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9. ISCB konferencija 9th ISCB Conference

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Medicinski fakultet Sveučilišta u Rijeci
Katedra za društvene i
humanističke znanosti u medicini
University of Rijeka, Faculty of Medicine
Department of Social Sciences
and Medical Humanities
9. ISCB 9th ISCB
konferencija Conference
„Globalna i dubinska bioetika
– Od nove medicinske etike
do integrativne bioetike“
U spomen na prof. dr. Ivana Šegotu
23. – 25. rujna 2012.
Rijeka, Hrvatska
Međunarodni znanstveni skup
KNJIGA SAŽETAKA
„Global and Deep Bioethics
–From New Medical Ethics
to the Integrative Bioethics“
Due to the memory of prof. dr. Ivan Šegota
September 23rd – 25th, 2012.
Rijeka, Croatia
International Scientific Conference
BOOK OF ABSTRACTS
ISCB
International Society
for Clinical Bioethics
Medicinski fakultet Sveučilišta u Rijeci
Katedra za društvene i
humanističke znanosti u medicini
University of Rijeka, Faculty of Medicine
Department of Social Sciences
and Medical Humanities
9. ISCB 9th ISCB
konferencija Conference
„Globalna i dubinska bioetika
– Od nove medicinske etike
do integrativne bioetike“
U spomen na prof. dr. Ivana Šegotu
23. – 25. rujna 2012.
Rijeka, Hrvatska
Međunarodni znanstveni skup
KNJIGA SAŽETAKA
Organizatori
ISCB (Internacionalno društvo
za kliničku bioetiku)
Hrvatsko društvo za kliničku bioetiku
Katedra za društvene i humanističke
znanosti u medicini
Medicinski fakultet Sveučilišta u Rijeci
„Global and Deep Bioethics
–From New Medical Ethics
to the Integrative Bioethics“
Due to the memory of prof. dr. Ivan Šegota
September 23rd – 25th, 2012.
Rijeka, Croatia
International Scientific Conference
BOOK OF ABSTRACTS
Organised by
ISCB (International Society of
Clinical Bioethics)
Croatian Society for Clinical Bioethics
Department of Social Sciences
and Medical Humanities
University of Rijeka, Faculty of Medicine
Organizacijski odbor / Organisation Board:
Mirko Štifanić
Iva Sorta Bilajac
Anamarija Gjuran-Coha
Arijana Krišković
Amir Muzur
Nada Gosić
Iva Rinčić
Igor Eterović
Martina Šendula-Pavelić
Tajana Tomak
Gordana Pelčić
Znanstveni odbor / Scientific Board:
Naoki Morishita
(Hamamatsu University School
of Medicine, Japan)
Miljenko Kapović
(University of Rijeka, Croatia)
Shigeru Mushiaki
(Shujitsu University)
Dinko Vitezić
(University of Rijeka, Croatia)
Iva Sorta Bilajac
(University of Rijeka, Croatia)
Farida T Nezhmetdinova
(Kazan State Agrarian
University, Kazan, Russia)
Hans-Martin Sass
(Goergtown University-Kennedy
Institute of Ethics, Washington
D.C.)
Michael (Cheng-Tek) Tai
(College of Medical Humanities
Chungshan Medical University,
Taiwan)
Luka Tomašević
(Katolički bogoslovni fakultet
Split, Croatia)
Tsuyoshi Awaya (Okayama University, Japan
Amir Muzur
(University of Rijeka, Croatia)
Iva Rinčić
(University of Rijeka, Croatia)
Mirko Štifanić
(University of Rijeka, Croatia)
Nada Gosić
(University of Rijeka, Croatia)
Motomu Shimoda
(Kyoto Women‘s University,
Japan)
Anamarija Gjuran-Coha
(University of Rijeka, Croatia)
Arijana Krišković
(University of Rijeka, Croatia)
Gordana Pelčić
(University of Rijeka, Croatia)
Izdavač/Publisher:
Medicinski fakultet Sveučilišta u Rijeci, Katedra za društvene i humanističke znanosti u medicini /
University of Rijeka, Faculty of Medicine, Department of Social Sciences and Medical Humanities
Uredili/Editors:
Gordana Pelčić, Goran Pelčić
Prijevodi/Translation:
Autori/Authors
Lektura za hrvatski jezik/
Croatian language proofreader
Gordana Perušić
Grafičko oblikovanje i tisak/
Layout and print:
Digital IN, Rijeka
Izdavač i urednici nisu odgovorni za eventualne propuste u sadržaju ili jezičnom izrazu u tekstu
sažetaka objavljenih u ovoj knjižici.
The publisher and the Editors do not feel responsible for any substantial or linguistic imperfection that might
be found in the abstracts published in this booklet.
ISBN 978-953-6384-91-4
CIP zapis dostupan u računalnom katalogu Sveučilišne knjižnice Rijeka
pod brojem XXXXXXXXX
Program konferencije
Conference Programme
9. ISCB konferencija / 9th ISCB Conference
23. – 25. rujna 2012. / September 23rd – 25th, 2012.
Rijeka, Hrvatska / Rijeka, Croatia
NEDJELJA, 23.09.2012./ SUNDAY, SEPTEMBER 23, 2012.
Hotel Jadran, Šetalište XIII. divizije 46
ISCB sastanak / ISCB meeting
PONEDJELJAK, 24.09.2012. / MONDAY, SEPTEMBER 24, 2012
Medicinski fakultet Rijeka / Faculty of Medicine, Rijeka
Braće Branchetta 20
9.00 – 10.00
Prijava sudionika / Registration (Aula Fakulteta / Entrance Hall)
10.00 – 10.30
Svečano otvaranje skupa / Conference opening
(Vijećnica, 3. kat / Council hall, 3rd floor )
- In memoriam: Ivan Šegota
(Tsuyoshi Awaya, Hans-Martin Sass, Michale (Cheng-Tek) Tai
Plenarna izlaganja / Keynote lectures
(Vijećnica / Council hall)
Predsjedava / Chairing: Gordana Pelčić and Naoki Morishita
10.30 – 11.00
Jaro Kotalik,2, Louis Pedri1
(1 Lakehead University,2Northern Ontario School of Medicin, Canada)
End of Life Care as a Power Play: Can All be Winners?
11.00 – 11.30
Hans-Martin Sass
(Goergtown University, Kennedy Institute of Ethics, Washington D.C.)
The Clinique as a Good Neighbor
11.30 – 11.45
Diskusija / Discussion
11.45 – 12.15
Stanka za kavu / Coffee break
6
IZLAGANJA / PRESENTATIONS
Vrijeme / Time
12.15 – 13.45
Vijećnica / Council hall - Treći kat / Third floor
Predsjedava/
Chairing
Michael (Cheng-Tek) Tai and Hans-Martin Sass
12.15 – 12.30
Mirela Bušić, Stela Živčić-Ćosić, Gordana Pelčić, Željko Župan, Martina Anušić Juričić, Željka Jurčić
(Institute for Transplantation and Biomedicine Ministry of Health)
The Croatian Model of Organ Donation and Transplantation
12.30 – 12.45
Tsuyoshi Awaya (Okayama University, Japan)
Bioethics as a Power for Improving Human Life
12.45 – 13.00
Luka Tomašević (Catholic Theological Faculty Split - University of Split)
Russian Bioethics from Orthodox Perspectives
13.00 – 13.15
Ivan Kaltchev
(Philosophical Faculty, University St. Kliment Ohridski Sofia, Bulgaria)
The Dignity of an Unborn Child: A Bioethical Position Against Abortion
13.15 – 13.30
Motomu Shimoda (Kyoto Women’s University, Japan)
Ethical and Legal Considerations of Non-Medical Genetic Testing Business
13.30 – 13.45
Diskusija / Discussion
13.45 – 14.45
Ručak / Lunch
IZLAGANJA PO SEKCIJAMA / PRESENTATIONS IN SESSIONS
Vrijeme / Time
14.45 – 16.00
Vijećnica / Council hall - Treći kat / Third floor
Predsjedava/
Chairing
Luka Tomašević and Motomu Shimoda
14.45 – 15.00
Jelena Hrgović, (Verebum, Split)
Culture – Context of Human Acting
15.00 – 15.15
Farida T Nezhmetdinova (Kazan State Agrarian University, Kazan, Russia)
Global Challenges and Globalization of Bioethics
15.15 – 15.30
Dinko Vitezić (on behalf of Croatian Central Ethics Committee Members)
Ethical Evaluation of Clinical Trials in Croatia
15.30 – 15.45
Shigeru Mushiaki (Shujitsu University)
Methodological Reflections on Technology Assessment Studies
15.45 – 16.00
Diskusija / Discussion
16.00 – 16.15
Stanka za kavu / Coffee break
7
IZLAGANJA PO SEKCIJAMA / PRESENTATIONS IN SESSIONS
Vrijeme / Time
16.15 – 17.30
Predsjedava/
Chairing
Ivan Kaltchev and Suzana Vuletić
16.15 – 16.30
Tatsuya Mima (Kyoto University, Japan)
Placing Morality in Brain: What is Neuroethics, if anything?
16.30 – 16.45
Iva Rinčić (University of Rijeka)
From a Deaf Printer to National Centre for Higher Education of the Deaf
and Hard-of-Hearing: How One More Idea of Ivan Šegota Grew into
Institutional Strategy
16.45 – 17.00
Yutaka Kato (University of Okayama, Japan)
Conscience in Healthcare and the Definition of Death in Japan
17.00 – 17.15
Ana Volarić Mršić (University of Zagreb)
Promulgation of Clinical Bioethics Through Mass Media in Croatia
17.15 – 17.30
Diskusija / Discussion
18.30
8
Vijećnica / Council hall - Treći kat / Third floor
Trsat – Razgledavanje i večera / Sightseeing and dinner
UTORAK, 25.09.2012. / TUESDAY, SEPTEMBER 25, 2012
Medicinski fakultet Rijeka / Faculty of Medicine, Rijeka
Braće Branchetta 20
Plenarna izlaganja / Keynote lectures
(Vijećnica / Council hall)
Predsjedava / Chairing: Tsuyoshi Awaya and Gordana Pelčić
09.00 - 09.30
Naoki Morishita
(Hamamatsu University School of Medicine, Japan)
Bioethics in Human History from the Past to the Future: Three Periods
of the Broadest Bioethics and “Digitalization”
09.30 – 10.00
Michael (Cheng-Tek) Tai
(Medical Humanities and Bioethics, College of Medical Humanities Chungshan
Medical University, Taichung, Taiwan)
Integrated Medicine from Asian Perspectives
10.00 – 10.15
Diskusija / Discussion
10.15 – 10.45
Stanka za kavu / Coffee break
9
Vrijeme / Time
Sekcija / Session – Treći kat / Third floor – Vijećnica /Council hall
10.45 – 12.30
Predsjedava/
Farida T Nezhmetdinova and Shigeru Mushiaki
Chairing
Iva Sorta Bilajac, Morana Brkljačić Žagrović
10.45 – 11.00 (Faculty of Medicine, University of Rijeka)
Clinical Ethics in Croatia
Suzana Vuletić
11.00 – 11.15 (Catholic Theological Faculty, University Josip Juraj Strossmayer of Osijek )
Moral-Bioethical Evaluation of Contemporary Biomedical Progress
Marina Guryleva (Kazan Medical University, Russian Federation)
11.15 – 11.30
Bioethics Understanding of the Genetic Modification of Athlete Organism
Ana Jeličić (University Department for Forensic Sciences, University of Split)
11.30 – 11.45
Contribution of Catholic Faith and Science to Bioethics
11.45 – 12.00
12.00 – 12.15
Diskusija / Discussion
Stanka za kavu / Coffee break
Vrijeme / Time
Sekcija / Session – Treći kat / Third floor – Vijećnica /Council hall
12.15 – 13.45
Predsjedava/
Tatsuya Mima and Iva Sorta Bilajac
Chairing
Marija Selak (Faculty of Philosophy, Croatia)
12.15 – 12.30
Notion of the World as a Main Notion in Integrative Bioethics
Olga Popova
12.30 – 12.45 (Institute of Philosophy, Russian Academy of Sciences, Russia)
Cross-Cultural Approach to the Problem of Brain Death
Silvana Karačić, Natalija Bačić (Health Resort Sveti križ)
12.45 – 13.00
Right to Internet Access
Gordana Pelčić, Anamarija Gjuran Coha, Goran Pelčić
13.00 – 13.15 (Faculty of Medicine – University of Rijeka)
The Age when Croatian Children Should Decide about Their Health?
