Ethics, bio-ethics and environment in healing designs.

ion, and must sometimes appear to be an unaffordable luxury to a fair portion of the world’s population, irrespective of ideology, tradition, or social status. And yet, while the temptation is to exhort scientific enquiry and design – push on, push as hard, as fast and as far as you can we are obliged also to pause, Ethics, Bio-Ethics and Environment in Healing Designs ....... African Journal of Reproductive Health Vol 13 No 4 December 2009 11 and attempt a holistic appreciation of the many factors that define the human being, definitions that transcend the pursuit of social objectives and scientific triumphs, and position the human entity as a repository of questions – including the hypothetical. This is what differentiates humanity from the rest of the living species. Proceeding logically, if one believes in the right of a woman to control her own body, that is, in the woman’s right to abortion, it becomes contradictory to oppose the position that the unwanted fetus be put to use for the salvation of an already existing, but medically afflicted human being. From this seemingly unassailable logic however, leaps out ancillary questions that act as checks, such as: since the same technological advance in scanning now makes it possible to detect deformations of the fetus even in the womb, would we be taken to the next logical step, where imperfect fetuses become spare parts, to be cannibalized for the repairs of the malfunctioning members of the species? And so on, and on, taking us into the even more daunting, and historically chastening minefield of eugenics. Cloning, we know, is another contentious issue. The world famous sheep, Dolly, finally put to rest the fundamental question of ‘if’, for the next target, and moved the issue more provocatively into the territory of ‘when?’ In short, if sheep, why not the human entity itself? Next, what are the implications? What might be the consequences? The former consideration – what implications? remains largely terra incognita. Some of these implications might even be psychological. Despite scientific success in mapping the human genome, opening up possibilities of its purposeful redesigning, several imponderables remain – such as the transmission and indeed perpetuation of negative genetic traits. These, while benign in one physical environment, might prove disastrous in another. Success in the culturing of a living specimen, we know, cannot be terminally defined. As long as it exists in a controlled environment, science may even claim some level of mathematical predictability in its development. Released into an extended and uncontrollable milieu however, an infinite catalogue of possibilities through myriad combinations becomes a logical consideration including, for the more complex species such as the human, psychological implications. And then, psychology itself comes in to complicate matters even further. What, yesterday, was considered as belonging to the purely psychological field, is beginning to yield ground to physiology. In other words, not just the brain, but even glandular secretions have been discovered to hold the key to certain psychologically defined abnormalities of human behaviour, so that the psychiatric couch is surrendering patients to the surgical gurney, or indeed, to the pharmacologist’s shelves. The ultimate direction seems clear – a holistic approach to healing, into which even the much marginalized ancient traditions – marginalized especially by the omniscient West – are being respectfully African Journal of Reproductive Health African Journal of Reproductive Health Vol 13 No 4 December 2009 12 drawn. Acupuncture appears to lead the way among such marginalized sciences. Not all, but many of these advances, such as cloning, raise ethical issues. As usual, the theologians generally have the easiest time of it. They turn to the scriptures, conduct their own controlled exploration of the divine text on any subject, select their interpretations and issue an encyclical. We must not neglect to mention their lunatic fringe, including the psychopaths, who believe that the way to fulfill god’s mandate on issues such as abortion, is to murder any wouldbe abortionist. Only three days ago, the United States provided us yet again a grisly reminder of the existence of such extreme zealots, the murder of medical abortionist in – of all places – a church! The contradiction of a resort to killing in order to fulfill the divine mandate – Thou shall not kill – on which such fundamentalist biblical fidelity is based – evidently escaped our soldier of the Divine Will. It is all part of the contradictory world we live in. While the world of science has leapt beyond the genetic barrier, the Roman Catholic church continues to wrestle with the abortion barrier. Only recently in East Africa, a Christian prelate denounced the use of condoms as Satan’s diabolical invention specifically designed to spread HIV Aids, rather than prevent the scourge. And only last year or the year before – I forget now – an Islamic leader stubbornly rejected the government’s attempts to inoculate its citizens against an outbreak of cerebrospinal meningitis in a vulnerable northern state, declaring that such measures were against the tenets of the Koran. For a number of years, the former President of South Africa espoused his own theory of the nature of HIV Aids and upheld it against scientific findings, thus basing the policy of his government on his personal revelationary authority. Fortunately for humanity, these whimsical theological and allied