**Bioethics and Education**

**Chapter 5**

Provisional chapter

**Bioethics in Education**

Bioethics in Education

Héctor Manuel Manzanilla-Granados

Héctor Manuel Manzanilla-Granados

http://dx.doi.org/10.5772/intechopen.74519

Abstract

undergraduate degree.

1. Introduction

Additional information is available at the end of the chapter

In dynamic ambits, systems have to be maintained in a constant process of adaptation. Thus, in the present chapter, we explore the integration of bioethics in all areas of higher education (physics-mathematics, the engineering sciences, social and administrative sciences, the biological-medical sciences, and the humanities), with the objective of establishing, as an essential part, bioethics in all disciplines of knowledge. All undergraduate university degrees converge in the relation among living beings, through knowledge-based interdisciplinary or multidisciplinary study. A close relationship has to be established between education and bioethics within the context of higher education, as teaching at the university level with values and ethics, achieves a contribution to the science of industry in terms of a greater professional ethical sense. Therefore, this work concludes that bioethics should form a fundamental part of every university

DOI: 10.5772/intechopen.74519

The learning process in higher education is based on the theoretical learning model defined as andragogy, which is an ensemble of techniques for teaching adults. The main characteristics of

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Keywords: bioethics, education, higher education, postgraduate, learning

Additional information is available at the end of the chapter

Ángel Morales-González, Judith Margarita Tirado-Lule, Alejandro González-Cisneros, Edgar Omar López-De-León, Alberto Sanchez-Morales and

Ángel Morales-González, Judith Margarita Tirado-Lule, Alejandro González-Cisneros, Edgar Omar López-De-León, Alberto Sanchez-Morales and

**Chapter 5** Provisional chapter

#### **Bioethics in Education** Bioethics in Education

Ángel Morales-González, Judith Margarita Tirado-Lule, Alejandro González-Cisneros, Edgar Omar López-De-León, Alberto Sanchez-Morales and Héctor Manuel Manzanilla-Granados Ángel Morales-González, Judith Margarita Tirado-Lule, Alejandro González-Cisneros, Edgar Omar López-De-León, Alberto Sanchez-Morales and Héctor Manuel Manzanilla-Granados

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.74519

#### Abstract

In dynamic ambits, systems have to be maintained in a constant process of adaptation. Thus, in the present chapter, we explore the integration of bioethics in all areas of higher education (physics-mathematics, the engineering sciences, social and administrative sciences, the biological-medical sciences, and the humanities), with the objective of establishing, as an essential part, bioethics in all disciplines of knowledge. All undergraduate university degrees converge in the relation among living beings, through knowledge-based interdisciplinary or multidisciplinary study. A close relationship has to be established between education and bioethics within the context of higher education, as teaching at the university level with values and ethics, achieves a contribution to the science of industry in terms of a greater professional ethical sense. Therefore, this work concludes that bioethics should form a fundamental part of every university undergraduate degree.

DOI: 10.5772/intechopen.74519

Keywords: bioethics, education, higher education, postgraduate, learning

#### 1. Introduction

The learning process in higher education is based on the theoretical learning model defined as andragogy, which is an ensemble of techniques for teaching adults. The main characteristics of

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

this model are the following: the students have a motivation for learning and they possess previous knowledge or prior experience in the areas of interest; in addition, they entertain values that they have achieved throughout their personal and academic lives. They are capable of making moral judgments concerning their environment and the situations in which they live [1]. As andragogy takes for granted that the student already has a set of values, the majority of higher education programs of study, do not have courses on ethics and values.

2. Relationship between bioethics and education

of their way of looking at things.

that the person has as an adult age.

comprises human values [3, 4].

compliance (mutuality)

Expectations, relationships, and interpersonal

Table 1. Stages to identify the behavior of an individual.

Stage 1

Stage 2

Stage 3

Stage 4

Stage 5

Stage 6

With respect to bioethics in education, it is important to know the different concepts contained in the former in order to be able to focus on a determined area that would be applicable in education. There exist many concepts; however, all converge at the same point: respect for life. On the other hand, morals based on universal principles is where bioethics in education plays a very important role, because it aids the individual to develop in a better manner independent

The teaching of ethics cannot be treated as an exact science, because there are different gradients in terms of morals and education that the individual possesses in a specific zone. One of the principal objectives that bioethics possesses is that of promoting critical thinking. The morals and ethics of each person depend on his/her life environment and of the childhood that this individual experienced. Nonetheless, according to the moral development theory of Jean Piaget, these ethical values can change or be developed depending on the life experiences

On certain occasions, bioethics can be learned or imitated according to the society or environment in which the person develops. As is noted in a case study, corruption, intransigence, or the abuse of power can be transmitted to an individual who comes into this ecosystem for the first time. Therefore, education is the basis of any culture, and the substrate of the culture

The current challenges of educative institutions include responding to the needs of the society, presenting plans of study that contain bioethical themes inserted into experimental areas. Thus, it can be concluded that the teaching staff should understand the theme of bioethics and its effect on future generations; they should work in a preventive manner to plan natural

resources and to have the human capital necessary without displacing it.

Punishment and obedience (heteronomy) Blind obedience, avoid punishments

Purpose and exchange (individualism) Follow a rule only when it benefits someone

Social system and conscience (law and order) Fulfill the duties that have been accepted by a group

Previous rights and social contract (utility) Aware of the diversity of values and opinions and their

Universal ethical principles (autonomy) Universal ethical principles that are met by the use of reason

relative origin

Live according to what close people expect

Bioethics in Education

89

http://dx.doi.org/10.5772/intechopen.74519

Bioethics in higher education seeks to contribute to undergraduate degree studies by not only offering knowledge on the science or the technique, but also by forming professionals endowed with moral excellence. It plays a part in science or industry by producing trained and morally formed professionals who can face the bioethical dilemmas present in the ambits in which they develop their activities with acumen [2].

Figure 1 represents how the higher education knowledge areas are interrelated within a system that interacts in a bioethics environment. This system has input elements that can cause a change in the system, for example: the inputs of ethical values and moral will generate in the system the formation of an ethical and moral professional.

Figure 1. Bioethics in higher education.

## 2. Relationship between bioethics and education

this model are the following: the students have a motivation for learning and they possess previous knowledge or prior experience in the areas of interest; in addition, they entertain values that they have achieved throughout their personal and academic lives. They are capable of making moral judgments concerning their environment and the situations in which they live [1]. As andragogy takes for granted that the student already has a set of values, the majority of higher education programs of study, do not have courses on ethics and values.

Bioethics in higher education seeks to contribute to undergraduate degree studies by not only offering knowledge on the science or the technique, but also by forming professionals endowed with moral excellence. It plays a part in science or industry by producing trained and morally formed professionals who can face the bioethical dilemmas present in the ambits in which they

Figure 1 represents how the higher education knowledge areas are interrelated within a system that interacts in a bioethics environment. This system has input elements that can cause a change in the system, for example: the inputs of ethical values and moral will generate in the

develop their activities with acumen [2].

88 Reflections on Bioethics

Figure 1. Bioethics in higher education.

system the formation of an ethical and moral professional.

With respect to bioethics in education, it is important to know the different concepts contained in the former in order to be able to focus on a determined area that would be applicable in education. There exist many concepts; however, all converge at the same point: respect for life. On the other hand, morals based on universal principles is where bioethics in education plays a very important role, because it aids the individual to develop in a better manner independent of their way of looking at things.

The teaching of ethics cannot be treated as an exact science, because there are different gradients in terms of morals and education that the individual possesses in a specific zone. One of the principal objectives that bioethics possesses is that of promoting critical thinking. The morals and ethics of each person depend on his/her life environment and of the childhood that this individual experienced. Nonetheless, according to the moral development theory of Jean Piaget, these ethical values can change or be developed depending on the life experiences that the person has as an adult age.

On certain occasions, bioethics can be learned or imitated according to the society or environment in which the person develops. As is noted in a case study, corruption, intransigence, or the abuse of power can be transmitted to an individual who comes into this ecosystem for the first time. Therefore, education is the basis of any culture, and the substrate of the culture comprises human values [3, 4].

The current challenges of educative institutions include responding to the needs of the society, presenting plans of study that contain bioethical themes inserted into experimental areas. Thus, it can be concluded that the teaching staff should understand the theme of bioethics and its effect on future generations; they should work in a preventive manner to plan natural resources and to have the human capital necessary without displacing it.


Table 1. Stages to identify the behavior of an individual.

Table 1 shows the stages that can identify an individual's behavior according to Kholberg. Kholberg establishes three levels of morals—level 1: preconventional morals, level 2: conventional morals, and level 3: postconventional morals, each of these levels with two stages [5].

2.2.4. Gottler

development [14].

2.2.5. Learning to know

2.2.6. Learning to do

2.2.7. Learning to live together

with others in all human activities.

improve it.

shared values that strengthen social cohesion [15].

institutional capacities within the ambit of education [16].

Education is the elevating influence, integrated by psychic caring (release from obstructions, teaching, inspiration, exercise) that the adult generation exercises on the development of the generation of individuals who are maturing, with the object of preparing that next generation to personally lead their own existence among the societies surrounding them in vital fashion, and with that the intelligent realization of the values that form the foundation of these societies [13]. On the other hand, education can also be considered as the basis for the growth of all societies. Education allows us to know, experience, and propose everything that is necessary to achieve the integral development of each individual, thus the development of a society. In this vein, Fernando Savagery has noted: "We are born humans but that is not sufficient: we also have to become one", which we will achieve through education of the individual based on human

Bioethics in Education

91

http://dx.doi.org/10.5772/intechopen.74519

Individuals as well as nations benefit from education. People achieve a better quality of life, obtain greater opportunities for employment and with this, sustained economic development. For nations, the potential benefits are mirrored in economic growth and the development of

UNESCO contributes to the creation of sustainable societies by accelerating progress toward the objectives of "education for all," while it aids member states to increase their human and

According to the latter, different international organizations seek education for all, equality of opportunity, and access to education. In order to achieve this, we cannot omit the four essential pillars of learning presented to us by Jacques Delors in his report entitled "The treasure within;

This pillar has as its purpose the acquisition of the elements of understanding and can be simultaneously considered as the means and the end of human life. In this knowledge, the importance of scientific reasoning and the need for a wide-reaching general culture is highlighted. This type of learning stimulates the critical sense, permitting one to decipher reality. The importance of "learning to learn, exercising the attention, memory, and thought" is emphasized [17], mentioning that the process of learning happens during one's entire life.

The purpose of "learning to do" is to be able to exert an influence on one's own ambit and

This pillar emphasizes the ability to learn to live together in order to participate and cooperate

learning to know, learning to do, learning to live together and learning to be" [17].

#### 2.1. Bioethics

Under this rubric, we present some definitions of bioethics, which considers the ethical aspects of the life sciences, as well as the relationships of humans with the rest of the living beings.

According to the World Health Organization (WHO), bioethics is a discipline that seeks to clarify ethical problems presenting in relation to health while conducting investigations on human beings, designing or implementing a health policy, and providing medical care (e.g., a regional bioethics program) [6].

According to the Joseph and Rose Kennedy Institute of Bioethics Encyclopedia, bioethics is the systematic study of human behavior in the area of the biological sciences and health care, to the extent that this behavior is analyzed based on moral principles and values [7].

#### According to Vallero,

Bioethics is the assemblage of moral principles and values needed to respect, protect, and enhance life. Engineers, medical practitioners, and all technical professionals must be clear regarding this meaning [8].

Bioethics should provide interdisciplinary and multidisciplinary training for any area of the natural and social sciences [9].

#### 2.2. Education

We live in a globalized world in which we must, every day, seek a better society, a society in which one can coexist with others, have respect for others, and in which the practice of these values is not simply by chance. That is, we are seeking a values-educated society.

Nonetheless, to speak of education and define it is not easy, in that it is an extremely broad theme. Therefore, it is important to situate ourselves within the context. For the latter, we will start by mentioning here some concepts of education cited by diverse authors.

#### 2.2.1. Aristotle

Education consists of directing the feelings of pleasure and pain toward an ethical order [10].

#### 2.2.2. Marañon

Education is an ethical overcoming of the instincts [11].

#### 2.2.3. Spranger

To educate is to transfer to another, with self-less love, the resolution to develop, from the inside out, all of one's capacity to receive and forge values [12].

## 2.2.4. Gottler

Table 1 shows the stages that can identify an individual's behavior according to Kholberg. Kholberg establishes three levels of morals—level 1: preconventional morals, level 2: conventional morals, and level 3: postconventional morals, each of these levels with two stages [5].

Under this rubric, we present some definitions of bioethics, which considers the ethical aspects of the life sciences, as well as the relationships of humans with the rest of the living beings.

According to the World Health Organization (WHO), bioethics is a discipline that seeks to clarify ethical problems presenting in relation to health while conducting investigations on human beings, designing or implementing a health policy, and providing medical care (e.g., a

According to the Joseph and Rose Kennedy Institute of Bioethics Encyclopedia, bioethics is the systematic study of human behavior in the area of the biological sciences and health care, to

Bioethics is the assemblage of moral principles and values needed to respect, protect, and enhance life. Engineers, medical practitioners, and all technical professionals must be clear

Bioethics should provide interdisciplinary and multidisciplinary training for any area of the

We live in a globalized world in which we must, every day, seek a better society, a society in which one can coexist with others, have respect for others, and in which the practice of these

Nonetheless, to speak of education and define it is not easy, in that it is an extremely broad theme. Therefore, it is important to situate ourselves within the context. For the latter, we will

Education consists of directing the feelings of pleasure and pain toward an ethical order [10].

To educate is to transfer to another, with self-less love, the resolution to develop, from the

values is not simply by chance. That is, we are seeking a values-educated society.

start by mentioning here some concepts of education cited by diverse authors.

Education is an ethical overcoming of the instincts [11].

inside out, all of one's capacity to receive and forge values [12].

the extent that this behavior is analyzed based on moral principles and values [7].

2.1. Bioethics

90 Reflections on Bioethics

regional bioethics program) [6].

According to Vallero,

2.2. Education

2.2.1. Aristotle

2.2.2. Marañon

2.2.3. Spranger

regarding this meaning [8].

natural and social sciences [9].

Education is the elevating influence, integrated by psychic caring (release from obstructions, teaching, inspiration, exercise) that the adult generation exercises on the development of the generation of individuals who are maturing, with the object of preparing that next generation to personally lead their own existence among the societies surrounding them in vital fashion, and with that the intelligent realization of the values that form the foundation of these societies [13].

On the other hand, education can also be considered as the basis for the growth of all societies. Education allows us to know, experience, and propose everything that is necessary to achieve the integral development of each individual, thus the development of a society. In this vein, Fernando Savagery has noted: "We are born humans but that is not sufficient: we also have to become one", which we will achieve through education of the individual based on human development [14].

Individuals as well as nations benefit from education. People achieve a better quality of life, obtain greater opportunities for employment and with this, sustained economic development. For nations, the potential benefits are mirrored in economic growth and the development of shared values that strengthen social cohesion [15].

UNESCO contributes to the creation of sustainable societies by accelerating progress toward the objectives of "education for all," while it aids member states to increase their human and institutional capacities within the ambit of education [16].

According to the latter, different international organizations seek education for all, equality of opportunity, and access to education. In order to achieve this, we cannot omit the four essential pillars of learning presented to us by Jacques Delors in his report entitled "The treasure within; learning to know, learning to do, learning to live together and learning to be" [17].

#### 2.2.5. Learning to know

This pillar has as its purpose the acquisition of the elements of understanding and can be simultaneously considered as the means and the end of human life. In this knowledge, the importance of scientific reasoning and the need for a wide-reaching general culture is highlighted. This type of learning stimulates the critical sense, permitting one to decipher reality. The importance of "learning to learn, exercising the attention, memory, and thought" is emphasized [17], mentioning that the process of learning happens during one's entire life.

#### 2.2.6. Learning to do

The purpose of "learning to do" is to be able to exert an influence on one's own ambit and improve it.

#### 2.2.7. Learning to live together

This pillar emphasizes the ability to learn to live together in order to participate and cooperate with others in all human activities.

## 2.2.8. Learning to be

This pillar of learning comprises the integrating of the other three pillars, in which development, in all of its aspects, is sought of the human being. Education must be pursued to create thinking human beings, creative, and free-thinking, so that they can be the creators of their own destiny.

Universities in each of their knowledge areas generate professionals who require the society. Thus, their graduates must know the social and cultural environment. The graduates must consider the discipline of bioethics in each of their knowledge areas as an essential part of the

Bioethics in Education

93

http://dx.doi.org/10.5772/intechopen.74519

There has been great interest in bioethics in field of medicine. However, it should not be forgotten that bioethics is important in other branches of knowledge too, such as the physicalmathematical sciences, the social sciences, the administrative sciences, and the humanities.

Higher education is centered on the creation of professionals who are trained to drive development. Knowledge acquired in the classroom presents utopic scenarios that are, on occasion, far from the social, economic, and environmental reality in which the world finds itself, thus generating knowledge without considering the fact that the constant change occurring in the

The application of science and technology in knowledge fields generated from higher education is modified by the changes taking place at the global level. This means that the professionals carrying out this application need to know the external factors that affect their knowledge area, in order to achieve results that benefit the population but that do not affect the environment in which they are developed [24]. For this to happen, it is necessary for educative systems to offer adequate preparation to ensure that the actions undertaken do not

The design or planning of systems of education should be constantly updated for the creation of professionals who are not only experts in their respective knowledge areas, but in addition, are able to solve the bioethical problems with which they may be confronted. This is the reason why, within the modifications of the curricular system, the insertion of bioethics is of vital

Educative models cannot be identified as neutral. From the deontological, that is, the normative ethical position's perspective, each of the degree program studies imparted should be constantly updated in terms of its values and world view. The views should be promoted from

Professionalism as an implicit objective of higher education can be expressed in terms of an array of values, attitudes, and behaviors that are in the interests of the society around oneself. Within this concept, it is also necessary to include the environment and living beings in general. Professionalism should aid in maintaining values above the social, economic, and political pressures to which a student during his/her formation can find him/herself submitted. The teaching of bioethics throughout the academic lives of the student is, on occasion, regarded as an independent process that may or may not be present in curricular maps, but that occurs in study assignments, whose teaching objectives include facing ethical situations in daily life. However, it is necessary for teaching to impart the most basic values of respect for life and for living beings, as well to prepare the student for new forms that put values to the

the historical perspective and from the reality encountered by each profession [24].

have repercussions on living systems or the physical beings with which they interact.

student's ambit can create an erroneous focus for decision making.

2.4. Bioethics as a discipline in higher education

importance for achieving human development.

profession [23].

This pillar of learning is found to be directly related to Edgar Morin's seventh pillar of learning in "The Ethic of the Human Gender" (130): "One necessarily human ethic, that is, an antoethic, should be considered as an ethic of the individual-societal-species loop, from which our properly human conscience and spirit arise" [18].

Finally, the objectives of an education are very diverse, depending on the context and focus desired. Nonetheless, something on which we can agree is that higher education should foster in the individual a necessarily human ethic that takes into account the individual-societyspecies triad with the purpose of forging a true relationship between the society and the individual in its midst, that is, forming the individual for a life in society.

#### 2.3. Bioethics in higher education

From its origins, education has always been related with the formation of values in individuals. Thus, the belief has been established that values are universal. Based on this belief, an ethic may be considered to be not just about the rights and obligations of the subjects, but rather concerning obligations, contents, and points of view [19]. This could have contributed to the fact that, in the 1990s, Latin America began to demonstrate interest in generating a higher education of quality, perceiving in this a tool for confronting the educative demands driven by globalization. [20].

This transformation of education cannot be considered an easy process to be conceived of by one or two individuals, as it not only comprises implementing values or moral issues. Transformation takes place, from the teacher who transmits values, regulations, and moral rights, and motivates the student to create a critical conscience, and learn to be and live together in society [21].

In any educative profession, without excluding the specialized area of study (the social sciences, the medical-biological sciences, the engineering sciences, the applied sciences, etc.), novel processes should be proposed to foster the autonomy of the student body, for example, information and communications technologies (ICT), in order for there to be a beneficial end for both the professor and the student. Similarly, educative institutions can promote the process of communicative interaction, fostered by new technologies, with the purpose of encouraging persons to seek, select, understand, and interpret the information engendered by the media in areas of public life through ethical responsibility [22].

The importance of producing critical thought in students of higher education lies in being able to provide the said students with the tools of defense for use when they are confronted with a moral or ethical problem—these tools will help students to choose the best values, norms, and moral rights to solve a contrariety in the social ambit.

Universities in each of their knowledge areas generate professionals who require the society. Thus, their graduates must know the social and cultural environment. The graduates must consider the discipline of bioethics in each of their knowledge areas as an essential part of the profession [23].

There has been great interest in bioethics in field of medicine. However, it should not be forgotten that bioethics is important in other branches of knowledge too, such as the physicalmathematical sciences, the social sciences, the administrative sciences, and the humanities.

Higher education is centered on the creation of professionals who are trained to drive development. Knowledge acquired in the classroom presents utopic scenarios that are, on occasion, far from the social, economic, and environmental reality in which the world finds itself, thus generating knowledge without considering the fact that the constant change occurring in the student's ambit can create an erroneous focus for decision making.

The application of science and technology in knowledge fields generated from higher education is modified by the changes taking place at the global level. This means that the professionals carrying out this application need to know the external factors that affect their knowledge area, in order to achieve results that benefit the population but that do not affect the environment in which they are developed [24]. For this to happen, it is necessary for educative systems to offer adequate preparation to ensure that the actions undertaken do not have repercussions on living systems or the physical beings with which they interact.

#### 2.4. Bioethics as a discipline in higher education

2.2.8. Learning to be

92 Reflections on Bioethics

properly human conscience and spirit arise" [18].

2.3. Bioethics in higher education

globalization. [20].

society [21].

own destiny.

This pillar of learning comprises the integrating of the other three pillars, in which development, in all of its aspects, is sought of the human being. Education must be pursued to create thinking human beings, creative, and free-thinking, so that they can be the creators of their

This pillar of learning is found to be directly related to Edgar Morin's seventh pillar of learning in "The Ethic of the Human Gender" (130): "One necessarily human ethic, that is, an antoethic, should be considered as an ethic of the individual-societal-species loop, from which our

Finally, the objectives of an education are very diverse, depending on the context and focus desired. Nonetheless, something on which we can agree is that higher education should foster in the individual a necessarily human ethic that takes into account the individual-societyspecies triad with the purpose of forging a true relationship between the society and the

From its origins, education has always been related with the formation of values in individuals. Thus, the belief has been established that values are universal. Based on this belief, an ethic may be considered to be not just about the rights and obligations of the subjects, but rather concerning obligations, contents, and points of view [19]. This could have contributed to the fact that, in the 1990s, Latin America began to demonstrate interest in generating a higher education of quality, perceiving in this a tool for confronting the educative demands driven by

This transformation of education cannot be considered an easy process to be conceived of by one or two individuals, as it not only comprises implementing values or moral issues. Transformation takes place, from the teacher who transmits values, regulations, and moral rights, and motivates the student to create a critical conscience, and learn to be and live together in

In any educative profession, without excluding the specialized area of study (the social sciences, the medical-biological sciences, the engineering sciences, the applied sciences, etc.), novel processes should be proposed to foster the autonomy of the student body, for example, information and communications technologies (ICT), in order for there to be a beneficial end for both the professor and the student. Similarly, educative institutions can promote the process of communicative interaction, fostered by new technologies, with the purpose of encouraging persons to seek, select, understand, and interpret the information engendered by

The importance of producing critical thought in students of higher education lies in being able to provide the said students with the tools of defense for use when they are confronted with a moral or ethical problem—these tools will help students to choose the best values, norms, and

individual in its midst, that is, forming the individual for a life in society.

the media in areas of public life through ethical responsibility [22].

moral rights to solve a contrariety in the social ambit.

