conference proceedings of congress International Bioethics 1999. Bioethics and dignity in a pluralistic society

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Conclusions

Susana Aulestiarte.
administrative assistant Member of the International Bioethics conference .
Member of the Interdisciplinary group of research Bioethics of the University of Navarra.

On behalf of the committee Organisers of these International Bioethics conference , in which we have tackled from an interdisciplinary point of view some of the most urgent bioethical problems in the context of a pluralistic society, it seems appropriate, at the end, to proceed to a brief recapitulation of what has been said during these days.

The first workshop, dedicated especially to examining the bioethical problems that arise in the initial phase of life, opened with the intervention of Professor D'Agostino, who spoke on the concept of human dignity and its role in current bioethical reflection. As he pointed out, bioethics seems unwilling, or at least unable, to adopt any language other than that of dignity. At the same time, however, it seems to be aware that this language is in need of continuous and laborious revision. The need for a re-semanticisation of the idea of human dignity and its application to human beings in their embryonic state, threatened by positive law, and the importance of not relegating this re-semanticisation exclusively to political consensus, thus became evident. The need for this reflection, we can add, results from the ambiguity that often surrounds the concept of dignity, an ambiguity that is often transferred to legal texts drafted in the shadow of moral pluralism, and which end up powerfully limiting the very critical work of bioethics.

An example of this limitation can be found in the topic addressed by Professor Melina, who spoke on the biological, anthropological and legal status of the human embryo. Indeed, this is an issue that has been systematically censured in the public discussion and this because, through various legislative decisions, it has been considered to have been resolved once and for all. However, it is an issue which, when inadequately resolved at the legislative level, reveals itself as a dangerous principle of dissolution for the entire legal order of society, even if it is presented as a way of peacefully resolving the otherwise inevitable conflicts that arise in a pluralistic society.

In this context, and in the face of approaches that make dignity staff dependent on the effective and verifiable possession of certain qualities, be it conscience, developed psychic life or quality of life, Professor Melina recalled, following Robert Spaemann, that the dignity of the person must be recognised for every biologically human being.

Also, in this first workshop, Professor May examined the ethical aspects involved in the new reproductive technologies, exposing and analytically arguing the position of the Magisterium of the Catholic Church, according to which reproductive techniques that replace the marriage act are not ethically acceptable.

After a detailed analysis of each of these techniques, Professor May briefly drew attention to a central point when we move into the realm of public discussion: the inaccuracy of the concept of right when one speaks vulgarly of the right to have a child. To this, Professor May objects that husbands and wives have the right to perform an action class that is in itself capable of receiving a new human life: the act of marriage; but they do not have the right to have a child. Their desire to raise and support a child is noble and legitimate, but this desire does not justify some or all of the means to achieve its fulfilment.

In the second workshop, we turned our attention to various bioethical problems with ethical and legal implications during the course of human life itself. In this line, Professor Aparisi addressed the ethical and legal implications of the project Human Genome, which aims to sequence the approximately one hundred thousand genes that make up the genome of our species by the year 2003, the date on which it will be possible to access the information contained in our genome.

Much of the ethical and legal reflection on this project focuses precisely on the use that will be made of this information. Anticipating the possible abuses that may occur in this field, Dr Aparisi pointed out the need to recognise a human right to privacy Genetics. On the other hand, and considering the possibilities that are opening up for engineering Genetics, Dr. Aparisi drew attention to the need to recognise a right to integrity Genetics, aimed at avoiding genetic manipulations that are not directly therapeutic in the germ line.

On the other hand, Dr. Thomas's speech, which focused on the exhibition of the current social discussion around the ethics of transplants, incidentally shed light on one of the most frequently invoked principles in Bioethics of late: the principle of autonomy. Acknowledging that even an appropriate action by the physician cannot be imposed against the patient's will, Professor Thomas emphasised that the opposite is also true: the physician cannot simply make his or her action dependent on what the patient wants. The patient can demand that something be left undone, but he cannot demand that something be done in a particular way. The physician is also an ethical subject. The patient's will is important to him, but as a subordinate written request . financial aid to choose the solution final from among several alternatives when these are ethically permissible. The patient's will cannot justify an ethically reprehensible action. This applies to the central issue of transplantation medicine: the will of the donor is no substitute for an objective ethical justification.

