Prof. Margit SutropDirector 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

The use of terms Morality is the embodiment of norms and

values which have been collectively acknowledged as binding. Morality refers to historically emerged practices of people and cultures.

Ethics refers to the whole domain of morality and to the theoretical reflection on moral values, norms and principles.

Theoretical ethics

Normative ethics (justification of norms)

Metaethics (language of morals, nature of value judgements)

Practical ethics

Applied ethics ( moral issues of different fields of life)

Professional ethics (values, obligations codified 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 are problem-oriented)

Philosophers not ministries leading the discussions

Training in ethics for all professions required

Fundamental changes in society (values under change, growing individual choices)

Urbanization, huge citiesGlobalizationSecularization of Western societiesDiversity of religionsGrowth of individual autonomyPeople are more aware of their rights and

less about their duties and responsibilities

Ethics in science

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 deals with ethical issues in biomedical research

Research ethics

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 a key 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 “Good scientific practice in research and scholarship”, 2000

Advances in science and technology create new ethical issues of research. From the question “what we can do?” to the question “what 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 should rule the world technologically, we must step outside science.

Continously pivoted, disputed

concepts & issues concept of human dignity the concept of personhood: when does human life

begin? the moral status of the human embryo

(abortion, stem cell research) the right of the individual versus the right of the

community respect for the human life versus beneficence

(duty to alleviate the suffering)

Attempts to formulate universal principlesThe Belmont Report (1979) Beauchamp and Childress “Principles 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 moral cultures: the need to respect plurality and ethical diversity (Asian, American, European bioethics)

American versus European principles of bioethicsTom Beauchamp and

James 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 the uptake of different values but of different interpretation or prioritization of values.

Moral values depend on our self-understanding, conception of good life, which depend on historical and economic situation, cultural tradition, 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?

Individualist framework in medical ethics Medical ethics, and more recently bioethics, have

been guided by values of liberal individualism. Values of autonomy and privacy introduced

later than beneficence and non-maleficence Principle of informed consent codified after

World War II to denounce the practices of Nazi medicine (Nuremberg code etc)

The Academy of Medical Sciences report, January 2006

Report “Personal 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 “public 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.

Reasons for re-thinking ethical frameworks 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 .

How to proceed? Arguing for a pluralist approach to values. 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 and public 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.

Thank you for your attention!