dictatorships of the Revelation do not lack for opponents even from within their own spiritual constituencies. Nor can we ignore the animal kingdom in this contest between text and text – between the closed, supposedly ethical derivatives of fundamentalist texts on the one hand, and the self-adjusting texts of scientific enquiry, written and unwritten, that can be summed up, for convenience, in the Hippocratic oath – a commitment to the mission of healing, with all its implications, of which Research forms a crucial part. I do not know what gods the animal rights fundamentalists worship – certainly it is none that presides over mine, that is, the Yoruba world-view. I am speaking of those animal rights zealots to whom arson and even maiming are considered legitimate forms of animal respect. So righteous and driven in their ethical convictions, they find nothing wrong in sending letter-bombs to laboratory workers, primed to maim and even kill the recipient. They set fire to farms where animals are bred for experimentation and generally make life unlivable for all such perceived enemies of the non-human animal kingdom, and even tangential suppliers of non-research material. It is not quite three or four years Ethics, Bio-Ethics and Environment in Healing Designs ....... African Journal of Reproductive Health Vol 13 No 4 December 2009 13 ago since a farmer, in the United Kingdom, who used to breed animals for scientific research – among other mundane uses threw in the sponge and closed down his farm altogether. Patients, whose hope of living a reasonably normal existence diminish every day, may find it difficult to bow down at the same altar as these animal rights brigades claim to worship. I feel certain that we all recoil at the thought of certain forms of animal experimentation, especially those that involve vivisection and deliberate infliction of suffering, but I find it extremely difficult to reconcile homicide against the human species with the responsibilities of any theological disposition – salvation and damnation. Those who concern themselves with the dangers unleashed on the world by the menace of bio-chemical terror had better understand that such danger does not emanate only from the overt religious fanatics. Anyone who has followed the tactics, as well as the pronouncements, of some of the extreme fringes in the United Kingdom alone, their regular break-ins into laboratories, releasing caged animals without any consideration of their case-histories, will know that such crusaders will not balk at an opportunity to unleash the most deadly viruses on society, and with selfrighteous relish. I merely speculate of course, but is there any certainty that the frequent outbreak of one contagion after the other, especially the animal related ones – mad-cow, bird-flu, swine-flu etc. etc. – are not traceable to the activities of some of these animal loonies? I have encountered some of them, individually, and to see the fire of fanaticism in those eyes is to be inducted into the capacity of the human mind to subsume the sacred ethic of life preservation under whatever ethic impels their all-consuming crusade. Well then, caught in the melodrama of zealotry, one can understand that not much argument is permitted by such crusaders on behalf of the propositions such as the implicit cruelty towards the human entity by their extremist actions. And of course I am not thinking of the direct physical and economic afflictions on human victims. No, I am thinking of what might term passive cruelty. Cruelty implies more than the extrusive, aggressive act. The passive, such as not providing, or deprivation, can be legitimately deemed an act of cruelty, intended or unintended – it all depends on what is withheld, whether it belongs within the realms of self-indulgence, or among the essentials for well-being and human survival – collectively or individually. To withhold a shot of heroin from a desperate addict may be viewed as an act of cruelty, or simply as a necessary step in a curative regimen, however painful. Marijuana as a means of easing the pain of the critically ill, is now increasingly prescribed by doctors, and has been legalized by certain states within the United States and some Scandinavian countries. And so, even within the area of forbidden or restricted drugs, we find ourselves on controversial terrain. How much more then – and I enter these arguments purely to lay the grounds for a broader consideration – how much more when areas of research are denied on any grounds, yet in the full African Journal of Reproductive Health African Journal of Reproductive Health Vol 13 No 4 December 2009 14 knowledge that opportunities for the amelioration of human existence may actually be found within those very proscribed areas. Withholding the rights of the afflicted to their chances of a curative discovery surely counts as an avoidable form of cruelty. The prolonged obstructive policies of the Bush government thus constitute, in my view, an act of cruelty, or to put it in the parlance of that nation’s own constitutional forbiddens – a cruel and unusual punishment. Has any attempt been made to itemize what are the rights of those afflicted by Parkinson’s disease, Alzheimer, muscular dystrophy, spinal bifida etc. etc.? With HIV-Aids ravaging the African continent, I doubt very much that the position of an absolutist for the rights of animals will cut much ice with the continent’s inhabitants over the use of animals in the feverish search for a cure, or effective prevention, any more than the pursuit of stem cell research in relation to other