Bioethics Issues in Arab Society Publisher Eubios journal of Asian and international bioethics: EJAIB, New Zealand. Official Journal of the Asian Bioethics Association (ABA). 4 H Index EJAIB Vol. 29 (2) March 2019 http://www.eubios.info/EJAIB32019.pdf Professor Abdul Jaleel Kadhim Alwali Department of Philosophy College of Humanities and Social Sciences United Arab Emirates University Al Ain , Abu Dhabi UAE jalilwali@hotmail.com Abdeljelil.kazem@uaeu.ac.ae +971506636703 https://chss.uaeu.ac.ae/en/profile/profile.shtml?email=abdeljelil.kazem ORCID#0000-0003-0119-302X Abstract Recent bioethical issues that have emerged in the field of medicine include, but are not limited to, eugenics (artificial insemination), palliative care (end of life care), euthanasia (medical resuscitation), abortion, and the development of enhanced human body parts. These bioethical issues have raised ethical questions related to the use of modern technology and how it may affect the future of society. These questions consider issues such as: what is the identity of future children? Have human beings become a commodity exchanged by those who have the ability to own them? What is the meaning of justice in medical treatment? How can physicians and nurses perform humanitarian work? Discussions of these questions should begin by determining their relationships with typical social and cultural values in society, such as life and death, marriage, family, fatherhood, motherhood, relatives, and next-of-kin. This paper presents a review of the important Arabic literature that has been written on these bioethical issues to show the contributions of Arab scholars in this field. Arabic studies in bioethics can be classified into three types: original Arabic writings, translated studies, and congresses held in the Arab region. I. Keywords Birth of Bioethics, Original Arabic Writing, Congresses, Bioethics Dilemmas Eubios Journal of Asian and International Bioethics EJAIB Vol. 29 (2) March 2019 II. Introduction The term 'bioethics' can be determined as "the ethics of medical and biological research".1 Bioethics as a field is "concerned with the ethics and philosophical implications of certain biological and medical procedures, technologies, and treatments, as organ transplants, genetic engineering, and care of the terminally ill".2 In this definition of Bioethics as a part of philosophy, the philosophers added some bioethics issues that become a global concern in recent years. Bioethics is a new field of philosophy that was introduced by Henry K. Beecher in his 1966 article entitled Ethics and Clinical Research3, which criticized the unethical approach of studies such as the Tuskegee Syphilis Study, which is well-known for being unethical regarding both its dependent variable and human rights. A. The dependent variable used in the Tuskegee experiment was "whether persons with syphilis were, in fact, better off without the treatment". 4 The subjects (participants) were mostly illiterate African-Americans from Tuskegee, Alabama (USA). The scientists who conducted the experiment knew that penicillin had become the standard treatment for curing syphilis by 1947, so they could have closed the study and administered penicillin to all the subjects; however, they withheld treatment from the participants and continued the experiment. B. With regard to human rights, there are six aspects of the study which can be considered highly unethical: no informed consent was obtained; the participants were not informed of all dangers; participants were autopsied after their death to cover their funeral costs; scientists denied some patients treatment in order to observe the individual dangers and fatal progression of the disease, rather than giving them the cure even though it was known and available; and the designers used a misleading advertisement, which promoted 'Last Chance for Special Free Treatment' although no treatments were given to the patients.5 In response to the Tuskegee Syphilis Study, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was established in 1974 to identify the basic ethical principles for conducting human research and to develop just and ethical guidelines. This can be considered the birth of bioethics. From this point, ethical conduct became a crucial issue in medicine for three reasons: (1) the inhumane treatment of research participants had become public knowledge; (2) the 1960s was a unique period of social and political change; (3) advances in technology led to new medical dilemmas. The four principles of bioethics are: autonomy, beneficence, non-maleficence, and justice. Thus, the social, political, and historical events described created the new field of "applied ethics in medicine"6 - Bioethics. This leads to an investigation of medical ethics, which is considered the elementary