Reception and transformation of bioethics in Croatia

Jeličić, Ana. (2016). Reception and transformation of bioethics in Croatia. PhD Thesis. Filozofski fakultet u Zagrebu, Department of Philosophy.
(Poslijediplomski doktorski studij filozofije) [mentor Čović, Ante].

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Abstract

The history, emergence and development of bioethics are very difficult to reconstruct both at the global and the regional level. However, it is not our aim to detect the birth of bioethics, to deal with the chronological data or to locate the exact place where it came from, despite of our wish to analyse the philosophical and social background, and the atmosphere that motivated the birth of a new ethical consciousness, and to reconstruct and valorise the reception and the transformation of bioethics in Croatia. However, it is important and necessary to detect places where new ethical doubts first manifested, where new questions came to life and perceived the ways in which they were shaped over time. Because of this, it is difficult to talk about the historical emergence of bioethics, but we can talk about different sources and directions as well as the development phases of bioethics in the world and in Croatia. The relationship between man and nature was actually distorted by the advancement of science and technology. The man of the nineteenth century seemed impossible and unimaginable to do what the man of the twentieth century did. At the technological level, changes have only been noticeable in recent years, but scientifically they have started much earlier and have actually prepared a field for technological development. The paradigm of knowledge by Francis Bacon was built on the postulates of empiricism and rationalism, reducing the image of the world, man and life to a mechanistic and materialistic perception. The paradigm “knowledge is power” overwhelmed the antique perception in which knowledge was identified with the good and virtue. The power of the new science is at the forefront of human–nature relations. He wanted to emphasize the right of man to dominate over the nature. New technological achievements and technological development throughout the 20th century enabled man to work faster, more precisely, more efficiently, to expand the scope of his work. The objects of his knowledge also expanded. In the short term, man has lost control over technological progress. Man’s technological awareness in the postindustrial age was no longer an ethical one, the one that was behind the competences of a man who built a science-technological civilisation. There was a big problem in that gap, but also that gap was a challenge of creating a new ethics. Ethics for the future. Observing the civilisation, and then the ethical discrepancy, the philosopher Hans Jonas has come up with a new ethics witch he built on fear of what jeopardizes man. Recognizing the possibility of destroying man H. Jonas built new ethical principles. He was caught up with new human activities that required new ethical reflections and concrete steps in ethics that, in the future, would be based on new principles that would fit the scientific and technical civilisation and that would prepare a ground for a new civilisation. One of these principles, most important, is the responsibility that has two fundamental roots: toward nature, not just the humans, and toward future, the future generations, survival and existence of life. H. Jonas measured the consequences of (scientific) research and activity not only in relation to man and his survival, but on all other living beings and on life in general, which was a kind of originality. The originality of his thought was in this expansion of personal responsibility to the future world or the world in the future and the belief that every form of life has a value in itself that is manifested in the aspiration for self-preservation and survival. This understanding of life has contributed to the shift from the anthropocentrism of modern science and philosophy under the influence of natural sciences towards biocentrism. The new ethical command, introduced by Hans Jonas was to work so that the effects of our actions are not devastating for the future possibility of life. Similarly, the German philosopher Vittorio Hösle began to think about a new ethics that would help a man to cope with new scientific and technical challenges and to orient himself in the new world. He detected the ecological crisis that resulted from the irresponsible relationship with nature, the irrational exploitation of nature or the indifference towards it. In short, because of the three factors: the chances of unlimited possibilities; the desire to exceed each quantitative limit and because of distorted relationship with nature. Hence, within philosophy, he developed ethics that would be necessarily ecologically oriented, and therefore universal, because he considered ecology a factor that could unite fragmented knowledge and place it in the interest of the common good. The goal of philosophy is, first of all, to overcome the hostile relationship between man and nature and to build new (ecological) systems that would be the foundation of political and economic activity. Apart