13.15 – 13.30 Diskusija / Discussion
13.30 – 13.45
Closing remarks and announcement of 10th ISCB
13.45 – 14.45
Ručak / Lunch
15.15 h
Izlet na otok Krk i večera / Excursion to the Island of Krk and dinner
(više detalja u finalnom programu / more details will be available in the final programme)
10
Sažeci izlaganja
Paper abstracts
11
12
Plenarna predavanja / Plenary lectures
JARO KOTALIK1,2, LOUISA PEDRI1
Centre for Health Care Ethics, Lakehead University
Northern Ontario School of Medicine. Thunder Bay, Ontario, Canada
[email protected]
[email protected]
1,2
1
End of Life Care as a Power Play: Can All be
Winners?
The “end of life care” became, at least in North America, a highly contested
territory. Patients, families, various health care professions, administrators and
those who fund the care often have opinions or requests concerning the kind of
care that should be given, to whom, and for how long; and these are not mutually compatible. Management of these patients is often discussed at ethics committees and is subject to clinical ethics consultations with some of the cases resulting in acrimonious legal battles. With increasing efficiency of life sustaining treatments in our hospitals, a significant number of patients’ lives are prolonged, but
others are allowed to die when life preserving interventions are either withheld
or withdrawn. These conflicts that pit the patient and/or the family against the
physician and/or the institution probably had its beginning in 1960 when resuscitation and ventilation became effective and practical. Many patients had felt
that these techniques became overused by physicians governed by “technological imperative” only to prolong dying, so they fought back with “living wills” and
advanced directives. However, over the last decade, the situation was reversed.
Today, it is more likely that in the most disputed situations, it is the patient and/
or families who demand more aggressive or longer interventions than the health
care professionals and their institutions are willing to provide, claiming futility.
This can be interpreted as a sign that the public does not respect the limitations of medicine. Or, it could be understood as health professionals callously
denying the benefit of life prolongation to those whose life they no longer consider worthwhile. Definitely the term “quality of life,” which was introduced in the
13
1980’s as a quantitative tool to measure how the disease and the treatment affects
a person’s life is now often being used to make subjective, off-the-cuff judgments
about the patient’s life, that unless that patient’s life has a certain “quality” it is not
worthwhile and therefore no professional obligation exists to support or defend
or extend that life, even if it were medically possible.
Bioethics expertise can clear some situations of confusion, improve communications, clarify obligations and attempt to mediate these conflicts. However,
often enough, a fundamental difference among parties persists and to avoid legal
battles one of the parties gives up. More often than not, the patient or surrogate
autonomy yields to physician’s autonomy. The conflict leaves the loosing party
with the feeling of being disrespected or overpowered; it produces anger, guilt, or
despair. Such outcome is regrettable, not only because of the harm to individuals
but also because it leads to disrespect for the health care system, and diminishes
its ability to build solidarity and community. We suggest that at least a part of
the problem is that the bioethics’ approach to analysis of such complex situations as they arise at the end of life is narrowly rationalistic and is unable to take
into account powerful instinctual and emotional reactions of those involved. We
suggest that the task of bioethics is to seek ways how enrich the everyday dialogues and ethical analysis among patient, families, professionals and institutional
managers. We are not proposing that aggressive treatment and life prolongation
has to be offered always when patient or family ask for that, but we maintain
that their desires, inclinations, needs and commitment, even if not defensible by
instrumental reasoning, should be valued and addressed. Providing more complete picture of these encounters in end of life care, we hope to increase mutual
understanding and empathy of involved parties and more sincere, nuanced and
imaginative search for “win-win” solutions.
14
HANS-MARTIN SASS
Goergtown University-Kennedy Institute of Ethics, Washington D.C.
[email protected]
The Clinique as a Good Corporate Neighbor
Clinics today are specialized in health repair services similar to car repair shops; procedures and prices are standardized, regulated, and inflexibly uniform.
Clinics of the future have to become Health Care Centres in order to be more
respected and more effective corporate neighbours in offering outreach services
in health education and preventive health care. The traditional concept of care
for health is much broader than repair management and includes the promotion of lay health competence and responsibility and healthy social and natural
environments. The corporate profile and ethics of the clinic as a good and competitive local neighbor will have to focus [a] on better individualized care, [b] on
education and services in preventive care, [c] on direct or web-based information and advice for general, seasonal, or age related health risks, and on developing
and improving trustworthy character traits of the clinic as a corporate person
and a good neighbor.
NAOKI MORISHITA
Department of Integrated Human Sciences, Hamamatsu University School of
Medicine, Hamamatsu, Japan
[email protected]
Bioethics from the Past to the Future: Three Periods
of the Broadest Bioethics and «Digitalization»
Bioethics in 1990s shifted to a situation of theoretical or methodological
diversity. This diversity actually reflected expansions of biomedical domains
themselves. As expanding movements have been advancing, the identity of bioethics has become dissipative early in 2010s. This dissipative situation applies
15
not only in USA but also in Japan. Now we need to take such an identity-loss
situation seriously and reconstruct bioethics.
If it is so more expanding and more dissipative, our bioethical reflections also
would need a wider perspective, which corresponds to those movements and covers the whole human history. This perspective is the broadest bioethics, which
would be redefined as “ethics on life” including living organic system. Since the
orthodox bioethics was formed in 1970s, it has been considered contradictory
to all the traditional medical ethics. But, from this viewpoint of the broadest
bioethics, we could recognize that both of them differ just only on a common
platform.
We try to roughly divide this broadest bioethics into three periods. Bioethics
1 is the first period of the broadest bioethics, which spread over in all the pre-modern societies. Bioethics 2 is the bioethics in the period of the so-called modern
society and medicine. Bioethics 3 had germinated from the second half of 1960s
to 1970s, had actualized in 1980s, and has been giving severe doubts to modernity of the orthodox Bioethics after 1990s.
Post-modernization, globalization, digitalization have been producing
expansions of bioethical domains and gave birth to Bioethics 3. It is digitalization among them that leads all those expansions. If we will frontally respond to the
period of Bioethics 3 produced by multi-dimensional digitalization, we need to
make all the borderlines around bioethics loose and place them in any broader
conceptual frame. Digitalization calls for new Bioethics in future.
MICHAEL (CHENG-TEK) TAI
Medical Humanities and Bioethics, College of Medical Humanities,
Chungshan Medical University, Taichung, Taiwan
[email protected] Integrated Medicine from Asian Perspectives
Traditionally, Asians, either a Chinese or a Hindu, believe that a person is
sick because his inner and outer forces have been off balanced. According to the
Chinese, the purpose of medicine is to restore the balance of yin and yang within
a body. Similarly a Hindu will strive to restore the harmony among the mind,
16
body and spirit system. Ancient Chinese believe that all things are composed of
two integrating forces of Yin and Yang. If balance of these two is broken, disease
will produce. „Yin and Yang and the four seasons are the beginning and end of all
things, the root of life and death. To go against them is injurious to life, to go with
them prevents serious diseases from arising.“ Hindu Ayurveda depicts mind,
body and spirit as the tripod supporting the world structure. Seeking a balance
within this tripod and between an individual and the rest of the world is the key
to a healthy good life. Though Chinese and Hindu use different expressions to
describe the basic structure of the universe, they both pinpoint the importance
of balance of the external and internal forces of the microcosm within the macrocosm. Their medicines are no doubt integrative that sees a person and illness
from holistic perspectives.
Key words: Yin and Yang, Five Elements, Chi, Ayurveda.
17
Usmena izlaganja / Oral presentation
TSUYOSHI AWAYA
Okayama University, Japan
[email protected]
Bioethics as a Power for Improving Human Life
Bioethics has succeeded greatly in improving medical practice and medical research. However, we neither need to nor should we confine bioethics to
medical ethics. Bioethics also includes environmental ethics, research ethics, etc.
But there is a further need. We need to add ‘civilizational bioethics’ and ‘lifeprotecting bioethics’ to the notion of bioethics. ‘Civilizational bioethics’ is the
multidisciplinary study which is concerned with advanced and frontier medical
technologies. It is based on civilization study. ‘Life-protecting bioethics’ is the
bioethics which protects human life, etc. against war, terrorism, disaster, etc. It
seems that both of them have become very important recently.
Bioethics in this context should be a power for improving human life, as well
as the world in which we live. Bioethics has little power at present. But it has
much potential power. We need to recognize this potential and think about what
we bioethicists can do to apply our bioethics towards improving human life in
the world by the power of bioethics. I would like to talk about this topic.
18
MIRELA BUŠIĆ1, STELA ŽIVČIĆ-ĆOSIĆ2,
GORDANA PELČIĆ3, ŽELJKO ŽUPAN4,
MARTINA ANUŠIĆ JURIČIĆ1, ŽELJKA JURČIĆ1
Zavod za transplantaciju i biomedicinu,Ministarstvo zdravlja Republike Hrvatske
Zavod za nefrologiju i dijalizu, Klinika za internu medicinu, Klinički bolnički centar
Rijeka, Medicinski fakultet Sveučilišta u Rijeci, Hrvatska
3
Katedra za društvene i humanističke znanosti u medicini, Medicinski fakultet
Sveučilišta u Rijeci, Hrvatska
4
Zavod za anesteziologiju i intenzivno liječenje, Klinički bolnički centar Rijeka,
Medicinski fakultet Sveučilišta u Rijeci, Hrvatska
1
[email protected]
1
2
Hrvatski model darivanja i presađivanja organa
Tijekom posljednjih deset godina, uvođenje niza organizacijskih mjera usmjerenih na unaprjeđenje transplantacijskog programa u Hrvatskoj rezultiralo je
stalnim porastom stope donora, koja je dostigla najveću razinu u 2011. godini
s 33,5 realiziranih donora na milijun stanovnika. Posebno tijekom posljednje
dvije godine, Hrvatska je doživjela izuzetan porast broja darivatelja organa te je
zahvaljujući tome danas jedna od vodećih država u svijetu u pogledu darivanja
i presađivanja organa umrlih osoba. Porast broja darivatelja hrvatskim je bolesnicima omogućio, u odnosu na druge europske zemlje, veću dostupnost ove
metode liječenja. U razdoblju između 2007. i 2011. godine lista čekanja se smanjila za 36% (sa 440 na 280 bolesnika koji čekaju na transplantat), a prosječno
vrijeme čekanja na transplantaciju bubrega sa 46 na 24 mjeseca.
Mnoge europske države su razvile različite organizacijske modele i strategije
za promoviranje darivanja i presađivanja organa, ali u većini broj raspoloživih
organa za presađivanje još uvijek daleko zaostaje za očekivanjima i njihovim
stvarnim potencijalom. Hrvatski model je nedavno prepoznat kao uspješan i
može se implementirati u drugim državama.
Analizirali smo najvažnije čimbenike koji su pridonijeli porastu darivanja
organa umrlih osoba u Hrvatskoj i omogućili da hrvatski model postane prepoznatljiv ne samo u regiji nego i u svijetu. Dobiveni zaključci zasnivaju se na
mišljenjima autora i otvoreni su za daljnju raspravu te predstavljaju poziv na
sustavno istraživanje, koje će definirati čimbenike što najviše doprinose razvoju
uspješnih programa darivanja i presađivanja organa.
