Guest Editorial: Decisions, decisions...

"Establish a routine for baby" used to be the rule handed to every new parent and there was wisdom in doing that – within reason – for babies and young children. As we age, the routines we create for ourselves can become an invisible prison. They certainly save energy in decision-making, increase our sense of security and give life a sense of predictability. But at what cost? The dictates of a self-constructed routine can take the colour out of life and restrict both our opportunities and potential for personal growth. If routines come to rule our lives, then any event which threatens them will create stress.

Some decisions, however, mark a change in the colour or a new turn in the pattern. They may even be definitive in creating the overall pattern either incrementally or as a result of a sudden change. Invariably they involve stepping outside the routine of our daily lives. Sometimes a decision which appears to be relatively minor suddenly brings us to halt when we realize it has moral implications we had previously not considered. John Kleinsman's article on Moral Cooperation in this Nathaniel Report highlights the complexity of what seems to be simple decision-making if we are to take into account the principle of moral cooperation. As John points out, a teenager's request to borrow a CD from a friend is actually an entry point into the complexity of moral decision-making.

Dr Anna Holmes writes about wisdom as "looking both backward and forward". Taking the time to retrace our way back through the decisions of the day or the week is not always easily done, but it can be very revealing. The interplay between routine and conscious decision-making may not be leading us in the direction we would really like to go. For example, does routine rule out some actions which would have been truly in accord with the Gospel? Does it sometimes over-rule the promptings of the Holy Spirit?

The forward-looking aspect of wisdom comes to the fore in Dr Elizabeth Hepburn's article about the use of advance directives in Australia. It takes some courage and determination to reflect upon how we would want medical issues around the end of our lives handled. This is major decision-making, but we may never do it if we are constrained by the routines we have set up to handle the minor decisions of daily life.

Just as a myriad of small decisions we make can take us towards or away from becoming the kind of person we know we could be, a similiar effect can occur at a community or societal level. The legal freedom to make individual decisions in certain areas may result in a societal movement in a direction not foreseen or not necessarily desirable. Taking stock of where the collective effects of individual decisions are taking us, and then redefining and re-stating where we want to go is wise at the community level as well as at the personal level.

It is also a wise strategy at the global level.

On 19 October 2005 the United Nations Educational Scientific and Cultural Organization (UNESCO) adopted a new Universal Declaration on Bioethics and Human Rights. The last decade has seen an acceleration in biotechnological and medical advances, and the Declaration is the outcome of some global stocktaking of the directions in which those advances have been taking us. Many aspects of biotechnology now transcend national borders, with the importing and exporting of embryos, stem cell lines, and organs, and research projects being carried out simultaneously in multiple sites around the world.

"While it is still up to states to create legal texts and instruments appropriate to their cultures and tradition, the general framework proposed by the Declaration can help 'globalize' ethics in the face of the increasingly globalized sciences," UNESCO said of the Declaration when it was adopted by the 33rd Session of its General Conference. [1] The Declaration can be found in the Social and Human Sciences section of UNESCO's website. [2]

The Declaration's first principle is the protection of human dignity and human rights. It is reassuring to see in a new global document an emphasis on human dignity as the fundamental attribute of human beings from which human rights are derived. There has been a strong trend in bioethics in recent years to claim "personhood" as the determinant of rights. This has been accompanied by attempts to define personhood in ways which categorize not only unborn children, but also babies and people with cognitive impairment as "non-persons", and thus without rights. In his article Personhood and Human Dignity, Father Michael McCabe has set out some of this thinking and its potential effects. In a second article, Spirituality, Suffering and Dementia, he outlines the importance of recognising and responding to the human dignity of those with dementia-related illness, rather than allowing utilitarian concepts of personhood to determine the community's response.

There has been some criticism of the new Declaration, including its perceived weakness in statements relating to future generations, the environment and the distribution of the benefits of biotechnology. Questions have been raised about whether it is actually a weaker statement than existing tools such as the Declaration of Helsinki on medical research. [3] If that is the case then there is the potential for the Declaration to lower standards rather than raising them.

Despite weaknesses born out of compromises among the states involved, the Declaration is a product of reflection on the myriads of decisions which have been, and are being, made in medical research and biotechnology around the world. It represents a global consensus about future decision-making, and has painted the road markings for the route ahead.

Knowing how difficult it can be at a personal level to reflect upon the many individual decisions we make, to identify patterns and then to discern the directions we wish to take, we should regard a global exercise which has done exactly this with some awe.

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[1] UN News Centre (20 October 2005). Press release UN adopts Universal Declaration on Bioethics and Human Rights, www.un.org/news.

[2] UNESCO (19 October 2005). Universal declaration on Bioethics and Human Rights. http://portal.unesco.org/shs/en/ev.php-URL_ID=1396&URL_DO=DO_TOPIC&URL_SECTION=201.html

[3] Dickson, David (21 October 2005). Sparks Fly over UNESCO Bioethics Pact, SciDev.Net, http://www.scidev.net/content/news/eng/sparks-fly-over-unesco-bioethics-pact.cfm

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Anne Dickinson is Executive Officer of the New Zealand Catholic Bishops Conference

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2005