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European experts produce draft on bioethics

BMJ 1994; 309 doi: (Published 23 July 1994) Cite this as: BMJ 1994;309:221
  1. T Sheldon

    A group of European experts has produced a draft convention on bioethics in an attempt to ensure that the benefits of science are not achieved at the expense of patients' rights. The Steering Committee on bioethics set up by the Council of Europe covers ethical issues ranging from those surrounding predictive tests for genetic diseases and intervention in human genes to the circumstances in which a doctor can disregard a psychiatric patient's refusal to give consent. This latest draft comes after more than two years of deliberations.

    For in vitro research on human embryos the draft defines a maximum limit of 14 days' development, though this excludes embryos preserved by freezing. It says that human embryos may not be created with the intention of conducting research on them. It also prohibits interventions aimed at modifying genetic characteristics that are not related to a disease.

    The bioethics convention calls for free and informed consent which can be withdrawn by the patient at any time. Treatment may be carried out on patients who are incapable of giving consent because of their age or mental state in certain circumstances, though it is accepted that even the draft text here needs “detailed re-examination.” Psychiatric patients may be given treatment without consent, but only if they are likely to suffer serious harm without it and then under legal protection of supervision and control.

    Former deputy chief medical officer Dr Michael Abrams, who chaired the working party that drafted the convention, said that despite the wide cultural, legal, and ethical spectrum they had tried to draw up a statement covering the major issues of bioethics facing medicine. “We have not sought a minimum but a common set of standards which everyone can adhere to.”

    Professor Henriette Roscam Abbing, the Dutch member of the working party, said that it had achieved agreement on an “optimum level of protection for individual rights.”

    The convention's aims have been to protect human dignity and individual rights in the face of accelerating developments in biology and medicine. It warns that scientific developments have a dark as well as a beneficial side. An awareness is needed of all possible consequences to ensure that the benefits prevail, it says.

    Professor Abbing explained that one of the underlying principles was that “as far as possible the patient has to be involved in medical decisions,” whether a patient was a child, had learning disabilities, or was otherwise legally incapable of making decisions. The first approach, she said, must be to assume the patient is capable.

    The Council of Europe, an intergovernmental group set up in 1948 to promote human rights, has no legal powers to enforce its conventions. But the authors argue that the bioethics convention like the council's human rights convention will be highly influential. The draft has now been put to European governments for consultation.

    * Embryo four days after fertilisation

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