19
MIRELA BUŠIĆ1, STELA ŽIVČIĆ-ĆOSIĆ2, GORDANA
PELČIĆ3, ŽELJKO ŽUPAN4, MARTINA ANUŠIĆ JURIČIĆ1,
ŽELJKA JURČIĆ1
Institute for Transplantation and Biomedicine,Ministry of Health, Croatia
Department of Social Sciences and Medical Humanities, Faculty of Medicine –
University of Rijeka
3
Department of Social Sciences and Medical Humanitie,Faculty of Medicine –
University of Rijeka
4
Department of Anesthesiology, Reanimation and Intesive Care, Faculty of Medicine
– University of Rijeka
1
[email protected]
1
2
The Croatian Model of Organ Donation and
Transplantation
During the past ten years, efforts to improve and organize the national transplantation system in Croatia resulted in a steadily growing donor rate, which has
reached its highest level in 2011 with 33.5 utilized donors pmp. Remarkably,
in the last two years Croatia has experienced a „boom“ of organ donation and
transplantation, and nowadays it is one of the leading countries of the world in
deceased donation and transplantation. That provided a much higher availability
of these treatment modes for the inhabitants of Croatia than for patients living
in other European countries. In the period between 2007 and 2011 the waiting
list decreased by 36% (from 440 to 280 persons waiting for a transplant) and the
median waiting time for kidney transplantation decreased from 46 to 24 months.
Many European countries have developed different organisational models and
strategies to enhance organ donation and transplantation, but in most countries the
number of organs available for transplantation is still lagging far behind the expectations and their real potential. The Croatian model has recently been recognized as
successful and it has the potential to become implemented in other countries.
We analyzed the most important factors which contributed to th e increase of deceased donation in Croatia and made it possible that the Croatian
model has become so successful. The obtained conclusions are based on
the authors’ opinions and they are open for further discussion, and an invitation for a systematic research which will define the factors, mostly con20
tributing to the development of the „successful model for organ donation
and transplantation“ in Croatia.
CHRISTIAN BYK
Judge, Paris, France
[email protected] Is There a Room Left for an Ethics of Global
Discussion?
There are several visions of the contribution of ethics to the technoscientific
society. One can think that ethics is integrated into the practices in order to control them or to moderate them and to make them socially acceptable. In a certain
manner, ethics adapts itself to the disciplines which call upon it -it becomes bioethics, for example - to legitimate them. Far from the regulation of the practices,
ethics may also be perceived by the scientific researchers as a major interrogation
on the relationship between science and society. It is found in the situation which
was that of Galileo, Pascal, Descartes, Newton or Einstein when they discovered
the laws of Nature. Between these two visions of ethics, one which opens out in
the good practices whereas the other confronts us with a dimension of the science which is not yet understandable to all, is there a room left for a global ethics
of the public discussion around the scientific controversies ?
Il existe plusieurs visions de la contribution de l’éthique à la marche d’une
société technoscientifique. On peut penser que l’éthique s’y intègre aux pratiques
afin de les réguler, de les modérer pour les rendre socialement acceptables. D’une
certaine manière, l’éthique s’adapte alors aux disciplines qui font appel à elle –elle
devient bioéthique, par exemple -, pour les légitimer.
Loin de la régulation des pratiques et du quotidien des applications médicales ou scientifiques de la technologie, l’éthique est aussi pour le chercheur scientifique une interrogation profonde sur le rapport de la science à l’homme et au
monde. Il se retrouve dans la situation qui était celle de Galilée, Pascal, Descartes,
Newton ou Einstein face à la découverte des lois du monde.
21
Entre ces deux visions de l’éthique, l’une qui s’épanouit dans les bonnes pratiques alors que l’autre nous confronte à une dimension de la science qui n’est
pas encore intelligible de tous, l’éthique du débat public autour des controverses
scientifiques peu-elle avoir une réalité ?
MARINA GURYLEVA
Kazan medical University, Russian Federation
[email protected]
Bioethics Understanding of the Genetic
Modification of Athlet Organism
In a sport of high achievements - the field of professional extreme, spectacular
and highly commercialized matured a large number of bioethical issues that require
public discussion. The Olympic slogan «citius, altius, fortius» requires the athlete
to using doping-special means, which increase efficiency and productivity. In the
21st century, scientists offered for doping modify the sportsmen’s genome.
There are three known genes, which can be used by athletes. The first begins
to act in the acute shortage of oxygen, stimulating the process of erythropoietin.
The second gene growth of the cells of the inside surface of blood vessels can be
used to improve blood supply of muscles. The third gene helps to build muscle
mass and regeneration tissue, which is very important for the athletes.
The use of genetic modification of the body of an athlete can greatly increase
the chances of achieving high results.
Some ethnic groups have a genetic predisposition to certain types of sports, for
example, athletes from Kenya - the best runners. Genetics now can recommend
a person to practice one or the other kind of sports: running, swimming, weight
lifting, football, basketball, on the basis of their genetic characteristics. So science
can allow people, who are not able to sports, to achieve high results?
Should be considered as an artificial change of some genes in sports doping
and how to treat it from the point of view of bioethics? Today the question remains open.
22
JELENA HRGOVIĆ
Verbum, Split
[email protected]
Kultura – kontekst ljudskog djelovanja
Ljudsko djelovanje nužno se odvija u kontekstu kulture, što je ujedno i kontekst bioetičkih izazova. U kontekstu kulture čovjeka je moguće promatrati kao
subjekt kulture, objekt kulture i pojam kulture, a svaka od tih dimenzija uključuje
različite vidove čovjekova djelovanja.
Na koji način koreliraju čovjek i kultura, u kojoj mjeri kultura određuje čovjeka, a u kojoj čovjek kulturu bit će govora i u ovom radu kojem je cilj ukazati na
važnost kulturnog okružja u kojem čovjek djeluje i u kojem je njegovo djelovanje
moguće bioetički vrednovati.
Autorica pokušava ukazati na važnost kulture kao takve, ali i odgoja za kulturu
svih dionika društva u kojem svijest o bioetičkim problemima i izazovima ovisi i
o kulturološkim dosezima.
Ključne riječi: kultura, čovjek, ljudsko djelovanje, bioetika, odgoj za kulturu, kulturni kontekst.
JELENA HRGOVIĆ
Verebum, Split
[email protected]
Culture – Context of Human Acting
Human acting necessarly is happening in the context of culture, what‘s actually context of bioetichal chalanges. In the context of culture it is possible to watch
human as subject of culture, object of culture and term of culture, and every of
those dimensions includes different views of human acting.
How corelates human and culture, in what measure culture defines human,
and in what human defines culture it will be said in this work whose goal is to
indicate importance of cultural enviroment in what human acts and in what his
acting is under bioetical evaluation.
23
Autor tries to indicate importance of culture as it is, but also importance of
education for culture all stakeholdersof the society were awareness of bioetical
problems and chalanges depends on cultural reaches.
Key words: culture, human, human acting, bioethics, education for culture,
cultural context.
ANA JELIČIĆ
Sveučilišni odjel za forenzične znanosti, Sveučilište u Splitu, Hrvatska
[email protected]
Doprinos katoličke vjere i nauke bioetici
Pacijenti u staroj Grčkoj nisu donosili odluke o svom liječenju niti su imali
pravo glasa kada se radilo o terapijskim metodama kojima su ih njihovi liječnici
podvrgavali. Svojim paternalističkim stavom liječnici su im ulijevali maksimalno
povjerenje, čuvali su im zdravlje i liječili ih.
Petstotinjak godina kasnije od Hipokratove zakletve utjelovljeni kršćanski
Bog svojim javnim djelovanjem je donio novi stav prema bolesti, postavio je
novi model liječnika, za razliku od onog grčkog i starozavjetnog, te je uzdigao
položaj pacijenta. Do Kristovog javnog djelovanja bolesnik se smatrao grešnikom, čovjekom koji je kažnjen za svoje grijehe ili grijehe svojih predaka, a Isusovim riječima i čudima on postaje osoba kroz koju se očituju djela Božja. Pomoću
čudesnih ozdravljenja on je iskazivao svoje milosrđe i suosjećanje, svoju brigu i
ljubav prema bolesnima i tjelesno osakaćenima, te svoje nadnaravno porijeklo.
Obje kulture, starogrčka i ona kršćanska, oduvijek su povezivale liječničku
struku s filozofijom. I jednoj i drugoj referentna točka promišljanja i djelovanja
bio je čovjek.
Medicina se kroz povijest vrpoljila između pacijenta i bolesti, a naglim tehnološkim razvojem, sve veću prednost davala je bolesti, zbog njene izazovnosti i
misterioznosti. S druge strane, Crkva i njen moralni nauk, nastavili su gajili svoj
terapeutski duh vodeći brigu o čovjeku-osobi i njegovu životu prema kojem su
izgradili i sačuvali trostruki stav: poštovanje, ljubav i služenje.
Ovim svojim etičkim i pastoralnim zadacima- poštivanje, ljubljenje i služenje
životu - teološko-moralni nauk ali i (moralni) teolozi ne samo da su našli svoje
24
mjesto i izborili svoj glas u medicinskoj etici već su udarili temelje novoj znanstvenoj disciplini, posvećenoj ispitivanju etičnosti, nužnosti, ispravnosti, dopuštenosti i granicama znanstveno-bio-medicinskog zadiranja u ljudski život – bioetici.
Do danas se katolička bioetika afirmirala kao neizostavni i integrativni dio
hrvatske i svjetske globalne bioetike kojoj daju specifični religiozni okvir razmišljanja i djelovanja. Njeno zalaganje je prepoznatljivo kroz ideje i projekte koji
inzistiraju na vjeri u svetost, darovanost, smislenost i dostojanstvo (ljudskog) života
koji se tumači kao poziv i prilika za suobličavanje Bogu.
Osim o životu, kroz kršćansku antropologiju gradio se stav i o čovjeku koji je
pozvan na odgovornost prema životu jer jedino on među živim bićima ima sustvoriteljsku snagu kojom utječe na tijek života, njegov razvoj ili zastoj.
Teološka nastojanja koja se temelje na božanskoj objavi a idu u prilog dostojanstvu ljudske osobe i svetosti života smatraju se posebnim doprinosima kršćanske religije modernoj bioetici.
ANA JELIČIĆ
University Department for Forensic Sciences, University of Split, Croatia
[email protected]
Contribution of Catholic Faith and Science to
Bioethic
Patients in ancient Greece did not make decisions about their treatment
or had the right to vote when it came to treatment methods, they were subjected by their doctors. Paternalistic attitude of the doctors instilled their
confidence , they took care of their wellbeing and treated them.
Five hundred years after Hippocratic oath, the embodied Christian God
with its public actions has brought a new attitude towards the illness, has
set a new medical model which was in contrast with Greek and the Old
Testament one, and has elevated the position of the patients.
Until Christ’s public ministry patients were considered to be sinful; the
man was punished for its sins or the sins of its ancestors, and with Jesus
25
words and miracles he becomes a person through which the word of God
is manifested. With the miraculous healings He showed his mercy and
compassion, with His caring and love for the sick and physically crippled,
and its supernatural origin.
Both cultures, ancient Greek and it Christian, have always linked the
medical profession with philosophy. For both of them the point of reflection and reference was a man.
