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III Biology, medicine and the future of mankind
On Tuesday afternoon the conference heard three presentations which, from quite distinct points of view, evoked some of the complex aspects of interaction between a society as a whole and the various individuals who together make it up. In a session entitled 'Biology, medicine and the future of mankind' one was reminded that both biological theory and medical practice have to a significant extent been marked by a peculiar fixation on the individual organism. Such fixations, however, may be said to have been outdated by developments in both fields; and - almost the same way as in physics - considerations of a more general (and in this case usually social) character must be invoked in order to properly understand and deal with phenomena which surpass the bounds of that which was formerly taken as 'typical' or 'normal'. At the same time, however, it is also clear that this fixation on 'tine individual' (often connected with the name of Virchow) has by no means prevented constant depersonalisation of the doctor-patient relationship; neither has it prevented the utilisation of biological knowledge for purposes of increasing the uniformisation not only of animal and plant cultures, but also of human behaviour. After reading through the papers in this session, one might perhaps say that what they are calling for, then, is a heightened respect for individuality that is rooted both in enhanced forms of socialisation at several distinct levels and in an awareness of what are often social determinants of biological phenomena.
In the first paper Dr Ribes gave a brief sketch of the state of play in biological research in general, and he considered a few of the factors pushing this research forward. He then linked present research prospects to underlying theoretical and philosophical themes, stressing especially the 'relational' character of life itself and the essential place reserved for this 'relational' character in the course of what he distinguished as 'vertical' evolution. Dr Ribes, in turn, demonstrated that questions of social ethics are never far from the surface in the life sciences, and he suggested a series of five basic guidelines pertinent to the utilisation and application of biological knowledge. Questions of evolutionary theory were at the heart of Dr Ribes' paper; and related ones were likewise crucial to Dr Mori's presentation of the views of Japanese ethologist and anthropologist Imanishi Kinji. An important part of Prof. Imanishi's work has been devoted to an understanding of the transition(s?) from primate 'society' to human society; and his own 'big-sociological' approach has been developed in contrast to that of Darwin and (as I learned later from Dr Nakaoka) to some of the positions taken by Engels. Dr Mori began with a quite interesting exposition linking recent developments in biological and behavioural theories with changes in political and social relations; and then went on to attempt an extension of Imanishi's 'bio-sociological' approach to evolution in order to explain the generation of conflicts within contemporary human societies. That his efforts in this last attempt were perhaps less than satisfactory was pointed out sharply by Dr Pandeya in the first intervention in the discussion. Dr Pandeya warned of the dangers of obscurantism and reductionism, which he considered inherent in this effort; he insisted on the importance of formulating concrete analyses of specifically social and political problems.
In the third position paper in this session Dr Milanovic spoke about the necessity of redefining the nature and the scope of the responsibility of the physician. While stressing the continuing historical importance of the responsibility incumbent on the medical practitioner as a member of a profession, Dr Milanovic stated that modern conditions now require the physician to conceive his duties in terms of a social rather than a narrowly professional obligation. It was again Dr Pandeya who added a bit of pepper to discussion on this point when he observed that the improvement of health-care systems around the world cannot be accomplished either by a redefinition of the responsibility of the individual physician or even of that of a national medical community taken by itself, because the main obstacles to effective health care are the transnational corporations dealing in pharmaceuticals and medical equipment and because these corporations are motivated by considerations of profit rather than of health. Dr Tsurumi later on agreed with this point, but, in turn, observed that in Japanese experience it seemed that physicians typically had to make the choice between serving the transnationals and serving the people. Drs Milanovic and Tsurumi can thus be said generally to have put emphasis on social conditions of medical practice, while Dr Pandeya stressed one of its major economic determinants. In the last intervention of the day Dr Rakic argued forcefully that an adequate understanding and treatment of many of the most important diseases nowadays itself requires implementation of a multidisciplinary approach incorporating knowledge not only from the medical and pharmacological, but also from the human and social sciences.
In the midst of the discussion, two interventions were made which bore on the topic of the conference as a whole rather than on the particular questions raised in this third session. In an intervention scheduled originally for the first session, Dr Furtado made the theoretical point that various technologies are important not 'in themselves', but as specific means more or less effective in endowing those who possess them with particular forms of power for transforming the world. Dr Furtado also previewed positions developed in detail in the paper by Dr Vidakovic and noted that since 1945 scientific-technological progress has been dominated by the arms race. Lastly, he differed with
Dr Wallerstein and argued that the balance of world power is now already in the process of being transformed in favour of the Third World countries.
