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Hastings on the Adriatic.

Hastings on the Adriatic

In early September 1990, The Hastings center held its second bioethics conference in Eastern Europe. Last summer we met in Pecs, Hungary. This year we convened at the Inter-University Centre in Dubrovnik, Yugoslavia, close by the walls of the old city that predates the Crusades.

Last year's Pecs conference was dramatic enough. That was our initial contact with several Eastern European colleagues fighting lonely battles to promote bioethical concerns in their home countries. This often meant directly taking on huge and hostile bureaucracies, both medical and political. Our intention was to help establish and support a genuine bioethics community in Eastern Europe, so as to strengthen the individual efforts of these Hungarians, Poles, Czechoslovaks, Bulgarians, Yugoslavs, East Germans, and Soviets. But all this was before the stunning events that have taken place in Eastern Europe and the Soviet Union since last fall.

The current political, social, and economic sea-changes were very much evident during the Dubrovnik conference. Sixty bioethicist participated, including representatives from the United States, Great Britain, Holland, Norway, Denmark, Switzerland, Bulgaria, Czechoslovakia, East Germany, Hungary, Poland, Yugoslavia, the Soviet Union, and Lithuania. Among the Eastern Europeans, there was a sense of euphoria over newly found freedoms, tempered by apprehension, and sometimes pessimism, over social, political, and economic dislocations or inertia. A proud young Czechoslovak Minister of Health admonished us to drive the term "Eastern Europe" from our minds. Czechoslovakia's cultural roots were in the Austro-Hungarian Empire, not further east. (Should we change the title of our conference from "East-West Bioethics 1990" to "Bioethics Here and There"?) Others from the old Eastern bloc did not want to forget the recent communist or socialist past, so to highlight needed reforms. The latter good-naturedly talked about "Eastern Europe and Czechoslovakia."

The conference spanned four days and was organized around substantive bioethical issues. The topics of the sessions included the following: the history and foundations of bioethics; the doctor-patient relationship; genetic screening, imperiled newborns, and abortion; reproductive technologies; animal research and environmental ethics; the AIDs epidemic; and end of life and termination of treatment decisions. Each session had speakers from North America, Western Europe, and Eastern Europe (and Czechoslovakia), with time left open for participant discussion. This permitted truly cross-cultural bioethical explorations.

While there was a genuine good-will and openness among the participants, whatever their political and national differences, certain substantive tensions surfaced recurrently during the several sessions. The first of these themes concerned the very goals of bioethics. Shoujld it be a theoretical venture dedicated to pursuing its elusive foundations and elucidating the moral experiences of patients and providers? Or should bioethics be predominantly practical and reformist in nature, responding to obvious inequities or injustices that require little ethical sophistication? The participants often pitted philosophy against politics, theory against action, intellectual exploration against moral rules and regulations. These are old themes, and bioethics no doubt needs judiciously to balance the concerns of both camps.

The differences in cultural and political contexts and what they mean for the ethical reform of health care systems is a closely related matter. The United States has its economic entrepreneurism, its dominantly individualistic ethics, and its protective legal interventions is health care practice. Western Europe has its welfare states and its more communitarian ethical concerns. Eastern Europe has had its socialist and communist economies and moral norms. Some countries are better prepared politically and culturally to deal with concerns for individual patients and their families, democratic openness and processes, and moral/cultural pluralism. Others are better able to cope with social inequities and injustices. Still others seem presently ill-equipped to deal with either social justice or concerns of individuals because of political systems built on arbitrary power and legal processes for which the public has little respect or trust.

Problems of social and individual injustices, allocation of scarce resources, and newly emerging environmental/ecological problems plague all countries, east and west. The latter was particularly driven home by a sobering report on mthe environmental pollution and ecological disaster confronting Bulgaria.

Despite these genuinely weighty and global matters, the conference had its decidedly human and local moments. These included a convention hotel that followed entrepreneurial mandates and scattered our conference participants all over Dubrovnik in favor of serving more lucrative Yugotours. A final conference dinner held in an openair restaurant overlooking the stoney-beached Adriatic was a happier moment. With waves lapping in the background, good times and good wine moved the Bulgarians to sing a "sad, national song." This spontaneously sparked songs from other countries represented at the conference, including improvised renditions of "Home on the Range" and "Amazing Grace" by the U.S. contingent. The evening ended with a Yugoslav, a Soviet, a Bulgarian, an American, and a Hungarian sitting around drinking brandy and smoking cigarettes, kidding each other about their "quasi-bioethical" prowess, laughing themselves to tears. This was not quite Plato's Symposium, but it was an extraordinary moment, a sign of the changing times. The Hastings Center is achieving its taks. We are helping to create a genuine community of Eastern Europe bioethicists and Western colleagues.
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Title Annotation:Hastings Center bioethics conference in Eastern Europe
Author:Donnelley, Strachan
Publication:The Hastings Center Report
Date:Nov 1, 1990
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