Suzuki & Dressels Good News for a Change (2002), Clive Hamiltons Growth Fetish (2003), Doug Cocks Deep Futures (2003), George Monbiots Age of Consent (2003), John Cavanagh & Jerry Manders Alternatives to Economic Globalization (2004), Jeffrey Sachs The End of Poverty (2005), and just about any book with Sustainability in its title. With all these solutions proposed by ethical philosophers, ecologists and environmental economists for so long, why havent we solved, or even seriously addressed, the big problems yet? There seems a significant gap between the theory and the practice. A new contender for the crown of biggest problem is one of psychology. How will the greedy be weaned off their addiction? How do we deal with peoples desires, motivations, beliefs, fears of change? One answer is soft power, the persuasive power of moral authority and ethically superior value-systems. The successful marketing of important ideas involves putting them into a form which combines a sound philosophical and scientific basis with simplicity, clarity, accessibility, usefulness, attractiveness and fun. A message to current and future leaders: would you want to be frowned upon by our wiser future descendants as one of the old-style leaders, or are you a true leader for the history books? What have some of our true leaders said about economic issues? Jesus said that it is easier for a camel to pass through the eye of a needle than for a rich man to get into heaven. Buddha said that the path to contentment does not lie in material things. Mohammed emphasized the virtue of charity, as one of the five pillars of Islam. Hospitality and generosity are surely one of the key solutions to social disorder, crime and conflict. Gandhi said there is enough for all of our needs, but not for all of our wants. And finally John Lennon said give peace a chance.

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Ecotourism Tourism is a popular hobby and an important economic activity. There are different reasons that people use to choose holiday destinations. Here we shall introduce the concept of ecotourism, and try to make you reflect on the potential impacts of tourism on local environments and cultures. Holidays This section includes a number of questions and activities, which we hope makes you think about the ethical issues of travel and holidays. Have fun! If you cannot think of where you have been, then think about what you would like to do. Q43. Reflect for five to ten minutes on two or three holidays you have had. Where did you go? What kinds of activities did you engage in? Q44. Make a list of things you enjoyed the most and the least? Q45. Compare your list with others. Think of some possible reasons why you liked or disliked these activities.

Now, read this postcard together

15 July 2003 Dear Lisa,

TO:
Thanks for the letter. Its really hot in the city. Do you think I may hope to shed a few kilos? Happy to know you have settled in your new home.

Lisa Yamamoto, 320 Fukuroda Heights Sakura 2-1-1 Tsuchiura, Ibaraki Japan 305-005

I took a 4-day break in Palawan, such a lovely place! I went island hopping around Honda Bay. And I also have a picture with a crocodile from the Wildlife Conservation Institute, if thats anything to brag about. Oh, my sister came over for a 2 week visit. It was fun being with her again. Take care,

FROM: Maria Santos 45 Rizal Drive Happy Village Quezon City Philippines 1001

Maria

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Q46. What kind of holiday did Maria have? Did she enjoy her holiday? Why do you think so? What do you think she did on her holiday? Q47. Write postcards to each other about your recent holiday.

Tourism and Nature Q48. Look at the tourist activities below. Are there any words that you dont understand? Adventure Racing River Rafting Photo Safari Surfing Beach bumming Canopy Walking Alternative Tourism Listening to Nature Sustainable Tourism Bungee Jumping Scuba Diving Cultural Tours Whale/Dolphin Watching Archaeological Tours Looking at Flowers Fishing Trekking Bird Watching Swimming Repelling Going to zoos Shell Collecting Hunting Collecting Insects

Q49. Now, classify them according to Martha Honeys classification scheme: 1. Wildlife Tourism: observing animals in their native habitat. 2. Nature Tourism: traveling to remote areas to enjoy and experience nature 3. Adventure Tourism: nature tourism involving risk-taking activities. Draw a table like this on a piece of paper Wildlife Tourism Nature Tourism

Adventure Tourism

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Can you think of any other activities for each of these types?

