Search

UNESCO's Bioethics Programme was established in 1993. In twenty years it has adopted three international declarations, on the human genome (1997), human genetic data (2003) and bioethics (2005); produced reports on a wide range of bioethics issues; and developed capacity building and public education programmes in bioethics. Yet UNESCO has sometimes struggled to assert its authority in the wider bioethics world. Some bioethicists have criticized the 2005 declaration and suggested that the World Health Organization might be better placed to advance bioethics. In 2011, after four years of debate, UNESCO decided not to draft a convention on human reproductive cloning, because consensus on the issue proved impossible. This article reviews the standard setting and capacity building activities of the UNESCO Bioethics Programme. While the Programme faces challenges common to most intergovernmental organizations, its achievements in expanding international law and building bioethics capacity should not be underestimated.

This paper argues that some of the misunderstandings surrounding the meaning and function of the concept of human dignity in bioethics arise from a lack of distinction between two different roles that this notion plays: one as an overarching policy principle, and the other as a moral standard of patient care. While the former is a very general concept which fulfils a foundational and a guiding role of the normative framework governing biomedical issues, the latter reflects a much more concrete and context-specific understanding of the patient as a "person". The importance of dignity as a policy principle will be described by appealing to the distinction between principles and rules as developed by some legal philosophers. The value of dignity as a standard of patient care will be illustrated with the help of concrete examples and by drawing on the taxonomies of dignity proposed by Jonathan Mann and other scholars. The overall scope of the article is to highlight this double and complementary role of human dignity in bioethics.

The Universal Declaration on Bioethics and Human Rights represents a significant milestone in the history of Law, particularly in the application of International Law to an important area of human activity, namely the medical sciences, the life sciences and the technologies which, linked to both, can be applied to human relations. In parallel with this, and as will be analysed in this article, the Declaration has involved adopting a clear position regarding cultural diversity and pluralism in relation to Biomedicine. In this paper the author highlights the fact that perspectives have been opened which have hardly been explored concerning Biomedicine, such as the recognition of the value and respect which cultural diversity (multiculturalism), economic and social diversity deserve in relation to the issues covered by the Declaration, and the acceptance that the owners of the rights are not only individuals, but can also be groups.

The UNESCO Universal Declaration on Bioethics and Human Rights of 2005 purports to articulate universal norms for bioethics. However, this document has met with mixed reviews. Some deny that the elaboration of universal bioethics norms is needed; some deny that UNESCO has the expertise or authority to articulate such norms; some regard the content of the UNESCO document as too vague or general to be useful; and some regard the document as a cog in the effort of like-minded cosmopolitans to codify their particular moral intuitions in international law. This issue examines the potential merits and pitfalls of the Universal Declaration on Bioethics and Human Rights.

The principle of respect for human dignity plays a crucial role in the emerging global norms relating to bioethics, in particular in the UNESCO Universal Declaration on Bioethics and Human Rights. This instrument, which is a legal, not merely an ethical document, can be regarded as an extension of international human rights law into the field of biomedicine. Although the Declaration does not explicitly define human dignity, it would be a mistake to see the emphasis put on this notion as a mere rhetorical strategy. Rather, the appeal to dignity reflects a real concern about the need to promote respect both for the intrinsic worth of human beings and for the integrity of the human species. But dignity alone cannot solve most of the dilemmas posed by biomedical practice. This is why international biolaw combines, on the one hand, the appeal to human dignity as an overarching principle with, on the other hand, the recourse to human rights, which provide an effective and practical way forward for dealing with bioethical issues at a global level.

Until recently, the answer to that question was obvious: from fertilization. The discovery that artificial cellular constructs, by nuclear transfer from adult cells and by other techniques, can produce blastocyst-like structures, which under some conditions may develop into embryos upon uterine implantation, with no fertilization, leads us to consider successful uterine implantation as necessary for the qualification of what is an embryo. This implies replacement of essentialist definitions by evolutionary ones. In addition, the concept of potentiality must not be restricted to genome formation but extended to subsequent epigenetic events in embryonic development.

While UNESCO's Universal Draft Declaration on Bioethics and Human Rights highlights appropriate ethical values, its principles are stated in absolute terms and conflict with one another. The Draft Declaration fails to sufficiently address the possibility of conflict between principles, and it provides no real guidance on how to strike a balance between them in cases where conflict occurs. The document's inadequate treatment of conflicting values is revealed by examination of cases where principles aimed at the promotion of autonomy and liberty conflict with those aimed at benefit maximization and harm minimization. I argue that liberty (and autonomy) may be less important in the context of health care than in other contexts, and I conclude by suggesting specific ways in which some of UNESCO's principles should be revised in order to better address the reality of conflicting values.

