Eubios Journal of Asian andInternational Bioethics
EJAIB Vol. 30 (2) March 2020
www.eubios.info

ISSN 1173-2571 (Print) ISSN 2350-3106 (Online)

Official Journal of the Asian Bioethics Association (ABA)

Copyright ©2020 Eubios Ethics Institute(All rights reserved, for commercial reproductions).

Contents
page
Editorial: Ethical Systems- Darryl Macer
33
An analysis of violence against health-care
professionals in Turkey from online media reports- Sukran Sevimli
34
Bio-law and biotechnological hyperconsumption:
towards bio-juridical resigniDication of twobioethical principles for protection of cognitive
health43
Camilo Noguera Pardo
Posthuman sexlessness in cloning, Pokémon, andNietzschean ethics
47- Jan Gresil S. Kahambing
Liberal environmentalism and global climate justice- Christopher Ryan Maboloc
51
BOOK REVIEW: The Ethics of Sustainability
57
Alex Waller
The Iraq Commitment Medals
58
Lana Adnan Issa al-Shareeda
Surrogate Motherhood in Nigeria: An EthicalAppraisal
59- Emmanuel Efem Etta & Mary Julius Egbai
Ordering Renewal
65
Editorial address, and all correspondence to:Prof. Darryl Macer, Ph.D., Hon.D.
President,
American University of Sovereign Nations (AUSN),
https://www.ausovereignnations.org
Email: darryl@eubios.info
EJAIB adopts and complies with the Committee on
Publication Ethics (COPE) Publication ethics andmalpractice policy. Our policy is on the EJAIB website.
All potential authors should have read these guidelines
and by submission of an article for publication you
acknowledge that you have complied with this policy.
Violations will be handled in proportion to the intention
and seriousness of the violation.
Registered address of EJAIB: P.O. Box 16 329, Hornby,
Christchurch 8441, New Zealand

Editorial: Ethical Systems

The ethical principle to do no harm is usuallyviewed from the perspective of health care
professionals minimizing risk of harm to vulnerable
patients, however in the Dirst paper in this issue of
EJAIB Sukran Sevimli reports on a challenge that she
has documented in Turkey, violence against healthcare professionals.
There are some shocking
accounts of how the families of patients become
angry with the medical staff, and may commit acts ofviolence.
This reframing of the question ofvulnerability is important for us to consider how toreframe the importance of a health care system thatminimizes unethical confrontation.
Human society is still in a process of evolution,
perhaps with some direction and others led bychance. Camilo Noguera Pardo presents a paper
exploring how hyperconsumption may damage our
cognitive health, and the responses of biolaw andbioethics. Jan Gresil S. Kahambing also discusses
some images of the future of a post-human and how
it may reshape the meaning of what it means to be ahuman being. Although the paper considers
sexlessness, it seems that the human desire to leave
descendants is strong all around the world, and newtechnology is being applied to achieve this.
Emmanuel Efem Etta and Mary Julius Egbai
described and examine the ethics of surrogate
motherhood in Nigeria.
Our world is more than simply human kind, andwe should consider the future world that we will
construct, as Christopher Ryan Maboloc explores inviews of liberal environmentalism and global climate
justice. Alex Waller reviews a book called The Ethicsof Sustainability. There has been a generation ofscholars exploring sustainability, so we hope thateventually we can see a more sustainable world.
In the Dirst and second week of March I joined the43rd Session of the United Nations Human Rights
Council in Geneva, and made a few statements in the
UN Assembly Hall. The respect for diversity andrights of all are critical, and it reminded me of thepassion I brought to the UNESCO missions. We haveto remain committed to our dreams to construct a
more ethical world. - Darryl Macer

34

Eubios Journal of Asian and International Bioethics 30 (March 2020)

An analysis of violence against
healthcare professionals in Turkey
from online media reports- Sukran Sevimli
Department of Medical History and Medical Ethics,
Dursun Odabas Research Hospital, Faculty of Medicine,
Van Yuzuncu Yıl University, Zeve Kampus,
65080 Van,Turkey
Email: sukransevimli@gmail.com

Abstract
Aim: Healthcare professionals have faced high rates
of violent injury and fatality in the workplace. This
study's objective was to evaluate the existingknowledge on the extent of workplace violence fromonline reports, to contribute on these incidents toserve as a basis for future research which could
provide a synergistic relationship via the media forpreventive policies.
Methods: This study utilizes a descriptive andqualitative analysis of online media reports onviolence against healthcare professionals that werecollected from two websites which are linked tomainstream media from January 1, 2012 to October
1, 2019.
Results: This online report analysis indicated a totalof 1028 incidents of serious violence occurredagainst healthcare professionals. The data of thestudy is in the forensic news category and it is seenthat physicians, especially male physicians (95%)
and emergency service (31%) are at the forefront ofphysical attacks. It is seen that patient’s relatives(92%) play an important role as aggressor and themost common causes of violence weredissatisfaction with the treatment or diagnosis(51%), services (24%), and expensive fees (5%).
Most of the headlines stated that there isinterpersonal violence; but did not mention healthpolicy, structural and organizational issues.
Conclusion: This study indicated that experiencing
different kinds of violence at healthcare facilities
have become common and normal news resulting inlife-threatening injuries of the victims. Because thepatients/patients relatives have thought that
healthcare workers are responsible for all problems
arising from the transforming health program. For
this reason, any kind of inconvenience is returning tohealth workers as violence. In conclusion, the media,
the government, and the healthcare professionals
should work together to produce solutions.
Introduction
Violence has been an important epidemic problem inall layers of societies and in the healthcare system inmany countries across the world (Medicine &Council, 2013). World Health Organization (WHO)indicated that violence is a universal problem that
disrupts the fabric of an individual and communities,
and threatens the life, and happiness of us all(WHO), 2019). Over the past two decades,

healthcare professionals (HCPs) have encounteredhigher violent risk by patients and/or patient
relatives (PPRs) at healthcare settings in China,
Turkey, Bangladesh and so on (Ferri et al., 2016;
Hasan et al., 2018; İnci & Bourse, 2014; Peng et al.,2016; Wu et al., 2015). Research has indicated that
HCPs are at a greater risk of WPV than other
employees. Correspondingly, Elliot (1997) indicatedthat HCPs experiencing violence is 16 times greaterthan other work places. In addition, WHO reported
that HCPs have faced physical violence between 8%
and 38% at some point in their careers (Gates,2004). In order to prevent this dangerous
development, many researchers and internationalfoundations have published their own research
reports (e.g., World Medical Association, World
Health Organization, Occupation Safety and HealthAdministration etc.) which included warnings, taking
measures and putting forward suggestions as well as
legal and ethical codes against the violence of HCPs
in the work place. The rights of the patient as well as
the obligations of the patient/relative are clearly
explained in the "Regulation on Patients' Rights"which was prepared by the Ministry of Health inTurkey (Yönetmeliği, 1998). Correspondingly, thepatient acts in accordance with the rules andpractices of the health institution and organization
she applies when she receives health service andacts with the awareness that she is a part of thediagnostic and treatment team with a participatory
approach (HHY. Art. 42 / A-a) (Sert, 2004).
However, WPV in the healthcare setting has its
own origins in a number of factors and also impacts.
Healthcare places are more prone to WPV thanothers due to its own special factors stemming fromthe nature of health issues. These are (i) healthsystem and policy (e.g., the rapid increase of the
population beneDiting from health services, theinability to make investments in health in line withthis increase, insufDicient central organization ofhealth and lack of sanctions)(Chauhan et al., 2017),(ii) hospital management (e.g. number and quality ofhealth personnel, the number of patients as well as
health resources, necessity of effective use of time)(Peng et al., 2016),(iii) the persistent intervention ofpatient/patient relatives (PPRs) (e.g.,
miscommunication, aggressive work environment
and violations of hospital procedures and low overall
health literacy rate, the desire to provide PPRs own
their justice on the basis of insecurity in the system)and (iv) hospital organization and ethical-legal
regulations (e.g., HCPs or PPRs' acts/expectations
beyond relevant procedures, violation of ethicalprinciples, European Convention on Biomedicine
and Human Rights 1999, and Patient Right
Regulation 1998)(Sert, 2004).
WPV has multidimensional negative impacts at
a healthcare setting; WPV affects the victim and theperpetrator as well as the PPRs, assistant healthpersonnel and even the other patients and relatives
who are there presently affected and deteriorating
relations between medical staff and their patients. In

Eubios Journal of Asian and International Bioethics 30 (March 2020)
addition, the victim may be absent from work due tothe treatment process. Therefore, HCPs cannot give
service or follow up to their patients, in addition thisprocess has caused Dinancial harm to the victim by
preventing him from beneDiting from theperformance-based supplementary payment systemin health care enterprises (Meker & Barlas, 2013;
Safety & Administration, 2017). To which thegovernment should shoulder the medical expenses
that is incurred by the damages on the victims. In
addition, there should also be psychological andlegal support for the victim. Furthermore, there isalso the unobserved heterogeneity distribution(unobservable effects that have been produced by
the attacks received by the victims who could also belabeled as mental health problems and lengthen the
duration of absences from work) that plays asubstantial part that affects the victims emotional
and physiological thinking that could potentiallyurge them to not go back to work (Campolieti,
Goldenberg, & Hyatt, 2008). These longer absencesfrom work could reDlect the impact of workplace
violence on organizational and personal outcomes(Campolieti et al., 2008). As for legal actions, thevictims that Dile for a law suit could also potentiallybe more draining Dinancially and emotionally as mostcases takes a long time before a verdict could evenbe decided on (Altaş, 2009). Correspondingly, thesenegative emotional experiences and that theperpetrators of violence are not punished in a shorttime (legal cases are usually concluded in a long timein Turkey (Altaş, 2009)) may be caused by a negative
effect on the quality of healthcare service delivery.
(e.g., anger, fear, depression, anxiety and sleep
disruption) may inDluence victims' health service along time. BrieDly, WPV cannot be considered as onlyinterpersonal violence between HCPs and PPRs it
should be evaluated as a serious public healthproblem.
WPV can be classiDied into two types, as
personal and structural. Personal violence is easierto recognize compared to structural violence
because it is visible and observable such as verbal
abuse, physical attacks, and sexual assault. Structural
violence on the other hand cannot be easily detected
due to the embedded injustice in structures
regarding unequal power or unequal living
opportunities (Galtung, 1969). Structural violence
was deDined by Johan Galtung as factors of structural
violence including inegalitarian distribution of
resources and burdens in the healthcare setting, therising number of patients, delimitation of thenumber of doctors and nurses, shortage of medical
supplies, physicians spending a short time both on
patient examination and obtaining informed
consent. In addition, powerful-inDluential people use
their power to change the egalitarian balance suchas disrupting the patient waiting line, haggling thedoctors through unreasonable demands, insistingthat the doctors give the more attention andcompassion, etc. This kind of issue can cause
structural violence and result in violations of the35

ethical principles of "do no harm, autonomy andjustice". These violations are perceived by patientsand their relatives as a direct attack of the HCPs, due
to their unawareness of the healthcare system andprotocol. Indeed, the patients and patients’ relatives(PPRV) have mostly tried to solve these kinds ofsystemic problems by violence.
International studies show that HCPs are
exposed personal and structural forms of violence intheir very line of work. WPV against HCPs is a global
and serious public health problem (Ferri et al., 2016)not only in Turkey but also in many countries. Whatcan be the reasons for this? There are threeimportant reasons the bio-psycho-social problems of
the patients, the attitude of the health personnel andthe problems in the health system.
WPV is more commonly reported in healthcare
settings. Reasons for such behavior is also varying
per situation. Some of these reasons are the diseasecrisis creates an unnerving environment for the P/
PRs. Patient’s expectations from the doctor will bevery high or their hope triggers their own agitations
and can lead to violence. Furthermore, many studies
and online headlines show that personal violence isclosely related to patient expectations. However,
PPRs cannot Dind a proper environment toimmediately solve their health problem. They have
faced some negative issues; the lack of interest of thehealth personnel, failure to provide enoughinformation about diagnosis and treatment,
negligence of eliminating the special concerns of thepatients during the informed consent process,overcrowding of the waiting rooms, and so on (K.
Ghosh, 2018). However, these expectations cannot
be met as quickly as the patient wants, not only from
HCPs individual attitudes but also some barriers in
the healthcare system. This condition directs us to
the second reason pointing to structural barriers in
the hospital system which initiates structural
violence. Many of the problems mentioned above arein fact due to the healthcare structure. For example,
a large number of patients limits the physician's timeand extends the waiting time. Limitation of hospital
resources (number of beds, medical equipment, staff
number, unsanitary practices) prevents patientsfrom receiving appropriate treatment (Ghosh, 2018).
Finally, the number of patients increases the burdenof the HCPs and can lead to exhaustion. The
problems in the health sector are intertwined, eachissue triggering one another.
WPV in the healthcare setting which includes
multi-faceted factors and inDluences has gained
visibility and acquired a space in the mainstream
media online news. This is important because people
can access with one click digital media to haveinformation from different media outlets,
opportunity to share readers' interpretations, nocosts, and the possibility to discuss the news withother readers, 24/7 updates, in-depth andbackground information and it has also an
indisputable inDluence, especially in guiding the36

Eubios Journal of Asian and International Bioethics 30 (March 2020)

perception and attention of society and determining
policy (Huesmann & Taylor, 2006; Nguyen, 2010).
WPV is frequently reported as Dirst-page news
because of attracting the public, as well as related
foundations and politicians. However these realworld HCPs and WPV online reports have involved
limited information according to each media’s own
policy or target; some headlines present WPVagainst HCPs as interpersonal violence, while somemedia present it as emotive narrative news (İnci &Bourse, 2014; Wu et al., 2015) "PPRs assault
pregnant doctor", or some online news headings thatjudge health personnel or the opposite; someheadlines make violence ordinary, e.g. "violence
continues".
Despite the serious impact of digital media onvarious layers of the public and policies, there arelimited studies about researching WPV in healthcare.
Therefore, this study will make a signiDicant
contribution to healthcare problem and WPV
presented by digital media. The mainstream media
news/reports of WPV have seriously inDluenced the
public perceptions; media can steer public attention
towards social-political issues and determinant ofthese issues which can be tackle or ignore. Therefore
these real-world violence reports can involve
different information according to the policy of each
media (global or national), the state health policy,
and public sensibility. For example, factors derived
from organizational or health policies behind theviolence are usually not included in the headlines.
Actually digital media may be more informative tocontribute to creating peaceful understanding
policymaking to prevent or to reduce violence.
On the other hand, the selection of headlines of
online news is of socio-cultural and economic
importance for journalists, readers and newspaper
advertisers. The headlines, which play a very
important role in the perception of society and theformation of policies, are deDinitely of special
importance. Hence online news reports help to us
understand WPV not only on journalists, agency
policy, government policy, but also for the public
perspective of healthcare settings and HCPs.
Therefore, this study has made a signiDicant
contribution to WPV in the healthcare setting.
Research question
This research is based on online media reports
which inDluence public awareness, and the Turkish
Medical Association and HCPs approaches. I try tounderstand whether online news reports about
violence against healthcare professionals has aneffect on public awareness of the issue. And the data
for this research is gathered from sources between
January 1, 2012 and October 1, 2019. As violence isincreasing unexpectedly each day, therefore
healthcare professionals started making a webpage,
as a collection of all of these online media news in
Turkey since 2012. And we have collected our
research data from these webpages.

The Dirst question is did the number ofincidences and reports of WPV in Turkey havebecome more prominent from 2012 until the present
time. As well as the change in characteristics in thenature of WPV perpetrated upon HCPs. We collected
online report headlines to analyze them, as
headlines are important for readers who will make adecision whether to read the article or not. Thus, if
headlines are inDluencing the awareness of people,
then they should include some kind of clues forcausal reasons or responsibilities of the healthcare
policy, hospital organizations or personnel that must
be implemented. Followed by the question, do theheadlines have a one-sided opinion such as bias ordoes it persuade readers to think of the issue in acertain similarity to that of the writer? Do theheadings contribute to the justiDication of violence?
Do the headlines give direct information about thenature of WPV perpetrated upon HCPs? Do theheadings reveal responsibility for violence as anindividual or politico-organizational-systemic
problem?
MethodDesign: This research was designed to evaluate
violence in online media reports against HCPs
between the periods of January 1, 2012 and October
1, 2019 as both a quantitative (e.g., number, gender,
and acts of violence) and qualitative (headline
analysis) study, across Turkey. Reports were fromnewspapers and online two news sites.
Data collection: In order to examine in great detailthe cases of violence that are reDlected in online
media, data were collected using two important
websites which have been organized and tallied foranalysis of the study. Reasons for choosing these web
pages were primarily because they contain content
focused on violence and protest activities involving
healthcare professionals. Secondly, these webpages
compile all the news contained in Turkish
newspapers/ medical magazine or editions (e.g.,
Cumhuriyet, Medi Magazin, Sözcü, Hürriyet,
Habertürk, Milliyet, ABC Newspaper). And lastly, we
can track the incidents in an organized system as far
back as 2010. As these webpages were legally
founded by the Turkish Medical Association (TTB)
and Health of Health Workers' Working Group (SÇS).
Turkish Medical Association (TTB) is constituted
under the Turkish Constitution with the law No.
6023, in 1953(TTB). TTB is a non-proDit organization
and 80% of doctors in Turkey are members of the
TTB. So, these data sources are the legal
representations of the media and websites of
Turkish medical organizations. Correspondingly, two
websites have been utilized to collect online articles
from mainstream media for the years 2012-2019,m o s t ly o n v i o l e n t n e w s a g a i n s t m e d i c a lprofessionals. A total of 1099 online reports wereidentiDied as violence against HCPs. After reviewing
the collected reports only 1028 were considered foranalysis as some were repeated on certain websites.

