20 Years of bioethics at UNESCO, interview with Henk Ten Have
A roundtable organized at UNESCO headquarters in Paris, on 6 September 2013, will bring together internationally renowned bioethics specialists to discuss, in public, UNESCO’s achievements in the realm of Bioethics over the last twenty years, and the role that the Organization should play in this field within the framework of the Post-2015 Development Agenda. One of the speakers will be Mr Henk Ten Have, Director of the Center for Healthcare Ethics at Duquesne University in Pittsburgh, USA, and former UNESCO Director of the Division of Ethics of Science and Technology.
You were Director of the Department of Ethics, Philosophy and History of Medicine in the University Medical Centre Nijmegen (the Netherlands) when UNESCO’s Bioethics Programm has been launched in 1993. What were the main concerns in bioethics at that time?
The main issues in bioethics around 1993 were concerned with the impact of medical technology, for example in end-of-life care and reproductive medicine. At the same it was already clear that many developing countries could not continue to afford all available healthcare for all of the population, so that issues of choices in healthcare and allocation of scarce resources became also more important.
Ten years later, in 2003, you joined UNESCO as Director of the Division of Ethics of Science and Technology. What were the main issues that you focused on?
The main issues in bioethics around 2003 were concerned with the globalisation of healthcare and medical research. More and more clinical trials with new drugs are outsourced to developing countries that generally lack the bioethical infrastructure (ethics review committees, legislation, information systems) that are available in developed countries. This discrepancy has been creating problems of injustice and sometimes exploitation and discrimination. Populations in resource-poor countries were recruited for clinical trials but could themselves never benefit from the results of those trials. At the same time, neoliberal policies of globalization forced countries to reduce expenditures in healthcare, so that access to public health services became reduced for larger parts of populations.
What are, according to you, the main achievements of UNESCO’s Bioethics Programm during the last two decades and what should be its role in the Post-2015 Development Agenda?
The main achievement of UNESCO's bioethics program is that it produced a broader vision of bioethics that included the moral concerns of all countries around the world, and not specifically the more developed ones. It contributed to broadening the agenda of bioethics (focusing not merely on new technologies and recent knowledge, but on issues of access to care and social justice that are more important for the majority of the world's population). It also widened the scope of ethical considerations by going beyond the usual perspective of the autonomous individual who decides what will be relevant care or whether he or she wants to participate in research; in many countries this individual perspective that dominant bioethics is embedded in a social and cultural context in which family, community, and society are equally important in healthcare.
Interview by Jasmina Sopova
Henk ten Have (The Netherlands) studied medicine and philosophy at Leiden University, the Netherlands. He received his medical degree in 1976 from Leiden University and his philosophy degree in 1983. He worked as a researcher in the Pathology Laboratory, University of Leiden (1976-1977), as a practising physician in the Municipal Health Services, City of Rotterdam (1978-1979), and as a Professor of Philosophy in the Faculty of Medicine and Faculty of Health Sciences, University of Limburg, Maastricht (1982-1991). From 1991 he was a Professor of Medical Ethics and the Director of the Department of Ethics, Philosophy and History of Medicine in the University Medical Centre Nijmegen, the Netherlands. In September 2003 he joined UNESCO as Director of the Division of Ethics of Science and Technology. Since July 2010 he is Director of the Center for Healthcare Ethics at Duquesne University in Pittsburgh, USA.
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