Medicine fidgeted through the history between patient and disease, and
with rapid technical development, increased advantage was given to the disease due to its challengeness and mystery. On the other hand, the Church
and its moral teachings, continued developing its own therapeutic spirit
of taking care of the man-person and his life to which they are built and
preserved through three-position: respect, love and service. With its ethical
and pastoral tasks- respect, love and life service- theological and moral
teachings and (moral) theologians have not only found their place and got
their voice herds in medical bioethics but they have set a corner stone for
new scientific discipline which is dedicated to the study of ethics, necessity,
validity, admissibility and limits of science and bio-medical interference
in human life-Bioethics. To date, the Catholic Bioethics established as an
essential and integrative part of Croatian and world global bioethics which
gives specific religious framework of thinking and acting. Its commitment
was recognized by the ideas and projects who insist on believing in the
sanctity, giftedness, significance and dignity of the (human) life, which is
interpreted as an invitation and opportunity conformed to God. In addition
to the life, the Christian anthropology is built on the attitude of a man who
is called to account for life, because he alone among creatures has been the
creative force, which affects the flow of life, its development or stagnation.
Theological efforts that are based on divine revelation and in favour of
human dignity and the sanctity of life are considered separate contributions
of the Christian religion to modern bioethics.
26
IVAN KALTCHEV
Philosophical Faculty, University‘St Kliment Ohridski Sofia, Bulgaria
[email protected]
The Dignity of an Unborn Child:
A Bioethical Position Against Abortion
The paper consists of two sections. In the first section the author validates the definition of abortion as homicide. Following the Christian tradition, the author embraces the brilliant analyses of Pope John Paul II.
According to the fundamental moral obligation of humanity, abortion is a
highly condemnable act by a human being. In the second section the author
examines the underlying biological, thanatological and ethical arguments
in favor of the dignity of an unborn child. The author concludes the following: humanity is obligated to put an end to the incredibly dangerous
justification of abortion because, according to the author, abortion is one of
the most fundamental problems of contemporary civilization.
SILVANA KARAČIĆ1, NATALIJA BAČIĆ2
Liječilište Sveti križ, Trogir, Hrvatska
Pravni fakultet Split (student)
[email protected]
1
2
Pravo na internet
Pravo na Internet odnedavno je u pojedinim zemljama (npr. Francuska, Estonija, Finska) uzdignuto na ustavnu razinu kao temeljno pravo koje je zaštićeno
najvišim pravno – političkim zakonom i temeljnim konstitutivnim državnim dokumentom. Internet je danas nezaobilazan medij koji se koristi za raznorodne
svrhe. Zagovornici konstitucionalizacije ovog prava ponajviše ističu kako je Internet ključni alat za postizanje govora, ali i za ostvarivane cijelog niza ljudskih
prava. No, postavlja se pitanje je li ispravno smjestiti bilo kakvu tehnologiju u ovu
uzvišenu kategoriju.
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SILVANA KARAČIĆ1, NATALIJA BAČIĆ2
Health Resort Sveti križ, Trogir, Croatia
Faculty of Low Split (student), Croatia
[email protected]
1
2
Right to Internet Access
Right to Internet access, also known as right to broadband in certain countries (Estonia, France, Finland) has recently been made a human right. We could
define this right as an opinion which claims that human being has the right to
access the Internet as a matter of utilizing a public utility. There is no doubt that
Internet is today unavoidable instrument which is used for many different purposes. Protectors of the idea of constitutionalisation of this right would emphasize Internet´s role in exercising freedom of speech, as well as many other fundamental human rights. But, the question is whether the fact that technology is an
enabler of rights, not a right itself has been neglected.
YUTAKA KATO
Okayama University, Japan
[email protected]
Conscience in Healthcare and the Definition
of Death in Japan
Brain death or neurologic death has gradually become recognized as human
death over the past decades worldwide. In Japan, the 1997 Organ Transplant Law
legalized brain death determination exclusively when organs are to be procured
from brain-dead patients. The law was revised in 2009 and the revised law went
into effect the following year. But the default definition of death continued to
be cardiac criteria, despite the fact that some criticized the revision for trying
to adopt an alternative definition. Meanwhile, reportedly, an increasing number
of Japanese citizens have come to understand neurologic death as human death
and future revision is likely. Against this backdrop, this presentation discusses a
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future option for brain death determination in Japan by taking into consideration conscience in healthcare. At present, the conscience of patients does not
seem to play crucial roles in healthcare of Japan. Japanese healthcare lacks the
practice of conscientious objection both by patients and healthcare professionals. Nevertheless, I argue in the presentation that citizens should be allowed to
oppose brain death determination even when the majority of Japanese citizens
endorse brain death determination and the definition becomes the default death
definition of the country in future. The presentation theoretically deals with the
pros and cons of the above approach mainly based on the literature. As non-religious self-determination is arguably also entitled to the same exemption, I also
discuss different types of (e.g. religio-cultural and scientific) objections to brain
death determination. The above approach likely has implications in other fields
of healthcare in Japan.
TATSUYA MIMA
Human Brain Research Center, Kyoto University Graduate School of Medicine, Japan
[email protected]
Placing Morality in Brain: What is Neuroethics, if
anything?
Recent advances in neuroscience opened up new technical possibilities –
mind-reading of human, neuro-enhancement using electromagnetic brain stimulation or neuro-feedback system or application of brain-machine-interfaces
(BMI) into everyday life, as well as the advent of new powerful psychotropic
drugs that can modulate the human affective state. In addition to the conventional problems in bioethics or medical ethics, such as informed consent and
human subject protection, neuroscience technology produced new terrains of
ethical problems. For example, laissez-faire neuro-enhancement combined with
commercialism may have the risk of increasing the social gap between the rich
and the poor, if a wealthy person can easily get “gain without pain”. Is it Brave
New World enabled by neuroscience?
29
The assumed mission of neuroethics is to examine the ethical, legal and social implications of neuroscience today. More ambitious neuroethicists may claim
that the unprecedented breakthrough in the neuro-theology or neuro-philosophy is coming nearby. We cannot predict the future of neuroscience, but, at
least, we could say that scientific and objective approach to mind-brain problem
cannot avoid having the connotations in more delicate topics in humanities, such
as the privacy, morality, subjectivity, personality or responsibility.
Roskies (2002) introduced a useful distinction in neuroethics, namely the
ethics of neuroscience and the neuroscience of ethics. The former includes two
terrains: the ethical issues in neuroscience research and the evaluation of the ethical, legal and social implications of neuroscience. The ethical problems in neuroscience may be treated in the framework of traditional bioethics. However,
the latter point can include new points which should require the integration of
the ethical consideration of research and the neuroscientific understanding of
human nature, especially morality. This is a truly novel and challenging question,
because the neuroscience of ethics is now investigating the brain system of human moral judgments.
In this paper, I will discuss this chiasm of neuroscience and ethics and
summarize the debate provoked by the seminal paper by Greene et al (“An fMRI
investigation of emotional engagement of moral judgment”, 2001).
SHIGERU MUSHIAKI
Shujitsu University
[email protected]
Methodological Reflections on Technology
Assessment Studies
When some new technology is being developed, it is now customary to assess the impact of the technology on the natural environment, especially in terms
of “sustainability.” But the technology may also have implications for the social
environment, that is to say, ethical, legal, and social implications. And last but not
least, the technology may have deep implications for what it means for us to be
30
human beings, i.e., ontological implications. While obvious, short-term implications are comparatively easy to perceive, it is often extremely difficult to grasp the
subtle, long-term externalities in the highly complex society. In order to objectively assess the natural, social, and human implications of the new technology,
an interdisciplinary collaboration of natural, social, and human scientists would
be indispensable.
The importance of the establishment of technology assessment studies
(TAS) is more or less acknowledged in Europe and the US. Unfortunately, it is
not the case in Japan according to my estimation, which seems to be one of the
reasons for the nuclear catastrophe in Fukushima. There are also other reasons
for worrying about the implications of robotic care of the elderly, just to give an
example. Some European and American scholars are concerned about the possible adverse effects of the human-robot interactions on vulnerable aged population, but I know few Japanese scholars who express the concern.
I will compare TAS in Europe and Japan, give methodological reflections
on the transdisciplinary constitution of TAS, taking examples from the field of
robotics and neurotechnology, and argue for the foundation of TAS institutions
with scientific, interactive, and communicative methods.
FARIDA T NEZHMETDINOVA
Philosophy & Law Department, Kazan State Agrarian University, Kazan, Russia
[email protected]
Global Challenges and Globalization of Bioethics
In modern world the main Global Challenges are:
• food safety and hunger;
• continuing fight against diseases and protection of human health;
• searching new energy and raw material;
• environmental and ecology risks;
• going to new technical platform and architecture of science.
Naturally, the solution of these problems has its mercantilist, an economic dimension. The winners in this race are take very much: creating new markets, potential customers, production of which is everyone - in any case, each preceded
31
by a risk of cancer, heart disease, AIDS, or else did survive. These problems, individually or together, in the future face of everyone. Under increasing pressure of
global competition our planet is becoming a kind of «laboratory”: a transgenic
living organism converts the flora and fauna of the world in a planetary network
bio factory, bio-farms, bio reactors, etc.
As a result, we have global development trends:
1. Increasing bio power.
2. Man-made hazards.
3. Globalization of bioethics or global bioethics (V.R. Potter).
Why bioethics became global?
• it is interdisciplinary dialogue platform
• social regulation of technology risks of the new development and changes in “material viability”
• constructive communication authorities, businesses, scientists and society
• support, research and social projects aimed at preserving the health and
welfare of human and nature
• “internal optics” of moral attitude to NBIC technology and new architecture of science
• condition for the development of civil society and rule of law
Today the global role of bioethics needs to develop her forms as:
1. Ideals, norms, principles
2. Humanitarian expertise.
3. Scientific discipline.
4. An educational subject.
5. Ethical committee.
6. Experts of bioethics
This must be done at all levels of Bioethics: theoretical, practical, clinical.
32
GORDANA PELČIĆ1, ANAMARIJA GJURAN COHA1,
GORAN PELČIĆ2
Katedra za društvene i humanističke znanosti u medicini, Medicinski fakultet
Sveučilišta u Rijeci
2
Katedra za oftalmologiju, Medicinski fakultet Sveučilišta u Rijeci
[email protected]
1
Dob kada bi djeca u Hrvatskoj trebala odlučivati o
svom zdravlju
Cilj: Cilj ovog istraživanja je utvrditi mišljenje zdrave i hospitalizirane djece
o dobi uključivanja djece u donošenju odluke.
Sudionici i metode: Ispitali smo dvije grupe djece. Jedna grupa je bila ispitana u školama (930 djece), druga grupa u bolnicama (115 djece), u gradovima
Pula, Rijeka, Crikvenica, Zagreb, Osijek i Knin. Ukupan broj djece je bio 1045
(68,4% djevojčica, 31,6% dječaka). Prosječna dob djece je bila 16,18 godina. Na
temelju istraživanja i pregleda literature koja je sadržavala upitnike vezane uz
informirani pristanak, kreirali smo upitnik. Upitnik se sastojao od dva dijela. Demografski podatci, podatci o bolesti i hospitalizaciji djece, primljenim informacijama i razumijevanju informacija, informiranom pristanku, donošenju odluka od
strane djece, su prikupljene u prvom djelu upitnika. Drugi dio upitnika se sastojao od 28 tvrdnji. Provedena je faktorska analiza na zajedničke faktore s Oblimin
rotacijom kako bi se ispitala faktorska analiza 28 tvrdnji. Podskala Odlučivanje
djece je bila uključena u daljnju analizu.
Rezultati: Prema mišljenju većine djece, dob za davanje pristanka je dob
od 16 godina i ne razlikuje s obzirom na hospitalizacije djece ili težinu bolesti.
Hijerarhijskom regresijskom analizom odgovora djece utvrdilo se četiri grupe
prediktora (demografske varijable, bolest, izvor informiranja i izvor odlučivanja)
koje objašnjavaju 25% variance Odlučivanja djece. Statistički značajna je bila jedino grupa Izvor odlučivanja. Unutar same grupe roditelji i djeca su bili statistički
značajan izvor odlučivanja.