What is Ecotourism?
Read what some people have thought about ecotourism:

Travelling to relatively undisturbed or uncontaminated natural areas with the specific objective of studying, admiring, and enjoying the scenery and its wild plants and animals, as well as any existing cultural manifestation

Responsible travel to natural areas that conserves the environment and improves the wellbeing of local people

Hector Ceballos Lascurain The Ecotourism Society

Q50. Think about your classification in the previous section and the table you made. Which of the activities can be considered as ecotourism? Q51. Write your own definition of ecotourism

Ecotour Packages Q52. Quickly scan for the main attractions of the ecotour packages offered by H&M Travel. What words would be appealing to a potential customer? Which ecotour package would you choose? Why? Q53. Are the two packages true examples of ecotourism?

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H & M Travel To: Mario Gonzalez From: Teresa Bautista Date: 5/4/2010 Re: Ecotour Package

Dear Mr. Gonzalez, Greetings from H&M Travel! It is nice to hear from you again. Regarding your inquiry, please find details as follows. For further assistance, please feel free to write to us. We will be glad to assist you. Best wishes, Teresa Ecotour Package A: Mountain Adventure Visit the mystical mountains where a world of raw and unspoilt treasures unfold. Come and behold the grandeur of breathtaking Crystal Falls. Go wild along the river, trekking through primitive mountain trails. Witness the glory of life in the legendary mountains for a bargain price of $100 !!!! Rates are inclusive of three nights accommodation and full breakfast/lunch /dinner daily. Leaves on M/W/F. Ecotour Package B: Fun in the Sun Soak up the sun at White Point, a place where magnificent mountains meet blue seas. Go windsurfing, sea-kayaking, boating, snorkeling! See a myriad of colors in the coral reefs teeming with breathtaking biodiversity. Simply relax and experience our special hibiscus aromatherapy and massage treatment. All these and more for a special price of $175!!! Rates are inclusive of two nights accommodation and breakfast. Leaves on T/Th/Sat.

Interview with the Bat-cave Guide: Mr. Anderson: How far is it to the batcave? Mike: Its just a 30-minute hike up the mountain, sir. Mr. A: Is it dangerous? Mike: No, sir. Ive been taking visitors up there since I was 8. Mr. A: That young? Mike: Around these parts, work is hard to come byso children need to help their parents earn a living. Mr. A: How much will it cost to hire your services for the day? Mike: Its up to you, sir. But the Tour Guide Association charges tourists a daily rate of $ 20.

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Mr. A: How much goes to you? Mike: Well, half goes to the association, bike rental fees cost $4, $3 for gasoline, $1 for entrance fee and the rest goes to me. Mr. A: Entrance fee? Mike: For the batcave, sir. At the Bat-cave entrance Mr. A: It is stinky. Mike: Yes, thats the odor of the bats. Watch your step, sir. Mr. A: What is that net doing there? Mike: Oh, the one hanging at the mouth of the cave? Thats for catching bats. Mr. A: Why in the world would you want to catch bats? Mike: Bats are a delicacy in this region. We usually eat them during feasts. Mr. A: Really? Mike: No kidding, sir. Bat meat is quite expensive when sold in town. Mr. A: How do you cook it? Mike: Its usually boiled in soysauce and vinegar, topped with chopped onions. Quite delicious! Would you like to try some, sir? Mr. A: Maybe, next time. Into the depths Mr. A: Oh, its fabulous down here. Those stalactites are simply wonderful! Mike: Yes, they are. Please use this umbrella, sir. Mr. A: Umbrella? Mike: .the bat droppings, sir.

Profile: Name: Mike Santos Marital Status: Married Occupation: Tour Guide

Age: 29 No. of Children: 2 Income: $2 /day

Q54. Lets think about this example: Who benefits from ecotourism? Does it contribute to environmental conservation? What do ecotourists learn? Are there any potential risks involved?

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Once in a South Pacific Island Island A, located in the South Pacific, has a local population of 800 people. In the early 1900s, the island was dependent on fishing and agriculture. Huts were made from coconut leaves. Non-islanders seldom visited this island in the middle of nowhere. All this changed in the 1960s when a film crew discovered the island. Images of white sand beaches were shown in various cinemas around the world. Some enterprising locals, with the help of foreign investment, then developed the island into a tropical paradise get-away for weary travelers. The 1970s saw the advent of rich tourists looking for exotic holidays away from civilization. More tourists came to the island in the 1980s. No longer was the island a quiet fishing community.

