Transcript Pealkiri - Erasmus Observatory on Health Law

Are European moral principles
universal?
Margit Sutrop
Director of the Centre for Ethics,
University of Tartu, Estonia
International Conference on Human Rights and
Biomedicine, Rotterdam, 10-12 December 2008
The main challenge
• Desire to establish universal values / to
respect ethical diversity
• “The increasing globalisation ... is heightening
the tension between the aspiration to
universality of ethics driven regulation and the
emerging reality of the diversity of moral
cultures in the world and the need to respect
plurality and ethical diversity.” (A.Plomer,
2005)
Attempts to formulate
universal principles
• The Declaration of Helsinki (1964)
• The Belmont Report (1979)
• Tom Beauchamp and James Childress
“Principles of Biomedical Ethics” (1979)
• Convention on Human Rights and
Biomedicine (Oviedo, 1997)
• UNESCO Universal Declaration on
Bioethics and Human Rights (2005)
Different meanings of the
word “principle”
• Principle=moral value, designates what we
appreciate/do not want to loose, it can be
formulated as a rule of action
• Ethical principle: a general principle which
defines what is a morally good action (morally
good action is such that maximizes
happiness / respects life, human dignity, does
not instrumentalize others / is in our own best
interest)
A critique of principles
• harmonisation has the effect of driving down
ethical standards to the lowest common
denominator
• the seeming consensus is hiding the fact that
moral and political dilemmas are still
continuing to exist, one avoids problematic
issues, no action will be taken
• the compromise may suppress the dialogue,
oblige one party to violate its values, lead to
moral and political intimidation
Identification, establishment,
harmonization
• Identification of universal values –
a) From is to ought: if shared by all moralities,
then bounding to everybody (UNESCO Decl)
b) Grounding on metaethical position: there are
moral truths to be discovered ( principlism) or
that ethics is the result of human agreements
(contractualist ethics)
• Standardization: standards established
• Harmonization of ethical rules/norms
Isn’t the question selfcontradictory?
• Are European moral principles
universal? – If they are universal, why
do we talk about European principles
instead of global bioethical principles?
Because identified by Europeans?
• More specifically: Are European moral
principles/values shared by all
Europeans?
Oviedo Convention
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The interests of human beings must come before the interests of
science or society
Bans all forms of discrimination based on the grounds of a person’s
genetic make-up, prohibits the use of techniques to help choose the
sex of a child, except for avoiding hereditary condition
Prohibits the creation of human embryos where countries allow in-vitro
research
States the principle according to which a person has to give the
necessary consent for treatment expressly, in advance and that such
consent may be freely withdrawn
Prohibits the removal of organs and other tissues from people not able
to give consent
Patients have a right to be informed about their health including the
results of predictive genetic tests. Recognizes the right not to know.
Are there specific problems with applying the
principles in post-Communist countries?
• 22 countries have ratified, the majority
are Central-East European countries,
except Latvia, Poland, Russia, Ukraine
• Finland, Sweden, Norway, France,
Germany, Ireland, Italy, UK,
Liechtenstein have not ratified
Possible reasons
• In W-E countries already existing legal
regulations, sometimes contradicting the
Convention
• In C-E Europe no regulation beforeinternational treaties create the new practice
• In C-E Europe pressure has not come from
the civil society but from the desire to
promote values of human dignity as part of
the common heritage of Europe
Inglehart-Welzel cultural map of the world,
2005
Basic values are
closely correlated,
they can be depicted
in two major
dimensions of crosscultural variation:
1) Traditional/secularrational
2) Survival/selfexpression values
The traditions/secularrational values dimension
The importance of religion
• Parent-child ties, defence
of authority
• Absolute standards and
traditional family values
• Reject divorce, abortion,
euthanasia, suicide
• High levels of national
pride
Survival and selfexpression values
Post-industrial society
• Emphasis on subjective
well-being, selfexpression, quality of life
• Environmental protection,
tolerance of diversity,
demand for participation
in decision making
• High interpersonal trust
Cultural differences of Europe as shared
value community
• As religion plays a role in valueorientation the divide is not always
between East- and West-Europe
• As accumulation of wealth influences
our attitudes towards survival/selfexpression values we notice indeed the
difference between post-communist and
old liberal democracies
European value community
• The shift from survival values to selfexpression values (self-determination,
participation) depends on the economic
development (patient rights, informed
consent)
• The shift from traditional/secular-rational
values depends on the secularization of
societies (abortion, euthanasia, stem cell
research, IVF, etc)
My argument
• The disagreement about values is often not
the result of the uptake of different values but
of different interpretation or prioritization of
values.
• Moral values depend on our selfunderstanding, conception of good life, which
in turn depend on historical events and
economic situation, cultural tradition, and
religious convictions.
There is no unity of
“European” bioethics
 The roots of rights-based liberal ethics are in
the political struggles of the early modern era
(the American Declaration of Independence,
the battlecries of the French Revolution, its
grounding fathers are Kant and Locke.
 Common-good based communitarian ethics
stands in opposition to liberal ethics, placing
more of an emphasis on citizenship and
community (its apologues are considered to
be Aristotle, Cicero, Thomas Aquinas, Hegel).
Liberalism versus
communitarianism
• Liberals seek to protect individual rights,
of which the most basic are the
autonomy of the individual or the right to
self-determination.
• For communitarians, the core values
are solidarity and responsibility.
Liberalism stresses rights,
communitarianism the common good.
Different meanings of dignity
(Häyry 2003)
• Kantian model (rational agents)
• Catholic doctrine (all human beings created
by God, icl. the unborn, the irrational)
• The genetic reading (incl artificially produced
human beings)
• Utilitarian model (human beings and other
sentient beings who suffer)
• Traditional cultures’ model (individuals of
specific importance)
Disagreement about solidarity
Søren Holm (1995) “Not just autonomy”:
“solidarity is missing from principlism”
Robert Baker (2005) “International
Bioethics and Human Rights”:
“The concept of solidarity lacks
resonance in much of Asia and all North
America”
Different meanings of solidarity
(Simm 2005)
• Solidarity as contract
• Solidarity as benevolence
• Solidarity as recognition of fundamental
interdependence (feeling of
togetherness, social unity)
Disagreement about solidarity
Søren Holm (1995) “Not just autonomy”:
“solidarity is missing from principlism”
Robert Baker (2005) “International
Bioethics and Human Rights”:
“The concept of solidarity lacks
resonance in much of Asia and all North
America”
Value conflicts
• Unavoidability of conflicts (incompatibility and
incommensurability of values)
• Many conflicts are resolvable, but no
authoritative way of solving conflicts
• Primary values (facts of the self, intimacy,
social order) should always be respected
• Solution appealing to historically conditioned
traditions and conceptions of good life that
the opposing protagonists share
Conclusions
 Values may come into conflict and we have to
choose which value we appreciate most.
Different hierarchies of values lead to
different moral practices.
 The acknowledgement of the diversity of
morals does not relegate one to a position of
ethical relativism.
• We need a comparative study of the use of
concepts and a discussion of different
interpetations of values.