Zaključak: Djeca žele sudjelovati u odlučivanju u dobi od 16 godina neovisno o hospitalizaciji ili težini bolesti. Prediktor Odlučivanje djece je jedini bio
statistički značajan u objašnjenju varijance Sudjelovanje djece u odlučivanju. Djeca
su mišljenja kako bi djeca i roditelji zajednički trebali biti uključeni u odlučivanje.
Ključne riječi: Dob; Djeca; Donošenje odluke; Informirani pristanak
33
GORDANA PELČIĆ1, ANAMARIJA GJURAN COHA1,
GORAN PELČIĆ2
Department of Social Sciences and Medical Humanities, University of Rijeka School
of Medicine, Rijeka, Croatia
2
Department of Ophtalmology, University of Rijeka School of Medicine, Rijeka,
Croatia
[email protected]
1
The Age when Croatian Children Should Decide
about Their Health
Aim: The aim of this study was to establish the opinion of healthy and hospitalized children about the age of children’s involvement in decision making.
Participants and methods : We examined two groups of children. One was
examined in schools (930 children), second in hospitals (115 children), in cities
of Pula, Rijeka, Crikvenica, Zagreb, Osijek and Knin. The total number of children was 1045 (68,4% of girls, 31,6% of boys). Average age was 16,18 years.
Based on pilot investigation and literature search about the questionnaires
related to age of informed assent, a questionnaire was drawn up. The questioner
had two parts. Demographic data, data about children’s illness and hospitalization, received information and understanding of this information, informed assent
and children’s decision making were collected in the first part of the questionnaire. The second part of the questioner was consist of 28 claims. Factor analysis on
common factors was conducted with Oblimin rotation with the purpose of evaluation of 28 claims factor structure. The subscale Children’s’ decision was included in further analysis.
Results: According to the opinion of most children, the age of consent is 16
years and does not differ regarding hospitalization and severity of illness. Hierarchic regression analysis of children answers determinate four group of predictors (demographic data, illness, source of information and source of decision
making) explain 25% of variance Children decision making. The source of decision
making was only statistically significant group. Within this group, only the parents and children as source of decision making were statistically important.
Conclusions: The children want to participate in decision making in age of
16 regardless of hospitalization and severity o illness. The group of “source of
34
information” was only statistically significant in explaining variance Children decision making. The children and parents should be involved in decision making
together based on children’s opinion.
Key word: Age, Children; Decision making: Informed consent
OLGA POPOVA*
Department of humanitarian Expertise and Bioethics, Scientific Center of Children’s
Health, Institute of Philosophy, Russian Academy of Sciences, Russia
[email protected]
Cross-Cultural Approach to the Problem of Brain
Death
At the present stage of development of science studying the actualization
of the philosophical and methodological basis of the diagnosis of death due to
two interrelated processes in the development of medicine: 1) strengthening
the processes of integration of medicine and bioethics, 2) the achievements of
Intensive Care and Transplantation. Doubts about the validity of the concept
of brain death, increased over the last decade with increased frequency and intensity are marked by such researchers as D.Shewmon; R.Veatch, S.Youngner,
E.Bartlett, etc. The presence of negative stereotypes in relation to the concept of
“brain death” in practice affect the decline in organ donation and for many countries is the reason for seeking new arguments in favor of the legitimacy of the
concept of brain death. Current controversies and disagreements on the issue of
brain death causes the need for uniform criteria for neurological determination
of death. However, the search for common criteria for brain death is faced with
the problem of socio-cultural determination of death, significant differences in
the interpretation of the interpretation of death, suffering, dying. Thus, the problem of the legitimacy of death is closely related to socio-cultural influence on the
definition and criteria of death. The death should be investigated not only as a
biological event, but also as a social construct.
*
Study was carried out with financial support from RFH grant 12-33-01419
35
IVA RINČIĆ
Katedra za društvene i humanističke znanosti u medicini
Medicinski fakultet Sveučilišta u Rijeci
[email protected] Od gluhog tiskara do Nacionalnog centra za visoko
obrazovanje gluhih i nagluhih: kako je još jedna
ideja Ivana Šegote prerasla u strategiju institucije?
Strateška orijentiranost Medicinskog fakulteta Sveučilišta u Rijeci profiliranju u referentnu regionalnu instituciju edukacije gluhih, već je nekoliko godina poznata činjenica na samom fakultetu, ali i u široj lokalnoj javnosti. Ono
što ipak mnogima ostaje nepoznato, bitno u povijesnoj perspektivi razvoja jedne
inicijative, te sadržaju i dosegu njenog ostvarenja, jesu njeni idejni počeci koje
s pravom pripisujemo profesoru Ivanu Šegoti (1938.-2011.), dugogodišnjem
pročelniku Katedre za društvene znanosti.
Prvi evidentirani trag Šegotinog interesa za gluhe na Medicinskom fakultetu potječe iz akademske godine 2002.-2003. pokretanjem izborne nastave kolegijem Kako komunicirati s gluhim pacijentima. Nakon nekoliko godina nastavne
aktivnosti, organizacije okruglog stola Bioetički aspekti komuniciranja s gluhim
pacijentima u okviru Riječkih dana bioetike 2006. i pratećeg Zbornika radova,
2007. dotadašnje ideje Ivana Šegote prerastaju u aktivnosti novog, projektnog
karaktera (projekt Ministarstva znanosti, obrazovanja i športa Republike Hrvatske Klinička bioetika: edukacija za komuniciranje s gluhim pacijentima, br. 0620000000-1345), rezultiravši i knjigom/udžbenikom Gluhi i medicinsko znakovno
nazivlje: Kako komunicirati s gluhim pacijentima (autor Ivan Šegota i suradnici) iz
2010.
Paralelno sa spomenutim događajima, u upravljačkoj strukturi fakulteta sazrijeva svijest o dugoročnoj važnosti i nužnosti etabliranja u instituciju pod sloganom Medicinski fakultet Sveučilišta u Rijeci – prijatelj gluhih. U sklopu spomenutog pokrenuta je uspostava trajne međunarodne suradnje s američkim Rochester Institute of Technology, kao i inicijativa ustanovljenja Nacionalnog centra za
visoko obrazovanje gluhih i nagluhih Republike Hrvatske.
36
Članak će ponuditi kronologiju spomenutog procesa, uočiti i definirati njegove ključne odrednice, te konačno, temeljem spomenutih odrednica za cilj ima
uspostaviti razvojne etape od ideje do strategije Medicinskog fakulteta Sveučilišta u Rijeci prema gluhima.
IVA RINČIĆ
Department of Social Sciences and Medical Humanities
Faculty of Medicine – University of Rijeka
[email protected]
From a deaf printer to National Centre for Higher
Education of the Deaf and Hard-of-Hearing: How one
more idea of Ivan Šegota grew into institutional strategy
Strategic orientation of the University of Rijeka Faculty of Medicine toward
prophiling into a referal regional institution for Deaf education, has for several
years been a known fact within the Faculty and in a broader community. Important from the historical perspective of the development of this initiative, its
content and range of its realisation, but unknown to many, remains its beginning,
rightly ascribed to Professor Ivan Šegota (1938-2011), who for a long time had
headed Department of Social Sciences.
The first evidenced trace of Šegota‘s interest in the Deaf at Faculty of Medicine dates from the academic year 2002/2003, when elective course on How to
communicate with deaf patients was launched. After a few years of teaching that
course, after the organisation of a round table on Bioethical aspects of communication with deaf patients within the frame of Rijeka Days of Bioethics in 2006,
and the following proceedings, the idea of Ivan Šegota grew up in 2007 into a
scientific project financed by Croatian Ministry of Science, Education, and
Sports (Clinical bioethics: education in communicating with deaf patients, No.
062-0000000-1345), resulting in the textbook entitled The Deaf and Medical Sign
Language: How to Communicate with Deaf Patients (by Ivan Šegota and collaborators) from 2010.
37
In parallel with the abovementioned events, consciousness matures within
the Faculty administration on the long-term importance and necessity of institutional affirmation under the slogan University of Rijeka Faculty of Medicine – a
Friend of the Deaf. Launched has been a continuous international collaboration
with the American Rochester Institute of Technology, as well as the initiative of
establishing a Croatian National Centre for Higher Education of the Deaf and
Hard-of-Hearing.
This paper will offer a chronology of the described process, and try to detect
and define its key characteristics which will help shape the steps of development
of an idea into the strategy of the University of Rijeka Faculty of Medicine toward
the Deaf.
MARIJA SELAK
Filozofski fakultet Zagreb, Hrvatska
[email protected]
Pojam svijeta kao temeljni pojam integrativne
bioetike
Nakana je ovog rada da uspostavi poveznicu između integrativne bioetike
i filozofije svijeta s osloncem na razumijevanju svijeta u filozofiji K. Lőwitha.
Naime, možemo uočiti da integrativno mišljenje koje je u bioetičkom misaonom horizontu razvijeno do nove paradigme znanja poprima kozmološki (u
smislu tradicionalne kozmologije) karakter, prvenstveno u smislu odmaka od
antropocentričke tradicije moderne filozofije. Tako se čovjek u okviru integrativnog mišljenja kao i u okviru Lőwithove filozofije svijeta ne nalazi više u centru
iz kojeg podvrgava svijet (kao što podrazumijeva prirodoznanstveno promatranje) nego se razumije i pozicionira samo u supostojanju. Dok u okviru filozofije
svijeta polazimo od obuhvatnog pojma svijeta i deduktivnim putem dolazimo
do čovjeka kao njegova sastavnog dijela, dotle u okviru bioetike, koja linijom
integrativnog mišljenja svoj vidokrug proširuje od čovjeka (medicinska etika)
preko biosa do kosmosa (kao pretpostavke i uvjeta održanja života), induktivno
dolazimo do obuhvatnog razumijevanja svijeta.
38
MARIJA SELAK
Faculty of Philosophy Zagreb, Croatia
[email protected]
Notion of the World as a Main Notion in
Integrative Bioethics
This paper will try to establish the link between integrative bioethics and philosophy of the world in philosophy of K. Löwith. Integrative reasoning that has
evolved in the new paradigm of knowledge in bioethical framework is receiving
cosmological character (in sense of traditional cosmology). We can observe this
change in its distance from anthropocentrical tradition of modern philosophy. In
integrative thought as in Löwith’s philosophy of the world man is not standing
in the centre form which he is subordinating the world anymore (as is the case
in natural sciences). He is understood only in coexistence. In philosophy of the
world we are starting from the comprehensive notion of the world and by deduction coming to a man as its component. On the other hand, in bioethics, which
is expanding its horizon from man (medicine ethics), from bios, to cosmos (as a
precondition of maintaining the life), by induction we are coming to comprehensive understanding of the world.
MOTOMU SHIMODA
Kyoto Women‘s University, Faculty for the Study of Contemporary Society, Japan
[email protected]
Ethical and Legal Considerations of
Non-Medical Genetic Testing Business
As the correlation between genes and diseases has been elucidated, genetic testing has started to become used for medical purposes such as diagnosis,
prognosis, and risk assessment. Recently, genetic testing has been applied to predispositional testing such as that for obesity or facilitation of supplement sales,
39
as well as non-medical and commercial purpose testing such as genealogical/
ancestry DNA testing or child talent testing. Such tests are offered by private
companies in the form of direct-to-consumer service. Points to be considered
in such field are as follows: scientific evidence of the testing; protecting consumers from „scams“; right of selection and satisfaction of the consumers; adequate
regulation: restriction by the government, self-regulation of the industries or free
market; stigmatization of specific population; quest for ethnic or personal identity; and parental intervention of children.
Based on the consideration of these topics, I clarify the ethical implication
and necessary conditions for the regulation of direct-to-consumer genetic testing.