The design or planning of systems of education should be constantly updated for the creation of professionals who are not only experts in their respective knowledge areas, but in addition, are able to solve the bioethical problems with which they may be confronted. This is the reason why, within the modifications of the curricular system, the insertion of bioethics is of vital importance for achieving human development.

Educative models cannot be identified as neutral. From the deontological, that is, the normative ethical position's perspective, each of the degree program studies imparted should be constantly updated in terms of its values and world view. The views should be promoted from the historical perspective and from the reality encountered by each profession [24].

Professionalism as an implicit objective of higher education can be expressed in terms of an array of values, attitudes, and behaviors that are in the interests of the society around oneself. Within this concept, it is also necessary to include the environment and living beings in general. Professionalism should aid in maintaining values above the social, economic, and political pressures to which a student during his/her formation can find him/herself submitted.

The teaching of bioethics throughout the academic lives of the student is, on occasion, regarded as an independent process that may or may not be present in curricular maps, but that occurs in study assignments, whose teaching objectives include facing ethical situations in daily life. However, it is necessary for teaching to impart the most basic values of respect for life and for living beings, as well to prepare the student for new forms that put values to the test. Bioethics as an independent discipline is important for achieving the integral formation of the students, but teaching bioethics in an integral and systematic fashion in all of the students' courses permits the latter to have a broader panorama concerning the decisions and dilemmas that they must face, so that they may respond to these in the best manner possible [25].

an undergraduate odontology degree. Here, the students were unaware of the importance of informed consent, as well as of the legal bases that they should take into account prior to

Bioethics in Education

95

http://dx.doi.org/10.5772/intechopen.74519

Similar to the views of Henríques [31], the importance of bioethics in the transformation of the pharmaceutical professional is highlighted. The author mentions the multidisciplinary relationship that exists among the pharmacist, the physician, and the nurse in terms of recommendation and administration of the drug. Because of the bioethical values acquired, the pharmacist possesses responsibilities concerning the regulations and control of the pharmaceutical products, as well as having knowledge on the properties and management of the medications, in addition to therapeutic alternatives and adverse consequences—overall, the

Bioethics is not only limited to inclusion in the disciplines of the medical-biological sciences area; it is also taking on a presence in administrative areas, as companies work by means of, with, and for persons through a link known as "human capital." Administrators carry out activities that involve management of the human factor; for this reason, they should possess the knowledge of, an attitude toward, and the management of bioethics so as not to cause harm to the mental and physical health of the persons contributing to the functions of the

Online or electronic learning refers to the utilization of information and communication technologies (ICT) as support for academic formation at a distance, combining pedagogical elements and multimedia resources for learning, in addition to using it as a platform that allows instructors and students to maintain contact in real or deferred time by means of communica-

The principal advantages of electronic education are ease of time management, the freedom to carry out other activities such as work-study programs, information by distant media, and allowing the students to use learning styles that best suit them, for example, videos, audios,

Bioethics, while it has not been fully adopted in the present higher educational system, appears to be even further away from being adopted by institutions offering online education. Nonetheless, this presupposes a greater possibility of having students who participate under the concept of less effort in academic activities and in participating with fellow students, to the point that they engage in the dishonest behaviors, rendering it difficult to discover that they

Online education has a great advantage in that it gives access to education to persons who did not have this previously, but without a sound teaching of bioethics, it is not possible to ensure that the professionals emerging from online courses are prepared to make decisions that entail

providing care for a patient [30].

priority is the well-being of the patients.

2.5. Bioethics in electronic learning

tion tools such as electronic mail.

have received a non-presential education.

the best benefits for the society in which they are developed.

and written texts [33].

enterprise [32].

Bioethics from a transversal perspective allows students to position, in the best way, the situations that they will encounter and for them to bear in mind, according to their university degree studies, the ethical problems that they will be called upon to solve.

It is easy to believe that bioethics would only be necessary in the area of the biological sciences, in that the investigation and practice of these specialities are in close proximity with human health. Notwithstanding this, in view of the current rate of technological advance, the areas of the exact sciences have acquired a greater need for the intervention of bioethics to solve bioethical problems. Therefore, it is necessary to offer a bioethical education in order to produce professionals who are prepared and who can provide solutions that are not always binary responses. In moral problems, there is the need for the capacity to analyze, understand, and provide solutions in not only an individual manner, but also one that benefits the society.

The process of teaching and learning bioethics should be characterized by transdisciplinarity that leads to integral reflection on the proposed situation by means of the values obtained through bioethical knowledge. It complies with the development of science and technology in a responsible fashion, generating spaces and activities allowing for the development of values and the solving of ethical problems and the problems surrounding the context of the courses that require this throughout their higher education [25].

Bioethics, in addition to forming professionals with the moral caliber to make decisions that solve dilemmas in terms of their knowledge, also helps to form citizens who have the capacity to choose to be motivated in their actions to a greater degree by their moral quality than by the judicial terms imposed upon them.

The Institutes of Education Sciences (IES) are recognized for the driving of their students in the scientific ambit, by means of seeding in them the curiosity for carrying out investigations in the search for solutions. However, within the bioethical environment, an attempt is also made to offer quality goods and services that benefit the population on the part of health professionals who give importance to the implementation of values and roles [26, 27].

World-class institutions should impart knowledge on bioethics in higher education. There is an overwhelming need for implementing professional transformation in schools in Latin America, such as an integral and complete transformation from the standpoints of morals and ethics in students in all disciplines. The objective of this transformation should be directed toward improving the conditions of human life [28, 29].

As of now the theme is scarcely known and it is of great concern that professionals emerge from their undergraduate degree studies without a clear idea of ethical values and legal questions, knowing that they are about to come face-to-face with an independent professional life. The need to create and implement a bioethics program arises due to the results of a study carried out in two Latin-American institutions of higher education, specifically teaching courses that leads to an undergraduate odontology degree. Here, the students were unaware of the importance of informed consent, as well as of the legal bases that they should take into account prior to providing care for a patient [30].

Similar to the views of Henríques [31], the importance of bioethics in the transformation of the pharmaceutical professional is highlighted. The author mentions the multidisciplinary relationship that exists among the pharmacist, the physician, and the nurse in terms of recommendation and administration of the drug. Because of the bioethical values acquired, the pharmacist possesses responsibilities concerning the regulations and control of the pharmaceutical products, as well as having knowledge on the properties and management of the medications, in addition to therapeutic alternatives and adverse consequences—overall, the priority is the well-being of the patients.

Bioethics is not only limited to inclusion in the disciplines of the medical-biological sciences area; it is also taking on a presence in administrative areas, as companies work by means of, with, and for persons through a link known as "human capital." Administrators carry out activities that involve management of the human factor; for this reason, they should possess the knowledge of, an attitude toward, and the management of bioethics so as not to cause harm to the mental and physical health of the persons contributing to the functions of the enterprise [32].

#### 2.5. Bioethics in electronic learning

test. Bioethics as an independent discipline is important for achieving the integral formation of the students, but teaching bioethics in an integral and systematic fashion in all of the students' courses permits the latter to have a broader panorama concerning the decisions and dilemmas that they must face, so that they may respond to these in the best manner possible [25].

Bioethics from a transversal perspective allows students to position, in the best way, the situations that they will encounter and for them to bear in mind, according to their university

It is easy to believe that bioethics would only be necessary in the area of the biological sciences, in that the investigation and practice of these specialities are in close proximity with human health. Notwithstanding this, in view of the current rate of technological advance, the areas of the exact sciences have acquired a greater need for the intervention of bioethics to solve bioethical problems. Therefore, it is necessary to offer a bioethical education in order to produce professionals who are prepared and who can provide solutions that are not always binary responses. In moral problems, there is the need for the capacity to analyze, understand, and provide solutions in not only an individual manner, but also one that benefits the society. The process of teaching and learning bioethics should be characterized by transdisciplinarity that leads to integral reflection on the proposed situation by means of the values obtained through bioethical knowledge. It complies with the development of science and technology in a responsible fashion, generating spaces and activities allowing for the development of values and the solving of ethical problems and the problems surrounding the context of the courses

Bioethics, in addition to forming professionals with the moral caliber to make decisions that solve dilemmas in terms of their knowledge, also helps to form citizens who have the capacity to choose to be motivated in their actions to a greater degree by their moral quality than by the

The Institutes of Education Sciences (IES) are recognized for the driving of their students in the scientific ambit, by means of seeding in them the curiosity for carrying out investigations in the search for solutions. However, within the bioethical environment, an attempt is also made to offer quality goods and services that benefit the population on the part of health professionals

World-class institutions should impart knowledge on bioethics in higher education. There is an overwhelming need for implementing professional transformation in schools in Latin America, such as an integral and complete transformation from the standpoints of morals and ethics in students in all disciplines. The objective of this transformation should be directed toward

As of now the theme is scarcely known and it is of great concern that professionals emerge from their undergraduate degree studies without a clear idea of ethical values and legal questions, knowing that they are about to come face-to-face with an independent professional life. The need to create and implement a bioethics program arises due to the results of a study carried out in two Latin-American institutions of higher education, specifically teaching courses that leads to

who give importance to the implementation of values and roles [26, 27].

degree studies, the ethical problems that they will be called upon to solve.

that require this throughout their higher education [25].

judicial terms imposed upon them.

94 Reflections on Bioethics

improving the conditions of human life [28, 29].

Online or electronic learning refers to the utilization of information and communication technologies (ICT) as support for academic formation at a distance, combining pedagogical elements and multimedia resources for learning, in addition to using it as a platform that allows instructors and students to maintain contact in real or deferred time by means of communication tools such as electronic mail.

The principal advantages of electronic education are ease of time management, the freedom to carry out other activities such as work-study programs, information by distant media, and allowing the students to use learning styles that best suit them, for example, videos, audios, and written texts [33].

Bioethics, while it has not been fully adopted in the present higher educational system, appears to be even further away from being adopted by institutions offering online education. Nonetheless, this presupposes a greater possibility of having students who participate under the concept of less effort in academic activities and in participating with fellow students, to the point that they engage in the dishonest behaviors, rendering it difficult to discover that they have received a non-presential education.

Online education has a great advantage in that it gives access to education to persons who did not have this previously, but without a sound teaching of bioethics, it is not possible to ensure that the professionals emerging from online courses are prepared to make decisions that entail the best benefits for the society in which they are developed.

#### 2.6. Bioethics in postgraduate education

Bioethics, viewed from the medical scope and in the postgraduate area is considered as an analysis of human behavior, encompassing the activities and roles engaged in by the health professional in society [34].

Bioethics needs to be adopted in online higher education programs because more and more universities offer degrees in this modality, and ethics and values should not be left aside in any

Finally, it is observed that it is necessary to incorporate the principles and norms of bioethics in the areas of higher education and postgraduate studies in such a way that it is involved in the development of the students' professional life, highlighting human values and responsibility, honesty in work. This involves a change of paradigm with the aim of increasing knowledge

Al Instituto Politécnico Nacional. Supported by SIP Project, No. 20180098, 20170393 y 20170471

ESCOM-IPN. Al Consejo Nacional de Ciencia y Tecnología, CONACyT, México.

\*, Judith Margarita Tirado-Lule<sup>1</sup>

1 Escuela Superior de Cómputo, Instituto Politécnico Nacional, México City, Mexico 2 Escuela Superior de Ingeniería Mecánica y Eléctrica, Instituto Politécnico Nacional,

, Alberto Sanchez-Morales<sup>2</sup> and

[1] Fernández VA. Andragogía vs Pedagogía. Un punto de vista comparativo. 1994;3(10):11-16. [cited 2017 Dec 4]; Available from: http://www.educacionyciencia.org/index.php/educacio-

, Alejandro González-Cisneros<sup>1</sup>

,

Bioethics in Education

97

http://dx.doi.org/10.5772/intechopen.74519

form of education.

Acknowledgements

Conflict of interest

Author details

México City, Mexico

References

Ángel Morales-González<sup>1</sup>

Edgar Omar López-De-León<sup>2</sup>

Héctor Manuel Manzanilla-Granados<sup>1</sup>

nyciencia/article/viewFile/82/pdf

\*Address all correspondence to: anmorales@ipn.mx

The authors declare no conflict of interest.

keeping in mind ethical principles in daily procedures.

Incorporation of bioethics in the pre- and postgraduate components of these fields is essential and invaluable for improving the quality of medical care and for continuing with scientific advances that benefit persons in terms of disease. Frequently, the professional solely takes into account the biological risks, that is, he/she attempts to avoid physical harm but forgets that the psychological, moral, or social damage that can arise can be greater than damage to physical integrity [35].

The importance of bioethics in postgraduate studies lies in that any investigation protocol that involves the participation of human beings should have the approval of an Ethics Committee, which should provide the informed consent document containing the following information: data of the investigator; data of the subject-under-study; explanation of the procedure that will evaluate the subject; benefits of the study; risks of the study, and the revoking of the informed consent if the subject wishes to withdraw from the project.

Customarily, this type of evaluation has as its objective the provision of the legal and ethical requirements that protect the subjects-under- investigation, in this manner safeguarding their physical, emotional, and moral integrity [36].

Therefore, there can be a difference between bioethics at the higher education level and that in the postgraduate area. While in the former, an ethical education is inculcated in the student by the professor and the academic authorities, in postgraduate studies, it is the result of the formation and evaluation of a committee charged with assessing the legal requirements for protecting the physical integrity of the patient.

## 3. Conclusions

Bioethics should be considered as a compulsory discipline within the curricula of different areas of university knowledge, not only in the area of medical-biological sciences. This is due to the dynamic environments of higher and postgraduate education systems. Bioethics is also considered as a learning framework that is the best way to teach decision-making based on ethics and human values that is necessary for the development of a country and even the world.

The main objective of university education is transformative. It makes beneficial changes in human beings transforming their character and personality. Education is a moral enterprise because it expands the values that have been received. Bioethics education has a similar objective; it invites individuals to participate in a professional community, in the construction and reinforcement of its identity through ethics in knowledge and professional practice.

Bioethics needs to be adopted in online higher education programs because more and more universities offer degrees in this modality, and ethics and values should not be left aside in any form of education.

Finally, it is observed that it is necessary to incorporate the principles and norms of bioethics in the areas of higher education and postgraduate studies in such a way that it is involved in the development of the students' professional life, highlighting human values and responsibility, honesty in work. This involves a change of paradigm with the aim of increasing knowledge keeping in mind ethical principles in daily procedures.

## Acknowledgements

2.6. Bioethics in postgraduate education

consent if the subject wishes to withdraw from the project.

physical, emotional, and moral integrity [36].

protecting the physical integrity of the patient.

professional in society [34].

integrity [35].

96 Reflections on Bioethics

3. Conclusions

Bioethics, viewed from the medical scope and in the postgraduate area is considered as an analysis of human behavior, encompassing the activities and roles engaged in by the health

Incorporation of bioethics in the pre- and postgraduate components of these fields is essential and invaluable for improving the quality of medical care and for continuing with scientific advances that benefit persons in terms of disease. Frequently, the professional solely takes into account the biological risks, that is, he/she attempts to avoid physical harm but forgets that the psychological, moral, or social damage that can arise can be greater than damage to physical

The importance of bioethics in postgraduate studies lies in that any investigation protocol that involves the participation of human beings should have the approval of an Ethics Committee, which should provide the informed consent document containing the following information: data of the investigator; data of the subject-under-study; explanation of the procedure that will evaluate the subject; benefits of the study; risks of the study, and the revoking of the informed

Customarily, this type of evaluation has as its objective the provision of the legal and ethical requirements that protect the subjects-under- investigation, in this manner safeguarding their

Therefore, there can be a difference between bioethics at the higher education level and that in the postgraduate area. While in the former, an ethical education is inculcated in the student by the professor and the academic authorities, in postgraduate studies, it is the result of the formation and evaluation of a committee charged with assessing the legal requirements for

Bioethics should be considered as a compulsory discipline within the curricula of different areas of university knowledge, not only in the area of medical-biological sciences. This is due to the dynamic environments of higher and postgraduate education systems. Bioethics is also considered as a learning framework that is the best way to teach decision-making based on ethics and

The main objective of university education is transformative. It makes beneficial changes in human beings transforming their character and personality. Education is a moral enterprise because it expands the values that have been received. Bioethics education has a similar objective; it invites individuals to participate in a professional community, in the construction and reinforcement of its identity through ethics in knowledge and professional practice.

human values that is necessary for the development of a country and even the world.

Al Instituto Politécnico Nacional. Supported by SIP Project, No. 20180098, 20170393 y 20170471 ESCOM-IPN. Al Consejo Nacional de Ciencia y Tecnología, CONACyT, México.

## Conflict of interest

The authors declare no conflict of interest.

## Author details

Ángel Morales-González<sup>1</sup> \*, Judith Margarita Tirado-Lule<sup>1</sup> , Alejandro González-Cisneros<sup>1</sup> , Edgar Omar López-De-León<sup>2</sup> , Alberto Sanchez-Morales<sup>2</sup> and Héctor Manuel Manzanilla-Granados<sup>1</sup>

\*Address all correspondence to: anmorales@ipn.mx

1 Escuela Superior de Cómputo, Instituto Politécnico Nacional, México City, Mexico

2 Escuela Superior de Ingeniería Mecánica y Eléctrica, Instituto Politécnico Nacional, México City, Mexico

## References

[1] Fernández VA. Andragogía vs Pedagogía. Un punto de vista comparativo. 1994;3(10):11-16. [cited 2017 Dec 4]; Available from: http://www.educacionyciencia.org/index.php/educacionyciencia/article/viewFile/82/pdf

[2] Urionabarrenetxea KM. La educación en bioética, camino para la profesionalidad. Revista de Calidad Asistencial [Internet]. Jan 2011;26(1):62-66. [cited Nov 20, 2017] Available from: http://linkinghub.elsevier.com/retrieve/pii/S1134282X10001491

[18] Morin E. Los siete saberes necesarios para la educación del futuro. "Los cuatro pilares de la educación" en La educación encierra un tesoro. In: Informe a la UNESCO de la Comisión internacional sobre la educación para el siglo XXI. Madrid, España: Santillana/UNESCO;

Bioethics in Education

99

http://dx.doi.org/10.5772/intechopen.74519

[19] Follari R. Ética y educación en la contemporaneidad. Revista de Ciencias Sociales. 2003;

[20] Garbanzo-Vargas GM, Factores asociados al rendimiento académico en estudiantes universitarios, una reflexión desde la calidad de la educación superior pública. Revista

[21] Pérez-Jiménez CV. Belín, Ser-y-saber docente para una ética educativa. Revista Venezolana

[22] Gozálvez V, García-Ruiz R. y Aguaded JI. La formación en competencias mediáticas: una cuestión de responsabilidad ética en educación superior. Revista Interuniversitaria de

[23] Couceiro-Vidal A. Enseñanza de bioética y planes de estudios basados en competencias: Educación. Médica. 2008;11:69-76. Available from: http://scielo.isciii.es/scielo.php?script=

[24] Cantú Martínez PC. La bioética en las instituciones de educación superior en el contexto

[25] Bermúdez de Caicedo C. Necesidad de la bioética en la educación superior. Acta Bioeth [Internet]. Jan 2006;12(1):35-40. [cited Nov 20, 2017]. Available from: http://www.scielo.cl/ scielo.php?script=sci\_arttext&pid=S1726-569X2006000100005&lng=en&nrm=iso&tlng=en

[26] Cantú-Martínez PC. Bioética y educación superior en México. Acta Bioethica. 2015;1:45-

[27] Morales González JA, Nava Chapoy G, Esquivel Soto J, Díaz Pérez LE. Principios de ética, bioética y conocimientos del hombre. Pachuca: Universidad Autónoma del Estado de

[28] Linares-Márquez P, Fraile Laiz B. Bioética y Universidad en América Latina. Propuesta de una estructura para la formación integral profesional. Revista Colombiana de Bioética. 2012;

[29] Bermúdez-de-caicedo C. Necesidad de la Bioética en la Educación Superior. OPS. Acta

[30] Buendía-López AL, Álvarez-de-la-Cadena-Sandoval C. Level of knowledge of bioethics in odontological careers in two latin american universities. Acta Bioethica. 2006;12:41-47.

[31] Henríques-Rodríguez RD. Bioética en la formación del profesional farmacéutico. Revista Cubana de Farmacia. 2006;40(3). Available from: http://scielo.sld.cu/scielo.php?script=sci\_

arttext&pid=S0034-75152006000300010&lng=es&tlng=es [Accessed: Nov 24, 2017]

1996. pp. 91-103

Educación. 2007;31(1):43-63

de Ciencias Sociales. 2006;10(2):369-392

Formación del Profesorad. 2014;28:17-28

sci\_arttext&pid=S1575-18132008000200005&lng=es

de la sustentabilidad. Ciencia UANL. 2014;65:24-30

52. DOI: 10.4067/S1726-569X2015000100006

DOI: 10.4067/S1726-569X2006000100006

Hidalgo; 2011. pp. 107-109

Bioethica. 2006;1:35-40

7(2):120-133

9(1):9-18


[18] Morin E. Los siete saberes necesarios para la educación del futuro. "Los cuatro pilares de la educación" en La educación encierra un tesoro. In: Informe a la UNESCO de la Comisión internacional sobre la educación para el siglo XXI. Madrid, España: Santillana/UNESCO; 1996. pp. 91-103

[2] Urionabarrenetxea KM. La educación en bioética, camino para la profesionalidad. Revista de Calidad Asistencial [Internet]. Jan 2011;26(1):62-66. [cited Nov 20, 2017] Available

[3] Hersh R. Chapter 3: El desarrollo del Juicio moral. In: El crecimiento moral. De Piaget a

[5] Kohlberg L. The Philosophy of Moral Development. Moral Stages and the Idea of Justice.

[6] Programa regional de la bioética [Internet]. 2017. Available from: http://www.paho.org/ hq/index.php?option=com\_content&view=article&id=5582%3Aregional-program-on-bio

[7] Comité de Bioética de Catalunya [Internet]. Available from: http://comitebioetica.cat/el-

[8] Vallero AD. Bioethics and the engineer. In: Biomedical Ethics for Engineers. 1st ed. Burlington: Elsevier Inc.; 2007. pp 49-102. https://doi.org/10.1016/B978075068227-5/5000

[9] Asmatulu R, Khan WS, Asmatulu E, Ceylan M. Biotechnology and bioethics in engineering education. In: Proceedings of the 2010 Midwest Section Conference of the American Society for Engineering Education; 22-24 September 2010; KS, USA: Lawrence; 2010. p. 1-10 [10] Terán-González CC, Perdomo-Vieras E, Castillo-Vázquez RA. Un Recorrido por el Pensamiento Educativo hacia la Transformación de la Educación en el Siglo XXI. Scien-

[11] Sáez-Alonso R. Interrogación sobre el sentido y las bases de una metateoría pedagógica.