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Q55. What could be a good title for this story? Q56. What do you think happens next? Write your own version. What will be the likely positive or negative impacts on the culture and environment of the Island? Case Study: Ecotourism in the Philippines As you read the following, what would you say are the key words of the passage? The Philippines, a developing country in South East Asia, is faced with the challenges of an increasing population, poverty, inequality, and corruption. With more than a quarter of the Filipino population falling below the poverty threshold, the pressure for productivity and growth has led to practices that have resulted in environmental stress and degradation. In response, the Philippine government has adopted the rhetoric of sustainable development as defined by the 1987 World Commission on Environment and Development. Government policies on economic development have reflected this vision of sustainability and poverty reduction. A major part of the governments economic development plan is ecotourism. Ecotourism, as a Philippine government policy, had its roots in the 1991, 20-year Tourism Master Plan developed by the Philippine Department of Tourism, the United Nations Development Program, and the World Tourism Organization. This blueprint on the development of the tourism industry aims to be sensitive, contribute to livelihood, minimize impact of negative factors, maximize and generate sustainable growth. In 1998, the Department of Environment and Natural Resources and the Department of Tourism issued a jointmemorandum, Guide Laws for Ecotourism Development in the Philippines, wherein ecotourism was defined as: A low-impact, environmentally-sound and community-participatory tourism activity in a given natural environment that enhances the conservation of biophysical understanding and education and yields socioeconomic benefits to the concerned community. The present government has reiterated the importance of tourism as a major engine of socio-economic development. Specifically, it has been promoting ecotourism as a key to sustainable development. Reading Analysis: Q57. What is the point-of-view of the author? Which word/phrase/part indicates the message of the text? What is the tone of the text? Who is being addressed? What kind of time and place is it set in? Do you agree or disagree with the authors main point? Is there a main point?

Activity: Talking Points on Ecotourism and Holidays In groups, please discuss at least two of the following questions: Q58. Q59. Q60. How important are holidays and leisure time in your life? What is the ideal holiday for you? Where will you go? What will you do? Who will you go with? Would you go on an ecotour? What factors would be important in your decision whether or not to go on an ecotour?

Q61.

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Q62.

Do you think that the goals of ecotourism can be achieved? Why? Why not?

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Have you gone on an ecotour? How did you feel and what did you know before going? And afterwards? Does school organize any "ecotrips" for the day?

Q63.

Are there any examples of ecotourism in your country? What kind of role does ecotourism play in your countrys development plan? What do you think are the ethical issues of ecotourism? Is it possible to resolve these issues? Is it necessary to find right answers to these questions? If you were given the authority to decide whether to adopt ecotourism policies for your country, would you do so or not? Why? Why not?

Q64.

Q23.

Possible Project Topics Make an ecotour brochure. Be as creative as possible. Research into ecotourism in your country. Create a country profile. Imagine that you are in charge of your countrys tourism department. How would you market your country as a prime ecotourist destination? The Earth Charter Initiative The principles of the Earth Charter reflect extensive international consultations conducted over a period of many years. These principles are also based upon contemporary science, international law, and the insights of philosophy and religion. Successive drafts of the Earth Charter were circulated around the world for comment and debate by nongovernmental organizations, community groups, professional societies, and international experts in many fields. [www.earthcharter.org] Vision for the Earth Charter Initiative The Earth Charter was officially launched at the Peace Palace in The Hague on June 29, 2000. The vision is to establish a sound ethical foundation for the emerging global society and to help build a sustainable world based on respect for nature, universal human rights, economic justice, and a culture of peace. The charter raises a number of points related to environmental ethics and can be used for debate. 2005-2014 is the Decade for Education for Sustainable Development, launched under the lead of UNESCO. There have been a number of global environmental statements, including the Convention on Biological Diversity and Agenda 21 that arose out of the 1992 Earth Summit in Rio de Janeiro. The texts are available on the Internet, but for discussion of environmental ethics this document is more challenging upon the readers, and it is yet to be adopted at the UN. Objectives of the Earth Charter: To promote the dissemination, endorsement, and implementation of the Earth Charter by civil society, business, and government. To encourage and support the educational use of the Earth Charter in schools, universities, faith communities, and many other settings. To seek endorsement of the Earth Charter by the UN. Preamble We stand at a critical moment in Earth's history, a time when humanity must choose its future. As the world becomes increasingly interdependent and fragile, the future at once holds great peril and great promise. To move forward we must recognize that in the midst of a magnificent diversity of cultures and life forms we are one human family and one Earth community with a common destiny. We must join to bring forth a sustainable global society founded on respect for nature, universal human rights, economic justice, and a culture of peace. Towards this end, it is imperative that we, the peoples of Earth, declare our responsibility to one another, to the greater community of life, and to future generations.