Finally, Dr Holland noted that many new technologies have the capacity to greatly reduce boring and repetitive work; but he also raised the spectre of widespread technological unemployment which might accompany their installation, and he apparently could not concretely envisage basic social changes capable of relieving the burdens of such unemployment. He did, however, mention the pressures for protectionism in certain industrialised countries which are faced with foreign competition based on technological innovation; but he did not consider which sort of countries such protectionism would conceivably be directed against.
Let us now turn once again to the more detailed summaries of the positions taken.
In his paper, La maîtrise de la vie: pour quoi faire? Dr Bruno Ribes gave an overview of certain aspects of current biological and medical research, and he then considered some of the short- and long-term perspectives in these fields. The paper is divided into three sections, the first of which focuses on the dynamics of mastering biological processes and considers some of the factors propelling modern science on towards greater control over life; the second is a critical reflection on what 'life' itself is; and the third then raises and examines the essential question of the purpose to which mankind's increasing scientific and technological abilities can and should be applied.
First of all, then, it is fairly obvious that there are urgent objective problems which necessitate a growing control over various aspects of life. Everyone nowadays is quite well aware, for example, that "industry pollutes and perturbs ecosystems and that we are going to have to give more and more attention to the effects which industry is having on the totality of life: not only on our environment, but certainly also on the strictly physiological conditionings of our contemporaries". Likewise, population growth and consequent deficiencies of food supplies urgently necessitate the development of biological knowledge which will be of use for agriculture and aquaculture. In today's world, and especially in the industrialised countries, the maintenance of individual health is facing severe problems; it is clear that "health is to a large extent jeopardised by our own conditionings [and] our styles of life, not to mention the stress inherent in urban and industrial life". At the national level, greater and greater expenditures have been and are being devoted to cope with worsening conditions of popular health. And, finally "it is clear that [all of] these same problems are being posed at the international level, given the fact that today we are witnessing an extremely rapid degeneration of the genetic patrimony of mankind, with a potential for hereditary illnesses, which, by the way, is increasing in proportion to our progress in mastering life". For example, because diabetics can now survive, their number has multiplied "by 2012 per cent in 28 years"; and because of breakthroughs in overcoming childhood afflictions "the augmentation of mental diseases... is today very considerable: at the present moment most developed countries have about a 2 per cent rate of mentally handicapped people [in their populations]; it is probable that this rate will reach 8 to 10 per cent in the 2050s." Besides the stimulus provided by these problems related to industry, agriculture and human health, it is also "manifest that biological research is being stimulated by formidable interests which are eager to obtain results that will allow them to turn their current investments into profits and which influence the end-results of scholarly research".
These general remarks concerning the perspectives for biological research in the foreseeable future can now be illustrated by considering in turn three concrete directions in which this research "is undoubtedly going to be intensified in a most spectacular way in the years to come". The first of these directions lies in the exploration of the marvellous possibilities that have been opened up by the bacteriological 'industry' - i.e. exploration of the possibilities offered by making bacteria produce a certain number of desired substances, "whether medicines and vaccines (e.g. insulin) or products for current consumption (e.g. silk, which is not a product of the silkworm itself, but rather of bacteria which live in it). Perhaps soon enough it will be possible to produce methanising and de-methanising bacteria. The great dream is to be able to make nitrifying bacteria which will enable plants to fix nitrogen; but in that case it will then be imperatively necessary to produce de-nitrifying bacteria, since it will be necessary to respect the nitrogen cycle in the world. This last eventuality shows that we are being posed with a crucial question: we are capable of doing many things, but, all in all, our knowledge is extremely limited...." It must especially be stressed that contemporary research "unavoidably takes place within a systematic perspective. However, if we do know a certain number of things quite exactly, our knowledge of totalities and of systems is very poor. From this point of view we are acting without a global perspective."
