health-ncp_net-sutrop_211008

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Prof. Margit Sutrop

Director of the Centre for Ethics, University of Tartu, Estonia

HEALTH-NCP-NET 1st Training, Brussels, 21.10.2008



` Morality and ethics

` Reasons of the boom in ethics

` Ethics as an integral part of research` Plurality of morals and unity of ethics: In search of

universal principles

` Changes in ethical frameworks: new challenges to

ethics



` Morality is the embodiment of norms and valueswhich have been collectively acknowledged asbinding. Morality refers to historically emergedpractices of people and cultures.

` Ethics refers to the whole domain of morality andto the theoretical reflection on moral values, normsand principles.



Theoretical ethics

` Normative ethics(justification of norms)

` Metaethics (languageof morals, nature of value judgements)

Practical ethics

` Applied ethics

( moral issues of different fields of life)

` Professional ethics

(values, obligationscodified in professional

practices)



` Medical ethics

` Bioethics

` Environmental ethics` Public ethics

` Media ethics

` Business ethics

` Ethics of sports

` Research ethics



` A search for shared values

` Institutionalization of ethics (first centre in 1969

Hastings Centre on Hudson)

` More courses of ethics in university curricula` Creation of special journals for ethics

` Ethical review system established

` Codes of ethics for different professions



` Institutionalization of ethics: neither of the previous

booms produced centres for ethics

` Ethics is treated as a subject where

controversies are normal (courses of ethics areproblem-oriented)

` Philosophers not ministries leading the

discussions

` Training in ethics for all professions required



` Research ethics: a kind of professional ethics

which sets and justifies the ethical standards of

conduct in research

` Bioethics: a kind of applied ethics which dealswith ethical issues in biomedical research



Standards of ethical conduct in science: honesty,

carefulness, openness, freedom, credit, social

responsibility, mutual respect,respect for subjects.

` Ethical standards of conduct in research play akey role in advancing the goals of science; in

promoting cooperation, collaboration, and trust

among researchers; and in attaining the public¶s

trust and support.` European Science Foundation¶s ³Good scientific

practice in research and scholarship´, 2000



` Advances in science and technology create new

ethical issues of research. From the question

³what we can do?´ to the question ³what we

should/may do´?` Max Weber : the natural sciences can give us

answers to questions about what we should do if

we want to rule the world technologi-cally. But to

answer the question whether we must or shouldrule the world technologically, we must step

outside science.



` concept of human dignity

` the concept of personhood: when does human life

begin?

`

the moral status of the human embryo (abortion, stemcell research)

` the right of the individual versus the right of the

community

` respect for the human life versus beneficence (duty to

alleviate the suffering)



The Belmont Report (1979)

` Beauchamp and Childress ³Principles of

Biomedical Ethics´ (1979)

The Oviedo Convention on Human Rights &Biomedicine (1997)

UNESCO Universal Declaration on Bioethics and

Human Rights (2005)



` The globalisation of medical resarch: the need to

capture universal values and formulate universal

principles (global bioethics)

` The emerging reality of the diversity of moralcultures: the need to respect plurality and ethical

diversity (Asian, American, European bioethics)



Tom Beauchamp andJames Childress (1979)

autonomy beneficence,

non-maleficence

justice

Peter Kemp, a.o

Barcelona Declaration

(2000)

autonomy

dignity

integrity

vulnerability



` The disagreement is often not the result of theuptake of different values but of differentinterpretation or prioritization of values.

` Moral values depend on our self-understanding,conception of good life, which depend onhistorical and economic situation, culturaltradition, and religious convictions.



Is there a need for changing ethical frameworks?

` From individual liberal ethics towards

communitarian approach

` individual rights versus the common good?

` Individual interests versus public interest?



Report ³Personal data for public good: using health

information in medical research´:

` Overemphasis on privacy and autonomy, including an

insistence on the need for explicit consent even though this

may be impractical or undesirable for other reasons.` The Academy invoked the ³public interest´ argument,

suggesting that inhibiting the use of medical records for

research is unethical because lives which could otherwise

have been saved by epidemiological research were being

lost.



` Instrumental reasons:

- epidemiological research is more difficult since without

a subject¶s informed consent it is impossible to gather

statistical data

- restrictions requiring new informed consent on the re-

use of biological samples and data severely limit

research;

` Substantial reasons: genetic information is by

nature shared among others thus raising doubts about

the traditional applicability of concepts like ownership

and privacy .



` No need to see individual-interest based and

collective-interest based ethical frameworks in

opposition. This is not an either/or issue. An

appropriate balance between the individual andpublic interests should be maintained.

` Values we care about are plural and contextual.

` There is no one overriding value, yet values are

objective and not relative.` Ranking of values only reasonable in particular

settings.

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