August 2005 - Proposed UNESCO Declaration on Bioethics and Human Rights

In January 2005 the UNESCO International Bioethics Committee (IBC) finalized its proposed Universal Declaration on Bioethics and Human Rights (cf. January 2005 Issue of the Month). Before the document was to be submitted to the UNESCO General Assembly this fall for consideration and adoption, a committee of government representatives was given the opportunity to review and amend the IBC draft. The committee held two formal meetings, on 4-6 April and 20-24 June, and an informal one on 17 May. At the first meeting, the government representatives raised multiple and often contradictory concerns about all aspects of the IBC draft, including its scope, intended audience, definitions (e.g., of 'bioethics') and principles. Some of these concerns echoed those of the WMA Ethics Unit regarding the lack of clarity or inappropriateness of the document's provisions for medical practice. Other government representatives wanted to ensure that the Declaration would entail no new obligations for States. The report of the meeting seemed to indicate that there was no possibility of compromise on the points of difference.

At the second formal meeting, however, consensus on a draft document was achieved, but only by eliminating most, if not all, of the IBC's substantive proposals. The new Draft Declaration is addressed to States rather than to all individuals and groups as the IBC had envisaged. Therefore, most of the obligations imposed on medical practitioners in the IBC draft have been deleted. The government representatives ensured that there would be no new obligations for States by simply repeating existing international agreements or by using vague terms such as "are to be respected", "should be taken into account", "should be given due regard", and "to the greatest extent possible". Even so qualified, however, some of the principles are inappropriately formulated, in particular Article 6 on consent and Article 7 on persons without the capacity to consent.

Article 6(a) states, "Any preventive, diagnostic and therapeutic medical intervention is only to be carried out with the prior, free and informed consent of the person concerned, based on adequate information." There is no exception for emergency treatment or for substitute decision making. Article 7 distinguishes between persons with and persons without the capacity to consent but does not explain the difference or say how it is to be determined in individual cases.

Unlike the various drafts of the IBC Declaration, this document will not be sent out for further consultation but will go directly to the UNESCO Executive Board and then to the Assembly. Those who think that the current draft should be changed are advised to address their concerns to their national representatives on the Executive Board, which will meet from 30 August to 15 September, and/or to delegates to the General Assembly (19 September to 7 October).

June 2005 - Abortion

There is likely no more controversial issue in bioethics than abortion. The word itself is used in many different ways. For the purposes of this article, it is useful to distinguish between 'spontaneous abortion' and 'induced abortion' and to focus on the latter. A further distinction is sometimes made between 'therapeutic abortion', for which a medical justification is offered (e.g., continuation of the pregnancy would endanger the life or health of the woman), and 'non-therapeutic abortion', where such medical justification is absent.

Until the mid-20th century, professional medical ethics was generally opposed to induced abortion, although this opposition was mitigated when the life of the mother was endangered by the pregnancy. The traditional formulation of the Hippocratic Oath included the statement, "I will not give to a woman an abortive remedy." In the original version of the WMA's updated version of this Oath, the Declaration of Geneva, physicians pledged to "maintain the utmost respect for human life from the time of conception…." In 1983 the words "from the time of conception" were changed to "from its beginning". These words were deleted at the May 2005 WMA Council meeting.

At the 1970 General Assembly in Oslo, Norway, the WMA adopted a statement on therapeutic abortion (subsequently known as the Declaration of Oslo) that authorized physician participation in therapeutic abortion under certain specific conditions. The relevant paragraph read as follows:

"5. Therefore, where the law allows therapeutic abortion to be performed, or legislation to that effect is contemplated, and this is not against the philosophy of the national medical association, and where the legislature desires or will accept the guidance of the medical profession, the following principles are approved:

• Abortion should be performed only as a therapeutic measure.
• A decision to terminate pregnancy should normally be approved in writing by at least two doctors chosen for their professional competence.
• The procedure should be performed by a doctor competent to do so in a hospital approved by the appropriate authority."

In 1983 the Declaration of Oslo was amended and the above paragraph 5 was simplified as follows: "Therefore, where the law allows therapeutic abortion to be performed, the procedure should be performed by a physician competent to do so in premises approved by the appropriate authority."

At the May 2005 WMA Council meeting it was agreed that the Declaration of Oslo should undergo major revision. The coordination of this task was entrusted to the WMA Secretariat. The Secretariat will contact National Medical Associations for their suggestions as to how the Declaration should be modified.