A second area of biological research in which great strides are undoubtedly going to be realised (although illusions here should be guarded against) is that "not of eugenics in the traditional sense, but of direct genetic control, by manipulation of the genes themselves for the purpose of overcoming certain hereditary diseases". This possibility confronts us with a major problem which is especially important for biologists: viz. they act in time, but the full effects of their interventions appear only gradually. In other words, if one knows the power of a particular bomb and sets the detonator, one can predict fairly certainly what results will occur within, say, thirty seconds. However, in dealing with biological processes, the chain of cause and effect is felt in the following generations; i.e. One is acting on long-range temporal processes and, moreover, "in a theoretically irreversible manner". On the other hand, biological intervention in time is now requiring more and more sophisticated forms of compensation: if one succeeds in provoking a particular mutation or alteration, for example, one is then immediately obliged to counterbalance this change in order to re-establish homeostasis. "We are thus becoming involved in a more and more rapid intervention-compensation process... [And] for modern medicine, death occurs when compensation is no longer possible. Now, our control over life - already at the industrial level, given the level of pollution, and probably at the agricultural level as well, given the uniformisation of plant cultures - will oblige us to put into effect more and more accelerated systems of compensation; and it is necessary to admit that in these circumstances we are unable to master the time factor."
A third area in which biological research will continue to come up with surprising breakthroughs is that of the modification of human behaviour. According to Dr Ribes, possibilities developed in this area raise problems that are much more severe than those connected either with bacteriological research or with genetic manipulation. "Without a doubt, we are going to be able to intervene deeply in the processes of the human psyche, and everything seems to indicate that most people will go along with this quite happily", because many of them are living in conditions of misery and stress. "Often without knowing it, many have already let themselves in for highly suspect forms of manipulation." The reader will readily recall certain types of lighting installed in supermarkets in order to psychologically dispose clients to buy more. Dr Ribes also recalled the case of certain schools in which tea-time has been given a novel twist: each student has his cup of tea, but these aren't just innocent refreshments. Students judged apathetic or lackadaisical have their stimulants, troublesome students have their sedatives; but "no-one has taken into account that apathy or troublesomeness, in fact, pertain much more to the psychological than to the physiological order".
The crucial question with which we are faced by the general development of biological knowledge is whether "under the pretext that we have certain powers, we [thereby] have the right to do everything and to let everything be done" that is able to be done. Should we "with ever more temerity exercise the powers that we have acquired over life"?
In answering this crucial practical question, one is led to consider a more theoretical one - viz. what is life? "All biologists look forward to the day when their knowledge will cover all of the structures and processes of a living organism. But even supposing that this goal is attained, we shall still not know what life is. For life is not only a given number of coded, programmed and regulated chemical substances which form a system"; it is also a dynamically constituted totality. Even "assuming that one day we might be capable of constructing a bacterium, we will not really know which dynamic has thereby been initiated or how, starting from such a bacterium, this new life will evolve".
In trying to grasp the essence of life, controversies about evolution constantly keep coming up; and "the problem of the evolution of life is at least as important as the problem of what constitutes it materially". But the debates on evolution are, of course, themselves quite thorny. Is evolution, as Jacques Monod claims, a series of chance events governed by necessity? Or is it, as Motoro Kimura believes, a series of coincidences triggered off by coincidences? On the other hand, do functions determine structures, or do structures determine functions? Without going into the details of such debates, it can be noted that many of the problems undoubtedly spring from our spontaneous representation of evolution "as a sort of rectilinear predetermined process generated by a directing principle.... Actually, evolution must be conceived in a systematic way: provoked by a totality of actions, reactions and regulatory processes, within a four-tiered structure of living particles, organisms, populations and relations between the living being(s) and the environment. In this perspective, structures and functions are in close correlation, reciprocally engendering and reinforcing each other."
This said, two types of evolution should be distinguished. There is first of all what might be termed a 'horizontal' evolution, which moves towards improved functioning within a fixed horizon. "Most of the great biologists have nowadays shown the extent to which living beings are controlled by extremely rigorous structures and by regulatory processes - i.e. by a solid internal necessity. 'Horizontal' evolution refines and reinforces such necessities; it is closely bound up with them; and it works towards a perfecting in accordance with necessity...."
"But inherent in life there is also a 'vertical' evolution which pushes living things - it is not too well known how or why - to enter into qualitatively superior forms of existence...." Now, "among scholars, the debates [about evolution] usually evolve around the question of the perfecting of the individual" and concern horizontal evolution. "In fact, we are unable to understand how, given that the structures of the living being are so necessary and so strictly regulated, it is possible for evolution towards qualitatively superior forms of existence to occur." But the more that one considers this problem, the more it seems that the fundamental dynamic of this vertical evolution consists of "something extremely mysterious inscribed in the depths of the living being" - viz. "its openness towards another living being". This openness is "already manifest at the biomolecular level, since the molecular chain proper to living things is dissymmetrical, and thus able to hook up with other molecular systems". And it is also "more and more evident as one ascends on the ladder of life. Life is always in a state of profound disposition towards the other, constantly awaiting and stimulating the other. Openness towards another living being is inscribed as a structural and structurising law of every form of life." And this openness advances towards vertical evolution "by means of combination or co-penetration with another living being". Thus, it is because a virus penetrates a bacterium that the former is able to modify its genetic make-up. Now, such co-penetration has been constituted by life as a fundamental law, presiding [for example] over the apparition of sexualisation, which is not primarily a law of reproduction [since reproduction had existed long before], but a law of co-penetration, offering an enhanced possibility for the emergence of qualitatively superior forms of life.
