UNESCO flaunts biomedical guidelines
UNESCO’s ideology of humanity has been described as a dialectic between freedom of research and respect for the rights of persons on whom the research is conducted. The dialectic is joined to protection against discrimination based on genetic characteristics.
The ideology, as described, fails to reach a true understanding of the nature of man as the subject of proposed research. In spite of this, UNESCO is the agency that has the UN’s standard-setting function of preparing and adopting international instruments, ethical guidelines, and statutory recommendations.
The Nuremberg Code of 1947 and the Helsinki Declaration of the World Medical Association in 1964 provided the historical model through their insistence that the interests of the individual patient, in all research involving human subjects, outweighed scientific interests and the interests of society.
But patterns of change and redefinition mark the scientific transition of the late 20th century. Although the Nuremberg Code is not subject to change as part of a legal decision, the Helsinki Declaration has already been amended several times. In the proposed Helsinki definitions and amendments (2000), the ethical standard that assured every human subject the “best proven diagnostic and therapeutic method” was dropped from the body of the text, and set at the end as an ‘additional’ principle. The distinction between therapeutic and non-therapeutic research was also eliminated, thus exposing the human subject to serious risks involved in experimental research.
The language of the International Ethical Guidelines for Biomedical Research Involving Human Subjects, prepared by the Council for International Organizations of Medical Sciences in collaboration with the World Health Organization, also causes concern. In that document, vulnerable individuals and groups are viewed as prospective subjects. The demands for people at risk of HIV for the right to clinical research and incompletely tested treatments lays the groundwork for experimental research on human subjects with untested drugs.
The usual triad of principles appears again as respect for persons, beneficence and justice, but admits that while these principles have equal moral force in the abstract, they may be given different moral weight and may be applied differently in decision making or courses of action. Research involving human subjects is distinguished from the practice of medicine, public health and other forms of health care, raising questions about the welfare of human subjects.
Proxy consent for individuals incapable of giving informed consent prompts concerns about the intentions of proxy givers and possible risks to vulnerable people. The extent of an investigator’s responsibility, if any, to provide medical services to the subject is not clear. In the case of complex research projects, it is stated that it may not be necessary to inform prospective subjects fully about every possible risk. Deception of the subject may be agreed to by an ethical review committee when it is seen as “indispensable to the methods of the experiment.” The statement is made that women in most societies have been discriminated against as human subjects.
In spite of any reservations the average citizen might have concerning such ‘principles,’ statutory recommendations, ethical principles and so on must be submitted to each member state. Those member states, in turn, submit UNESCO’s recommendations or conventions to the appropriate authorities within their states within one year of their adoption. The member states then report the status of their educational, scientific and cultural institutions and activities – as well as all action taken on the recommendations and conventions – to UNESCO.
In addition, the educational, scientific and cultural institutions within each member state are expected to become associated with UNESCO through the formation of a national commission. The formation of such a commission provides the tool for insemination of UN doctrines within the agencies of the state and among the political, intellectual and spiritual elites whose support (and funding) will decide acceptance or rejection.
UN statutory language can also be introduced within state statutes. Ethical guidelines may be disseminated as educational standards, or even as rationale within judicial decisions. Partnerships with international agencies may also be formed with local governments acting as disseminators of UN standards.The spread of ‘smart growth’ programs, limiting urban sprawl through state governors in the U.S., is an example of the application of Agenda 21 principles to U.S. cities. And, as both the U.S. and Canada have already experienced, the WHO Healthy Cities programs have created partnerships with local governments in a number of Canadian and American locales.