afflictions. These arguments will continue for a long time, and none of the conclusions will ever be universally satisfactory. One does not have to be a Buddhist to accept that cruelty, to any species that is capable of sensing, diminishes our very humanity. To see a dog whimpering when it has fallen into a ditch or been hit by a motor car does not fail to touch us in that same zone of empathy where feeling for fellow humanity is lodged. Ultimately however, one accepts that the most solemn responsibility of humanity is the preservation of, and enhancement of life for its own species, and this collective subjectivity tends to govern most of human undertakings, even when our purposes are declared to be altruistic. Genetic design – better known as engineering in crops is largely motivated, not out of a love of nature, but in order to tap into faster and larger yields, not forgetting the production of crops that are resistant to pests and plant diseases, especially in a world whose populations, in certain areas, have certainly outstripped their food provision capabilities. The risks of distorting the organic integrity of these plants, to the detriment of the survival of the specific plant species will remain the only deterrent, not a lofty concern for the basic right of nature to pursue her own tempo of evolutionary changes. In a mere three years, despite all anxieties, including official ban in some nations, transgenic farming has increased twofold throughout the world – from 17 million hectares, as I recently learnt to forty million. Nature, it seems, has become too slow for human needs, not only that, it is being demonstrated among the more advanced nations, that genetic tampering in food crops can actually build up human resistance to certain diseases, if not prevent them altogether, when such crops are made a regular part of the human diet. Theology based – or indeed any ideology based interdictions in experimentations that involve ‘tampering with Nature’ simply cannot be permitted to take primacy over the imperative of human survival in the multiple strategies of healing – from intervention with plants, animals, or stem cells research Ethics, Bio-Ethics and Environment in Healing Designs ....... African Journal of Reproductive Health Vol 13 No 4 December 2009 15 that involves the unwanted fetus, itself produced by the ultimate beneficiary of such designs – humanity itself. I must not leave you with the impression that the theological role in healing is an entirely solemn, life-anddeath affair. That would be to turn the health mission into an entirely humourless preoccupation, and we know that doctors themselves recommend the lighter side of existence as essential to fundamental well-being. Well then, I shall let you into some family secrets which might reveal one of the contributory factors to the very early interest of, not just our celebrant, Olikoye Ransome-Kuti, but his elder sister, Dolupo to medicine. Dolupo became a nursing sister, while their younger brother, Beko, also took to the stethoscope. Fela was the exception, but then, if you recall, he was a great proselytizer for traditional African medicine, not forgetting his passionate advocacy of ganja, also known as marijuana, as the cure-all, prevent-all medication for all known and unknown diseases. My own immediate family – we are all related on my maternal side as some of you know already – also donated two siblings to the medical field, a brother and a sister. One, Femi, became a Professor of Medicine, now charged with AIDS research and prevention, while my sister, Tinu, like Dolupo, became a Nursing Sister. In my own case, well, I don’t have to tell you, I don’t know one end of the stethoscope from the other. However, a certain family experience, one that unites us all, stayed with me, one that certainly led to my early informed interest in preventive medicine. To get to the point my belief in the virtues of what you eat or do not eat as the basis of sound health surely had its roots in a medical ritual from recollected childhood. I shall reserve an extract – a quite fortuitous testimony from my recent Memoirs – till towards the end, just to buttress the solidity of a familiar saying that has unfortunately undergone the usual theological misappropriation and distortion. Anyone with this childhood experience will agree with me that the true version of whatever they were taught should really be “the fear of medication is the beginning of wisdom”. Here is why. The treatment for any stomach disorder in my home, as in many other western or Christian missionary influenced home, was straightforward Epsom salts, castor oil or cenapodium – mostly the last two. It was no different in the Ransome-Kuti family. How regularly Koye and his siblings were subjected to this ordeal, I really do not know, but what is undeniable is that the family matriarch, the formidable Mrs. Funmilayo Ransome-Kuti, and my mother, belonged in the same school of missionary pharmacology. Mrs. Kuti applied that prescription with religious zeal to the pupils enrolled in her primary school, which was attended by her own children. That school was known as Mrs. Kuti’s Class, a sort of preparatory school for we call the secondary school. Although I have no recollection of witnessing Koye specifically undergo that treatment, I have no doubt in my mind that Mrs. Kuti’s own children were African Journal of Reproductive Health African Journal of Reproductive Health Vol 13 No 4 December 2009 16 subjected to the same internal cleansing system. In any case, Koye was a being of almost inhuman empathy, so if, by a