[12] Itze O-H. La actualización de los directores de educación primaria en el Distrito Federal

[13] Sáez-Alonso R. La Teoría de la Educación: Una Búsqueda sin Término en la Construcción del Conocimiento de la Educación. Encounters in Theory and History of Education. 2007;

[15] Núñez-Rodríguez HM. Educación de corte empresarial en el marco de la globalización

[16] UNESCO. Conferencia Mundial sobre la Educación Superior – 2009: La nueva dinámica de la educación superior y la investigación para el cambio social y el desarrollo, Jul 5–8,

[17] Delors J. "Los cuatro pilares de la educación" en La educación encierra un tesoro. In: Informe a la UNESCO de la Comisión internacional sobre la educación para el siglo XXI.

[Tesina] México. Distrito Federal: Universidad Pedagógica Nacional; 2005

[14] Savater F. El valor de educar. 2nd ed. Barcelona: Editorial Ariel, S.A.; 1997. 102 p

from: http://linkinghub.elsevier.com/retrieve/pii/S1134282X10001491

[4] Piaget J. The Moral Judgment of the Child. New York: Simon & Schuster; 1997

Kohlberg. Madrid: Ed. Narcea; 1988. ISBN: 9788427706330

San Francisco, CA: Harper & Row Pubs; 1981

comite-2/que-es-la-bioetica [Accessed: Oct 18, 17]

Revista Complutense de Educación. 1994;5(2):231-248

[Tesis] México: Universidad Autónoma de México; 2015

Madrid, España: Santillana/UNESCO; 1996. pp. 91-103

2009; París. Paris: UNESCO; 2009. pp. 1-9

ethics&lang=es [Accessed: Oct 18, 17]

tific Journal. 2017;2(5):29-48

8:109-126. ISSN: 2560-8371

5-9

98 Reflections on Bioethics


[32] Pérez-Gómez CH. Bioética, empresa y administración. Universidad & Empresa. 2006;5 (11):163-181

**Chapter 6**

**Provisional chapter**

**Russian School of Bioethics: History and the Present†**

This chapter presents the results of a comparative analysis of the Genesis of the word "bioethics" in Russian and foreign scientific literature. It is inferred that from the beginning, "bioethics" carried in itself a philosophical content that becomes deeper in the conditions of globalization and development of modern technologies. The philosophical content gives the opportunity to create interdisciplinary dialog in heated discussions on bioethical issues. An important feature of the Russian school of bioethics is its interdisciplinarity. This reliance is mainly on medicine, philosophy, law, sociology, and education. Serious attention is paid to the Russian bioethics, the ethics of clinical research, and ethical committees of different levels. At the moment, we can talk about new topics of Russian bioethical discourse such as agrobioethics, nanobioethics, genetic editing, and ethical issues of medical and psychological enhancement of human.

**Keywords:** bioethics, philosophy, globalization, Russian school of bioethics,

Today in the twenty-first century, it can be stated that our civilization has encountered a number of global problems such as the problem of preservation of peace on the Earth, ecology, food and demographical problems, the problem of overcoming the poverty of the majority of the humankind, and the problems of health and quality of life. As a consequence, they give rise to large-scale tasks that are waiting for their solution, and bioethics plays not the least important role in this context. It is important to mention that the uprising of bioethics

**Russian School of Bioethics: History and the Present†**

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.5772/intechopen.74526

Nezhmetdinova Farida Tansykovna and

Nezhmetdinova Farida Tansykovna and

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

modern technology, interdisciplinary dialog

Dedicated in the memory of Professor Boris Yudin.

Guryleva Marina Yuryevna

Guryleva Marina Yuryevna

**Abstract**

**1. Introduction**

†

http://dx.doi.org/10.5772/intechopen.74526


#### **Russian School of Bioethics: History and the Present† Russian School of Bioethics: History and the Present†**

DOI: 10.5772/intechopen.74526

Nezhmetdinova Farida Tansykovna and Guryleva Marina Yuryevna Nezhmetdinova Farida Tansykovna and Guryleva Marina Yuryevna

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.74526

#### **Abstract**

[32] Pérez-Gómez CH. Bioética, empresa y administración. Universidad & Empresa. 2006;5

[33] Gallego-Rodríguez A, Martínez-Caro E. Estilos de aprendizaje y e-learning. Hacia un mayor rendimiento académico. Revista de Educación a Distancia. 2003;7:1-10

[34] Schonhaut BL, Carvajal HC. Dimensiones y dilemas de la ética en educación en ciencias de la salud. Revista Chilena de Pediatría. 2007;78:196-201. DOI: 10.4067/S0370-41062007000200013

[35] Outomuro D. Fundamentación de la enseñanza de la bioética en medicina. Acta Bioethica.

[36] Outomuro D, Sánchez NI, Kohn Loncarica AG. Certificados de conformidad bioética.

Revista de la Asociación Médica Argentina. 2001;114:23-28

(11):163-181

100 Reflections on Bioethics

2008;14:19-29

This chapter presents the results of a comparative analysis of the Genesis of the word "bioethics" in Russian and foreign scientific literature. It is inferred that from the beginning, "bioethics" carried in itself a philosophical content that becomes deeper in the conditions of globalization and development of modern technologies. The philosophical content gives the opportunity to create interdisciplinary dialog in heated discussions on bioethical issues. An important feature of the Russian school of bioethics is its interdisciplinarity. This reliance is mainly on medicine, philosophy, law, sociology, and education. Serious attention is paid to the Russian bioethics, the ethics of clinical research, and ethical committees of different levels. At the moment, we can talk about new topics of Russian bioethical discourse such as agrobioethics, nanobioethics, genetic editing, and ethical issues of medical and psychological enhancement of human.

**Keywords:** bioethics, philosophy, globalization, Russian school of bioethics, modern technology, interdisciplinary dialog

#### **1. Introduction**

Today in the twenty-first century, it can be stated that our civilization has encountered a number of global problems such as the problem of preservation of peace on the Earth, ecology, food and demographical problems, the problem of overcoming the poverty of the majority of the humankind, and the problems of health and quality of life. As a consequence, they give rise to large-scale tasks that are waiting for their solution, and bioethics plays not the least important role in this context. It is important to mention that the uprising of bioethics

<sup>†</sup> Dedicated in the memory of Professor Boris Yudin.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

is of a multiple-factor character rather than just a combination of causes. It is a system of interrelated factors which caused a synergetic effect in the form of bioethics which is a science about search, assessment, and choice of a criterion of moral attitude to all living things.

The range of questions bioethics covers astounds by its diversity. Nevertheless, they are all united by the priority of such human values as life, health, well-being, and justice. Another characteristic trait of bioethics is its interdisciplinary nature, when representatives of medicine, law philosophy, biology, and of different religious confessions take part in bioethical

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 103

In fact, how can one define boundaries between life and death, who has the right to choose the limits of his existence—a professional or a common human being—what is the legal status of an embryo conceived *in vitro*, is the surrogate maternity justified, what will a person think about his or her possible genetic engineering and possible cloning, is it moral to use a human being or an animal as a clinical test object, is it possible to "dissemble" a human being for "spare parts" and organize their public bidding because of the total "deficit," are genetically modified products of agriculture and of medical nanotechnology safe for man, are medical-

These questions have been heatedly discussed in both foreign and domestic literature for

Two events, important for all those dealing with bioethics, occurred not long ago. First, 47 years ago in 1971, Potter published his book "Bioethics: the bridge to the future" in which he introduced the notion of "bioethics." He defined it as "a new field of knowledge integrating biological knowledge and the system of human and moral values …. I used *bio* to represent biological knowledge, the science of live systems, and I used *ethic* to represent

Second, it has been 92 years since the German theologian and Pastor Fritz Jahr (1895–1953), whom Hans-Martin Sass justifiably called the father of bioethical research, proposed the term

According to Potter, the development of the new discipline of bioethics was supposed to build a bridge between two notions—science and the human nature. In his work "Bioethics: the bridge to the future," Potter defined the priority of the problem, namely the problem of survival in the conditions of the modern world. His aim was to define and in the best way to develop changing environmental conditions and the optimum adjustment of a human being to this environment with the aim of improving the civilized world and of defending the scientific, cultural, and intellectual progress necessary for the survival of the humankind [4]. Potter thought that the final aim of bioethics was "not only in enriching the life of every person but also in extending the survival of humankind and in the suitable structure of the society" [5]. Later, Potter also included medical aims and aims related to health into his prospects. Reich, the chief editor of the Encyclopedia of Bioethics in five volumes [6], which stood several publications and became the classical theoretical basis for all those, who deal with problems of bioethics, underlines that Potter's subjective understanding of bioethics was anthropocentric (survival of a human being) rather than biocentric (survival and state

discussions.

social resources distributed fairly, and so on?

**2. Brief history of notion of "bioethics"**

knowledge of systems of human moral values" [1].

"bioethics" (Bio-Ethik) already in the distant 1926 [3].

more than 90 years already.

This chapter considers the arguments supporting the following statements:


The range of questions bioethics covers astounds by its diversity. Nevertheless, they are all united by the priority of such human values as life, health, well-being, and justice. Another characteristic trait of bioethics is its interdisciplinary nature, when representatives of medicine, law philosophy, biology, and of different religious confessions take part in bioethical discussions.

In fact, how can one define boundaries between life and death, who has the right to choose the limits of his existence—a professional or a common human being—what is the legal status of an embryo conceived *in vitro*, is the surrogate maternity justified, what will a person think about his or her possible genetic engineering and possible cloning, is it moral to use a human being or an animal as a clinical test object, is it possible to "dissemble" a human being for "spare parts" and organize their public bidding because of the total "deficit," are genetically modified products of agriculture and of medical nanotechnology safe for man, are medicalsocial resources distributed fairly, and so on?

These questions have been heatedly discussed in both foreign and domestic literature for more than 90 years already.

## **2. Brief history of notion of "bioethics"**

is of a multiple-factor character rather than just a combination of causes. It is a system of interrelated factors which caused a synergetic effect in the form of bioethics which is a science about search, assessment, and choice of a criterion of moral attitude to all living things.

**1.** Bioethics appeared as a result of global changes both at the level of the depth conversion and achievements of modern science and the consequence of the globalization process manifested in the speed of its development and in the increasing influence of the impor-

**2.** On the one side, bioethics is an interdisciplinary field of knowledge, while on the other side, the level of understanding of the problems bioethics is solving, such as the ultimate grounds of human existence, its identity, dignity and justice, boundaries of the good and the evil, eco-axiological orientations of scientific research, and political solutions decision making, without any doubt giving priority to the philosophical matrix of its content existence.

**3.** A high level of potential and real hazards of achievements in modern biotechnologies, and the prevention and non-admittance of their use without preliminary humanitarian expert evaluation assign special social-regulatory status to bioethics. In this respect, "the search," "choice," and "assessment" of moral attitude to the living are the key notions. They become tools of "advanced experience" (Yudin) when situations of possible harm for the living are "played over" in the expert environment, remaining within the scenario "What

**4.** Bioethics is already an established independent branch of science of the epoch of the postnon-classical science, the subject of which is the assessment and the choice of a criterion of moral attitude to all flesh, the last being the congregation of living systems and its separate

**5.** D. Callahan thinks that bioethics could not have appeared as a separate branch if at the same time there were no cultural and public achievements. Those decades were the soil for a great number of social changes and cultural reforms and the increasing role of human rights. This also shaped up as a revival of the subject of moral philosophy, growth of interest in regulatory and applied ethics, as well as dissatisfaction with the then predominant academic stress put on theoretical problems and striving to cultural radical changes [2].

**6.** Today, as Potter predicted, bioethics has expanded beyond an interdisciplinary dialog and the geographic range [1, 45]. It has become global in all respects. We can find the bioethical discourse in different scientific disciplines and technological practices. Representatives of different countries and confessions take part in bioethical discussions; bioethical schools and international communities of bioethicists are being formed and work successfully.

**7.** This chapter explains about the Russian school of bioethics which is a multidimensional phenomenon. However, before passing on to the history and modern time of its development, it is necessary to remind about the origins of bioethics and its founders. It is important as Russian bioethics blends seamlessly with the world context. Not only does it develops main areas of bioethics but also creates new platforms for bioethical discourse.

tance of the global community joint activities in the solution of global problems.

This chapter considers the arguments supporting the following statements:

102 Reflections on Bioethics

if….?" that possibly will never be used to make a film [1, 20].

elements including the nature, a human being, and so on.

Two events, important for all those dealing with bioethics, occurred not long ago. First, 47 years ago in 1971, Potter published his book "Bioethics: the bridge to the future" in which he introduced the notion of "bioethics." He defined it as "a new field of knowledge integrating biological knowledge and the system of human and moral values …. I used *bio* to represent biological knowledge, the science of live systems, and I used *ethic* to represent knowledge of systems of human moral values" [1].

Second, it has been 92 years since the German theologian and Pastor Fritz Jahr (1895–1953), whom Hans-Martin Sass justifiably called the father of bioethical research, proposed the term "bioethics" (Bio-Ethik) already in the distant 1926 [3].

According to Potter, the development of the new discipline of bioethics was supposed to build a bridge between two notions—science and the human nature. In his work "Bioethics: the bridge to the future," Potter defined the priority of the problem, namely the problem of survival in the conditions of the modern world. His aim was to define and in the best way to develop changing environmental conditions and the optimum adjustment of a human being to this environment with the aim of improving the civilized world and of defending the scientific, cultural, and intellectual progress necessary for the survival of the humankind [4]. Potter thought that the final aim of bioethics was "not only in enriching the life of every person but also in extending the survival of humankind and in the suitable structure of the society" [5]. Later, Potter also included medical aims and aims related to health into his prospects. Reich, the chief editor of the Encyclopedia of Bioethics in five volumes [6], which stood several publications and became the classical theoretical basis for all those, who deal with problems of bioethics, underlines that Potter's subjective understanding of bioethics was anthropocentric (survival of a human being) rather than biocentric (survival and state of the biosphere) [7]. At the same time, in his other work "The Global bioethics," Potter says that his understanding of bioethics was influenced by the work "The land ethic" by Leopold (1949), and he formulated his concept proceeding from the close relation between the bioethical theory and the ecological ethics [7]. In this book, Potter continues to develop the idea of close interaction of ethics with ecology, medicine, and science and puts the main accent on the ethics of survival and the global ethics. Stating that bioethics should be built on interdisciplinary relations and on the basis of many disciplines, he proposed two important spheres, which seem independent but at the same time need each other. Medical bioethics and environmental bioethics do not intertwine as the former deals with short-term topics such as options proposed to individuals by their doctors in the efforts to prolong their life by using organ transplants, man-made organs, experimental chemotherapy, and all the latest findings in the field of medicine. "Environmental bioethics has a long-term view concerning what we should do to maintain the ecosystem in a form compatible with reproduction of future generations. Nevertheless, these two branches of bioethics should intertwine reliably in the cause of protection of the individual health, control over reproduction and in respect of the meaning of human population growth" and he introduces the terms "global bioethics" and environmental bioethics [7].

the first permanent interdisciplinary research group. Its work reflected the main directions of

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 105

The first encyclopedia of bioethics was published in 1978. In his article "The word 'Bioethics' its birth and heritage of those who created it" published in 1994, its chief editor Reich confessed that he was in a serious doubt as whether to use the word "bioethics" in the title of the encyclopedia, which supposedly should have been entitled "Encyclopedia of medical ethics" [10]. He wrote: "On the one side it seemed acceptable to use the established name of the discipline to name it, but on the other I was inclined to use the new word of 'bioethics' because I felt the term of medical ethics was too narrow as it ran counter to ethics of life sciences. Nevertheless it was too bold to give the title of 'bioethics" to encyclopedia as the word 'bioethics' appeared in the works of only one man and was included into the name of only one institute" [11]. At that moment, Reich thought that he was facing such difficult questions as "whether the discipline or the field of knowledge name 'bioethics' will really develop; whether it will last and whether the word 'bioethics' will be used to name the whole field of science" (*i.e., biomedical studies and their consequences for human beings—F.N.*). In addition, it is significant that he addressed not specialists in biology and medicine but to the editor-in-chief of the 16-volume encyclopedia of the social sciences, David Sills, who confirmed that "word

Potter's "Global bioethics" was published in 1988 [12]. Together with dividing bioethics into two branches, Potter stressed that it was necessary to go further than Leopold and further than medical bioethics and that super-specialization in any sphere can stand against aims of admissible survival in the global scale. Two branches should be integrated, brought to one point of view and called global bioethics, stressing two meanings of the word "global." On the one hand, the system of ethics is global if it is united and comprehensive, and in the more

In the introduction of the second issue of the "Encyclopedia of bioethics," Reich defines bioethics as "a systematical study of the field of moral – including moral views, decisions, behavior and policy – in life sciences and medical care, that uses diversity of ethical methodologies in interdisciplinary space." Proceeding, he specifies that "publishers consider bioethics to *be a discipline going beyond medical ethics* (italics supplied by F.N.). It integrates the moral interpretation of medical and scientific points of view on health of the population, environment, public ethics and protection of animals" [14]. It is important to pay special attention to the article "Bioethics" written by Daniel Callahan, one of the scientists who was one of the originators of bioethics both as a term and as a branch of science. He defined bioethics as a science "which is the product of biomedical achievements related to the environment and social sciences" [15]. In his article, he also stresses that bioethics is the further transformation of medical ethics, and while the primary center of bioethics is medicine and health care, the possibilities of bioethics cover multiple spheres and disciplines widely classified as "**life sciences**": "Bioethics appeared to steer people to a wide field of moral life problems, which usually cover medicine, biology, environment, population and social sciences" [15]. It is important to mention such fundamental works as "Foundations of bioethics" by Engelhart Jr, and "The principles of biomedical ethics" by Beauchamp and Childress which played the key role in the development of bioethics [16, 17].

bioethics and brought the international recognition.

will be established and the interest to this sphere will grow" [11].

common sense, if it is of the world scale [13].

Still earlier, Fritz Jahr, who was inspired by the comparative studies of Wilhelm Wundt concerning physiology and psychology of humans, animals, and plants as well as by philosophic contemplations of Fechner about the potential life of plant soul, transformed and broadened the categorical imperative of Kant into a bioethical imperative. He understands it as follows: "Respect every live creature in principle as a goal in and of itself and – if possible – consider it as such" [3]. Sanctity of law of God (moral law) was the foundation of the categorical imperative of Kant while the sanctity of life was the foundation of Jahr's bioethical imperative. While Kant's model was formal and rigorous, Jahr, who admitted interrelation between taking care of oneself and care for others, replaced the dignity of respecting the law by the dignity of compassion to all "live factors of growth" that is both to life and all its forms. It goes without saying that it was not Jahr who invented live ethics. Referring to European and Oriental traditions, in 1926, he published an article entitled "Natural sciences and teaching ethics" where he gave the subtitle "Old Knowledge in new clothes" describing the function of natural sciences for education and teaching biological research ethics [3].

Ideas and work of a scientist Andre Hellegers from the University of Georgetown became an important contribution into the uprising and development of bioethics as a term and a discipline [8]. According to Reich, he confirmed the term "bioethics" and with this the field of knowledge, social movement in the academic world, in biomedical sciences, governments, and mass media. He was the first in the world to establish an institute of bioethics on the basis of interdisciplinary research and approaches, namely the Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics. Together with his colleagues, he believed that bioethics would be a unique field integrating science and ethics, and so much attention should be paid to studies of underlying moral values appearing in bioethical concepts. At the same time, he thought that his role was to be "a link" between medicine, philosophy, and ethics. Andre Hellegers is justifiably thought to be "the chief architect of ideas of this science" [9]. He developed the work plan for the Kennedy Institute, having organized the first permanent interdisciplinary research group. Its work reflected the main directions of bioethics and brought the international recognition.

of the biosphere) [7]. At the same time, in his other work "The Global bioethics," Potter says that his understanding of bioethics was influenced by the work "The land ethic" by Leopold (1949), and he formulated his concept proceeding from the close relation between the bioethical theory and the ecological ethics [7]. In this book, Potter continues to develop the idea of close interaction of ethics with ecology, medicine, and science and puts the main accent on the ethics of survival and the global ethics. Stating that bioethics should be built on interdisciplinary relations and on the basis of many disciplines, he proposed two important spheres, which seem independent but at the same time need each other. Medical bioethics and environmental bioethics do not intertwine as the former deals with short-term topics such as options proposed to individuals by their doctors in the efforts to prolong their life by using organ transplants, man-made organs, experimental chemotherapy, and all the latest findings in the field of medicine. "Environmental bioethics has a long-term view concerning what we should do to maintain the ecosystem in a form compatible with reproduction of future generations. Nevertheless, these two branches of bioethics should intertwine reliably in the cause of protection of the individual health, control over reproduction and in respect of the meaning of human population growth" and he introduces the terms "global bioethics"

Still earlier, Fritz Jahr, who was inspired by the comparative studies of Wilhelm Wundt concerning physiology and psychology of humans, animals, and plants as well as by philosophic contemplations of Fechner about the potential life of plant soul, transformed and broadened the categorical imperative of Kant into a bioethical imperative. He understands it as follows: "Respect every live creature in principle as a goal in and of itself and – if possible – consider it as such" [3]. Sanctity of law of God (moral law) was the foundation of the categorical imperative of Kant while the sanctity of life was the foundation of Jahr's bioethical imperative. While Kant's model was formal and rigorous, Jahr, who admitted interrelation between taking care of oneself and care for others, replaced the dignity of respecting the law by the dignity of compassion to all "live factors of growth" that is both to life and all its forms. It goes without saying that it was not Jahr who invented live ethics. Referring to European and Oriental traditions, in 1926, he published an article entitled "Natural sciences and teaching ethics" where he gave the subtitle "Old Knowledge in new clothes" describing the function of natural sciences

Ideas and work of a scientist Andre Hellegers from the University of Georgetown became an important contribution into the uprising and development of bioethics as a term and a discipline [8]. According to Reich, he confirmed the term "bioethics" and with this the field of knowledge, social movement in the academic world, in biomedical sciences, governments, and mass media. He was the first in the world to establish an institute of bioethics on the basis of interdisciplinary research and approaches, namely the Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics. Together with his colleagues, he believed that bioethics would be a unique field integrating science and ethics, and so much attention should be paid to studies of underlying moral values appearing in bioethical concepts. At the same time, he thought that his role was to be "a link" between medicine, philosophy, and ethics. Andre Hellegers is justifiably thought to be "the chief architect of ideas of this science" [9]. He developed the work plan for the Kennedy Institute, having organized

and environmental bioethics [7].

104 Reflections on Bioethics

for education and teaching biological research ethics [3].

The first encyclopedia of bioethics was published in 1978. In his article "The word 'Bioethics' its birth and heritage of those who created it" published in 1994, its chief editor Reich confessed that he was in a serious doubt as whether to use the word "bioethics" in the title of the encyclopedia, which supposedly should have been entitled "Encyclopedia of medical ethics" [10]. He wrote: "On the one side it seemed acceptable to use the established name of the discipline to name it, but on the other I was inclined to use the new word of 'bioethics' because I felt the term of medical ethics was too narrow as it ran counter to ethics of life sciences. Nevertheless it was too bold to give the title of 'bioethics" to encyclopedia as the word 'bioethics' appeared in the works of only one man and was included into the name of only one institute" [11]. At that moment, Reich thought that he was facing such difficult questions as "whether the discipline or the field of knowledge name 'bioethics' will really develop; whether it will last and whether the word 'bioethics' will be used to name the whole field of science" (*i.e., biomedical studies and their consequences for human beings—F.N.*). In addition, it is significant that he addressed not specialists in biology and medicine but to the editor-in-chief of the 16-volume encyclopedia of the social sciences, David Sills, who confirmed that "word will be established and the interest to this sphere will grow" [11].

