Professor Henk ten Have, thank you for joining us for this live session
Can you first start by telling us what is bioethics?
Answer
In general, it is the reflection and analysis of the ethical issues regarding present day medicine and health care.
It concerns questions related to transplantation, end of life, but also research problems and the distribution of scarce resources such as the lack of appropriate medication in many developing countries.
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Editor
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Bioethics is something which can be seen from more than one angle, and every opinion has its justification, how do you deal with this?
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In UNESCO, we are aware that in the world there are at least 3 different approaches to bioethics:
1) A focus on medicine and health care,
2) a focus on human rights,
3) a focus on nature and the environment.
Within these approaches many people have different views. Think for example about the discussions on abortion, stem cells and euthanasia. This is acceptable since people have divergent values. At the same time, accepting the diversity does not mean that we should not search for values that we share, moral notions that we have in common.
In UNESCO this search for common values has for example resulted in the Universal Declaration on Bioethics and Human Rights which identified 15 fundamental bioethical principles on which all 192 member states could agree.
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Hwaa
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Question
In 2001, went back on his promise as always to regulate carbon dioxide emissions from power plants. He refused on the basis that it would prevent his country from continuing in its tracks towards a perceived prosperity.
The Kyoto Protocol was a 1997 Int'l accord that other countries have responded to in like manner, and have chosen to acknowledge as they wish, according to their agenda.
The corporate world depends upon the non-appliance of the above and consensus to he World Trade Agreement, T.R.I.P.S etc., but through the World Social Forum, many are resisting the pressure to submit to a autocratic tendencies within the current system of globalization
This year, before the season of Spring dawns upon us, environmental activists.
Would it be true to say, that the Corporate world is increasingly independent on two main sources of raw material for its economic benefit
a) Oil
b) Genetic engineering and forms of?
If this is so, how much would you say that these corporate entities are in powers of influence in order to ensure their futures?
If this is the case, how much is this unethical agenda, determining consumer power?
And if this is the case,
what is happening within the realm of bioethics on a proactive level that is seeking to address the balance.
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WE will have no other choice than to increase awareness that in fact we are all dependent on the prudent use of our resources. If we do not our children will suffer the consequences.
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I'm sure you've heard of the case of the little girl Ashley who is nicknamed 'Pillow Angel'.
She is a 9 year old girl with the brain of a 3 month old baby and the doctors say there is no chance of improvement for her.
Her parents chose to stun her growth with an operation to keep her body as that of a 9 year old to improve her quality of life.
What do you think of this case?
Answer
The case should be analyzed in terms of the basic principles of bioethics.
In this case relevant is the principle of benefit and harm. This is the argument of the parents: the child can be much better cared for when she is small and has no reproductive system.
The question is whether this argument is true; the care is better for the carers but is it also better for Ashley herself? I am not so convinced. Then there is the principle of dignity; removing organs from someone or restricting her growth can make a person better manageable, but it does not respect the condition of the person as such.
Care is never facile and easy, and we should adapt the persons we care for to our requirements (that would be contrary to the concept of care). Therefore, I do not think there are moral justifications for the interventions done in this case.
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Rasha
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I want to know who is in charge of legislating laws related to bioethics, and if it is an international organization, can we say that these laws will be obligatory to the whole world?
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Bioethics legislation in the first place is made in countries.
For example in France, Parliament after long debates and public involvement have adopted so called bioethics laws. However, many countries do not have the expertise to develop such laws.
They have asked UNESCO to give them assistance in providing general frameworks of principles that can guide their legislative efforts. Such guidance is for example provided in the Universal Declaration on Bioethics and Human Rights (also available in Arabic on the UNESCO website); it expresses 15 fundamental principle that are valid for all countries.
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H...
