Old World News: Knowledge Comes but Wisdom Lingers

Abstract

For fifteen years no national ethics committee has matched the quality and value of the work of the U.S. President's Commission. Its analyses and guidance remain some of the most useful in bioethics. The need to continue to produce such work is widely recognized. In Europe various countries have set up various types of committee, but none has yet had the same impact. The closest is probably the French national committee, which has produced nearly forty guidance notes (Avis) in the last decade. Within France they have had a considerable impact and, in some cases, have led to changes in the law. But any wider influence that the committee might have is prevented by the French language law, which requires that all official documents only be published in French. There are other national committees--in Denmark and Italy, for instance. The Danish Council of Ethics has taken the need for public consultation very seriously and reaches a large portion of the Danish population, particularly school children. But the council's analyses of ethical dilemmas have not so far attracted much attention outside the country. Those of the Italian committee have had even less influence, probably because the government appointed so many committee members to represent every possible sectarian interest that the committee cannot function. The need for a committee in the United Kingdom--indeed for two committees, one for medical ethics generally, and one for medical research ethics--has long been recognized. The creation of either has, however, been effectively stymied by the medical officers at the Department of Health who advise ministers. For some curious reason--perhaps because they think it helps to keep discussion of medical ethics centered within the medical profession--they have ensured for two decades that British governments do the least possible about medical ethics dilemmas. Research ethics committees (the U.K. equivalent of IRBs), for instance, struggle to function because the Department of Health refuses to mandate any support for them, either funding or training. On average they review eighty research proposals each year, yet some have to do so without any budget. Other bioethics issues are dealt with in an ad hoc fashion, as late in the day as possible. Bob Edwards, the driving force behind the development of in vitro fertilization, asked for consideration of the law and ethics of assisted reproduction as early as 1969. Yet the Human Fertilization and Embryology Act only came into force in 1990, twelve years after the first test tube baby was born. This September afforded another splendid example of last-minute ad hockery. …