Potter's "Global bioethics" was published in 1988 [12]. Together with dividing bioethics into two branches, Potter stressed that it was necessary to go further than Leopold and further than medical bioethics and that super-specialization in any sphere can stand against aims of admissible survival in the global scale. Two branches should be integrated, brought to one point of view and called global bioethics, stressing two meanings of the word "global." On the one hand, the system of ethics is global if it is united and comprehensive, and in the more common sense, if it is of the world scale [13].

In the introduction of the second issue of the "Encyclopedia of bioethics," Reich defines bioethics as "a systematical study of the field of moral – including moral views, decisions, behavior and policy – in life sciences and medical care, that uses diversity of ethical methodologies in interdisciplinary space." Proceeding, he specifies that "publishers consider bioethics to *be a discipline going beyond medical ethics* (italics supplied by F.N.). It integrates the moral interpretation of medical and scientific points of view on health of the population, environment, public ethics and protection of animals" [14]. It is important to pay special attention to the article "Bioethics" written by Daniel Callahan, one of the scientists who was one of the originators of bioethics both as a term and as a branch of science. He defined bioethics as a science "which is the product of biomedical achievements related to the environment and social sciences" [15]. In his article, he also stresses that bioethics is the further transformation of medical ethics, and while the primary center of bioethics is medicine and health care, the possibilities of bioethics cover multiple spheres and disciplines widely classified as "**life sciences**": "Bioethics appeared to steer people to a wide field of moral life problems, which usually cover medicine, biology, environment, population and social sciences" [15]. It is important to mention such fundamental works as "Foundations of bioethics" by Engelhart Jr, and "The principles of biomedical ethics" by Beauchamp and Childress which played the key role in the development of bioethics [16, 17]. The Beauchamp and Childress concept of bioethics includes four principles and a set of rules, validate it using the principles. Rules in turn are used to justify moral decisions and actions in specific situations. The basic principles of bioethics, according to Beauchamp and Childress, is the principle of respect for patient autonomy, which has grounded, in particular, the concept of informed consent; dates back to the Hippocratic principle of "do no harm," which requires minimization of damage to the patient during the medical intervention; the principle of "do good" (beneficence), emphasizing the physician's responsibility to take positive steps to improve the condition of the patient; finally, the principle of justice, emphasizing the need for fairness and equal treatment of patients, and equitable distribution of resources (which are always limited) in the provision of medical care [17].

This brief history of notion of "bioethics" and ideas that influenced the formation of the Russian school of bioethics can be illustrated in a table form (**Table 1**).


**3. Outlook of Russian school of bioethics**

**Table 1.** Main authors and ideas that influenced the formation of Russian school of bioethics.

**Name Where/Time The main idea**

1996.

ethics, 1994

The Foundation of Bioethics,

The principles of biomedical

scientists.

H. Tristram Engelhart, Jr.

Tom L. Beauchamp and James F. Childress

A special place, in our opinion, the development of bioethics, has been made by Russian

"Moral diversity is real. It is real in fact and in principle. Bioethics and healthcare policy have yet to take this diversity seriously. Those who teach bioethics, those who engage in bioethics committees, even those who produced textbooks tend to discount the diversity of understanding regarding the morality of particular health care choices (e.g., regarding abortion, commercial surrogacy, euthanasia/ germline genetic engineering, inequalities in access to health care, infanticide, organ sales) or the nature of morality (e.g., theological, deontological, virtue-based) [18].

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 107

The basic principles of bioethics, according to Beauchamp and Childress, is the principle of respect for patient autonomy, which has grounded, in particular, the concept of informed consent; dates back to the Hippocratic principle of "do no harm," which requires minimization of damage to the patient during the medical intervention; the principle of "do good" (beneficence), emphasizing the physician's responsibility to take positive steps to improve the condition of the patient; finally, the principle of justice, emphasizing the need for fairness and equal treatment of patients, and equitable distribution of resources (which are always

limited) in the provision of medical care [17].

Russian school of bioethics originates from the late 1980s of the twentieth century [19]. Among Russian authors, one should first of all mention the well-known Russian philosopher, the academician of Russian Academy of Science (RAS), Professor Boris Grigoryevich Yudin, starting with such fundamental work "Ethics of science. Problems and discussions" [19] written together with the scientist Frolov, four of eight chapters of which are dedicated to problems of bioethics (however, this term was not used at that time yet and Yudin himself confessed that he first heard about bioethics in 1989, when American philosophers came to the Institute of Philosophy of Russian Academy of Sciences) [20]. In 1990, he, as a member of a Russian delegation, visited the leading bioethical centers in the USA. In 1991, he gave the first educational course of bioethics at the philosophy department of Moscow State University, in Russia. The sector of bioethics was organized in the Institute of Human of the Russian Academy of Sciences (RAS) in 1992, and Yudin became the head of it by the invitation of Frolov. The bioethics sector was one of the most active departments of the Institute of Human. It started carrying out research of such issues as the informed consent, ethical problems of experiments with animals, and ethical aspects of new reproductive technologies. Yudin can justifiably be called one of the founders of the domestic scientific school of bioethics, a leader of the Russian bioethics [21, 22]. Together with the Russian national committee on bioethics, the sector studied social-ethical problems, arising during implementation of the "Human genome" project [23, 24]. Yudin also took an active part in another direction of work of the Institute of Human,


**Table 1.** Main authors and ideas that influenced the formation of Russian school of bioethics.

## **3. Outlook of Russian school of bioethics**

**Name Where/Time The main idea**

Russian school of bioethics can be illustrated in a table form (**Table 1**).

Bioethics: the bridge to the

"…a new field of knowledge integrating biological knowledge and the system of human and moral values …. I used *bio* to represent biological knowledge, the science of live systems, and I used *ethic* to represent knowledge of systems of human moral values" [1].

He used the term "bioethics" to refer to interdisciplinary research moral problems of biomedicine, primarily associated with the need to protect the dignity and rights of patients [8, 9]. He was the first in the world to establish an institute of bioethics on the basis of interdisciplinary research and approaches, namely the Joseph and Rose Kennedy Institute for the Study of Human Reproduction and Bioethics. Together with his colleagues, he believed that bioethics would be a unique field integrating science and ethics, and so much attention should be paid to studies of underlying moral values appearing in bioethical concepts. At the same time, he thought that his role was to be "a link" between medicine,

Defines bioethics as "a systematical study of the field of moral – including moral views, decisions, behavior and policy – in life sciences and medical care that uses diversity of ethical methodologies in interdisciplinary space." Proceeding, he specifies that "publishers consider bioethics to *be a discipline going beyond medical ethics* (italics supplied by F.N.). It integrates the moral interpretation of medical and scientific points of view on health of the population, environment, public ethics and protection of

He defined bioethics as a science "which is the product of biomedical achievements related to the environment and social sciences" [15]. In his article, he also stresses that bioethics is the further transformation of medical ethics, and while the primary center of bioethics is medicine and health care, the possibilities of bioethics cover multiple spheres and disciplines widely classified as "**life sciences**": "Bioethics appeared to steer people to a wide field of moral life problems, which usually cover medicine, biology, environment, population and social sciences" [15].

The term "bioethics" (Bio-Ethik) understands it as follows: "Respect every live creature in principle as a goal in and of itself

and – if possible – consider it as such" [3].

philosophy, and ethics.

The Beauchamp and Childress concept of bioethics includes four principles and a set of rules, validate it using the principles. Rules in turn are used to justify moral decisions and actions in specific situations. The basic principles of bioethics, according to Beauchamp and Childress, is the principle of respect for patient autonomy, which has grounded, in particular, the concept of informed consent; dates back to the Hippocratic principle of "do no harm," which requires minimization of damage to the patient during the medical intervention; the principle of "do good" (beneficence), emphasizing the physician's responsibility to take positive steps to improve the condition of the patient; finally, the principle of justice, emphasizing the need for fairness and equal treatment of patients, and equitable distribution of resources (which are always limited)

This brief history of notion of "bioethics" and ideas that influenced the formation of the

animals" [14].

Global bioethics, 1988

teaching ethics, 1926

Chemical and engineering

Encyclopedia of bioethics/ W.T. Reich Editor-in-chief.

N.Y. 1978, 1995

Daniel Callahan Bioethics. Encyclopedia of

bioethics. N.Y., 1995

future, 1971

in the provision of medical care [17].

Fritz Jahr Natural sciences and

Andre Hellegers Bioethics center formed //

news, 1971

Van Rensselaer Potter

106 Reflections on Bioethics

W.T. Reich, chief

editor

A special place, in our opinion, the development of bioethics, has been made by Russian scientists.

Russian school of bioethics originates from the late 1980s of the twentieth century [19]. Among Russian authors, one should first of all mention the well-known Russian philosopher, the academician of Russian Academy of Science (RAS), Professor Boris Grigoryevich Yudin, starting with such fundamental work "Ethics of science. Problems and discussions" [19] written together with the scientist Frolov, four of eight chapters of which are dedicated to problems of bioethics (however, this term was not used at that time yet and Yudin himself confessed that he first heard about bioethics in 1989, when American philosophers came to the Institute of Philosophy of Russian Academy of Sciences) [20]. In 1990, he, as a member of a Russian delegation, visited the leading bioethical centers in the USA. In 1991, he gave the first educational course of bioethics at the philosophy department of Moscow State University, in Russia. The sector of bioethics was organized in the Institute of Human of the Russian Academy of Sciences (RAS) in 1992, and Yudin became the head of it by the invitation of Frolov. The bioethics sector was one of the most active departments of the Institute of Human. It started carrying out research of such issues as the informed consent, ethical problems of experiments with animals, and ethical aspects of new reproductive technologies. Yudin can justifiably be called one of the founders of the domestic scientific school of bioethics, a leader of the Russian bioethics [21, 22]. Together with the Russian national committee on bioethics, the sector studied social-ethical problems, arising during implementation of the "Human genome" project [23, 24]. Yudin also took an active part in another direction of work of the Institute of Human, namely humanitarian expertise. The staff of the institute prepared expert reports for governmental bodies and international organizations. Under the guidance of Yudin, the Institute of Human was the first to develop a project "The human potential of Russia" [25].

Yudin and Tischenko are the authors of the concept of social-humanitarian support of innovative activity, including ideas of ethical and social-humanitarian expertise (proactive diagnostics, assessment, and risk management) developed earlier [33]. They think that it is not only scientists who must understand something and engineers, who must develop something, but also representatives of different social groups who must realize the personal, professional, and (or) public meaning of discoveries and inventions (both already existing and the future ones). While solving these tasks, bioethics in the mode of joint work with biomedical sciences and technologies brings the sphere of social relations in order practically in the same way as science brings order into the world of relations in nature, and this is the meaning of the idea

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 109

Honored Scientist of the Russian Federation, Doctor of Philosophical Sciences, Doctor of Juridical Science, full professor, the head of the Russian Unit of International Network of the UNESCO chair in bioethics, the head of the Department of the ethical, legal, and sociological expertise in medicine of the Volgograd Medical Research Center, Sedova has made a significant contribution into the development of Russian and international bioethics. Since 1985, she has been the head of the department of philosophy, bioethics, and law. She is also the founder and co-chairwoman of the Regional Ethical Committee (REC) which began its work in 1985. In 2002, she organized and headed the department of ethical and legal expertise of scientific research in the Volgograd Scientific Centre of the Russian Academy of Medical Sciences (RAMC), which was also the first in Russia. She made a great theoretical contribution into the validation of the three-level structure of bioethics, the development of a hierarchic model of ethical committees for Russia. Sedova also developed a concept of feedback in the system "the moral- the law" and legal institutionalization of bioethics ("Legal foundations of bioethics," М, 2004) [35], worked out principles of organization and structure of ethical committees in Russia ("Applied bioethics," М, 2002—in collaboration with the Academician of RAMC, Petrov) [36], and wrote works on the issues of informed consent ("The Law and the Ethics in pediatrics: the issue of informed consent," М, 2004) [37]. Sedova has established and successfully publishes the magazine "Bioethics" which is the first in Russia and prints articles of current concern in bioethics from the interdisciplinary point of view: philosophy, medicine, law, sociology, and other scientific fields. This magazine enjoys a well-deserved respect and is included into the base of the Russian Scientific Citation Index (RSCI) and into the list of peer-reviewed journals of the State Commission for Academic Degrees and Titles of the Russian Federation [38].

Doctor of Sciences in Philosophy, Professor Siluyanova, who is a pioneer in teaching biomedical ethics at the higher medical school of Russia, can be quite justifiably attributed to founders of modern Russian bioethics. She approached bioethical issues from the point of view of Russia Orthodoxy. In her works such as "Modern medicine and Orthodoxy" (1998) [39], "Ethics of the art of treatment" (2001) [40], "Anthropology of disease" (2007) [41], and others, she states that the main difference between "an Orthodox doctor" and "a non-Orthodox one" is in understanding the nature of a disease of a person. For an Orthodox doctor, a disease is always a result of malfunctioning of the unity of spiritual and physiological in a human being. The Orthodox doctor also understands that the cure depends on restoring this unity as well, as the basis of the personal integrity that is the attainment of cure depends not only from the organism but also from the personality. She also considers the problem of human rights through the

of social-humanitarian support of innovative activity [34].

In 2005–2013, Yudin was the head of the department of comprehensive problems of the study of man at the Institute of Human of the RAS and made a crucial contribution into the development of bioethics as both a research area and an academic subject. He trained young specialists in philosophical bioethics and organized a number of conferences and trainings in bioethics with the participation of international specialists. Several projects in humanitarian issues of biology and medicine were implemented at the Institute of Fundamental and Applied Research by means of Russian and international grants.

Yudin carried out huge international work in the field of bioethics. Since 1998, he was an expert from the Russian Federation, and from 2000 till 2004, he was a member of the Committee on Bioethics of the Council of Europe. He participated in elaborating and passing protocols, regulating the use of achievements of genetics in medicine, scientific studies on a human being, and organ transplants. He made presentations at the world congresses in bioethics. In recent years, Yudin paid much attention to the ethical regulation of a matter of biotechnological engineering, "improvement" of a human being, to the imperative of fidelity in research and understanding of philosophy as an expertise [26]. The multi-author book "Philosophy of biomedical studies: the ethos of the beginning of the third millennium" (2004) under the editorship of Yudin is very interesting by its choice of material and the number of covered problems [27].

Together with the famous Russian scientist Frolov, Yudin was the founder of not only the Institute in the Study of Human but also the "Human" journal [28]. In Russian, it is called "Chelovek." This journal has become a main public platform of the most interesting discussions and became a blood vessel supplying fresh "blood" in the form of new, original ideas and approaches, which were first of all related to bioethical problems.

Sadly, Professor Yudin passed away in 2017, but his scientific works and ideas are still popular and continued by his colleagues.

Doctor of philosophy, Professor Tischenko, who held the same views as those of Professor Yudin [24], became his associate, and his scientific interest covered such fields as bioethics (issues of justice, ethics of genome studies, euthanasia, and transplantology), bio-power and bio-politics, and the philosophy of post-classical science. Tischenko develops the idea of "local contingent rationality" of scientific and moral discourses, competing for recognition in the sphere of the secular language, and introduces the understanding of the genesis of a new configuration of "bio-power" related to decentered social biomedicine institutes which function controlling procedures of interpretation of being, the fact of existence, and the appropriate number of people. One should specially mention a number of his books and articles, such as "Phenomenon of bioethics" and "To the origins of bioethics" which have already become classical for bioethical discourse [29–31]. His fundamental work "Bio-power in the era of biotechnologies" was published in 2001. Tischenko emphasizes that "bioethics is the field of interdisciplinary research of ethical, philosophical and anthropological problems arising due to the progress of biomedical science and introduction of advanced technologies into the healthcare practice" [32].

Yudin and Tischenko are the authors of the concept of social-humanitarian support of innovative activity, including ideas of ethical and social-humanitarian expertise (proactive diagnostics, assessment, and risk management) developed earlier [33]. They think that it is not only scientists who must understand something and engineers, who must develop something, but also representatives of different social groups who must realize the personal, professional, and (or) public meaning of discoveries and inventions (both already existing and the future ones). While solving these tasks, bioethics in the mode of joint work with biomedical sciences and technologies brings the sphere of social relations in order practically in the same way as science brings order into the world of relations in nature, and this is the meaning of the idea of social-humanitarian support of innovative activity [34].

namely humanitarian expertise. The staff of the institute prepared expert reports for governmental bodies and international organizations. Under the guidance of Yudin, the Institute of

In 2005–2013, Yudin was the head of the department of comprehensive problems of the study of man at the Institute of Human of the RAS and made a crucial contribution into the development of bioethics as both a research area and an academic subject. He trained young specialists in philosophical bioethics and organized a number of conferences and trainings in bioethics with the participation of international specialists. Several projects in humanitarian issues of biology and medicine were implemented at the Institute of Fundamental and

Yudin carried out huge international work in the field of bioethics. Since 1998, he was an expert from the Russian Federation, and from 2000 till 2004, he was a member of the Committee on Bioethics of the Council of Europe. He participated in elaborating and passing protocols, regulating the use of achievements of genetics in medicine, scientific studies on a human being, and organ transplants. He made presentations at the world congresses in bioethics. In recent years, Yudin paid much attention to the ethical regulation of a matter of biotechnological engineering, "improvement" of a human being, to the imperative of fidelity in research and understanding of philosophy as an expertise [26]. The multi-author book "Philosophy of biomedical studies: the ethos of the beginning of the third millennium" (2004) under the editorship of Yudin is very interesting by its choice of material and the number of covered

Together with the famous Russian scientist Frolov, Yudin was the founder of not only the Institute in the Study of Human but also the "Human" journal [28]. In Russian, it is called "Chelovek." This journal has become a main public platform of the most interesting discussions and became a blood vessel supplying fresh "blood" in the form of new, original ideas

Sadly, Professor Yudin passed away in 2017, but his scientific works and ideas are still popu-

Doctor of philosophy, Professor Tischenko, who held the same views as those of Professor Yudin [24], became his associate, and his scientific interest covered such fields as bioethics (issues of justice, ethics of genome studies, euthanasia, and transplantology), bio-power and bio-politics, and the philosophy of post-classical science. Tischenko develops the idea of "local contingent rationality" of scientific and moral discourses, competing for recognition in the sphere of the secular language, and introduces the understanding of the genesis of a new configuration of "bio-power" related to decentered social biomedicine institutes which function controlling procedures of interpretation of being, the fact of existence, and the appropriate number of people. One should specially mention a number of his books and articles, such as "Phenomenon of bioethics" and "To the origins of bioethics" which have already become classical for bioethical discourse [29–31]. His fundamental work "Bio-power in the era of biotechnologies" was published in 2001. Tischenko emphasizes that "bioethics is the field of interdisciplinary research of ethical, philosophical and anthropological problems arising due to the progress of biomedical

science and introduction of advanced technologies into the healthcare practice" [32].

Human was the first to develop a project "The human potential of Russia" [25].

Applied Research by means of Russian and international grants.

and approaches, which were first of all related to bioethical problems.

problems [27].

108 Reflections on Bioethics

lar and continued by his colleagues.

Honored Scientist of the Russian Federation, Doctor of Philosophical Sciences, Doctor of Juridical Science, full professor, the head of the Russian Unit of International Network of the UNESCO chair in bioethics, the head of the Department of the ethical, legal, and sociological expertise in medicine of the Volgograd Medical Research Center, Sedova has made a significant contribution into the development of Russian and international bioethics. Since 1985, she has been the head of the department of philosophy, bioethics, and law. She is also the founder and co-chairwoman of the Regional Ethical Committee (REC) which began its work in 1985. In 2002, she organized and headed the department of ethical and legal expertise of scientific research in the Volgograd Scientific Centre of the Russian Academy of Medical Sciences (RAMC), which was also the first in Russia. She made a great theoretical contribution into the validation of the three-level structure of bioethics, the development of a hierarchic model of ethical committees for Russia. Sedova also developed a concept of feedback in the system "the moral- the law" and legal institutionalization of bioethics ("Legal foundations of bioethics," М, 2004) [35], worked out principles of organization and structure of ethical committees in Russia ("Applied bioethics," М, 2002—in collaboration with the Academician of RAMC, Petrov) [36], and wrote works on the issues of informed consent ("The Law and the Ethics in pediatrics: the issue of informed consent," М, 2004) [37]. Sedova has established and successfully publishes the magazine "Bioethics" which is the first in Russia and prints articles of current concern in bioethics from the interdisciplinary point of view: philosophy, medicine, law, sociology, and other scientific fields. This magazine enjoys a well-deserved respect and is included into the base of the Russian Scientific Citation Index (RSCI) and into the list of peer-reviewed journals of the State Commission for Academic Degrees and Titles of the Russian Federation [38].

Doctor of Sciences in Philosophy, Professor Siluyanova, who is a pioneer in teaching biomedical ethics at the higher medical school of Russia, can be quite justifiably attributed to founders of modern Russian bioethics. She approached bioethical issues from the point of view of Russia Orthodoxy. In her works such as "Modern medicine and Orthodoxy" (1998) [39], "Ethics of the art of treatment" (2001) [40], "Anthropology of disease" (2007) [41], and others, she states that the main difference between "an Orthodox doctor" and "a non-Orthodox one" is in understanding the nature of a disease of a person. For an Orthodox doctor, a disease is always a result of malfunctioning of the unity of spiritual and physiological in a human being. The Orthodox doctor also understands that the cure depends on restoring this unity as well, as the basis of the personal integrity that is the attainment of cure depends not only from the organism but also from the personality. She also considers the problem of human rights through the lens of Orthodoxy. The basic rights stated and listed in the Universal Declaration of Human Rights (1948, the UN) [42] are unconditional, and the difficulty arises when the list of these rights grows unlimitedly and such rights as "reproductive rights" and "sexual rights" become attached to it. Their real nature lies in willfulness and seeking to change the human nature itself with inevitably fatal consequences for it. Bioethics is the knowledge, the task of which is to protect human life from possible kinds of "artificial" and "invented" rights on changing one's nature, on the denial of moral laws protecting the nature, society, and human life.

Agrobioethics is understood as a mechanism of social control and regulation of new "material viability" in bioeconomics [47, 48]. Agrobioethics represents a new approach to the solution of ethical dilemmas, which can arise in everyday practice of using new technologies in agriculture. It is an experience of solving disputes, inter-personal and social communication for solving controversies both between producers and customers and between the state and the civil society [45, 46].