from philosophers, new ethical consciousness can be recognized in thought of many theologians who have become involved in the new ethical discourse. Speaking about theological attempt to respond to the challenges of the contemporary world in the light of the birth of a new ethical consciousness, we pointed out the Swiss theologian, Hans Küng. The conditions of survival and survival of man on earth in human and civilized conditions H. Küng saw in inter-religious dialogue. First of all, he tried to reconcile religious beliefs or different worldviews with the intention of contributing to world peace. Therefore, he began with ecumenical theology as a factor of unification and a prerequisite of unity and peace, to continue his work by developing ethics. Despite various ethical traditions, there are common norms, values, ideas and goals that are acceptable and recognizable to most societies. H. Küng took this fact as the starting point of his scientific-research and social-cultural work that could concentrate on two major tasks: peace among religions and the development of global ethics, both united in the Project’s world ethos. The Project was based on three theses: there is no progress of the human race without world ethos; there is no world peace without religious peace and no religious peace without religious dialogue. However, philosophers and theologians were not the only one to take care of the future of man. The power of human activity in one historical moment of the scientific and technological era has grown especially in the field of medicine. In the seventies of the twentieth century, people witness the technicisation of medicine, its dehumanisation, which was due to new technical and scientific achievements especially in biomedicine that enabled new kinds of human intervention in (human) nature. Physicians were increasingly subject to criminal law because of their omissions. Specialisations in medicine were tighter, and like other activities they increasingly perceived market demands. With the development of technology, medical personnel have been given new medical instruments, devices that facilitated their diagnostics and rehabilitation procedures and processes, enabling them new ways of treating the disease, but also giving patients more hope for healing. Technology in medicine unquestionably made it easier for physicians and medical staff to do their job. Technology opened up their work space which brought new problems, and then a new sense of responsibility. In larger society that provoked activities and movements with the goal to promote the rights of the patient. New ethical doubts required new solutions, and they were made by ethical committees that were bent on new laws, codes, regulations, and declarations. Regardless of the reasons for their establishment, various new ethical commissions assist physicians by taking over part of their responsibilities. The wave of new thinking in health care, as a system that faces numerous ethical doubts, has been launched by American journalist Shana Alexander, who in 1962, in the renowned American magazine Life, published an article titled Medical miracle and a moral burden of a small committee. They decide who lives, who dies. Presenting this particular case and other ethical-medical problems to the public health problems of individuals presented in media has become an indicator of the new social consciousness and the cultural and moral development of individuals and communities. The public has begun to help ethical hospital commissions, to interfere in their decisions, to dialogue about the most important and most difficult moral dilemmas in medical practice, which has greatly influenced wider social affairs. First steps from the traditional to a new ethics in medicine happened inside ethics committees in the 1960s and 1970s. Scientific and technological progress manifested itself through the establishment of a growing number of ethical commissions of interdisciplinary character and the introduction of a new medical ethics course at the medical faculty around the world. The pioneers of inventive interdisciplinary approach to new medical problems are actually the bases of the various developmental lines of a new ethics in medicine, which later adopted the name of bioethics, and why the new medical ethics is considered by many to be the first stage in the development of bioethics. The first step towards bioethical institutionalisation is officially recognized by the Dutch obstetrician, demographer and physiologist André Hellegers. He introduced in his biomedical research an ethical dimension which resulted in the founding of an institute called Joseph and Rose Kennedy Institute for Human Reproduction and Bioethics, using the term bioethics for the first time in the name of an institution. The Kennedy Institute at Georgetown University in Washington (USA) was the first institute to introduce bioethics into its study program as a human reproduction study. The philosopher Daniel Callahan closely collaborated with André Hellegers, who in 1969 together with psychiatrist Willard Gaylin founded The Hastings Centre in New York, the first American and thus the World Institute for Bioethics. What marked the initial developmental