© Springer International Publishing Switzerland 2016
Alireza Bagheri, Jonathan D. Moreno and Stefano Semplici (eds.)Global Bioethics: The Impact of the UNESCO International Bioethics CommitteeAdvancing Global Bioethics510.1007/978-3-319-22650-7_1414. Bioethics in Arab Region and the Impact of the UNESCO International Bioethics Committee
(1)
Anesthesiology and Critical Care Medicine, Sorbonne Paris Cité University, Paris, France
(2)
Anesthesiology and Critical Care Medicine, El Manar University, El Manar, Tunisia
Abstract
Arabic countries are in the Eastern Mediterranean region which is the cradle of the three major monotheistic religions Judaism, Christianity and Islam. While Arabic countries share a religious and cultural background, a recognizable diversity exists among these countries due to various schools of jurisprudence. Since its establishment, the UNESCO International Bioethics Committee (UNESCO-IBC) has had very strong ties with Arabic countries. This chapter examines how the UNESCO IBC has shaped and impacted bioethics development in the Arab region. It also describes how Arabic countries, in turn, have contributed to international bioethical debates.
14.1 Introduction
The Arab region has its own cultural identity and traditions. This unique situation is based on the unity of language, culture, religion, socio-economic circumstances and demographic distribution. Even though Arabs feel they belong to the same community and share common values, they are not completely homogeneous. Coarsely we can divide Arabic countries into three big entities, even if the boundaries of these regions do not represent the true divisions between the entities: Gulf countries, North-African countries and Middle Eastern countries. Gulf countries include: Bahrain , Kuwait , Oman , Qatar , Saudi Arabia , United Arab Emirates and Yemen . North-African countries include: Mauritania, Morocco , Algeria, Tunisia , Libya , Egypt and Sudan. Middle Eastern countries include: Lebanon , Syria , Palestine , Iraq and Jordan. In terms of bioethics development, it is important to mention that not all these countries are on the same level. For instance, among these countries, Kuwait, Qatar, Mauritania, Morocco, Palestine and Iraq have no ethics committees (Abou-Zeid et al. 2009). The contribution of Muslim physicians to medical sciences and practice is well documented and reflected in the medical literature especially between ninth and sixteenth centuries. A review of the flourishing time of Islamic medicine in medieval times shows a great attention to the ethical issues in medicine by the Muslim physicians such as Rhazes (865–925 AD), and Avicenna (980–1038). For centuries onward, their medical ethics instructions were dominant teaching and practice in medicine which followed by other prominent Muslim physicians (Bagheri 2014). In the contemporary era, however, development of the Islamic Code of Medical Ethics (1982) by the International Organization for Medical Sciences (IOMS), in 1981 in Kuwait is noticeable (IOMS 1981). In the Arab world based on Islamic teachings, bioethics is applied in a different context than in the West. While there are Shiites, Sunnis and other minorities, in Arabic countries, bioethical reflections are based on Islamic Shari’a . Despite this common foundation however, a diversity of approaches in bioethics exists in Arabic countries. This diversity derives from the various schools of jurisprudence, the different sects within Islam, the differences in cultural background as well as the different levels of religious observance (Daar and Al Khitamy 2001).
In addition, values that would be considered universal at the global level may not be fully adopted by some religious communities, indicating that they are not always concerned by secular bioethics (Filiz 2011). Currently, many Arabic countries, have established local ethics committees at their universities and hospitals, independent ethics committees (IEC), or research ethics boards (REB), which are all very active. In addition, National Ethics Committees (NEC), which was recommended by UNESCO, have been established in many countries in the region. Although, the NEC’s missions are completely different from those of local committees, it is not uncommon to see a local committee playing the role of NEC, which may create confusion and tension. However, several problems still exist at the national level: national ethics committees do not meet regularly; and their composition is not as diverse as that recommended by UNESCO especially in terms of gender balance. In Arab region , the contribution of scientists and physicians in bioethical discussions is dominant, and the participation of anthropologists, lawyers, philosophers and sociologists is not as sought after as it should be. Furthermore, national ethics committees only have an advisory role with no real authority (Abou-Zeid et al. 2009). An added complexity is that many prefer to talk about Muslims, not about Islam; considering that not all Muslims are Arabs, and not all Arabs are Muslims. In this chapter we use these two terms interchangeably as we believe that this better reflects the reality of our society.