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 111

Global challenges and strategic and social-economic priorities of the future of the humankind have made it necessary to fasten the study, forecast and development of means which should promote sustainable development, provide population safety and quality of life, protect ecology, and improve the rational use of nature. Currently developed countries are starting the formation of a new technological base of economic systems based on the use of the latest achievements in biotechnologies, information science, and nanotechnologies including agriculture, medicine, veterinary, ecology, and other spheres. This will make it possible for the humankind to solve four main problems it is facing today—food supply, quality of health care, degradation of environment, and problems connected with the exhaustion of power,

On the one hand, we are contemporaries of the global problems that need urgent solution as we are talking about the future of the humankind. On the other hand, we witness or directly participate in scientific fundamental cutting-edge achievements which make it possible to change fundamentals of being on the level of life and artificial matter or their synthesis. In 2002, the National Scientific Fund of the USA and the American Ministry of Economy using forecasts of scientists prepared and published a well-known Report on Convergent technologies NBIC (NBIC: N—nano, B—bio, I—infor и C—cogno). It stressed out that the convergence

In 1998, a famous Russian scientist who is currently the directors of the Institute named after Kurchatov, Mikhail Kovalchuk, proposed his own version of uniting together these four fields of knowledge. In 2011, in his article named "Convergence of sciences and technologies is a breakthrough into the future," he gave both conceptual basics and serious arguments supporting the convergence of NANO-BIO-INFO-COGNO (NBIC). It is important that when compared with pure technological solutions of the NBIC technologies future development forecast, he includes humanitarian sciences in this process. According to Kovalcuk, the main objective of today's post-industrial stage of development of the society is reproduction of systems of live nature. The first stage is combining technological possibilities of modern microelectronics with achievements in studies of live nature (nano-biotechnologies). This means creating hybrid anthropomorphic technical systems of bionic type. The second stage is the integration of nano-biosensor platforms created at the first stage, that is, the development of technologies of atomic-molecular design and self-organization on the basis of atoms and

of NBIC technologies would become the basis of a new technological structure [49].

bioorganic molecules, the result of which are biorobotic technical systems [50].

Another factor that makes the notion of bioethics preferable is the NBIC technologies convergence, which represents a mutual interaction of information technologies, biotechnologies,

**4. Conclusion: Global trends to global bioethics**

raw materials, and other recourses.

Starting from 2009, the Institute of Philosophy of Russian Academy of Sciences publishes "Work books in bioethics" dedicated to its different branches; in 2010, it started to publish international e-journal "Medical anthropology and bioethics" [43].

In Kazan (Republic of Tatarstan), professor of philosophy Nezhmetdinova obtained the grant to develop a course of bioethics for students in 1994. This course passed attestation by the University of New York, and in 1996, it was approved and supported by the University of Kent (Great Britain). This program became the basis for the course in biomedical ethics, when Nezhmetdinova started lecturing it to students of the medical university by the initiative of Professor Albitskiy. At that time, it was regarded as something exotic. In the following 3 years, it became possible to prove the livability of this field and to "capture" the wider public, and the independent chair of biomedical ethics and medical law with the course in the history of medicine was established in 1998, which was the first to be developed in Russia. As the desire to study the new scientific field was enormous and there was no methodological support, a textbook "The law and medicine: bioethical foundations" was written in 1998 [44], and bioethical issues became part of scientific research work of the staff, doctoral students, and degreeseeking applicants of the chair. In 2000, Nezhmetdinova and Guryleva developed legal and regulatory documents, and with the support of the rector of the Kazan Medical University, Professor Amirov organized an ethical committee with local functions. Three years later, due to the growth of multicenter clinical studies and the appearance of legal regulatory actions, namely the law of the Russian Health Ministry "On approval of Rules of clinical practice in Russian Federation," there appeared the necessity to organize a Regional Ethical Committee (Regional Committee of ethical issues in clinical drug trials under the Ministry of Healthcare of the Republic of Tatarstan). This situation was an exception rather than a rule for Russia. There was a disastrous lack of knowledge, but the Kazan school of bioethics has the great stroke of luck. Since 2002, the topical nuts-and-bolts course was organized with the support of UNESCO for ethical committees of the post-soviet countries, and representatives of the Kazan school Nezhmetdinova and Guryleva took an active part in conferences and workshops, first as trainees and then as full participants of discussions. The Forum of committees in ethics of the CIS member-countries organized by Kubar enabled the whole commonwealth to take a common stand in issues of ethics of clinical studies and to think about legal aspects not only of clinical trials but also about medical practice as is evidenced by such model laws as "On protection of human rights and dignity in biomedical studies in the CIS member-countries" and "On ethical-legal protection and safety of genetic medical studies in the CIS membercountries" passed by the Inter-Parliamentary Assembly of the CIS countries.

One can say about the birth of a new research area of agrobioethics developed by the initiative of Nezhmetdinova [45]. This is due to global challenges and bio-technologization of economy [46]. Agrobioethics is understood as a mechanism of social control and regulation of new "material viability" in bioeconomics [47, 48]. Agrobioethics represents a new approach to the solution of ethical dilemmas, which can arise in everyday practice of using new technologies in agriculture. It is an experience of solving disputes, inter-personal and social communication for solving controversies both between producers and customers and between the state and the civil society [45, 46].

## **4. Conclusion: Global trends to global bioethics**

lens of Orthodoxy. The basic rights stated and listed in the Universal Declaration of Human Rights (1948, the UN) [42] are unconditional, and the difficulty arises when the list of these rights grows unlimitedly and such rights as "reproductive rights" and "sexual rights" become attached to it. Their real nature lies in willfulness and seeking to change the human nature itself with inevitably fatal consequences for it. Bioethics is the knowledge, the task of which is to protect human life from possible kinds of "artificial" and "invented" rights on changing one's

Starting from 2009, the Institute of Philosophy of Russian Academy of Sciences publishes "Work books in bioethics" dedicated to its different branches; in 2010, it started to publish

In Kazan (Republic of Tatarstan), professor of philosophy Nezhmetdinova obtained the grant to develop a course of bioethics for students in 1994. This course passed attestation by the University of New York, and in 1996, it was approved and supported by the University of Kent (Great Britain). This program became the basis for the course in biomedical ethics, when Nezhmetdinova started lecturing it to students of the medical university by the initiative of Professor Albitskiy. At that time, it was regarded as something exotic. In the following 3 years, it became possible to prove the livability of this field and to "capture" the wider public, and the independent chair of biomedical ethics and medical law with the course in the history of medicine was established in 1998, which was the first to be developed in Russia. As the desire to study the new scientific field was enormous and there was no methodological support, a textbook "The law and medicine: bioethical foundations" was written in 1998 [44], and bioethical issues became part of scientific research work of the staff, doctoral students, and degreeseeking applicants of the chair. In 2000, Nezhmetdinova and Guryleva developed legal and regulatory documents, and with the support of the rector of the Kazan Medical University, Professor Amirov organized an ethical committee with local functions. Three years later, due to the growth of multicenter clinical studies and the appearance of legal regulatory actions, namely the law of the Russian Health Ministry "On approval of Rules of clinical practice in Russian Federation," there appeared the necessity to organize a Regional Ethical Committee (Regional Committee of ethical issues in clinical drug trials under the Ministry of Healthcare of the Republic of Tatarstan). This situation was an exception rather than a rule for Russia. There was a disastrous lack of knowledge, but the Kazan school of bioethics has the great stroke of luck. Since 2002, the topical nuts-and-bolts course was organized with the support of UNESCO for ethical committees of the post-soviet countries, and representatives of the Kazan school Nezhmetdinova and Guryleva took an active part in conferences and workshops, first as trainees and then as full participants of discussions. The Forum of committees in ethics of the CIS member-countries organized by Kubar enabled the whole commonwealth to take a common stand in issues of ethics of clinical studies and to think about legal aspects not only of clinical trials but also about medical practice as is evidenced by such model laws as "On protection of human rights and dignity in biomedical studies in the CIS member-countries" and "On ethical-legal protection and safety of genetic medical studies in the CIS member-

nature, on the denial of moral laws protecting the nature, society, and human life.

countries" passed by the Inter-Parliamentary Assembly of the CIS countries.

One can say about the birth of a new research area of agrobioethics developed by the initiative of Nezhmetdinova [45]. This is due to global challenges and bio-technologization of economy [46].

international e-journal "Medical anthropology and bioethics" [43].

110 Reflections on Bioethics

Global challenges and strategic and social-economic priorities of the future of the humankind have made it necessary to fasten the study, forecast and development of means which should promote sustainable development, provide population safety and quality of life, protect ecology, and improve the rational use of nature. Currently developed countries are starting the formation of a new technological base of economic systems based on the use of the latest achievements in biotechnologies, information science, and nanotechnologies including agriculture, medicine, veterinary, ecology, and other spheres. This will make it possible for the humankind to solve four main problems it is facing today—food supply, quality of health care, degradation of environment, and problems connected with the exhaustion of power, raw materials, and other recourses.

On the one hand, we are contemporaries of the global problems that need urgent solution as we are talking about the future of the humankind. On the other hand, we witness or directly participate in scientific fundamental cutting-edge achievements which make it possible to change fundamentals of being on the level of life and artificial matter or their synthesis. In 2002, the National Scientific Fund of the USA and the American Ministry of Economy using forecasts of scientists prepared and published a well-known Report on Convergent technologies NBIC (NBIC: N—nano, B—bio, I—infor и C—cogno). It stressed out that the convergence of NBIC technologies would become the basis of a new technological structure [49].

In 1998, a famous Russian scientist who is currently the directors of the Institute named after Kurchatov, Mikhail Kovalchuk, proposed his own version of uniting together these four fields of knowledge. In 2011, in his article named "Convergence of sciences and technologies is a breakthrough into the future," he gave both conceptual basics and serious arguments supporting the convergence of NANO-BIO-INFO-COGNO (NBIC). It is important that when compared with pure technological solutions of the NBIC technologies future development forecast, he includes humanitarian sciences in this process. According to Kovalcuk, the main objective of today's post-industrial stage of development of the society is reproduction of systems of live nature. The first stage is combining technological possibilities of modern microelectronics with achievements in studies of live nature (nano-biotechnologies). This means creating hybrid anthropomorphic technical systems of bionic type. The second stage is the integration of nano-biosensor platforms created at the first stage, that is, the development of technologies of atomic-molecular design and self-organization on the basis of atoms and bioorganic molecules, the result of which are biorobotic technical systems [50].

Another factor that makes the notion of bioethics preferable is the NBIC technologies convergence, which represents a mutual interaction of information technologies, biotechnologies, nanotechnologies, and cognitive science. The term was introduced in 2002 by Mikhail Roko and William Bainbridge, the authors of the most important for today's work in this direction, the report "Converging Technologies for Improving Human Performance 1" prepared in 2002 in the WTEC [51]. NBIC convergence has not only huge scientific and technological importance. Technological possibilities appearing during the NBIC convergence inevitably will cause serious cultural, philosophical, and social disturbances. In particular, this concerns the revision of traditional understanding of such fundamental notions as life, mind, a human being, nature, existence. It is quite possible that from the certainty based on everyday experience, the humankind has to move to understanding that in the real world there are no clear boundaries between many phenomena, which were previously considered to be of dual nature. First of all, due to recent research, the traditional difference between live and inanimate loses its meaning. In the same way, the difference between a rational system possessing mind and free will and rigidly programmed system is gradually fading. Already today, live beings are created "artificially" with the help of gene engineering. One of these days, it will become possible to create complex live beings (also with the help of nanotechnologies from separate molecular-size elements.) In addition to broadening the boundaries of human creativity, this will also mean the transformation of our understanding of life and death. All this is in the center of bioethical discourse.

and nanotechnological communities refer, are mainly based on principles and approaches developed within the secular liberal bioethics. At the same time, positions of religious concepts, in particular of modern Christian social doctrines, are barely reflected in official international, state, and professional documents even though the substantial part of the society keeps Christian or Muslim ethical norms. The religious understanding of the world first of all is based on the creative mission of God. It is in the creation of all the living: life, a man, the nature. Modern NBIC technologies undermine the belief in creationism. Hence, a necessity arises in both the new interpretation of sacred books and the development of religious ethics. Speaking about technological challenges, modern researchers and scientists cannot help but use the chance to express their anxiety and call to vigilance. Analyzing characterizing traits of the modern society (using the American one as an example), an American scientist Nesbitt

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 113

The last 25 years of the twentieth century and the beginning of the twenty-first century gave rise to such a specific phenomenon which the German sociologist Ulrich Beck named "other modern" or "the society of risk" [56]. And we think that he quite correctly stressed the change of the meaning and use of the notion "risk" which from the category of the personal area only

Second, if the previous century risk was considered to be a result of insufficient development of technologies and scientific knowledge, today risk appears where there is redundancy of technological and scientific progress [57]. This emerges the following questions: "Should we worry about this or leave it to the discretion of scientists-technologists? If we should then are there any humanitarian practices providing our bodily safety and fundamental basics of

In the Kazan school of bioethics, great attention is paid to the applied nature of bioethics. Updating of applied ethics seems quite natural in this respect. Here, we should remember the meaning given to ethics by classics of antique philosophy Plato and Aristotle. For Plato, ethics being the structural part of philosophic knowledge should teach the art of life. He thought that this was the real and highest possible good for a man [58]. While distinguishing theoretical and applied levels of the philosophical knowledge system, Aristotle also defined their aims as the truth and the good. He included ethics, politics, and economy into applied philosophy, thus emphasizing that ethics was the applied philosophy and so philosophical foundation of ethics is definitive in its character [59]. Judging from all said above, it is possible to make the following assumption: when this or that scientific discipline claims to be bioethics

in interdisciplinary discussions, its philosophical origin is logical and crucial.

calls it the Zone Poisoned by Technology, where

**1.** We feel fear about technology and worship it.

**3.** We take violence as a norm of life.

moves to the global level.

nature?"

**4.** We love technology as children love toys.

**5.** Our life has become estranged and erratic [55].

**2.** We are unable to tell reality from fantasy any more.

Also, today we witness futuristic or manifesting scenarios of the development of the human society. In his presentation made already in the autumn of 2010 at the scientific conference "Future talk" in Vienna, which discussed technologies of the future, a futurologist and trans humanist Raymond Kurzweil [52] spoke about fantastic possibilities that could become quite real: in the nearest 20 years, the humankind would be able to make the so-called "reserve copy of a brain," which would contain records of all reminiscences; a person will be able to look though his or her past which will be projected into his eyes: special nano-robots regulating the health of human being will be implanted into his blood system; in the 30s of the current century, the computer will prove existence of the artificial intellect, and it will be able to understand human words as a man does and will be able to pass the Turing test; the implantation of a special chip into the brain which will create virtual reality of "complete submersion" will become feasible; by 2040, a human body will be able to transform into any form which will also be made of a huge number of nano-robots, and all internal organs will be replaced by cybernetic devices. In conclusion, Kurzweil forecasts the coming of the complete "technological singularity" by 2045, the result of which will be turning the Earth into a single gigantic computer, and gradually this process will involve the whole of Universe [53].

In 2011, the "Project 2045" was developed in Russia, and a Manifesto of a strategic public movement "Russia 2045" was published. The Manifesto proclaims the demand for creating a new ideological paradigm for the necessity of "using breakthrough technologies for improvement the man himself and not only his habitat. We think that it is possible and necessary to eliminate aging and even death, to overcome fundamental limits of physical and psychological abilities, defined by restrictions of a biological body" [54].

The appearance of new options of the humankind future can form new moral Decalogues. They differ substantially from Biblical, Muslim, and other confessional variants of ethical codes. Currently, most official documents in bioethics, to which professional medical, biological, and nanotechnological communities refer, are mainly based on principles and approaches developed within the secular liberal bioethics. At the same time, positions of religious concepts, in particular of modern Christian social doctrines, are barely reflected in official international, state, and professional documents even though the substantial part of the society keeps Christian or Muslim ethical norms. The religious understanding of the world first of all is based on the creative mission of God. It is in the creation of all the living: life, a man, the nature. Modern NBIC technologies undermine the belief in creationism. Hence, a necessity arises in both the new interpretation of sacred books and the development of religious ethics.

Speaking about technological challenges, modern researchers and scientists cannot help but use the chance to express their anxiety and call to vigilance. Analyzing characterizing traits of the modern society (using the American one as an example), an American scientist Nesbitt calls it the Zone Poisoned by Technology, where


nanotechnologies, and cognitive science. The term was introduced in 2002 by Mikhail Roko and William Bainbridge, the authors of the most important for today's work in this direction, the report "Converging Technologies for Improving Human Performance 1" prepared in 2002 in the WTEC [51]. NBIC convergence has not only huge scientific and technological importance. Technological possibilities appearing during the NBIC convergence inevitably will cause serious cultural, philosophical, and social disturbances. In particular, this concerns the revision of traditional understanding of such fundamental notions as life, mind, a human being, nature, existence. It is quite possible that from the certainty based on everyday experience, the humankind has to move to understanding that in the real world there are no clear boundaries between many phenomena, which were previously considered to be of dual nature. First of all, due to recent research, the traditional difference between live and inanimate loses its meaning. In the same way, the difference between a rational system possessing mind and free will and rigidly programmed system is gradually fading. Already today, live beings are created "artificially" with the help of gene engineering. One of these days, it will become possible to create complex live beings (also with the help of nanotechnologies from separate molecular-size elements.) In addition to broadening the boundaries of human creativity, this will also mean the transformation of our understanding of life and death. All this

Also, today we witness futuristic or manifesting scenarios of the development of the human society. In his presentation made already in the autumn of 2010 at the scientific conference "Future talk" in Vienna, which discussed technologies of the future, a futurologist and trans humanist Raymond Kurzweil [52] spoke about fantastic possibilities that could become quite real: in the nearest 20 years, the humankind would be able to make the so-called "reserve copy of a brain," which would contain records of all reminiscences; a person will be able to look though his or her past which will be projected into his eyes: special nano-robots regulating the health of human being will be implanted into his blood system; in the 30s of the current century, the computer will prove existence of the artificial intellect, and it will be able to understand human words as a man does and will be able to pass the Turing test; the implantation of a special chip into the brain which will create virtual reality of "complete submersion" will become feasible; by 2040, a human body will be able to transform into any form which will also be made of a huge number of nano-robots, and all internal organs will be replaced by cybernetic devices. In conclusion, Kurzweil forecasts the coming of the complete "technological singularity" by 2045, the result of which will be turning the Earth into a single gigantic

computer, and gradually this process will involve the whole of Universe [53].

cal abilities, defined by restrictions of a biological body" [54].

In 2011, the "Project 2045" was developed in Russia, and a Manifesto of a strategic public movement "Russia 2045" was published. The Manifesto proclaims the demand for creating a new ideological paradigm for the necessity of "using breakthrough technologies for improvement the man himself and not only his habitat. We think that it is possible and necessary to eliminate aging and even death, to overcome fundamental limits of physical and psychologi-

The appearance of new options of the humankind future can form new moral Decalogues. They differ substantially from Biblical, Muslim, and other confessional variants of ethical codes. Currently, most official documents in bioethics, to which professional medical, biological,

is in the center of bioethical discourse.

112 Reflections on Bioethics


The last 25 years of the twentieth century and the beginning of the twenty-first century gave rise to such a specific phenomenon which the German sociologist Ulrich Beck named "other modern" or "the society of risk" [56]. And we think that he quite correctly stressed the change of the meaning and use of the notion "risk" which from the category of the personal area only moves to the global level.

Second, if the previous century risk was considered to be a result of insufficient development of technologies and scientific knowledge, today risk appears where there is redundancy of technological and scientific progress [57]. This emerges the following questions: "Should we worry about this or leave it to the discretion of scientists-technologists? If we should then are there any humanitarian practices providing our bodily safety and fundamental basics of nature?"

In the Kazan school of bioethics, great attention is paid to the applied nature of bioethics. Updating of applied ethics seems quite natural in this respect. Here, we should remember the meaning given to ethics by classics of antique philosophy Plato and Aristotle. For Plato, ethics being the structural part of philosophic knowledge should teach the art of life. He thought that this was the real and highest possible good for a man [58]. While distinguishing theoretical and applied levels of the philosophical knowledge system, Aristotle also defined their aims as the truth and the good. He included ethics, politics, and economy into applied philosophy, thus emphasizing that ethics was the applied philosophy and so philosophical foundation of ethics is definitive in its character [59]. Judging from all said above, it is possible to make the following assumption: when this or that scientific discipline claims to be bioethics in interdisciplinary discussions, its philosophical origin is logical and crucial.

"*In the framework of applied ethics, the theoretical analysis, public discourse and direct morally responsible decision-making merge together and become a content of a real practice organized correctly. It is a special form of theorization. Theorization directly integrated into the life process, a kind of theorization in the terms of life."* (italics by F.N.) [60]. As a consequence, the interpretation of the meaning of the adjective "applied" related to the noun "ethics" gains a special meaning. In this respect, the view point of Bakshtanovskiy and Samogonov, which states that what it involves is first of all the integration of both sides of ethics—both moral practice and ethical knowledge into the field of reflection about the nature of the applied ethics, seems most trustworthy and well reasoned. This finds its reflection in ethical know-how for the interaction of two sides of applied ethics (rational analysis of moral choice situations, ethical design and modeling, ethical expertise and consulting, etc.). And further, the meaning of the word "applied" used with the noun "ethics" is considered as a supplement understood as a process of moral creative art, concretization procedure, an *act of a moral choice* (italics by F.N.) The concept of these authors considers the modus Vivendi of the applied ethics to be the moral choice, and the applied ethics is defined as "regulatory and value subsystems concretizing moral (business ethics, ethics of journalism, bioethics and etc.) and the theory of concretizing of moral, project-oriented knowledge" [61].

Here, we can speak about concrete types of bioethics, institutionalization of which we witness today, such as biomedical ethics, agrobioethics, sports bioethics, ecological bioethics and global bioethics, scientific bioethics, and so on. The peculiarity of biological aspects of regulatory and value subsystems on this level is the frequent use of the complementarity principle, which presupposes combination of elements of professional codes and regulatory acts with principles of bioethics on a case-by-case basis rather than consistently [64]. **3.** Practical or clinical bioethics is a concrete bioethical expertise or visualization of a problem, which demands to make moral choice right here and now in the situation that (as a rule) is not supported by previous experience in medicine or any other sphere of human activity

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 115

This is translated into bioethical know-how. Examples of these solutions form a bank of bioethical casuistry which becomes a practical and methodological basis of project-oriented "advanced knowledge" that provides research of and transforming influence on "small

The level of clinical bioethics represents the brightest from of "bioethical feasibility." It is here that the identification of bioethical problem and its detection take place. Tischenko emphasizes that "visualization, detection (from the bottom to the top) of the real moral order is a prerequisite of correction, moral healing both of a separate human being and the society in the whole. Bioethics in particular is trying to solve this problem in modern biomedicine by clarifying the essence of relations between moral entities, existing in it, and proposing ways

Speaking about the clinical level of bioethics, it is necessary to emphasize that it is influenced by the American tradition, including the US legislative system as it is based on precedence which does not allow mandatory and generally binding nature and compulsoriness of legal norm and the law. In this case, the question arises as to whether bioethical casuistry is compulsory and valuable. Suffice it to recall the legislative mess with the right to organize ethical committees in the Russian Federation, beginning with the possibility to organize them which first appeared due to the Article 16 of the federal law "On foundations of public health protection in Russian Federation," which was later withdrawn and did not appear in the last federal law "On foundation of public health protection in Russian Federation" passed in 2011 [67]. These three levels of bioethics are closely interconnected. Within the bioethical discourse, the theoretical analysis, public discourse, and direct making of a morally responsible decision fuse together and become the subject matter of a real practice that is properly organized. We would like to point that it is a special form of theorizing which is included into the process of

**1.** Being the interdisciplinary field of knowledge by its birth, bioethics leans toward philosophy by its content's "specific gravity" and reflects results of global social changes affecting

**2.** The subject of bioethics as a new scientific discipline is search, definition of principles, and criteria of moral attitude to all the living, and as a social technology—evaluation and

regulatory-value systems" [65].

life and a special form of responsible decision making.

choice of the moral criteria for the living.

Based on the above, it is possible to make the following conclusions:

the ultimate foundations of man, nature, and the society.

of their arrangement" [66].