"It is necessary here to meditate deeply on what sexualisation means. At the level of bacterial reproduction, the individual divides into two, on an average of once every two hours; there is multiplication or quantification of a single being, two from one. Once sexualisation has appeared, one passes from the order of quantity to that of quality; there is no longer a two from one, but a one from two. More importantly, the entire relational state between living beings becomes essential to life itself. No longer does the individual possess the key to the definition of life, if it is true that the definition of life (as opposed to matter) implies reproduction; the individual shares this definition of life with a partner. Henceforth life is [something common] between two living beings. The unity between two living beings, what sort of reality does it have?" Without being able to answer this question, one is incapable of grasping what life is. The preceding observations lead one to conclude that "all forms of research concerning the finality of life are vain. The position of the finalists is strictly untenable, and that of the anti-finalists is no less so. There is a search and an exploration which passes from living being to living being [and] which moves through and beyond us. Life consists of making the other desperately [a faire l'autre éperdument].... Desperately -i.e. with a great disdain for losses, without knowledge of where things are going to end up, but with the eventuality always present that a breakthrough might be produced into qualitatively higher forms of existence. Anyone who wants to define life must take into full consideration the 'logic' of this dynamic which traverses all living beings. The living being is the in-itself (i.e. Obeying a profound necessity) which never ceases to ex-ist (to go out of itself) in the other. And the more we progress on the scale of living beings, the more we perceive not only that internal necessities become progressively more rigorous, but also that the urgency to ex-ist in the other becomes more and more essential."
According to Dr Ribes, it is imperative in the world today to assume the responsibility inherent in this logic of life and, if possible, "to add to life a supplement of 'logic' ". In this light, several suggestions can be made in regard to perspectives for using the various forms of control over life which are being provided by biological research.
The first suggestion is based on the proposition that the purpose or finality of life consists of "desperately making the other". "There is nowadays a certain divergence among biologists: some of them are carrying out research and trying to understand the 'how' of life; others are concerning themselves immediately with the 'why', so as to assign a finality to life.... [Nevertheless] we are being compelled more and more to recognise - in regard to industry, agriculture and world health policies - that one cannot... propose a 'why' without modulating it with a 'how' ".
Secondly, in regard to the various forms of current research aimed at the modification of human behaviour as well as in regard to the various forms of genetic manipulation, the great concern must not only be that of pushing forward horizontal evolution, of determining life or even 'perfecting' it. While such projects are undoubtedly necessary, "our fundamental aim must be to de-fine life, to determine it and not to shut it up within ready-made moulds or frameworks. This is all the more necessary because life is and must remain adaptive", if it is not to be wiped out. "Quantities which we may today consider as being the most desirable are not necessarily those which will be the best in the world of tomorrow, given probable modifications in the environment as well as transformations in the social order."
Likewise, efforts in the fields of biology "must aim at preserving, restoring and intensifying the relational character of living beings". That is obvious at the theoretical level; but at the practical level, when one sees what is being done or being prepared (particularly in regard to genetic manipulation and modifications of human behaviour), one can justifiably ask to what extent the relational character of human life is going to be safeguarded in the future.
Concomitantly, Dr Ribes then insisted that "the singularity of the individual" be respected in biological research. In particular, "we do not have the right to say straightaway that the biological comes first and thus conditions the psychic; it is often the inverse which is operative - i.e. the psychic determines the biological". Thus, it will not do to intervene too facilely, at the biological level, "for in reality we will only be treating the effects and not the causes of the ailment or afflictions, and the causes are often to be sought within the psychic framework of each individual".
