Ten years ago bioethics, a new branch of science that embraces biology, medicine, hygiene, ethics, and philosophy, was confirmed on a national level thanks to the initiative of the presidium of Ukraine’s National Academy of Sciences (NAN) and its president, Academician Borys Paton. The Bioethics Committee, established at the NAN, has undertaken the role of organizer and coordinator with the goal of raising the committee to the level of an international association on bioethics. This was the time when international organizations, such as UNESCO, the World Health Organization, and the Council of Europe, named bioethics as one of the priority directions of development. Thus, Ukraine could not stand apart from world trends, and in the last decade Ukrainian scientists have accomplished much. Today bioethics occupies its rightful place in the activities of medical and biological institutions, and this subject is being taught in faculties of biology, medical schools, and even secondary schools.
However, many issues remain unresolved, e.g., disease prevention, vaccination, and the increasing application of assisted reproductive technology, which are drawing mixed reactions.
The issues that scientists are examining today, such as the relationship between people and bioethics, the role of this branch of science in ecology, philosophy, and technological progress, are raised in The Day’s interview with Yurii KUNDIIEV, M.D., member of the National Academy of Sciences of Ukraine and the Academy of Medical Sciences of Ukraine, and the director of the Kyiv-based Institute of Work-Related Medicine.
Dr. Kundiiev, few people in our society understand what bioethics is, when it emerged, who founded it, and what role it plays in every person’s life.
“In its broadest sense, bioethics is respect for human life in its every manifestation, understanding life as the highest and most precious gift. Bioethics is called upon to resolve ethical questions related to medicine, life sciences, and its related technologies, and takes into consideration social, legal, and ecological aspects. People are often surprised why attention is being focused on bioethics. The fact is that bioethics embraces nearly every sphere of people’s lives. It was founded by the distinguished American scholar and prominent oncologist Dr. Van Rensselaer Potter, who published Bioethics: Bridge to the Future in 1971. The book talks about the environment, which is polluted all over the planet and threatens human life and the life of every living creature. Potter’s book also considers the latest achievements in the sphere of ecology, the creation of new medical technologies, the practice of organ transplants, assisted reproductive technology, and the use of embryonic tissue. All this needs to be considered from the standpoint of respect for man’s dignity. It is a vital question in our country these days. Bioethics deals with all these questions.”
What activities can serve as an example of misuse of the newest technologies, violation of people’s ethical rights, and lack of respect for human dignity?
“Let’s take one aspect, the use of embryonic tissue. With the help of embryonic tissue you can heal various defects, particularly disorders of the nervous system. This is wonderful, this is really a great achievement, but we will thus be turning women into embryo- producing factories. Is this ethical? Religious figures oppose this, and the pope has severely condemned this practice. Another important point is that the application of the latest technologies is absolutely inadmissible without a thorough study of far-reaching consequences: how it may end for a person, his/her descendants, and all future generations. Another example is clinical trials of new drugs. UNESCO’s general declaration on bioethics and human rights, adopted in October 2005, provides for maximum benefits to patients or participants of any research from the development and application of scientific knowledge, and the complete nullification of harmful effects.
“In the last 10 years more than 2,200 clinical trials were conducted in Ukraine. This is much more than in any European country. Why? Because it is cheap in Ukraine. In the US, for example, personal insurance in such cases is 1.5 million dollars and in Ukraine - 7,500 hryvnias, i.e., 1,000 times less! Let’s recall the thalidomide tragedy, when German scientists synthesized this drug in order to reduce signs of toxicosis during pregnancy. Children without limbs began to be born, although research had been done earlier on animals and there were no negative results. There are also discussions of interference in the human genome. This is extremely dangerous. Even a simple change in the genome can sometimes cause serious diseases.”
What should be done to optimize life in our society with the help of bioethics?
“The question of assisted reproductive technology, which helps women overcome a number of obstacles to getting pregnant, is very vital for Ukraine. It can be applied because of reasons other than a woman’s barrenness: when there is a risk of a child inheriting genetic anomalies or a threat of viral disease transmission (e.g., AIDS). Assisted reproductive technology enables a single woman to bear a baby. A number of ethical and social questions arise in connection with this. Nearly 4,500 Ukrainian children have been born thanks to this technology. Next is the question of organ and tissue transplants. Although bioethical standards are built into most international and legal acts in the sphere of health, particularly the International Code of Medical Ethics (1949), Convention on Human Rights and Biomedicine (1997) etc., cases of organ trade are often reported. This method of earning money is reaching an international scale. This proves once again that you cannot solve the problem by legal methods alone. There is a need for activity aimed at changing social opinion and searching for safe orientation points.”
What measures should the state adopt?
“Bioethics is gradually developing in our state. The 3rd Congress on Bioethics, which took place recently in Kyiv, is proof of this. This is a sort of state-conducted measure aimed at supporting this branch of study. Our state has to support the declaration and adopt a national document based on it. At the same time, one has to understand that changes which are taking place have an impact on life on earth. Urgent measures must be adopted on the international, national, and regional levels. Among them is the General Declaration on Bioethics and Human Rights, adopted by UNESCO in October 2005. In addition, products and foods must be marked so that people who want to buy a kilogram of carrots, say, can read a special insert containing information on where these carrots were grown and which pesticides and chemicals were used. This will mean culture and respect for people.”
What is the potential danger for an average citizen’s health from the point of view of bioethics as a science?
“A pharmaceutical market with its characteristic market relations is being formed in our state today. But a medico-social orientation should prevail in this market. When there is a lack of it, this market turns into sheer business, where fantastic sums are earned from people’s sufferings. Since cardiovascular disease is the number-one killer in Ukraine, drugs used for treating and preventing this type of disease should be the number-one focus in trade. But aggressive promotion intrudes into this process. The top-selling drugs are those that are foisted on patients through advertising. This is why drug advertisements are banned in most countries. The same situation should exist in our country. There are many cases when people treat themselves and end up poisoning themselves with drugs. This question should in no way be ignored by the state.”
What should be emphasized in considering bioethics from the viewpoint of the country’s ecological state? What are the philosophical underpinnings of bioethics?
“I would reply to this in the words of the UN General Assembly: ‘Any economic activity is worthwhile only when it is not harmful to human health.’ This is the key thesis. Coal-mining and metallurgical companies earn good profits, but what impact do they have on the country’s ecology and people’s health? As for philosophical importance, bioethics has a thousand-year-old history: its roots go back to Hippocrates. The main emphasis is that human dignity and individuality should be protected. Everyone should be certain that his/her rights and freedoms are respected.”
