Frequently, a technological advance in science leads to new ethical, moral and political challenges for society. Its implementation may lead to important cultural changes, not always in agreement with the established order and requiring a response by Law. Once the new policies have been enforced, however, new ethical problems arise which require new laws, always within the limit that cannot be overstepped: human rights.
The existence of many different individual sensitivities makes consensus impossible on such ticklish issues as embryo research or blood transfusions in Jehovah’s Witnesses. Accordingly, a new discipline born in the last quarter of the 20th century –bioethics– attempts to provide more or less objective answers to hardly agreeable issues.
The Bioethics and Law Observatory of the University of Barcelonahas been prompting initiatives to contribute to a greater knowledge of these issues by society. Indeed, only a fully informed society may make truly democratic decisions. In this sense, the last initiative has been a summer course on Bioethics today: unresolved questions, in collaboration with the Esteve Foundation, held on 10-14 July 2006 at the University of Barcelona and raising the following issues:
1. Sexual and reproductive health in adolescence
Maria Casado, director of the Bioethics and Law Observatory of the Parc Científic of Barcelona, discussed some of the conflicts involved in minor-related sexual relationships, such as accessing prevention methods or emergency contraception like the morning-after pill, whether or not doctors have a duty to inform the parents, or the adolescent’s autonomy to decide upon questions like pregnancy interruption. Contradictory policies –like having condom vending machines available in high schools and failing to provide suitable information both at school and at home– seem to be the main issues at stake.
2. Patient’s autonomy: the Advance Directive
Albert Royes, secretary of the Bioethics and Law Observatory of the Parc Científic of Barcelona, developed some of our inherent rights when we become patients. These basic rights include receiving honest and true information on our health condition, making decisions on it if we are able to, giving or not giving our informed consent, rejecting any medical action, and making anticipated decisions. In connection with the latter, the Advance Directive is presented as one of the greatest advances in favor of the patient’s autonomy. However, while this right has been enforced by law in some communities, not less polemical ones –euthanasia and medically assisted suicide– are still pending.
3. Ethical aspects and international agreements on stem cell research
Josep Santaló, professor at the Cell Biology, Physiology and Immunology Department of the Autonomous University of Barcelona, clarified some of the most important concepts of one of the most outstanding scientific topics today. The definition of stem cells, their properties, their different types and the pros and cons of each were explained. Among the three different types of stem cells (adult, fetal and embryonic), the latter are most controversial because they require using preimplanted embryos. The different conceptions on what an embryo is and when human life begins cast doubt on a type of experimentation which, on the other hand, is altogether complicated and promising.
4. Biomedical research and clinical trials
Florencia Luna, the Argentinian president of the International Association of Bioethics (IAB), reviewed the history of ethics and research in humans, starting from the times when ethics were not a part of research (e.g. the methods and experiments committed by the Nazis during World War II) until the creation of international ethical regulations of biomedical research in human subjects, such as the Declaration of Helsinki in 1964. However important these regulations may be, they are to be improved in issues like placebo use, conflicts of interests, or moral obligations of laboratories upon the completion of certain investigations.
5. Blood transfusion refusal by Jehovah’s Witnesses
Pilar Antón, senior professor of Ethics and Healthcare Law at the University of Barcelona School of Nursing, provided a good example of conflict between religion and health: the issue of blood transfusions in Jehovah’s Witness patients. The faithful’s belief that this issue concerns God’s decision faces the healthcare system with a dilemma, particularly when refusing blood transfusion is life-threatening. Despite the existence of substitution or alternative treatments which do not interrupt blood flow, these involve increased costs and risks that many healthcare providers are unwilling to take.
6. Embryo and embryonic stem cell research
Javier Sádaba, professor of Ethics and Philosophy of Religion at the Autonomous University of Madrid, offered a philosophical approach of the topic developed by Josep Santaló. Sádaba emphasized the value of the embryo and the conception of life as a major source of conflict, pointing out that becoming a newborn child is only one among the possibilities an embryo has before its implantation in the uterus. His opinion was that the reluctance to scientific topics such as therapeutic cloning should be overcome. In this sense, Sádaba denounced the lack of information, both among citizens (ethical and philosophical aspects) and in the scientific and academic communities (scientific issues in the humanistic scope).
7. Oocyte donation
Lidia Buisán, head of the Anesthesia and Pain Unit of the General Hospital of L’Hospitalet de Llobregat, is a doctor and a lawyer who explained the risks related to oocyte donation in women –these risks not always being properly explained to donors. The ovarian stimulation used to obtain oocytes involves using hormonal methods that have side effects and shorten the woman’s reproductive life. The required anesthesia and abdominal puncture are not without hazards. The donor will be at risk of multiple pregnancy if she does not take precautions during ovarian stimulation. Accordingly, it is key that all related information should be provided before performing oocyte donation.
8. Ethical, social and juridical issues on assisted reproduction techniques and sex selection
Ana Sánchez-Urrutia, associate professor of Constitutional Law at the University of Barcelona, explained the different assisted reproduction techniques available (artificial insemination, in vitro fertilization or Gamete Intrafallopian Transfer) and the current law in our country. Not surprisingly, the possibility of previously selecting the newborn’s sex was the most ticklish issue of her submission. Today, this is a punishable offense unless it is done for therapeutic purposes. While many defend the revocation of this prohibition, just as many see this possibility as the beginning of a ‘babies à la carte’ system.
9. Human dignity, human rights and constitutional rights
María Luisa Marín, associate professor of Philosophy of Law at the Universidad Complutense of Madrid, went through national and international jurisprudence to ascertain the meaning of human dignity –the ultimate boundary that no biotechnological advance may cross. This, however, is a diffuse term that law books do not define explicitly. Despite its subjective component, human dignity is actually present, one way or the other, in documents such as the Universal Declaration of Human Rights, or in laws like the German constitution. In Spanish law, human dignity plays a function that legitimates political order, which promotes the inherent rights of each person and is interpretative –given that all our regulations should be interpreted according to this precept.
10. Women and science
Maria Jesús Buxó, professor of Cultural Anthropology, brought the sessions to a close reflecting on the flagrant discrimination against women in the scientific community, where they are poorly considered in the experimentation field and their presence in scientific and academic boards is even scarcer (see document Women and Science, published in collaboration with the Esteve Foundation). This greatly unbalanced situation makes gender equality policies such as parity –controversial as it may be– indispensable to provide symmetrical opportunities.