Finally, "it is important for us to preserve the historical character both of particular living beings and of humanity as a whole". According to Dr Ribes, "we are living at a moment of time in history, and it is not our place to level this history off or to normalise it. We do not have the right to prevent mankind - by planning health too quickly or by intervening biologically - from going through the adventure of an emergence, of becoming otherwise. In effect, this adventure of becoming the other is the only real meaning that can be prescribed to life. It is necessary for us to realise today that a biology which would aim at suppressing the other, and at suppressing the adventure of the other in us, even within our psyche, such a biology would be foolish and profoundly illogical."
In his paper, Restructuring a framework for the assessment of science and technology as a driving power for social development: a bio-sociological approach, Dr Mori Yuji extended the anthropological methods developed by Prof. Imanishi Kinji to contemporary power relationships; and he applied Imanishi's non-Darwinian theory of evolution in order to analyse such power relationships at the systems level.
Dr Mori began by remarking that although the social sciences themselves are devoted especially to investigating the unique characteristics of human society and its development, they have, nevertheless, been strongly influenced by the biological sciences. Since the time of Darwin, for example, the theory of biological evolution has acted as a major challenge to social ideas. At the same time, however, developments in biological theory can be shown to reflect the particular social circumstances in which they arise.
The historical merit of Darwin, of course, lay not in the discovery of evolution, but in his having "firmly established a scientific theory to explain the causes of evolution". Nevertheless, the Darwinian approach is marred by what might be called its fixation on the individual organism and its genes. "The quintessence of Darwinism is that: (1) an overproductivity of living beings exceeding the possible bounds of survival occurs; and (2) superior-inferior differences exist between individual organisms, and, hence, as a result of the 'struggle for existence' between these organisms, only the fit are able to survive. In this process natural selection operates." In other words, the 'selection' of 'fit' individuals is left to 'Nature'. This position is common both to Darwinism and to neo-Darwinism; and 'natural selection' defined in this way has "come to be regarded as a major cause of evolution".
"... One of the unique characteristics of modern culture is the existence of the following [contradiction]: on the one hand, people have a high degree of trust in the axiomatic nature of natural laws; on the other, they have a vagueness and uncertainty regarding [the nature of] social laws", and there are few scientific laws explaining specifically social phenomena. In this regard, it is interesting to note that "Darwinism and neo-Darwinism have both been shaped by the influence of a competitive society; however, when evolution [or development] based on competition and [the principle of] the survival of the fittest were established as natural laws, they were also, in fact, accepted as laws governing society. Needless to say, nowadays such ideas have so fully penetrated people's life that they are regarded as common-sense. Moreover, an extreme form of Darwinism, social-Darwinism, is now being emphasised; and ideologies of big-powerism, war and aggression applicable to human society are being marched out." All in the name of the progress of the human species.
Mention of social-Darwinism cannot fail to raise the subject of aggression; and, in this connection, one might recall that in 1963 Konrad Lorenz sparked off a lively debate with his book On Aggression. Lorenz detailed how "both animals and humans are equally endowed with aggressiveness". For animals, however, "aggressive behaviour does not lead to the defeat of the other power but rather becomes a bond of solidarity between the animals"; and thus "aggressive behaviour functions to maintain order in the animal world". With human beings, on the other hand, the manifestation of aggression may lead to killing the other party and may lead to war. "The beginning of the 1960s was the time when the... cold war reached its extreme and the United States' invasion of Vietnam became 'America's Vietnam war'. The formation of Lorenz' theory of aggression and the debates around it could not have possibly occurred in isolation from this historical setting." Yet, without entering fully into the details of this debate, it can be observed that "Lorenz formulated and developed his theory by focusing on the aggressive behaviour of [individual] biological organisms and human beings. In this respect, the core of his theoretical construct is identical with Darwin's".
Another theory based on neo-Darwinism and attempting to analyse human nature and society is socio-biology - a subject which has received considerable publicity since the publication in 1975 of Edward Wilson's Socio-biology: A New Synthesis. "Socio-biology can be defined as an interdisciplinary science drawing on biology (particularly ecology and physiology), psychology and other social sciences. Research covering such fields is also referred to as big-sociology and animal sociology." Leaving aside Wilson's own motivation for his research work, it is clear that the well-publicised debate concerning this scientific theory reflected social tendencies particular to the period of transition from the 1970s to the 1 980s. As noted above, "behind the debate on Lorenz' theory of aggression was the manifest display of human aggression in the Vietnam war.... The identical situation does not exist at present; in fact, it might seem as if behaviour directly exhibiting aggression has already been hidden from view. Still, oppression has not disappeared, nor has opposition to oppression; it seems, rather, as if a powerful, complex, oppressive organization - one that it is difficult to come to grips with - is gradually blanketing the world. Isn't this the reason why the path to liberation is no longer clearly visible?" And it is in the light of the "political, social, cultural and natural crisis of the modern world" that socio-biology is advanced as an attempt at finding a solution to the problems faced by mankind.