stage of bioethics (new medical ethics) was the principality. Tom Beauchamp and James Childress played the leading role this stage of bioethics development with their book Principles of Biomedical Ethics. Following this chronological sequence, it emerges that bioethics was born within health institutions (clinical bioethics) and within medical university programs (academic bioethics) where bioethical principles were adopted at medical faculties within the subject of new medical ethics. In this first phase of development of the new medical ethics, bioethics was determined by principality and was called Georgetown bioethics, while the subject of bioethics was limited to health care and biomedical research. However, research suggests that such perception and bioethics definition largely moved from the notion of bioethics that was created by Van Rensselaer Potter II, an American biochemist and oncologist from Wisconsin University in Madison, who create the term bioethics. In 1962, he expressed concern about dangerous knowledge that was not followed by wisdom, and dangerous scientists whose purpose is to supervise and control everything. Reflecting on the new scientific and social situation, V. R. Potter wondered about the boundaries of science and scientists. With these questions and concerns and also with fear, V. R. Potter began to build a vision of the bridge to the future that would be later called bioethics (Bioethics. Bridge to the Future, Prentice Hall, Englewood Cliffs, NJ, 1971), although the term bioethics was used for the first time a year ago (“Bioethics: The Science of Survival”, Perspectives in Biology and Medicine, 14/1970, pp. 127–153; “Biocybernetics and Survival”, Zygon – Journal of Religion and Science, 5/1970, pp. 229–246). Terminologically, the word bioethics is conceived as a bridge that combines bios and ethos, humanistic with natural sciences, ethical values with biological or biomedical facts. On the other hand, with its meaning, bioethics has become wisdom or knowledge of survival, the condition of survival on earth, a specific form of moral reflection, and a new opened area ofthinking about the possibilities of survival of life and man and in the end a new discipline in relation to medical ethics. From today’s point of view, we are talking about the so-called Potter’s bioethics that has experienced internal development, from the phase of so-called bridge bioethics to the stage of global bioethics. In this second phase of development, bioethics has been methodologically defined through ethical pluralism and scientific interdisciplinarity, while in the subject matter it encompassed all the questions concerning life in all its forms. The new medical ethics has been tied with Catholic moral theology, because the principles of moral theology have gradually begun to apply in medical ethics, beginning with the complicated relationship between physician and patient. Great support to all the moral theologians, in that time has come from Pope Pius XII. Who showed great interest in new ethical dilemmas? Today many consider this Pope to be the founder of Catholic bioethics. The encyclical of Pope Paul VI Humanae vitae has been published in 1968 and for many reasons even today is considered as an important material in field of bioethics. About 20 years later (1984) Archbishop Elio Sgreccia began teaching the first lectures in bioethics at the Catholic University of Sacramento, and thus struck the foundations of institutionalisation of Catholic bioethics or bioethical education at Catholic universities. Pope John Paul II became one of the guides in Catholic bioethics. His thought in field of bioethics we can find in Evangelium vitae (1995). In this important bioethical document of ecclesiastical teaching, Pope wrote beautiful word regarding to sanctity of life, and called for inviolability and defence of life in all circumstances. Through theological-pastoral activity inspired by the aforementioned encyclicals from the Second Vatican Council, as well as frequent and contentious speeches of Pope to physicians and medical staff in the middle of the last century, Croatia has started to create a climate suitable for accepting and spreading bioethics. The Homeland War also contributed to that. The embryonic developmental phase of bioethics in Croatia began in the mid-eighties of the last century (1986) at the Faculty of Philosophy of the Society of Jesus in Zagreb with the credit of Professor Valentina Pozaić who founded the Centre of Bioethics which had a rich bioethical publication and activities related to bioethical issues within the new medical situations. His close associates were members of the Croatian Catholic Medical Society. On the other hand, Professor Ivan Cifrić, from the Department of Sociology of the Faculty of Humanities and Social Sciences at the University of Zagreb, extends bioethics in sociological circles and links it with ecological issues. In 1997, he organized a conference Bioethics – Ethical Challenges of Science and Society. Professor Nikola Visković, from the Faculty of Law at the University of Split, calls for legal regulation of the relationship between man and animals, but also on the ethical responsibility that people have to extend to inhuman