B. Mamulashvili. Human Genetics: Ethical Problems of the Present and Future. - Bioethics. - Tbilisi: Lega - 2001- 25 p. - Bibl. 23 - in Georgian.
Increasing progress of medical genetics is accompanied by large number of moral and juridical problems, solving of which is associated with great human pain and understanding of human values. For example, attention of wide society is attracted to the problem of the opportunity of obtaining genetically identical copies of live people.
One of the basic features of ethical problems of medical genetics is the fact, that heritable diseases are passed to the descendants through reproduction processes. So the problems of medical genetics are not individual, they are rather family problems.
Other significant feature of heritable diseases is, that very little per cent of diseased by heritable diseases can be healed with some success. Generally medicine is limited by prevention and diagnostic methods of these diseases. It is also doubtful, would any person like to know his fate, if he can do nothing with it. One more specific feature of ethical problems of genetics is the fact, that the basic object of genetic practices is treatment of children, which are not born yet. Modern American scientist Walters thinks, that basic ethical problem of modern medical genetics is observance of confidentiality of genetic information, volunteer character of genetic testing and population screening of the individuals, availability of medical genetic assistance (testing, consulting etc), for different segments of population, interrelation of potential good and evil in implementation of various genetic interventions. Medical genetics use numerous methods. We should admit genealogical analysis, testing and screening. Classic instrument to reveal genetic character of some disease, it is drawing up the genealogy, what, on its' side includes number of unpleasant ethical problems. The doctor - genetics specialist draws up genealogical map after receiving and analysing full information, though usage of this map by the patient is also associated with number of ethical problems, caused by information and can hurt not only the patient himself, but also is relatives. This information can cause his dismissal from job, breaking of the marriage, fear towards the future etc. Though if the information includes probability of heavy psychical or somatic disease, the doctor - genetics specialist has to provide full information and consult his relatives, to avoid some unpleasant accidents; even in those cases, what the patient has some objections, the relative (who needs it) shall receive information. Genetic diagnosis can be significant harm for the patient and his family and provide cause for their social discrimination.
Genetic screening of the population is carried out to identify the carriers of the gene of heritable disease. Classic example for it is the screening program, which identifies those new-born children, who has Phenilcetonuria - heaviest heritable disease. This disease hurts the brain and marrow. Timely diagnostics, special diet, excluding Phenylalaline, together with psycho-reactive therapy and social adaptation methods yield quite significant general results.
Application of screening programs can cause moral conflicts, related to confidentiality, which obliges the doctor - genetics specialist to inform the patient about the possibility of heavy heritable disease. Medical genetics goes on developing, studies and looks for the ways out, to reveal heavy genetic diseases and cure them. In addition, medical - genetic assistance shall be the right of any human and correspondingly. The government shall guarantee it. It is also important to ensure confidentiality of genetic information, opportunity for personal choice for the citizens, protection of incapable people. There are prohibitions of usage of genetic information as a basis for national, ethnic, economic, political etc. discrimination.
B. Mamulashvili. Ethics in Psychiatry. - Bioethics.- Tbilisi: Lega - 2000 - 20 p. - Bibl. 19 - in Georgian.
Among other medical disciplines psychiatry is more close to a person - Homo sapiens, his mental world and hence to the philosophy and ethics. Formation of psychiatry, as an independent medical discipline is associated with paternalistic relation between the doctor and patient. This is the starting point for the attitude of the society to the insane people, as to the ill ones.
French doctor Phillip Pinelle gave qualification of the insane people. His reform became the apotheosis of medical paternalism. Pinelle's paternalism is not only ethical position, it is also the core of "moral therapy", where moral and physical perfection of the doctor receives special significance.
English doctor Connel deepened ethical aspect of Pinelle's treatment method. He proposed to exclude all treatment methods, which discriminated the patient. Connel's system "No restraint" caused great commen in the Europe and of 60 - 70-ies. In the USA new policies - policies of deinstitutionalisation of the psychiatric patients was carried out. It implies the policies rejecting enforcement of patients to stay in the hospital. Majority of the patients was enforced to stay in the hospitals, though they did not need to stay there. They underwent the principle of supervision and non-respect, which was directed to the hate, rather to their treatment and rehabilitation.
