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Paolo Grieco

Starting from this issue “Leadership Medica” and "Leader for Chemist" will tackle hot subjects involving human kind by the means of interviews to prominent personalities of the scientific, philosophic, religious and right world. The first round of interviews has concerned Monsignor Sgreccia and Prof. Viano, Cotta , Manni, Anzani and Faden. First of all the opinion of "Leadership Medica"'s editor in chief, Genina Iacobone.

Genina Iacobone
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Editor, on the magazines you edit “Leadership Medica” and “Leader for Chemist”, you have given great importance to bioethics. Since this issue it starts-off a series of articles dealing with the topical themes the bioethics is involved the most. Why bioethics deserves so much attention?

We are living a great confusional period. Scientific research has greatly advanced and at the same time it has risen problems involving directly medical professions. I deem important asking  for the opinion of persons specifically oriented toward so delicate and complex themes so to transmit to our readers who already, thanks to  Internet, are all over the world. 

Do you refer to the transformation in act in society, for example, to the concept of family?

I would say better the transformation occurring in the interpersonal relationship, the abandoning  of the concept of complementarity between man and woman, carrying this fact misunderstandings not only among Laics but even in the Christian world. 

Within the debate about bioethics, many Laics bear that it is possible to go on being catholic, manifesting love for one's own God, even if bearing Laics theories. How do you evaluate these opinions?

First it is to clear what laic means. In the Utet dictionary the term is the opposite of 'cleric' and points out only whom does not  belong to priestly orders. Quite different is the definition of 'laicism' that still in the Utet dictionary, means 'the principle concerning the human kind autonomy, that is the need that those activities develops according to peculiar rules. So it cannot be invoked lawfully  in name of any legitimate human activity and cannot mean only a claiming of State in front  of Church” 
So on consequence those who bears the idea inside your question must clear if they are Laics or if they inspire in laicism, this difference - as you can easy sense - is determining. 

The Christian morals plant the need to get, throughout sacrifice, to the spiritual elevation.

Not only the catholic morals requires sacrifice, it is enough to get informed about all religions to verify it. On my opinion the catholic faith  as deemed by common man and not by saints, is joyful, throws life beyond life and this way determines the defeat of death.  From the coming of Jesus on earth, the Christianity is founded over love and love brings to the spiritual elevation.  On the opposite, for the unbelievers, the concept of life lies only on matter, on physicalness and  ends with death; and for man it is a dreadful reality that keeps away any incentive any reason to live an useless  life without aims. It is not a fault of the faith if humanity undergoes adversities, but it is the fault of the bad faith. 

When the physical suffering is terrible, man could give up and ask not going on his agony.

Are we talking about euthanasia? Keeping life is a principle not admitting violations. Accepting euthanasia is the consequence of the reality we live in, built on by paradoxes. We have the gynaecologist struggling to make a sixty years old woman having a child and on the other side the physician specializing in abortion and, on consequence, who specializes in euthanasia. Bioethics must set itself the aim to fix quite exact limits between right and wrong, limits both Laics and Catholics must observe.. 

How can be changed all that?

The damage carried over  these earlier fifty years is very serious. It must be talked to young people, starting from the time they are still attracted by the spurs of our society. This is a task for the families. Father Virginio Rotondi said : “world is wrecked since families are wrecked”. Behind a drug addicted boy, or a boy suffering psychical disturbs, there's almost always a wrecked family. On the other side pressures over families operated by mass media are so heavy that it is needed an as far as strong presence as in families. An important rôle must be played by religions since, even different, they  have a  common denominator: the safeguard of man and society. 
In dealing with bioethics topics we will report all opinions, even those inspired to laicism, on mutual respect. Young want certainties, let's leave doubts to adults, who can also ponder, provided they do not damage anyone. Luckily in the earlier times there's a return of young to values, those real values, and not built on dissertations by intellectuals. 

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Elio Sgreggia

L.M: Monsignor Sgreccia, yours have been one of the first authoritative voices to deal with ethics in Italy throughout the university teaching and several important works. What can we think about the way a so difficult matter is perceived and understood in a society that appears as it were in a moral tension and getting ever far from the Christian values?

Sgreccia: The problem has been sensed since the times when the bioethics was founded in America by the first founders, as by Potter. 
The current society, starting from Enlightenment and up to the achievement of the experimental sciences has been featured by the refusal of God and by an absolute trust in science. Potter talks about bioethics as it were the 'surviving science'. If the scientific pole does not meet the ethic pole the human kind may meet a catastrophe. Human kind owns indeed the means to self-destroy: the atomic bomb, the genetic engineering, the ecological bomb...

LM: How did the international scientific world react to this aspect?

Sgreccia: “In front of the progress the catholic world gives priority to human values. 
Ours is a fideist position,  it's a position having obtained the respect of the laic world at an extent that within it there are antiabortionists. It does not happen instead for whom support that who has lost mental faculties does not have anymore any value. We bring foreground, we revere human life, whenever he is healthy or he's ill.

