Focus on Human Dignity and Human Rights: A Global Movement for Ethics in Medicine
There is a felt need to adopt ‘global ethics’ to indicate ethical science devoted to protecting the environment and our own future species.
Rapid strides in medical technology with an artificial human being almost in sight, designer babies, organ and gene replacements, are all creating an explosion of ethical dilemmas in medicine. Where should technology stop? The world is becoming more ‘anthropocentric’, to the extent that entire species of other animals are disappearing. On the clinical level, conflict between medical practitioners and their patients is becoming more and more common today. At least partly, this is due to failure to recognize each other as individuals and human beings, each with their own rights.
The need of the day is to adopt ‘global ethics’ (a term coined by the American biochemist Van Rensellaer Potter) to indicate ethical science devoted to protecting the environment and our own future species. Named ‘bioethics’, these are ethical principles based on sound transcultural understanding. The UNESCO Universal Declaration on Bioethics and Human Rights, adopted on 19 October 2005 codifies these principles. Among them, the first principle is that of Human Dignity and Human Rights: (Article 3): 1. Human dignity, human rights and fundamental freedoms are to be fully respected. 2. The interests and welfare of the individual should have priority over the sole interest of science or society.
Based on this principle, more than 114 Units across the world will mark the First World Bioethics Day with a uniform program on topics around human dignity and rights.
In 2001, the UNESCO Chair in Bioethics was established at the International Center of Health, Law and Ethics, University of Haifa. The UNECO Chair Haifa, headed by Prof. Amnon Carmi, gradually established a number of Units at medical Universities all across the world. Their aim was to form a network to ‘coordinate and stimulate an International Network of Institutes for Medical Ethics Training (NIMED)’. The UNESCO Chair of Bioethics is tasked with developing a culturally sensitive yet responsive syllabus in ethics for medical schools all over the world. Dr. Russell D’Souza, an Indian psychiatrist settled in Australia is heads the Asia Pacific region for the UNESCO Bioethics Chair, Haifa. The Indian Medical Association, Medical Council of India, National Board of Examinations, and Vice-chancellors of several health Universities in India are all Units of UNESCO Chair. Units for medical students are also being formed. Among such units, the Central India Unit is based at PGIMER-Dr. RML Hospital in Delhi. The International Forum of Teachers in Bioethics has been established for membership to medical teachers who are already trained in bioethics.
All Units meet at least once a year to discuss progress and formulate future plans. At their Annual Meeting in 2015, a decision was taken to mark the signing of the UNESCO Universal Declaration by observing a World Bioethics Day, with programs focused on the First Principle of Bioethics- Human Dignity and Human Rights. The UNESCO bioethical principles are:
- Respect for human dignity and human rights (Article 3.1)
- Priority of the individual’s interests and welfare over the sole interest of science or society (Article 3.2)
- Beneficence and non‐maleficence (Article 4)
- Autonomy (Article 5)
- Informed consent (Article 6)
- Protection of persons unable to consent (Article 7)
- Special attention to vulnerable persons (Article 8)
- Privacy and confidentiality (Article 9)
- Equality, justice and equity (Article 10)
- Non‐discrimination and non‐stigmatization (Article 11)
- Respect for cultural diversity and pluralism (Article 12)
- Solidarity and cooperation (Article 13)
- Access to healthcare and essential medicines (Article 14)
- Benefit sharing (Article 15)
- Protection of future generations (Article 16)
- Protection of the environment, the biosphere and biodiversity (Article 17).
Thus, these principles not only emphasize the imperative changes we should bring in our attitudes and behavior towards each other, but also to the environment and to other species.
To improve the applicability and acceptability of these Principles among the healthcare fraternity, a novel case based approach is used. A number of ‘casebooks’ illustrating principles of bioethics are available free on the net (Casebook Series, Bioethics Core Curriculum. It is recognised that many ethical questions that doctors face daily- around right to care of the terminally ill, ability to make decisions for oneself, use of specific interventions without recognising religious or cultural practices; do not have any black or white answers. An informed yet culturally sensitive and humanitarian approach is needed to deal with such complex issues which have multifaceted dimensions and have no easy answers. These case dilemmas aim to focus on these issues and encourage dialogue and discussion.
As the Bioethics Movement widens, it is hoped that not only will health care improve, but also mutual respect and recognition between patients and their healthcare providers will enter a more informed and respectful phase.
*Author is Professor & Head, Department of Psychiatry & De-addiction Services; Centre of Excellence in Mental Health, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, and member of Council for National Institute of Mental Health and Neurosciences.
The views expressed in this article are author’s personal.