 |
Previous letter |  |
Bioethics information and analysis newsletter - August 2009 - N°116
Report of the Estates General on bioethics
The Estates General on bioethics finished on 23rd
June 2009. The government wanted that this public debate promotes "the
educated and informed thinking of most people on questions which commit our
common future" in prevision of the revision of bioethics laws in 2010. Three
public forums, in Marseille, Rennes and Strasbourg, put an end of these six
month collective dialogue. During each of them, a panel of citizens trained
during two weekends, could interviewed an expert committee before drawing a
report publishing their opinions relative to the questions which were submitted.
A Website was also made, offering the possibility to all who wanted it to talk
about different debated subjects. Here we present you the main conclusions of
the Estates General.
Research on embryo, PD/PGD
During the forum in Marseille, the issues of
research on the embryo, preimplantation diagnosis and prenatal diagnosis have
been debated. The panel of citizens has estimated in its final opinion that “the
embryo should only have a status of future people only from the moment when it
will be part of a parental project.” The research on embryo thus should be
subject to a double regimen: the prohibition of any research on the embryo with
a parental project and the authorisation under conditions for the supernumerary
embryos. Also the panel recommended that the retention period of supernumerary
embryos is reduced from 5 years to 1 year, at the end of which they should be
destroyed.
The 2004 bioethics law prohibits in principle the research on supernumerary
embryo, without parental project, but allows a derogation for five years under
two conditions: the requirement of a major therapeutic advance and the absence
of alternative method of comparable effectiveness. The main challenge of the
revision of the bioethics law is thus based on this prohibition with derogations:
should we maintain it with or without derogations or abolish it? To answer
prudently it is necessary to know the results obtained with the embryonic cells
and the alternatives; however we must note the citizens in their opinion
regretted to have been scarcely informed about researches conducted on adult
stem cells and iPS cells which constitute such alternatives. Then we will not be
surprised to know that they pronounced in favour of the authorisation of
research on the embryo while hoping that “none [research] is privileged at
the cost of others”.
Regarding the preimplantation diagnosis (PGD) and the prenatal diagnosis (PD),
if they were worried about a lack of solidarity, and deplored “the deficit of
information given to the future mother about the mandatory or non-mandatory
character of different prenatal examinations”, nonetheless they wanted that
PGD centres are more numerous. For them, we have to consider PGD and PD as “an
individual rectification” and “not as a tool of collective selection”,
“the solution to the handicap passing exclusively by the research on the
diseases and not by the elimination”.
Medically assisted procreation
In Rennes, the debate was based on a
possible extension of the medically assisted procreation. The panel estimated
that "the love that exists within a couple justifies, whatever the nature of
this couple (heterosexual or homosexual), the right for this couple to be parent".
For all that, the MAP should not be permitted to homosexual couples, or to
single women in the name of the non discrimination men-women. Indeed MAP for
homosexual (men) couples would need to resort to surrogate motherhood,
unanimously refused by the members of the panel because it would not be "respectable
that a woman could bear a child who does not come from her own parental project".
Moreover, the panel thought it was essential that “the medically assisted
procreation is still reserved to cases of medical infertility”. On the other
hand, it was in favour of the adoption for homosexual couples. It showed that it
was attached to the principle of gratuity of gamete donation, and to the
principle of anonymity, even if it wishes for this one to have “relaxed
modalities”.
Organ donation, predictive medicine
The panel of Strasbourg should come to a
decision on organ donation and predictive medicine. It challenges the regimen,
currently in force in France, of the presumed consent in matter of organ
donation from dead donors. Indeed it considered that a solidarity support has to
be subject to an assumed and thus voluntary choice. It recommended to establish
a register of the “yes” and the expansion of the circle of living donors.
It stated to be in favour of the development of “communication campaigns”
which are for “information and not for promotion” Finally, regarding
predictive medicine, it was worried about the usage of predictive tests,
favoured by over-the-counter Internet sales.
Free and …. useless contributions ?
The articles posted on the official Website
of the Estates General represented a massive alert on the growing eugenics of a
society which substitutes the technique to humanism. They were not worried about
scientific advances that they greatly acclaimed, but about the lack of
solidarity to the weakest people, dehumanisation of medical practices, extension
of practices of prenatal and preimplantation diagnosis and researches on embryo.
These opinions did not seem to satisfy the general rapporteur of the Estates
General, Alain Graf, who, as a conclusion, wrote about them: "these few
analysis elements show that it is advisable, at least, to consider cautiously
the opinions expressed on the site"…
The human and the person - F.- X. Putallaz and B. N. Schumacher
Common borders
The history of peoples teaches us that the stability of a society is based in
part on its capacity to establish the borders on the good places, borders
capable to accompany by their stability the flows which model the culture and
the people and without which the societies would be paralyzed. Ignoring these
facts should result in huge numbers of conflicts by creating turbulence areas
which do not profit to anyone.
