Bioethical Discussion in Israel

Francesca Levi-Schaffer

Bioethics has become an increasingly important issue in Israel as well as in other developed Western countries during the past few years, particularly in view of the most recent discoveries in the field of medicine, such as the various possibilities of IVF, gene therapy and last but not least, cloning.

Israel offers a unique setting for ethical discussions because of the deep Jewish roots of the majority of its population (80%), and the Christian and Muslim roots of the minorities. Religion as a major source for moral behavior is still a very strong reference point in the Israeli society even though only a fifth of the Israeli population is religiously observant. In spite of and together with this there is a very active secular, non-observant, non-religious, sometimes agnostic or atheistic part of the population. These citizens do not refer to the moral teachings of religion but rather seek a secular common ground that is built up by rational wills and some common " bon sense".

In addition, Israel provides a country of multiethnic composition. In fact although nowadays the majority of Israelis were born in Israel, new immigrants coming from approximately 40 different countries in the world still constitute part of its population (25%). These immigrants who come from many divergent countries such as the United States, Ethiopia, Russia, Morocco, Italy and Georgia, bring with them and transmit to their children many different cultural backgrounds.

Given this multifaceted setting, the State of Israel needed in the past to develop an Ethical Code for the Israeli Defense Forces (The Army), and now is faced with the necessity to create an Ethical Code for Israeli scientists.

I am currently a member of "The National Research and Development Council Committee" that has the duty to prepare such an Ethical Code and the Counselor for Misconduct in Science of the Rector of The Hebrew University of Jerusalem. In this role, I have recently been given the task to prepare a draft of Ethical Code for the Researchers of my University.

In my presentation I will illustrate the questions of bioethics that I had to face in the preparation of the draft of Ethical Code for my University. I will also present the first draft of the Ethical Code for the Hebrew University.

In spite of the fact that I will be presenting "my Israeli" experience, which reflects the multifaceted nature and peculiarities of our State, I believe that this experience is not very different from that faced by scientists in a democratic Western country.

Therefore I hope that it can be a useful example for researchers of other countries keeping in mind that the main values we want to defend are quite universal.

The need to create the field of bioethics and, as a consequence of this, of organizing Ethical Committees and of producing Ethical Codes, etc. has recently arisen from the recent tremendous advancements in technology, biology and medicine, that were difficult to predict just 50 years ago. These advancements have changed the aspects of natural sciences, such as biology and medicine, from essentially descriptive disciplines to more pragmatic sciences that are able to modulate, change and, I dare to say, "create". The biomedical field has consequently become the "Science of the possible and of the impossible". The term Bioethics was proposed only 30 years ago by Van Rensselaer Potter in an article entitled "The science of survival". Because of this, in recent years scientists have been faced with a new and serious question, which they must also correctly answer: "Can we do all what is possible to do?"

But why has a State like Israel decided that these questions should be asked and answered in the formal frame of a Code formulated by a body of experts nominated by the Parliament? Because bioethics is a political issue and not just a private issue of scientists closed in the fortified walls of Academia. This is not only because scientists are members of a society and of a State but also because politics, which is the main activity and tool of a State, is there to organize the society, to decide, to make laws; and a State that is defined by people, territory and government is democratic if it respects the life of its citizens.

Among all these concerns, where should bioethics be placed? Ethics is the science of human behavior that in the common language now has the meaning of behavioral rules that we should follow after we have evaluated and accepted given values.

Bioethics is specialized in the field of biology and therefore of life. Its goal is the rational analysis of moral problems in biomedicine and their connection with humanities. Bioethics wants also to be a systematic reflection on all the interventions of man through science and technology on living individuals to identify the values and the rules that guide human action.

I perceive bioethics as a tool by itself for the scientists to define the fundamental ethical principles that they have to accept.

Scientists have to accept the fundamental human rights, first of all the right to life as a fruit of rational consideration .To strengthen this point I would like to quote Spinoza who wrote, in accordance with Socrates and Plato, that "Any bad action is due to an intellectual mistake" and Aristotle who wrote, that "Every rational activity (and I would like to add, such as scientific research) aims at some end or good".

Scientific research has therefore from my point of view intrinsic ethics, and scientists' activity in research should be intrinsically moral, but of course this does not imply that scientists should be given freedom without constraints. I believe that scientists can choose to behave ethically in their scientific research through a rational choice in the frame of two hypothetically crossing parallel lines, necessity of freedom and necessity of control. A fair and therefore satisfactory limitation to uncontrolled freedom seems to me the responsibility that scientists should practice.

