null
Lucia A Keegan  12/18/2006 03:02:48 PM  From  DB/Inbox:  Lucia A Keegan

Cable 
Text:                                                                      
                                                                           
      
UNCLAS        PARIS 07806

SIPDIS
cxparis:
    ACTION: UNESCO
    INFO:   POL ECON AMBU AMB AMBO DCM SCI

DISSEMINATION: UNESCOX
CHARGE: PROG

APPROVED: AMB: LOLIVER
DRAFTED: POL: AVHOUCKE, MAPOI
CLEARED: SHS: JSHOFF

VZCZCFRI401
RR RUEHC
DE RUEHFR #7806/01 3491035
ZNR UUUUU ZZH
R 151035Z DEC 06
FM AMEMBASSY PARIS
TO SECSTATE WASHDC 3806

UNCLAS SECTION 01 OF 02 PARIS 007806 
 
SIPDIS 
 
FROM USMISSION UNESCO PARIS 
 
E.O. 12958: N/A 
TAGS: UNESCO TBIO US KSCI FR
SUBJECT: USUNESCO: 13th SESSION OF THE INTERNATIONAL BIOETHICS 
COMMITTES CHARTS FUTURE COURSE ON THE TWO WORKING GROUP REPORTS: 
SOCIAL RESPONSIBILITY AND HEALTH AND CONSENT 
 
¶1.  Summary: The 13th session of the International Bioethics 
Committee (IBC) examined the preliminary reports of its working 
groups on social responsibility and health and on consent. During 
the debate on social responsibility and health, IBC members 
reiterated their independence from UNESCO itself and member states. 
The debate on consent focused on patient autonomy, the different 
types of consent, and regulation of the flow of information related 
to a patient's right to know. A UNESCO official urged that the 
reports and subsequent debate adhere to the principles and language 
contained within the Declaration itself. End Summary. 
 
¶2. Following the adoption of the Universal Declaration on Bioethics 
and Human Rights in 2005, the International Bioethics Committee 
(IBC), at its 12th session in Tokyo in December 2005, decided to set 
up two commissions in order to prepare reports concerning two 
principles stated in the Declaration: one on consent (Articles 6 and 
7) and one on social responsibility and health (Article 14). This 
session of the IBC sought to assess and debate the preliminary 
reports of the two working groups. 
 
¶3. At the opening, Henk ten Have, Director of the Division of the 
Ethics of Science and Technology, gave a detailed account of 
activities undertaken by UNESCO for the dissemination, the 
promotion, the application, and the elaboration of the principles of 
the Universal Declaration on Bioethics and Human Rights. 
 
Social Responsibility and Health 
-------------------------------- 
 
¶4. Director-General Matsuura stressed that the IBC should adopt a 
different approach than other international forums such as the World 
Health Organization. Nouzha Guessous-Idrissi (from Morocco) recalled 
that the IBC's role is not to replicate work already done by other 
organizations, but to refocus and redefine the debate from the point 
of view of bioethics. She stressed the importance of Article 14 of 
the Declaration as it acts as a synthesis of the Declaration itself, 
as well as parts of other existing declarations, for example Article 
27 of the Universal Declaration on Human Rights. An invited expert, 
William Schabas from the Irish Centre for Human Rights, linked the 
debate on Social Responsibility to Article 27 of the Universal 
Declaration on Human Rights. He stated that if there is a right to 
benefit, then people who have that right also have a right to 
determine the direction of research. While holding up a photo of 
Eleanor Roosevelt, he made a gratuitous remark against the United 
States by saying that the U.S. was "at one time" a leader in the 
development of human rights. Gabriel d'Empaire (from Venezuela), 
Vice-Chairperson of the IBC, called for specific levels of 
responsibility, a precise definition of the concept of "highest 
attainable standard of health" with criteria for the realization of 
this goal, and rational selection of necessary medicine. 
 
¶5. Numerous IBC members complained that the developing world has not 
received the benefits of health care technology. Donald Evans (from 
New Zealand) stated that the world needs international 
responsibility, declaring that developed countries exploit 
developing countries. Gamal Ibrahim Abou Serour (from Egypt) claimed 
that governments in developing countries are complicit in the brain 
drain. Claude Huriet (from France) said that improving health in 
developing countries does not come from innovation and technology. 
He insisted that basic needs can and shall be satisfied without 
access to the latest technology. Prakash Narain Tandon (from India) 
asserted that the objective of the IBC is to reduce gaps between the 
rich and poor countries and within countries. 
 
¶6. Jeanine-Anne Stiennon (from Belgium) said that governments cannot 
provide health care for their entire populations. For example, in 
Europe, citizens over the age of 70 do not receive the cancer 
medications and other forms of health care promised their 
government. Prakash Narain Tandon asserted that inequities exist in 
the United States: 35 million people go hungry and 30 million people 
have to pay for their health care. He said that it would be a 
disaster if health care became part of the world economy as the 
World Bank has suggested. Kwang-ho Meng (from South Korea) insisted 
that bad lifestyles are responsible for fifty percent of today's 
health problems. He said that fighting against malnutrition is one 
of the best ways to improve world health. 
 