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The following is a list that includes products that have tested positive to containing genetically engineered material:
Frito-Lay Fritos Corn Chips
Bravos Tortilla Chips
Kellogg's Corn Flakes
General Mills Total Corn Flakes Cereal
Post Blueberry Morning Cereal
Heinz 2 Baby Cereal
Enfamil ProSobee Soy Formula
Similac Isomil Soy Formula
Nestle Carnation Alsoy Infant Formula
Quaker Chewy Granola Bars
Nabisco Snackwell's Granola Bars
Ball Park Franks
Duncan Hines Cake Mix
Quick Loaf Bread Mix
Ultra Slim Fast
Quaker Yellow Corn Meal
Light Life Gimme Lean
Aunt Jemima Pancake Mix
Alpo Dry Pet Food
Gardenburger
Boca Burger Chef Max's Favorite
Morning Star Farms Better'n Burgers
Green Giant Harvest Burgers (now called Morningstar Farms)
McDonald's McVeggie Burgers
Ovaltine Malt Powdered Beverage Mix
Betty Crocker Bac-Os Bacon Flavor Bits
Old El Paso Taco Shells
Jiffy Corn Muffin Mix
Sources: Genetic ID (an independent testing firm) and Consumer Reports (September 1999).
Please could you comment on the what role the consumer plays in in making something questionable, quite acceptable?
Answer
The important concern with Genetically Modified Organisms (GMOs) is that we cannot be completely certain that they are safe.
If this is the case then we should at least have a choice in whether or not we want to use these products. This implies that they should be adequately labeled so that people can make a decision.
The main argument in favor of GMOs is that this will make it less expensive to produce and grow the products. The prices can go down and more people can have food. This is a nice argument but so far the prices have not gone down, so who is in fact benefiting from this development?
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Breathe
- Egypt
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What is the difference between euthanasia and dying with dignity?
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The difference is an important moral distinction:
- Euthanasia is intentionally ending the life of a patient. In this case, the patient dies due to the intervention of his or her doctor.
- Dying with dignity is letting die; no longer interfering or treating a patient so that he or she is given a chance to die. Of course in such cases all things need to be done to relief suffering and care for the patient, but we no longer prevent or resist that he or she is going to die. In this case the patient dies due to his or her disease.
There is a relationship between the two; if we continuously prevent patients to die (for example by a policy of resuscitation regardless of the patient's condition) he or she can eventually only die by asking the doctor to help him die.
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Rasha
- Egypt
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Peace and thanks for answering my question.
Ashley's case really makes me think a lot about the right and wrong in the science development. What is your own view about this case in specific?
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From a moral perspective I do not agree with the interventions in this case. We should first of all respect the condition of human beings and treat them according to their condition. It can be very annoying or burdensome to care for some of our fellow human beings, but that is precisely what is the essence of care: that we take the other person as he or she is, and give our efforts to help him or her.
We should adapt our efforts and the environment to the people we are caring for and not the other way around - that we expect the people we are caring for to adapt to our requirements and make it more easy for us to care for them.
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Is religion one of the aspect that determine the red lines that medicine should not cross?
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Religion of course is identifying basic moral values. In UNESCO we have meetings with representatives of different religions to ask them whether there are values that are shared among all religions.
Obviously there are and you can argue that there are universal values that are common or universal , even if perhaps in each religion the way the value is expressed can be different.
Human dignity or the value of human life are such values that are shared among all people, regardless of their religion.
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Jack
- United States
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Personally, I'm very convinced that euthanasia IS the ethical choice. Why is it that some people just want to see others suffer and not relief them from it?
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Euthanasia is the wrong answer to suffering. The vocation of medicine is to relief suffering and there are currently excellent ways to relieve and end suffering. But it does not mean that ending the life of a human being is then justified in order to end the suffering of this person.
These are two different approaches.
There is also another problem with euthanasia. If a person who is suffering indeed wishes to end his life in order to stop suffering, then it is his or her responsibility and moral decision. Why is he or she asking another person (i.e. the doctor) to end his or her life?
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Khaled Metwalli
- United Kingdom
Profession
Businessman
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In the UK, there has been quite an uproar over hybrid cells.
What's the big deal and why do people say they are unethical? If they will help medicine improve then I vote for them!
Answer
You will probably not have the position that the end justifies the means and that everything is allowed that will promote medicine. This is the position of the past where people have been sacrificed in order to promote medical experimentation.
There is now a general framework of ethical principles within which medicine can be promoted. The problem with hybrid cells is that we are completely ignorant about possible risks. If you cross species borders you can run the risk not only of introducing new viruses into human beings, but also of creating completely new viruses.
Look at what is happening with bird flu at the moment. If we create hybrid cells now in order to solve medical problems we run the risk that we create other fully uncontrollable problems in the future.
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Susan
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You say you oppose what Ashley's parents chose to do, yet I think it makes total sense!