A number of researchers divide bioethics into three levels—theoretical, practical, and applied. In particular, philosopher Sedova gives the following explanation:

"Theoretical bioethics is a combination of knowledge about attitude of man to all the living represented in the form of an axiological discourse.

Practical bioethics is the institutionally shaped standardizing regulation and value expertise of the attitude of man to all life forms. Corresponding standards are documented in the form of oaths, charters and declarations, which are not legally binding in their essence.

Applied bioethics is the description of concrete situation of human behavior related to the living" [62].

At the same time, based on the definition of bioethics as a search, assessment, and choice of a criterion of moral attitude to all the living [63], the following definition to these three levels can be proposed:

**1.** The theoretical level is an interdisciplinary and complex analysis of ethical and axiological aspects in theory and practice of various kinds of human activity with respect to the living

In this case, we can speak about concepts and theories (e.g., humanism, utilitarianism, deontology, etc.), which shape and define the moral attitude of a man to the living in historical-cultural and social context. Here, we can lay emphasis on the peculiarities of recurrence and non-recurrence of moral decision making as an axial principle depending on existing technological possibilities of live systems transformation.

**2.** The applied level is bioethical aspects of regulatory and value subsystems of concrete types of activities (medicine, science, politics, sport, agriculture, etc.), which are controlled and regulated by professional codes and moral commandments, laws and regulatory acts, which include those lens of the public discourse.

Here, we can speak about concrete types of bioethics, institutionalization of which we witness today, such as biomedical ethics, agrobioethics, sports bioethics, ecological bioethics and global bioethics, scientific bioethics, and so on. The peculiarity of biological aspects of regulatory and value subsystems on this level is the frequent use of the complementarity principle, which presupposes combination of elements of professional codes and regulatory acts with principles of bioethics on a case-by-case basis rather than consistently [64].

"*In the framework of applied ethics, the theoretical analysis, public discourse and direct morally responsible decision-making merge together and become a content of a real practice organized correctly. It is a special form of theorization. Theorization directly integrated into the life process, a kind of theorization in the terms of life."* (italics by F.N.) [60]. As a consequence, the interpretation of the meaning of the adjective "applied" related to the noun "ethics" gains a special meaning. In this respect, the view point of Bakshtanovskiy and Samogonov, which states that what it involves is first of all the integration of both sides of ethics—both moral practice and ethical knowledge into the field of reflection about the nature of the applied ethics, seems most trustworthy and well reasoned. This finds its reflection in ethical know-how for the interaction of two sides of applied ethics (rational analysis of moral choice situations, ethical design and modeling, ethical expertise and consulting, etc.). And further, the meaning of the word "applied" used with the noun "ethics" is considered as a supplement understood as a process of moral creative art, concretization procedure, an *act of a moral choice* (italics by F.N.) The concept of these authors considers the modus Vivendi of the applied ethics to be the moral choice, and the applied ethics is defined as "regulatory and value subsystems concretizing moral (business ethics, ethics of journalism, bioethics and etc.) and the theory of concretizing of moral, project-oriented

A number of researchers divide bioethics into three levels—theoretical, practical, and applied.

"Theoretical bioethics is a combination of knowledge about attitude of man to all the living

Practical bioethics is the institutionally shaped standardizing regulation and value expertise of the attitude of man to all life forms. Corresponding standards are documented in the form

Applied bioethics is the description of concrete situation of human behavior related to the

At the same time, based on the definition of bioethics as a search, assessment, and choice of a criterion of moral attitude to all the living [63], the following definition to these three levels

**1.** The theoretical level is an interdisciplinary and complex analysis of ethical and axiological aspects in theory and practice of various kinds of human activity with respect to the

In this case, we can speak about concepts and theories (e.g., humanism, utilitarianism, deontology, etc.), which shape and define the moral attitude of a man to the living in historical-cultural and social context. Here, we can lay emphasis on the peculiarities of recurrence and non-recurrence of moral decision making as an axial principle depending

**2.** The applied level is bioethical aspects of regulatory and value subsystems of concrete types of activities (medicine, science, politics, sport, agriculture, etc.), which are controlled and regulated by professional codes and moral commandments, laws and regulatory acts,

of oaths, charters and declarations, which are not legally binding in their essence.

on existing technological possibilities of live systems transformation.

which include those lens of the public discourse.

In particular, philosopher Sedova gives the following explanation:

represented in the form of an axiological discourse.

knowledge" [61].

114 Reflections on Bioethics

living" [62].

living

can be proposed:

**3.** Practical or clinical bioethics is a concrete bioethical expertise or visualization of a problem, which demands to make moral choice right here and now in the situation that (as a rule) is not supported by previous experience in medicine or any other sphere of human activity

This is translated into bioethical know-how. Examples of these solutions form a bank of bioethical casuistry which becomes a practical and methodological basis of project-oriented "advanced knowledge" that provides research of and transforming influence on "small regulatory-value systems" [65].

The level of clinical bioethics represents the brightest from of "bioethical feasibility." It is here that the identification of bioethical problem and its detection take place. Tischenko emphasizes that "visualization, detection (from the bottom to the top) of the real moral order is a prerequisite of correction, moral healing both of a separate human being and the society in the whole. Bioethics in particular is trying to solve this problem in modern biomedicine by clarifying the essence of relations between moral entities, existing in it, and proposing ways of their arrangement" [66].

Speaking about the clinical level of bioethics, it is necessary to emphasize that it is influenced by the American tradition, including the US legislative system as it is based on precedence which does not allow mandatory and generally binding nature and compulsoriness of legal norm and the law. In this case, the question arises as to whether bioethical casuistry is compulsory and valuable. Suffice it to recall the legislative mess with the right to organize ethical committees in the Russian Federation, beginning with the possibility to organize them which first appeared due to the Article 16 of the federal law "On foundations of public health protection in Russian Federation," which was later withdrawn and did not appear in the last federal law "On foundation of public health protection in Russian Federation" passed in 2011 [67].

These three levels of bioethics are closely interconnected. Within the bioethical discourse, the theoretical analysis, public discourse, and direct making of a morally responsible decision fuse together and become the subject matter of a real practice that is properly organized. We would like to point that it is a special form of theorizing which is included into the process of life and a special form of responsible decision making.

Based on the above, it is possible to make the following conclusions:


**3.** Bioethics is a new type of scientific knowledge which is based on procedures and methods of "advanced experience" when the theoretical analysis and gaining new knowledge, public discussion, and practical moral decision making take place simultaneously.

**Author details**

**References**

Nezhmetdinova Farida Tansykovna\* and Guryleva Marina Yuryevna

Kazan State Agrarian University, Member of the International Society of Clinical Bioethics,

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 117

[1] Potter VR. Bioethics: Bridge to the Future. Englewood Cliffs, NJ: Prentice-Hall; 1971. 340 p [2] Callahan D. Bioethics as a discipline. In: Reich WT, editor-in-chief. Encyclopedia of

[4] Potter VR. Bioethics: Bridge to the Future. Englewood Cliffs, NJ: Prentice-Hall; 1971. p. 48 [5] Potter VR. Bioethics: Bridge to the Future. Englewood Cliffs, NJ: Prentice-Hall; 1971. p. 67

[8] Hellegers A. Bioethics center formed. Chemical and Engineering News. Oct 11, 1971. p. 7

[9] Reich WT, editor-in-chief. Encyclopedia of Bioethics 1978. Vol. V1-5. NY; 1995. p. 324 [10] Reich WT. The word "Bioethics": Its birth and the legacies of those who shaped it. Кennedy Institute of Ethics Journal (The Johns Hopkins University Press). 1994;**4**:329 [11] Reich WT. Introduction. In: Reich WT, editor-in-chief. Encyclopedia of Bioethics. Vol.

[14] Reich WT. Introduction. In: Reich WT, editor-in-chief. Encyclopedia of Bioethics. V1-5.

[15] Daniel Callahan. Bioethics as a discipline. In: Reich WT, editor-in-chief. Encyclopedia of

[16] Engelhart Jr HT. The Foundation of Bioethics. Oxford University Press. 1986, 1996. 446 р [17] Tom L, Beauchamp JL, Childress JF. Principles of Biomedical Ethics. Oxford University

[18] Engelhart Jr HT. The Foundation of Bioethics. Oxford University Press; 1996. p. 3

[6] Reich WT, editor-in-chief. Encyclopedia of Bioethics 1978. Vol. V1. NY; 1995. 322 p

[7] Potter VR. Global Bioethics. Michigan State University Press; 1988. p. 72

[12] Potter VR. Global Bioethics. Michigan State University Press; 1988. pp. 74-77

[13] Potter VR. Global Bioethics. Michigan State University Press; 1988. p. 78

[3] Sass H-M. Postscript/Fritz Jar. Essays in Bioethics 1924-1948. 2013. pp. 126-129

\*Address all correspondence to: nadgmi@mail.ru

Bioethics. Vol. V1 . NY; 1995. p. 248

V1-5. NY; 1995. p. XXI

NY; 1995. p. XXI

Press; 1994. 378 p

Bioethics. Vol. 1. NY; 1995. pp. 247-248

National and Local Ethical Committee, Kazan, Russia

**4.** Considering the place and role of bioethics in the conditions of global changes, one can see that its social-regulatory status, the aim of which is to prevent negative consequences of breakthrough technologies, becomes evident.

The present rector of the Kazan State Medical University Professor Sozinov has been the head of the chair of biomedical ethics and medical law since 2003. Due to his efforts, it has become the first in the country among chairs of educational institutions providing teaching bioethics together with legal foundations of health, study of patients' rights, and their implementation in modern conditions as well as rights, responsibilities, and protection of medical workers themselves. The following events were organized in Kazan: the workshop in ethics of clinical trials for members of ethical committees and researchers, the conference in ethics and law, the first Russian congress "Bioethics and human rights," the workshop of the Forum of committees in ethics of the CIS member-countries, the international research and practice conference under the auspices of UNESCO "Gender equality and bioethics," and numerous round tables in ethical and legal issues of health care and medical science within large medical forums. Since 2003, Professor Sozinov has been the head of the Regional Committee in Ethics, and starting from 2006, he is the member of the Russian Committee in Bioethics under the Commission of the Russian Federation for UNESCO and since 2007—the head of the Forum of committees in ethics of the CIS member-countries. Professor Sozinov also is a member of the Managing Council of "The Strategic Initiative for Developing Capacity in Ethical Review (CIDCER)" of the World Health Organization (WHO). The study of ethical-legal problems arising in different fields of medicine (pulmonology, infectious diseases, dentistry, orthopedics and traumatology, obstetrics and gynecology, pediatrics, etc.) is the main scientific direction of the chair.

Today, a great number of books and articles are published, and conferences and symposia are held every year. Significant in this respect is the Encyclopedia of global bioethics which was recently published under the editorship of philosopher Henk Ten Hava and which contains 358 articles by more than 400 authors [66, 68].

In the present time, Kazan studies in the field of bioethics have a comprehensive and interdisciplinary character and cover different fields of medicine and biology, sport, food, and ecological safety. In the recent years, we witness broadening of the discourse in the field of bioethics, and there are studies related to the philosophical analysis of consequences of breakthrough technologies implementation for the solution of global problems.

## **Acknowledgements**

The authors want to thank ANO "Kazan open University of talents 2.0" (ANO "KOUT 2.0") for supporting our publication.

## **Author details**

**3.** Bioethics is a new type of scientific knowledge which is based on procedures and methods of "advanced experience" when the theoretical analysis and gaining new knowledge, pub-

**4.** Considering the place and role of bioethics in the conditions of global changes, one can see that its social-regulatory status, the aim of which is to prevent negative consequences of

The present rector of the Kazan State Medical University Professor Sozinov has been the head of the chair of biomedical ethics and medical law since 2003. Due to his efforts, it has become the first in the country among chairs of educational institutions providing teaching bioethics together with legal foundations of health, study of patients' rights, and their implementation in modern conditions as well as rights, responsibilities, and protection of medical workers themselves. The following events were organized in Kazan: the workshop in ethics of clinical trials for members of ethical committees and researchers, the conference in ethics and law, the first Russian congress "Bioethics and human rights," the workshop of the Forum of committees in ethics of the CIS member-countries, the international research and practice conference under the auspices of UNESCO "Gender equality and bioethics," and numerous round tables in ethical and legal issues of health care and medical science within large medical forums. Since 2003, Professor Sozinov has been the head of the Regional Committee in Ethics, and starting from 2006, he is the member of the Russian Committee in Bioethics under the Commission of the Russian Federation for UNESCO and since 2007—the head of the Forum of committees in ethics of the CIS member-countries. Professor Sozinov also is a member of the Managing Council of "The Strategic Initiative for Developing Capacity in Ethical Review (CIDCER)" of the World Health Organization (WHO). The study of ethical-legal problems arising in different fields of medicine (pulmonology, infectious diseases, dentistry, orthopedics and traumatology, obstetrics and gynecology, pediatrics, etc.) is the main scientific direc-

Today, a great number of books and articles are published, and conferences and symposia are held every year. Significant in this respect is the Encyclopedia of global bioethics which was recently published under the editorship of philosopher Henk Ten Hava and which contains

In the present time, Kazan studies in the field of bioethics have a comprehensive and interdisciplinary character and cover different fields of medicine and biology, sport, food, and ecological safety. In the recent years, we witness broadening of the discourse in the field of bioethics, and there are studies related to the philosophical analysis of consequences of break-

The authors want to thank ANO "Kazan open University of talents 2.0" (ANO "KOUT 2.0")

through technologies implementation for the solution of global problems.

lic discussion, and practical moral decision making take place simultaneously.

breakthrough technologies, becomes evident.

tion of the chair.

116 Reflections on Bioethics

**Acknowledgements**

for supporting our publication.

358 articles by more than 400 authors [66, 68].

Nezhmetdinova Farida Tansykovna\* and Guryleva Marina Yuryevna

\*Address all correspondence to: nadgmi@mail.ru

Kazan State Agrarian University, Member of the International Society of Clinical Bioethics, National and Local Ethical Committee, Kazan, Russia

#### **References**


[19] Yudin BG*,* Frolov IT. The ethics of science. Problems and Discussions. Politizdat; 1986. pp. 80-81

[41] Siluyanova V. Anthropology of Disease. Publishing House of Sretensky Monastery;

Russian School of Bioethics: History and the Present http://dx.doi.org/10.5772/intechopen.74526 119

[42] Universal Declaration of Human Rights. 1948. Available from: http://www.un.org/en/

[43] Medical Anthropology and Bioethics. Available from: http://www.medanthro.ru/

[44] Nezhmetdinova FT, Islanova NN. Law and Medicine: Bioethics the Basics. Textbook.

[45] Nezhmetdinova F. Agrobioethics and new types of financial viability. In: VI-th National Congress on Bioethics Sep 20-23, 2010, Kyiv, Ukraine. Materials and Research Work.

[46] Nezhmetdinova F. 2013. Global challenges and globalization of bioethics. Croatian

[47] Nezhmetdinova F. Bioethics: Theory and practice of moral choice in modern science. In: The 10th Conference of International Society for Clinical Bioethics (ISCB), Aug 30-31,

[48] Nezhmetdinova F. Agrobioethics as mediation technology in the conflict between supporters and opponents of food products with GMO. Bioethics and medical ethics: A dialogue of the 21st century. In: Collection of Scientific Works on Materials of the International Scientific Conference, Oct 10-11, 2014, Kazan, Russia. (Programme and abstracts, Tsuyoshi A, Yudin BG, Nezhmetdinova FT, Tishchenko PD, Guryleva ME, Sedov NN, Mushiake S, Borgia L, Griffo D, Mima T, Kubar OI, Kawahara N, Obasi M, Pelicic G, Shimoda M, Morimoto S, Maksimov IL, Tomashevich L, Haas M, and others,

2013. Main Theme: Reconstructing Bioethics. Kushiro, Hokkaido, Japan. 2014

Scientific Publication). Kazan: Publishing House of KSMU; 2014. pp. 48-49

[49] Report on Convergent technologies NBIC. Available from: http://www.wtec.org/ ConvergingTechnologies/Report/NBIC\_report.pdf [Accessed: Dec 12, 2017]

[50] Kovalchuk MV. Convergence of sciences and technologies – Break in future. The Russian Nanotechnologies. Jan–Feb 2001;**6**(1-2):13-24. Available from: www.nanorf.ru [Accessed:

[51] Roco MC, Bainbridge WS, editors. Converging Technologies for Improving Human Performance. Nanotechnology, Biotechnology, Information Technology and Cognitive Technology. NSF/DOC – Sponsored Report. Arlington, Virginia: National Science Foundation; 2002. Available from: http://www.wtec.org/ConvergingTechnologies/1/

[52] Grossman L. 2045: The year man becomes immortal. TIME Magazine. Thursday, Feb 10, 2011. Available from: http://www.time.com/time/health/article/0,8599,2048138,00.html

[53] Raymond, Kurzweil. When a Person Becomes Immortal. Available from: http://www. time.com/time/health/article/0,8599,2048138,00.html [Accessed: Dec 12, 2017]

udhrbook/pdf/udhr\_booklet\_en\_web.pdf [Accessed: Dec 12, 2017]

Medical Journal. Feb 2013;**54**(1):83-85. DOI: 10.3325/cmj.2013.54.83

Kazan: Publishing House "Printing House". 1998. 280 p

2007. 304 p

[Accessed: Dec 12, 2017]

Kiev. 2010. pp. 88-89

Dec 12, 2017]

NBIC\_report.pdf [Accessed: Dec 12, 2017]

[Accessed: Dec 12, 2017]


[41] Siluyanova V. Anthropology of Disease. Publishing House of Sretensky Monastery; 2007. 304 p

[19] Yudin BG*,* Frolov IT. The ethics of science. Problems and Discussions. Politizdat; 1986.

[20] Yudin BG. To bioethics I've had a difficult path. The appearance of the scientist.

[23] Yudin BG. Ethical and Legal Aspects of the Project "Human Genome". Moscow; 1998

[24] Yudin BG. Bioethics: Questions and answers. (co-author with Tishchenko PD). Progress-

[25] Yudin BG. In: Yudin BG, editor. Human Potential as a Critical Resource of Russia.

[26] Yudin BG. Human expertise. To the rationale of the research project. Val. A. Lukov. 2006 [27] Yudin BG. Philosophy of Biomedical Research: The Ethos of Science in the Beginning of

[29] Tishchenko PD.The phenomenon of "bioethics". Questions of Philosophy. 1992;**3**:104-113 [30] Tishchenko PD. To the beginnings of bioethics. Questions of Philosophy. 1994;**3**:62-75

the Third Millennium. Moscow: Institute for Human Science; 2004. p. 48 [28] Human. Available from: http://www.chelovek21.ru/ [Accessed: Dec 12, 2017]

[31] Tishchenko PD. Bio-authority in the Age of Biotechnology. IPHRAS; 2001. 137 p

[32] Tishchenko PD. To the beginnings of bioethics. Questions of Philosophy. 1994;**3**:16

[33] Tishchenko PD. Again about the need for humanitarian expertise. In: Tishchenko PD, editor. Workbooks on Bioethics. Vol. 16. (co-authored with Yudin BG, Stepanova GB,

[34] Tishchenko PD. Social technologies and transdisciplinary innovation foundation. In: Workbooks on Bioethics. Issue 14. Transdisciplinarity, Nanotechnology and Innovation. Moscow: Publishing House of Moscow Humanity University, IFRANE; 2012. pp. 11-16

[36] Sedova NN, Petrov AV. The Concept of Human Rights in Medicine. Part 1. Volgograd:

[37] Sedova NN, Ertel LA. Law and ethics in Pediatrics: The problem of informed consent.

[39] Siluyanova V. Modern Medicine and Orthodoxy. The Holy Trinity St. Sergius Lavra:

[38] Bioethics. Available from: http://journal-bioethics.ru/ [Accessed: Dec 12, 2017]

Knowledge, Understanding and Skills. 2006;**1**:96

[22] Yudin BG. Bioethics: Principles, Rules, Problems. Moscow; 1998

[21] Yudin BG. Introduction to bioethics. 1998

pp. 80-81

118 Reflections on Bioethics

Tradition, 2005

IPhRAS; 2007

Askarinam AI). 2013. pp. 5-11

Publishing House of VolGMU; 2004

[40] Siluyanova V. Ethics of treatment. 2001. 208 p

Progress. 2004

[35] Sedova NN. Legal foundations of bioethics. Triumph. 2004

Publishing House of Moscow Metochion; 1998. 204 p


[54] Manifesto of the Strategic Social Movement "Russia 2045". Available from: http:// www.2045.ru/manifest [Accessed: Dec 12, 2017]

**Section 3**

**Bioethics and Technology**


**Bioethics and Technology**

[54] Manifesto of the Strategic Social Movement "Russia 2045". Available from: http://

[55] Nesbit J. High technology, deep humanity. Technologies and our searches of sense. John Nesbit with the Assistance of Nana Nesbit and Douglas Fillips. Moscow: Nuclear

[57] Sadovnichy VA. Knowledge and wisdom in the being globalized world. In: Sadovnichy VA, editor. The Report at Plenary Session of the IV Russian Philosophical Congress "Philosophy and the Civilization Future". May 24, 2005. Moscow State University; 2005.

[58] Reale G, Antiseri D. Western Philosophy from the Origins to the Present Day. I.Antiquity.

[59] Reale G, Antiseri D. Western Philosophy from the Origins to the Present Day. I.Antiquity.

[61] Bakštanovskij VI, Somohano JV. Applied ethics: Idea, reason, way of being. Questions of

[62] Sedova NN. All laws were once moral norms, but not all moral norms become laws.

[63] Nezhmetdinova FT. The problem field of bioethical discourse: new approaches. Materials of the IV Russian Philosophical Congress National Conference on "Bioethics: Actual Problems". In: Abstracts and Presentations IV Russian Congress of Philosophy.

[64] Nezhmetdinova FT. Integral character of bioethics or the expansion of the field of bioethical discourse. Philosophical problems of biology and medicine: Issue 3: Traditions and innovations. In: Proceedings of Annual All-Russia. Scientific.-Pract. Conf. Publishing

[65] Nezhmetdinova FT. Bioethics in the context of scientific strategies. In: Proceedings of the Saratov University. Vol. 2. T.9. Series. Philosophy, Psychology, Pedagogy. 2009.