How does socio-biology approach these problems, however? If one consults socio-biological literature, it is apparent that at the centre of discussion is the interaction between mind, action and genetic structure. Positions on the different sorts of interaction between these three - e.g. in human beings versus animals -may allow one to throw light on the distinction between instincts and the ability to learn. Nevertheless, like other forms of neo-Darwinism, socio-biological theory is based on the individual organism; and for this reason its statements about society remain open to objection. "Simply adding together human beings and their actions does not make a society. This is the problem in the socio-biological approach to human society."
Now, although any particular science must begin with examining the elements composing a system, at some point or another it is necessary to examine the functioning of the system as a whole. And "the big-sociology of Imanishi Kinji is an example of a non-Darwinian theory of evolution that approaches things from the systems level. Imanishi adopts a holistic point of view". "In contrast to Darwin, who based his theory on the overproductivity of living beings and variations between organisms (i.e. the construction of a theoretical system based on the organism), Imanishi takes into consideration the historical and social nature of a species to construct a theoretical system based not on an organism belonging to a species..., but on a society of species.... That is why his theoretical system is called big-sociology." For Imanishi, every biological species constitutes a society; and "society is a universal phenomenon", of which human society is only one example. Interspecies sociology and intraspecies sociology constitute the two main divisions of big-sociology; "the former takes into consideration geographical and historical factors; the latter... includes the level of the individual organism and of a society of species".
In contrast to the Darwinian tradition, "Imanishi's theory of evolution gives primacy not to genetic mutations within the individual organism, but rather to the way in which an entire species is transformed". Likewise, according to neo-Darwinism, mutation occurs randomly via natural selection; according to Imanishi, however, "mutation is incorporated into a species systematically". Dr Mori stated the major conclusion of this big-sociological theory as follows: "congeneric organisms (which are the same morphologically and functionally, or systematically and behaviourally) must undergo change in the same way when the time for change arrives. Moreover, as a result of these changes brought about by mutation occurring in all the organisms of the species, mutation improves the species' fitness to win." According to Imanishi, the development of human society followed this path.
The formation of herds is a characteristic of higher animals; and "Imanishi stresses the importance of sister relations as the origin of group life among the higher animals. In line with this, it is possible to trace the origin of culture as far back as the establishment of the herd. It was through farming that human beings came to take a completely different evolutionary path from animals. What is of importance here is that farming allowed the production of a social surplus. In contrast to biological evolution, therefore, which occurred by a metamorphosis in the form of the body itself so as to adapt to Nature, human beings evolved as the result of modifying the environment and achieving independence from Nature. To put it another way, human beings evolved through culture. In fact, we can consider that speciation in humans came about through culture and that culture is the same as species in the animal kingdom. What was most important in bringing about [the change from animal to human] was the use of tools. This became technology and is at present referred to as 'science and technology'. The production of social surplus by the use of technological power brought about the stratification of human society, owing to the unequal possession of the surplus. Between societies, too, it is creating a hierarchical structure. As in the animal kingdom's food chain, groups within [human] societies or societies [States] themselves are appearing as predators. In this sense, human beings today are living in a dual hierarchical structure."
Within the big-sociological framework of analysis, "three levels of production and consumption can be distinguished: (1) the organism level; (2) the social level; (3) the political level". In Imanishi's theory, of course, the social level is characteristic of all biological species. The political level, on the other hand, is encountered only in certain human cultures; and "the origin of the political level can be found in the attempts to solve the problem of the possession and distribution of the social surplus that appeared as the result of human beings starting an agricultural life.... [And] the stratification of species society was brought about by political power." Within human societies the social and political levels "generally overlap"; but there is today a great gap between the two which is perhaps exemplified most strikingly by the modern nuclear weapons systems whose "sole function is to play a political role" and which are a "factor impeding social development".