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Earth, Our Home Humanity is part of a vast evolving universe. Earth, our home, is alive with a unique community of life. The forces of nature make existence a demanding and uncertain adventure, but Earth has provided the conditions essential to life's evolution. The resilience of the community of life and the well being of humanity depend upon preserving a healthy biosphere with all its ecological systems, a rich variety of plants and animals, fertile soils, pure waters, and clean air. The global environment with its finite resources is a common concern of all peoples. The protection of Earth's vitality, diversity, and beauty is a sacred trust.

The Global Situation The dominant patterns of production and consumption are causing environmental devastation, the depletion of resources, and a massive extinction of species. Communities are being undermined. The benefits of development are not shared equitably and the gap between rich and poor is widening. Injustice, poverty, ignorance, and violent conflict are widespread and the cause of great suffering. An unprecedented rise in human population has overburdened ecological and social systems. The foundations of global security are threatened. These trends are perilousbut not inevitable. The Challenges Ahead The choice is ours: form a global partnership to care for Earth and one another or risk the destruction of ourselves and the diversity of life. Fundamental changes are needed in our values, institutions, and ways of living. We must realize that when basic needs have been met, human development is primarily about being more, not having more. We have the knowledge and technology to provide for all and to reduce our impacts on the environment. The emergence of a global civil society is creating new opportunities to build a democratic and humane world. Our environmental, economic, political, social, and spiritual challenges are interconnected, and together we can forge inclusive solutions.

Universal Responsibility To realize these aspirations, we must decide to live with a sense of universal responsibility, identifying ourselves with the whole Earth community as well as our local communities. We are at once citizens of different nations and of one world in which the local and global are linked. Everyone shares responsibility for the present and future well being of the human family and the larger living world. The spirit of human solidarity and kinship with all life is strengthened when we live with reverence for the mystery of being, gratitude for the gift of life, and humility regarding the human place in nature. We urgently need a shared vision of basic values to provide an ethical foundation for the emerging world community. Therefore, together in hope we affirm the following interdependent principles for a sustainable way of life as a common standard by which the conduct of all individuals, organizations, businesses, governments, and transnational institutions is to be guided and assessed.

Principles
I. 1. RESPECT AND CARE FOR THE COMMUNITY OF LIFE Respect Earth and life in all its diversity. a. Recognize that all beings are interdependent and every form of life has value regardless of its worth to human beings. b. Affirm faith in the inherent dignity of all human beings and in the intellectual, artistic, ethical, and spiritual potential of humanity.

2.

Care for the community of life with understanding, compassion, and love. a. Accept that with the right to own, manage, and use natural resources comes the duty to prevent environmental harm and to protect the rights of people.

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b. Affirm that with increased freedom, knowledge, and power comes increased responsibility to promote the common good.

3.

Build democratic societies that are just, participatory, sustainable, and peaceful. a. Ensure that communities at all levels guarantee human rights and fundamental freedoms and provide everyone an opportunity to realize his or her full potential. b. Promote social and economic justice, enabling all to achieve a secure and meaningful livelihood that is ecologically responsible.

4.

Secure Earth's bounty and beauty for present and future generations. a. Recognize that the freedom of action of each generation is qualified by the needs of future generations. b. Transmit to future generations values, traditions, and institutions that support the long-term flourishing of Earth's human and ecological communities.