Eubios Journal of Asian and International Bioethics 30 (March 2020)
Media articles are important, to understandhow the media presents and explains WPVs against
HCPs to the public, and how journalists approach
WPVs in their online platform. In addition,complaints of HCPs have reported the white code
system of the ministry of health. However, since thereports on these complaints were not published by
the Ministry, they were not included in the study(Table 1).
Study criteria: After collecting the data, weorganized the articles by some criteria; Dirst,
according study key words such as doctor, nurse,
HCP, hospitals, violence, aggression, assault, WPV in
healthcare setting. Second, separating articles
according to headlines and omitting irrelevant
articles that are focused on medical education, salaryand union issues of HCPs that have no connection to
WPVs.
ClassiQication of HCPs: The collected data indicatedthat physicians were the primary target in statehospitals and second target is in the private
hospitals health setting. Only a few cases can be seenthat they are targeting nurses or other healthprofessionals.
IdentiQied study variables: The identiDied study
variables of incidents were gender, position, type ofviolence, number of violators, healthcare setting
violence, and the reason of violence, personal
violence tools, and health service for quantitative
analysis. In addition online reports headlines werecollected and classiDied to analysis for qualitative
analysis.
Headline analysis: Newspaper headlines areimportant to attract people and to encourage themto read the whole article. Correspondingly,
researchers show that casual readers have continued
to read the story if the headlines have inDluenced
them by being emotive, social or cultural (Taiwo,2007).Therefore, online headlines are not neutral,transparent or 'innocent, versus they have related
media policy and the ideological system, people
emotions and culture (Olowe, 1993).In thesereasons, we collected online headlines from websites
between 2012-2019 and analyzed them tounderstand present approaches on WPV. The
analysis carried out was according to somekeywords (e.g., assault, HCP, P/PR, legal-ethicalrules). These headlines analyzed thematic andepisodic. In these reasons, we collected online
headlines from websites and analyzed them tounderstand the present approaches on WPV. This
analysis is carried out according to some keywords(e.g., assault, HCP, P/PR, legal-ethical rules). These
headlines were analyzed by being both thematic andepisodic (Iyengar, 1996). Most of them had episodic
framing which draws people’s attention to theindividual as a HCPs responsibility rather thaninstructional/general health policy issues whilesome thematic headlines were regarding an
explanation of HCPs or their association which
focused on health policy, structural issues of health37

or can uncontrolled factors (Iyengar, 1996; Metila &Humanities, 2013).
Data analysis: Standard descriptive statistics wereused to describe the data. Associations between
categorical variables were tested with chi-square
tests. All data analyses were conducted using SPSS
16.0.
Ethical considerations
Approval for the study was received from the local
Ministry of Health Ethical Commission on
16.01.2019-14.
Results
This research has identiDied a total of 1090 news
items were published in two major websites which
was linked to mass media mainstream. Of these,
1028 included statements about attacks, protests or
attacks and 71 reports did not meet the inclusion
criteria (Figure 1).
The research data were deDined according to thedetermined criteria and their numbers andpercentages were evaluated in Table 1. The data
revealed that incidents of violence against HCPs are
an important problem throughout Turkey. The study
data collection found that 87% of the male HCPs
experienced P/PRV. Online reports indicated that
80% of the health care workers were doctors, 20%
were nurses and the others were 0.9% other healthpersonnel. Of them 99% were working at the statehospital. As already mentioned, the problems in thehealth sector are intertwined and each triggers eachother.
Healthcare structure problems are an importantrole to emerge personal violence. However, in thisstudy, we deDined the structural violence cases whichwere arising from direct legal procedures, healthmanagement, or insufDicient medical devices
problems. When we look at the gender of the patientor patient relatives who apply violence, it is seenthat 95.1% is male. Of the violators 92.2% are thePRs, 0.6% are patients and 7.2% are HCPs. Other
important data are that there are individual attacks
and collective attacks of the patient relatives against
HCPs. According to study data, 79% of the attacks
were individual and 21% of the attacks were carriedout collectively (as a group).
Study data indicated that reasons for violent
attacks included: 24% excessive waiting time
duration, 24% were miscommunication, 13% weredissatisfaction with received treatment, 12% were
workplace conDlict, 9% were denial to write of a
medical report, 8% were lack of Informed consent,
7% were over the counter medication request and
3% were death of the patient. Some of these reasons
are related to doctors' attitudes such as
miscommunication, the dissatisfaction of patients
because of receiving treatment and informed
consent. Correspondingly, some of them wererelated health structure such as excessive waiting
time, workplace conDlict and death of the patient.

38

Eubios Journal of Asian and International Bioethics 30 (March 2020)

Online media news identified through Google (news collected on the
Selected online news reports headlines for inclusion
criteria and key words
Excluded irrelative
online reports

Selected news reports headlines forquantitative and qualitative analysis
Figure 1. Screening Dlow diagram

Table 1. Characteristics of online reported workplace violence in the health sector of Turkey between
2012-2019
Gender of Victimn%Victims’ Positionn%

The Violator/s

n

%

Male

890 86.6

Doctor881 85.7

Patient relative

948 92.2

Female138 13.4

Nurse

138 13.4

Patient

80

Other

9

Number of Violatorsn

0.9

Gender of Violator

n

Male

978 95.1

Individual

810 78.8

Public hospital

1019 99.1

Female

50

4.9

Group

218 21.2

Private hospital

9 0.9

n

%

Personal Violence
Tools

n

Healthcare Service
typen

Excessive Waiting Time 247 24.0
Duration (structural)

Fist-Kick

737 71.7

Emergency Room319 31.0

Miscommunication(personal)

244 23.7

Knife

192 18.7

Pediatric Services

182 17.7

137 13.3

Sexual Harassment

59

5.7

Outpatient unit

208 20.2

Workplace ConDlict
120 11.7(Hospital management)

Gun

24

2.3

Medical unit and 133 12.9
Family medicine

Denial to write of a 92
medical report (Legalmedical)

8.9

Verbal Abuse

14

1.4

Surgical unit

87

8.5

L a c k o f I n f o r m e d 85
Consent (Personal)

8.3

Chair-table-door 1
Throwing

0.1

Cardiology

51

5.0

76

7.4

Arson doctor's room

0.1

Intensive Care Unit

44

4.3

27

2.6

Ambulance Employee 4

0.9

The Reason ofViolence

Dissatisfaction with
Received Treatment

Over the Counter
Medication Request(legal)Death of the Patient(personal)

%

7.8

1

%

Hospitals

%

n %

%

N=1028 *Structural violence is often seen in the following: (the rising number of patients, delimitation of the number ofdoctors and nurses, shortage of medical supplies, powerful and inDluential people take advantage and disrupts the patient
waiting line, and so on)Eubios Journal of Asian and International Bioethics 30 (March 2020)(it is not clear that death is related to the treatmentof the doctor).
In addition some requests were not appropriate
in accordance with legal regulations such as a denial
to write a person' medication request (some persons
wanted to take medicine on behalf of his/herpatients who did not come into the healthcare
settings, or the wanted drug is not related to thepatient's health condition), denial to write a medical
report (some people want to get a doctor's report inorder not to go to work even if they are not ill or
people who have health to work can ask the doctor
to give them a report that they cannot work or be asoldier because of disease or handicap).
Our study also evidenced that the most frequent
violence was physical and the prevalent aggressors
were PRs. Some of the forms of attack and weapons
used found in our study are: 72% used kick-or Dist,
19% used a knife, 2.3% used guns, 1.4% did verbal
abuse (verbal harassment is not a complaint unless avery serious situation occurs), and 0.1% threw achair or-table against HCPs.
According to the data of the study, some healthservices seem more risky. The percentage of violencein these services were: 31% were emergency room,
20% were outpatient unit, 18% were pediatricservices,13% were medical units and family
medicine, 9% were surgical unit, 5% werecardiology, 4% were intensive care unit, and 1%
were ambulance employees. Most of them wereabout patient issues and after that, violence tophysicians and other health personnel."
The study data shows that there is violence inalmost every health service except the laboratories.
Furthermore, a patient's medical condition wasclosely related to violence, according to study data ofemergency services, pediatric unit, and outpatient
unit. In addition, the units related to the healthoutcomes of the patients are the target of theviolator, for example, cardiology, surgery unit andintensive care unit.
HCPs have limited time and too many patientsand patient relatives have caused noise, chaos anddebate (family inside and/or outside) lead to many
problems apart from medicine. Therefore thedisease crisis affects the hospital environment andprepares a wider crisis environment. The data ofhealthcare work violence in Turkey are summarizedin Table 1.
Qualitative analysis (headline analysis): The news
headlines carry important clues about the content of
the news and the reader is affected positively or
negatively by the headline. The fact that the headings
expressing violent incidents carry the same orsimilar words may give the impression that the news
belongs only to a recurring event. Or the headline
may direct the reader to read the full text of thenews. Therefore, the title can lead the reader to focus
and synthesize the situations associated with thetitle. When content analysis of online news is done, it
is seen that there are different reasons for the events

39in the press. These problems include ethical andlegal problems, long-standing patient problems,
and/or insufDicient health personnel, lack ofresources and/or problems of resource allocation.
Table 2. ClassiDication of Headlines

Online report headlines (Episodic
or thematic framework)

n=1028

1. Headlines present violence against HCPs,
as standard/normal interpersonal violence(keywords: threat, beat, assault, continue,
not to end) (episodic)

789

2. Headlines on some claims on patient rights
violations as legal-ethical-medical issues.
(keywords: claim, informed consent, a longtime waiting, patient's death) (episodic)

136

3. Headlines on P/PRs violated legal-ethicalrules and they punished (keywords: reject towrite a prescription, illness report or
examine) (episodic)

60

4. Headlines on protest or press statement
against violence. (keywords: statement,
protest, declaration or speech) (thematic)

43

Discussion
Health care is the most important public affairs
concern for most citizens; each kind of news about
health care and healthcare settings always attracts
the attention of society. The violence that occurs inhealth institutions and HCPs protest against violence
have steered the attention of the public, therefore
these kind of news are often found on the front page.
For that reason, this study contributes byhighlighting how violence is a signiDicant
phenomenon and that HCPs are at risk of suffering
aggressive assaults and how the media present these
events, because the media is important in organizing
and developing social-legal-ethical responses
regarding WPV. In fact, certain HCPs’ associations
Dight to have even harsher punishment for violent
people including zero-tolerance (Singh, 2017).
Furthermore, digital media plays a more
effective role in spreading the information ofincidents as well as information on the protests,
press releases and public responses to the events. On
the other hand, the media may exaggerate or
misinterpret incidents due to lack of information or
to attract an increased number of click on the digitallink drawing trafDic. The online report is oftenemphasized on the victimization of the P/PRs whoare violent or HCPs. However, in reality, not only the
P/PRs are affected but also the HCPs by the poor
conditions of the current victimizing environment.
Indeed, WPV at healthcare setting is usually bilateral.
Therefore, media reports should include structuralproblems as well as personal HCPs practiceproblems, this in turn could have contributed moreto the solution of the WPV. That’s why; these online

40

Eubios Journal of Asian and International Bioethics 30 (March 2020)

reports should provide synergistic relationshipamong the media organizations, policies, and law
binding agencies, to create common sense andsolution to WPV.
There are several studies that focus on violenceagainst HCPs which have been undertaken in several
countries (Raveel & Schoenmakers, 2019). However,there are only a few online reports studies about
violence against HCPs (e.g., Bangladesh, China,
Australia, and Turkey). This study also reviewed
online reports regarding violence against HCPs thatwere opened to judicial investigations. Thus it isdifDicult to compare these studies because of thevariations of the study data. In this study, I focusedon online reports of violence against HCPs in Turkey
from January 1, 2012 and October 1, 2019, involving
1028 incidents.
This study data indicated thatperpetrators were95% male, attacking male HCPs (87%), and 79% ofthem attacked individually. In another study
conducted by Duğan in Turkey, analyzed 296 news
stories on HCPV between 2011-2013; 23% were also
males perpetrator and 24% victims were also males
and gender is not clearly stated in some news(Duğan, 2015). In this regard, gender studies has
also indicated that men play an important role invarious violent incidents in society both perpetrator
and victim (Cooper & Smith, 2012; Harders, 2011).
This study also indicated that 86% victims weredoctors, and 13% were nurses. Correspondingly, aBangladesh study found similar data where
physicians were 96% and nurses were 2% of thevictims (Hasan et al., 2018). The main reason that
doctors are targeted is that they are in a decisionmaking position because of their profession, that the
P/PRs are the direct contact person and that the
majority of the society accepts the doctor as the
person responsible for the solution of patients'
health problems. Not taking into account therelationship of hospital organization, policy or othersocial, economic and political problems of the healthpolicy and directs all its anger to the doctor who isconsidered responsible and not on structural issues(Farmer, et al., 2006).
This study indicated that perpetrators attack
used violent actions such as kick or-Dist (72%), knife(19%), sexual harassment (6%), gun (2.3%), verbal
abuse (1.4%) and chair or-table-or door throwing(0.1%). Another study conducted in Turkey shownthat perpetrators mostly used physical power (28%),
knife (7%) , verbal assault (3.7%), gun, pistol or riDle(1.7%), materials used in the news is not speciDied(3.1%), and mobbing (1%) (Duğan, 2015). Bothstudy results have shown the perpetrators'
intentions of giving serious injuries/harms for HCPs.
They don’t care about the general reasons ofhealth service. They almost turn all their anger,
current tensions, and concerns about life to the
HCPs. Because, this study data has also shown thatmost of the violent attack were caused due to longwaiting times (24%), miscommunication was thesecond reason (24%), third is an illegal request of

the patient (denial to write a medical report or
medicine due to ethico-legal-medical reasons)(16%), fourth is patient dissatisfaction (13%), Difth
was mess of hospital plan and organization (12%),sixth is lack of informed consent (8%) and seventh isafter receiving patients death information (2.6%).
Correspondingly, Duğan's thesis (2015) indicatedthat the emergence of violence on the part of P/PRs
was contributed by the following; (9.1%) refusal toaccept hospital rules, (6.1%) late intervention to thepatient, (4.4%) lack of interest of health personnel,(3.4%) reports of patient's death in the hospital
premises, (2.7%) psychological problems, and(1.0%) dissatisfaction with the services received or
results (Duğan, 2015).
However, another data revealing the real causeof these problems is the situation in the state andprivate hospitals. Our study also stated that HCPs in
private hospitals indeed encountered less WPV(1.3%), because most of their clientele are whitecollared individuals, they have Dinanciallystabledpatients, fair and limited waiting time, bettermedical service, good social facilities, providing a
Dive-star hotel like experience and a better
relationship with patients. Actually this conclusionindicated that main problem of WPV is on thesystemic-organizational-policy emphasizing on
structural inefDiciency. This is noted by otherresearchers; the conditions of HCPs in private
hospitals have encountered less WPV, because of its
limited patients number, better medical service,
good social facilities, quality accommodation
services and a better relationship with patients(Kanjaksha Ghosh, 2018).
Our study indicated that 31% of violenceoccurred in an emergency room, and 20% in an
outpatient unit. Correspondingly, another study
which was analyzed emergency department news
between 2010-2012, indicated that 23% of
emergency service news had a negative tone in
Turkey (Acar, Çevik, Uyguner, & ÇINAR, 2013) and
Bangladesh study stated that the places where
violence is highest are emergency service (52%) andindoor (41%) (Hasan et al., 2018).
In addition to these descriptive data, weanalyzed the tone of the online headlines which has
increased with digital technology on the public andgovernmental level and the contribution of the press
to public perception on the subject will be evaluated.
A headline is important as it is the essence of thenews. The readers will read the whole story of news
if the headlines are interesting enough for them. This
study was able to show that people who are exposed
to episodic framing tend to put the blame on an
individual level or who is the subject of the report,
while those exposed to thematic reports are putting
the blame on the organization or a higher position
that the report is focusing on (Iyengar, 1996).
Actually, we don't know if journalists have aconscious approach to this. Maybe they need to think
about episodic and thematic reports and review
their current approach. There are only a few studies

Eubios Journal of Asian and International Bioethics 30 (March 2020)
in Turkey regarding the analysis of the headline wasavailable and no study data from other countries
were found.
1. Headlines present violence against HCPs, asstandard/normal interpersonal violence: The
headlines in this category included an episodic
approach; therefore they have focused on the conDlict
between the HCPs and the P/PRs. In this regard, 789
out of 1028 headlines attacking the doctor was
reported as an interpersonal case and have made thedoctors both weak and the social reputation of thedoctor's profession is damaged. In addition, thepractice of violence against doctors is normalized.
WPV is usually carried out by PRs, therefore thisheadline is important to indicate this situation in
Turkey. Examples:"This time the violence came from the patient, notpatient' relatives!" 19.08.2014 (Medi-Magazin,2014).
The violence of Patient Relatives to a resident in
Ankara 02/17/2013 (SÇS; TTB).
A new one while the pain is still fresh ... Patient'
relatives attacked to a Professor Doctor assaulted
patient relatives! 09/10/2018 (SÇS)
Attacked with Scissors and dragged on the ground!
12/06/2017(SÇS; TTB)
“Relatives of the patient who did not want to wait inline, attacked the doctor:
The doctor underobservation in intensive care” (Medi-Magazin, 2019;SÇS)
Some news headlines contain the word claim. In
the context of the choice of this word, which creates
uncertainty as to whether the attack has taken place,it can be said that the victim may have lied and thatthe victim of violence has been victimized once more
(Durur, 2017; İnci & Bourse, 2014). Examples:
The alleged assault against doctor from acommissioned ofDicer in Cizre 15.04.2013
The alleged assault on healthcare worker inOsmaniye 12/15/2016 (SÇS; TTB)
The claim violence against a doctor in the hospital in
Adıyaman 08.02.2019 (SÇS; TTB)In Şanlıurfa female doctor was assaulted
12/20/2018 (SÇS; TTB)
In some headlines, the continuity of the news ofviolence is emphasized and despair is constructed
and normalized with a meaning that measures
cannot stop these events (İnci & Bourse, 2014).
Examples:Violence in a health setting continues 09.12.2016(SÇS; TTB)
Violence in Health Doesn't Stop ... 12.06.2017 (SÇS;TTB)
2. Headlines on some claims on patient rights
violations as legal-ethical-medical issues: These
headlines in this category included an episodic
approach, therefore they have focused on the conDlict
between the HCPs and the P/PRs. Examples:
Violence to the physician: A political party manager
said 'I waited for a long time', attacked the doctor!
23.08. 2017 (SÇS).