IVA SORTA BILAJAC1, MORANA BRKLJAČIĆ ŽAGROVIĆ2
Katedra za društvene i humanističke znanosti u medicini, Medicinski fakultet
Sveučilišta u Rijeci
2
Poliklinika Sv. Rok, Zagreb, Hrvatska
1
[email protected]
2
[email protected]
1
Klinička etika u Hrvatskoj
Klinička etika definira se kao etika kliničke prakse, a bavi se etičkim pitanjima koja proizlaze iz kontinuirane, svakodnevne skrbi za pacijenta. Temelji se
na intenzivnoj poveznici kliničke prakse s edukacijom iz biomedicine, zdravstva
i bioetike.
Prema „Bioetičkoj enciklopediji“, najvažnija obilježja kliničke etike jesu:
usmjerenost na pitanja etike u kontinuiranoj, svakodnevnoj skrbi za pacijenta;
teorijske rasprave o različitim modelima etičkog odlučivanja u praksi; izjednačavanje važnosti etičkih pitanja u medicinskoj praksi s edukacijom i istraživanjem.
Iz navedenih obilježja mogu se izvesti ciljevi kliničke etike: razvoj smjernica za
edukaciju; razvoj smjernica za istraživanja; razvoj modela etičkog odlučivanja u
kliničkoj praksi.
Ovo izlaganje osvrnuti će se - na tragu ranije spomenutih ciljeva - na tri ključna razvojna momenta kliničke (medicinske) etike u hrvatskom sustavu biome40
dicine i zdravstva: razvoj sadržaja iz medicinske (kliničke) etike u curriculumu
studija medicine, od 1991. g. do danas; uspostavljanje moralno-pravnog okvira
za provođenje istraživanja i osiguravanje dobre kliničke prakse, s posebnim osvrtom na Zakon o zaštiti prava pacijenata RH iz 2004. g., te mjesto i ulogu informiranog pristanka; kliničke etičke konzultacije – razvoj, mjesto i uloga etičkih
povjerenstava.
Zaključno, želi se istaknuti potreba za približavanjem europskim (i svjetskim)
standardima, na pragu ulaska Hrvatske u Europsku Uniju.
Ključne riječi: edukacija, istraživanje, klinička etika, kliničke etičke konzultacije, Hrvatska.
IVA SORTA BILAJAC1, MORANA BRKLJAČIĆ ŽAGROVIĆ2
1
Department of Social Sciences and Medical Humanities, University of Rijeka
School of Medicine, Rijeka, Croatia
2
Polyclinic Sv. Rok, Zagreb, Croatia
1
[email protected]
2
[email protected]
Clinical Ethics in Croatia
Clinical ethics is defined as the ethics of clinical practice, and it deals with
ethical issues arising from the ongoing, daily care for the patient. It is based on
intensive connection between clinical practice and education in biomedicine,
health and bioethics.
According to the „Encyclopedia of Bioethics“, the most important features of
clinical ethics are: focus on the questions of ethics in the continuous, daily care
of the patient; theoretical discussions about different models of ethical decisionmaking in practice; equating the importance of ethical issues in medical practice
with education and research. From these features goals of clinical ethics can be
derived: development of guidelines for education, development of guidelines for
research, development of models of ethical decision-making in clinical practice.
This presentation will focus - on the track of the aforementioned goals - on
the three key developmental moments of clinical (medical) ethics in the Croatian system of biomedicine and health care: the development of the content
41
of medical (clinical) ethics in the curriculum of medical schools since 1991 till
today; establishment of a moral-legal framework for the conduct of research and
to ensure good clinical practice, with special reference to the Croatian Act on
the Protection of Patients‘ Rights from 2004, and the place and role of informed consent; clinical ethics consultations - development, place and role of ethics
committees.
Finally, the authors wish to emphasize the need to approach the European
(and other international) standards, on the threshold of Croatian accession to
the European Union.
Key words: clinical ethics, clinical ethics consultation, Croatia, education,
research.
LUKA TOMAŠEVIĆ
Katolički bogoslovni fakultet Split, Svučilište u Splitu
[email protected] Ruska bioetika iz pravoslavne teološke perspektive
I u ruskom postkomunističkom društvu osjetila se potreba stvaranja bioetike.
Naime, i u Rusiji su se pojavljivala velika etička pitanja koja je izazivala medicina,
posebice je to bilo pitanje abortusa, kao i pravedne raspodjele državnih medicinskih sredstava. Dakle, i u Rusiji bioetika svoj hod započinje u medicinskoj etici
ili kliničkoj bioetici.
U njezinoj pozadini stoji i teološko promišljanje etike i života Ruske pravoslavne Crkve koja je u više navrata intervenirala kod Vlade, a izdala je i svoj Dokument o socijalnim pitanjima gdje je jedan broj posvećen bioetici.
Autor pokušava rekonstruirati početak bioetike u Rusiji, nadasve stav Ruske
pravoslavne Crkve, ali nastoji ponuditi teološku etičku pozadinu ruske pravoslavne misli koja se temelji na Svetom pismu i Predaji.
Ključne riječi: bioetika, Rusija, kršćanstvo, pravoslavlje, medicina, teologija,
tradicija,etika.
42
LUKA TOMAŠEVIĆ
Catholic Theological Faculty Split - University of Split
[email protected] Russian Bioethics from Orthodoks Perspectives
There was a need for creating bioethics in the Russian postcomunistic society.
Namely, important bioethical issues emerged in Russia too, specially emerged
the issue of abortion and the fair distribution of national medical recourses. Accordingly, we can say that bioethics in Russia begins with the medical or clinical
ethics.
There is theological reflection on ethics and life of Russian orthodox church
repeatedly intervened with the goverment on those issues and they also published The Document on Social Issues, whose one issue is dedicated to the bioethics. The author tries to reconstruct the beginning of bioethics in the Russia,
specially the stand of Russian orthodox church. The author aims to offer the
theological, ethical background of Russian orthodox thought which is based on
Holy Scripture and Tradition.
Key words: Bioethics, Russia, Christianity, Orthodox Christianity, medicine, theology, tradition, ethics
JAMES E. TROSKO
Michigan State University, College of Human Medicine, USA
[email protected] Role of a New View of Human Nature in Global
and Deep Bioethics
It has been said: “Every ethic is founded in a philosophy of man and every
philosophy of man points towards ethical behavior.” ( James Drane, 1972) Given that we live in a pluralistic world of hundreds of religions, philosophies of
life and in grossly different physical and cultural environments, but all sharing
the same life-limiting laws of nature, we are now witnessing a major collision
43
between these non-life –sustaining human moral behaviors and the immutable
natural life-sustaining natural laws. This was clearly seen by Henry Bent when
he stated: “It is said there is a clear distinction between natural and human laws.
Natural laws always hold; they are descriptive, while human laws can be broken; they
are prescriptive. But the two kinds of laws are not totally separate- human laws must
not demand the physically impossible; they must recognize and be based on the laws
of nature that cannot be broken. Human laws also tend to be overthrown if they go too
far against human nature- if they are inhuman or grossly unreasonable…So the “Is”
and the “Ought” aren’t as clearly separable as a neat classifying mind might wished.”
(Henry Bent, 1975) That is what Dr. Van Rensseleaer Potter had in mind when
he coined the terms, “Bioethics”, Global Bioethics”, and “Deep Global Bioethics”. With all these various culturally-shaped, non-life-sustaining views of human
nature fueling “moral” behavior that is rapidly destroying the physical world, on
which all life depends, a universal- and trans-cultural- view of human nature is urgently needed. Only one trans-cultural means of knowing will be able to provide
a scientifically –accepted view of human nature. Therefore, the goal should be to
access, from each branch of science, the understanding of the biology of human
nature. With human nature being the result of the fusion of the “primitive and
modern” brain, human beings have created a global environment with human
and ecological stresses with his biologically-determined ability to use abstractions, to communicate those abstractions with symbols, to translate those abstractions into “things”, and to be able to “value” those things,. With the cultural
inheritance of the myth that science can only determine the way the world “is”,
while the humanities, social sciences, lawyers, philosophers, and theologians,
who normally do not have a scientific view of human nature or of the nature of
the philosophy of science, must determine the way the world “ought to be”. It
is this class of individuals, in position of global-, national-, and local- political
power, who continue to make major decisions of the use (or non-use) of scientific knowledge and technology for the earth’s inhabitants. As a result, They
have created a non-scientifically-based cultural environment that is affecting
the human being’s ability to survive. In effect, cultural evolution is occurring far
more rapidly than biological evolution of his ability to adapt to ever-changing
physical, psycho-social or cultures. It is time, now, that cultural, religious, ethnic,
and racial differences integrate scientific views of human nature into their “world
views” of human nature. It will be a matter of re-inventing new images of each
traditional view of human nature, so that new prescriptions of moral behavior
will not contradict life-sustaining natural laws.
44
DINKO VITEZIĆ, JASMINKA MILINOVIĆ, ARIJANA
LOVRENČIĆ-HUZJAN, VLADIMIR BORZAN, VLASTA
BRADAMANTE, JOSIP ČULIG, MENSURA DRAŽIĆ,
VIKTORIJA ERDELJIĆ, BORIS FILIPOVIĆ GRČIĆ,
MISLAV GRGIĆ, NEVEN HENIGSBERG, ANTONIO
JURETIĆ, KATICA KNEZOVIĆ, DAVOR MILČIĆ,
SUZANA MIMICA MATANOVIĆ, MARIJA PEĆANAC,
NADA RUSTEMOVIĆ, MIROSLAV SAMARŽIJA, MELITA
ŠALKOVIĆ-PETRIŠIĆ, EDUARD VRDOLJAK
[email protected]
Središnje etičko povjerenstvo, Hrvatska
Etička procjena kliničkih ispitivanja u Hrvatskoj
Klinička ispitivanja (KI) u ljudi treba provoditi u skladu s etičkim načelima koja
imaju svoje temelje u Helsinškoj deklaraciji te su u skladu s načelima dobre kliničke
prakse (DKP) i zahtjevima iz navedenih propisa. Prema ICH E6 smjernice o dobroj
kliničkoj praksi neovisno etičko povjerenstvo štiti prava, sigurnost i dobrobit svih
ispitanika uključenih u klinička ispitivanja, a s posebnom pozornosti na ona ispitivanja koja mogu uključiti ispitanike iz vulnerabilnih skupina. KI se u Hrvatskoj
provode i u skladu s lokalnim zakonima (Zakon o lijekovima, Pravilnik o kliničkim
ispitivanjima i dobroj kliničkoj praksi), koji su u skladu s europskim zakonodavstvom, a Ministarstvo zdravlja daje konačno regulatorno odobrenje za provođenje
KI. Od 2004. godine sva KI u Hrvatskoj moraju biti pregledana od strane Središnjeg
etičkog povjerenstva (SEP) i pozitivno mišljenje treba biti izdano prije započinjanja
KI. SEP ima 19 članova, uključujući liječnike iz različitih područja medicine, predstavnike bolesnika, teologa i pravnika. Tijekom postupka procjene SEP razmatra
znanstvene i etičke aspekte ispitivanja, uključujući i kvalifikacije istraživača, ustanove, osiguranje te financijske aspekte istraživanja. Dodatno je potrebno mišljenje
povjerenstava za pedijatriju i psihijatriju Ministarstva zdravlja za KI koja se planiraju
provesti u tih specifičnih vulnerabilnih skupina bolesnika. Mišljenje o kliničkom
ispitivanju mora biti izdano u roku od 30 dana od datuma valjanoga zahtjeva. Dodatna mišljenja su potrebna za svaku veliku izmjenu u planu KI. SEP je od prosinca
2007. godine odgovoran i za davanje mišljenja o neintervencijskim ispitivanjima.
45
SEP je, u skladu s dobro definiranim postupkom, izdao pozitivno mišljenje
za 617 kliničkih ispitivanja (od svibnja 2004.). U prosijeku je tijekom protekle
tri godine odobreno 80 KI godišnje. Najveći broj KI je u području onkologije
(144), mentalnih i bihevioralnih poremećaja (93) te endokrinih, metaboličkih i
poremećaja prehrane (81).