In order to fulfill these four broad commitments, it is necessary to:

II.

ECOLOGICAL INTEGRITY

5. Protect and restore the integrity of Earth's ecological systems, with special concern for biological diversity and the natural processes that sustain life. a. Adopt at all levels sustainable development plans and regulations that make environmental conservation and rehabilitation integral to all development initiatives. b. Establish and safeguard viable nature and biosphere reserves, including wild lands and marine areas, to protect Earth's life support systems, maintain biodiversity, and preserve our natural heritage. c. Promote the recovery of endangered species and ecosystems. d. Control and eradicate non-native or genetically modified organisms harmful to native species and the environment, and prevent introduction of such harmful organisms. e. Manage the use of renewable resources such as water, soil, forest products, and marine life in ways that do not exceed rates of regeneration and that protect the health of ecosystems. f. Manage the extraction and use of non-renewable resources such as minerals and fossil fuels in ways that minimize depletion and cause no serious environmental damage.

6. Prevent harm as the best method of environmental protection and, when knowledge is limited, apply a precautionary approach. a. Take action to avoid the possibility of serious or irreversible environmental harm even when scientific knowledge is incomplete or inconclusive. b. Place the burden of proof on those who argue that a proposed activity will not cause significant harm, and make the responsible parties liable for environmental harm.

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d. Prevent pollution of any part of the environment and allow no build-up of radioactive, toxic, or other hazardous substances.

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c. Ensure that decision-making addresses the cumulative, long-term, indirect, long distance, and global consequences of human activities.

e. Avoid military activities damaging to the environment.

7. Adopt patterns of production, consumption, and reproduction that safeguard Earth's regenerative capacities, human rights, and community well being. a. Reduce, reuse, and recycle the materials used in production and consumption systems, and ensure that residual waste can be assimilated by ecological systems. b. Act with restraint and efficiency when using energy, and rely increasingly on renewable energy sources such as solar and wind. c. Promote the development, adoption, and equitable transfer of environmentally sound technologies. d. Internalize the full environmental and social costs of goods and services in the selling price, and enable consumers to identify products that meet the highest social and environmental standards. e. Ensure universal access to health care that fosters reproductive health and responsible reproduction. f. Adopt lifestyles that emphasize the quality of life and material sufficiency in a finite world.

8. Advance the study of ecological sustainability and promote the open exchange and wide application of the knowledge acquired. a. Support international scientific and technical cooperation on sustainability, with special attention to the needs of developing nations. b. Recognize and preserve the traditional knowledge and spiritual wisdom in all cultures that contribute to environmental protection and human well-being. c. Ensure that information of vital importance to human health and environmental protection, including genetic information, remains available in the public domain.

III. SOCIAL AND ECONOMIC JUSTICE 9. Eradicate poverty as an ethical, social, and environmental imperative. a. Guarantee the right to potable water, clean air, food security, uncontaminated soil, shelter, and safe sanitation, allocating the national and international resources required. b. Empower every human being with the education and resources to secure a sustainable livelihood, and provide social security and safety nets for those who are unable to support themselves.

c. Recognize the ignored, protect the vulnerable, serve those who suffer, and enable them to develop their capacities and to pursue their aspirations.

10. Ensure that economic activities and institutions at all levels promote human development in an equitable and sustainable manner. a. Promote the equitable distribution of wealth within nations and among nations. b. Enhance the intellectual, financial, technical, and social resources of developing nations, and relieve them of onerous international debt.

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c. Ensure that all trade supports sustainable resource use, environmental protection, and progressive labor standards. d. Require multinational corporations and international financial organizations to act transparently in the public good, and hold them accountable for the consequences of their activities.

11. Affirm gender equality and equity as prerequisites to sustainable development and ensure universal access to education, health care, and economic opportunity. a. Secure the human rights of women and girls and end all violence against them. b. Promote the active participation of women in all aspects of economic, political, civil, social, and cultural life as full and equal partners, decision makers, leaders, and beneficiaries. c. Strengthen families and ensure the safety and loving nurture of all family members.