41

They broke the nose of the doctor who gave thenews of death 25.07.2017 (SÇS; TTB).
Beat the doctor who wished patients to receive asequence number 22.02.2016 (SÇS; TTB).
Attack to the doctor who objected to the write illegal
report in Antalya (SÇS; TTB).
Attacks doctor because he held a responsible doctorfrom his father's death 04/20/2013(SÇS; TTB)
Moreover, online news both headline andcontent can create a negative image for doctors due
to sensationalization presentation of media/
journalists. Examples:
Doctor's 'sarcastic attitude' was slapped: 'This slap
was the slap of the people’) 16.02.2018 (TTB).
Doctor who was not prescribed drugs in Urfa wasbeaten 08.07.2017 (SÇS; TTB)
The doctor wanted X-ray from his 4-year-old son's;
he was angry and he distributed up emergency room
21.04.201 (SÇS; TTB)
3. Headlines on P/PRs violated legal-ethical rules
and they punished: These headlines in thiscategory included an episodic narrative; therefore
they have focused on the conDlict between the HCPs
and the P/PRs. In some of the headlines in the attack
news against doctors, it was concluded that violence
was justiDied with details such as not writingprescriptions or reports, giving news of death. Hereare some news headlines that can be evaluated inthis context:
The doctor was threatened by a patient relative who
received 16 months in prison because of
threat15.02.2019 (SÇS).
The perpetrator attacked doctor with cobblestone,
the judge wanted the penalty 09/11/2018In Antalya,'patient said to the doctor, “You'll examine like adonkey” judge wanted Dine for those words.
07.09.2018 (SÇS)
4. Headlines on protest or press statement
against violence. These headlines in this category
included a thematic approach and placesconsiderable emphasis on structural problems. They
also included the name of institutions that makestatements such as the Ministry of Health and the
Chamber of Physicians. Such news reports theseriousness of the situation, the health policy, thehealth organization and the number of patients, but
unfortunately, they have not played a role to createcommon sense. Examples:
Doctors protest once violence 11.21.2018(SÇS).
In the state hospital: One health worker is exposed
to violence every hour 07.20.2018 (SÇS).
Declaration of the Turkish Medical Association
against violence was announced in Ş a n l ı u r f a
30.07.2018 (SÇS)
BrieQly, the above analysis shows us that thepress does not take enough structural issues into
consideration. As we mentioned earlier, the numberof patients, the weight of the workload, the lack of
medical staff and medical resources, limited time,42

Eubios Journal of Asian and International Bioethics 30 (March 2020)

fatigue or burnout. In addition some topics are
related on structural violence which is not
mentioned both on headlines and content. These
are; Dinancial losses of both HCPs and government;
loss of labor; priorities of the performance system(performance which are payment to healthprofessionals as much as the number of patients)
problems arising from general health policy or
hospital organization; failure to relate the main
source of violence to the general problems of thehospital (the number of patient-doctors have to takecare of 80 to 200 patients each day (Çamsarı, 2013).
These Digures vary according to the doctor's
specialty and population in Turkey; limitation of
resources, time and staff. The online report oftenemphasized the victimization of the P/PRs who are
violent or HCPs. However, in reality, not only the P/
PRs but also the HCPs are affected by the poor
conditions of the current victimization environment.
Indeed, WPV victimization is usually bilateral.
Therefore, when the media reports have included
structural problems as well as personal HCPs
practice problems, they will have contributed moreto the solution of the WPV. These online reports
should provide synergistic relationship among themedia organization, policy, and law binding agencies,
to create common sense and solution.
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Bio-law and biotechnologicalhyperconsumption: towards biojuridical resignification of twobioethical principles for protectionof cognitive health*- Camilo Noguera Pardo
El Bosque University, Colombia.
Center for Integral Human Development, Sergio
Arboleda University, Colombia.
Email: camilo.noguerap@usa.edu.co

Abstract

Several studies have reviewed the connection
between cognitive pathologies and exposure tocertain biotechnologies. In this article I brieDly
examine four issues: I introduce, from theoreticalcontributions by contemporary philosopher ByungChul Han, the neuronal damage caused bybiotechnological hyper-consumption; I demystify theidea that the legal system should not intervene in the
moral and social systems; I show, based on threescientiDic studies, some of the cognitive pathologies
due to unregulated use of speciDic biotechnologies; I
propose that biolaw, as a legal neoform and asuitable legal framework for the normative
regulation of biotechnologies, may organize anddirect them towards cognitive health, as an
unconditional basis for human development,
through resigniDication of the principles of integrity
and vulnerability coined by Jacob Dahl Rendtorff andPeter Kemp in their 2000 book entitled Basic EthicalPrinciples in European Bioethics and Bio-law.

Introduction

Byung-Chul Han, in his essay entitled La sociedad delcansancio (the Society of Tiredness), examines someof the effects of "overabundance of positivity", theneuronal consequence of continued exposure ofhuman beings to certain forms of life and culture; hereviews the pandemic of the 21st century, which he43

considers to be neuronal. This new society, which istired and neuronally ill, has explicit symptoms of adisease: depression, attention deDicit hyperactivity
disorder (ADHD), borderline personality disorder(BPD), occupational burnout syndrome (ODS),
among other disorders. His study is not a mere
philosophical speculation, but corresponds to otherdiagnoses made by intellectuals of notable prestige,
on the one hand, and with numerous scientiDic works
focused on the test of relationship or links between
cognitive damage and certain contacts with culturalforms on the other hand.
“We check behind the digital medium, which, below
the conscious decision, decisively changes our
behavior, our perception, our sensation, our thinking,our coexistence. We get drunk today with the digital
medium, without being able to fully assess theconsequences of this drunkenness. This blindness andsimultaneous obnubilation constitute the current
crisis.” (Chul-Han, 2018, p.11).
While the Byung-Chul Han approach is sharp,
relevant and current, it is not ex nihilo. From ajudicious reading of Nietzsche, Franz KaDka, Walter
Benjamin, Merleau Ponty, Paul Cézanne, Hanna
Arendt, Gregory the Great, Giorgio Agamben, Martin
Heidegger, Jean Baudrillard, Roberto Esposito,
among others.
“Due to lack of calm, our civilization leads to a new
barbarism. At no time has active been quoted more,that is, the restless. Consider, therefore, among thenecessary corrections that must be made to thecharacter of humanity the strengthening of thecontemplative element to a large extent” (Nietzsche,
2007, p.180).
Byung-Chul Han deepens his initial intuition
about the "overabundance of positivity" as one of thecharacteristic elements of the "performance society"and analyzes its consequences. The sharpness of hisanalysis is twofold: on the one hand, he arrives at acurrent and relevant reading of the intellectuals
mentioned and many others who also warned about
the dangers of unlimited techno-scientiDic progress;on the other hand, his deductions, based onliterature and philosophy, correspond to scientiDic
evidence, some of which will be cited below.
In summary, Byung-Chul Han's work reviews how
biotechnological hyper-consumption and some of its
cognitive demands reduce the mind to a digitalswarm and digital communication that inevitably
end up cracking cognitive health; a digital swarm ofdigital men who eventually become Hikikomoris.
Hikikomoris are people who live outside society.
These people decide their isolation. They prefer tospend their days at home in front of television, social
networks and video games, rather than sharing withpeople in personal ways. Hikikomoris develops
mental disorders over time which deDinitely
compromises their cognitive health.
A cognitive demand for technological hyperconsumption, typical of the fatigue society and the∗ This article was written in the framework of a postdoctoral fellowship (2019-2020) at El Bosque University, Colombia.

44

Eubios Journal of Asian and International Bioethics 30 (March 2020)

performance society, is multitasking. The individual,is overwhelmed by a multiplicity of biotechnologicalstimuli and the needs that they entail, that fragment
his attention. This fragmentation has negative effects
on cognition. In the words of Byung-Chu Han: “Theexcess of positivity is also manifested as an excess ofstimuli, information and impulses. It radicallymodiDies the structure and economy of care. Becauseof this, perception is fragmented and dispersed. The
technique of time management and multitasking
attention does not mean progress for civilization. It
is rather a regression. Not only multitasking, but also
activities such as computer games arouse wide but
superDicial attention, related to the surveillance
status of a wild animal. Recent social developments
and the change in the structure of attention cause
human society to get closer and closer tosavagery” (Ibid, p. 34).
This biotechnological hyper-consumption causes
more and new cognitive sequelae. An example that isincreasingly visible is the IFS (Information Fatigue
Syndrome). This syndrome is a psychic diseaseproduced by biotechnological information:“Those affected complain of increasing paralysis ofanalytical capacity, disruption of attention, general
concern or inability to assume responsibilities. A
major symptom of the IFS is the paralysis of analyticalability. Analytical capacity constitutes thought. Toomuch information causes thought to be stunted. In
short, it is the ability to distinguish the essential fromthe non-essential. The glood of information to which
we are exposed today undoubtedly decreases theability to reduce things to the essence. And, in fact, thenegativity of distinction and selection belongs
essentially to thought. The tiredness from information
also includes symptoms that are characteristic ofdepression. Among the symptoms of the IFS is also theinability to assume responsibility. Responsibility is an
act that is linked to certain mental and temporary
conditions.” (Byung-Chul Han, pp. 88,89,90).
This work articulates the link between an
unregulated use of biotechnologies orbiotechnological hyper-consumption, and cognitive
damage. Hence, I formulate the following thesis: biolaw has a responsibility to cognitive health thatconsists in regulating the use of biotechnologies withbinding and limiting force, through theresigniDication and speciDication of speciDic bioethicalprinciples.
Legal order and other systems
The relations between the legal system and themoral system have been a constant reDlection of thephilosophy of law and legal theory for centuries. The
position whether these two systems are the same,
are antagonistic or different, but at the same time,
related, has varied between different conceptions
and schools of law: legal formalism, legal historicism,
legal relativism, Scandinavian legal realism, North
American legal realism, legalism, constitutionalism,
neo-constitutionalism, critical school of law,originalism, living constitution and schools ofnatural law. All these conceptions and schools of law
address the problem and throw dissimilar
conclusions about the relations between the systems
in question.
Basically, the legal system (in this case bio-jury)
and the moral system (in this case bioethics) are
intrinsically related. Their relationship has the same
reasons that the philosophy of law has explained toprove that law and morals have close relationships:
1) morality is a source of law, since respect for
morality is something that matters to the common
good, and the common good is one of the purposesof law; 2) “it is a function of law to create a climate,so to speak, conducive to the fulDillment of morality,
not only in the sense of not creating obstacles tovirtuous life, but also in promoting an empire of
ethical order, and this because the greater moral
perfection of men contributes effectively to the social
order and the realization of the common good”(Noguera Laborde, 2003, p.139); 3) the law makes
moral life possible, since a goal of the legal order ismaking morality possible.
In accordance with the above, I defend the thesis
according to which bio-law and bioethics aredifferent but related systems; more speciDically, I
promote the right of communities to cognitive healthfor human development, through the resigniDicationand speciDication of bioethical principles. In
particular, I develop the idea that bio-law enables
and regulates bioethical principles and, with that,can be a binding legal framework to regulate, beyond
the deliberative frameworks of bioethical principles,the uses that individuals make of new technologies
or, more exactly, of biotechnologies, by putting limits
on biotechnology generators over the abuse of theconsumer. Therefore, in this research I propose thattwo principles be reshaped to preserve cognitive
integrity: the principle of integrity and the principleof vulnerability.
Use of biotechnologies and cognitive
damage: scientific evidence
It is a scientiDic fact, not a philosophical speculation
or a literary Diction, that the exposure of the humanbrain to certain biotechnologies triggers adverse andharmful effects on cognitive health. I refer andabbreviate two scientiDic investigations in thisregard.
In 2010, researchers Victor C Strasburger of the
Department of Pediatrics, University of New Mexico
School of Medicine; Amy B. Jordan of Anneberg Public
Po l i c y Ce n te r, U n i ve r s i t y o f Pe n n s yl va n i a ,Philadelphia, and Ed Donnerstein of the Departmentof Communications, College of Social and Behavioral
Sciences, University of Arizona, published a review
article entitled "Health Effects of Media on Children
and Adolescents.” In the article, they argued, on ascientiDic basis, that spending an average of 7 hours
on television, the Internet, video games and cell
phone have consequences on children such as eating
disorders, disorders in moods, sexuality, learning,
substance abuse and eating disorders.

Eubios Journal of Asian and International Bioethics 30 (March 2020)
In July 2011, researchers Betsy Sparrow ofColumbia University; Jenny Liu of Wisconsin
University; and Daniel Wegner of Harvard University
published an article "Google Effects on Memory:
Cognitive Consequences of Having Information at
Our Fingertips", in the Science Magazine. The article,
now known in the scientiDic community as the article
on the "Google Effect," reveals proven effects of theInternet on the human brain. Researchers show, withtests applied to university students, that the Internet
has begun to replace memory. Data banks begin toact as a collective and available memory for
consultation. In sum, the "Google Effect" proves that
it is increasingly difDicult for human beings toremember, that is, to have a good memory. In otherwords, overexposure to this type of biotechnology
undermines memory and, consequently, affects suchcognitive function.
In short, it is possible to establish a necessary
causal relationship between neuronal damage andexposure to certain technologies.
Integrity and vulnerability: epistemologicalresignification
Jacob Dahl Rendtorff and Peter Kemp described four
ethical principles or common moral values for
European bioethics and bio-law: autonomy, dignity,
integrity and vulnerability. In this investigation, I
examine and re-signify two of these principles:
principle of integrity and principle of vulnerability.
Erick Valdés has criticized the approach of J.
Rendtorff and P. Kemp and developed, based on his
criticism, a resigniDication of the principles inquestion. His criticism basically consists in pointing
out that these principles can only be shared in aformal way, that is, communities can agree to accept
those principles, but not necessarily the content of
those principles. Hence, they cannot be considered
bio-legal principles but bioethical. His resigniDicationconsists in granting to these principles normative
force and binding power to guarantee their
obligatory nature and, therefore, their denominationof bio-law. This thesis has been ratiDied by Tom L.
Beauchamp in 2019. Both exhibitions are found in
the book “Biolaw and Policy in the Twenty-FirstC e n t u r y. B u i l d i n g A n s w e r s f o r N e w
Questions” (Valdés and Lecaros, 2019). This researchgoes beyond Valdés' criticism, not only pointing out
the need to juridify bioethical principles, but also to
specify that juridiDication towards a speciDic end: thepreservation of cognitive health as a fundamental
basis for human development. Ultimately, thisresearch proposes a speciDied resigniDication of theprinciples of integrity and vulnerability. Such a
proposal has, then, an implicit moral claim, because
it tends to protect and develop a particularconception of good that corresponds to cognitive
health.
The principles of European bioethics and bio-law,identiDied and deDined by Rendtorff and Kemp, could
acquire a greater strategic value if they functioned
legally; that is, if they reach, at least partially, a45

legally binding value. Clearly, in their original
constitution, the principles do not enjoy that statute,because they simply function as common moral
standards. It is the Danish theorists who assume thatthe principles have a legal condition, which in myopinion is non-existent. The principles of European
bio-law indicate rather ontological conditions or
general values, but the epistemological conDigurationof each of the principles does not indicate an explicit
normative and legal content. Hence, a well-executed,
systematized and legalized principled model isneeded to generate new regulatory certainties on
biomedical practices.
Therefore, I propose that, in order to limit, with alegal framework, the indiscriminate use of certain
biotechnologies to preserve cognitive health, theRendtorff and Kemp principles of integrity andvulnerability be resigniDied and speciDied. This
resigniDication consists, speciDically, in two aspects:
Dirst, to grant them normative force; second, specify
the scope and purpose of that normative force, thatis, its epistemological density.
Rendtorff and Kemp (2000) assume that theirprinciples have already been legalized because
although they are ethical principles, they "aresomehow" already part of the law. However, that
represents an arbitrary leap from ethics to law,which is inadmissible, to build a logical bio-law in its
formal and material aspects. Consequently, andwithout afDirming that this could be a deDinitive biojuridical model, I show, very synoptically, how thetwo principles already mentioned of European
bioethics and bio-law could be redeDined andjuridiDied. Such resigniDication and juridiDication
optimizes the proposal of Rendtorff and Kemp. Fromthe preceding diagnosis, the principles can be
redeDined as follows (Valdés 2015; Valdés 2019).
Respect for integrity: which indicates the right ofevery human being to 1. Remain unalterable in his
physical, psychological, biological and genetic
constitution, and protect him from any detriment,
damage and alteration. It is based, mainly, on the
Declaration of Helsinki (1964) which states "theright of the subject of experimentation to safeguard
his integrity, and the duty to respect that integrity."
Respect for vulnerability: which orders the respect
and protection of the inherently reliable condition of
the human being. Indeed, the human being, in its
biological and psychological dimensions, isvulnerable and, as such, is exposed to damages, risks
and threats. Valdés has stressed that the procedural
extension of this principle is greater than that of theother three since, in material terms, autonomy,
dignity and integrity are subject to the Dinite andmortal condition of human beings. Therefore, thevulnerability principle assumes an ontologicalpreeminence (but not necessarily normative) withrespect to the Dirst three.
I now show how Rendtorff and Kemp should haveproceeded if they had made a correct and explicit
juridiDication of their principles. The process ofjuridiDication of the principles of bio-law that Valdés

46

Eubios Journal of Asian and International Bioethics 30 (March 2020)(2015) has proposed is theoretically simple. It is
about transforming them into concrete rules of abinding nature through legal speciDication of theprinciples of biomedical ethics. I make the caveatthat observing how the principles of European biolaw are constructed epistemologically (more as
ontological conditions than as legal norms), stilllegalized, its scope would only apply to solving
rather simple cases in the context of bioscientiDic
practices. To address and cover all or most of thecomplex cases, a more comprehensive andessentially legal bio-law model is required, which wewill offer, together with Erick Valdés and Laura
Victoria Puentes (2020), in a book soon to appear.
For now, and taking into account the above, I test
the proposal for juridiDication. To do this, I willcontrast the two principles analyzed, with thecontemporary event of biotechnological hyperconsumption and determine whether this should be,in some way, regulated by international legal
systems. In the same act I will provide more
epistemological content with the principles
mentioned, granting them more concreteness andlimiting their originally vague and general scope.
Applied the principles, already endowed with
content, as a binding regulatory framework for nontherapeutic genetic practices, the result could be thefollowing:
The principle of respect for integrity would reject
the effects of biotechnological hyper-consumption.
Respect for the genetic integrity of the human being
implies the right of each individual to live an
authentic human life, that is, endowed with a
psychological and cognitive structure that has notbeen altered, tendentiously and harmfully, byexternal agents. At the same time, and in
deontological terms, psychological and cognitive
integrity must be understood as part of the culturaland social duties that a certain identity implies.
In view of this argument, some procedural rulesof beneDicence that regulate the protection of
integrity should be considered, namely: always dowhat is good for the other; protect and defend therights of others; prevent damage to others; andpromote the good of others. In short, once theprinciple of integrity is legalized, it will not endorse
deregulation of biotechnological hyperconsumption.
In turn, the juridiDication of the principle ofrespect for vulnerability implies the consideration ofcertain rules of non-maleDicence, such as "notcausing unnecessary harm" or "not depriving othersof the assets of life", so, before this epistemologicalcontent of the principle, the same principle would
reject the individual and social effects oftechnological hyper-consumption.
In this way, the process that I have described,
indicates that a substantial difference between
bioethics and bio-law resides in its binding
character. However, depending on the proceduraland epistemological differences between the two
disciplines, the difference is observed in that the

speciDication of the bioethical principles has
different consequences than that applied to theprinciples of bio-law; that is, that the former tends toraise the standard of deliberation, while the second
tends to provide the basis for regulations; that is, forjuridiDication.