14.2 Ethics and Islamic Teachings in the Arab Region
For many Muslims, religious beliefs are a fundamental part of both personal and social existence in their daily life and a major determinant for healthcare decision-making. In Islamic teachings, the importance of inter-human as well as human-divine relations has been emphasized. The prophet of Islam, Muhammad (puh), announces the perfection of morals as the aim of his appointment. He says, “I have been appointed as the prophet for the completion and perfection of morals” (Abu Abdallah Muhammad 1002 AD). In the field of bioethics, UNESCO aims to provide a platform where ethics, science, culture, philosophy and medicine are joined together towards a common good. The general aim is to associate, and not oppose, all cultures to create a virtuous circle for an “osmosis of cultures”, recognizing that all individuals are equal in dignity. At the global level, there is a growing awareness of the ethics work of Muslim scholars, bioethicists, physicians and philosophers. For the Arabic mind, the concept of healthcare implies involvement not only of healthcare providers, but also of legal and/or religious experts within a framework of social responsibility. Based on Islamic teaching, the concept of health is associated with hygiene, hydration, comfort and care. Its boundary, based on the global concept of physical, psychological, social and spiritual well-being extends to interacting with the patients and their family in the context of community. This approach forms a cornerstone of the duties of the physician which necessarily includes attention to respect of the person and ethics in general. It is stated in the Holy Qur’an: “We have honoured the children of Adam” (17:70). Other potentially relevant citations would be: “God enjoins equity and charity” (16:90); “My Lord enjoins fairness” (7:29); “Be fair; God loves those who are fair” (49:9).
Ethical considerations in Arab region are not restricted to the medical field and encompass good manners and morals. Furthermore discussions cannot be confined to a battle between autonomy and collective community interests. In light of this tension, human dignity is a complex concept that has been proposed to be at the core of bioethics. This has been emphasized in several international documents such as the UNESCO Universal Declaration on the Human Genome and Human Right s (1997). However, it can be found as early as in the opening of the Preamble of the 1948 Universal Declaration of Human Right s, adopted by the United Nation s, where it states that: “Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world” as well as in its first Article where it says: “All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood” (United Nations 1948). Dignity however is difficult to clearly define. Like the principles of bioethics, it is rooted on practical grounds to prevent exploitation and abuse, but is also aiming for clear respect for principles and values. In fact, one of the difficulties (and beauty) of dignity is that it possesses a dual acceptance. Taken as a general principle, it infers that it would be a means to protect against external aggressions, against the excessive “liberty” of others on the one hand, and on the other hand, it would be understood as an individual claim, a means to promote an individual conception of liberty. However, a question remains whether dignity is more related to an individual, or to a group value. The question is very relevant to Arab philosophy. Medieval and modern Arab philosophers have taught us that if we consider justice as an equivalent of dignity (with the goal of achieving equity and equality of chances, and then fighting against discrimination), we find a harmonious agreement between different theories of justice: Procedural (libertarianism); Utilitarianism ; or Egalitarianism . In 2004 in a conference in Paris, the International Bioethics Committee brought together representatives of various world religions. The conference concluded that it is possible to formulate universal principles based on common values. It also acknowledged the existing differences in moral views on particular issues. In this regard reference was made to the Muslim religion exemplifying a common ethic among so many different cultures, nations, and traditions (ten Have and Gordijn 2013). When Western philosophy says: “I think, therefore I am”; the East responds: “You are, therefore I am”. Such an understanding can be useful in the light of a trans-cultural approach. Given the individuality and singularity of humans, we are all different. However, to enhance global understanding, a constructive cross-cultural dialogue should be promoted.
International ethical guidelines, such as the Nuremberg Code , Helsinki Declaration, WHO Guidelines, and reports of UNESCO in the field of bioethics, have been developed and are applied in many countries including Arabic countries. However, cultural characteristics still need to be taken into account more carefully. These cultural differences explain, for example, why the issue of regulating stem cell research elicited concerns from some scientists reluctant to see any regulation on stem cell, while other regulating bodies tried to balance scientific freedom with ethical constraints. Another example is the issue of prohibitions of human reproductive cloning, and the production of hybrid forms combining human germ cells and the germ cells of other species. In the globalized world, these kinds of research do not only simply “belong” to the West, and this type of experimentation concerns all mankind, medically, scientifically, culturally, socially, anthropologically, and even spiritually. Faced with the new advances of science, each citizen can consider ethical deliberations as a method of protection which demands justification before continuing with the scientific development. As the predominant ethical value shifts from “beneficence” to “autonomy”, the application of biomedical sciences has evolved progressively from a purely paternalistic approach to a contract-based approach. We should in fact act as humanists, promoting a true therapeutic alliance between the scientists and the public. This evolution will provoke (and already does) specific tensions to the Arabic countries where traditionally “the good of the group” often prevails over “the good of the individual” as the value of autonomy becomes less relevant than in the West.
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