[66] Tishchenko PD. Modern biotechnology in a culture of the "other modernism". Philosophy Mathematics and Technical Sciences. Under the General Editorship of

[67] Federal Law of Russian Federation. On Foundations of Public Health Protection in Russian Federation. Available from: http://www.consultant.ru/document/cons\_doc\_

[68] Encyclopedia of Global Bioethics. H enk Ten Hava Edt. Springer International Publishing;

Professor SA. Lebedev: Textbook for Universities. Academic Project. 2006. 588 p

[56] Beck U. Risk Society: Towards a New Modernity. Frankfurt: Suhrkamp; 1986. 384 p

www.2045.ru/manifest [Accessed: Dec 12, 2017]

Publishing House "Petropolis"; 1994. pp. 118-125

Publishing House "Petropolis"; 1994. pp. 155-161

[60] Huseynov A, Apresyan RG. Ethics. Gardariki. 2005. 393 p

Vol. 2. Moscow: Modern Notebooks; 2005. pp. 684-685

Heating Plant: TransitBook; 2005

pp. 18-19

120 Reflections on Bioethics

pp. 31-35

Philosophy. 2007;**9**:39-40

Journal "Bioethics". 2009;**1**:45-44

House "Printberri"; 2009. pp. 170-173

LAW\_121895/ [Accessed: Dec 12, 2017]

2016. p. XXXVI, 3030. ISBN: 978-3-319-09482-3

**Chapter 7**

**Provisional chapter**

**Marching for 3D Printing: Its Potential to Promoting**

**Marching for 3D Printing: Its Potential to Promoting** 

Technology has the capacity for helping African citizens realize their basic rights. The recent introduction of the disruptive technology—3D printing—has the potential to impact millions of lives through a variety of revolutionary medical solutions, including surgery and the treatment of intractable health conditions. As the technology progresses, so does the practical enjoyment of health rights. This chapter argues that the human rights-based approach to 3D printing technology can be helpful in focusing discussions and actions on health well-being and security for individuals in Africa. Having first analyzed the impact of the technology in revolutionizing healthcare, the chapter provides an overview of the complex health challenges this young continent is faced with. Further, it also explores the most relevant African regional laws and standards, guidelines and policy initiatives requiring African governments to use technologies that can advance the human right to health. It concludes that the healthcare agenda of African countries needs to be better integrated and coordinated to ensure that the technologies have a positive impact on health rights. It further concludes that the African Union Commission should promote the researching and utilization of this technology in the implementation

of national health policies and strategies of African countries.

**Keywords:** 3D printing, access to healthcare, Africa, human rights, technology

Relatively new in its adoption, 3D printing technology is a rapidly expanding method of manufacturing that has found numerous applications in areas such as automotive, aerospace and defense industries [19]. 3D or three-dimensional object printing is an additive manufacturing process that creates a physical object from a digital design. It is a set of processes in

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

DOI: 10.5772/intechopen.75649

**Access to Healthcare in Africa**

**Access to Healthcare in Africa**

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.75649

Solomon Tekle Abegaz

Solomon Tekle Abegaz

**Abstract**

**1. Introduction**

#### **Marching for 3D Printing: Its Potential to Promoting Access to Healthcare in Africa Marching for 3D Printing: Its Potential to Promoting Access to Healthcare in Africa**

DOI: 10.5772/intechopen.75649

Solomon Tekle Abegaz Solomon Tekle Abegaz

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.75649

#### **Abstract**

Technology has the capacity for helping African citizens realize their basic rights. The recent introduction of the disruptive technology—3D printing—has the potential to impact millions of lives through a variety of revolutionary medical solutions, including surgery and the treatment of intractable health conditions. As the technology progresses, so does the practical enjoyment of health rights. This chapter argues that the human rights-based approach to 3D printing technology can be helpful in focusing discussions and actions on health well-being and security for individuals in Africa. Having first analyzed the impact of the technology in revolutionizing healthcare, the chapter provides an overview of the complex health challenges this young continent is faced with. Further, it also explores the most relevant African regional laws and standards, guidelines and policy initiatives requiring African governments to use technologies that can advance the human right to health. It concludes that the healthcare agenda of African countries needs to be better integrated and coordinated to ensure that the technologies have a positive impact on health rights. It further concludes that the African Union Commission should promote the researching and utilization of this technology in the implementation of national health policies and strategies of African countries.

**Keywords:** 3D printing, access to healthcare, Africa, human rights, technology

## **1. Introduction**

Relatively new in its adoption, 3D printing technology is a rapidly expanding method of manufacturing that has found numerous applications in areas such as automotive, aerospace and defense industries [19]. 3D or three-dimensional object printing is an additive manufacturing process that creates a physical object from a digital design. It is a set of processes in

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

which material is joined or solidified under computer control to create a three-dimensional object, with material being added together. 3D Printing is used in both rapid prototyping and additive manufacturing [13]. In the realm of health, the introduction of the disruptive technology—3D printing—has the potential to impact on millions of lives through a variety of revolutionary medical solutions including surgery and the treatment of otherwise difficult health conditions. The application of technology in the area of health is wide ranging. 3D printing can help generate a part of the human body that is an accurate replicate of a patient's own structure. Experts have developed 3D printed skin for burn victims and airway splints for babies. Also, 3D printed models made of different materials representing bone, organs and soft tissue are produced in a single print procedure. 3D printers are also playing significant roles in improving the success rates of stages, but first tests are looking promising in a variety of areas, operations and for crafting amazing artifacts. Many 3D printed medical solutions are still in their experimental stage.

medical application, section three assesses the situation of access to healthcare as a challenge in Africa and the African countries' obligation to create conditions which would assure to all medical services and medical attention in the event of sickness of their needy population. Capitalizing on the State obligation to make healthcare available and accessible, section four and five are allocated for the discussion on the essentials of utilizing the benefits of 3D technology as a human right to address access to healthcare gaps in Africa. Finally, the chapter

Marching for 3D Printing: Its Potential to Promoting Access to Healthcare in Africa

http://dx.doi.org/10.5772/intechopen.75649

125

To do this research, the writer reviewed the scholarly literature, reports, technology-focused websites, human rights law and relevant organizational statements. The chapter relies heavily on elaborations given by relevant United Nations (UN) treaty bodies to identify substantive rights of access to healthcare and the obligation they entail against African governments that signed relevant human rights treaties. The sources for institutional statements are the primary websites of UN agencies and treaty bodies, major government bi-lateral organizations and international Non-Governmental Organizations (NGOs) working actively in health. The overall objective is to promote the capitalization of the technology by informing the African governments and people of Africa, disseminating information, educating people and popularizing the subject so people can claivm the benefit of the technology. It is hoped that the work will eventually lead to leveraging 3D printing as a driving force in Africa's health rights'

**2. Evolution of 3D technology and its utilization in the healthcare**

Undoubtedly, technology can be utilized to disrupt or promote human security. Technology can facilitate repression through censorship of expression, block or filter access to information, monitor online activity and more effectively and efficiently control populations than in the pre-digital world [35]. Equally, it can also be innovatively, creatively and very effectively used to sensitize communities regarding issues that require advocacy, promotion and protec-

An example of innovative technology that recently emerged with many benefits for human security is 3D printing. The modern history of 3D printing dates back to the 1980s when Charles Hull invented the stereo-lithography apparatus (SLA) Printer around 1987 [24]. Since then, there is an ever-growing list of astounding accomplishments using 3D printing. In 2004 and 2005, a Chinese company WinSun developed a 3D printing spray nozzle and automatic material feeding systems. Three years later, in 2008, they printed an actual wall for a building [27]. In 2015 WinSun printed a five-storey residential apartment building [27]. But they did not stop there. To top off this feat, they also built a 3D printed 1100 square meter villa that came complete with internal and external decorations. Today, the technology is expanding rapidly; almost every week new printers and printing materials offering novel possibilities as well as excfiting new applications appear [19]. In the case of Dubai-based construction firm Cazza Technologies, the company's large robotic 3D printers already allow them to construct architecturally complex buildings at unprecedented speeds. All of the essential structural

closes by concluding the entire discussion.

safeguards.

tion, such as health rights [18].

Despite the revolution being brought about by technology in the medical sector together with some developments seen on the continent concerning the application of technology in general [13, 14, 15], access to healthcare remains a huge challenge in Africa. The continent is confronted with an increased demand beyond the treatment of AIDS, malaria and other communicable diseases to address the non-communicable ones such as heart attacks and cancers. There are a variety of illnesses throughout the continent—half the population still lacks adequate health services. According to researches, fewer than 50% of Africans have access to modern health facilities [16]. Further, many African countries spend less than 10% of their Gross Domestic Product (GDP) on healthcare. This is in contradiction with African governments' political commitment they made to allocating 15% of their GDP to the health sector pursuant to the Abuja Declaration of 2001. Only very few African countries have implemented this objective [17]. Africa is faced with a dearth of trained healthcare professionals as many of them prefer to live and work in places like the USA and Europe.

In order to address the challenges of access to healthcare to their needy populations, African States have assumed several obligations under regional human rights treaties and non-binding political commitments. These norms and standards obligate States Parties to those treaties and declarations, *inter alia*, to fulfill the right of access to healthcare—a duty is placed on States to actively implement the right. There are several ways in which access to healthcare will be enjoyed, such as through adoption of cost-effective technologies. As the technology progresses, so does the practical enjoyment of health rights. African countries have to embrace technology to close the healthcare gap, thereby performing their heath rights' obligation to their people in accordance with agreed regional human right norms and standards.

Due to the relatively new introduction of the 3D printing, the link between this technology, the human right to healthcare and the obligation of States has not been fully explored. This chapter therefore seeks to critically examine whether the human rights-based approach to 3D printing can be helpful in focusing discussions and actions on health well-being and security of individuals in Africa. The chapter is structured into six sections. Preceded by a brief introduction about 3D printing, health and human rights obligations to healthcare in general in section one, section two describes the 3D technology and its application with a focus on its medical application, section three assesses the situation of access to healthcare as a challenge in Africa and the African countries' obligation to create conditions which would assure to all medical services and medical attention in the event of sickness of their needy population. Capitalizing on the State obligation to make healthcare available and accessible, section four and five are allocated for the discussion on the essentials of utilizing the benefits of 3D technology as a human right to address access to healthcare gaps in Africa. Finally, the chapter closes by concluding the entire discussion.

which material is joined or solidified under computer control to create a three-dimensional object, with material being added together. 3D Printing is used in both rapid prototyping and additive manufacturing [13]. In the realm of health, the introduction of the disruptive technology—3D printing—has the potential to impact on millions of lives through a variety of revolutionary medical solutions including surgery and the treatment of otherwise difficult health conditions. The application of technology in the area of health is wide ranging. 3D printing can help generate a part of the human body that is an accurate replicate of a patient's own structure. Experts have developed 3D printed skin for burn victims and airway splints for babies. Also, 3D printed models made of different materials representing bone, organs and soft tissue are produced in a single print procedure. 3D printers are also playing significant roles in improving the success rates of stages, but first tests are looking promising in a variety of areas, operations and for crafting amazing artifacts. Many 3D printed medical solutions are

Despite the revolution being brought about by technology in the medical sector together with some developments seen on the continent concerning the application of technology in general [13, 14, 15], access to healthcare remains a huge challenge in Africa. The continent is confronted with an increased demand beyond the treatment of AIDS, malaria and other communicable diseases to address the non-communicable ones such as heart attacks and cancers. There are a variety of illnesses throughout the continent—half the population still lacks adequate health services. According to researches, fewer than 50% of Africans have access to modern health facilities [16]. Further, many African countries spend less than 10% of their Gross Domestic Product (GDP) on healthcare. This is in contradiction with African governments' political commitment they made to allocating 15% of their GDP to the health sector pursuant to the Abuja Declaration of 2001. Only very few African countries have implemented this objective [17]. Africa is faced with a dearth of trained healthcare professionals as many of them prefer

In order to address the challenges of access to healthcare to their needy populations, African States have assumed several obligations under regional human rights treaties and non-binding political commitments. These norms and standards obligate States Parties to those treaties and declarations, *inter alia*, to fulfill the right of access to healthcare—a duty is placed on States to actively implement the right. There are several ways in which access to healthcare will be enjoyed, such as through adoption of cost-effective technologies. As the technology progresses, so does the practical enjoyment of health rights. African countries have to embrace technology to close the healthcare gap, thereby performing their heath rights' obligation to

Due to the relatively new introduction of the 3D printing, the link between this technology, the human right to healthcare and the obligation of States has not been fully explored. This chapter therefore seeks to critically examine whether the human rights-based approach to 3D printing can be helpful in focusing discussions and actions on health well-being and security of individuals in Africa. The chapter is structured into six sections. Preceded by a brief introduction about 3D printing, health and human rights obligations to healthcare in general in section one, section two describes the 3D technology and its application with a focus on its

their people in accordance with agreed regional human right norms and standards.

still in their experimental stage.

124 Reflections on Bioethics

to live and work in places like the USA and Europe.

To do this research, the writer reviewed the scholarly literature, reports, technology-focused websites, human rights law and relevant organizational statements. The chapter relies heavily on elaborations given by relevant United Nations (UN) treaty bodies to identify substantive rights of access to healthcare and the obligation they entail against African governments that signed relevant human rights treaties. The sources for institutional statements are the primary websites of UN agencies and treaty bodies, major government bi-lateral organizations and international Non-Governmental Organizations (NGOs) working actively in health. The overall objective is to promote the capitalization of the technology by informing the African governments and people of Africa, disseminating information, educating people and popularizing the subject so people can claivm the benefit of the technology. It is hoped that the work will eventually lead to leveraging 3D printing as a driving force in Africa's health rights' safeguards.

## **2. Evolution of 3D technology and its utilization in the healthcare**

Undoubtedly, technology can be utilized to disrupt or promote human security. Technology can facilitate repression through censorship of expression, block or filter access to information, monitor online activity and more effectively and efficiently control populations than in the pre-digital world [35]. Equally, it can also be innovatively, creatively and very effectively used to sensitize communities regarding issues that require advocacy, promotion and protection, such as health rights [18].

An example of innovative technology that recently emerged with many benefits for human security is 3D printing. The modern history of 3D printing dates back to the 1980s when Charles Hull invented the stereo-lithography apparatus (SLA) Printer around 1987 [24]. Since then, there is an ever-growing list of astounding accomplishments using 3D printing. In 2004 and 2005, a Chinese company WinSun developed a 3D printing spray nozzle and automatic material feeding systems. Three years later, in 2008, they printed an actual wall for a building [27]. In 2015 WinSun printed a five-storey residential apartment building [27]. But they did not stop there. To top off this feat, they also built a 3D printed 1100 square meter villa that came complete with internal and external decorations. Today, the technology is expanding rapidly; almost every week new printers and printing materials offering novel possibilities as well as excfiting new applications appear [19]. In the case of Dubai-based construction firm Cazza Technologies, the company's large robotic 3D printers already allow them to construct architecturally complex buildings at unprecedented speeds. All of the essential structural components for tall buildings, including reinforcements with steer rebar, can be 3D printed using this technology [20]. The leading countries in the world immersed with this technology are the USA followed by the United Kingdom and New Zealand.

reason, patients in Sub-Saharan *Africa, thus have* very *limited* or no access to *healthcare* clinics and basic *health. The section that follows gives an overview of some of the challenges of healthcare* 

Marching for 3D Printing: Its Potential to Promoting Access to Healthcare in Africa

http://dx.doi.org/10.5772/intechopen.75649

127

Not all things in Africa are going bad, despite that it is considered as a backward or dark continent. There are initiatives in the health sector that are moving in the right way. A large number of African countries, such as Senegal, Ghana, Gabon, Cote d'Ivoire, Kenya and Benin, have begun to work at setting up various types of universal medical insurance coverage in an effort to reduce social inequalities. In addition, international solidarity (Global fund, Gates Foundation, etc.) and pressures from civil society have made possible a number of successes against diseases such as onchocerciasis (river blindness), polio, human immune-deficiency virus and tuberculosis. Here, mention must be made of the 300 or so medical doctors trained at the School of Medicine in Dakar (Senegal) by French professionals between 1918 and 1950, who made a major contribution to the almost complete eradication of the epidemic and endemic diseases that took a heavy toll on West African peoples, such as trypanosomiasis (sleeping sickness), plague, yellow fever and smallpox [30]. As a result, Africa's healthcare

Despite the efforts made in improving the healthcare systems by African countries, enormous challenges exist within this sector. Unfortunately, preventable deaths of children under five remain very high in Sub-Saharan *Africa* due to poor *access* to timely and quality *healthcare* interventions [28]. While child mortality rates have plummeted since the 1990s, evidence shows that progress on its reduction in most developing countries has witnessed a widening *gap* as well as a concentration of 'under-five' deaths in the most deprived communities [28]. Eighty-three per cent of the highest number of people in rural areas who are not covered by essential *healthcare* services is in *Africa*. However, it is not only rural Africa that the center of access to healthcare is a challenge. It seems even those who lead Africa are not in a different position. It is not uncommon to see many African leaders and government officials traveling to get their medical treatment abroad. Ian Taylor has observed that from 2000 to 2012, 10 African heads of states who have died from natural causes had been receiving medical care abroad and except 2, the rest have died abroad while receiving treatment [29]. This demonstrates that African leaders lack confidence in their own country's healthcare systems. A failure to invest in national healthcare systems in Africa, which ultimately will lead to extreme shortages of healthcare facilities, goods and professional personnel, is the potential cause of

Another unfortunate fact in Africa is it bears one-quarter of the global disease burden, yet has only 2% of the world's doctors. While medical professionals in neuron-related diseases are in demand, whether in the area of neurosurgeons, or neurologists, or neuroradiologists, there is not a single facility in all of sub-Saharan Africa (except South Africa) dedicated to diseases of the nervous system on the level of the criteria followed in the countries of the northern hemisphere [30]. Unfortunately, the ratio of neurosurgeon/capita in sub-Saharan

**3. Challenges to healthcare in Africa: An overview**

coverage to the rural population has grown exponentially.

*service in the region.*

the problem.

Coming to the medical application of the technology, this is rapidly creating new ways by which the medical industry can enhance our lives and save billions of dollars in healthcare costs. As highlighted in the introductory section, the additive manufacturing applications within the medical community are diverse. It is recognized that medical uses for 3D printing, both actual and potential, will bring revolutionary changes [21]. They can be organized into several broad categories including: creation of customized prosthetics, implants and anatomical models, tissue and organ fabrication, manufacturing of specialty surgical instruments, pharmaceutical research regarding drug fabrication, dosage forms, delivery and discovery as well as manufacturing medical devices [24]. Concerning implantation, researchers are now using 3D printers to cheaply create medical devices that can be directly implanted into the human body. Doctors have fashioned 3D-printed splints to help children with rare breathing disorders and have successfully implanted a 3D-printed titanium sternum and ribs into a cancer patient [23]. Benefits provided by application of 3D printing in medicine include not only the customization and personalization of medical products, drugs and equipment but also cost-effectiveness, increased productivity, the democratization of design and manufacturing and enhanced collaboration. The technology enables quick, cost-effective development of new medical devices as well as customized end-use products that improve the delivery and results of a patient's care [26].

In terms of its cost, except in recent years, the average cost of a 3D printer was floating around the \$50k mark, but due to consumerism and an increase in demand and subsequently production, one can now purchase a respectable 3D printer for the substantially lower cost of \$1800 [27]. If that is still too expensive for our pockets, there is even a \$49 3D printer available for pre-order on Kick starter [27]. Despite the seeming affordability of the technology in some areas, it is the majority of the Western world that embraces the benefits of advanced technology, with Sub-Saharan Africa still working to provide for the most basic needs such as adequate healthcare, food and sanitation. Healthcare development without an eye toward improving technological capacities is likely to further hamper Sub-Saharan Africa's overall well-being [1].

Whereas 3D technology is not an end in itself, its effective usage empowers people and communities to become self-sufficient in meeting their basic needs and reach their full potential. The 3D technology has several connected advantages for the continent Africa, ranging from the provision of an impetus to the democratization process and good governance; facilitating Africa's integration into the new information society by use of its cultural diversity as a leverage; helpful tools for a wide range of applications such as remote sensing and environmental, agricultural and infra-structural planning. While technology in general and 3D printing in particular offers several of these possibilities to promote healthcare and the overall the development of the African region, there is limited influence of technology in healthcare. The deprivation of technology in general prevents individuals in certain parts of the world, for instance in the countries making up Sub-Saharan Africa, from realizing certain fundamental, internationally recognized rights, such as the right to health [1]. Partly for this reason, patients in Sub-Saharan *Africa, thus have* very *limited* or no access to *healthcare* clinics and basic *health. The section that follows gives an overview of some of the challenges of healthcare service in the region.*

## **3. Challenges to healthcare in Africa: An overview**

components for tall buildings, including reinforcements with steer rebar, can be 3D printed using this technology [20]. The leading countries in the world immersed with this technology

Coming to the medical application of the technology, this is rapidly creating new ways by which the medical industry can enhance our lives and save billions of dollars in healthcare costs. As highlighted in the introductory section, the additive manufacturing applications within the medical community are diverse. It is recognized that medical uses for 3D printing, both actual and potential, will bring revolutionary changes [21]. They can be organized into several broad categories including: creation of customized prosthetics, implants and anatomical models, tissue and organ fabrication, manufacturing of specialty surgical instruments, pharmaceutical research regarding drug fabrication, dosage forms, delivery and discovery as well as manufacturing medical devices [24]. Concerning implantation, researchers are now using 3D printers to cheaply create medical devices that can be directly implanted into the human body. Doctors have fashioned 3D-printed splints to help children with rare breathing disorders and have successfully implanted a 3D-printed titanium sternum and ribs into a cancer patient [23]. Benefits provided by application of 3D printing in medicine include not only the customization and personalization of medical products, drugs and equipment but also cost-effectiveness, increased productivity, the democratization of design and manufacturing and enhanced collaboration. The technology enables quick, cost-effective development of new medical devices as well as customized end-use products that improve the delivery and

In terms of its cost, except in recent years, the average cost of a 3D printer was floating around the \$50k mark, but due to consumerism and an increase in demand and subsequently production, one can now purchase a respectable 3D printer for the substantially lower cost of \$1800 [27]. If that is still too expensive for our pockets, there is even a \$49 3D printer available for pre-order on Kick starter [27]. Despite the seeming affordability of the technology in some areas, it is the majority of the Western world that embraces the benefits of advanced technology, with Sub-Saharan Africa still working to provide for the most basic needs such as adequate healthcare, food and sanitation. Healthcare development without an eye toward improving technological capacities is likely to further hamper Sub-Saharan Africa's overall

Whereas 3D technology is not an end in itself, its effective usage empowers people and communities to become self-sufficient in meeting their basic needs and reach their full potential. The 3D technology has several connected advantages for the continent Africa, ranging from the provision of an impetus to the democratization process and good governance; facilitating Africa's integration into the new information society by use of its cultural diversity as a leverage; helpful tools for a wide range of applications such as remote sensing and environmental, agricultural and infra-structural planning. While technology in general and 3D printing in particular offers several of these possibilities to promote healthcare and the overall the development of the African region, there is limited influence of technology in healthcare. The deprivation of technology in general prevents individuals in certain parts of the world, for instance in the countries making up Sub-Saharan Africa, from realizing certain fundamental, internationally recognized rights, such as the right to health [1]. Partly for this

are the USA followed by the United Kingdom and New Zealand.

results of a patient's care [26].

well-being [1].

126 Reflections on Bioethics

Not all things in Africa are going bad, despite that it is considered as a backward or dark continent. There are initiatives in the health sector that are moving in the right way. A large number of African countries, such as Senegal, Ghana, Gabon, Cote d'Ivoire, Kenya and Benin, have begun to work at setting up various types of universal medical insurance coverage in an effort to reduce social inequalities. In addition, international solidarity (Global fund, Gates Foundation, etc.) and pressures from civil society have made possible a number of successes against diseases such as onchocerciasis (river blindness), polio, human immune-deficiency virus and tuberculosis. Here, mention must be made of the 300 or so medical doctors trained at the School of Medicine in Dakar (Senegal) by French professionals between 1918 and 1950, who made a major contribution to the almost complete eradication of the epidemic and endemic diseases that took a heavy toll on West African peoples, such as trypanosomiasis (sleeping sickness), plague, yellow fever and smallpox [30]. As a result, Africa's healthcare coverage to the rural population has grown exponentially.

