FOCUS - Spring 2014
back to cover Spring 2014
Former CHPE Senior Visiting Fellow Dr. Henk ten Have Delivers School of Medicine Distinguished Lecture
by Jos Welie, PhD
On Wednesday April 16, Dr. Henk ten Have, Director of the Center for Healthcare Ethics at Duquesne University in Pittsburgh, PA, presented one of the six 2013-14 School of Medicine Distinguished Lectures. This particular lecture was jointly sponsored by Creighton University's Center for Health Policy and Ethics, the Department of Medicine, and the Health Sciences Continuing Education division. Ten Have studied medicine and philosophy at Leiden University, the Netherlands. After serving two decades in different academic capacities, from 2003 to 2010 he served as director of UNESCO's Division of Ethics of Science and Technology in Paris, France. This was not the first time Ten Have visited CU. In 2001, he spent three months at CHPE as a Senior Visiting Fellow.
This time, Dr. Ten Have's visit to CU was much shorter, consisting of two main events. On the evening prior to his keynote, Ten Have kindly agreed to meet with the medical students who are part of Project CURA. This student-run association serves primarily to provide health education and primary prevention for underserved and minority populations of Omaha and eastern Nebraska, but also organizes service trips abroad for medical students between their freshman and sophomore years. Rallied by CURA's energetic president, first year medical student Jocelyn Wu, some eighty students attended, mostly from the CU School of Medicine, but with additional representation from the College of Nursing and the College of Arts and Sciences. More than a dozen faculty and staff members facilitated the table discussions.
Jos Welie and Henk ten Have
Those interested in the details of Ten Have's Distinguished Lecture can find a streamed version at the following URL: http://bluecast.creighton.edu/Panopto/Pages/Viewer/Default.aspx?id=61cf0eb2-538e-4a40-b727-f0d7451cf3b7
Focus readers interested in still more material on global bioethics may want to peruse the new Handbook of Global Bioethics, co-edited by Henk ten Have: http://link.springer.com/referencework/10.1007%2F978-94-007-2512-6
As these freshmen medical students are preparing for their service trips to a variety of different countries, including Romania, Ghana, India, and Ecuador, Ten Have prodded students to think about the broader picture. For example: What are the most efficient health care systems in the world and what criteria should be used to make that determination? To explain the differences between a country such as the United States, which spends the most but is actually very ineffective (#46 on the global list), and much higher ranked countries such as Ecuador (#20), Ten Have pointed to the underlying value systems. Which does the country value more: The individual or the community? Cooperation or competition? And does it view health care as a commodity or as a basic good? But he also encouraged students to look at the commonalities. What concerns do people in different countries have in common, what ethical principles do we all share? This, then, led to a review of the Universal Declaration on Bioethics and Human Rights, adopted by the UNESCO in 2005. Whereas prevailing American bioethics promotes only four bioethical core principles (Respect for patient autonomy, Beneficence, Non-maleficence, and Justice), this declaration identifies 15 such principles. Some of these 15 can be viewed as specifications of the former four, but others are certainly novel, such as Respect for cultural diversity and pluralism, Solidarity and cooperation, Social responsibility and health, Protecting future generations, and Protection of the environment, the biosphere and biodiversity. Such an expanded focus of reflection also enables the development of a global bioethics, which was the main theme of Ten Have's keynote lecture on April 16.
Dr. Ten Have's presentation was entitled "Vulnerability: Challenges to bioethics in a global context." He began by acknowledging that vulnerability as a bioethical principle is a relative newcomer. While the notion surfaces in the famous Belmont Report from 1979 and in several other guidelines on the ethics of bioethical research since, it was only acknowledged as a full-fledged principle of bioethics in the aforementioned UNESCO declaration from 2005: "In applying and advancing scientific knowledge, medical practice and associated technologies, human vulnerability should be taken into account. Individuals and groups of special vulnerability should be protected and the personal integrity of such individuals respected." Ten Have analyzed this new ethical notion, using both a philosophical and a political perspective, and then moved to a discussion of vulnerability as phenomenon of globalization.