Political Sea Changes and Bioethics: Prague 1991

Abstract

The Hastings Center's three bioethics conferences in 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 then Eastern bloc. We heard about tipping of Hungarian doctors, disappearance of public funds earmarked for health care, and patients' mistrust, in Russia and elsewhere, of their health care providers. Yet many European colleagues, especially young, were reluctant to speak frankly and openly, no doubt fearing recriminations. Despite glasnost and perestroika no one had an inkling of enromous political, liberating events that would begin in Europe a few weeks hence. We were merely trying to build a community of few isolated and embattled bioethicists working in several bloc countries. By August 1990 when we met in Dubrovnik, Yugoslavia, democratic movements had swept over many 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 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 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 wake of abortive Soviet coup, future--both new freedoms and 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 defenders of the Russian White House (Parliament Building), having returned to Moscow deeply depressed by news of coup only to be respirited by people who spontaneously took their stand with Boris Yeltsin. Yugoslavian colleagues from Zagreb arrived to tell about tragedy taking place in Croatia and about their unsuccessful efforts to marshal international humanitarian and medical aid for victims of ongoing violence. The Czechoslovakian Minister of Health, chastened by a year in office, informed us of stark fiscal and political realities facing 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 Czech health care system. The mood in Prague was marked not by airy, youthful freedom, but rather by muted anger and sober realism, despite relief and joy over failed Soviet coup. To immediate political events were added reports of corrosive effect of morally degraded and bankrupt societies. Indeed, one theme underlying separately convened environmental and bioethics meetings was 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 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 human community and nature. …