Responsibility is the moral duty to take the burden and the consequences of one's own actions or intentions, under a personal, moral and legal point of view. Responsibility is taken in freedom of choice after the evaluation of the values in discussion.

As a consequence I believe that scientists have the duty, prior to undertaking any new research, to consider its possible applications and to ask themselves, "Is it right, is it correct in the sense of is it good, is it morally acceptable?"

Regarding the Draft of the Ethical Code, I would like to stress that it has to be viewed as a normative ethics document. It was born by the study of values, principles, and rules of behavior in relation to what is allowed and what is not, in the sense of what is good and what is bad in the field of scientific research. It also looks for the foundation and justifications.

To follow or not to follow an Ethical Code is a free act that implies a moral responsibility where the only duty is to respond to one's own conscience. In fact the conscience represents the awareness of the ethical value of a given action and not the emotion, although subjective reactions can take place concomitantly. Here we talk about a rational judgement in relation to what is good or bad.

In the framework of modern philosophy, which is more sensitive than classical philosophy to this subject, I would like to add that an Ethical Code should be a call to the realization of the values that are founded on the work of intelligence, which is a reflection of the reason rather than just a group of rules.

Therefore in writing this draft I prepared a document with clear deontologic rules, but the document also indicates that the evaluating reason is present all the time to interrogate itself on the best goals, on the best tools, on the values that we want to preserve and acquire, and above all on the quality and the meaning of human life.

And now let us read and comment on the main points of the Draft.

Basic principles and values

"The enterprise of science is the expansion of human knowledge beyond what is already known through research into the biological, physical, human and social world. Science is the free pursuit of inquiry in these fields and its value rests in its being one of the richest resources for humanity's welfare, through the human desire to know and to understand nature.

Our ethical principles for research draw their moral authority from the earlier Jewish sources, that teach us the value of human life and the principles of human behavior."

Comment

Here, as I commented in the introduction, I pointed out the Jewish roots of our society. I would like to comment that both Muslim and Christian religions have moral principles similar to Judaism especially in respect to the value of human life. I also believe that non-religious scientists would accept human life as the highest value to be respected.

"While scientists understand that the pursuit of knowledge and the report of the full and the objective truth is a value of itself, scientists, as citizens of a democratic country, should be concerned that their work is used only for the betterment of society."

Comment

Here, like Lewis said 40 years ago there is the fact that "We presume on the part of those who follows any scientific intellectual vocation a sort of tacit oath never to subordinate the motive of objective truth seeking to any subjective preference or inclination or any experience or opportunistic consideration" i.e., that scientists' goal is the seeking of objective truth.

Also, I recall that we are scientists living in a democratic State. A democratic State should facilitate the work of a scientist and be a sort of moral tutor for the researcher.

"Research in every field is carried out through established and validated research methods and the subsequent publishing of the results so that the data and the interpretations may be reviewed, questioned and verified."

Comment

This is a deontologic point on how to carry out proper research. This point is amplified under Integrity, below.

Responsibility

"Scientists are responsible for the formulation of the aims, the operative phase of their research and, in part, for its application(s)."

Comment

Responsibility is a main brick of an ethical code as I pointed out before. However I believe that a scientist can only be partially responsible for the applications of his research for obvious practical considerations. I would like to propose that the responsibility of the applications of the research should be under the control of the democratic State, as the representative of the society. However I also think that the scientists should not completely forget the product of their research once it has gone out from his laboratory.

Scientists are responsible for practicing their profession in good faith and in accordance with the principles of honesty and the accepted standards of scientific methodology.

Comment

Here again a deontologic remark on how to do proper science.

"In carrying out research, the scientists undertake the obligation to pursue research while complying with those requirements that safeguard human life, welfare, dignity and liberty. Hence, the scientists bear special responsibility for those participating as patients or subjects in scientific research. The principles of the Helsinki Declaration regarding clinical experiments involving humans determine the scientist's responsibility in such projects and, in the spirit of these principles, that responsibility for non-clinical experiments involving human subjects exists.