They did it to be able to care for HER better. They can carry her in their arms when they are going out. If her body DOES grow, her little brother said they might need to use a trolley to carry her. Which offers this little girl more dignity in your opinion?
Answer
But it is Ashley' s own life that she will grow and get older. How can parents prevent that their child will be older and thus less manageable? I still am not convinced that it will be in her best interest. It shows respect, in my view, to accept that Ashley will develop into a mature human being and cannot be carried around any longer in a trolley like all of us.
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A very high profile case right now is pitting Novartis, the multinational pharmaceutical organization, against the Indian government in a patents case.
If Novartis wins the case, millions of poor in Africa will lose the source of cheap AIDS drugs they depend on.
How do you feel about this case?
Answer
In the UNESCO Declaration on Bioethics and Human Rights there are two relevant fundamental principles adopted: benefit sharing and social responsibility.
They both are relevant because the idea is that we have an obligation to do something about health care for developing countries. If people are dying from infectious diseases that can be treated but medication is not available because it is too expensive due to patenting, then the moral choice is between the duty to provide adequate health care and the duty to respect the patent law system. I think that the answer should be clear: you cannot allow to let your population die or suffer because there are patents benefiting the commercial interests of companies.
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Maged
- Egypt
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Are sperm and ova banks where you can go to buy them for fertilization ethical?
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Not on itself I would argue. This is not material like coca cola. They serve a particular purpose and they should be used in that context.
For example, if you have sperm banks you should take care that the interest of future children are served. If in the future the child has an integrity crisis and wishes to know who is his or her biological father, there should at least be the possibility to have the data available.
The same for ova, although this is more complicated because the harvesting of ova is burdensome and risky for the donor women. The main point is that these "materials" can be isolated from their human context and from the context of medicine.
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The argument on the side of the pharmaceutical companies is strong as well. Patents allow them to invest better in R&D which will eventually bring more innovation.
What system do you suggest that can balance between availability to the poor and the rights of the pharmaceutical companies?
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The argument of the companies is of course often used. But a large proportion, sometimes even more than that for R&D is used for promotion and publicity.
I think that there should be an agreement about a basic list of medication that should be available for people in developing countries for a much lower price, even if that would imply the risk that these cheap drugs are channeled back to the developed countries.
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Mahmoud
- Malaysia
Profession
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How do you feel about organ transplantation?
I think it's only a matter of time before we start seeing organ sales taking off
Answer
The sale of organs is explicitly rejected in several UNESCO documents. The problem that we have to solve is how we can make more organs available. By promoting organ sales we further deteriorate the inequalities that already exist in health care. The poor will be exploited and only the well to do will benefit.
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Mary-Ann
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What do you think of cloning?
I watched this movie called the island, and it was a really scary look at the future. There were farms that were harvesting clones that people can then use to obtain organs or anything they need should they suffer an accident or something.
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Cloning is an ambiguous term. On the one hand it can refer to cloning human beings and making copies of human beings, as in the movie. On the other hand it can refer to stem cells that will never develop into human beings but are only the undifferentiated materials that can help to solve some problems.
Of course there is a moral debate about the status of such cells and here countries have different views. Cloning of human beings will never be very important; who wants to have clones as children if he or she can conceive in the natural way. If people want to have cloned children because they are "copies" of previously died children for example, they make a mistake: even if children are cloned, they will never be the same person since the context and the circumstances will always be different.
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Khaled Metwalli
- United Kingdom
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What about stem cell research? Do you think it should be allowed?
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The answer will depend on moral argument.
If you think that stem cells are harvested from the destruction of embryos and embryos are THE beginning OF human life, it is clear that you cannot destroy one human life in order to help others.
On the other hand if you argue that the early stages of embryonic development are of course important but they are not entitled to the same moral and legal protection as developed human beings, you can allow stem cell research like they did in the UK until 14 days of development.
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Editor
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The time for the session is nearly up. Thank you for this interesting talk, Professor.
Finally, what do you think can be done to raise bioethics awareness around the globe?
Answer
I think that this exchange will be a contribution.
Bioethics is first of all a public debate so that we need to promote discussion in newspaper and media. Secondly, international bodies like UNESCO and governments should better promote bioethics. One way to promote it is through education. In schools and universities much more attention should be paid to bioethics.