stage of this new ethical field, because philosophical and ethical heritage focuses on the concepts of human lives, duty, responsibility, human dignity, and the special covenants of medical ethics. In addition, medical ethics implements international standards for the protection of patients and the ethical framework for medical careers, which is considered the basic reference for the international declaration of human dignity. Eubios Journal of Asian and International Bioethics EJAIB Vol. 29 (2) March 2019 Bioethics as a concept has been used in Arab culture in the following contexts: ethics of life, ethics of biology, ethics of scientific research on organisms, ethics of medicine and biology, ethics of health and life sciences. This paper presents a review of the important Arabic literature that has been written in Arabic on these bioethical issues to show the contributions of Arab scholars in this field. To illustrate that, I will classify the Arabic bioethics literature into three types: original Arabic writings, translated studies, and congresses held in the Arab region. III. Bioethics literature in Arab Society The impact of bioethical issues in Arab society is very weak and marginal; publications on the subject are very rare. It has not received much attention in Arab society compared to other societies around the world. This is because Arab society has tended to focus on other international political issues such as globalization, the Clash of Ideas, the Clash of Cultures, and the Arab Spring. This indicates that these issues are more important to Arab society than bioethical issues. In addition, these issues are focused on not only because they are considered significant political issues, but because some governments have encouraged Arab scholars to discuss them. Researchers have classified Arabic studies in bioethics into three types. The first type is the writings of Arab scholars in this field (Original Arabic Bioethics Writings). The second type is texts on this subject which have been translated into Arabic (Translated Materials). The third is the conferences and symposiums held in the Arab region to discuss this topic (Congresses and Conferences). Figure 1. Number of Bioethics Issues Papers written in Arabic literature (original Arabic bioethics writings, translated texts, and congresses). Source Keywords Subjects Numbers of Bioethics Papers UAEU Library Bioethics Original Arabic writings Books 9 Journal Articles 0 Newspaper Articles 62 Congresses 6 Sultan Qaboos University Library Bioethics Original Arabic writings Books 0 Journal Articles 17 Newspaper Articles 155 Congresses 33 Eubios Journal of Asian and International Bioethics EJAIB Vol. 29 (2) March 2019 IV. Original Arabic Bioethics Writings These researches have been written by Arab scholars; however, these publications are very few and limited. They have addressed general topics in the field of bioethics, such as scientific thinking, biology, genetics, science and moral values, and genetic engineering. Examples of these studies include: Saleh, Fawaz's, Legal Studies of Medical and Bioethics.7 This book consists of six chapters. The first chapter provides information about bioethics and its relationship with law, the second chapter discusses the principles on which bioethics is based, the third chapter states the importance of human rights and dignity, the fourth chapter provides evidence and proof regarding bioethics, and chapters five and six focus on the development of medicine, the effect of biomedicine on patients, and the responsibilities of the doctors. The book not only focuses on the aspects of law, but also on the ethical considerations of medicine. Padela, Furber, Kholwadia, and Moosa's Dire Necessity and Transformation: Entry‐ points for Modern Science in Islamic Bioethical Assessment.8 In this book, the authors discuss how modernity, globalization, and technological advancements challenge religious systems to revisit their traditional doctrines and ethical codes in order to provide guidance for contemporary society. The dialogue between tradition and modernity is apparent in biomedicine where scientific advancements present novel ethical challenges to patients, healthcare workers, and society at large. Chamsi-Pasha and Albar's Western and Islamic Bioethics: How Close is the Gap?9 This article presents the history of the four principles of biomedical ethics in Islamic teachings and elaborates on the differences between Islamic and contemporary Western bioethics. Padela, Arozullah, and Moosa's Brain Death in Islamic Ethico‐Legal Deliberation: Challenges for Applied Islamic Bioethics.10 In this paper, the authors analyze the verdicts of the Organization of Islamic Conferences' Islamic Fiqh Academy (OICIFA) and the Islamic Organization of Medical Sciences (IOMS) from the perspective