Zaključno, model centralizirane procjene kliničkih ispitivanja, proveden od
strane Središnjeg etičkog povjerenstva kao neovisnog tijela, potvrdio se tijekom
posljednjih osam godina kao prikladan za Hrvatsku.
DINKO VITEZIĆ, JASMINKA MILINOVIĆ, ARIJANA
LOVRENČIĆ-HUZJAN, VLADIMIR BORZAN, VLASTA
BRADAMANTE, JOSIP ČULIG, MENSURA DRAŽIĆ,
VIKTORIJA ERDELJIĆ, BORIS FILIPOVIĆ GRČIĆ,
MISLAV GRGIĆ, NEVEN HENIGSBERG, ANTONIO
JURETIĆ, KATICA KNEZOVIĆ, DAVOR MILČIĆ,
SUZANA MIMICA MATANOVIĆ, MARIJA PEĆANAC,
NADA RUSTEMOVIĆ, MIROSLAV SAMARŽIJA, MELITA
ŠALKOVIĆ-PETRIŠIĆ, EDUARD VRDOLJAK
Central Ethics Committee, Croatia
[email protected]
Ethical Evaluation of Clinical Trials in Croatia
Clinical trials (CT), which involve human subjects, should be conducted in
accordance with the ethical principles that have their origin in the Declaration
of Helsinki, which are consistent with Good Clinical Practice (GCP) and the
requirements of these Regulations. According to the ICH E6 Guideline on Good
Clinical Practice, an independent ethics committee safeguards the rights, safety,
and well-being of all clinical trial subjects, with special attention to trials that may
include vulnerable subjects. CT in Croatia are conducted in accordance with local laws (Drug law, and specific acts), which are in accordance with European
legislation, and the Ministry of Health gives a final regulatory approval for CT.
Since 2004, all clinical trials in Croatia have had to be reviewed by the Central
46
Ethics Committee (CEC) and a favourable opinion must be issued before a clinical trial commences. The CEC has 19 members, including medical doctors from
various field of expertise, a representative of patients, a theologian and a lawyer.
During the procedure, CEC assesses scientific and ethical considerations of the
trial, including qualifications of the investigators, institutions, the insurance, and
the methods and amounts of payments. The opinion of the Ministry of Health
Paediatric and Psychiatric Committee is needed for CT in these specific vulnerable groups of patients. Opinions on clinical trials have to be issued in 30 days
from the date of a valid application. The opinions are also given for substantial
amendments to the trial and every additional investigational site has to be approved by the Committee. Since December 2007, the CEC has also been responsible for issuing opinions on non-interventional trials.
According to a defined procedure and discussion, the CEC positive opinion
has been given to 617 clinical trials (since May 2004). During the last three years
80 clinical trials per year in average have had a positive opinion from the CEC.
The greatest number of clinical trials has been in the field of oncology (144),
mental and behavioral disorders (93), and endocrine, nutritional, and metabolic
diseases (81).
In conclusion, the model of centralized clinical trial assessment through the
Central Ethics Committee, as an independent body, has been confirmed during
the last eight years as appropriate for Croatia.
ANA VOLARIĆ MRŠIĆ
Sveučište u Zagrebu, Hrvatski studiji
[email protected]
Promicanje kliničke bioetike putem mas medija u
Hrvatskoj
Potaknuti čestim medijskim sadržajima koji se bave bioetikom, došlo je vrijeme da se bioetičari počnu posvećivati i sustavnom proučavanju mogućnosti
koje pružaju nove medijske tehnologije, kao i medijska istraživanja u svrhu
kvalitetnijeg promicanja bioetike kao znanosti.
47
Bioetika kao relativno mlada znanstvena disciplina, stara tek tridesetak godina, svojim munjevitim razvojem i difuznim širenjem u znanstvenim krugovima i
institucijama, jasno pokazuje da je ravnopravni partner u znanstvenim raspravama kada su u pitanju sve one grane znanosti koje dotiču čovjeka i biosferu.
Multidisciplinarni i „integrativni“ karakter bioetičke znanstvene metode
proučavanja suvremene stvarnosti, čak se i etimološki uklapa u sva ona događanja kojima je cilj proučavanje društvenih pojava i inovacija, pa tako i na planu
sredstava društvene komunikacije. Naime, novinarska struka je i najzaslužnija za
tako munjevito širenje bioetike u sve društvene sfere, jer su upravo novinari bili
najbrži suradnici u prenošenju bioetičkih rasprava u najširu javnost od samih početaka.
Taj se trend zadržao do danas, tako da su upravo djelatnici u medijima i svi
koji se bave medijskom mrežom najbliži suradnici u prenošenju bioetičkih informacija. Zbog toga bi trebalo posvetiti više pažnje upravo stručnoj izobrazbi
novinara u bioetičkom smislu, kako bi oni koji se bave ovom vrstom novinarstva
zaista profesionalno obavljali svoju službu, dajući kliničkoj bioetici ono mjesto
koje joj pripada, tj. znanstveno utemeljenje u okviru svih ostalih znanstvenih
disciplina kao što su medicina, biologija, sociologija, filozofija itd. Također će
umijeće u korištenju tehnoloških dostignuća na planu medijske komunikacije
uvelike pomoći bioetičarima da znanstveni razvoj kliničke bioetike bolje približe
široj medijskoj publici.
Ključne riječi: nove medijske tehnologije, bioetika, medijska publika
ANA VOLARIĆ MRŠIĆ
University of Zagreb, Croatian studies
[email protected]
Promulgation of Clinical Bioethics through Mass
Media in Croatia
Encouraged by the frequent media content on bioethics, the time
has come for bioethicists to begin to dedicate themselves to a systematic study of the possibilities offered by new media technologies,
48
and media research in order to better promote bioethics as a science.
Bioethics as a scientific discipline is relatively young and its lightning development and spreading diffusion in scientific circles and institutions, clearly show
that it is an equal partner in the scientific debate when it is a question of branches
of science which relate to man and the biosphere.
The multidisciplinary and „integrativ“ character of the bioethical scientific
method of studying contemporary reality, even fits ethimologically into all those
events whose aim is the study of social phenomena and innovation, and into the
plan of means for social communication. In other words, the journalistic profession is most to be credited for the lightning spreading of bioethics, and in particular clinical bioethics in all social spheres, because it is precisely the journalists
who were the speadiest collaborators, from the very beginning, in transmitting
the bioethical debate in the widest public forum.
That trend has continued until today, so that those who work in the media,
and all who are involved in the croatian’s media network, are the closest collaborators in transmitting bioethical information. Therefore, we should pay more
attention to the professional training of journalists in terms of clinical bioethics,
so that those who are involved in this sort of journalism can really perform their
services professionally, giving bioethics that position which belongs to it, that is
the scientific foundation in the context of all other scientific disciplines such as
medicine, biology, sociology, philosophy etc. Also the skill in using all advances
in the field of media communication will greatly increase the help to bioethicists
so that the scientific development of clinical bioethics can be brought closer to
the wider media audience.
Key words: new media tecnologies, bioethics, audience
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SUZANA VULETIĆ
Katolički Bogoslovni Fakultet, Sveučilište Josip Juraj Strossmayer u Osijeku
[email protected]
Moralno-bioetičke prosudbe suvremenog
biomedicinskog napretka
Moderna biomedicina, obilježena je novim znanstvenim saznanjima, visoko sofisticiranom opremom i nizom učinkovitih terapeutskih, tehničkih i
farmakoloških mogućnosti. Ona je tim povećala kvalitetu življenja, zadovoljstvo,
sigurnost i zdravlje ljudi. I zahvaljujući tom, ima istaknutu i respektabilnu ulogu
u životu suvremenog čovjeka.
No, današnja se biomedicina više ne ograničava svojom tradicionalnom
usmjerenošću da samo potpomaže ljudski život u trenucima njegove patnje i
boli, već nastoji potpuno zagospodariti ljudskim životom, genetskom programiranošću i biotehnološkom održivošću.
Pojam progresa u kontekstu biomedicinskih znanosti nudi veoma prodorna
i ljekovita sredstva poput mogućnosti kontrole ljudskog rađanja i umiranja, te
konstantnog životnog razvojnog procesa, dovodeći na taj način u pitanje mogućnost točnog utvrđivanja i/li određivanja svih momenata fizičkog života: njegova
početka, razvoja i kraja.
Zahvaljujući znanstveno-tehnološkoj integraciji unutar biomedicinskih znanosti, postalo je ostvarivo kreirati život u laboratoriju s mogućnostima intervencija na njegovoj nasljednoj genskoj arhitektonici, tehnološki održavati život na
ventilacijskim uređajima, kontrolirati taj isti život, istraživati ga, dopirući do najsitnijih dijelova atoma organizma, manipulirati njime i proizvoljno ga okončavati, ili zamrzavati do trenutka kada će „svemoguća“ medicina biti u stanju ponuditi
čovjeku „mit medicinske besmrtnosti“.
Neki od uobičajenih moralno-bioetično upitnih intervenata suvremene biomedicine prisutni su, tako, na svim ovim područjima:
–– područje ljudske prokreacije: je lišeno svoje izvorne potrebe za: bračnom svezom, odgovornog roditeljstva (sterilizacijom, kontracepcijom),
potrebe za drugim (medicinski pot/pomognutim oplodnjama, kloniranjem…); i nudi se mogućnost izbora kontracepcije (u širokoj farmakološkoj ponudi: interceptiva, kontragestativa, abortiva).
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–– područje genetike: na području ljudskog genoma učestale su brojne
upitne intervencije genetskim inženjeringom, uvidom u mapu gena,
modificiranjem genetičke informacije, genskom terapijom, genotipskom selekcijom, ‚terapeutskim‘ i reproduktivnim kloniranjima, eugenikom/poboljšanjem i alteriranjem nasljednjih svojstava kao i genetičkom
samo-regulacijom čovjeka koja vrednuje ljude njihovim genetskim profilom, propagirajući ideologiju genetskog determinizma koja vodi prema
genetičkoj diskriminaciji.
–– područje embriološkog stadija: ugroženo je nedefiniranošću statusa već
začetog djeteta teorijama progresivne humanizacije i ostalih bioloških
redukcionizama kojima je doveden u pitanje antropološko/pravni status
ljudskog embrija. Učestali su i moralno etički upitni eksperimentalni
zahvati na embrijima, istraživanjima na matičnim stanicama, njihovo zamrzavanje/kriokonzerviranje. Prisutne su brojne mogućnosti intervencije prenatalne dijagnostike (terapeutskih, istraživačkih ili alteracijskih
ciljeva), kao i nametnutog ili zatraženog abortusa suvremenih oblika
eugenike.
–– područje razvojnog stadija: obilježeno je procjenom života po kriterijima kliničke kvalitete života i ekonomskih jednadžbi zdravstvenog menadgmenta vođenog cost-benefit logikom ulaganja u zdravstvenu asistenciju. Ljudski život se podvrgava raznim proizvoljnim/neutemeljenim
znanstvenim pokusima istraživalačke znatiželje i pred/kliničkim istraživanjima koja se kose s poštivanjem ljudskog dostojanstva. Prisutno je i
trgovanje ljudskih organa, alterirajuća uporaba cyborg biomedicine, medicinskih asamblera i ostalih arteficijalnih organa, kao i eksperimentalna
nanotehnologija.
–– područje života u terminalnoj fazi: označeno je kontrolom i hiperdozom analgetičnog suzbijanja boli, terapijske upornosti (pitanje ne/
razmjernih sredstava), palijativnog liječenja, utvrđivanja smrti, presađivanja organa, eutanazije, distanazije, biološke oporuke anticipirane i
samodeterminirane smrti.