In the sixties in the Europe and afterwards in the USA anti-psychiatric movement took place, which implied, that "there are no psychiatric diseases, there are only micro-social crisis situations". Schizophrenia is a social label; there are no psychically diseased, it is isolation of normal individuals from the society by means of the psychiatrists. Psychiatry is not a science and the psychiatrists are the policemen in white coats. In 70-80-ies the social context of psychiatric assistance generally was determined by protection of human rights of the mentally diseased. In Georgia these ideas were reflected in "Georgian Law on Health Protection". It contains key principles of ethical-legislative protection of the psychically diseased. Each person with psychical disorder shall be treated with proper respect to his human dignity. Mentally sick people are most vulnerable social group. In all civil societies stigmatisation, social isolation, unjustified limitation of rights shall be restricted. Any form of humiliation of mentally ill people deserves proper assessment and sanctions.
Attitude of the society to the mentally ill people greatly determines the moral image of this society.
B. Mamulashvili. Moral and ethical Problems of Human Reproduciton. - Bioethics. - Tbilisi: Lega - 2001 - 25 p. - Bibl. 27 - in Georgian.
Applying of modern reproductive technologies is associated with complex philosophic, religion, juridical and moral problems, most part of which can not be solved easily. There are two methods o artificial fertilisation: Artificial insemination and in vitro fertilisation.
Artificial insemination can be homologous - using the husband's sperm and heterologous - using donor's sperm. In the case, when there is donor ovule, the terms are the same. In the case of homologous fertilisation zygote is implanted to the same woman, from whom it was taken and in the case of heterologous - to other woman (donor mother).
In the homologous method biological and social parent of the child are one and the same. Therefore such method causes less ethic contradiction and it is not against juridical norms of formation of the family and marriage. Applying of heterologous method is associated with numerous moral difficulties and often it leads to the court. On one hand it is appreciated, as an expression of altruism and on the other hand it is irresponsible attitude towards the god's will. Ethically it is most difficult to differentiate between good and the evil, regarding rights of the child, born as a result of artificial fertilisation. They have right to receive information about their biological parents. This information includes also genetic information, what frequently leads to tragic collisions. Extracorporal fertilisation, or in vitro is one of modern reproductive technology.
In the case of in vitro fertilisation many ethical problems arise. Namely, what is ontological and moral status of the embryo? At what stage the embryo can be regarded as a human being? In what degree it has human rights, etc.
Regarding modern data of human embryogenesis, it was determined, that in some sense the embryo is a career of human dignity. Embryo is not a simple part of internal organs of a woman.
Manipulations with the embryo, with the aim of gender change, are also associated with complex moral problems. In the case of in vitro fertilisation, likelihood of many-embryo pregnancy is greater, compared with the natural case. Therefore the doctors provide "embryo reduction", or destroying of excess embryos. And what do we have? Treatment method, which aim to overcome the infertility problem, leads to destroying of new life. One of the most complicated issues, arisen in the case of ovule donning is the issue of determining motherhood. Who should be regarded as mother of a child? who gave birth to him or whose ovule was used?
In many countries all over the world there are discussions about so called surrogate motherhood. As a result of similar manipulations a child can have 5 parents. All over the world there is clearly negative position regarding surrogate motherhood. It is regarded as a new form of selling one's body, what makes woman a life incubator.
All religious have negative attitude to artificial fertilisation and especially to fertilisation through in vitro and heterologous methods. We regard some methods (in vitro) of artificial insemination inadmissible, as it destroys harmony of the world and turns a human into a good, object of purchase and sell.
B. Mamulashvili. Bioethics and Deontology in Clinical Transplantology. - Bioethics. - Tbilisi: Lega - 2001 - 6 p. - Bibl. 8 - in Georgian.
The modern transplantology, based on surgical method, means thousands of patients who have gained the second life after having been transplanted various organs or tissues.
Transplantology is recognised method to cure hopeless patients - the last hope for them and the maximum risk for a surgeon. It is natural, that such progress in surgery require to re-determine human principles. Transplantation of a kidney or a lung of an alive person by a surgeon needs new interpretation of the standards of ethics and it contradicts with the Hypocrite oath "do not harm". Patients' relatives risk their lives for the least chance of saving him though their rights are violated.
82 % of polled is against persons, genetically not related to the patient, as a donor; 64 % of polled agree with the principle of declared consent, 36 % - possibility to receive consent of the close relatives. 99,5 % per cent of polled are against the usage of the corps without relatives' consent, even abandoned one and 38 % of polled completely excludes any manipulations on the corps, without pre-declared consent, except for medical expertise.