of applied Islamic bioethics and raise several questions that, if answered by future juridical councils, will better meet the needs of clinicians and bioethicists. Rady, Verheijde, and Ali's Islam and End-of-life Practices in Organ Donation for Transplantation: New Questions and Serious Sociocultural Consequences.11 This study concludes that: 1) many practical aspects of end-of-life organ donation conflict with the Islamic faith's core principles of care for the dying and their families; 2) defining the societal role of transplantation medicine is not uniquely a matter of accounting for technical capabilities and expertise; 3) Muslim scholars should critically evaluate new evidence about end-of-life practices in organ donation, their effects on the care of terminally ill patients and their families, and the consequences on the cultures of Muslim communities worldwide.12 Eubios Journal of Asian and International Bioethics EJAIB Vol. 29 (2) March 2019 Padela's Islamic Medical Ethics: A Primer.13 This paper seeks to achieve two things: to introduce the scope of Islamic Medical Ethics literature and to develop an Islamic perspective on bioethical issues such as abortion, gender relations within the patientdoctor relationship, end-of-life care, and euthanasia. Ateega Beljl's Euthanasia Between Permissibility and Criminalization.14 This article provides explanations of the meaning of euthanasia and the history of its development, its different types and justifications, as well as medical, legal, and Islamic perspectives of euthanasia. Zakaria Fouad's Scientific Thinking.15 The important chapters in this book are: The problem of inheritance and control of human qualities, Science and human values, and Science and ethics in the present age. Saeed Al Hafar's Biology and Human Destiny.16 In this text, the author predicts the possibility of human cloning, and recommends applying genetic scientists' discoveries according to ethical values. Mohameed Al-Rubaie's Genetics and Humanity.17 This research is an introduction to human genetics and genetic engineering technology. The author raises several questions; for example, do only wealthy countries benefit from these scientific advancements? Will the gap between North and South be reduced? Could the results be used for military purposes? Abdullah Al-Omar's Science and Moral Values.18 This book explores the neutrality of science and the responsibility of scientists and researchers towards society and life, as well as the sanctity of human life. The author rejects the practice of human cloning on the grounds of loss of identity. Nahedh Al-Basqmi's Genetic Engineering and Ethics.19 The issues presented in this book are related to human experimentation, artificial reproduction, abortion, human organ transplantation, disease and death, and human enhancement. Ahmed Mahmoud Subhi's Philosophy of Medicine. 20 This book presents an investigation of the relationship between philosophy and medicine throughout history, the responsibility of doctors towards patients, and the moral issues regarding this relationship. Mohammed Abed Al-Jabri's Ethics and Bioethics.21 In this text, the researcher asks the question: To what extent is it permissible to use science to control the areas of reproduction and offspring, the field of genetics, change of living organisms, the field of mind, legitimacy, and death? Eubios Journal of Asian and International Bioethics EJAIB Vol. 29 (2) March 2019 Hassan Mousa's, Reproduction Controversy Science, Religion and Morals.22 This book provides a discussion of the subject of cloning from the perspectives of science, religion, philosophy and ethics. Joseph Malouf's Ethics and Medicine.23 This study considers contraception, abortion, artificial insemination, and euthanasia. The author presents the Islamic and Catholic views of these new ethical issues. V. Translated Studies The translated studies have tended to focus on the nature of life, genetics, and biology, and unlike the original Arabic bioethics texts, have not addressed the details or any specific issue of modern medical ethics. Some examples of these studies are as follows: Atighethci Dariusch's Islamic Bioethics; Problems and Perspective, translated from Italian to Arabic by Lubna Alraidi.24 This book provides a critical analysis of the different perspectives and debates in Muslim countries in terms of religious and legal points of view. It also discusses new technologies in biology, organ donation, and genetics cloning. Pierre-André Taguieff's Bioethics: Towards a Project of Intellectual Cause, translated by Abdulhadi Al edresi. This book was written by a French philosopher and director at the French National Center for Scientific Research in the Paris Institute of Political Studies. The subject of the book is bioethics as an ideological issue and its meaning from different perspectives.25 Frances Kreek's Nature of Life, translated by Ahmed Mostajer.26 This book provides a description and analysis of the phenomena of nature, the creativity of life in the past and present, and the expectation of life development in the future. It does not consider new bioethics issues. Harsenay and Hton's Genetic Prediction, translated by Mastafa Ibrahem.27 This text investigates the problems of science research and its goals and evaluates the developing field of genetic engineering and its effect on ethics, especially regarding gene modification and human enhancement. Roz Steven's Biology, Ideology and Human Nature, translated by Mustafa Ibrahim Fahmy. 