Conclusion

Biotechnological hyper-consumption generates
cognitive damage in individuals. Cognitive damages
supported by scientiDic evidence include mooddisorders, eating disorders, learning disorders andsexuality disorders. However, there is no binding
global framework to regulate biotechnological abuseof consumers or the information that biotechnology
generators should include in their products.
Bioethical principles are not enough toinstitutionalize binding frameworks. It is not enoughto biojuridically resignify the bioethical principles,that is to say, it is not enough to grant a binding
character to the bioethical principles, but it isnecessary to specify a normative character,endowing them with greater epistemologicalcontent. Cognitive health is the fundamental basis
for human development. Accordingly, it is necessary
to protect cognitive health from biotechnologicalhyper-consumption, through bio-juridiDication andspeciDication of bioethical principles.

References
Beauchamp, Tom. (2019). A Defense of Universal Principles inBiomedical Ethics. In, Valdés, E. y Lecaros, J.A. Biolaw and
Policy in the Twenty-First Century: Building Answers for New
Questions, Switzerland: Springer.
Byun-Chul H. (2018). La sociedad del cansancio. Barcelona:
Herder.
Byung-Chul H. (2018). El enjambre. Barcelona: Herder.
Byun-Chul H. (2018). Hiperculturalidad. Barcelona: Herder.
Byun-Chul H. (2018). Buen entretenimiento. Barcelona: Herder.
Casabona, C.R. (Dir). (2011). Enciclopedia de Bioderecho y
Bioética. Granada: Comares.
Fisher, Matthew, Goddu, Mariel K. y Keil, Frank C. (2015).
Searching for Explanations: How the Internet InDlates
Estimates of Internal Knowledge. Journal of Experimental
Psychology 144(3): 674-687.
García Lorca, Federico. (2008). Federico García Lorca. Obracompleta II. Poesía, 2. España: Akal.
Nietzsche, Friedrich. (2007). Humano, demasiado humano.
Madrid: Akal.
Noguera Laborde, R. (2003). Elementos de gilosogía del derecho.
Bogotá: Fondo de publicaciones Universidad Sergio
Arboleda.
Rendtorff J. y Kemp, P. (2000). Basic Ethical Principles in
European Bioethics and Biolaw (Vol I). Barcelona and
Copenhagen: Institut Borja di Bioetica &Centre for Ethics andLaw.
Sparrow, Betsy, Lui, Jenny y Wegner, Daniel M. (2011). Google
Effects on Memory: Cognitive Consequences of Having
Informations at Our Fingertips. Sciencexpress (Report): 1-6.
Strasburger, Victor C., Jordan, Amy B, y Donnerstein, Ed. (2010).
Health Effects of Media on Children and Adolescents.
Pediatrics 125(4): 756-767.
Valdés, Erick, Noguera Pardo, Camilo, y Puentes, Laura Victoria(2020). Biolaw: Origins, Doctrine and Juridical Applications on
the Biosciences, Switzerland: Springer.

Eubios Journal of Asian and International Bioethics 30 (March 2020)

47

Abstract

Despite these, Manoj further concludes his pointby afDirming a possibility of posthuman asexuality.
He says that the “cyborg world could certainly
become sexless” (p. 33). Moreover, the movement of
posthuman sex, which in this case is situated inbetter cyborg sex, can be countered again on theargument of the abyss or the meaninglessness thatlooms within the background of sexual afDluence (cf.
Kahambing, 2019a). In this paper, I will present
other arguments that advance the possibility ofasexuality in the posthuman. First, I will discussŽižek’s argument of voiding sexual difference.
Second, I will expand such an argument through theself-replicating possibilities of cloning and fullcyberspace immersion. And Dinally, I will explore
some of the arguments that include or exclude
Nietzschean ethics in this prospect.

Posthuman bioethics and sexlessness
In Dr. V.R. Manoj’s Cybofree: Posthuman Bioethics fora Sustainable Humanity (2019), he reiterates how in
the future a completely trans-human cyborg canconclude the fact that “the essence of reproduction
may completely escape the need for sex” (p. 33). Hebacks this point by the non-necessity of bodies
coming together for contact, real-time transfer ofgenetic information, and the preference of highinformation credits than orgasms. In this sense, “wecould evolve into a species which has time to devote
to other activities. People need not anymore beconcerned that they need to Dind a partner real fast
before their biological clocks stop ticking” (p.33). At
present, radical technology, he hopes, can open thisfuture by ‘incredibly cheap and easy tele-dildonics’
for better cyborg sex by noting the following:
1. Better contraceptives made by nanotechnology
which can effectively Dilter out sexuallytransmitted microbes while not compromising on
pleasure.
2. Bionic implants that can help people unable tohave sexual relations.
3. Hormonal switches for voluntary control offunctions.
4. Drugs to effectively help people who Dind
abstinence for religious purposes difDicult tohandle.

Voiding sex and sexual difference
In plotting and contrasting the domain of
possibilities for the argument of asexuality in the
posthuman, Žižek explains the less-known prototypeof Alan Turing’s imitation game. The game tests if a
machine can process thinking itself. This is done bycomparing two computer interfaces: one interface isoperated by a human and the other is operated by acomputer. The comparison seeks to Dind out whether
there is any differentiation between the “thinking”
processed by the human and the computer ormachine. To explain the digitalization that is at workin the differentiation of thinking between man andmachine, one only has to look at the meaning andfunction of an ‘interface’. Žižek in Incontinence of the
Void (2017) wrote that “inter-face means preciselythat my relationship to the other is never face-toface, that it is always mediated by the interposed
digital machinery” (p. 169). What the less-known
prototype of this game points to, however, is theinitial task of determining the answers between a
man and a woman. Later, this has provided a
jumping board towards replacing the woman with amachine since at best, the results of symbolic
utterances between a man and woman provide nulland erroneous results. Turing explains this inrhetoric: “What will happen when a machine takes
the part…? Will the interrogator decide wrongly as
often when the game is played like this as he does
when the game is played between a man and awoman?” (Turing, 1950, p. 434). Sexual difference,
thus, creates a sort of imbalance in thestraightforward determination of human rationality,
which is just right against the presumed objective ofcognitive processing by a machine. The question“can machines think?” can only be determinedthrough the interfaces between a man and amachine, so that sexual difference can be voided as areal purely human representation. Concerning sexual
difference, Copjec’s Sex and the Euthanasia of Reason
shares Žižek’s thought of sexual difference asassuming the stance of the real:“Sex serves no other function than to limit reason,
to remove the subject from the realm of possible

Valdés, Erick. (2019). Towards a New Conception of Biolaw. In,
Valdés, E. y Lecaros, J.A. Biolaw and Policy in the Twenty-First
Century: Building Answers for New Questions, Switzerland:
Springer.
Valdes, Erick (2015). Bioderecho, daño genético y derechos
humanos de cuarta generación, México, Boletín mexicano de
Derecho Comparado 48(144): 1197-1228.

Posthuman sexlessness in cloning,
Pokémon, and Nietzschean ethics- Jan Gresil S. Kahambing
Leyte Normal University, Tacloban City, Philippines
Email: vince_jb7@hotmail.com
An inquiry into the bioethical or ethical componentof post-humanism can be through the question ofsex. Following from Manoj’s idea of a cyborg as
having a “sexless” possibility, this paper presents
other arguments that advance the possibility ofasexuality in the posthuman. First, I begin with a
discussion of Žižek’s point concerning the cessationor voiding of sexual difference. Second, I willcontinue such an argument through the selfreplicating possibilities of cloning and fullcyberspace immersion, the later as prototyped by
Pokémon. And Dinally, there seems to be an inevitablethread that begs to link the concept of theposthuman to Nietzsche; so I will explore some of
the arguments that include or exclude Nietzschean
ethics in this prospect.

48

Eubios Journal of Asian and International Bioethics 30 (March 2020)

experience or pure understanding. This is themeaning, when all is said and done, of Lacan'snotorious assertion that 'there is no sexual relation':sex, in opposing itself to sense, is also, by deginition,
opposed to relation, to communication. This
psychoanalytical deginition of sex brings us to ourthird complex of questions, for, degined not so much by
discourse as by its default, sexual difference is unlike
racial, class or ethnic differences. While thesedifferences are inscribed in the symbolic, sexual
difference is not: only the failure of its inscription ismarked in the symbolic. Sexual difference, in otherwords, is a real and not a symbolic difference. Thisdistinction does not disparage the importance of race,class or ethnicity; it simply contests the current doxa
that sexual difference offers the same kind of
description of the subject as these others do. Norshould this distinction be used to isolate
considerations of sex from considerations of other
differences. It is always a sexed subject who assumes
each racial, class or ethnic identity” (Copjec, 1994).
Žižek asserts: “What if sexual difference is not
simply a biological fact, but the Real of anantagonism that degines humanity, so that once
sexual difference is abolished, a human being
effectively becomes indistinguishable from amachine” (ZNS; Italics; cf. Kahambing, 2018). In thissense, sexuality can be considered as the “obstacle”
towards man’s ideal form. Incidentally, this ideal
form of man can be recalled in Nietzsche. Ann Boyd(2018) wrote in this journal that Nietzsche,particularly his concept of the Ubermensch, has been
continually cited by scholars for and against
transhumanism. Putting this in Nietzsche’s terms,
the cognitive product of man and woman thatcomprises the human is only representative of thelast man in Thus Spoke Zarathustra (1969), taken as
the opposite of the superman.
How then would Nietzsche’s idea of Last Man linkto the notion of voiding sexual difference? The last
man is man still at the intersection point between
the realm of sexuality and the future realm of sexless
possibility. The last man is, then, the man who is still
tailing at the end of sexuality, who still has sexuality,and hence the present. This is the man who relishes
the thought that sex is still the functioning
mechanism that operates the transactions of society.
As in all postmodern reading of the anthropocentric
episteme of modernity, the last man is the modernman. And this can be read in Albert Camus’ The Fallwhen Camus speaks as Clamence as he generalizes
the human condition in modernity: “A single
sentence will sufDice for modern man: he fornicatedand read the papers” (1956, p. 6). It can be drawn
then that the disposition which besets the modern
man is one that is highly sexuated in the mostcarefree sense of the term, but mostly inactive at theabyss that permeates in his lifestyle. Once this sexual
difference and the basic notion of sex are voided, one
can proceed to an asexual conception of theposthuman. The possibilities that extend thisargument lies in cloning and full cyberspace
immersion.
Genetic cloning
Voiding sex can also be explained in the possibility ofa posthuman as a by-product of cloning. Historically,
it was proposed in 1903 by W. Sutton that “genes
reside on chromosomes” and it was backed
experimentally in 1910 by T.H. Morgan, which led tothe technologies of gene mapping (Brown, 2006, p.
3). This led to the production of a “comprehensive
analysis of the relative positions of over 2000 genes
on the four chromosomes of the fruit Dly, Drosophilamelanogaster,” in 1922. But this was incomplete as
the real understanding of the gene’s molecularnature came later in the 40s. The experiments in1944 and 1952, leading up to their developments in
1966, had broken down the structure of a genetic
material that was the DNA. Henceforth, “thestructure of DNA was elucidated, the genetic code
cracked, and the processes of transcription andtranslation described” (Brown, p. 3). What followedin the years 1971-1973 was a revolution:
recombinant DNA technology or genetic engineering,“and having at their core the process of gene cloning,”
led to the “rapid and efDicient DNA sequencing
techniques that enabled the structures of individual
genes to be determined” as improved now in modern
biotechnology (Brown, p. 4). This will come as no
surprise that the current technological franchisemight already be able to create a clone. As explicatedin Marshall (2015, p. 93), a clone is a “cell, group ofcells, an organism produced asexually from a single
ancestor and is genetically identical to a single
ancestor,” in which a human clone means “thecreation of a genetically identical copy of ahuman” (p. 94).
This is one self-replicating
possibility that does not involve sexuality.
Pokémon, or full immersion prototyping
There are self-replicating possibilities that involve
the absence of sexual differentiation e.g. transfer ofconsciousness, virtual reality, etc. If one can thentransfer one’s consciousness from one body toanother, or to some new other (synthetic) host-body,sexuality would no longer hold its desire andfunction. The ontological level here can be seen in
the way that sexual differentiation disappears, since
the transfer may happen regardless of whether the
body from which consciousness transfers is male orfemale. It should be noted however that strictly
speaking, sexuality can be separated from desire, asa kind of organ (desire) without body (sexuality) as
seen for example in Žižek’s explication of Gilles
Deleuze’s ideas and their implications in Organs
without Bodies: Deleuze and Consequences (2016).
Sex and sexation are still signiDicant in a post-humanera, because it brings into fore the clariDicatory pointof this paper regarding sex: it puts Žižek precisely on
the speculative turn of continental philosophy, whichis to say that he goes beyond mere hermeneutics andthat his speculations on the future can still radicallyEubios Journal of Asian and International Bioethics 30 (March 2020)
reach an extreme, even the traumatic end of
sexuality.
Another possible path that this end can take isvirtual reality (VR). Here, Žižek explains the general
lesson of VR from no other than the crazed gamethat was released in July 2016 - Pokémon Go. It is a“location-based, augmented-reality game for mobile
devices, typically played on mobile phones; players
use the device’s GPS and camera to capture, battle,
and train virtual creatures (“Pokémon”) who appear
on the screen as if they were in the same real-world
location as the player” (Žižek, 2017, p. 151). But thisis merely AR or Augmented Reality. Žižek
differentiates the four levels of reality in thistechnology: there is VR (Virtual Reality), AR(Augmented Reality), MR (Mixed Reality), and RR(“real” Reality ‘which we perceive and interact
with’). The idea is that AR, MR, and even RR can beneglected in the argument for self-replicating
possibility since the important feature of VR is notfound in the other three. In which case, Žižek (2017,p. 153) says that “when we deal with the newdevelopments in Virtual Reality (VR) technology, we
usually focus the prospect of full immersion, thereby
neglecting the much more interesting possibilities ofAugmented Reality (AR) and Mixed Reality (MR).” To
quote:“In VR, you wear something on your head(currently, a head-mounted display that can look likea boxy set of goggles or a space helmet) that holds ascreen in front of your eyes, which in turn is poweredby a computer. Thanks to specialized software andsensors, the experience becomes your reality, gillingyour vision; at the high end, this is often accompanied
by 3D audio that feels like a personal surround-soundsystem on your head, or controllers that let you reachout and interact with this artigicial world in an
intuitive way. The forthcoming development of VR willheighten the level of immersion so that it will feel as if
we are fully present in it: when VR users look (andwalk) around, their view of that world will adjust in
the same way as it would if they were looking or
moving in real reality” (Žižek 2017, p. 153-154).
In VR, the possibility of being sexless arrives as amechanism of total immersion where, before thetransfer of consciousness, the subject’s
consciousness initially goes into cyberspace.
Although this might work into full consciousness
immersion as an extreme possibility and still might
be distant as a futuristic reality, cloning as alreadywithin the grasp of technology, still trumps in its
immediacy the interesting take that VR might bring.
What the idea of Pokémon brings is the prototype ofa full immersion into this space in the future where
sexlessness resides in the ability to choose virtual
bodies, a kind of reproduction of the self through amachine.
This exposes a glaring thought: is this not selfmachinery reproduction or the precise ontologicaldeal that presages the declining motion after the
climax of sexual differentiation, so that the true
ascent of man, its apex, lies not in spirituality but in

49

technology? Žižek’s position extrapolates the extent
of posthuman futurism under the aegis of thetechnological facets that can designate themselves as
replacement of traditional enlightenment or in
Nietzsche’s term, as a critique of morality. Žižek says
that: “The end of sexuality in the much celebrated
posthuman self-cloning entity expected to emerge
soon, far from opening up the way to pure spirituality,
will simultaneously signal the end of what istraditionally designated as the uniquely humanspiritual transcendence. All the celebrating of the new"enhanced" possibilities of sexual life that Virtual
Reality offers cannot conceal the fact that, oncecloning supplements sexual difference, the game isover.” (ZNS; cf. Kahambing, 2018).
But is a Nietzschean critique of morality a properargument to supplant the bioethical component of
posthuman sexlessness? How much of Nietzschean
ethics or critique of morality can be involved? Ann
Boyd (2018) already claims that “Nietzsche’s
overhuman is the ideal person, not an eternalversion of the human or a radically enhanced form,
rather one that has attained mastery of the will” (p.
139). How do we understand this?
Nietzsche’s ethical view of the posthuman
Why is Nietzsche, rather than any philosopher, an
important part of the subject within the discussionof posthumanism? Alain Badiou writes about an
event (événement) and in one of his writings asked
the question who is Nietzsche (Badiou, 2001, p.
1-11). He answers that Nietzsche is an event: “thisevent is an absolute break, whose obscure proper
name is Nietzsche” (Badiou, 2001, p. 3). This meansthat Nietzsche, the name, is an event that breaks theworld in two as his madness: “that he is the name,not only of what announces the event, not only thename of the rupture, but ultimately the name of theworld itself” (p. 8). An event is a “creative novelty”
that sutures the future, or more precisely, tarries
with the future; in which case Nietzsche, more thananyone, with his concept of the superman as the manof the future becomes the event that signals thebreakage of two possible worlds into which the pastand future collide. Hence, the name Nietzsche
becomes a signiDicant part of the future that includes
the posthuman.
Francesca Ferrando (2013) speciDically pinpoints
Nietzsche’s signiDicance in the broad terminology ofthe posthuman. Narrowing down Boyd’s point
concerning Nietzsche’s involvement intranshumanism, Ferrando situates Nietzsche within
anti-humanism, which projects the criticalassessment of what is human. As such, theunderstanding of Nietzsche and Foucault on at theend of man Dits well in this area of posthumanism.
This is important since the discussions of the‘Nietzschean-Foucauldian legacies’ whose themes
include the ‘death of man’ and technologies of theself are part of anti-humanism. The end of man
supports the necessary consequence of the birth of
the superman.