living beings. Professor Tonči Matulić, on the other hand, gave a big effort to contribute to the bioethicisation of the Croatian public. Catholic newspaper Glas Koncila, launched in 1999 his column Guidebook for Bioethics. Later, bioethics as an interesting research area was recognized by other theologians in Croatia, such as Professor Luka Tomašević, who deals with integrative bioethics from the theological perspective. Within the education system and social sciences, bioethics is first placed in Croatia at the Faculty of Medicine of the University of Rijeka at the Department of Social Sciences, thanks to Professor Ivan Šegota. From today’s perspective, one editorial work of Ivana Šegota is particularly distinguished. In 1996, in scientific journal Društvena istraživanja he edited a thematic issue “New Medical Ethics”. There I. Šegota presented bioethics as a new medical ethics. That influenced the perception of bioethics as a new medical ethics in its early stage of development in Croatia. I. Šegota and his associates (e.g. Nada Gosić) developed a more systematic bioethical education. The most important result of bioethical education was the new awareness of personal ethical responsibility so necessary to new generation of physicians and other medical personnel who had the opportunity for the first time in the history of Croatian universities to attend a course of new medical ethics or bioethics at the Rijeka Medical faculty in the early nineteenth century. Professor I. Šegota started publishing Bioetički svesci in 1999 at Department of Social Sciences on his Faculty, which increased significantly the public interest in bioethical issues. On the other hand, the development of integrative bioethics in Croatia has its own history. In 1998, in the framework of the scientific-cultural event Days of Frane Petrić in Cres, was organized a symposium under the title The Challenges of Bioethics, and three years later in Mali Lošinj, also in the framework of the Days of Frane Petrić, an international symposium Bioethics and Science in the New Epoch, which was a turning point in the development of bioethics in Croatia. These gatherings, besides being strictly conceived and constructed according to the principle of interdisciplinary, brought together almost all the scientists who were dealing with bioethical issues, contributing to their mutual acquaintance, networking, and to jointly create and realize further steps towards establishing bioethics in these areas. The path was not simple and required much effort, establishing and continually strengthening international cooperation, institutionalizing of bioethics, sensibilisation of the public for bioethical issues, persistent work on educational models of bioethics and designing numerous scientific-research projects in favour of developing and spreading the concept of integrative bioethics in South East region of Europe and the world. Croatian scientists at this conference demonstrated their willingness to dialogue and accept different methodological approaches to individual bioethical subjects, thus opting for methodological pluralism at the expense of initial American bioethical principality. The conference The Challenges of Bioethics, thanks to the initiative of Professor Ante Čović, set the foundation for building a platform for a richer bioethical debate and reflecting on emerging bioethical problems and challenges in Croatia and the world. From that date, we can begin to talk about the emergence, but also the development of the concept of integrative bioethics, the transformation of bioethics, which has spread through numerous international projects and symposiums, as well as publications (e.g. book series “Bioethics”, the publishing house Pergamena, Zagreb) during the years. Exploring the birth and development of integrative bioethics in Croatia we can notice numerous parallel events that are difficult to reconstruct or network in order to gain insight into the richness of bioethical events. It is enough to mention the Franciscan Symposium Responsibility for Life in 1999 or Rijeka Days of Bioethics from 1999, or The Days of Frane Petrić in 2001, and a scientific-cultural event of Lošinj Days of Bioethics established in 2002 in Mali Lošinj, thanks to the Croatian Philosophical Society, the Croatian Bioethics Society, and the Town of Mali Lošinj. This work follows a detailed and individual review of all the Lošinj Days of Bioethics from 2001 to 2016 and the accompanying events as well as other scientific and cultural events of significance for the development of integrative bioethics and sensibilisation of the Croatian public for bioethical issues as well as a list of relevant legal provisions, declarations and the rest. It follows a review, analysis and valorisation of scientificresearch bioethics projects at the level of Croatia in the period from 1990 to 2006. Then, within the new project cycle from 2007 to 2013, we present and vaporise scientific projects created within the framework of the scientific program Bioethics – from the plurality of perspectives to the integrative knowledge. Further, in this thesis we analyse and evaluate the scientific programs (South-eastern European Integrative Bioethics Network; Bioethics – from