Michael Fuchs National ethics councils - Deutscher Ethikrat

Michael Fuchs National ethics councils. Their backgrounds, functions and modes of operation compared
and secondary school pupils. Local ethics commissions in France have the right to
draw the attention of the national committee to new problems. This sometimes results
in suggestions for reports and Opinions. The provisions of the decree were given
statutory force by the two “Bioethics Laws” of 1994.
Composition
The founding decree provided for a membership of 37. This number was increased
in 1997, so that, in addition to the Chair and two honorary chairs, the Committee
now has 39 members. The Chair is appointed by decree of the President of the Republic.
Another five members belonging to the five principal faiths and philosophies
(Roman Catholicism, Protestantism, Judaism, Islam and Marxism) are also Presidential
appointments. Then come a group of 19 individuals qualified by their competence
and interest in ethical problems, and 15 persons from the research sector.
Those 19 (formerly 16) members are selected by the relevant ministries and the
Prime Minister or appointed from among the members of the National Assembly
and the Senate, the Conseil d’Etat and the Court of Cassation by the presidents of
these bodies. As a result two of the Committee’s 42 members are politicians in the
strict sense of the word. The 15 persons from the world of science are members of the
Academies and the major national collèges, research institutes and universities, or are
appointed by them. These statutory requirements have not led to the formation of
blocs. The competence for appointments is not divided among different scientific
cultures or based on a dichotomy between experts and lay persons.
Issues
The formation of the CCNE introduced a form of political advisory activity in
France that had previously been quite unusual (see Byk/Mémeteau 1996). The
founding decree had raised questions of demarcation in relation to the functions of
existing institutions. President Mitterrand’s emphasis on the implications of research
and of novel medical techniques resulted in an attempt to leave the treatment of traditional
issues of medical and professional ethics within the field of competence of
the doctors’ professional organizations. However, such a division between matters of
bioethics and research ethics on the one hand and professional medical ethics on the
other can by no means be regarded as beyond dispute. Furthermore, the CCNE’s repeated
consideration of euthanasia shows how changes in medical technology also
have repercussions on long-established questions of medical ethics.
Overall, the tasking of the individual bodies has proved to be a complex process
involving the founding decree and its interpretation, referrals by the competent institutions
of state, the CCNE’s conception of its own role as it has emerged from its
work, and additional legal instruments. Chief among these instruments is the Law on
the Protection of Human Subjects of Medical Research, the Loi Huriet of 1988, which
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deals comprehensively – that is to say, with a wider field of application than the German
Medicinal Products and Medical Devices Laws – with the functions and status
of ethics commissions in such research projects. In addition, this Law put an end to
the debate on whether the existing CCNE ought also to serve as a central commission
for research projects involving human subjects, either as a body to which appeals
could be directed or in order to rule on particularly important or complex cases. The
decision that the regional commissions have sole responsibility for these matters
means that the CCNE must concentrate on general issues. Consideration of the
Opinions hitherto published, however, reveals a broad spectrum, from the very first
Avis, on the sampling of dead human embryonic and fetal tissue, to the eightieth, on
the role of occupational medicine. It extends from the major international issues
such as embryo research or cloning, via psychological research and oncological studies,
to the ethical aspects of neurosurgery, which have hitherto not, or not systematically,
been addressed in bioethics, let alone by advisory bodies.
Mode of Operation
The Committee appoints rapporteurs for the subject-matter under consideration,
who are responsible for the scientific question, the research problem or the ethical issue
concerned. A working party made up of members of the Committee and external
specialists is formed, and begins by determining whether the issue in hand is a
genuine scientific problem and whether it has not already been examined by the
Committee or is not covered by existing law. The working party then approaches the
documentation centre (Centre de Documentation en Ethique) of the INSERM (Institut
National de la Santé et de la Recherche Médicale); the founding decree provides
that the CCNE shall receive administrative and technical support from this body. In
particular, the INSERM is required to provide the Ethics Committee with a documentation
and information centre on the ethics of the life and health sciences. Next
comes the ethical debate, which may extend over several months. Its outcome is a scientific
report, an ethical report and a draft Opinion (Avis) which are published and
forwarded to the Committee’s Technical Department and to a 14-member subcommittee.
The latter submits the text, after examination and discussion, to the Plenary
Committee, which meets at approximately six-weekly intervals to consider and discuss
the drafts. It then returns the text to the working party for revision. In most cases,
the Committee finally adopts the report together with the Opinion unanimously.
However, dissenting positions are allowed for and have in some cases been expressed,
attached to the report and published with it. In some cases, areas of consensus and
dissent are recorded, but not the results of a vote on dissenting positions.
In addition to the working parties assembled for the purpose of compiling an
Avis, there is a permanent working group on molecular biology and reproductive
techniques and another on the neurosciences.
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