Fred Gifford and Ana Rodriquez, `bioethics in Costa Rica: origins and challenges
ASSIGNED READING/WORKS FOR REVIEW ARTICLES (TWO) /EXAMS GRADES
ACADEMIC YEAR 2011/2012.
1.1 MEDICAL BIOETHICS
1.2 Introduction
Bioethics is the study of controversial morals brought about by improvements in biology and
medicine. People who study bioethics are concerned with the moral questions that arise in the
relationships among life sciences, biotechnology, medicine, politics, law, and philosophy. It also
includes the study of the more commonplace questions of values which arise in primary care and
other branches of medicine.
1.3 Revolutions of medical bioethics around the globe
Different countries have undergone drastic revolution in which their medical practitioners ought
to operate. Need for upright medical ethics rose in many countries as away of instilling values in
physicians .Catholic church has played a crucial role in putting in place some of this bioethics
that have been adapted by many states. Many countries have concentrated much on medical
research with enormous budgets set aside to cater for it.
Costa Rica’s government for instance, run system of health care provision popularly known as
the caja wads which was put in place in 1943, based on the principals of universality, equality
and solidarity. This system has been praised by the native Costa Rican people as being effective
and fair. In spite of this, this system has been faced with confrontations from certain reforms
arguing that there’s need for bioethical debate and reflection, Gifford and Rodriquez (2011),
On research involving human subjects, ethical concerns about clinical trials in the 1990 resulted
in the attempt to set up regulations and regulatory bodies. This history has been filled with
controversy. Government regulations with a research ethics committee set up by Caja was
subsequently terminated. There remain worries about whether the present system of oversight of
human subjects’ research is adequate, Gifford and Rodriquez (2011).
The Roman Catholic being the official religion of Costa Rica has considerable influence over
policy and public opinion on morality. For example in the year 2000, it declared vitro
fertilization unconstitutional.
The result failure to question authority is exacerbated by a particular cultural future of Costa
Ricans a strong desire to get along peaceably and not confront others about disagreements. This
makes it harder to challenge the medical profession on bioethical issues that are controversial.
In the beginning of 1970s, there was a crisis along with the rising costs of medical technology
and an aging population which led to a crisis in healthcare system with long waiting lists and
lack of resources. This plight led to reforms which saw business decisions and a focus on
efficiency into the way clinics and other health care settings were run and the way in which
doctors thought. Because of these reforms, many doctors opted to venture in private sectors
opening their own businesses. These changes brought about ethically dubious motivations with
doctors competing with others and providing poor health care to Costa Ricans Gifford and
Rodriquez (2011).
Reforms led to transfer of all responsibility of provision of healthy care to Caja which also saw
the transfer of people from the ministry of health??? of to the Caja hence rising conflicts between
world views and the two parties. The main cause of conflicts between the ministry of health and
the Caja is to have influence on who does what in bioethics and who takes what seriously.
On research involving human subjects, the committee that was selected to carry out the research
was much divided. Some in effect opposed the all the research on human subjects. Others were
motivated primarily to enable research to go forward and saw the concern with bioethics and
regulations mostly an improper imposition that would hinder research. In 1998, this committee
and the regulations were eliminated Rodriquez (2011).
Many African countries have found bioethics in medicine very important to an extent that they
have incorporated it in their curriculum and their government invested extensively in the same.
According Bengo and Masiye (2011), University of Malawi College of medicine is one of the
very few medical colleges in Africa that considers the subject of bioethics and research ethics as
necessary and indispensable. Its one of the few medical schools in Africa to introduce a
compulsory biomedical ethics curriculum, which covers all five years training. the center for
bioethics in eastern Africa and southern Africa was established in 2001. The center is committed
in helping health care professionals, researchers students and policy makers in addressing ethical
questions in Malawi. It seeks to promote the ethical practice of medicine and the ethical conduct
of biomedical research in Malawi. It also provides training to ethics committee members and
researchers on research ethics, clinical trial monitoring and good clinical practice.
To achieve its goals Center for bioethics in Eastern and Central Africa, (CEBESA) has two main
components which includes research and training that deals with teaching of bioethics to
undergraduate students in all programs in the college from first year to the fifth year, teaching of
bioethics and research ethics to post graduate students in the master of public health degree, and
master of medicine, provide training to ethics committee members and researchers on research
ethics, good clinical practice and research methodology Bengo and Masiye (2011).
Countries without proper bioethics put in place have encountered unscrupulous physicians who
have prescribed unnecessary and expensive drugs, ordered unnecessary special medical
examinations and disregarded patients best interests and welfare in favor of their wallets.
Renzong (2011) asserts that Market oriented health care has seriously eroded medical
professionalism in China. Chinese bio-ethists have been on the forefront addressing similar
issues in the past for example sometimes working with medical professionals, sometimes
offering an opposing view. For example when the medical profession did not express concerns
about the use of executed prisoners’ organs for transplantation, bio-ethists did and the
government ended the practice.