As far as this ethical justification is concerned, and even taking into consideration the ambiguities surrounding the state of brain death, Dr Thomas clearly stated that the peculiar epistemological status of brain death fulfils this condition, under which organ donation to a curable patient is valid as a legitimate act. This statement opened a discussion on the concept of brain death that has continued to this day, and which has highlighted the need to strengthen the interdisciplinary work on this issue.

For his part, Professor Méméteau stressed the importance of the figure of conscientious objection in bioethics, insofar as it makes it possible to raise the need for critical reflection on questions of compromise and consensus, which so often anaesthetise consciences. As he himself underlined, the possibility of a conscience clause assumes the existence of threats to fundamental human values, as well as the inadequacy of positive law to stop such threats. It is indeed the case that in many cases the law has ceased to fulfil its function of protecting the weak. The case of abortion is obvious. But no less so is the use of human embryos for research.

Moral pluralism is often invoked as a justification for similar legislation. In this sense, it is paradoxical that it is precisely pluralism that, according to Professor Méméteau, is lacking in the bioethical discussion, which in many cases relies on the persuasive force of its opinions, its moral authority and the complex decision-making techniques of its committees to propose rules parallel to those of the state. Professor Méméteau considered it appropriate to warn of one of the dark aspects of pluralism, namely the tendency to produce a certain indifference or scepticism towards the morality of actions, which will then be judged solely on the basis of criteria of effectiveness. On these assumptions, human dignity is called into question in a thousand ways, and is now confused with the quality of life.

Professor Méméteau's intervention was completed by Dr. Durán and Prof. Escrivá, who underlined the importance of conscientious objection in a plural society, stressing the need to distinguish a right to conscientious objection specifically distinct from the right to ideological and religious freedom.

In this third and final workshop, it was planned to examine the bioethical issues that arise in the terminal phase of life. Dr Shewmon began by outlining the controversies surrounding the identification of brain death and death of the person. The bioethical interest of these controversies lies in the fact that any variation in the medical diagnosis of death could affect, at least from entrance, the criteria for transplantation. As highlighted in the discussion, the diagnosis of death has changed throughout history. There is now a broad medical consensus on brain death. This consensus emphasises that, in a state of brain death, the cessation of cardiac and respiratory functions becomes irreversible. On the basis of this irreversibility, it is doubtful, to say the least, that transferring the criterion of death to a later point in time would add any ethically relevant considerations.

For his part, Professor Herranz spoke this morning on euthanasia and the dignity of dying. In his lecture he again drew attention to the ambiguity that surrounds the term dignity today employment , which he referred to two polar positions. For one, all human lives, throughout their duration, from conception to natural death, are endowed with an intrinsic, objective dignity, possessed equally by all. For the other, on the other hand, human life is a precious good, endowed with an excellent dignity, which is distributed unequally among human beings and which, in each individual, undergoes fluctuations with the passage of time, to the point where it can be extinguished and disappear. This latter position equates dignity and quality of life, and it is from this perspective that some call for euthanasia as a right.

The only point in common between the two positions is the condemnation by both of what is known as therapeutic incarceration. After a exhibition of what the internship of each of these two positions entails, Professor Herranz developed some considerations about the peculiar dignity of the terminal patient, arguing that it is precisely in this status where professions such as Medicine and Nursing rediscover their original vocation: to come to the aid of weakened human life.

Finally, this morning, Professor Ollero showed us the legal side of discussion on euthanasia. After a quick review of some of the arguments usually put forward to support the decriminalisation of euthanasia, Professor Ollero highlighted the disadvantages of such arguments from a legal point of view. Indirectly, he also pointed out the risk that would follow for the bio-health professions, as decriminalisation would end up having a significant effect on the attitude of respect for life, characteristic of staff , and on the trust that the latter deserves from the patient.

Professor Ollero also disagreed with the position that makes the claim to death a right. Although from a legal point of view we could do anything that is not expressly punishable by law, such a possibility does not authorise us to claim death as a right.

After this summary, I would like to thank you, on behalf of the University of Navarra, for your attention and participation in these conference, and I hope that this occasion for dialogue may be the beginning of interdisciplinary colloquia on Bioethics issues.