LM: Which is on your opinion the most serious problem among those planted by bioethics?

Sgreccia: “We must wonder what our body is. It's a kind of machine we can assemble, disassemble as we like when it is not perfect, or is it a substantial part of our ego? Nowadays for example many people justify abortion in front of acts of violence occurring in many places all over the world, but killing the son of a raped woman is not to do good to him.  To do good means helping her and support her”.

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Professor Carlo Augusto Viano

LM: Professor Viano, which are the substantial topics of the “Laic Bioethics Manifesto“ that since it was issued has risen so many reservations?

Viano: The essential aspect of the document is the highest importance given to the autonomy of the patient when collaborating with the physician.
We want a bioethics favouring pluralistic solution, wherein there is not, on a side, authority or laws, no privileged positions for certain lines of conduct in loss of whichever else.

LM: As expected the negative replies come mainly from the catholic part 

Viano: Surely it concerns an opposition of cultural kind, very sensed in different countries, and especially in ours. But the laic and catholic bioethics has points over which they can meet. I'm talking about topics as the therapeutic persistence to keep a patient alive at all costs and the informed consent.

LM: The points on discussion instead?

Viano: There's a strong disagreement about the themes concerning procreation, the beginning of life, the fertilization practices and the family meant as regard to its traditional aspects and the problems related to the end of life.

LM: Reasoning in terms of laic bioethics means to exclude tout court God's existence, any norm of religious-moral kind. Are you convinced about it?

Viano: Not at all. The faith in God configures in many ways. The laic ethics focalises the freedom in choice of the individual as regard to God, also in the way one's own faith is interpreted, in front of the alternatives of the contemporaneous medicine. For the laic ethics it is perfectly proper that individuals acknowledge over themselves the sovereignty of an ecclesiastic authority providing that it is different from the state authority.

LM: You've written that the laic bioethics does not fight for wild experimentation and coercion of anybody's will. Well then for you the most important is the individuals' freedom.

Viano: Yes, the freedom in choosing for example if to abort or to end a pregnancy at risk if the woman thinks this way she meets the will of her own God.

LM: And how must physicians act?

Viano: Many legislation, even ours, foresee the conscientious objection. Who is a doctor must know that he may face difficult choices for his own conscience.

LM: Which are the outlooks you think will come true between the two positions: the laic and the catholic?

Viano: By the legislative and political point of veil the conflict will surely go on, but it concerns divergences about which law can do really few. I'm sure that there will be many people, even among believers, who will border the medical practises the religious vision of bioethics trends to set apart.

LM: So do you see a medical science winning ever more?

Viano: Superstition and ignorance are much more spread in the medical sciences. But the practices the contemporaneous medicine offers trend to spread very quickly, as it happens for the consumption of industrial products in countries that have refused them till little time ago.

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Professor Manni

LM: Professor Manni don't you think that  modern medicine has become too 'proud', too haughty in order to the technological instruments it has on disposal and has made it more difficult facing the ethic problem?

Manni: “If on a side we must not forget that technology has made medicine make many steps forward, we cannot either deny that today it is recorded a lack of humanity.On my opinion the change, the deterioration of the physician-patient relationship goes together with the break of the concept of family, a family once meaning love, respect, care of values“. 

LM: You have often dealt with transplants.

Manni: “We must get convinced that the donation of organs is a human work, it's a moral donation. We do not need organs when we are in the coffin, while they can make other persons live. The problems is very difficult and furthermore it must not be forgotten that in Italy the culture of the body is quite different from region to region “. 

LM: How do you judge the law about transplants earlier passed?

Manni: “ It has been chosen the solution regarding the informed silence-assent that is the solution foreseeing that the silence of the citizen is equal to the consent whereas the citizen is widely informed. It's a solution supporting civil rights, foreseeing absolute security norms, but anyhow it is a set of rules very difficult to manage since it is required a correct and complete information not easy to put in act in a country as ours. Nevertheless the problem is wider since that it is not enough a law, it is necessary to form the acknowledgement of donation. There's a further typical aspect that delays transplant surgery in our country. A transplant requires very high-capacitated medical personnel and also equipped with exactness equipment. 
In Italy the 'critic areas' wards as those of intensive care are under the requirements “. 

LM: Another topical matter about bioethics is that of the assisted fertilization.

Manni: “It's a very serious matter since among the physicians themselves there are divergent opinions. But it's a problem putting into light the contradictions of a society too. On a side there are women wanting abortion without planting any moral problem on the other side there's who wants a son all costs even employing the frozen sperm of the dead husband... 
Society starts from the concept of the absolute freedom in choice.  Man has the right to get everything without taking into account its rightfulness. 

LM: So a crisis of values in the society but a moral crisis in medicine too.