12. Uphold the right of all, without discrimination, to a natural and social environment supportive of human dignity, bodily health, and spiritual well-being, with special attention to the rights of indigenous peoples and minorities. a. Eliminate discrimination in all its forms, such as that based on race, color, sex, sexual orientation, religion, language, and national, ethnic or social origin. b. Affirm the right of indigenous peoples to their spirituality, knowledge, lands and resources and to their related practice of sustainable livelihoods. c. Honor and support the young people of our communities, enabling them to fulfill their essential role in creating sustainable societies. d. Protect and restore outstanding places of cultural and spiritual significance.

IV. DEMOCRACY, NONVIOLENCE, AND PEACE 13. Strengthen democratic institutions at all levels, and provide transparency and accountability in governance, inclusive participation in decision making, and access to justice. a. Uphold the right of everyone to receive clear and timely information on environmental matters and all development plans and activities which are likely to affect them or in which they have an interest. b. Support local, regional and global civil society, and promote the meaningful participation of all interested individuals and organizations in decision making. c. Protect the rights to freedom of opinion, expression, peaceful assembly, association, and dissent. d. Institute effective and efficient access to administrative and independent judicial procedures, including remedies and redress for environmental harm and the threat of such harm. e. Eliminate corruption in all public and private institutions. f. Strengthen local communities, enabling them to care for their environments, and assign environmental responsibilities to the levels of government where they can be carried out most effectively.

14. Integrate into formal education and life-long learning the knowledge, values, and skills needed for a sustainable way of life.

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a. Provide all, especially children and youth, with educational opportunities that empower them to contribute actively to sustainable development. b. Promote the contribution of the arts and humanities as well as the sciences in sustainability education. c. Enhance the role of the mass media in raising awareness of ecological and social challenges. d. Recognize the importance of moral and spiritual education for sustainable living.

15.

Treat all living beings with respect and consideration.

a. Prevent cruelty to animals kept in human societies and protect them from suffering. b. Protect wild animals from methods of hunting, trapping, and fishing that cause extreme, prolonged, or avoidable suffering. c. Avoid or eliminate to the full extent possible the taking or destruction of non-targeted species.

16.

Promote a culture of tolerance, nonviolence, and peace.

a. Encourage and support mutual understanding, solidarity, and cooperation among all peoples and within and among nations. b. Implement comprehensive strategies to prevent violent conflict and use collaborative problem solving to manage and resolve environmental conflicts and other disputes. c. Demilitarize national security systems to the level of a non-provocative defense posture, and convert military resources to peaceful purposes, including ecological restoration. d. Eliminate nuclear, biological, and toxic weapons and other weapons of mass destruction. e. Ensure that the use of orbital and outer space supports environmental protection and peace. f. Recognize that peace is the wholeness created by right relationships with oneself, other persons, other cultures, other life, Earth, and the larger whole of which all are a part. THE WAY FORWARD As never before in history, common destiny beckons us to seek a new beginning. Such renewal is the promise of these Earth Charter principles. To fulfill this promise, we must commit ourselves to adopt and promote the values and objectives of the Charter. This requires a change of mind and heart. It requires a new sense of global interdependence and universal responsibility. We must imaginatively develop and apply the vision of a sustainable way of life locally, nationally, regionally, and globally. Our cultural diversity is a precious heritage and different cultures will find their own distinctive ways to realize the vision. We must deepen and expand the global dialogue that generated the Earth Charter, for we have much to learn from the ongoing collaborative search for truth and wisdom. Life often involves tensions between important values. This can mean difficult choices. However, we must find ways to harmonize diversity with unity, the exercise of freedom with the common good, short-term objectives with long-term goals. Every individual, family, organization, and community has a vital role to play. The arts, sciences, religions, educational institutions, media, businesses, nongovernmental organizations, and governments are all called to offer creative leadership. The partnership of government, civil society, and business is essential for effective governance. In order to build a sustainable global community, the nations of the world must renew their commitment to the United Nations, fulfill their obligations under existing international agreements, and support the

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implementation of Earth Charter principles with an international legally binding instrument on environment and development. Let ours be a time remembered for the awakening of a new reverence for life, the firm resolve to achieve sustainability, the quickening of the struggle for justice and peace, and the joyful celebration of life.

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