Tim primjenama biotehnološkog napretka na području biomedicine, pobuđene su mnoge nade, ostvarene zapanjujuće učinkovitosti, ali i potaknuti novi
bioetički strahovi mogućnostima intervencije nad ljudskim bićem, kako je proročki još davnih godina upozoravao pok. Prof. Šegota.
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Sva ova nabrojena dostignuća su istovremeno fascinirajuća i zastrašujuća, te
zahtijevaju svoja ograničenja, ukoliko nadilaze temeljne vrijednosti koje se moraju poštovati u promicanju i obrani svakog ljudskog života. I upravo je to moralna
zadaća integrativne bioetike!
U simbiozi, morala i biomedicine, teološko-etičkih principa i medicinske deontologije, moguće je ostvariti nove bioetičke kriterije koji će biti u stanju ukazati i očuvati apsolutnu vrijednost, nepovredivost i dostojanstvo ljudskog života
pred svim izazovima koji se nameću suvremenoj biomedicini.
Jedino u toj integrativnoj bioetičkoj objedinjenosti, biomedicina ima šanse
održati se u svojoj tradiconalnom poimanju, shvaćene kao ars sacra.
SUZANA VULETIĆ
Catholic Theological Faculty, University Josip Juraj Strossmayer of Osijek
[email protected]
Moral-Bioethical Evaluation of Contemporary
Biomedical Progress
Modern biomedicine is marked with new scientifically knowledge, highly sophisticated equipment and numerous effective therapeutical, technological and
pharmacological possibilities. These possibilities substantially raised the quality
of living, satisfaction, security and health of people. Due to those improvements,
biomedicine has prominent and respectable role in a life of contemporary humans.
However, today biomedicine is not limiting itself with the traditional orientation to help and to cure the human life in the moments of his great desperateness
of suffering and pain. Instead, its’ goal became to put under its control almost
complete domain of human life using its scientific progress of genetically programming and biotechnological sustainability.
The term of progress in the context of biomedical sciences is offering very
pervasive and successful resources, such as opportunity to control the human
birth and dying, as well as the possibilities of constant monitoring and intervening in the life in all developmental stages, what brings into the question the
52
accuracy of determination of all the moments of physical life: its beginning, evolution growth and its end.
Due to scientific - technological integration within the biomedical sciences,
it became possibility to create the life in laboratory with the interventional possibilities on its genetically architectonics. There is a possibility to technologically
sustain a life on the ventilation device, and to control that same life by many
clinical researches, outreaching the smallest part of the organism, to manipulate
and to arbitrarily terminate or to freeze (crioconservation) it, to the point when
“omnipotent” medicine would be able to offer a “myth of medical immortality”.
We are singling out some of the usual moral-bioethical questionable interventions of contemporary biomedicine present in all of these areas:
–– area of human sexuality: procreation is deprived from its original need
for: marriage bound; responsible parenthood (by sterilization, contraception), need for the other (by medical assisted procreation, cloning...).
There is also a quite wide option of variety contraceptive selection (interceptive, contragestatives, abortives).
–– genetically area: is commonly presented with numerous questionable
interventions by the genetically engineering, insight in genome map,
modification of genetically information, genetic therapy, genotypic selection, „therapeutically“ and reproductive cloning, eugenic/improvement and upgrading, an altering the hereditary properties, as well as by
genetically self-regulation of the human being, which evaluates people
by their genetic profile, propagating an ideology according to the model
of genetic determinism which lead to genetic discrimination.
–– area of embryonic stage: is compromised by today’s undefined status of
already conceived child through theories of progressive humanization
and other biological reductionism jeopardizing the question of legal/
anthropological and ontological status of human embryo. Questionable
are also moral-ethical experiments on embryos such as researches on
stem cells as well as technique of freezing/crioconserving. Problematic
are also many possible interventions of prenatal diagnostics and prenatal
selection (with different therapeutically, exploring and altering scopes),
or possibility of the “medical” request of imposed abortion of contemporary eugenic modes.
–– area of human developmental stage: is marked by the life valuation
according to the criteria’s of clinical quality and economical equation of
53
sanitary management ruled by the cost-benefit logic of investment. The
human life is subordinated to the different unfounded experiment of
research curiosity and pre/clinical trials which are often contradict with
the compliance of human dignity. Big bioethical problem is connected
with the human organ trading, altering use of cyber biomedicine, medical
assemblers and other artificial organs and experimental nanotechnology.
–– terminal life stage: is signified by the control and hyper-dose of analgesic suppression of the pain; therapeutically persistence (question of un/
proportional measures), palliative treatment, death establishment, organ transplantation, euthanasia, dysthanasia, patient self-determination
act, biological will of anticipated and self-determinated death.
Applications of mentioned biotechnological progress on the field of biomedicine, have raised many hope excitements and showed astonishing efficiency, but
also induced many new bioethical fears of those interventions within the human
life, as we heard the prophetic warning of prof. Šegota, already many years ago.
All those enumerated achievements are in the same time fascinating and
frightening, and they require warnings regarding their limitations, especially if
the contemporary achievements are crossing the border going beyond the basic
values which has to be respected by the promoting and defending every human
life. And that is exactly the moral assignment of integrative bioethics!
In the symbiosis of moral theology and biomedicine, theological and ethical principles as well as the principle of the medical deontology, it is possible to
establish a new bioethical criterion, which would be in position to indicate and
to preserve the absolute value, inviolability and dignity of life toward every challenge imposed by the modern medical progress.
Only in this integrative bioethical unification, a contemporary biomedicine
has a real chance to maintain her traditional understanding as an “ars sacra”.
54
Popis sudionika / List of participants
55
56
Adresar /
Adress Book
57
Tsuyoshi Awaya
Professor and Chairman
Department of Bioethics,
Graduate School of Medicine,
Dentistry and Pharmaceutical
Sciences,
Okayama University
2-5-1, Shikata-cho, Okayama, Japan
700-8558
Tel: +81-86-235-6742
Fax: +81-86-235-6619
Mobile:+81-90-3377-6800
[email protected]
http://homepage1.nifty.com/awaya
Mirela Bušić
Institute for Transplantation and
Biomedicine
Ministry of Health
The Republic of Croatia
Ksaver 200a
10 000 Zagreb, Croatia
tel: +385 (1) 460 7606
fax;+38514610841
http://www.mzss.hr/
Christian Byk
Secretary general - International
Association of Law, Ethics
and Science
19 rue Carpeaux, 75018 Paris
France
[email protected]
58
Marina Guryleva
Kazan Medical University
Butlerov str., 49,
Kazan, Russian Federation
Tel: (843)2364530
Fax: (843)2364530
[email protected]
Jelena Hrgović
Verbum, Split
[email protected]
Ana Jeličić
Sveučilišni odjel za forenzične
znanosti
Sveučilište u Splitu
Ruđera Boškovića 31
21000 Split
[email protected]
Ivan Petrov Kaltchev
Sofia University, Philosophical
Faculty
15 Tsar Osvoboditel Blvd, Sofia,
Bulgaria
Tel: 00359 9308 200
[email protected]
Yutaka Kato
Okayama University
Research Fellow, Japan Society for the
Promotion of Science
2-5-1, Shikata-cho, Okayama, Japan
700-8558
Tel: +81-86-235-6742
Fax: +81-86-235-6619
[email protected]
Jaro Kotalik
Professor, Northern Ontario School
of Medicine,
Lakehead University
Centre for Health Care Ethics
Room AC 123B
955 Oliver Rd. Thunder Bay, ON
P7B 5E1
[email protected]
Tatsuya Mima
Human Brain Research Center
Kyoto University Graduate School of
Medicine,
Shogoin Kawahara-cho54, Sakyo-ku,
Kyoto 606-8507, Japan
tel: +81-75-751-3602
Fax: +81-75-751-3202
[email protected]
Naoki Morishita
Professor of Ethics
Department of Integrated Human
Sciences
Hamamatsu University School of
Medicine
1-20-1 Handayama Higashi-ku
Hamamatsu 431-3192 JAPAN
Tel:053-435-2229;-2236 fax:053435-2236
email:[email protected]
Shigeru Mushiaki
Shujitsu University
Nishigawara 1-6-1, Naka-ku,
Okayama-shi, 703-8516 JAPAN
Telephone: +81-86-271-8147
Fax:+81-86-271-8147
[email protected]
Farida T. Nezhmetdinova
Kazan State Agrarian University
Head of Philosophy and Law
Department
K.Marks st., 65.
Tatarstan Republic 420015, Kazan
Russia
[email protected]
Louisa Pedri
Lakehead University Centre for
Health Care Ethics
955 Oliver Road, Thunder Bay, ON,
P7B 5E1
Tel: 807 983 3007
[email protected]
Gordana Pelčić
Department of Medical Humanities
and Social Sciences
University of Rijeka - School of
Medicine
B. Branchetta 20
51 000 Rijeka
Hrvatska/Croatia
59
Olga Popova
Institute of philosophy of Russian
Academy of sciences. 119992, Russia,
Moscow,
Volkhonka Str., 14
Scientific Center of Children’s Health,
Russian Academy of Medical
Sciences, Laboratory for Legal
Problems of Children’s Health Care
Tel.: (495) 697-90-67.
Fax: (495) 609-93-50.
[email protected]
Iva Rinčić
Assistant Professor
Department of Social Sciences and
Medical Humanities
University of Rijeka, School of
Medicine
Brace Branchetta 20
51 000 Rijeka, Croatia
Tel: +385-51-651-282 Fax: +385-51651-219
[email protected]
Hans-Martin Sass
Georgetown University
Kennedy Institute of Ethics,
Healy Hall, 4th Floor,
20016 Washington, D.C., USA
[email protected]
Marija Selak
Filozofski fakultet Zagreb
Ivana Lučića 3
[email protected]
60
Motomu Shimoda
Faculty for the Study of
Contemporary Society
Kyoto Women’s University
605-8501 Higashiyama Kyoto,
JAPAN
tel +81-75-531-9187
Osaka University Graduate School of
Medicine, Invited Prof.
[email protected]
Iva Sorta-Bilajac Turina
Assistant Professor of Medical Ethics
Department of Medical Humanities
and Social Sciences
University of Rijeka - School of
Medicine
B. Branchetta 20
51 000 Rijeka
Hrvatska/Croatia
tel: +385 51 651282
fax: +385 51 651219
[email protected]
Michael (Cheng-tek) Tai
Chair professor of medical
Humanities and ethics
Chungshan Medical University,
Taichung.Taiwan.
office phone: +886-4-2473-0022
ext.12146
[email protected]
Luka Tomašević
Catholic Theological Faculty Split University of Split
Zrinjsko-Frankopanska 19
Tel: 021/541714
[email protected]
James E. Trosko, Ph.D.
Department of Pediatrics/Human
Development
College of Human Medicine
Michigan State University
East Lansing, Michigan 48824
Tel: 517-884-2053
[email protected]
Dinko Vitezić,
Central Ethics Committee, Croatia
[email protected]
Vuletić Suzana, PhD
Assistant Professor
Catholic Theological Faculty in
Đakovo, University Josip Juraj
Strossmayer of Osijek
Petra Preradovića 17, 31400 Đakovo
[email protected]
61
Skup su potpomogli: / The conference was sponsored by:
Medicinski fakultet Sveučilišta u Rijeci /
University of Rijeka, Faculty of Medicine, Rijeka, Croatia
Republika Hrvatska, Ministarstvo zdravlja /
Ministry of Health, Croatia
Primorsko – goranska županija /
Primorsko – Goranska County
Grad Rijeka /
City of Rijeka
Vivera d.o.o.
Alkaloid d.o.o.
Jadranski galenski laboratorij d.d. Rijeka /
Jadran Galenic Laboratory, Rijeka
Poliklinika Medico, Rijeka /
Medico Polyclinic
Turistička zajednica općine Baška /
Municipality of Baška Tourist Board
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