The Social Dimension of Certain Bioethical Approaches

The fundamental principles and practices in public health often obscure the infringement of personal welfare for the sake of the public good. It would be no exaggeration to take this as the core of bioethical concerns as regards preventative public medical health care.

AIDS

Orthodox bioethics sees patients suffering from AIDS as unique and irreplaceable persons, made in the image of God. It may be that most people want to marginalize them, highlighting the protection of society as a whole and the fear of transmission of the infection as a justification. These reactions lead patients into a locked-in, private environment, with all that this entails. A shining exception is the observance of privacy on the part of the medical profession. Orthodox theology and bioethics see the problem of health as a means of communication and an opportunity to express the wondrous nature of the person. The existence of these diseases has to do more with the anthropocentric view of human life and the experience of love. This is why the approach to the problem through the theology of the person, both from the point of view of the doctor and that of the patient/carrier, presents a unique opportunity for dealing with it as a problem which has to do with the unique and irreplaceable identity of the patient.

One bioethical parameter linked to AIDS is the exclusion of homosexuals and user of intravenous drugs from blood donorship, in the interests of protecting the public weal. The issue arose in 1980, when the AIDS virus was discovered. Since an exact diagnosis of the virus is difficult, exclusion of high-risk groups was an easy solution. This exclusion resulted in certain groups ending up in the margins and in ghettos. But since AIDS isn’t confined to homosexuals, why are they being targeted, with the result that valuable bottles of blood are being lost needlessly? The World Health Organization makes no mention of such a ban, but in Greek blood donation centres, anyone with just a single sexual contact or use of intravenous drugs since 1977 is excluded, as are those who frequently change sexual partners without the use of prophylactics and those who believe that there’s a chance they may have been exposed to the virus.

AIDS is one of those diseases that has many and varied repercussions on psychological, social, economic, biological, personal and public levels. It tests the moral values of society and of individuals. The psycho-social needs of the AIDS sufferer and carrier should be kept within the framework of human rights, with respect for their personalities. An important step would be to understand their problems and how to deal with them as people with social and moral dimensions.

Smoking

When tobacco was first used, it didn’t raise questions or cause concerns regarding any likely ramifications it would have for our health, because the sole aim was profit. After 1920, research began into the link between smoking and diseases such as cancer of the lung and oral cavity and a number of respiratory illnesses. These days, issues associated with the use of tobacco have been taken out of the sphere of personal principles and autonomy because of the recognition of the serious consequences which smoking has for public health. The moral obligation to protect a susceptible population has been reinforced by the dangers of tobacco at all stages of children’s development and by the fact that these specific dangers can be averted.

The morality related to issues of public health may not be clear-cut, because often the obligations and rights of society as a whole may be different from or clash with those of an individual patient. The overwhelming scientific evidence of the harmful effects of tobacco now leave no room for objections and disagreements as regards the conflict between individual and collective rights. The evidence justifies the imposition of restrictions on smoking in the work and public places, while the absence of a total ban allows adults to choose freely where and how much they smoke.

Predictive genetics

One of the fundamental bioethical issues raised by applied genetics in the diagnosis and prevention of disease is the reassessment of the terms of therapy, illness and normality. Another important parameter which has been introduced is the recognition of the causes of the disease as lying within the individual. Until the development of genetics, most sicknesses were attributed to external causes. With the opportunity for genetic diagnosis, it has become recognized that many illnesses have a genetic/hereditary root. A third field which is of particular importance in the bioethical assessment of genetic prevention is genetic counselling. Given that none of the genetic diseases are treatable, it would appear that predictive medicine, through genetics and counselling, will acquire a more elective and less therapeutic character.