As Korea pushes to loosen bioethics laws to develop gene therapies, and verges on passing a bill that allows patients to refuse life-sustaining treatment, the concept of bioethics has come to the forefront of discussion.
Professor Darryl Macer is a leading expert in bioethics, former UNESCO regional adviser, and president of the American University of Sovereign Nations, who believes bioethics is the bridge between different disciplines that allows people to work together to make more informed choices.
Professor Macer sat down with Korea Biomedical Review Thursday at the 18th Asian Bioethics Conference Thursday to talk about the history, progress, and future of bioethics.
|Professor Darryl Macer makes his points during a recent interview with Korea Biomedical Review on the sidelines of the 18th Asian Bioethics Conference at Yonsei University, Seoul, on Thursday.|
Question: What is bioethics?
Answer: Bioethics is the love of life. The term has been around for around 90 years, but the concept of bioethics is pre-human. It is old as culture. It talks about the balance between good and harm.
Bioethics tackles difficult questions such as organ transplantation, dialysis, genetic technology, abortion, and euthanasia. When talking about organ transplantation, bioethics addresses who should get it and who should not.
It goes back to the Hippocratic Oath written over 2,500 years ago when doctors were trying to form a profession. It primarily was a promise not to give abortion drugs and a signal to others that said, “You can come to us if you don’t want to be killed.” It is an example of doctors following ethical guidelines.
But the term bioethics had not been used until recently. There is discussion over how it should be taught. In the 1990s, some study of bioethics arose, partly from Western influence. In academic structures, where you have more and more specialties, people are asking whether bioethics should be a specialty in philosophy. But there are worries that it may misrepresent the field.
But all in all, bioethics is necessary because it seems we have lost touch with ourselves and nature. We substitute money or material things for real human values. Bioethics reminds us of what these values are.
Q: Then how is bioethics different from ethics?
A: One of the differences between moral and bioethics education is that ethical studies outline the rules and laws we need to follow. Ethics shows us the right and wrong and tells us to follow the rules. Bioethics teaches us how to make decisions that are good (or not good) for me and those around me. Those teaching bioethics help students think about how we make decisions. There are cases sometimes where the law is wrong, and you need to go against the law.
Bioethics takes difficult questions for society and thinks about them. It’s good because you have a forum where you can discuss issues. Sometimes the result of the discussion will lead to a law and sometimes not. If people are in harm’s way, legal reform should be suggested. The government can change specific statutes and administrative guidance. But that doesn’t mean you need to have a law for each issue. It may do more harm to have a bill. There is a tendency to make laws and then regret them later.
Q: Does bioethics translate across cultures?
A: We cannot just translate American bioethics textbooks for application to other countries. Bioethics hinges on cultural context and social relationships. Social structures in Korea are different from the U.S. For example, the individual idea of autonomy is different from familial autonomy. Korean social values center mostly on family, while in the U.S., it’s more about the individual. Of course, in both cultures, you will find individualistic Koreans and communitarian Americans, but generally, social norms tend to be collective.
Q: Korea recently announced it would change life-sustaining treatment laws. How does bioethics apply here?
A: It is essential that each society talks about the limits of life-sustaining treatment. We may have a mechanical view of medicine and healthcare. That’s not what human beings are. Many people don’t want to die with tubes. You want a peaceful death. If it’s not going to work, then you want to be able to decide that nothing can be done.
When we have more difficult questions such as life-sustaining treatment, we have to make decisions. If we put people on life-sustaining treatment or a ventilator and they don’t recover, we have to decide when to turn off the machine. But we must also question whether we are playing God.
Q: Bioethics is a relatively new term in Korea. How and why should it be expanded here?
A: Korean society, like many Southeast Asian countries, has a structured paternalistic society that keeps decision-making people away from ordinary people. There have been populist movements in Korea with political demonstrations, but for the most part, power lies with the elite. The elite makes decisions on behalf of other people.
Bioethics may lead to a more profound form of democracy. A government should share its thinking. It will give people a voice in the decision-making process.
Of course, good decisions do not stem from pure popular voting. Just because a majority believes it’s okay does not mean that it is a good policy. In Korea, it's common for a political leader to become extremely popular one moment and then embroiled in scandals and then dies off. The cycle seems to repeat itself. You also see results like Brexit in England, and other presidential elections where they choose someone and later regret it.
This is why we talk about bioethical maturity. It tries to mature the society so that people can cope with sudden changes in opinion and give people say in the decision making process. Meanwhile, bioethics aims to develop long-term sustainability and challenge controversial issues.
In Korea and around the world, bioethics should be part of a curriculum taught at schools. When we teach science and technology, we also need to talk about ethics.
I worked with many Korean bioethics experts to translate bioethics books into Korean. I would like to introduce the concept to every citizen in school. Bioethics allows students to think about things and does not involve just memorization. The current school system focuses on that though. That is why I established the American University of Sovereign Nations. I would like everyone to learn about bioethics and then have them spread out to teach it others as well. I would introduce the concept of bioethics by the people, and for the people. That has been the focus of my work. This is my dream.
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