This essay focuses on two underlying presumptions that impinge on the effort of UNESCO to engender universal agreement on a set of bioethical norms: the conception of universality that pervades much of the document, and its disregard of structural inequalities that significantly impact health. Drawing on other UN system documents and recent feminist bioethics scholarship, we argue that the formulation of universal principles should not rely solely on shared ethical values, as the draft document affirms, but also on differences in ethical values that obtain across cultures. UNESCO's earlier work on gender mainstreaming illustrates the necessity of thinking from multiple perspectives in generating universal norms. The declaration asserts the 'fundamental equality of all human beings in dignity and rights'(1) and insists that 'the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition'(2) yet it does not explicitly recognize disparities of power and wealth that deny equal dignity and rights to many. Without attention to structural (as opposed to merely accidental) inequities, UNESCO's invocation of rights is so abstract as to be incompatible with its avowed intention.

A number of problems plague universal declarations. To the extent that those drafting and adopting the declaration represent a range of different views, consensus can only be obtained if the declaration makes minimalist claims that all can support, or makes claims that are vague enough that they can be interpreted to everybody's satisfaction. To the extent that a universal declaration avoids these problems, and takes an unequivocal and controversial stand, it does so by privileging the view that is hegemonic (at least among those responsible for the declaration). After discussing these problems I ask whether such declarations could nonetheless do any good.

The latest (June 2005) draft of UNESCO's proposed Universal Declaration on Bioethics and Human Rights is a major disappointment. The committee of government 'experts' that produced it made sure that it would not introduce any new obligations for States, and so the document simply restates existing agreements and lists desirable goals without specifying how they can be achieved. This article focuses on the shortcomings of the document as it would apply to health care. These shortcomings are evident in the document's scope, aims and principles. The conclusion is that if UNESCO still thinks that such a declaration is needed, it should produce either an ethical document addressed to individuals and groups, which would be primarily educational in nature, or a legal document addressed to States, which should not have the word 'ethics' in its title.

Some people might argue that there are already too many different documents, guidelines, and regulations in bioethics. Some overlap with one another, some are advisory and lack legal force, others are legally binding in countries, and still others are directed at narrow topics within bioethics, such as HIV/AIDS and human genetics. As the latest document to enter the fray, the UNESCO Declaration has the widest scope of any previous document. It embraces not only research involving human beings, but addresses broader concerns in medicine and healthcare. The UNESCO draft declaration has some minor weaknesses, but on the whole, the strengths outweigh the weaknesses. One weakness is that some items in the draft are stated in a way that is too restrictive, thereby appearing to rule out legitimate activities. A strength of the Declaration is that it is relatively brief, yet at the same time contains sufficient detail to make it something more than a rehearsal of mere pieties. As the most recent of the numerous bioethics and human rights documents, the UNESCO draft draws on many of the earlier documents and also includes some of the most recent thinking about ethical norms and obligations. Perhaps its greatest strength lies not in details of the principles or their implementation, but rather in its stature as an international declaration issued by a United Nations organization.

The Universal Draft Declaration on Bioethics and Human Rights seeks to provide moral direction to nations and their citizens on a series of bioethical concerns. In articulating principles, it ranks respect for human rights, human dignity and fundamental freedoms ahead of respect for cultural diversity and pluralism. This ranking is controversial because it entails the rejection of the popular theory, conventionalist ethical relativism. If consistently defended, this theory also undercuts other United Nations activities that assume member states and people around the world can reach trans-cultural judgments having moral authority about health, pollution, aggression, rights, slavery, and so on. To illustrate problems with conventionalist ethical relativism and the importance of rejecting it for reasons of health, human rights, human dignity and fundamental freedoms, the widespread practice of female genital circumcision or cutting is discussed. These surgeries are virtually a test case for conventionalist ethical relativism since they are widely supported within these cultures as religious and health practices and widely condemned outside them, including by the United Nations.

The authors analyse and assess the Universal Draft Declaration on Bioethics and Human Rights published by UNESCO. They argue that the Draft has two main weaknesses. It unnecessarily confines the scope of bioethics to life sciences and their practical applications. And it fails to spell out the intended role of human dignity in international ethical regulation.