Manni: “It has been lost the sacredness of the death. The death bothers. Life seems to be made of happiness, publicity, and sex. The physicians themselves are not anymore used to death and furthermore they speak too much. Who listens to them needs to understand the concepts, otherwise confusion increases and the consequences in the moral field become more serious. 

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Professor Sergio Cotta

LM: Professor Cotta, bioethics is a multidisciplinary science. It does not regard only medicine, but religion right and philosophy. You, as a philosopher of law, have assumed quite defined and intransigent positions.

Cotta: “Bioethics sets again the dissension between science and religion with the difference that here it does not concern earth rotating around the sun but it comes into play the man itself. Man is the only being having the possibility to intervene over himself. We are facing huge seriousness problems. Think about the assisted insemination, a technical insemination upsetting  the nature of family at all. There's no more affection, love; the concept of creation is upset. Think about cloning. If I want my cloning I condemn the cloned man to be born not free and to have my own intellectual and physical features”. 

LM: Has the great scientific project brought happiness to man then? It seems not, since what is happening in the world of the young.

Cotta: “Do you remember the DDT discover after the Second World War? That insect powder seemed perfect but notwithstanding everybody got aware that it was dangerous and nobody used it anymore. Scientists peer at the possibilities to find new techniques, but it is not sure that they are right. Even they need a proof. The techniques object of bioethics if put into action will carry huge troubles for the human family. As regard to young we must not limit ourselves in teaching them ethics, but the foundations of ethics “. 

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Professor Anzani

LM: Professor Anzani it seems that in Italy it's getting wider the debate among those supporting a laic vision of the bioethics lying over the freedom in choosing of individuals and a catholic conceiving of the problem. What do you think about this contraposition of views?

Anzani: I do not reason in Catholics and Laic terms. I prefer to reason in human terms. No scientist can deny the religiousness of man (not the faith that is another thing). In other words I require the respect of the 'human value', that cannot be disowned. Has not bioethics risen just after of the  Trial of Nuremberg? It is required to say stop to the nefariousness of the nazism and to reflect about the biologic field and the wider sense of life.

LM: There are anyhow troubles in the communication between laic and Catholics.

Anzani: If the laic is in good faith it is necessary to talk without a spirit of imposition and overwhelming. I do not tolerate fences, net divisions. Maybe today it has not come yet the time to dialogue, we have not learnt yet the art of talking.

LM: In the hospital wards, substantially patients demand for euthanasia, for example the giving up to trying to keep them alive at all costs? In other words how does the public opinion sense the bioethics problem when the problem is planted in a hospital?

Anzani: People want to be looked after and want to recover. It's hard to accept the fatal prognosis and that there's nothing to do anymore. It must be replied referring to truth and man. 
That's why it's important to find educational and cultural moments concerning death for physicians and nurses. 
They must know how to love and dialogue.
The same is worthy for young who need an education focalising family.

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Professoressa Ruth Faden

Dr. Faden, Which are the most controversial issues on bioethics in the Usa?

Faden: The most controversial issues in bioethics in the U.S. today include the ethics of research on human embryos; physician assisted suicide; protection of human subjects; fairness in federal policies affecting access to health insurance; rationing of medical care; drug development and international research; trust in medical care institutions and physicians, in the face of rapid changes in the organization; and financing of medical services. 

The American society is open to change, but do the people realize that the problems posed by bioethics involve more radical turns, for instance, in the traditional concept of family? 
For example, if  a woman decides to utilize a semen-bank to have a child. 
What is your opinion?

Faden: It remains an open question wheter, or to what extent, advances in biomedical science are precipitating radical changes in the foundations of the human experience. 
This question lies at the heart of the American, such as international debates on human cloning and genetic enhancement. 

Many scholars in various disciplines argue that a patient is free to decide even to put an end to his life to avoid suffering. 
Apart from any religious consideration, how do you assess this view?

Faden: Wheter, or under what conditions, it is ever permissible for a person to end her/his suffering by taking their own life is an ancient question. 
It seems to me possible to construct a scenario in which the suffering and indignity of the patient is severe enough, and death sufficiently imminent, that it can be argued that a physician's assisting with the patient's competent and considered decision to die is morally justifiable. 
It is another question, however, wheter public policy should permit such actions. 

Some may argue that the modern medical science - too confident in technology - tends to remove the thought of death and suffering. From this point of view, don't you think the bioethics problems are a challenge to reaffirm the limits of human life and those of science?

Faden: Bioethics certainly serves to reaffirm the limits of the human experience as it calibrates our capacity for empathy and moral discernment. 

The first set of interventions is devoted to the bioethics topic in general with some mentions to special problems (abortion, assisted fertilization, therapeutic persistence to keep a patient alive at all costs, etc.) themes that next issues will be examined singly.
The statements recollected prove that the bioethics sector is a particular and demanding one. 
It deals with the meaning of life and death, pain andsuffering and that will involve next generations too, maybe the most serious problem we must face next century. 

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