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Eubios Journal of Asian and International Bioethics 30 (March 2020)

The difference of this to posthumanism, however,is that “posthumanism does not rely on any symbolic
death” (Ferrando, p. 31) but is more Derridean thanNietzschean-Foucauldian when it ‘deconstructs’ theimage of man. With Žižek’s voiding of sexual
difference in posthumanism as a traumatic asexualend, the elements of the real far surpass symbolic
tones. If there is anything that connects
posthumanism in general to Žižek’s, it is the act ofgoing beyond - in the sense of deconstructing - ‘man’,
which for Žižek can be scrutinized underpsychoanalytic and hence even under ‘real’terminologies.
What is further vital in Ferrando’s analysis is her
understanding that posthumanism can go beyond
technological means of (re)production. Žižek mighteven share the other equally crucial point that
Ferrando contributes (2013), which is that “althoughposthumanism investigates the realms of scienceand technology, it does not recognize them as its
main axes of reDlection, nor does it limit itself to theirtechnical endeavors, but it expands its reDlection to
the technologies of existence” (p.30). This is where
Nietzsche also comes in, when existence is nevertotally attached to modern technology, as inFoucault’s technologies of the self or Nietzschean
self-artistry. With this, Ferrando recommends theinvestigation of the geological time of the
Anthropocene wherein the human becomes
decentered from its primary focus: the human is nolonger seen as an “autonomous agent” but is “locatedwithin an extensive system of relations” (p. 32).
But will Nietzsche save the transhumanist
process in terms of its ethical warranty? Agatonović(2018) directly Dits into the question of whether or
not Nietzsche can be used on the advancement oftranshumanism by targeting on the coordinates of
the transhumanist process. His insights can begleaned from a counter-reading and are therefore
against the relationship of Nietzsche and thetranshumanist agenda. His thoughts are basedlargely on the idea that Nietzsche’s conception ofenhancement, which is directly tied to theconception of overcoming in the sense of going
beyond man, goes against the transhumanist
conceptions of enhancement. This is based moreparticularly on the idea that Nietzsche’s concept ofovercoming then did not yet fully consider theinsertion of modern technology. Instead, Nietzsche
from his context, certainly cannot possibly include
this technological enhancement as a means ofovercoming because he relies simply on traditionaland not technological means. What Nietzsche means
when he says that the superman must not be an
accident is that he must undergo cultural means
such as “adequate education, formation, socialcultural values, examples of humanexcellence” (Agatonović, 2018, p. 437), hence
implying that the superman must overcome throughthe coordinates of life-afDirmation, of saying ‘yes’ tolife from what has been and what will be (cf.
Zimmerman, 1986, p. 156). But what Agatonović

does further, in the end, is a form of association interms of the rules of replacement in symbolic logic:
to illustrate his position (p) of thinking against therelationship of Nietzsche (N) and transhumanism (t)[symbolically: p ● (N ● t)], he cleverly uses Nietzscheand his position to think against transhumanism[hence: (p ● N) ● t], which gives the same thought all
the same. He does this when he argued that
Nietzsche can still serve a purpose in therelationship with transhumanism but only throughNietzsche’s critique of morality as countering theprocess. That is to say, that the critique of morality
can be used as a critique of the transhumanist
conceptions of human enhancement, so that the
moral presuppositions that underlie the means of
medicine and technology when they are guided by“universal moral considerations (Agatonović, p.
437),” can be replaced by the creative act of a more
traditional overcoming of self-knowledge. In thewords of Zarathustra: “let your spirit and your virtue
serve the meaning of the earth, my brothers…
physician, help yourself: thus also help your sick. Letthat be his best help, that he sees with his own eyes
the one who heals himself” (Nietzsche, 1969, I).
However, if Nietzsche can be read as a counter tothe transhumanist process because his ethics can becontextualized through culture or education(Bildung), then this can also be situated as a part ofthe posthumanist process. Ferrando (2013) notes ofthe fact that posthumanism not only accommodates
cultural elements, but posthumanism is necessarily
cultural. The posthuman process is cultural because
it hinges on cultural studies (as in Halberstam andLivingston, 1995; Badmington, 2000; Miah, 2008).
On the outset, the term “posthumanity” is deDined
not in univocal terms with posthumanism, but is thebroad academic term for the studies of “the humancondition to the posthuman” and which can beextended to “future generations of beings
evolutionarily related to the humanspecies” (Ferrando, p. 32).
Recapitulation
In this paper, I expounded on some of the argumentsthat advance posthuman sex through the possibilityof sexlessness. There are good reasons to suppose
the advancement of asexual posthumans whensexual difference and sex can easily be voided
through self-replicating possibilities. The crucial
thought to bear in mind here is that the sexual
cessation may not even take the form of a symbolic
death but of the real. If cloning and cyberspace
immersion (in Pokémon) will be situated in the real,
the game is over for sex. Although the philosophicaland psychoanalytical undertones of the concepts ofsex, sexation, sexual difference, and sexuality arestrictly distinguishable, there is a tie that connects
them in reproduction, so that the attack on
reproduction (recall Manoj), links the idea ofsexlessness. What this paper was able to reroute is
the notion of Nietzsche’s ethics within the concept of
the posthuman: what if sex stands on the stage of theEubios Journal of Asian and International Bioethics 30 (March 2020)
last man and sexlessness in the posthuman can set
the stage towards the superman? Nietzsche’s ethics,
as explicated in his critique of morality, is involved inthis case when it makes overcoming the impetus forhuman advancement no matter that, liberally
speaking, for Žižek this can go on as a kind of
fashionable way to insert a sexless possibility
whether in modern technology or in cultural
movements. Posthumanism, posthumanity, andtranshumanism are broad terms that require further
philosophical inDiltration and these had to include,
rather than delimit, as many ethical considerations
as possible. The question of sex in man and theposthuman is a crucial entry more than ever at thispoint.

References
Agatonović, M. (2018).
The Case of Transhumanism: The
Possibility of Application of Nietzsche’s Ethics and Critiqueof Morality Today. Philosophy and Society, 29(3), 317-474.
Badiou, A. (2001). Who is Nietzsche? Pli, 11, 1-11.
Badmington, N. (Ed.) (2000). Posthumanism. New York: Palgrave.
Boyd, Ann. (2018). Transhumanism Challenge to Bioethics.
Eubios Journal of Asian and International Bioethics, 28(5),137-140.
Brown, T. (2006). Gene Cloning & DNA Analysis: An Introduction.
Fifth Edition. University of Manchester, UK: Blackwell
Publishing.
Camus, A. (1956). The Fall (J. O’Brien, Trans.). New York: Vintage
Books.
Copjec, J. (1994). Sex and the Euthanasia of Reason. In Copjec, J.
(Ed.), Supposing the Subject (pp. 16-44). London: Verso.
Ferrando, F. (2013). Posthumanism, Transhumanism,
Antihumanism, Metahumanism, and New Materialisms.
Existenz: An International Journal in Philosophy, Religion,
Politics, and the Arts, 8(2), 26-32.
Halberstam, J., and Livingston, I. (Eds.) (1995). Posthuman
Bodies. Bloomington: Indiana University Press.
Kahambing, J. G. (2018). Without Sex: An Appraisal of Žižek’s
Posthumanism. International Journal of Žižek Studies, 12(2),1-16.
Kahambing, J.G. (2019a). The Ethical Nihilism of Hedonistic
Posthuman Sex. Eubios Journal of Asian and International
Bioethics, 29(6), 203-207.
Kahambing, J.G. (2019b). The Derrida and/to Žižek on theSpectral Victim of Human Rights in Anil’s Ghost. International
Journal of Žižek Studies 13(3).
Manoj, V.R. (2019). Cybofree: Posthuman Bioethics for a
Sustainable Humanity (Ed. Darryl Macer). Eubios Ethics
Institute: New Zealand.
Marshall, D. (2015). Human Cloning: Specigically, REM Driven
Human Cloning. Vincent Eastwood Interview.
Miah, A. (2008). Posthumanism in Cultural Theory. In Gordijn, B.,
and Chadwick, R. (Eds.), Medical Enhancement andPosthumanity (pp. 71-94). Berlin: Springer.
Nietzsche, F. (1969). Thus Spoke Zarathustra: A Book forEveryone and No One (R. J. Hollingdale, Trans.). New York:
Penguin Books. (Original work published 1883-1891).
Turing, A. (1950). Computing Machinery and Intelligence. Mind,
59(236), 433–460.
Žižek, S. (2016). Organs without Bodies: Deleuze andConsequences. Routledge.
Žižek, S. (2017). Incontinence of the Void: EconomicoPhilosophical Spandrels. Cambridge: The MIT Press.

51Žižek, S. (n.d.). No Sex, Please, We’re Post-human! Retrieved fromhttp://www.lacan.com/nosex.htm.

Liberal environmentalism andglobal climate justice- Christopher Ryan Maboloc, Ph.D.
Ateneo de Davao University, the Philippines
Email: ryanmaboloc75@yahoo.com

Abstract

Liberal environmentalism, or green politics, intends
to Dind a compromise between the prevailing global
economic order and the need to protect theenvironment. The idea of sustainability, introducedin the Rio Summit, is the central component ofinternational climate agreements. But on closer
analysis, it can be argued that the problem of climatechange is rooted in a neo-liberal system in which
corporate interests collude with state policies. The
free market is one of the fundamental causes of thesystematic destruction of the environment. Big
corporations, so motivated by proDit, cannot be
trusted to absorb the huge social costs ofenvironmental degradation. For this reason, the useof indigenous wisdom is proposed to balance ourway of life and environmental preservation. The
study argues that climate justice would requiredismantling an exploitative economic order to avert
the existential threat from changing climactic
patterns.
The tipping point
L i b e ra l e nv i ro n m e n t a l i s m d e a l s w i t h t h einstitutionalized norms designed to address theissues concerning environmental protection. At thesame time, it seeks to preserve the prevailing global
economic order in its approach. Laws, rules, andpolicies, in this regard, exhibit the compromiseamong governments and powerful corporate
interests. The reality of climate change reveals itself,
in this sense, as a collective problem made worse by
the rent-seeking ways of big corporations and statepolicy makers who exploit the earth for their own
good and beneDit.
The antagonists in the issue of climate change aregovernments, states, and corporations. Some leadersseem to be more concerned about growth andprogress without considering the impact of
economic activities on the environment. Upon closer
analysis, environment advocates are actually battling
structural issues. For Greta Thunberg, the climate
crisis is the consequence of the “fairy tales of eternal
economic growth.”1 However, Adam Kalkstein, is
quick to point out that such may not the case. In an
op-ed for the New York Daily News, he opines:“In fact, the planet has warmed by about 1.0°
Celsius over the past century, and temperatures

1 https://time.com/5684216/greta-thunberg-un-climate-action-summit-climate-speech/

52

Eubios Journal of Asian and International Bioethics 30 (March 2020)

continue to rise in concert with increasing greenhousegas concentrations. Impacts from this warming arealready being felt in the form of rising sea levels(about 3.1 mm per year), more common heat waves,and more intense (but not necessarily more frequent)storms and beyond. Yet despite this, humans havethrived due to a multitude of advancements.”2
Kalkstein recognizes the problem of climatechange, but he disagrees with Greta that the earth isat its tipping point. He believes that the problem lies
mostly in the less developed countries, in which thethreat of climate change is exacerbated by the lack ofinfrastructure, pollution, and the poor enforcementof environmental policies. However, he adds thatscience does not support the claim of Greta that theearth’s ecosystem is nearing collapse, Kalksteinthinks that “unlike Greta’s bleak outlook, thesolutions would require relatively few changes toour current lifestyles.”3
Stephen Bulanyi writes that “it is not clear where
Thunberg’s politics lie, or where they will go in the
future, but her rhetoric mirrors the left of theenvironmental movement, a wing of which has longcautioned that reductions in consumption andgrowth will be required to deal with the climate
crisis.”4 But such move towards the left isunderstandable considering the absence of any clear
cut approach when it comes to Dinding the balance
between environmental preservation and economic
development. Bulayni writes:“Thunberg’s great contribution is to convince thewider public of the bankruptcy of that outlook, and toindict years of missed targets as the failures that theyare. Politicians don’t appear to take her, very
seriously. They are happy to bask in her light, perhaps
convinced this new insistence on immediacy will pass,as all the others did.”5
Globally, we are at a political tipping point.
Politicians and policy makers now Dind themselves inan end-game. Greta inspires a solid form ofradicalism, one that is, while moved by the politics ofliberals, brings advocates at the front in the struggle
to save the planet from destruction. Climate wars
might ensue, for example, in view of the sheer
necessity to preserve the natural environment or in
the Dight for water resources in the future. The
message of Greta, at the very least, is a strong moral
wakeup call for everyone.
It may be necessary to provide Greta’s advocacy
with a democratic platform to make it effective andsensible since the inDluence of hegemonic politics
and the ambition of poor societies to attainindustrial growth lurk in the background. From a
neo-liberal viewpoint, the need to improve thestandard of living of people is apparent though thetruth of the matter is that most societies suffer fromthe impact and effect of climate change due to thelack of the technical competence to manage such anissue at the top level of the bureaucracy.
Tilting the balance of power
Steven Bernstein argues that the hegemony in global
politics has less importance when it comes toclimate discussions. Bernstein thinks that “the statecentric view of hegemonic stability theory has
proven of limited usefulness in explaining either
international environmental cooperation or
normative development.” 6 However, such anassessment may not be realistic. It can be counteredthat the problem of pollution remains big in weakstates whose leaders lack the political will to
implement laws against environmental exploitation
and abuse.
When it comes to environmental problems andissues, society often considers what individuals orhuman beings can do to help mitigate the impact ofabnormal climate patterns. We emphasize thatcitizens should be conscious of their duty to protect
the environment and for this reason, must use rightjudgment in terms of their actions. When we look at
polluted waterways, people would pin the blame on
the lack of discipline of individuals living near theseplaces. Modern society will then judge the poor as
irresponsible and should be punished for their
behavior.
But the above judgment hides the fact that poor
people, who are often blamed for the miserable
plight of the natural environment, are actually
powerless. When it comes single-use plastics, theculprit is not really the kind of economy that exists
among poor consumers but the way capitalism also
takes advantage of the situation of the poor.
Corporations possess the resource, inDluence, andpower to control the economy. In this way, the poor
are put into situations beyond their control.
The basic point is that environmental destruction
cannot be blamed solely on individuals. In thePhilippines, road widening projects often result tothe deliberate and senseless cutting of century-old
trees, all in the name of progress. Such cases areoften rampant given the rapid infrastructuredevelopment that is being pursued by every
government administration. In relation to this,people need to ask if there has been any consultation
to ensure that no harm is done against them.
The crafting of laws and policies, however,remains undemocratic. For instance, while there is a
total log ban in the Philippines, there are illegal
logging activities in some provinces that continue toreduce the country’s forest covers. Antonio
Contreras writes about the fact that despite massive
funding to protect the environment in the

2 h#ps://www.nydailynews.com/opinion/ny-oped-sorry-greta-youre-mostly-wrong-20190924-t7dep?sqnfmhpjgcwv6iyfesm-story.html
3 h#ps://www.nydailynews.com/opinion/ny-oped-sorry-greta-youre-mostly-wrong-20190924-t7dep?sqnfmhpjgcwv6iyfesm-story.html

4 h#ps://www.theguardian.com/commenEsfree/2019/sep/ 30/greta-thunberg-enemies-inacEon-climate-crisis
5 h#ps://www.theguardian.com/commenEsfree/2019/sep/ 30/greta-thunberg-enemies-inacEon-climate-crisis
6 Steven Bernstein, The Compromise of Liberal Environmentalism, (New York: MIT Press, 2002), 13.

