The Importance of Ethical Guidelines in Medicine Today[*]

Introduction

In Genesis 8 : 21 it is written that after the flood waters of the deluge had subsided: “when the Lord smelled the pleasing odour, the Lord said in his heart, ‘I will never again curse the ground because of man, for the imagination of man's heart is evil from his youth; neither will I ever again destroy every living creature as I have done’.”

And further on, in Genesis 9 : 13 “I set my bow in the cloud, and it shall be a sign of the covenant between me and the earth, when I bring clouds over the earth and the bow is seen in the clouds.”

God, who theologically must be considered as representing the highest ethical authority, is transformed here from the punishing vengeful God who called down the deluge to a forgiving God. The bow he has set in the clouds can be seen time and again when the threatening clouds disappear and the sun breaks through - the rainbow.

God now leaves man free to choose between good and evil. In his essay “The Myth of Sisyphus” Albert Camus interprets this as indicating that for all practical purposes God no longer exists. Mankind has been abandoned by God and is left helplessly and hopelessly to its own devices and yet must nevertheless attempt to attain happiness in the teeth of the absurd conditio humana. Sisyphus therefore becomes an absurd but happy shifter of stones, who does not despair despite the futility of his actions.

This motif can also be found in many novels by Günther Grass, e.g. in the dialogue in the marriage scene in Ein weites Feld or in Die Rättin.

John Irving, who is unimaginable without Günther Grass, also uses this motif. However, God has not completely abandoned mankind, instead - albeit much later after the exodus of the Children of Israel from Egypt - he provides mankind with guidelines in the form of the Ten Commandments. The Commandments are to be found in Exodus 20. Not without reason were the Commandments chiseled in stone as a sign of their imperishability; their presentation on Mount Sinai stands for the birth of theological ethics.

God now reserves judgment until evolution ends in the apocalypse. Then - or possibly at the end of man's mortal life - God will call every man to account.

Such religious reflections give rise to the question whether the Ten Commandments would not suffice in themselves as guidelines for persons in difficult situations and why we need ethics to deal with the questions posed by our civilisation.

Marion Gräfin Dönhoff put this question to the moral philosopher Hans Jonas in an interview for the newspaper Die Zeit in 1989. At that time Jonas gave the following answer: “The Ten Commandments only provide a framework for our social order and personal conduct. Ethics must embody teachings about how one should act” ([5]).

At the outset this appears to be presumptuous. However, as certain of our actions are actions which are forced upon us and we have to make choices between how we would personally like to act and the rules of the external world in which we live, we continually need new codes of practice for morality, duty and justice, for “thou shalt” and “thou shalt not”.

1 Introductory paper given at the 96th Conference of the German Society for Pediatric Medicine and the 38th Annual Conference of the German Society for Pediatric Surgery, Stuttgart, 14 - 17 September 2000

References

• 1 Einbecker Empfehlungen (revidierte Fassung) . Grenzen ärztlicher Behandlungspflicht bei schwerstgeschädigten Neugeborenen.  MedR. 1992;  206-207
• 2 Empfehlungen der Dtsch . Ges. f. MedR zur Behandlung schwerstgeschädigter Neugeborenen.  GBH und Flett. 1986;  46 665-666
• 3 Holschneider A M. Verantwortungsethik, ein Problem der Gegenwart (Grenzen in der Behandlung angeborener Fehlbildungen).  Dtsch Ärzteblatt. 1989;  86: A: 3060 - 3066, B: 2126 - 2132, C 1856-1859
• 4 Holschneider A M, Holschneider V. Aspekte zur Behandlung Neugeborener mit schwersten angeborenen Fehlbildungen.  Arztrecht. 1990;  33 97-101
• 5 Jonas H. Ein Zeitgespräch mit dem Moralphilosophen Hans Jonas über Euthanasie und Ethik.  Die Zeit. 1989;  35 (25) 9
• 6 Merkel R. Grenzprobleme von Medizin, Ethik und Strafrecht. Vortrag auf der Arbeitstagung Kinderchirurg. Chefärzte. Priem/Chiemsee; 21. 6. 1998
• 7 Venter J C. Der Mensch in der Gen-Falle.  FAZ. 2000;  84 43
• 8 von Weizsäcker V. .  Dtsch Z Nervenheilkunde. 1925;  88 264

1 Introductory paper given at the 96th Conference of the German Society for Pediatric Medicine and the 38th Annual Conference of the German Society for Pediatric Surgery, Stuttgart, 14 - 17 September 2000