De la biologie à l'éthique les comités d'éthique de biologie

Abstract

Bioethics has been stimulated by two happenings. Indignation provoked by the behaviour of Hitler's regime against the unfortunate deportees and the splendid progress of biology and medicine. One can distinguish two periods in the history of ethical committees. Firstly a period concerned only with local regional, hospital or university committees and a later period concerned with national committees (the first was created in France in 1983).

Three revolutions which pose important ethical questions have changed medicine in the last fifty years:

1. A therapeutic revolution with therapeutic trials (well organised trials on healthy volunteers, or comparative trials which are both morally necessary and necessarily immoral).

2. Organ transplantation with questions about the donor (dead or living) or the recipient who becomes a chimera.

3. Epidemiological enquiries with the difficult question of creating a register.

The biological revolution which came later has given man three masteries:

1. Developments in birth control, such as the RU of Baulieu, which can terminate pregnancy.

2. Artificial insemination ranging from treating male infertility to a matter of convenience.

3. In vitro fertilisation leads to the problem of what to do with supernumerary embryos.

Genetic developments lead to progress in predicting the predisposition to disease as well as the power to modify the inherited genetic makeup. The invention but not the discovery can be patented. Finally progress in knowledge of the nervous system leads to two important bioethical problems, psychopharmacology and nerve tissue grafts.

These difficult questions and the tensions that they have engendered have led ethical committees to formulate the following principles to guide their judgement:

1. The definition of a person at the very beginning of life, with the tendency to consider an embryo as a potential person.

2. Respect for knowledge depends on two precautions; confining some research to a small number of laboratories and having a moratorium on some new findings.

3. Eliminating the financial element from blood transfusions or organ donation.

4. The responsibility of the researcher who should deal with the ethical problems created by his or her research as it develops.

What is the role of the law in ethics? What legislation can be and what cannot be forecast? How can we develop the teaching of bioethics particularly in higher education, medicine and law? Can we start sufficiently early teaching morality in schools? How do we develop the necessary international arrangements? By increasing meetings? By creating a European bioethics committee? Finding an answer to these questions was the object of a meeting in Madrid in March 1992 of the chairmen of the national ethical committees of Europe.