miracle, he somehow escaped the treatment, he must undoubtedly have felt deeply for many of his mother’s victims. I sometimes visited on a Saturday – the day of general medical and other inspections and witnessed the sick parade. The ailing – who were also boarders were examined by Mrs. Kuti in person to decide who would be sent to the clinic at Ibara or Iporo, or could be treated in her own consulting room cum dispensary. That clinic took place in the screened-off section of the wrap-around corridor that also served the Kuti family for their dining-room, casual receptionroom, judicial hearing and disciplinary court etc. etc. The dispensary consisted of just the small-sized first-aid box mounted on a wall, its key kept with her or with her husband, Daodu, who also either deputized in her absence or joined her in the ritual inspection of the sick parade. Sometimes, one of the bigger pupils served as a kind of nursing assistant to the Chief Physician herself. Now, in my catalogue of medical demonology, the inventor of castor oil or cenapodium must be counted the most sadistic beast that ever emerged from the original Slough of Despond. It was, in my view, very typical of the missionary philosophy of the necessity of human suffering, that cenapodium should have been made to penetrate the homes of African convertites as a blind article of curative faith. But it was not just a curative application it was also preventive, and with a fiendish regularity, at least in my own home in Ake parsonage. In my home also, every last Saturday of the month, and sometimes in between was purgative day and never, thought I, was a word more aptly chosen. That intermediate stage between Paradise and Hell called Purgatory has been experienced by some of us as children, only it was called Purgative, so when we approach the Heavenly Gates and some officious angel tries to shunt me into that Awaiting Trial room called Purgatory, I’m going to tell him or her point-blank – don’t waste your time, I’ve been there. Just take me straight to Hell – it can’t be any worse. Purgative Day we were all lined up the entire household, children, wards from relations and other house appendages, augmented by neighbours who sadistically contributed their own junior household for the ordeal. We opened our mouths one by one and the loathsome spoonful was fed into that quivering gap. If you had been "naughty" you were further punished by being deprived of the slice of lemon whose astringency at least took off some of the nausea that instantly wracked your body. After taking your dose, you remained lined up on one side the Chief Dispenser had to make sure that you did not vomit it out. So did you, because if you did, the process began all over again. During this period, on a visit to the General hospital at Iporo, I discovered, to my intense fury, that this stuff actually existed in capsules. Filled with righteous indignation, I raced home and demanded to know why we had to be subjected to this torture by the spoonful instead of utilising the relatively painless method of Ethics, Bio-Ethics and Environment in Healing Designs ....... African Journal of Reproductive Health Vol 13 No 4 December 2009 17 swallowing a capsule. My mother gave me that familiar look that I recognised as being the nearest conceivable expression of divine omniscience. "Because the liquid form is far more effective", she replied. "Did I really think that that tiny capsule could do what a table spoonful would do?" Of course, she had carelessly strayed into my territory, which was that of argumentativeness. "How many capsules," I demanded, "would make a tablespoonful? Two? Six? A dozen?" I was prepared to swallow an entire jar of the capsule form in preference to a teaspoonful of that colloid. She knew where I was headed of course, and swiftly brought the argument to a close. "The very effort that you make in order to swallow your medicine, the distasteful part of it, is an essential part of the cure". End of argument. I have to confess that I accepted some kind of logic in her claims – with a difference. I had simply arrived at one of my early life discoveries some curatives are meant to be far worse than the disease – never mind whether the motivation comes from a theologically derived ethic, or from traditional wisdom that is common to all societies. I know that I despise those societies which resort to coating plain medication with licorice and even sweeten toothpaste to make children clean their teeth – that is the other face of the fundamentalist coin, one that makes absence of pain or unpleasantness a virtue. Go and set up shop in Onitsha market and see if you’ll acquire patronage unless you prescribe an injection no matter the complaint – you see, that painful prick is what interests your patients, not the actual content in the syringe. And the bigger your needle, the more efficacious it is supposed to be. All I can admit to is that my partisanship of preventive medicine has never abated since those early years when I learnt that there were worse things than being ill, and even teetering on the very verge of death. It was a lesson that I took with me when I departed these shores and landed in the United Kingdom, and here, to assure you I do not exaggerate, is the promised extract from my Memoirs – YOU MUST SET FORTH AT DAWN. During my first full year in England, 1954 to 55, and here begins the quote, I.... “.....dutifully ate anything that was put before me. It was my health strategy for that strange, cold, and dismal land that existed, surely, solely to ensure my death from a thousand cold related