Eubios Journal of Asian and International Bioethics 30 (March 2020)
Philippines, the political power structures in the
country, however, continue to inDluence theoutcomes of environmental laws and policies so“characterized by skewed distribution of economic
and political power…”7
The imbalance in terms of political power in thePhilippines is made manifest during the Marcos
regime. The former dictator saw to it that a memberof the First family or a crony holds one board seat inevery logging Dirm.8 Such showed not only theblatant abuse of power of the Marcos regime, but it
also hastened the destruction of forests. The country
did not beneDit from the exploitation of its natural
resources. Crony capitalism only fattened the bankaccounts of many corrupt politicians.
The Kyoto Protocol and Paris Agreement
According to John Dryzek, Richard Norgaard, andDavid Schlosberg, “climate change presents perhaps
the most profound [or greatest] challenge ever tohave confronted human social, political, andeconomic systems.”9 Finding a real solution to thechallenges at hand has been the primary motivationin the Kyoto Protocol. However, President George
Bush refused to sign the agreement. Politics, forobvious reasons, always gets in the way. The
agreement, however, is a pragmatic step forwardthat is grounded in free market principles. Bernsteinsays:“The Kyoto mechanisms all work on the same basic
principle: that assigning property rights to emissions
and creating a market that allows them to betransferred will enable emission reductions to beachieved where it is most efgicient, or cheapest, to doso. They can be considered market or incentive-based
mechanisms because they rely on the establishment ofa market for emission credits to create price signals,
and thus incentives for buyers.” (p. 10).
The Kyoto Protocol unveiled the imbalance in the
global political order. President Bush argued that the
Kyoto arrangement would harm the US economy. But
in truth, he was obviously bowing to politicalpressures at home. In this way, the decision of thepresident was based on his desire to protect US
economic interests. For him, singing the Kyoto
agreement would stiDle the growth in job creation in
the US. Bernstein, thus, is correct to say that“whereas it opens up opportunities for new forms ofmanagement , and perhaps for democratic
participation as well, it also reinforces the role of themarket.” (p.10).
Meanwhile, the Paris Agreement on Climate
Change, signed by 196 states in 2016, is supposed to53

advance many of the prior commitments made after
Kyoto. Signatory countries have been asked to reporttheir emission reduction progress while also keeping
in mind the goal of limiting the rise of global
temperatures to no more than 1.5 degrees
centigrade. The Paris pact asks all governments toreveal their mitigation projects. Its “20-20-20”
strategy hopes to achieve a 20% carbon emission
reduction, a 20% renewable energy market share,
and a 20% increase in energy efDiciency.
President Donald Trump, using Article 28 of theParis Agreement, has notiDied the UN of thewithdrawal of the United States from the accord.
President Trump has reasoned that the consensus
would harm the US economy which again is echoing
the same sentiments used by President Bush inrejecting the Kyoto agreement. President Trump
mentioned that his decision is founded on his“America First” policy. Although the reaction to thepresident’s decision was largely negative, Mr. Trump
maintains that he remains focused in “helping
businesses and workers.”10
Most discourses in Third World societies areusually framed around the idea of state corruption
and also by the lack of funding. But as what Dryzek,
Norgaard, and Schlosberg would show, such isinadequate in terms of understanding the real
culprit of the issue. In a way, people underestimate
the harm caused by corporations since the same
have the power to hide everything under the guise of
their CSR projects. The trouble lies in the effect ofindustrial activities. Dryzek, Norgaard, andSchlosberg say:“National governments are embedded in market
economies that constrain what they can do, and thesocial realm is often limited by economistic frames
and discourse. However, markets are not necessarily
just a source of constraint. Markets are also made up
of producers and consumers who might themselveschange their behavior in ways that reduce emissions.
The most important producers here are large
corporations.”11
The above points to the challenges before us. BP
once marketed itself as “Beyond Petroleum” until theoil spill in the Gulf of Mexico. It can be argued thatthe real problem is the neo-liberal system that has
for so long a time controlled the world.
Consumerism dictates how people behave andexplicates, as a result of the lifestyles created by themarket, why individuals tend to think of theenvironment as nothing more than a commodity thatis meant to be consumed. Indeed, what is to be done
is to irrevocably overhaul an exploitative system.

7 Antonio Contreras, “The Political Economy of State Environmentalism: The Hidden Agenda and its Implications on Transnational

development in the Philippines.” In Capitalism Nature Socialism 2:1 (1991): 66.
8 Marites Vitug, “Forest Policy and National Politics.” In Forest Policy and Politics in the Philippines, ed. Peter Utting (Quezon City: Ateneode Manila University Press, 2000), 11.
9 John Dryzek, Richard Norgaard, and David Schlosberg, Climate Change and Society: Approaches and Responses. (Oxford: Oxford
University Press, 2011), 1.
10 https://thehill.com/policy/energy-environment/335955-trump-pulls-us-out-of-paris-climate-deal
11 Dryzek, Norgaard, and Schlosberg, Climate Change and Society: Approaches and Responses, 1.

54Eubios Journal of Asian and International Bioethics 30 (March 2020)

Free market environmentalism orindigenous wisdom?
Liberal environmentalism is an approach thatconsiders, Dirst and foremost, the sustainability ofthe people’s ways of life. The idea of sustainable
development, in this respect, does not reject themanner in which states and societies handle climate
justice issues. Although citizens desire to protect theenvironment, they may not be able to do away withthe modern ways of living. Meaning to say, liberal
environmentalism is the attempt at some form of acompromise. There is really no way to return to theoriginal state of our natural environment. Jessica
Dempsey explains:“The approach desired by the scientist-bureaucrat
can be summarized as follows: “In order to make live,
one must make economic.” In other words, for diverse
nonhumans to persist, biodiversity conservation must
become an economically rational, sometimes evenprogitable, policy trajectory. For several decades now,environmental economists and policymakers havediscussed the need for a market…”.12
What government policy makers are looking atare economic frameworks that are acceptable. For
instance, it may well be counter-productive for
impoverished states to wait for investors if there
are persons who want to put up a coal-Dired plant.
Hence, Bernstein (2002, p.2) thinks that the“norms of liberal environmentalism predicate
international environmental protection on the
promotion and maintenance of a liberal economicorder.” Any government cannot just walk awayfrom its perceived comfort zone. In this case, the
Rio Conference comes to mind. Bernstein notes:“The elements of the specigic compromise
institutionalized at Rio include state sovereignty
over resources (and environment and development
policies) within a particular state’s borders on thepolitical side, the promotion of global free tradeand open markets on the economic side, and thepolluter pays principle and its implicit support ofmarket instruments over strict regulatory
mechanisms and the precautionary principle on the
management side.” (p.4).
Bernstein mentions the fact that sustainable
development had “emerged in the 1980s as thatbreakthrough idea, becoming the dominantconceptual framework for responses tointernational environmental problems andcapturing the imagination of world opinion. In thisway, liberal environmentalism is the marriage
between sustainability and environmental
protection. While neo-liberals will acknowledge
the effect of corporate greed and a ‘throw-away
culture’ on the environment, they also realize thatthe means of survival of people cannot just rejectwhat states have been building for centuries –industries, corporations, exploitation of natural
resources. Jan Narveson, in this regard, argues infavor of the free market.13
The concept of a free market rests in theposition that states can protect the environmentby strengthening private property rights. The
argument proposed by Narveson is that theconcept of public goods only reinforces the“tragedy of the commons” which puts our natural
resources into the hands of the government whichin the end might not be able to preserve it. Tony
Smith rejects such an argument. The idea of
putting our natural resources into private hands
does not guarantee that the environment will besafe from abuses or over-exploitation. It is notnecessary to privatize public property to achieve
an equilibrium with the natural environment.14
A shift to a green economy, one that is based oncommunal preservation, has been suggested. The
idea includes small farms, urban gardening, andthe abandonment of the use of commercial
pesticides that have been proven to be harmful tothe environment. Industrial farming and largescale agricultural plantations, for example, havebeen blamed for massive forest denudation due tothe need to clear thousands of hectares of land asa requisite for large-scale plantations.
It may be said that climate debates among
nations at the UN remain to be interest-based, akind of politics that is deDined by those who are in
positions of power in the global hegemonic order.
This can be challenged, however, when we speakof indigenous peoples (IP), whose local wisdom
has not been utilized in Dighting climate change,
although their communities are good models forthe harmonized relation between human beingsand nature. Western models and rationalities areusually employed in climate discussions, with theuse of scientiDic evidence as the universal basis forevery claim, sans the contribution of indigenous
knowledge.
Indigenous peoples and communities havebeen reduced into helpless moral patients. Though
they too are stakeholders in the climate change
debate, their important voices have been pushed
in the sidelines in favor of universal liberalprinciples. But if history is to be used as judge
when it comes to human survival, IP communities
are a good example. In fact, for hundreds of years,
IP communities have survived the onslaught ofcolonialism and modernity. IP communities havefound ways to adapt to the present times. Jose
Mencio Molintas elaborates:“The indigenous peoples in the Philippines
continued to live in their relatively isolated, selfsufgicient communities, at the time when mostlowland communities had already been integrated

12 https://canadiandimension.com/articles/view/the-tragedy-of-liberal-environmentalism
13 Jan Narveson, “The Case for Free Market Environmentalism.” In Journal of Agricultural and Environmental Ethics, 8:2 (1995), 145.

14 Tony Smith, “The Case against Free Market Environmentalism.” In Journal of Agricultural and Environmental Ethics 8:2 (1995), 131.

Eubios Journal of Asian and International Bioethics 30 (March 2020)
into a single colony under Spain in the 1700s and1800s. They were able to preserve the culture andtraditions of their “ethnos” or “tribe” as reglected intheir communal views on land, their cooperative
work exchanges, their communal rituals, theirsongs, dances, and folklore.”15
Karl Gaspar says land for indigenous peoples issacred.16 This means that for IP communities,
there is a bond between humans and the earth,which means that IP wisdom teaches us to respect
the environment and not to overuse the same, totake only what is needed, and not to exploit the
goods of the earth. According to Molintas, “land isa central issue to indigenous peoples because it
deDines their very existence.”17 Land deDines theway of life of IP communities. It is this way of lifethat enables local ethnic groups to preserve theenvironment. This is because the survival of thetribe depends on land.
For local tribes, the idea is to take only from theearth what a person needs and nothing more. The
way of life of indigenous peoples teaches us torespect mother-nature and for this reason, wemust not abuse the natural environment. The
employment of indigenous wisdoms brings us to arealization of the important value of maintaining
the balance between human interests andenvironmental preservation. Perhaps, this is themost useful proposition against the onslaught of amodern consumer culture which tend tocommodify everything.
Indeed, the intrusion of corporations continue
to threaten endemic cultures and the tradition ofIPs. An avalanche of intruders does not only
disrupt the peaceful lives of the locals but also
harms the future of indigenous cultures. While
indigenous wisdom is important in learning how
to adapt to global climactic changes and react
urgently to catastrophic events, the same is under
threat from a neo-liberal system that focuses on
economic growth at the expense of human lives.
As such, we must understand how local wisdom
can be used to counter the destructive forces ofcapitalistic expansionism.
On global climate justice
The biggest problem confronting humanity is thelack of a moral voice in the effort to solve the climate
crisis. The frustration that comes from Greta is amanifestation of the sentiments of cause-oriented
groups who believe that governments are not doing
enough to address the issue. Yet, the real trouble
comes from the fact that the United Nations does nothave any authority or control over corporate

55

misdeed. Enforcement becomes another issue inview of the fact that compliance is difDicult in Third
World countries. Moreover, the belief among thepoor is that the lifestyle of afDluent individuals is tobe blamed for all the climate mess we are in.
Markets have proven themselves to be a destroyerof worlds. This has been shown in the Great
Depression when Wall Street crashed. The mostrecent of course is the subprime market in the US
that caused a recession, forcing the US Treasury to
inject hundreds of billions of dollars to bail out
banks and huge corporations. In 1997, the Asian
Dinancial crisis also stiDled growth while Structural
Reform Adjustments in Latin America during the
80’s plunged the continent into political chaos. The
truth of the matter is that ordinary citizens do nottrust big corporations. There is no guarantee that
corporations are willing to absorb the enormous
social costs of climate change. In the end, the proDitdriven agenda of corporations prevents the worldfrom realizing a consensus when it comes to a
pragmatic solution.
In truth, climate politics is full of ironies andcontradictions.18 While the UN is aware that theconcept of a free market economy has contributed tothe climate crisis, it also cannot criticize a dominant
neo-liberal system. Third World countries cannot
just tear down their coal-Dired plants like Germany,
considering that green energy is expensive to
produce. In addition, the problem is that it is difDicult
to entice investors to build new power plants sinceinvestment returns cannot be guaranteed bynational governments. While the Philippines desires
to construct or even operate the mothballed Bataan
facility, it actually does not have the technicalcompetence. The reality is that we are still
dependent on fossil fuels. Bernstein Dinds a problem
with the UN strategy:“While this [UN)] strategy may make someheadway within liberal environmentalism, it is also
subject to the limits of corporate self-regulation since
the UN has no mandate to independently regulate
private corporations. At the same time, some civilsociety groups, frustrated with the limited ability ofinternational institutions to address environmental
concerns under the current governing arrangements,
have begun to launch more radical forms of
opposition to challenge the legitimacy of existing
institutions.”19
The way forward is to dismantle the grip ofcorporate [oil] interests in climate discussions. Thismeans that states and governments should make thewell-being of the environment a priority and not theeconomic interests of multinational Dirms. This will

15 Jose Molintas, “The Philippine Indigenous Peoples’ Struggle for Land and Survival and Life: Challenging Legal Texts.” In Arizona Journalof International and Comparative Law 21:1 (2004): 275.
16 Karl Gaspar, Manobo Dreams in Arakan: A People's Struggle to Keep Their Homeland. (Quezon: Ateneo de Manila University Press,2011), 1.
17 Molintas, “The Philippine Indigenous Peoples’ Struggle for Land and Survival and Life…,” 275.
18 Bernstein, The Compromise of Liberal Environmentalism, 12.
19 Ibid., 13

56

Eubios Journal of Asian and International Bioethics 30 (March 2020)

require recognizing local culture and ways of life thatpay respect to nature. For instance, mining Dirms
should not touch ancestral lands. States should
guarantee the protection of indigenous communities
from the intrusion of destructive mining and otherindustrial practices that harm the environment. Thismeans putting an end to a proDit-driven system.
Communities must be given the freedom to pursue
their indigenous ways of life without interference
from outsiders.
The “polluter pays principle” reveals that those
who produce pollution should pay for the health andenvironmental costs of pollution. But this marketdriven principle is not effectively working. This isbecause such a method only incentivizes
environmental destruction, forcing poor societies tosell their balance in their carbon limits. Poor
countries do not actually have industries that match
those in the First World. For this reason, the money
states get from selling their carbon emission quotas
do not contribute to cleaning the earth. The funds
that come from these approach that the state earns
only goes into the pocket of corrupt politicians who
cut corners to get contracts from the government
and thus, continue to take advantage of the mostvulnerable in their societies. Roy Cordato explains:“The use of "market-based instruments" to enforce
these arbitrary curtailments of the use of property areoften justigied on the grounds of "economic efgiciency."
Instruments such as tradable emissions permits are
said to result in less misdirection of resources thancommand and control solutions to pollution problems.
However, when the fundamental concept of pollution
is misguided, and the target reductions are madearbitrarily without the benegit of market signals as tothe costs of production or the wishes of the consumers,
no instrument is efgicient”.20
Unsound environmental practices, Smith (1995)
notes, can harm the future generation And yet the
future generation cannot sue today’s violators. Thereis a need, in this regard, to protect people from rentseeking or “the possibility of state policy being
dictated by a coalition of state ofDicials and privateinterests groups.” (p. 138). To enforce the same, it isnecessary for governments to strengthen their
institutional approaches to environmental issues.
Civil society groups must work toward thedemocratization of decision-making processes inweak states. Violators of environment laws must be
punished and be held accountable for the social
costs. The idea is to rectify an injustice and to
redistribute resources in order to beneDit the poor.
Liberal environmental justice may put constraints
on choices that might affect the situation of theworst off, which in this case are the poorest.21
Protecting the planet means protecting the mostvulnerable people. Climate justice, in this way, isabout the preferential treatment we must give tothose who are mostly affected by calamities –women and children, persons with disability (PWD),
the poor and homeless among us. We must
remember that moral responsibility is about theburden we carry for causing pain and discomfort topeople. To protect the planet as our home alsomeans that societies have to compensate all those
who have been victims of irresponsibility andcorporate greed.

Conclusion

This paper started with an assessment of Greta
Thunberg’s speech at the UN Climate Summit. We
examined her position under the moral lens ofliberal environmentalism. Such view considers thepower of market forces while also recognizing theduty to preserve the environment. In this way, it canbe said that green politics is still market driven since
as Bernstein notes, states can only look for acompromise, but cannot do away with an economic
system that has undermined climate policies. The
position of this paper points to the free market as
the fundamental root of the problem when it comesto environmental degradation.
Free market environmentalism argues for thestrengthening of private property rights to protect
the environment from the “tragedy of the commons.”
The problem, however, is that corporations cannot
be trusted to absorb the social costs. The idea of“polluter pays” only incentivises the overexploitation of the environment. The approach using
the market only reinforces the root cause ofenvironmental degradation in the world today. The
more urgent thing to do is to determine ways thatwill protect the environment from the rent-seeking
ways of private interest groups. ProDit is the main
motive of corporations. It is also the enemy of theenvironment.
The concept of using indigenous wisdom toward
a greener society has been proposed countless times.
The way of life of indigenous peoples is rooted incommunal practices that consider the land as sacred.
The basic point with regard to such is that it
counters the commodiDication of resources andmakes the respect for mother-nature the centerpieceof human activities. The threat, however, remains
because of the intrusion of corporate interests in IP
areas. For this reason, the government must secure
the rights of IPs to their land and way of life.
States and governments, through thearrangements and dialogues led by the UN, have notfound a solution. The reason is more economic thanpolitical. Some powerful state interests are out there
to protect market forces. This is obvious given thehegemonic system in global politics. Climate politics,
in this way, has become more of a problem rather
than a positive way forward, following Thunberg’s
outcry. The “polluter pays” approach does nothing to

20 Roy Cordato, “The Polluter Pays Principle: A Guide to Policy Makers.” (Washington: The Institute for Research on the Economics ofTaxation, 2001), ii.
21 Derek Bell, “How can Political Liberals be Environmentalists.” In Political Studies 50: 714.

Eubios Journal of Asian and International Bioethics 30 (March 2020)
reduce in a signiDicant way the carbon footprints ofafDluent industrial societies.
Indeed, the threat remains. The threat comesfrom state interests that also collude with corporate
interests. Governments, in this way, wrongly
negotiate climate justice on the basis of such
systemic defect. For this reason, there is a need todismantle neo-liberal systems and market structuresthat cause environmental harm. The problem ofclimate change, in this way, requires more thangreen politics. Markets tend to protect economic
interests above everything else. Society must
recognize the needs of the powerless who havesuffered from the inaction of policy makers andleaders.