28 This book encourages supporters of human enhancement to dispose of criminals and people with disabilities. The author uses biological determinism as a model for the research, based on the theory proposed by Darwin and Hobbes. Group of authors, Genetic Code of Man, translated by Ahmed Mostajer.29 This book addresses the impacts of biology and medicine in the twenty-first century on ethics, law, and society. Eubios Journal of Asian and International Bioethics EJAIB Vol. 29 (2) March 2019 Gregory E. Benis' Who Fears the Cloning of Man, translated by Ahmed Mostajer & Fatima Naser .30 In this book, the author examines the problems caused by advanced genetic engineering in humans, particularly their impact on families and human dignity. The writer identifies two positions in the field of cloning, the first is the theory of nonsexual reproduction through cloning(he is supported this theory). The second position is natural reproduction through sex . He is rejected this cloning because it affects the integration of the family and human dignity. VI. Congresses and Conferences This aspect of Arabic bioethics studies is comprised of conferences held in the Arab region, including Casablanca, Morocco, Algeria, Lebanon, and Dubai. The topics addressed at these conferences relate to medical ethics, biology, human rights, gene modification, and other ethical issues regarding birth control technology. However, the number of these publications is very limited and considered insignificant compared to the importance of bioethics issues and the number of Western publications which have addressed these issues. Nevertheless, some examples of these conferences are as follows: Tenth Annual Congress on Drug Formulation and Analytical Techniques, held December 10-11 2018 in Dubai, UAE, organized by the University of Chicago. Theme: 'Inventing a formula for Drug Development and Analytical Techniques'. This conference sought to determine how innovators are closing the gap between product development and adoption, to better identify cyber threats and reduce information security risks, and to debate the potential of greater cross-industry and cross-sector collaboration in the race for faster, cheaper, better cures.31 First International Bioethics Conference held at Sultan Qaboos University, Muscat sultanate of Omann,2015. Around sixty researchers attended the opening ceremony of the conference, which aimed to investigate important ethical issues in the field of medicine and biology, and how these can lead to different perspectives depending on society, beliefs, and research. The conference presented six main topics for discussion over three days: bioethics from an Islamic perspective, the contemporary challenges of bioethics, the issues of ending life and its consequences, global bioethics and benefit sharing, Ebola and its bioethical problems, and genetics and biotechnologies.32 Bioethics Issues for Women: Ethics of reproductive healthsocial and political conditions in Arab countries, held at the University of Beirut, Lebanon, in 2014. This conference focused on public health workers, primarily physicians, nurses, and healthcare teams. It explored the difficult ethical, social, and legal issues of genetic technology and assisted reproductive technologies, as well as future threats to Arab regions regarding issues related to medicine, ethics, political implications, and points of view that could affect every process of research in reproductive healthcare.33 Eubios Journal of Asian and International Bioethics EJAIB Vol. 29 (2) March 2019 Symposium on Human Right and Genetics, held in Rabat, Morocco, in 1997. The topics of this symposium were: the ethical dilemmas posed by the progress of genetic engineering, the definition of the ethics of knowledge, and the threat to the future of the human being and his dignity. The symposium emphasized the importance of scientific knowledge as a value of civilization, of not evaluating scientific progress with emotional attitudes, and of respecting human dignity and the mysteries of creation. VII. Bioethical Dilemmas in Arab Society VII.I. Telling the truth to