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Political sea changes and bioethics - Prague 1991.

The Hastings Center's three bioethics conferences in Eastern and Central Europe have been increasingly dramatic. We first met in July 1989 in Pecs, Hungary. Twenty-five colleagues gathered to plan our new international work and to introduce ourselves to health care realities and bioethical issues in the then "Eastern bloc." We heard about the "tipping" of Hungarian doctors, the "disappearance" of public funds earmarked for health care, and patients' mistrust, in Russia and elsewhere, of their health care providers. Yet many Eastern European colleagues, especially the young, were reluctant to speak frankly and openly, no doubt fearing recriminations. Despite glasnost and perestroika no one had an inkling of the enromous political, liberating events that would begin in Eastern Europe a few weeks hence. We were merely trying to build a community of the few isolated and embattled bioethicists working in the several Eastern bloc countries.

By August 1990 when we met in Dubrovnik, Yugoslavia, democratic movements had swept over many Eastern European countries. We had now grown to over fifty conference participants. The mood was of elation and newly found freedoms, mixed with anxiety over what might come, including social chaos and new cultural oppressions. Whatever the apprehensions, a young Czech Minister of Health boldly told us to get things straight: there is not and never was an "Eastern Europe." Czechoslovakia in particular had its roots in Western Europe and the Austro-Hungarian Empire. The "Eastern past" was over and done with.

By late August of this year as nearly 100 of us met in Prague, Czechoslovakia, in the wake of the abortive Soviet coup, the future--both the new freedoms and the new chaotic events--had begun to materialize. Despite our fears and against our expectations, two colleagues arrived from post-coup Moscow. One had been among the defenders of "the Russian White House" (Parliament Building), having returned to Moscow deeply depressed by the news of the coup only to be "respirited" by the people who spontaneously took their stand with Boris Yeltsin. Yugoslavian colleagues from Zagreb arrived to tell about the tragedy taking place in Croatia and about their unsuccessful efforts to marshal international humanitarian and medical aid for the victims of the ongoing violence. The Czechoslovakian Minister of Health, chastened by a year in office, informed us of the stark fiscal and political realities facing the Czech health care system. During an impromptu public dialogue, he enlisted our support in making bioethics an integral part of his efforts to overhaul and humanize the Czech health care system.

The mood in Prague was marked not by airy, youthful freedom, but rather by muted anger and sober realism, despite the relief and joy over the failed Soviet coup. To the immediate political events were added reports of the corrosive effect of morally degraded and bankrupt societies.

Indeed, the one theme underlying the separately convened environmental and bioethics meetings was the systemic moral and cultural havoc wrought by forty-plus years of Communist hegemony. Bulgarians and Czechs spoke about systematic disregard of environmental and plublic health concerns and the withholding and misuse of vital information in service of heavy industrialization. They spoke of bureaucratic obfuscation, in which no one was held accountable and all went unpunished for "crimes" against the human community and nature. Others emphasized the moral annihilation of individual citizens, and the undermining of moral responsibility and individual action. For the sake of the Communist state, individual human beings have been rendered passive and apathetic, awaiting moral, political, and economic initiatives from "above."

For example, the Bulgarian and Czech participants reported that their countrymen have been estranged from traditional relations to both nature and political processes. Overcome by pessimism, they are presently incapable of adequately understanding and fighting for the health and integrity of their bodies, spirits, and environment. A democratic political, social, and personal regeneration is required. But they and other Eastern and Central Europeans have yet fully to comprehend the cultural and political forces that have undercut moral initiative and individual responsibility and destroyed ture human community. As further examples, there were reports that the elderly, the handicapped, and the dying are threatened with isolation and abandonment by various communities, whether family, health care, or the larger society. These are among the communally "dismembered," who suffer a secular excommunication.

Amidst the moral, cultural, and political horrors there sounded several bright and important notes. In the face of ethical and public policy dilemmas arising from economic development, promotion of public health, and protection of the environment, there was a call for an "ethics of responsibility" and a concern that democratic values and institutions survive the challenge of local and impending global crises.

There was also decided attention and concern given to th "bioethically neglected": the chronically ill, the irreversibly dying, and desperately sick children and their families. Health care providers in Prague and elsewhere are beginning to redress the human needs of these patients and their families. Physicians and bioethicists geniunely struggle with the moral pluses and minuses of telling terminally ill cancer patients their prognosis. They consider seriously the relation of bioethical principles and imperatives to traditional moral communities, with their plurality of visions of the humanly and morally good life. For example, do and should patient autonomy, informed consent, and truth-telling have the same moral valence in Polish, Bulgarian, Romanian, and Russian medicine as they do in American health care? Should bioethics be "regional" rather than "universal," tapping the strengths of particular moral traditions?

Out of such discussions can come a reinvigoration of old conceptions and values: individual and communal responsibility; the individual and communal significance of genuinely democratic processes, of education, and of the mutual tolerance required of those with different moral visions; the centrality of respect for persons, trust, compassion, and empathy. These are vital lessons for the West as well as the East, but they have an immediate, urgent significant for those who must systematically reconstitute, regenerate, or resurrect their communities.

Strachan Donnelley is director of education and associate for environmental ethics, The Hastings Center.
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Title Annotation:bioethics conference in August, 1991, in Czechoslovakia
Author:Donnelley, Strachan
Publication:The Hastings Center Report
Date:Nov 1, 1991
Words:997
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