¶7. Some IBC members linked the debate on bioethics to the debate on 
intellectual property rights. Toivo Maimets (from Estonia) argued 
that the world needs public financing for the development of 
important drugs with no patent protection. Jean Martin (from 
Switzerland) argued against intellectual property rights and also 
suggested creating a convention against smoking. William Schabas 
argued that the inability to obtain access to needed medicine 
constitutes a human rights violation. 
 
¶8. Arguing that inequalities in health care are immoral and 
unethical, Jean Martin insisted that the IBC take advantage of its 
independence to display courage in the drafting of its documents and 
recommendations, even if it is sometimes politically and 
diplomatically incorrect. Marwan Hamade (from Lebanon) argued that 
the IBC should limit its objectives specifically to what is in 
Article 14 and that the role of the working group report should be 
to give new rules of engagement on social responsibility. All 
members agreed that the report should convince stakeholders at all 
levels, to adopt socially responsible behavior. Jeanine-Anne 
Stiennon suggested that the word 'should' be changed to read 'shall' 
in Article 14 of the Declaration. 
 
Consent 
------- 
 
¶9. IBC Members discussed autonomy and consent and the problem posed 
for uninformed patients. 
 
¶10. Members discussed the problem of paternalism as it affects the 
doctor-patient relationship. Members said that paternalism should be 
avoided; however, Ole Johannes Hartling (from Denmark) noted that in 
some situations, i.e. for unconscious patients, paternalism is 
occasionally necessary. In paragraph 26 of the report, it is stated 
that the relationship between the doctor and the patient "cannot be 
equal to equal." Gabriel d'Empaire commented on this point, saying 
that this should not be presented as fact rather that the 
relationship depends on circumstances. 
 
¶11. Ching-li Hu (from China) argued that cultural differences should 
be taken into account. He explained that in China, medical decisions 
are often made by the family as a whole. Sissel Rogne (from Norway) 
objected to this idea of putting emphasis on the family decision 
making model due to the fact that this touches upon gender issues 
related to patient autonomy. Mr. ten Have countered that cultural 
differences do exist, but that this cannot be used to say that 
principles of consent do not apply. He insisted that in any 
discussion of an exception to informed consent, the exception must 
be made in relation to principles found elsewhere in the 
Declaration. 
 
¶12. Many IBC members brought up the difference between consent at 
the clinical treatment level and at the research level. Members 
repeatedly asked for greater elaboration on what consent is in each 
scenario. Mr. ten Have argued that this question must be clarified 
by referring to the terms used within the Declaration itself. 
 
¶13. Concerning secondary usage of biological samples for scientific 
research, paragraph 79 of the draft report states that it is "not 
acceptable" to obtain "overall prior consent." Ephrat Levy-Lahad 
(from Israel) expressed concern about this language as many biobanks 
currently obtain this kind of consent when dealing with the 
secondary usage of biological samples in scientific research. A 
Canadian observer intervened on this point to comment that in Canada 
and the U.S., the use of samples for secondary research is subject 
to ethics committee reviews and that secondary consent can be 
waived. 
 
¶14. Debating on patients' right to know/not to know, Claude Huriet 
(from France) and a Tunisian observer commented on the need for the 
report to address the role of the media. Both delegates said that 
much of the information available online is not accurate. The two 
delegates stressed the adverse effects that incorrect information 
can have on informed consent and the doctor-patient relationship. 
 
¶15. In paragraph 31 of the draft report, the "right not to know" is 
mentioned. Several IBC members requested a more in-depth exploration 
of this topic within the report. However, ten Have reminded members 
that "the right not to know" is not mentioned within the Declaration 
itself. He maintained that there must be a correlation between the 
report and the Declaration. 
 
¶16. Observers from the Ivory Coast and Tunisia requested that the 
report make a distinction between a legitimate representative and a 
legal representative in situations where a patient may be unable to 
give consent. Fawaz Saleh (from Syria) remarked that the question of 
legitimate and legal representatives is something that originates in 
domestic law of a state. In addition, he argued that a legal 
representative is always a legitimate representative, but a 
legitimate representative is not always a legal representative. 
 
¶17.  COMMENT: IBC members (36) are appointed by the DG as 
"independent experts" to make recommendations and give advice. 
(Edmund Pellegrino, Chairman of the President's Council on 
Bioethics, is a member of the IBC but was not able to attend this 
meeting.)  It is one of several such bodies (COMEST is another, 
particularly problematic one). Pronouncements of IBC may sound to 
the outside world as if they represent UNESCO views.  In addition, 
it can be used to start momentum for and influence the direction of 
normative instruments. In 2005, the IBC presented a draft Bioethics 
Declaration to Member States that was largely unsatisfactory to 
Member States (for different reasons), and had to be rewritten; but 
because the IBC draft was the starting point, the process was 
difficult and constrained. The existence of these bodies of 
"independent experts" raises serious governance questions; the USG 
may want to consider whether to challenge the creation and 
continuation of these bodies. END COMMENT. 
OLIVER