Another example of the current gap between the social and the political levels is seen in regard to the reproduction of the human species, especially with the population explosion in the developing countries, although this is often explained as simply a biological phenomenon. According to Darwin's theory, for example, "the overproductivity of living beings beyond the survival limit becomes the cause of the struggle (competition) for survival and promotes evolution". Thus, it is assumed that an invisible hand is working for progress, and that things are going as best they should. Nevertheless, one cannot fail to remark that the countries affected by population pressure are those which (1)"have been controlled, exploited or oppressed by international predators"; (2)are "rapidly attempting to accumulate social surplus through an internal ruling class of predators"; or (3) are beset by both internal and external predators. According to Imanishi's theory, physical needs in human society are always mediated by culture, and human survival must be guaranteed through culture. In the case of population pressures, "it is not because of overpopulation that poverty and starvation occur"; but, rather, it is more and more difficult to accommodate a growing population when exploitation and oppression are creating poverty and starvation. And "so long as the structure of robbery, exploitation and oppression remain the same", various types of 'aid' will "merely aggravate the situation".
It was noted above that "what gives production activities in human society their unique characteristic is production based on science and technology", and "one can call this culture". It will also be recalled, however, that in the process of evolution there emerged a variety of human cultures which in certain ways resembles the variety of animal species. Yet, whereas different species remain distinct because cross-breeding does not occur, "culture comes into existence through mutual influence and receptivity"; culture tends, in other words, towards universality.
Modern science and technology have "freed production power and brought about social development"; but it cannot be overlooked that they were "perfected in the European world because of the industrial revolution", and thus "their natures were formed against a European social and cultural background". Hence, it is possible to speak of "the cultural element in science and technology". And it is "quite natural that in the European world both [science and technology] have been a consistent whole rooted in society. At the same time, however, it is natural for problems to arise when Western science and technology are transplanted into a society with a different culture". In order for "the universal and general principles of science and technology" to contribute to global social well-being, it is therefore necessary to define and meet the objective needs of the non-European cultural areas. This is "indispensable in order for science and technology to root themselves... as culture" in these societies.
In conclusion, Dr Mori said that "modern science and technology have brought into play enormous,... productive powers and have made possible rapid communication and the high-speed transportation of goods and people". But he wondered whether the very achievements of modern science had not given rise to the - necessarily temporary - illusion that human societies can be manipulated in the same way as things can be. In this regard, one can distinguish two contradictory approaches to social development. "The first is to strengthen social organisation and social order. The second, in contrast, is to increase the amount of freedom - i.e. to expand possibilities. We can say, for example, that modern science and technology have brought about an increase in productivity through the high rate of organization of a production system; on the other hand, however, they have also made the people who work into no more than parts of the production machinery. If this is the case, then modern science and technology are working for the oppression of human beings. So long as an increase in material production and a decrease in work do not tie in to the construction of a social system that increases social and human freedom, it is clear that modern science and technology in their present forms lack the power for [contributing to] social development."
Dr Milanovic next presented a position paper entitled Human aspects of the medical sciences: medical technology and the physician's responsibility. The physician's responsibility is a very delicate matter and cannot rightly be limited to his legally defined duties. If the physician only complies with accepted norms, but does not do all that he should in caring for his patients, he will certainly, for example, feel a burden on his conscience. The contemporary physician is "torn between rigorous regulations, exceptionally high expectations from society, his own human needs, his other obligations and tasks and his own conscience"; according to Dr Milanovic, he is "in the most complex existential situation, burdened with dilemmas by which no other profession is attended". Let us, then, consider some of the specific problems faced by today's medical practitioner.
A doctor first of all encounters people, his patients, who find themselves in a position or role for which they have not been prepared. The physician can, of course, only effect a cure if there is at least a minimum of co-operation on the part of the patient and his environment; and although it is therefore not legally the physician's responsibility, he is, nevertheless, concerned with the total state of the surroundings and with the existence of cultures that "are in conflict with modern medicine" and human health.
Another specificity of the physician's role derives from "the exceptionally high level of social expectations" which he must fulful. "If the public detects a lack of sympathy with those in affliction, [or if it detects] bureaucracy and formalism in medical organization, it reacts very severely. It would certainly be wrong to advise... the same patience in waiting for urgent medical aid as that shown [towards] the slow rhythm of work in today's administration"; but it is, nevertheless, all too obvious that physicians occupy a very difficult and contradictory position in any society in which 'money makes the world go around'. The disparity between serving the needs of others and lining one's own pocket "will inevitably be expressed in the controversial functioning of medical institutions and the behaviour of the physician". Apart from such 'external distorting influences', however, "the sphere of medicine is an area of creation", in whose "humane character... lies the intention of searching for possibilities of exceeding ourselves and the situations that limit us, for higher forms of unity with our own nature and with other people".