Despite the efforts made in improving the healthcare systems by African countries, enormous challenges exist within this sector. Unfortunately, preventable deaths of children under five remain very high in Sub-Saharan *Africa* due to poor *access* to timely and quality *healthcare* interventions [28]. While child mortality rates have plummeted since the 1990s, evidence shows that progress on its reduction in most developing countries has witnessed a widening *gap* as well as a concentration of 'under-five' deaths in the most deprived communities [28]. Eighty-three per cent of the highest number of people in rural areas who are not covered by essential *healthcare* services is in *Africa*. However, it is not only rural Africa that the center of access to healthcare is a challenge. It seems even those who lead Africa are not in a different position. It is not uncommon to see many African leaders and government officials traveling to get their medical treatment abroad. Ian Taylor has observed that from 2000 to 2012, 10 African heads of states who have died from natural causes had been receiving medical care abroad and except 2, the rest have died abroad while receiving treatment [29]. This demonstrates that African leaders lack confidence in their own country's healthcare systems. A failure to invest in national healthcare systems in Africa, which ultimately will lead to extreme shortages of healthcare facilities, goods and professional personnel, is the potential cause of the problem.

Another unfortunate fact in Africa is it bears one-quarter of the global disease burden, yet has only 2% of the world's doctors. While medical professionals in neuron-related diseases are in demand, whether in the area of neurosurgeons, or neurologists, or neuroradiologists, there is not a single facility in all of sub-Saharan Africa (except South Africa) dedicated to diseases of the nervous system on the level of the criteria followed in the countries of the northern hemisphere [30]. Unfortunately, the ratio of neurosurgeon/capita in sub-Saharan is 1/3,000,000 while it is 1:200,000 in the northern hemisphere. On the other hand, in medical imaging, sub-Saharan Africa's ration is 1 MRI/25 million inhabitants, while it is 25 MRIs/ one million inhabitants in the northern hemisphere [30]. Life expectancy in Africa is 15 years lower than the global average because the continent has to deal with the significant burden of epidemics without the infrastructure to fight them. The continent is, according to the Gates Foundation, a mix of new and persistent healthcare challenges [30].

(CEDAW) [32]; the 1989 Convention on the Rights of the Child (CRC) [11] and the Convention on the Rights of Persons with Disabilities [33] stipulate that the right to health is to be enjoyed by everyone without discrimination. Moreover, States have committed themselves to protecting this right through international declarations, domestic legislation [12] and policies and at international conferences. In this way, the right in question has also been proclaimed by resolution 1989/11 of the Commission on Human Rights, the Vienna Declaration and Program of Action of 1993, the Millennium Development Goals (MDGs) and the Sustainable

Marching for 3D Printing: Its Potential to Promoting Access to Healthcare in Africa

http://dx.doi.org/10.5772/intechopen.75649

129

Parallel to global human rights treaties, regional human rights conventions, including the 1996 European Social Charter (as revised) [31], the 1999 Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social And Cultural Rights [7], the 1981 African Charter on Human and People's Rights (also known as the "Banjul Charter") [10], as well as the African Charter on the Rights and Welfare of the Child [9] uphold that the right to access to healthcare is a fundamental human right that needs to be respected, promoted and fulfilled. Every State has ratified at least one international human rights treaty recognizing the right to health. Thus, they have the obligation to respect, protect and fulfill the

The incorporation of health as a human right in the various global and regional treaties implies that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services. Again, the human right to healthcare means that hospitals, clinics, medicines and doctors' services must be accessible, available, acceptable and of good quality for everyone on an equitable basis, where and when needed [3]. Except those obligations that have immediate effect, (i.e., States' immediate obligation in relation to the right to health are that they have to guarantee that the right will be exercised without discrimination of any kind and the obligation to take steps toward the full realization of the right) [3], States have the obligation to progressively realize the right to health over a period of time. Meaning that, States' parties that have ratified a treaty which incorporates the right to health have a specific and continuing obligation to move as expeditiously and effectively as possible toward the full realization of the right. The realization of their obligation may be pursued through numerous, complementary approaches, such as the formulation of health policies or the implementation of health programs, or the adoption of specific legal instruments [3]. This chapter focuses and suggests the African States' obligation to adopt programs aimed at ensuring their healthcare—needy population enjoys the benefits of the 3D

Development Goals (SDGs).

right to healthcare to their needy populations.

technology and its application for the realization of the right.

**healthcare**

**5. The obligation to benefit 3D technology in realizing access to** 

The link between the right to enjoy the benefits of scientific progress and other human rights, notably the right to health, has been underscored. Scientific and technological advancement are crucial in health development and poverty reduction. According to Yvonne Donders, the

Researchers predict that non-communicable diseases such as diabetes, cancer and cardiovascular disease will overtake communicable and nutritional diseases by 2030. Right now communicable diseases such as malaria, pneumonia, Ebola, HIV/AIDS and even leprosy have a negative effect on continental growth [30]. It was in view of addressing the physical and mental challenges that disease or ill-health might bring about to humans that human rights laws promised the right of everyone to the highest attainable standard of physical and mental health, which includes *access* to all medical services.

## **4. Access to healthcare as a human right in Africa**

The African continent is faced with a myriad of human rights challenges—"surveillance, privacy laws, threats, imprisonment, intimidation and killings have been happening across the continent, lending to the assertion that regional institutions with a human rights mandate are largely failing to protect the victims" [18]. However, human rights interests in Africa are not limited to the protection from unlawful detention, freedom from censorship of opinion and arbitrary killings. Equally, human rights are also about the ability to enjoy a variety of facilities, goods, services and conditions necessary for the realization of the highest attainable standard of health [3]. True, ensuring a healthy life is the spindle upon which a person's whole personality and well-being depend. To be without healthcare is a frightening prospect, for death is the inevitable consequence [29]. Access to healthcare helps people identify and seize opportunities to grow and develop and to better their lives and those of their families and communities. It also facilitates an individual's participation in society, in the economy, in government and in the development process itself.

Human rights lay standards, norms and principles—they aim to ensure human well-being. Focusing on the right to health, it is one of the fundamental human rights enshrined in the leading and binding human rights documents, including the Constitution of World Health Organization (WHO), 1946, where health is defined as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" [2]. The preamble further states that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an adequate standard of living [8]. Again, the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) [5]; the 1969 International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) [34]; the 1975 Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) [32]; the 1989 Convention on the Rights of the Child (CRC) [11] and the Convention on the Rights of Persons with Disabilities [33] stipulate that the right to health is to be enjoyed by everyone without discrimination. Moreover, States have committed themselves to protecting this right through international declarations, domestic legislation [12] and policies and at international conferences. In this way, the right in question has also been proclaimed by resolution 1989/11 of the Commission on Human Rights, the Vienna Declaration and Program of Action of 1993, the Millennium Development Goals (MDGs) and the Sustainable Development Goals (SDGs).

is 1/3,000,000 while it is 1:200,000 in the northern hemisphere. On the other hand, in medical imaging, sub-Saharan Africa's ration is 1 MRI/25 million inhabitants, while it is 25 MRIs/ one million inhabitants in the northern hemisphere [30]. Life expectancy in Africa is 15 years lower than the global average because the continent has to deal with the significant burden of epidemics without the infrastructure to fight them. The continent is, according to the Gates

Researchers predict that non-communicable diseases such as diabetes, cancer and cardiovascular disease will overtake communicable and nutritional diseases by 2030. Right now communicable diseases such as malaria, pneumonia, Ebola, HIV/AIDS and even leprosy have a negative effect on continental growth [30]. It was in view of addressing the physical and mental challenges that disease or ill-health might bring about to humans that human rights laws promised the right of everyone to the highest attainable standard of physical and mental

The African continent is faced with a myriad of human rights challenges—"surveillance, privacy laws, threats, imprisonment, intimidation and killings have been happening across the continent, lending to the assertion that regional institutions with a human rights mandate are largely failing to protect the victims" [18]. However, human rights interests in Africa are not limited to the protection from unlawful detention, freedom from censorship of opinion and arbitrary killings. Equally, human rights are also about the ability to enjoy a variety of facilities, goods, services and conditions necessary for the realization of the highest attainable standard of health [3]. True, ensuring a healthy life is the spindle upon which a person's whole personality and well-being depend. To be without healthcare is a frightening prospect, for death is the inevitable consequence [29]. Access to healthcare helps people identify and seize opportunities to grow and develop and to better their lives and those of their families and communities. It also facilitates an individual's participation in society, in the economy, in

Human rights lay standards, norms and principles—they aim to ensure human well-being. Focusing on the right to health, it is one of the fundamental human rights enshrined in the leading and binding human rights documents, including the Constitution of World Health Organization (WHO), 1946, where health is defined as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity" [2]. The preamble further states that "the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." The 1948 Universal Declaration of Human Rights also mentioned health as part of the right to an adequate standard of living [8]. Again, the 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) [5]; the 1969 International Convention on the Elimination of All Forms of Racial Discrimination (ICERD) [34]; the 1975 Convention on the Elimination of All Forms of Discrimination Against Women

Foundation, a mix of new and persistent healthcare challenges [30].

health, which includes *access* to all medical services.

128 Reflections on Bioethics

government and in the development process itself.

**4. Access to healthcare as a human right in Africa**

Parallel to global human rights treaties, regional human rights conventions, including the 1996 European Social Charter (as revised) [31], the 1999 Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social And Cultural Rights [7], the 1981 African Charter on Human and People's Rights (also known as the "Banjul Charter") [10], as well as the African Charter on the Rights and Welfare of the Child [9] uphold that the right to access to healthcare is a fundamental human right that needs to be respected, promoted and fulfilled. Every State has ratified at least one international human rights treaty recognizing the right to health. Thus, they have the obligation to respect, protect and fulfill the right to healthcare to their needy populations.

The incorporation of health as a human right in the various global and regional treaties implies that everyone has the right to the highest attainable standard of physical and mental health, which includes access to all medical services. Again, the human right to healthcare means that hospitals, clinics, medicines and doctors' services must be accessible, available, acceptable and of good quality for everyone on an equitable basis, where and when needed [3]. Except those obligations that have immediate effect, (i.e., States' immediate obligation in relation to the right to health are that they have to guarantee that the right will be exercised without discrimination of any kind and the obligation to take steps toward the full realization of the right) [3], States have the obligation to progressively realize the right to health over a period of time. Meaning that, States' parties that have ratified a treaty which incorporates the right to health have a specific and continuing obligation to move as expeditiously and effectively as possible toward the full realization of the right. The realization of their obligation may be pursued through numerous, complementary approaches, such as the formulation of health policies or the implementation of health programs, or the adoption of specific legal instruments [3]. This chapter focuses and suggests the African States' obligation to adopt programs aimed at ensuring their healthcare—needy population enjoys the benefits of the 3D technology and its application for the realization of the right.

## **5. The obligation to benefit 3D technology in realizing access to healthcare**

The link between the right to enjoy the benefits of scientific progress and other human rights, notably the right to health, has been underscored. Scientific and technological advancement are crucial in health development and poverty reduction. According to Yvonne Donders, the right of individuals to enjoy the benefits of scientific advancement implies the right of access to scientific and technological advancement. In this regard, the African States adoption of the Universal Declaration of Human Rights (UDHR) and ICESCR that guarantee the right to enjoy the benefits of scientific progress and its applications is a step in the right direction [5, 8]. The African States' obligation to healthcare moves further to ratifying global and regional treaties. Equally, they have the responsibility for incorporating into their domestic legal and policy framework an individual's right to enjoy the benefits of the 3D technology (which is a result of advancement or practical application of science) progress and its applications in the area of health. This emanates not only because the enjoyment of benefits of science and its application is a fundamental right, but also the realization of the right to healthcare imposed an obligation on the part of the States to make administrative, financial, educational, social and other measures, including judicial remedies [4].

Using the foregoing mandate, the Commission has made several efforts to promote the realization of the right to healthcare on the continent. For instance, the Commission adopted Resolution 141 (Access to Health and Needed Medicines in Africa) following advocacy by the Human Rights and Access to Medicines Clinical Group, a collaboration of the Centre for Human Rights at the University of Pretoria and the Washington College of Law at American University. In its resolution the Commission states that "access to needed medicines is a fundamental component of the right to health and that States Parties to the African Charter have an obligation to provide

Marching for 3D Printing: Its Potential to Promoting Access to Healthcare in Africa

http://dx.doi.org/10.5772/intechopen.75649

131

In the same vein, the Commission can use a wide range of promotional activities, including dissemination of information, making recommendations on the gaps in access to healthcare on the continent and the need to critically study and design strategies for the application of

Increasingly, African governments express their commitment to the defense of human and peoples' rights of access to healthcare on the continent by issuing various norms and standards as well as setting up various institutions relating to human rights protection and promotion on the continent. Among the various norms included are article 16 of the African Charter on Human and Peoples' Rights, article 14 of the African Charter on Human and Peoples' Rights, Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa, article 14 of the African Charter on the Rights and Welfare of the Child,

Regrettably, in spite of these lofty ideas, the daily lives of Africans do not always manifest the concrete benefits of these initiatives. Africa remains beset, as it were, by gaps in implementing healthcare rights caused by factors such as socio-economic and political problems, corruption, poverty, armed conflicts and the abuse of individuals' fundamental rights. More remains to be done in order to translate the benefits of human rights protection and promotion into the daily healthy lives of the peoples of Africa. To address the challenges, African States must focus on building better healthcare infrastructures. Africa's existing promotional activities need to be catapulted by amalgamating 3D technology in implementation. This needs to hap-

To better adopt the technology, the African Commission should urge African States to guarantee the full scope of access needed to 3D technical applications in medicine. There is a need for developing a communication strategy aimed at strengthening the Commission's corporate identity and the positioning of its activities in the area of advancing medical care. Such a strategy should build and maintain creative and effective communication partnerships, particularly with the technologically developed world; promote 3D technology usage; ensure responsiveness to the rapidly changing 3D technology and environments and advocate for media

3D technology for the progressive realization of the right through available resources.

where appropriate needed medicines, or facilitate access to them" [6].

**6. Conclusion**

pen in a flawless manner.

as well as article 16 the African Youth Charter.

In implementing the right to enjoy the benefits of scientific progress and thereby to foster healthcare services, States are under an obligation to invest, to the maximum possible, in scientific and technological advancement and share the benefits. Against this background, the development of vaccines and medicines against widespread diseases has done much to improve life expectancy. In the same way, science and research in the field of information technology, including mobile telephones, the internet and satellite television, have accelerated the flow of information throughout the world, which has proven particularly beneficial to developing countries. It is thus submitted that African States have the obligation to invest, to the maximum possibility, in 3D technological advancement and share the benefits to promote access to healthcare services. International co-operation and solidarity are equally crucial in this regard for African countries to discharge their obligation. This is especially important for ensuring availability of resources from the international community when resources are scarce within African States.

#### **5.1. Africa Union Commission: Its mandate to promote healthcare in Africa**

The *African* Charter on Human and Peoples' *Rights* is the foremost African legal instrument intended to protect and *promote* human rights and basic freedoms on the continent. As noted previously, the right to healthcare is protected under article 16 of this instrument. In addition, the Charter also crafts mechanisms of promoting the spectrum of rights enshrined there. The African Commission on Human and Peoples' Rights (hereinafter "the African Commission or the Commission") is a mechanism designed to promote human rights [10], including the right of access to healthcare in the region. The Commission is composed of 11 members chosen from among African personalities of the highest reputation, known for their high morality, integrity, impartiality and competence in matters of human and peoples' rights. In particular, the Commission's promotional mandate includes [10]:

*To collect documents, undertake studies and research on African problems in the field of human and peoples' rights, organize seminars, symposia and conferences, disseminate information, encourage national and local institutions concerned with human and peoples' rights, and, should the case arise, give its views or make recommendations to governments;….*

Using the foregoing mandate, the Commission has made several efforts to promote the realization of the right to healthcare on the continent. For instance, the Commission adopted Resolution 141 (Access to Health and Needed Medicines in Africa) following advocacy by the Human Rights and Access to Medicines Clinical Group, a collaboration of the Centre for Human Rights at the University of Pretoria and the Washington College of Law at American University. In its resolution the Commission states that "access to needed medicines is a fundamental component of the right to health and that States Parties to the African Charter have an obligation to provide where appropriate needed medicines, or facilitate access to them" [6].

In the same vein, the Commission can use a wide range of promotional activities, including dissemination of information, making recommendations on the gaps in access to healthcare on the continent and the need to critically study and design strategies for the application of 3D technology for the progressive realization of the right through available resources.

## **6. Conclusion**

right of individuals to enjoy the benefits of scientific advancement implies the right of access to scientific and technological advancement. In this regard, the African States adoption of the Universal Declaration of Human Rights (UDHR) and ICESCR that guarantee the right to enjoy the benefits of scientific progress and its applications is a step in the right direction [5, 8]. The African States' obligation to healthcare moves further to ratifying global and regional treaties. Equally, they have the responsibility for incorporating into their domestic legal and policy framework an individual's right to enjoy the benefits of the 3D technology (which is a result of advancement or practical application of science) progress and its applications in the area of health. This emanates not only because the enjoyment of benefits of science and its application is a fundamental right, but also the realization of the right to healthcare imposed an obligation on the part of the States to make administrative, financial, educational, social

In implementing the right to enjoy the benefits of scientific progress and thereby to foster healthcare services, States are under an obligation to invest, to the maximum possible, in scientific and technological advancement and share the benefits. Against this background, the development of vaccines and medicines against widespread diseases has done much to improve life expectancy. In the same way, science and research in the field of information technology, including mobile telephones, the internet and satellite television, have accelerated the flow of information throughout the world, which has proven particularly beneficial to developing countries. It is thus submitted that African States have the obligation to invest, to the maximum possibility, in 3D technological advancement and share the benefits to promote access to healthcare services. International co-operation and solidarity are equally crucial in this regard for African countries to discharge their obligation. This is especially important for ensuring availability of resources from the international community when

**5.1. Africa Union Commission: Its mandate to promote healthcare in Africa**

The *African* Charter on Human and Peoples' *Rights* is the foremost African legal instrument intended to protect and *promote* human rights and basic freedoms on the continent. As noted previously, the right to healthcare is protected under article 16 of this instrument. In addition, the Charter also crafts mechanisms of promoting the spectrum of rights enshrined there. The African Commission on Human and Peoples' Rights (hereinafter "the African Commission or the Commission") is a mechanism designed to promote human rights [10], including the right of access to healthcare in the region. The Commission is composed of 11 members chosen from among African personalities of the highest reputation, known for their high morality, integrity, impartiality and competence in matters of human and peoples' rights. In particular,

*To collect documents, undertake studies and research on African problems in the field of human and peoples' rights, organize seminars, symposia and conferences, disseminate information, encourage national and local institutions concerned with human and peoples' rights, and, should the case arise, give* 

and other measures, including judicial remedies [4].

130 Reflections on Bioethics

resources are scarce within African States.

the Commission's promotional mandate includes [10]:

*its views or make recommendations to governments;….*

Increasingly, African governments express their commitment to the defense of human and peoples' rights of access to healthcare on the continent by issuing various norms and standards as well as setting up various institutions relating to human rights protection and promotion on the continent. Among the various norms included are article 16 of the African Charter on Human and Peoples' Rights, article 14 of the African Charter on Human and Peoples' Rights, Protocol to the African Charter on Human and Peoples' Rights on the Rights of Women in Africa, article 14 of the African Charter on the Rights and Welfare of the Child, as well as article 16 the African Youth Charter.

Regrettably, in spite of these lofty ideas, the daily lives of Africans do not always manifest the concrete benefits of these initiatives. Africa remains beset, as it were, by gaps in implementing healthcare rights caused by factors such as socio-economic and political problems, corruption, poverty, armed conflicts and the abuse of individuals' fundamental rights. More remains to be done in order to translate the benefits of human rights protection and promotion into the daily healthy lives of the peoples of Africa. To address the challenges, African States must focus on building better healthcare infrastructures. Africa's existing promotional activities need to be catapulted by amalgamating 3D technology in implementation. This needs to happen in a flawless manner.

To better adopt the technology, the African Commission should urge African States to guarantee the full scope of access needed to 3D technical applications in medicine. There is a need for developing a communication strategy aimed at strengthening the Commission's corporate identity and the positioning of its activities in the area of advancing medical care. Such a strategy should build and maintain creative and effective communication partnerships, particularly with the technologically developed world; promote 3D technology usage; ensure responsiveness to the rapidly changing 3D technology and environments and advocate for media liberalization and deregulation to ensure a more central, dynamic and effective contribution of communication to the work of the Commission. Driven by technological convergence, it is here argued that the concentrated use of 3D technology can bring unprecedented comparative advantages to the continent. The knowledge-based economy of the future will depend more and more on the effective use of this technology. Rapid advances in technology coupled with the low-cost of acquiring 3D technology tools are opening new windows of opportunity for Africa to accelerate access to healthcare services. The 3D printing revolution can accelerate Africa's goals in the right to health, fostering intra-regional trade, integration into the global economy, as well as realizing its security needs. This must be reinforced by African governments' political will to improving knowledge, skills and resources and creating collaboration and consensus among key stakeholders.

[4] UN Committee on Economic, Social and Cultural Rights. General comment no. 3. The Nature of States Parties' Obligations. Article 2 of the Covenant. 14 December 1990.

Marching for 3D Printing: Its Potential to Promoting Access to Healthcare in Africa

http://dx.doi.org/10.5772/intechopen.75649

133

[5] UN General Assembly, International Covenant On Economic, Social and Cultural

[6] The African Commission on Human and Peoples' Rights. Resolution on Access to Health

[7] Organization of American States (OAS). Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social and Cultural Rights. November 16,

[8] UN General Assembly, Universal Declaration of Human Rights. December 10, 1948. 217

[9] Organization of African Unity (OAU). African Charter on the Rights and Welfare of the

[10] OAU. African Charter on Human and Peoples' Rights ("Banjul Charter"). June 27, 1981.

[11] UN General Assembly Convention on the Rights of the Child. November 20, 1989.

[13] Christopher B. 3D printing: Third edition. CreateSpace Independent Publishing

[14] 3D Hubs. What is 3D printing?: The definitive guide to additive manufacturing [Internet]. Available from: https://www.3dhubs.com/what-is-3d-printing [Accessed December 25,

[15] Wikipedia. 3D printing [Internet]. Available from: http://en.wikipedia.org/wiki/3D\_

[16] Lily BC. Taking on the Challenges of Health Care in Africa [Internet]. June 16, 2015. Available from: https://www.gsb.stanford.edu/insights/taking-challenges-health-care-

[17] World Health Organization (WTO). The Abuja Declaration: Ten years on [Internet]. Available from: http://www.who.int/healthsystems/publications/Abuja10.pdf [Accessed

[18] Eliot N. The Use of Information and Communications Technology (ICTs) in Human Rights Promotion: A Case Study of the African Commission on Human and Peoples'

[19] Helena D. Applications of 3D printing in healthcare. Polish Journal of Thoracic and

Rights [Thesis]. Msida MSD 2080, Malta: University of Malta; 2015

Cardiovascular Surgery. 2016;**13**(3):283-293. DOI: 10.5114/kitp.2016.62625

Rights. December 16, 1966. United Nations, Treaty Series, 993

and Needed Medicines in Africa. November 24, 2008

CAB/LEG/67/3 rev. 5, 21 I.L.M. 58 1982

printing [Accessed December 14, 2017]

africa [accessed January 21, 2018]

September 23, 2017]

[12] Constitution of the Republic of South Africa. 1996

United Nations, Treaty Series, 1577

Platform; 2016. pp. 1-318

E/1991/23

1999. A-52

Child. 1999

A III

2017]