References
B el l , Derek . 2002. “ How c a n Pol i t i c a l Li b era l s b e
Environmentalists?” In Political Studies 50: 703-724.
Bernstein, Steven. 2002. The Compromise of Liberal
Environmentalism. New York: MIT Press.
Bernstein, Steven. 2002. “Liberal Environmentalism and Liberal
Global Governance.” In Global Environmental Politics 2 (3):1-16.
Bulanyi, Stephen. 2019. “Greta Thunberg’s Enemies are Right tobe scared.” In The Guardian. Retrieved from https://www.theguardian.com/commentisfree/2019/sep/30/gretathunberg-enemies-inaction-climate-crisis. Accessed on
November 8, 2019.
Cama, Timothy and Henry, Devin. 2017. “Trump: We are gettingout of Paris Climate Deal.” In The Hill. Retrieved fromhttps://thehill.com/policy/energy-environment/ 335955trump-pulls-us-out-of-paris-climate-deal. Accessed on
November 19, 2019.
Contreras, Antonio. 1991. “The Political Economy of State
Environmentalism: The Hidden Agenda and its Implications
on Transnational development in the Philippines.” In
Capitalism Nature Socialism 2 (1): 66-85.
Cordato, Roy. 2001. The Polluter Pays Principle: A Guide to Policy
Makers. Washington: The Institute for Research on the
Economics of Taxation.
D e m p s e y, J e s s i c a . 2 0 1 7 . “ T h e t r a g e d y o f l i b e r a lenvironmentalism.” In Canadian Dimension 51 (2). Retrieved
from https://canadiandimension.com/ articles/view/thetragedy-of-liberal-environmentalism. Accessed on November
7, 2019.
Dryzek, J., Norgaard, R. and Schlosberg, D. 2011. Climate Change
and Society: Approaches and Responses. Oxford: Oxford
University Press.
Gajanan, Mahita. 2019. “Greta Thunberg gives powerful speech
at UN Climate Summit.” Time Magazine. Retrieved fromhttps://time.com/5684216/greta-thunberg-un-climateaction-summit-climate-speech/. Accessed on November 7,
2019.
Gaspar, Karl. 2011. Manobo Dreams in Arakan: A People's
Struggle to Keep Their Homeland. Quezon City: Ateneo deManila University Press.
Kalkstein, Adam. 2019. “Sorry Greta Thunberg, but you’re(mostly) wrong.” In New York Daily News. Retrieved fromhttps://www.nydailynews.com/opinion/ny-oped-sorrygreta-youre-mostly-wrong-20190924t7depDksqnfmhpjgcwv6iyfesm-story.html. Accessed on
November 6, 2019.
Molintas, Jose. 2004. “The Philippine Indigenous Peoples’
Struggle for Land and Survival and Life: Challenging Legal

57

Texts.” In Arizona Journal of International and Comparative
Law 21 (1): 269-306.
Narveson, Jan. 1995. “The Case for Free Market
Environmentalism.” In Journal of Agricultural andEnvironmental Ethics, 8(2): 145-156.
Smith, Tony. 1995. “The Case against Free Market
Environmentalism.” In Journal of Agricultural andEnvironmental Ethics 8 (2): 126-144.
Vitug, Marites. 2000. “Forest Policy and National Politics.” In
Forest Policy and Politics in the Philippines, ed. Peter Utting.
Quezon City: Ateneo de Manila University Press, 2000.

BOOK REVIEWThe Ethics of Sustainability

Authors: Kibert, C.J., Thiele, L., Peterson, A.
and Monroe, M. 2010
Available online at: https://www.cce.uDl.edu/wp-content/u p l o a d s / 2 0 1 2 / 0 8 /Ethics%20of%20Sustainability%20Textbook.pdf

Reviewed by Dr Alex Waller
Email: arwaller1@hotmail.com

This book is the foundation for a subsequent
volume Working Toward Sustainability: Ethical
Decision Making in a Technological World publishedby Wiley (2011). The freely available online version
reviewed here, contains much of the text without the
supporting illustrations and Digures of later
purchasable editions. Nonetheless it remains an
extremely useful supporting text for university
students embarking on environmental ethics
courses. Sustainability is now an established ethicalprinciple. However, it is important to recognise thatthe term has multiple deDinitions and is used bydifferent actors to reinforce their own agendas. The
widely quoted Brundtland Report’s deDinition ismore than thirty years (a generation) old yet for
many societies the new generation’s needs havealready been compromised. Kibert et al’s book
begins by highlighting some of the fundamental
issues relevant to sustainability including population
growth, consumer behaviour, resource depletion,
climate change, biodiversity loss, soil and water
quality, as well the inequality of wealth distribution.
These are all just as if not more important today as
they were ten years ago when The Ethics of
Sustainability was written. For example, last year the
IPCC reported regarding the biodiversity crisis that
one million species are now facing imminent
extinction. The remainder of the introductory
chapter outlines the alternative frameworks forsustainability including the Hannover Principles, thethree legged stool, corporate responsibility andnature based systems conditions.
Written with engineering students in mind
Kibert et al establish an inextricable link between
sustainability and technology. Yet, recognizes thattechnology and science alone cannot address thecomplex issues of sustainability in isolation ofhuman behaviour and relations. The book is divided
into three sections: the foundations with historical

58

Eubios Journal of Asian and International Bioethics 30 (March 2020)

insights, the theoretical basis of ethics relevant tosustainability and then putting principle into
practice. SpeciDic chapters are devoted to exploring
the very concept of sustainability, an overview of
ethical philosophy, the social and environmental
ethics and a thorough background to capitalistic andeconomic ethics.
The authors make the ethical issues explicit andunpack them in a coherent and comprehensive
manner. In the third chapter for example, different
perspectives of various religions are seen as
contemporary Christianity emphasizing
stewardship, Hebrew-Christian social justicedemonstrating interdependence and relations
between people, Islam and Catholics largely agreeing
on concepts of justice, equality, equity and charity
and that as God created all living things they have
intrinsic value in themselves. Buddhist ethics arebuilt upon respect and relational values. These
points underpin many arguments in favour ofenvironmental justice. Secular classical philosophicalethics emphasis qualities of leadership, and virtues
such as wisdom; qualities in short supply it seems insome present-day governing bodies, yet essential ifsustaining meaningful and fulDilled lives is theultimate goal we are aiming for. The authors notethat deontological ethics of rules and duties has
evolved to establish various rights. However, rights
in this present day sense is from a clearly western
origin and could be seen as a western ideal. Other
major frameworks are outlined and discussed suchas consequentialism being useful when a uniDied
approach for common outcome is sort, or that
pragmatism has strength in setting strategies toachieve attainable goals. The central chapters
explore principles that are fundamental tosustainability: procedural and distributive justice,polluter pays, precaution with the virtue of prudence
at its core, reversibility, intergenerational justice andthe right to know.
The Dinal section of The Ethics of Sustainability
demonstrates how ethical principles and theories ofchange and social learning can be applied in decision
making and to resolve conDlicts. This reveals somebarriers in simplistic analyses and highlights thelong-term beneDits of systems thinking. To conclude
the authors apply the theory of planned behaviour
and the diffusion of adoption of technologicalinnovations to demonstrate how changes inpersonal, professional and societal norms take time
to be taken up and become embedded. There are avariety of brief case studies from different contexts
around the world that are cited to illustrate thepoints and bring the theory to life.
The Ethics of Sustainability is very readable andclearly conveys the core points relevant to its title.
The fact that it so accessible and not dependent on
the ability to pay is surely the essence of sustainableethics, being not only affordable to alreadyadvantaged people. In my mind, this adds greater
credence to the authors as they have applied theprinciples to themselves. This too is a founding

principle of AUSN; Education for the people by thepeople. I strongly recommend The Ethics of
Sustainability as a valuable resource for backgroundreading for all researchers and students new tosustainability and environmental ethics.

The Iraq Commitment Medals- Lana Adnan Issa al-Shareeda, Ph.D.
Iraq/USAI have written previously about the ethicalissues raised by the Iraq war (Issa, 2010). This shortpaper is not to diminish any conception of the evils
of war, but reports on postwar cooperation between
The USA and Iraq. It is extraordinarily rare whensomething good comes out of war (Šmihula, 2004).
But even in the most noxious tropical miasma or
foul-smelling Southeast Asian swamp emerges thelotus blossom – a fragrant and very ornamental
Dlower prized for its beauty and sweet scent(Mukherjee et a., 2010). So it is possible something
positive can emerge from the horrors of war(McBean, 1998).
The Iraq Commitment Medal (ICM) is in thesame category (Figure 1). The ICM was authorized
by the Government of Iraq in June 2011 for all
Coalition Forces nations who sent military troops toserve in Iraq during Gulf War II (Al-Dlaimi, 2001).
The award was created as a thank you or inappreciation to those countries to helped tooverthrow a tyrant and Dinally establish freedom for
the Iraqi people. However, the Government of Iraq’s
ofDicial authorization letter stated that each of the 42
Coalition Forces nation could manufacture the ICMs
at their own expense and distribute them to theirown troops.
Each Coalition Forces nation refused theGovernment of Iraq’s offer. Only the U.S. government
initially accepted the ICMs and has allowed retention
by each individual recipient, but not for wear.
However, the whole matter lay dormant for almost a
decade.
In November 2019, the Government of Iraq
issued an exclusive license in an ofDicial
authorization letter to a U.S.-based Dirm called SEATE
Services to manufacture, distribute and redesign theICM (Al-Shimari, 2019). They further authorized acivilian version of the ICM, in addition to the militaryversion of the medal (Le Blanc, 2020).
SEATE
Services is in the process of distributing all ICMs toeach Coalition Forces nations for free so they can
distribute the ICMs to those military and civilian
government workers who earned the medal (LeBlanc, 2020). To date, only the Government ofNicaragua has authorized the acceptance of the ICM
for retention by the recipient and ofDicial wear on theuniform (Chamikorn, 2020).
The civilian and military version of the ICM are
the same except the ribbons on the medals areEubios Journal of Asian and International Bioethics 30 (March 2020)
reversed for the military version (black-to-red) andcivilian version (red-to-black; Figure 1,2).
The
medallions are the same. As there are at least six
different widths and types of ribbons for each
Coalition Forces nation, SEATE Services ismanufacturing these ICMs to meet each Coalition
Forces nation’s military speciDications so the medal
can be worn on the uniform.
The further good news is that the ICMs will beoffered for sale to non-recipients; i.e., museums,
ribbon and medal collectors, replacement medals,
public and private displays, patriotic organizations,veterans groups, extra medals for personal display
boxes, memorials, etc. All the proceeds will be given
as charitable contributions to bioethics
organizations or societies, fund national andinternational bioethics conferences, support
internationally-accredited universities, help
bioethics education programs plus also support aid
to Arab refugees living in the many refugee camps
throughout the Middle East and Thailand.
The ICM now stands as a symbol of recognitionof past selDless service to others, but it also stands asa real symbol for future selDless service to many.
Figure 1: Photos of the Iraq Commitment Medals

Civilian

Military

59

Republic of Nicaragua to the Kingdom of Thailand.
Ofgicial Approval of the Government of Nicaragua toFormally and Ofgicially Accept the Iraq Commitment
Medal for Retention and Wear by their Recipients.
Consulate of the Republic of Nicaragua: Bangkok,
Thailand. https://mail.google.com/mail/u/0/#inbox/
KtbxLxGPngtjsQbDrRKZJwvdmbsLSMrPlq
Issa, L. (2010) .The Invasion of Kuwait: Reasons, Agentsand Chances for Peace, pp. 89-96 in Macer, D.R.J. and
Saad-Zoy, S. Asian-Arab Philosophical Dialogues on War
and Peace. UNESCO: Bangkok.
Le Blanc, L. H. III. (2020, February 11). Letter from
SEATE Services to U.S. Secretary of State Michael R.
Pompeo, U.S. State Department, Washington, D.C. Offer
the Iraq Commitment Medal to U.S. State Department
Civilian Employees. SEATE Services: Bangkok, Thailand.
McBean, S. C. (1998). Out of War: True Stories from the
Front Lines of the Children’s Movement for Peace inColombia. New York, NY: Scholastic Press.
Mukherjee, P. K., Mukherjee, D.; Amal K. Maji, A. K., Rai, S.,
and Heinrich, M. (2010). The Sacred Lotus (Nelumbo
nucifera) Phytochemical and Therapeutic ProDile.
Journal of Pharmacy and Pharmacology, 61(4), 407–
422.
Šmihula, D. (2014). The Use of Force in International
Relations. San Francisco, CA: Veda Publishing Co., p.
67.
The Sacred Lotus (Nelumbo nucifera) – Phytochemical
and Therapeutic ProDile. Journal of Pharmacy andPharmacology, 61(4), 407–422.

Surrogate Motherhood in Nigeria:
An Ethical Appraisal- Emmanuel Efem Etta
Lecturer, Department of Philosophy, University ofCalabar, Calabar, Cross River State, Nigeria

References
Al-Dlaimi, S., Dr. (2001, June 11). Letter from Dr. Saadoun
al-Dlaimi, Iraqi Minister of Defense, Iraq Ministry of
Defence to Dr. Leon Panetta, U.S. Secretary of Defense,
U.S. Department of Defense, Washington, DC. Ofgicial
Authorization and Offer of the Iraq Commitment Medal
to the U.S.A. and other Coalition Forces Nations.
Baghdad, Iraq:Iraq Ministry of Defence, Government of
Iraq.
Al-Shimari, General N. H. (2019 November 07). Letterfrom General Najah Hasan Ali Al-Shimari, Iraqi Minsterof Defence, Iraq Ministry of Defence to Mr. Leonard
H.Le Blanc III, SEATE Services, Manhattan, KS, USA.
Approval for an ExclusiveLicense to Manufacture,
Distribute and Sell the Iraq Commitment Medal.
Baghdad, Iraq: Iraq Ministry of Defence, Governmentof Iraq.
Chamikorn J. (2020 January 28). On behalf of the
Honorary Consul (MR) Kritsada Mahavijit, Personal
Assistant to Honorary Consul, The Consulate of the- Mary Julius Egbai
Lecturer, Department of Philosophy, University ofCalabar.
Calabar, Cross River State, Nigeria
Email: samuelbassey15@yahoo.com
Abstract
The question of surrogate parenthood comes when awoman who wishes to conceive and raise a child is
medically incapable of carrying a pregnancy. The
inability of a Nigerian woman to fall pregnant withinmonths of marriage is usually seen as a cause foranxiety and if this condition continues for someyears, the woman is tagged barren and treated as awoman with a disability. In most cases, thehusband's family mount pressure on the husband toeither marry an additional wife or another wife to
produce a child. This leads many women to makedesperate decisions that may not necessarily be
legally recognized, including the practice of buying
babies. This leads many Nigerian women to makedesperate decisions that may not necessarily be60

Eubios Journal of Asian and International Bioethics 30 (March 2020)

legally acknowledged, including buying babies fromsurrogate mothers. The article examines surrogate
motherhood practice in Nigeria.
Keywords: Nigeria, surrogacy, Motherhood, Ethics.
Introduction
According to Warnock (1984) surrogacy means ―thepractice whereby one woman carries a child foranother with the intention that the child should behanded over after birth. Surrogate motherhood
involves a contract or agreement between desiring
parents and a fertile woman who is going to be thesurrogate mother of the child-to-be. The surrogate
mother is either fertilized with the sperm of thecontracting man or artiDicially conceived the embryoof commissioning couple through IVF and go
through a full-time pregnancy. According to theagreement surrogate mother has no right on thechild after birth, she has to surrender the child to theprospective parents, just after birth. Thus surrogacy
is also deDined as contractual pregnancy. Surrogacy
arrangements may take several forms, depending on
where the gametes come from. Gametes, i.e., spermand egg may be supplied by one or both of thecommissioning couple, the gestational mother/ or
her partner or by the third-party donor. Based onthese criteria surrogacy can be divided in to two
type- 1) traditional surrogacy and 2) gestationalsurrogacy.
Traditional Surrogacy
In Traditional Surrogacy (T.S) a woman becomes
impregnated by artiDicial insemination or in vitro
fertilization, using her egg and the sperm of anotherman (either the commissioning father or donor)(Strasser 2015, p.85). She agrees to carry the child tofull term before the birth and relinquishes herparental right just after the birth of the child.
Gestational Surrogacy
In Gestational Surrogacy (G.S) a woman isimpregnated by the fertilized embryo through IVF
technology like traditional surrogacy she agrees tobear the child to full term and relinquish herparental rights just after the birth of the child. The
difference between T.S and G.S is that in T.S thegenetic mother is the gestational mother but ingestational surrogacy gestational mother andgenetic mother are two different persons (Quinn &Huddleston 2017, p.228).
Surrogate Parenthood in Nigeria
There is currently no legal framework governing
surrogacy in Nigeria; however, there is a countrywide system of regulated third-party reproduction(Adelakun, 2018). The pro-natalist nature of thetypical African society where procreation is calledinvaluable has undoubtedly contributed to the slow
rate of acceptability in the conduct of surrogacy aswell as to the possible development of a regulatory
framework work. Some current investigation
exposed the custom of surrogacy in some parts ofthe country most especially among the rich families
who are unable to give birth to children, although thevalidity of such actions remains debatable provided
the non-existence of any legislation or constitutional
pronouncement on the said operation.
Surrogacy contracts in Nigeria are based on
simple contract terms; therefore, the concern iswhether such contracts which are conceived forsurrogacy purposes can be enforced in our national
courts. Amidst other conditions, most contracts
require two key elements to make them legitimate
and enforceable: The sides must agree (based on anagreement between the parties), and something ofworth must be swapped to serve as a condition(Makinde et al, 2016).
As with most jurisdictions, it becomes
enforceable in Nigerian once a contract has satisDied
the required element. Although there is no law or
statute in Nigeria regulating the surrogacy act, its
contracts and pacts remain enforceable. The
morality and public policy standpoint may present a
contrary view on the enforcement of surrogacy
contracts; nevertheless, it does not alter the fact thatsurrogacy contract terms fall within legally
enforceable agreements (Makinde et al, 2016). So, tosay the least, it may be suggested that legislativeintervention enactments are needed to help curb
possible abuse or exploitation of the procedure.
Hence there is the need for a legal framework serves
to guarantee adequate enforcement.
Ethical Issues
Perhaps the greatest moral objection against
surrogacy lies in the notion of selling baby insurrogate motherhood. These arise when surrogacy
is commercialized or it involves monitorytransactions. According to the contract, thesurrogate mother would bear the child up to ninemonths and renounce her parental rights just after
the birth of the child however she is paid a ransom
for doing this. The moral problem with sellingpersons in this context would be understood withthe help of Immanuel Kant's moral doctrine.
According to Immanuel Kant, "everything in the
kingdom of ends has either a price or adignity” (Paton 1947). If it has a price something else
can replace it as an equivalent, for example, mywristwatch, If I found my wrist-watch old fashioned I
have two ways either I sell it or exchange it withanother wristwatch. But if a thing is exalted above all
price and has no equivalent then it has dignity. For
example, persons have dignity means they are
priceless, they are not replaced by anything else.
Thus Kant's distinction between things with a priceand things with dignity helps us to understand whatis wrong in selling human beings. The selling of
human beings treats rational human subjects ascommodities, which is an insult to that person’s
dignity.
On this ground Herbert Krimmel in his article“The Case Against surrogate Parenting suggests that”
Things one pays for have a way of being seen asEubios Journal of Asian and International Bioethics 30 (March 2020)
commodities” (Krimmel 1983, p.37). It means that
putting a price on a person would transform theminto mere commodities which are an affront to his
dignity. However, this is done in surrogacy. According
to Krimmel surrogacy contracts turn children into
commodities though not permanently but
temporarily which degrades their self-worth(Krimmel 1983, p.37). He says ―Even though one of
the ends may be stated altruistically as an attempt tobring happiness to an infertile couple, the child isstill being used by the surrogate. She creates it notbecause she desires it, but because she desires
something from it (Krimmel 1983, p.38). Exchangeof money in surrogacy makes the fact clear that achild is a means to its biological mother's end.
Here it would be pertinent to discuss anotherproblem cropping out from the surrogacy issue.
Surrogacy arrangements not only degrades humanvalue but also degrades the bond between a
newborn and its mother. Research reveals that boththe newborn child and gestational mother are tied ina profound bond during pregnancy. The hormone
oxytocine plays a crucial role to establish such bonds
and promote maternal instincts. This bond becomes
more profound after the birth of the child.
Interaction between gestational mother and thenewborn like skin to skin to skin contact,breastfeeding initiate the continuous release ofoxytocin which promotes this bond and helps the
newborn to develop and cure the mother. It is
undeniable that this deep emotional bonding isestablished during pregnancy and it gradually grows
with the period of gestation. In this context, Rosalie
Ber maintains, ―One much-neglected aspect of thesurrogate mother's mental health relates to thephenomenon of bonding…though lacking scientiDic
proof many psychologists, psychiatrists anddevelopmental biologists believe that a special tie
develops during gestation between many, if not
most, pregnant mothers and the child they bear in
their womb (Ber 2000, p.153). Carrying a baby in thewomb, feeling her existence within body, supplying
her nutrients, feeling her kick after Dive months andat mature stage of pregnancy seeing her movements
within the body gradually grows the urge to love her,cuddle her, protect her from every harmful thing,
and then departing from that baby just after thebirth inevitably breaks forth emotional shock that
may lead to severe depression.
Ted Peters in his book For the Love of Children:
Genetic Technology and the Future of the Family
states, “The surrogate mother is likely to gind thewhole adventure more difgicult in executing than inplanning. The various methods of implantation arecomplex and time-consuming…The pregnancy may
include unforeseen side effects, and the childbearing
itself may be quite painful. As the bond develops
between the surrogate mother and the life growing in
her womb, it may be difgicult to think of the child as‘theirs ‘and not ‘hers’. The relinquishment of the baby
may turn out to be much more difgicult than61