the plurality of perspectives to integrative knowledge) and scientific conferences, in particular one held in Dubrovnik in 2004 (Bioethics in Southern and South-eastern Europe. The prospects for integrative ethical reflection on the basis of intracultural differences in Europe). At this conference began stronger bioethical cooperation and more serious dialogue between the countries in the Central, South and Eastern parts of Europe. Starting from the aforementioned tasks or goals of international bioethical cooperation, leading bioethicists form Croatia in cooperation with partners from other countries in mentioned parts of Europe realized the key projects and factors of development and distribution of concept of integrative bioethics (Southeast European Bioethical Forum; International Summer School of Integrative Bioethics; Bioethics Referral Centre for Southeast Europe). Each of those projects is described to detail in this work, following chronological connection with the Lošinj Days of Bioethics and bioethics activities in Bosnia and Herzegovina, and even with some events at the world level (e.g. 9th World Bioethics Congress). Project Integrative bioethics: Development of the centre of excellence and doctoral study of the University of Zagreb (director: Ante Čović) occupies a special place in this paper because of its relevance in the development and distribution of integrative bioethics and the establishment of Croatia as one of leading countries in the field of bioethics. This section of thesis includes attempts and successful realisation of the function and structure of various bioethical institutions in Croatia. In this paper, the work of the Centre of Excellence for Integrative Bioethics is presented as a place of “philosophising” the bioethics. It is a place where study of the work of V.R. Potter in the context of modern bioethics is taken very seriously. It is a place where bioethicists study comparative analysis of European and Georgetown bioethics, do the research of the roots of bioethics in the contemporary Europe, exploring sources that have influenced the formulation of bioethics and research some current bioethical topics to establish theoretical and practical interactions (interdisciplinary, international, intercultural, interreligious and other) and to aggregate the totality of the human survival perspective to set the orientation and to achieve orientation knowledge in the transition to world-historical epochs. The methodological characteristics of integrative bioethics, pluriperspectivism, and the interest of integrative bioethics in life in its integrity and the richness of manifestations are the most important characteristics of third phase of development of bioethics, integrative bioethics. The opportunity for “philosophising” bioethics with the correct vaporisation of Potter’s global bioethics has begun on the European soil, precisely within integrative bioethics in Croatia. However, this was preceded by several attempts to revitalize the Potter’s idea, within the legal framework of European institutions, by defining European bioethical principles, and by discovering and interpreting the European heritage in the light of integrative bioethics (Albert Schweitzer’s and Pierre Teilhard de Chardin’s legacy). In this word we take in consideration and we analyse all of that including the modern currents that have resulted with European bioethical principles (Peter Kemp and Jacob Dahl Rendtorff). Certain number of Croatian bioethicist find their scientific interest in digging through European spiritual, cultural and spiritual heritage, in search of bioethics precursors. In this work we deal with the results of research done by Iva Rinčić and Amir Muzur from the Department of Social Sciences and Humanities of the Faculty of Medicine at the University of Rijeka (Fritz Jahr and the birth of European bioethics, Pergamena, Zagreb 2012). Investigating heritage and importance of Fritz Jahr they contribute to affirmation of Fritz Jahr as a real father of bioethics. Croatian scientists and bioethicists put F. Jahr in the centre of scientific attention as a man who used and coined the term bioethics in 1926. They did the thorniest research on the phenomenon of Fritz Jahr on the global scale and still are doing that trough activity in the frame of scientific project Fritz Jahr and the European roots of bioethics: The foundation of the international network of scientists (EuroBioNethics) and the Documentation and Research Centre for European Bioethics “Fritz Jahr”. All this significantly contributed to the Europeanisation of bioethics and its philosophizing, or the constitution of European bioethics in frame od Croatian and integrative bioethics that had its beginning as a program idea from the scientific project Bioethics and Philosophy by professor Ante Čović. The reconstruction of the history of bioethics in Croatia has risen in the reconstruction of conceptual transformation of bioethics into a completely new scientific and cultural phenomenon, unique in the regional, European and world level, European bioethics. This work is an attempt of chronological reconstruction, analysis and vaporisation of that process.

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