These considerations are also checkable in political matter. The acceleration of
the technique in particular in scientific and medical fields – debates on
termination of pregnancy, medically assisted procreation, research on embryo,
transplantations, end of life, rationing of care, etc. – obliges to make
“informed” decisions. Our post-modern societies which rejected any reference to
the transcendent, the research of permanent borders remains (becomes?) an
emergency to resist the temptation to contrast sharply in the instant, with an
emotion wave or to rely on partial expert opinions. The creation of ethic
committees is an attempt to research a founding thinking, however these
committees, which reflect the various ideologies of a society, cannot not
pretend telling the truth but they only give a consensual opinion.
The book we introduce you today intends to approach these permanent borders, in
order the great majority of actors and decision makers can recognise them,
beyond the economic divergences. This is the ambition of this book, fruit of a
two-year work conducted by twenty European university famous persons (physicians,
biologists, philosophers, etc) under the direction of François Xavier Putallaz
and Bernard Schumacher, both being privat docent and research and teaching
associates in philosophy at the University of Fribourg. In a great movement the
book presents today’s controversies (first part), explores the philosophical
foundations received as an inheritance for centuries and without the studies of
them it would be difficult to have a fair vision of current controversies
(second part) and finally proposes some landmarks for a prospective study (third
part).
Human dignity
We have to recognize the obvious: any
ethical option relies on a conception from the man and the desire shown during
the debates on bioethics to protect the human dignity refers us to the difficult
task to recognise the meaning of this term and to provide an explanation.
Several chapters of the book are thus dedicated to this study and deal in
biomedical matter with the experimentation and the end of life. In the study
about the experimentation on the human being, the philosopher
Jean-François Mattéi notes a reversal of the relations of medicine to human
body: "this is no more the natural health of the body that constitutes the
end of the medicine; on the contrary it is the technical development of the
medicine which becomes little by little the end of the body health", "this
reversal became possible by the reduction from the person to the subject, from
the subject to the body and from the body to the product". If the status of
the human body disturbs the jurists it is because it indicates a humanity which
does not limit to the corporeity. "Should we, even with its consent, develop
new types of research dedicated to modify its humanity and to produce a new type
of being, at the border of human and non-human, that we call cyborg or superman?"
the negative answer to this question relies on a metaphysical presupposition,
not the one of the soul or of the spirit but on this of freedom, because where
the matter is recognised as determined the spirit considers as free. The
philosopher Jacques Ricot dealing with the dignity of the dying person
mentions the "three semantic spheres of the dignity": the dignity-decency,
which refers to an attribute of the person who, subjective, can deteriorate, the
dignity–freedom in the meaning that to decide the time of one’s death
would be the manifestation of his dignity, and finally the ontological
dignity, as "absolute value of the human being, deriving from the single
fact that he is a man". Finally the analysis from Professor Robert
Spaemann, "il n’y a pas de bonne façon de tuer" (there is no good way
to kill), shows that the trends which found the demand to recognise euthanasia
and suicide, illustrated by Peter Singer. He particularly mentions the link
between euthanasia and demography – link particularly more efficient given the
fact that it remains hidden – and between euthanasia and research of pleasure,
research excluding any form of pain. Yet, talking about the value of a life (is
this life worth living?”) "supposes previously the life as condition" and
to avoid it is a prelude to thousands of crimes. Finally the article by Bernard
Schumacher on the definition of the human death is fundamental to discuss the
question of organ retrieval by focusing the debate on death criteria.
The person
If the notion of person is yet in the centre
of these thoughts, some chapters treat it more directly without depriving the
reader from a fascinating tangent in the history of the philosophy from Saint
Augustin to Peter Singer, with Saint Thomas Aquinas, Hobbes or Kant. This is the
case of the articles now we are going to introduce, inviting the authors to
excuse us to mention so rapidly ideas where each chapter deserves a deep reading.
Gunter Rager and FX Putallaz explore the links between dignity,
individual and person or individuality and existence, Laurence Renault,
Georges Cottier, Berthold Wald relate the appearance of the Self through
Duns Scot, Descartes and Locke and the articulation of the Self to the person,
Theo Kobush shows the appearance of the notion of freedom in the modern
philosophy which comes from the medieval philosophy. Finally the thoughts of
prospective at the end of the book, particularly the article by Pascal Ide on
the border between the man and the animal (enjoying the one and the other a
significant corporeal otherness), those by Philippe Cormier and Jean
Claude Wolf on the border between the persons – otherness and
intersubjectivity – do the persons are replaceable?- and those on the
phenomenology and the otherness man/woman, by Roberta de Monticelli and
Hanna Barbara Gerl-Falkovitz, will give the reader a necessary hindsight
to measure the quality of contemporaneous ethical debates and the efficient
tools to establish common borders to all of us.
1- L’humain et la personne, sous la direction de
François-Xavier Putallaz et Bernard N. Schumacher, Ed. Cerf, avril 2009.
©
Monthly newsletter, distributed free of charge, published by the
Jérôme Lejeune Fondation.
37 rue des Volontaires - 75 725 Paris cedex 15 -
www.genethique.org
Director of the publication : Jean-Marie Le Méné - Editor in chief : Aude
Dugast
Contact : contact@genethique.org -
+33 (0)1 44 49 73 39
- ISSN 1638-198 X