It is the responsibility of our scientists to use laboratory animals in experiments in accordance with Israeli law and international standards. It is the responsibility of the scientists to use hazardous material (biological, radioactive, pathogenic) in a manner which protects the entire laboratory staff and the environment in general.

It is also the responsibility of the scientists to carry out their work with respect to our ecosystem."

Comment

The Helsinki Declaration regarding clinical experiments is mentioned together with the laws for the proper use of laboratory animals. Also the proper use of hazardous material should be kept in mind so as not to endanger human lives and the environment.

The respect for our ecosystem stems from the respect that a scientist has to have of Nature, to which we all belong.

Integrity

"Scientists must use their scientific methods in good faith and must honestly, accurately and completely describe their experiments, results and interpretations of the data. The scientist must share the data with colleagues through publication of the research, its methodology, and the researchers' assessment of its meaning.

Publication allows the research to be known within the community of science, to be independently verified and tested by others, and to be available to society in general.

Scientists are responsible for acknowledging all the sources of financial support for the project as well as the contributions of all participants in the research project both those in the laboratory and those whose research may have contributed ideas or data.

Scientists are responsible for disclosing any potential financial or other conflicts of interests which could be regarded as affecting the project's design or the interpretation and/or presentation of the results."

Comment

Here we deal with deontologic issues. In the first paragraph I imply that a scientist has to be the descriptor of the reality. Reality has to be correctly and honestly reported. This even if sometimes in the subjective, his beliefs, his wills and even his personality can specifically influence the interpretation of the data.

"Scientists should carry out their work with fidelity to the rules of research, i.e. with methodological scruple and with validated and accepted methods. They have to be extremely precise in communicating their data in a way that they are susceptible to be controlled by the scientific world and that they serve as solid basis for subsequent works. Also publication of the data will make them available for society in general."

Comment

Here I would like to mention that during the last few years the phenomenon of falsification of data and plagiarism has been a problem in the scientific community especially in the field of biomedicine.

This is mostly because the publication of data is the unique benefit that the researcher can gain out of his work, which can bring him/her fame and career advancement.

There are other responsibilities of the scientists such as for his collaborators and for the Institute in which he carries out his research work. Also very important are the sources of funding for research and conflicts of interests that can arise.

Freedom

"Academic freedom is the freedom to discuss (orally or in print) ideas and their interpretations. The researcher has the freedom and responsibility to plan experiments, to analyze theories and data and their interpretation equitably and with depth and precision and without prejudice. The researcher will pursue his/her inquiries without being influenced by his/her funding sources, superiors or personal ideologies or beliefs. At the same time the researcher should be sensitive to the needs of the society of which he/she is a part."

Comment

In discussions of ideas and their interpretations the scientist is fully free. He has however to take responsibilities when he plans the experiments and analyzes the data.

Scientists should free themselves from their beliefs and ideologies and always remember that the ultimate goal is to preserve life and its dignity.

This is therefore the Draft for the Ethical Code for the Researcher of the Hebrew University that I have recently submitted to the Rector.

I would like to remind you that it is a draft and as so it has to be corrected, improved especially with the contribution of scientists from the humanistic fields who can bring a different perspective which will be a very important contribution.

References

  1. On Being a Scientist: Responsible Conduct in Research, 2nd Edition, Committee on Science, Engineering and Public Policy, National Academic Press, Washington, DC, 1995.
  2. Universal Declaration of Human Rights.
  3. Un Paradiso Perduto, Marcello Cini, Ed. Feltrinelli, Milano, 1994.
  4. La Nature et la Regle, J-P Changeux and P. Ricoleur, Ed. Odile Jacob, Paris 1998.
  5. Storia Della Filosofia Occidentale, Bertrand Russell, Ed. Longanesi, 1972.
  6. Ethics, Aristotle.
  7. Encyclopedia of Bioethics, Reich W.T., McMillan, NY, 1995.
  8. Manuale di Bioetica, S. Sgreccia, Ed. Vita e Pensiero, Milano, 1994.
  9. Enciclopedia Italiana Treccani.
  10. Etica, B. Spinoza, Ed. Cedam, Padova, 1947.
  11. Sommario di Storia della Filosofia, Mario dal Pra, Ed. La Nuova Italia, Firenze, 1963.

Prof. Dr. Francesca Levi-Schaffer
Dept. of Pharmacology
Hadassah Medical School, The Hebrew University
Jerusalem 91010, Israel