This article argues that in the quest for global bioethics in its relation to the promotion of women's health and women's rights, the main challenge is to, first, rise above the relativist trap and second, to solve the false dilemma between individualism and collectivism. Particularly in order to improve women's position and advance their well-being in many developing countries with patriarchal cultural practices, there is an urgent need to introduce modern medicine and to share more evenly and efficiently the health care resources of the industrialized societies. This presumes that we can find a normative bioethical approach that promotes the rights of individuals without striving for cultural assimilation and disrespect. From the philosophical point of view this means that we have to overcome the debate between the rival views of justice, and rather find the shared features of the various approaches, thus diminishing the exaggerated polarizations between them. The author claims that despite its importance in women's rights protection, feminist bioethics cannot remain as a normative alternative that can replace either liberal or communitarian approaches. Instead feminism needs to be part of both liberal and communitarian ethical thinking. Communitarianism, for its part, cannot offer an alternative to either liberalism or feminism, but it can function as an essential critical balancing force within these approaches. Individualist liberalism, on the other hand, has to find its way into collective social structures and accept their maintenance, instead of exhausting itself in its attempts to lift individuals above or beyond their social contexts. All in all, the article shows that in finding the global bioethical norms the incompatibility between universalist and relativist reasoning or between individualist and collective ethical positions per se is not the main problem. Rather the problem is in our persistent tendency to believe that such an incompatibility exists. However, if we overcome the debate on whether one cultural background is superior to another, we can find a way to agree on some common norms that are based on shared values of very different traditions. Finding globally acceptable values, however, is not enough unless we pay more attention to their promotion in practice, in very different economic, social and political circumstances.

The United States is becoming increasingly pluralistic. Pediatricians must become familiar with the factors that affect the emotional, physical, and spiritual health of their patients that are outside the kin of the traditionally dominant value system. Although many articles have addressed the cultural and ethnic factors, very few have considered the impact of religion. Islam, as the largest and fastest-growing religion in the world, has adherent throughout the world, including the United States, with 50% of US Muslims being indigenous converts. Islam presents a complete moral, ethical, and medical framework that, while it sometimes concurs, at times diverges or even conflicts with the US secular ethical framework. This article introduces the pediatrician to the Islamic principles of ethics within the field of pediatric care and child-rearing. It demonstrates how these principles may impact outpatient and inpatient care. Special attention is also given to adolescent and end-of-life issues.

Allegations negating the role of law in the resolving the controversial problem of human cloning are unjustified. Human rights, implying the magnitude and value of human person and deeply rooted inherent dignity of the human being, constitute the very foundation of every legal order. Every lawyer, as well as every specialist in medicine or biology must be aware of his own human dignity and the ethical consequences. Among the standards of the Council of Europe in the context of human cloning there must be mentioned the Additional Protocol of January 12, 1998 on the Prohibition of Cloning Human Beings. It is the integral element of the normative system of the mother convention, the European Bioethical Convention of April 4, 1997. It has the distinguished place - within this system as far as its substantial provisions exclude the possibilities of limitations and derogation. The system of the Convention and the Protocol must be viewed in the light of a broader normative environment, including the integral system of the European Convention on Human Rights and the set of recommended bioethical standards. The absolute prohibition embodied in the Protocol is limited to all the methods leading to the creation of genetically identical human beings. The protocol does not directly regulate cloning of human tissues and cells, including embryonic stem cells. However, some conclusions may be taken from the Convention and from the recommended standards. It is the assumption of the Convention and the Protocol that the guarantees embodied there must be apprehended as practical and effective ones, justifiable and not excluding the use of proper sanctions by the State. It is an unacceptable view that scientists are excluded from the sphere of the functioning of the above-mentioned prohibition. The real sense of this prohibition is to stop the unlimited liberty and arbitrary practice of such scientists. The freedom of scientific research is not absolute, and must be guided by the respect for human dignity and human rights, as by well as protective guarantees embodied in the Convention and recommended standards.

All research on specific clinical aspects of human health and of patient-investigating-community-ecosystem must be based philosophically on ethical principles which are not rigid rules but reference guides to humanize all research processes. We analyze the following principles: integrity/totality; respect for the individual which includes the ethical duties of no wrongdoing and autonomy; welfare, equity/justice. And for research in animals we include the principle of respect for the ecosystem. The international statements of the AMM and of the CIOMS are formulations containing protective ethical principles of human rights and humanitarian practices in animal research and they are of essential importance in any research.