the patient Some Arab people sell their property (home, furniture, valuable goods) or may take out loans in order to pay for medical treatment inside or outside of their countries. However, if a patient has a chronic or incurable disease, should they be told that their case is incurable and hopeless, and therefore that there is no need to sell anything or obtain loans for treatment? What should really be done in this case? Even if the patient is told about their situation, then social customs imposed by family members create a pressure to treat the patient regardless of the consequences or the results. Therefore, should treatment follow tradition or science? VII.II. Family members' priority As humans, all family members have an equal right to receive medical care; there should be no discrimination among family members. However, in some countries, a father has less priority than a mother, or a baby is not given the same importance as a father or mother. In this case, what would religion or culture dictate? Who has the priority in a family to receive medical care? VII.III. Right to live In the majority of Arab countries, some poor people sell their body parts to cover living costs. In these cases, the hospitals list them as 'donors'. However, this is fraudulent because they are not donors. The beneficiaries of this business are rich patients who obtain the body parts. Ethically speaking, do rich people have the right to receive donations from the bodies of poor people because of their money? VII.IV. Medical services In most, if not all, Arab countries, the medical services provided are poorer than services offered in developed countries. Therefore, many patients seek expensive medical care outside their countries. People who receive this type of medical care can be classified into two types: Rich people who can afford the travel and treatment costs and travel to a country of their choice in order to receive sufficient medical care. Some Arab governments also offer financial support for selected patients to receive medical care in other countries. Eubios Journal of Asian and International Bioethics EJAIB Vol. 29 (2) March 2019 People who cannot afford medical care expenses or do not receive support from their government will die from their illness or their family will sell whatever they can to raise money for travel and medical care. Is this ethically acceptable? VII.V. Human body trafficking In other cases, some people are promised job opportunities outside of their countries but they become victims of human body trafficking. These individuals usually die. Ethically, who is responsible for these cases? VIII. Conclusion It is not possible to find religious answers to most bioethical issues in medical science; therefore, some interpretation is required. However, should this interpretation be led by religious clerks or philosophers? In the context of Arab culture, it is important to note that interpretations proposed in Islamic philosophy led to the execution of several philosophers who were accused of being heretic. Indeed, neither religious clerks nor philosophers have given significant focus to providing logical explanations for these issues. Likewise, a search of Islamic philosophy regarding Islamic, Arabic, and cultural heritage does not provide solutions for most of these modern issues. Thus, although future values will not be the same as current values, it is vital to formulate the meanings of freedom, duty, responsibility, human dignity, and the development of dialogue between science, philosophy, and ethics. 1 Oxford Dictionaries | English. (2018). bioethics | Definition of bioethics in English by Oxford Dictionaries. [online] Available at: https://en.oxforddictionaries.com/definition/bioethics [Accessed 30 Dec. 2018]. 2 www.dictionary.com. (2018). the definition of bioethics. [online] Available at: https://www.dictionary.com/browse/bioethics [Accessed 30 Dec. 2018]. 3 Beecher, H.K., 1966. Ethics and clinical research. In Biomedical ethics and the law. Boston, MA: Springer. pp.215-227. 4 Explorable.com. (2008). Tuskegee Syphilis Study Research without Empathy. [online] Available at: https://explorable.com/tuskegee-syphilis-study [Accessed 30 Dec. 2018]. 5 ibid 6 Kunis, C.L., 2018. Morality and Medicine: An Historical Perspective, lecture delivered at Global Bioethics Initiative, July 26 2018, New York, USA. 7 Saleh, F. (2015). Legal studies in medical and bioethics. [online] Acatap.org. Available at: http://www.acatap.org/index.php/40-acatap-books/scientific-books/123-31-8-2015-147 [Accessed 30 Dec. 2018]. 8 Padela, A.I., Furber, S.W., Kholwadia, M.A. and Moosa, E., 2014. Dire Necessity and Transformation: Entry‐points for Modern Science in Islamic Bioethical Assessment of Porcine Products in Vaccines. 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