Dr Trevor Stammers from the Centre for Bioethics and Emerging Technologies was invited to address the first National Bioethics Conference in Oman in March 2015.
Through this blog he discusses the key topics raised at the conference and the challenges facing the field of Bioethics around the globe. Beauty has an address – Oman – at least according to its tourism poster ad campaign.
Muscat certainly is a beautiful city but my visit there in the first week of March was not as a tourist, but as one of two speakers from the UK invited to address the first National Bioethics Conference in the country.
Some 150 delegates attended the three-day event along with some students from the medical faculty of the Sultan Qaboos University in Muscat where the conference was held. Most speakers were from the region but there was good international representation too with speakers from Uruguay, Italy, Canada, Austria, Uganda and Belgium as well as the UK.
The first morning was given over to Islamic bioethics and it was fascinating to see how a world faith very different from Christianity in many ways, still has similar issues in relating its sacred texts to the contemporary world of high-tech medical dilemmas. Islamic jurists are certainly kept occupied with deliberating and issuing fatwas on issues ranging from sourcing embryonic stem cells to end of life decisions such as whether a diagnosis of brain death allows the removal of organs for donation for transplant.
Controversy over end of life issues arose in the first lecture of the second day when one of the leading advocates of euthanasia in Belgium spoke about how he saw the practice evolving. One of his slides on modes of death had a category of “Paternalistic physician shorting of terminal agony” which accounted for 1.9% of deaths.
In the plenary discussion I questioned whether this was in fact involuntary euthanasia and was not reassured by the reply given that this only applied to the very last stages of death. Administering a lethal dose of medication with the intention of ending the patient’s life is still euthanasia and it is not only terminal patients who endure “agony”.
The Ebola crisis was focus of the afternoon session where end of life issues of a very different kind came into play. There was much discussion of the interplay of public health measures with local culture and religious customs especially in Islamic countries. The requirement in usual circumstances that the bodies of the dead undergo ritual washing presents obvious hazards in an Ebola outbreak and the critique of Western approaches in the ongoing outbreak in West Africa were presented alongside the valuable lessons learned from previous outbreaks in Uganda in previous years.
The final day was dedicated to genetics and biotechnology at which I presented on the hope and hype surrounding the UK government’s recent vote to permit three and four parent IVF to be attempted in humans.
Before my lecture plenty of controversy had been generated by a lecture on the recent successful birth in Sweden following a womb transplant. I was unaware that several patients had already died in previous attempts in the Middle East to achieve this and the speaker concluded that the dangers involved almost certainly meant it would not become a widespread practice any time soon even though not specifically proscribed in Islam.
Though my own presentation would have provoked an outcry if given at a bioethics conference in the UK, and indeed had led to such in the media before the vote, there was no visible dissent surrounding my conclusions that the procedure was both unsafe and unethical. The UNESCO delegation present at the conference which included a Professor of cell biology expressed their appreciation for me having raised important issues that had been ignored or side-lined in the stampede to pass the legislation in a mere 90 minute debate in the House of Commons.
There was very little, if any, publicity worldwide about the maternal and fetal deaths in the initial womb transplant attempts. Three parent IVF even if it succeeds at all is highly unlikely to do so without abortion or miscarriage of the first ‘failures’ from the technique. They seem equally inevitable however and those scientists and patients alike wanting to be the first to succeed should be prepared for them.
The global audience attracted to this international event and the candour with which highly controversial issues were openly discussed both bring great credit to the Oman National Bioethics Committee for all their vision and enterprise in arranging this inaugural conference. I hope it will not be the last.