Its own body of special skills and techniques is, of course, another aspect of the specificity of the medical profession. As in other fields, this medical corpus is now too large to be mastered by any one individual. "The constant development of investigations and the application of their results in diagnosis and therapy have brought about continuous specialization", involving, on the one hand, the constant narrowing of specialists' skills, but, on the other, more and more penetration, exactitude and efficiency. This constant specialization, however, has resulted in a "quite unpersonal" relationship between physician and patient, more like that between things than between living people. "The present-day patient... in many respects reminds us of production material travailing on the assembly line"; rarely is a diagnosis made nowadays on the basis of personal contact, knowledge and sympathy. As the economic concerns of large institutions require rational expenditure of time, energy, materials and the greatest possible speed at work, the patient's files may become thicker and thicker, but there is no one person who knows very much about him; and bureaucratic orientations in organization tend to increase the 'collective irresponsibility' of individually responsible experts.
What alternative is there to this situation? The medical profession must, obviously, continue to use modern techniques/technologies, "without which there is no efficient medicine": it must, likewise, continue to observe economic principles. An alternative, however, will require medicine "to return the human character to the relationship between the physician and the patient. Not only biological, chemical and other techniques, but also the human word, a human attitude and understanding on the part of the physician, must again become means by which health is restored."
Another aspect of the social responsibility of the physician is connected to present inequalities in the distribution of and access to medical facilities. For example, in all advanced countries, "regardless of... whether medicine is socialised or practiced privately", patients seek access to first-class medicine in serious and complicated cases; and sociological investigations show that patients with more favourable social status (higher education, income, reputation, political power, etc.) tend to frequent the more reputable medical institutions. Although this fact highlights the extent to which the distribution of resources constitute's "a limiting factor... [for] both the professional possibilities and the responsibility of the physician, the way out lies certainly not in the administrative manipulation of patients, but in the general (scientific, technical, technological, personnel) advancement of all medical institutions to a high level corresponding to the standards of modern science". Doctors can and must display initiative in working for such a solution, and in this project they "will certainly be supported by all democratic forces of the society".
As a social institution, medicine is very much imbued with an ethic of high individual professionalism - i.e. with "an ideal of the expert who acquires a good reputation through irreproachable work". Although a holdover from the times when medicine was a trade, this concept "contains in itself very important elements without which one cannot build the internal feeling of responsibility... towards the patients. This concept implies constant observation, acceptance and application of the results of science and technology; and any instance of lagging behind modern developments, and thus of ignorance and inefficiency, it proclaims unethical. Although this ethic takes for its norms the exact principles of science, it represents a very important accelerator, not only of scientific progress, but also of the humanisation of medicine....
"Without [however] underestimating the professional concept of responsibility of the physician and the role which it has played and will continue to play in the development of medical science and organization, it seems... necessary to emphasise that [this conception] is inadequate for the needs of modern science and of progress." The individual scope of the practitioner's responsibility to himself or to his profession does not adequately reflect the realistic demands made by modern society. The concept of medical responsibility should thus be redefined as "responsibility to the community - [and] not only to the local or national community...; thus conceived, the principle of responsibility to the community includes, first of all, the responsibility of the physician to himself as a human being who seeks his affirmation and his happiness in the accomplishment of the health and happiness of other people, of society as a whole. Thus conceived responsibility does not permit reduction of the physician's responsibility to the professional and routine performance of his duties, to the separation of his personal from his social life, but rather expands it into a creative, critical attitude towards oneself and others, towards the social totality as a whole."
It can be hoped that this redefinition of medical responsibility will guide physicians to a better understanding of the tasks and possibilities facing them today; but the place of medicine in social life should not be idealised. By itself medicine cannot overthrow antiquated forms of social organisation; "neither can it become a starting point for deeper social transformation", for it is always only a part of a given society. But, nevertheless, "in medicine, more than in any other area, as through a prism there are refracted and resolved the problems of the human individual, who is equally strangled by the depredations which time brings on and crushed by the rushing wheel of modern civilization. With the necessary ability to appreciate the pains, desires, anxieties, needs and capabilities of modern man, the physician can become an important factor in the solution of [modern man's] existential problems.... And this openness and human determinedness of the physician, his critical engagement in the struggle to change the world to which he belongs, his entrance upon the broad social stage, and his increased load of responsibility can be equally useful, both to mankind and to medical science."