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Doing ethics in Italy.

Doing Ethics in Italy

Italy has been the site for a recent flurry of international conferences on bioethics involving Hastings Center staff. Strachan Donnelley, the Center's director of education, participated in a four-day meeting in February 1988 on "Leadership in Bioethics," held at the Rockefeller Foundation's Conference Center, Villa Serbelloni, in Bellagio, Italy. Jointly organized by Edouard Bone of The European Association of Centers of Medical Ethics and Al Jonsen of The Society for Health and Human Values, the conference brought together directors of centers of medical ethics (or their representatives) from Belgium, England, France, Italy, The Netherlands, Spain, Sweden, Switzerland, and the United States.

The goal of the Bellagio conference was to lay the foundation for cooperation on bioethical issues that are international in scope, especially AIDS issues. Participants also discussed establishing a North American Association of Centers of Bioethics, both to coordinate bioethical research and education in North America and to facilitate international cooperation. This would be a precursor to a world association of bioethics centers.

The Bellagio participants began the meeting's substantive work in comparative bioethics by examining informed consent in medical and research settings. Each center reported on its work concerning informed consent, and three cases studies were presented--an involuntary hospitalization in Scotland, a genetic screening research program for Huntington's Chorea in Sweden, and a realimentation study on an elderly nursing home population in Switzerland.

Familiar topics emerged--the relation of law and ethics; questions of competence or capacity for decision-making; the subtle coercion of vulnerable populations, both in research and therapy; patient autonomy and medical paternalism; and the intricate connections between ethics and science, especially in research protocols.

One underlying theme in these discussions was that problems of bio-ethics, including informed consent, are approached differently within different cultural contexts. American Edmund Pellegrino argued that in North America, the tendency is to start with the individual and the ethical principle of respect for persons (autonomy) and then raise questions of decsional competency or capacity with respect to participation in research or decisions about therapeutic interventions. In Europe, Nicole Tery of France contended, the tendency is to begin with the community and to see the individual within a wider social, cultural, and institutional fabric. This places the decision-making emphasis on professional and legal duties and communal resources, rather than on the preferences of individuals.

In April, Susan Wolf, associate for law at the Center, attended a conference in Milan on the relationship of science and ethics sponsored and hosted by the Istituto Scientifico H San Raffaele. Over the course of four days, the participants presented papers on a wide variety of topics. Arno Motulsky and Laurence O'Connell from the United States gave introductory papers on the major themes of the conference. Dietrich Von Engelhardt of West Germany and Jean Francois Malherbe of Belgium then presented papers on man as a biological entity and person and the nature of normalcy and pathology, with discussants from Spaim and Italy.

Evandro Agazzi, from Switzerland and Italy, provided a historical perspective on the relationship of science and ethics, and Joseph Fuchs, also of Italy, a theological perspective. Edgar Morin of France and Edmund Pellegrino of the United States then addressed the responsibilities of the scientist and physician. Finally, Luigi Lombardi Vallauri from Italy examined the development of legal norms, with responses from Wolf as well as Canadian and Italian participants. Interspersed throughout the program were shorter communications on more specific topics. These included presentations by Souzy Dracopoulou of Greece on the value of animal and human life, Nusret Fisek of Turkey on medical responsibility toward the individual and society, and M.A.M. Abul Fadl of Egypt, who addressed Islamic approaches. The conference proceedings are expected to be published.

In May, Hastings Center director Daniel Callahan traveled to Venice for a two-day meeting on bioethics sponsored by the International Balzan Foundation. The Balzan Foundation, based in Switzerland, has in the past awarded major prizes in Europe for scientific achievement. This conference represented its first foray into bioethics.

The conference was divided into four segments, the first taking up the moral responsibility of the scientist. The speakers in this segment included Callahan and Jeremy Rifkin from the United States. Callahan argued that scientists must take moral responsibility for the harms they produce as well as the benefits, and that scientific and medical research, however valuable, is an optional activity--there is no moral obligation to pursue it. Rifkin discussed recombinant DNA technology, arguing that the question of whether to embark on genetic engineering is, together with the nuclear issue, the most important ever to face humanity.

The second portion of the program examined euthanasia. Among the four speakers in this segment was Heleen DuPuis of The Netherlands, strongly advocating active euthanasia. Klaus Demmer of Italy presented a theological perspective. The third topic was reproductive technologies. Peter Singer of Australia spoke on "The Ethics of Embryo Experimentation," Mary Warnock of England on "What Do We Want of the Family?" and Elio Sgreggia of Italy on artificial insemination and the 1987 document from the Congregation for the Doctrine of the Faith. The final segment concerned randomized clinical trials and their fairness to patients. There was considerable emphasis on the consent process, with presenters from England, Italy, and Belgium.

Comparative international bio-ethics is clearly coming of age.

Susan M. Wolf is associate for law, and Strachan Donnelley is director of education, at The Hastings Center.
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Title Annotation:Special Supplement: International Perspectives on Biomedical Ethics
Author:Wolf, Susan M.; Donnelley, Strachan
Publication:The Hastings Center Report
Date:Aug 1, 1988
Previous Article:The Rome bioethics summit.
Next Article:In Greece, lament for the dead, denial for the dying.

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