anticipated, and for weeks afterward, she might beburdened with a sense of loss” (Peters 1996, 63).
Surrogacy arrangements destroy such bonds,
parting mother from her new born. Now in response
to Dirst objection it is said by the proponents ofsurrogacy that surrogate motherhood is not a case of
baby selling, rather this is the case of selling service.
It occurs in three stages; Dirst, the surrogate motheris impregnated by the sperm of the couple or by theembryo fertilized in a laboratory whose genetic
m a te r i a l p e r h a p s s u p p l i e d e i t h e r by t h ecommissioning couple or donor, through IVF. Second,
the legal stage where a contract is made between
surrogate mother and the commissioning couple
which holds that the surrogate has to go through afull-term pregnancy and deliver the child to thecommissioning couple after the birth of the newborn
and breach of contract would cause monitorycompensation. Then comes the third stage, where
the question of money comes, the surrogate receives
money out of her service. So it is concluded thatsurrogacy is just a case of selling service not a case of
selling the baby.
But the opponents retort that if money is paid
for gestating the child which is termed as ‘service’ inthis context then there should be no legitimate
expectation on the part of the couple that the childwill be delivered to them just after the birth and inturn the surrogate mother also has no liability tohand over the child. Fact is that if surrogate motheris being paid for her service then she has no liability
to deliver her child to the expectant couple, what she
is paid for is simply gestating the child . However,this is not done. So here raises the question about
the object of trading money. The commissioning
couple pays money for the child not for the service.
The couple desires the child and that is why
surrogate is being paid for the gestating child andliable to deliver the child. From this point, it isassumed that in case of surrogacy money is
exchanged for the child not for the service. Hencesurrogacy arrangement is an example of baby selling.
In response to such objection, the proponents ofcommercial surrogacy suggest focusing on the role ofsurrogate mother. A surrogate acts like a procreator
while providing an ovum, then she acts like a host to
the fetus, she helps the fetus to develop safely in her
womb, nurtures it and protects the fetus. All thesethings she does as a ―foster mother or a ―wet nurse(Peters 1996, 63) who looks after the child when anatural mother cannot do so. For example, let us
assume a situation where a governess looks after achild whose parents are very busy in their working
Dield and thus appointed her to take care of their
only child with a handsome salary. In such asituation, that governess does all the things that amother is supposed to do, from day to night, and for
doing this she is paid. But this does not imply that
she makes that child a mean to her Dinancial end. She
simply sells her service against which she receives
money. In the case of surrogacy surrogate motheralso plays the same role as a governess who is62

Eubios Journal of Asian and International Bioethics 30 (March 2020)

nothing but a caretaker of the child. However, given
the biological and psychological attachment
following from gestation such a surrogate is a reallymore intimate caretaker than a mother. Her service
which is a unique kind of caretaking engagement
does not degrade the child's dignity as a humanbeing. Now another doubt might be raised regarding
the role of commissioning couple. It may be doubted
that the child is a means to fulDill the emotional endof the commissioning couple as they are purchasing
the surrogate's service. Perhaps this objection does
not take a strong position against commissioning
couple. It is true that the commissioning couple who
are the legal parents of the child purchase thesurrogate's service, but they do so to arrange theirchild's early biological development. For example,
beside surrogacy there are lots of cases where
biological and gestational mother becomes incapable
to bear children after few months of pregnancy. Insuch cases doctors operate her and keep thepremature baby in an incubator which functions likean alternative womb and survives the child. This
medical procedure charges a heavy amount and theparents admit that for the sake of their child. The
same thing happens in case of surrogacy also. The
commissioning couple here provides the necessary
genetic material and makes an arrangement for theirchild's early biological development that is why they
appoint surrogate who will rent her womb for ninemonths to beget their child. All these arrangements
are done to have their own child who is an end in
himself. Thus it is concluded that surrogacy
arrangement has no connection with baby selling.
owever, the above discussion shows thatsurrogacy is not baby selling though it brings forth
another burning issue regarding the service of thesurrogate. Opponents of surrogacy alleged thatcommercial surrogacy is similar to prostitution.
American feminist Andrea Dworkin says in thiscontext that surrogacy is ― a new branch of female
prostitution with the help of scientists (Dworkin,1983). According to the opponents both surrogatesand prostitutes use their body to earn money. In
both cases, physical service is being offered inabsence of emotional attachment. Thus it degrades
the dignity of women's reproductive system. So it isimmoral.
According to E. S. Anderson surrogacy
commodiDies reproduction. She uses a term―alienated labor to the service of surrogate mother(Anderson 2018, p.167). The term ―Alienated Labor
is taken from Hegelian philosophy and used to referto such situations where the product of labor isseparated from the producer because the producer
surrendered it to the market. According to Anderson
pregnancy should not become a form of alienatedlabor, because it commodiDies women's reproductive
labor. Anderson holds that pregnancy is not likeother services, it has great worth, great value
because it is about a preparation to bring a new life
and that is why it owes dignity which should not be
forbidden (Anderson 2018, p.167). As surrogacy

commodiDies pregnancy and degrades it‘s worth, sosurrogacy is immoral.
Surrogacy seems problematic for two reasons;one, it involves monitory transaction and second, it
departs the child from its gestational mother. It is
discussed before that an emotional bond generates
between mother and fetus during the period ofpregnancy. This bond becomes more profound after
the birth of the child and for many emotional andmedical reasons the new born and its gestational
mother needs to live together, which helps the baby
to develop and mother to recover soon. Thus
departing the baby just after the birth from thegestational mother seems non-human. It damages
the fetal maternal bond, which is the purest bond oflove and affection, second, monitory transaction
destroys the respect and dignity of reproduction.
Following the famous philosopher Immanuel Kant
we can say dignity is priceless. However, there aremany things which are priceless for instance a gold
spec of my grand grandmother. But if thieves come tomy house and ask for that keeping a gun at my child,
I will surrender it for the sake of my child's life. But
human dignity is something which cannot be
exchanged by anything, neither by money nor bypower nor for the sake of any good consequence.
Hence commoditizing reproductive dignity isimmoral.
Moral Evaluation of Surrogacy
Surrogacy arrangement can be divided into two
kinds, viz altruistic surrogacy and commercial
surrogacy. In altruistic surrogacy surrogate motherbears the child for the commissioning couple orperson just for the sake of humanity. She does notmake any Dinancial proDit out of her service. Howeverin commercial surrogacy the surrogate is appointed
for nine months and she receives monetarycompensation for gestating and delivering the childafter birth. Ethical objections against surrogacy
arrangements crop out when the monetarytransaction gets involved. When money lies at theheart of surrogacy arrangement it is alleged either asa baby selling business or as modern version of
prostitution. In this section we intend to evaluate themoral justiDication of commercial surrogacy from thesix different ethical point of view.
Moral Evaluation of Surrogacy from theUtilitarian Standpoint
We shall begin with utilitarianism. Utilitarianism put
stress on the consequence produced by an action. If
an action produce good consequence for the
maximum number of people then that action is good
(Nagla 2016, p.3). Hence from utilitarian point ofview a successful commercial surrogacy may not be
ethically wrong or impermissible as sucharrangement serves the interest of all the parties
involved in surrogacy. Mainly three parties are
involved in commercial surrogacy Dirst, thecommissioning couple or person, second thesurrogate mother and third the baby. Among themEubios Journal of Asian and International Bioethics 30 (March 2020)
Dirst two are directly involved as they initiate sucharrangement and the third one gets involved being a
result of such arrangement. A successful commercial
surrogacy arrangement brings happiness to all ofthem. The commissioning parents became happy
after having their child, the surrogate motherreceives good amount of money out of her service
which may remove her Dinancial crisis and the baby
receives parents. Thus nobody is deprived ofreceiving beneDits. Hence from utilitarian point ofview commercial surrogacy is morally justiDiable.
Moral Evaluation of Surrogacy from the
Deontological Standpoint
However deontologists may hold different positionin case of justifying commercial surrogacy as
deontological ethics gives priority to the moral duty
than the consequence. According to Immanuel Kant
a person should not be used as a means to an end(Korsgaard 2012, p.76). In case of commercial
surrogacy the surrogate mother is used to fulDill thewishes of the commissioning couple or person. She
has to bear the child for nine months and relinquish
the baby just after the delivery. Despite she is paid
for her service but in major cases the amount does
not balance over her emotional loss. It is undeniable
that during gestation a bond is established between
mother and her child. This relationship cannot be
equalized with the relation between a labour and hisor her product. Besides, for Kant human beings havedignity which is exalted over price. Hence humanbeings should not be reduced to commodity that arepurchased and used. A woman being a surrogate
puts her womb for rent for nine months and acts
merely as a reproductive machine which degrades
her dignity. Nevertheless surrogacy is morally wrong
since referring to Kant‘s ethics it is not universally
applicable. For Kant ―act only in accordance withthat maxim through which you can at the same time
will that it become a universal law (Korsgaard 2012,p.77). Surrogacy cannot be universalized because
had it been taken as a universal way of reproduction
then every woman would look for a surrogate togestate her child, and nobody would be ready toconceive her own child. Consequently conceiving
one‘s own biological child will become meaningless.
Thus from deontological point of view surrogacy ismorally wrong.
Moral Evaluation of Surrogacy from theStandpoint of Virtue Ethics
On the other hand virtue ethics maintains that virtue
lies between two extremes. Extreme of any feeling isvice. Virtue ethics put stress on agent‘s character, thestates of character from which actions Dlow. When amother gives up her child after carrying her ninemonths in her womb, for the sake of humanitarian
ground to those couple who are infertile her action
would be considered as benevolent. But when she
receives money for doing so that implies that she
conceived the baby for achieving monetary proDit. It
may be said that in surrogacy the surrogate makes

63

proDit out of her service, but then it can be asked
what kind of service? If she is paid for her service
then she is not bound to relinquish her baby after
the birth. However this does not happen. If surrogate
mother denies to give up her baby after a successful
delivery then she will not be paid. Hence surrogate
mother is paid against her baby. Thus in case ofcommercial surrogacy money becomes thealternative of a human baby. Undoubtedly thisdegrades the bond between mother and child andlust for money makes this action vice. So from thestand point of virtue ethics surrogacy is morally
right if and only if it is performed for the sake of
benevolence but if monetary proDit gets involved insurrogacy then it is a morally wrong action. In thiscontext of virtue ethics it seems pertinent that it has
become a fashion nowadays having baby fromsurrogacy (). Many fertile couple who belong to theupper-class of the society appoints a surrogate
because of avoiding the hazards of pregnancy. Theiractions are also vice as the lack of proper courage
leads there action.
Moral Evaluation of Surrogacy from theStandpoint of Care Ethics
Care ethics is a well- known feminist approach tomorality. However in case of commercial surrogacy
feminists are divided into two groups having theirown distinguish standpoint. Some feminists support
commercial surrogacy saying that it paves the wayfor exercising reproductive freedom. For thesefeminists, a woman must have right to use her bodyas she chooses, if that invokes her to rent her womb
she is allowed to do so. On the other hand anothergroup of feminists believe that surrogacy is anarrangement which exploits poor and needy women(Korsgaard 2012, p.80). In this arrangement poor
women are exploited by the upper-class people.
They also charged that commercial surrogacy
commodiDies women‘s body and resulting children.
Now we will evaluate the moral justiDication ofcommercial surrogacy from the standpoint of care
ethics. According to Virginia Held “...the ethics of care
concerns itself especially with caring
relations” (Held 2006, p.19). Caring relations haveprimary value. Now, as far as relation of care isconcerned, the best example is the relation between
a mother and her child. A mother who gestates her
child for nine months into her womb, by virtue of her
nature develops a profound emotional bonding oflove and care for the child. She is the best care takerof the child and nothing in the world can replace her.
However, in commercial surrogacy – a surrogate
mother is contractually bound to relinquish her baby
just after the birth and for doing this she receives alucrative amount. Thus commercial surrogacy turns
a mother into a labor and her child into a product orcommodity and humiliates the mother-childrelationship. As care ethics emphasizes on the caring
relationship it seems that commercial surrogacy may
fail to receive moral permission from this point of
view.

64

Eubios Journal of Asian and International Bioethics 30 (March 2020)

Moral Evaluation of Surrogacy from theStandpoint of Principlism
The dominant form of principle based ethics put
stress on four principles namely autonomy,
beneDicence, nomaleDicence and justice. Now we areabout to explore the morality of commercial
surrogacy from this point of view. The Dirst principle
autonomy has already been considered as thedominant principle in the Dield of medical ethics.
Autonomy is concerned about the freedom of thewill commercial surrogacy engages two parties
namely the surrogate mother and the commissioning
couple or person. While discussing the moral meritof commercial surrogacy under the light of principleof autonomy question may raise whose autonomy it
is. That of the commissioning couple or that of thesurrogate mother? In case of commissioning couple
or person, it is clear that as they are desiring forbaby they make an autonomous choice to have baby
through Surrogacy however in case of surrogate it
seems arbitrary that whether her participance isfully autonomous or not (Goldberg 2014.). The fact isthat, that in commercial surrogacy most of thesurrogates belong to poor family. They take part incommercial surrogacy to fulDill their family needs.
Often this participation is not voluntary rather out ofthe pressure of family. Thus it can be assumed that
not all time participation of surrogate isautonomous. Sometimes a passive coercion works
behind her participation. The principles ofbeneDicence and nonmaleDicence stand for providing
medical beneDits to the patient and do no harm. In
case of commercial surrogacy the surrogate mothermight be beneDitted by the amount that she receives
from the commissioning party but the fear of harmto her mental and physical health persists. In an
article Ethical Issues in Gestational Surrogacy Rosalie
Ber has focused on some crucial points considering
the health hazard of surrogate mother. She
questioned that if the surrogate develops somecritical health problems for example breast cancer ormalignant tumors who will take her responsibility
after contract has been fulDilled (Ber 2000, p.153).
Would the commissioning couple take theresponsibility of surrogate‘s children or family if shedies during delivery or some sort of illness induced
from pregnancy? Apart from the fear of physicalharm to the surrogate there also remains the fear of
mental harm that results after parting from the child.
Hence in any case commercial surrogacy cannot
bypass the fear of harm to the surrogate mother. The
principle of justice stands for equality and fairness.
Commercial surrogacy fails to answer questions
from this ground. For example if a deformed child isborn who will take his/her responsibility. If both ofthe parties refuse to take that child what will
happen? Besides, let us assume a scenario where
doctors are bound to terminate the child to save thesurrogate mother‘s life at the Dinal stage ofpregnancy. Would the commissioning couple takeher responsibility? According to the surrogacy
contract the surrogate has performed all her duties

but after this incident would she be paid for her
service by commissioning couple? Such questions
remain unanswered. Thus it is assumed thatcommercial surrogacy is not morally justiDied fromthe standpoint of principle based ethics.
Conclusions
The aim of this research is to introduce and elucidate
the controversy over surrogate motherhood Nigeria.
We have focused on the central point of these issues
that succeeds controversy. The problem withsurrogacy leads to a serious allegation namely
exploitation of poor women, in third world countries
like Nigeria. In Nigeria surrogates are paid around$400 which is a lucrative amount to them indeed.
However in comparison to the rate of surrogates indeveloped countries this rate seems to be very
cheap. Hence it is alleged that surrogacy
arrangement in third world countries like Nigeria,
exploits poor and needy women. The vulnerability ofpoverty is being exploited in the whole system.
References
Held, V.(2006), The Ethics of Care: Personal, Political and Global,
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