1.4 Critical review
It’s clear that the Catholic Church has played an important role in setting bioethical trends of the
above mentioned countries. African countries have found bioethics in medicine very important to
an extent that they have incorporated it in their curriculum and their government invested
extensively in the same. University of Malawi College of medicine is one of the very few
medical colleges in Africa that considers the subject of bioethics and research ethics as necessary
and indispensable. Its one of the few medical schools in Africa to introduce a compulsory
biomedical ethics curriculum, which covers all five years training. the center for bioethics in
eastern Africa and southern Africa was established in 2001.The center is committed in helping
health care professionals, researchers students and policy makers in addressing ethical questions
in Malawi. It seeks to promote the ethical practice of medicine and the ethical conduct of
biomedical research in Malawi. It also provides training to ethics committee members and
researchers on research ethics, clinical trial monitoring and good clinical practice. In spite of this
some countries in the world like Costa Rica find it difficult to implement bioethical policies in
medical health. They have been faced with intense opposition from the political side and
divisiveness in the medical sector. The Costa Rican ministry of health has given out powers to
implement important medical policies to the incompetent Caja which is faced with frustration
from workers who did not want to retire from government and were otherwise posted to work
with it.
Bioethicists have had a resounding contribution in the medical profession for example Chinese
bio-ethists have been on the forefront addressing moral wrongs in the medical profession in the
past for example sometimes working with medical professionals to rectify situations, sometimes
offering an opposing view towards what they feel is wrong. For example when the medical
profession did not express concerns about the use of executed prisoners’ organs for
transplantation, bio-ethists did and the government ended the practice.
1.5 Conclusions
Medical schools and hospitals have not actively embraced and supported bioethics as it is the
case in Costa Rica and some other parts of the world. There are very few well trained bioethicists
in the world with the skills and credibility to provide effective and appreciated bioethics
consultations in the clinical care setting. African countries on the other hand haven’t fully
appreciated what western medication does considering what the traditional healer can offer.
The politics of ethics
Bengo and Masiye (2011) assert that, Bioethics in Malawi started long time ago as a result of
conflicts among human beings. Ethics manifested itself during colonial rule when Joseph
Chilembwe, the first Malawian freedom fighter, led an uprising in 1915 against forced
recruitment of Malawians into the British army during the First World War. He was against the
ill treatment of Malawians who were forced to work in European estate without pay.
Malawi became independent in 1964 with President Kamuzu Banda as its first president. In 1971
he declared himself president for life and Malawi became a one party state. Various laws were
constituted that continued to curtail personal liberties until 1993. Malawi continued to suffer
massive social, political and economic in justices that characterized Doctor Kamuzu Banda
regime.
In 1992, opposition against one party rule took a new turn 1992 when catholic bishops issued a
pastoral letter openly and publicly condemning one party rule, the violation of human rights and
the lack of freedom of speech and democracy. The pastoral letter gave an impetus to the popular
movement demanding political change. Student, workers went to the street to demonstrate. To
strike in support of the pastoral letter. Even though president Banda threatened the bishops’
withy executions at first, he eventually gave in to the demands of the pastoral letter by proposing
to have a referendum on malty party democracy. Parliamentary elections were carried out and
Kamuzu Banda was defeated by Bakili Muluzi a Muslim who became the president in a
Christian dominated country, Bengo and Masiye (2011).
Since the remarkable Roman Catholic pastoral letter, Malawi has seen and experienced a
redefinition of ethics, the rebirth of Christian ethics in Malawi. The after of the pastoral letter
was that, Malawi became a free and independent state. Culture has always surpassed the strength
of political disarmament in Malawi at the wake of socialism (ubuntu and umuthu) in this context;
bioethics is seen as a relationship of a human being with himself or herself with nature or other
human beings. This relationship is based on corporation and fairness and its root in the African
moral thinking of umuthu or ubuntu as it commonly known in southern African countries.
Ubuntu means being humane. It is a moral reflection of African humanism and moral systems.
Malawi considers Ubuntuology as the main theory of African Bantu bioethics. One becomes
human through positive relationship and encounters which are based on respect, trust, hope and
justice. In this context, those who relate well are considered good and humane, Bengo and
Masiye (2011).
Some countries have recognized the importance of political ethics and have adhered themselves
to fully supporting them for example: Renzong 2011, Chinas ministry of education was
sponsoring bioethics workshops for graduate students at southeast university in Nanjing. In 1987,
the first book on bioethics moved beyond the scientific realm and entered the legal arena. The
important roles in of ethics in scientific advancement and the law was realized both through
litigation and two national conferences, national conference on social, ethical and legal issues in
euthanasia which took place in Shaghai July 1988 and the 1979 conference in Guangzhou
specifically focused on this topic.
1.4 Critical review
From the above studies, political ethics started long time ago in Africa as a result of freedom
fighting in the pre colonial period. As it is the case in Malawi, Ethics manifested itself during
colonial rule when Joseph Chilembwe, the first Malawian freedom fighter, led an uprising in
1915 against forced recruitment of Malawians into the British army during the First World War.
He was against the ill treatment of Malawians who were forced to work in European estate
without pay. This was also manifested in South Africa during the apartheid regime where
Africans fought relentlessly led by nelson Mandela to induce moral and respect for humanity.
Countries like China has government policy on reform openness which created the need for
bioethists, also created an atmosphere in which discussion of various and competing view points
was tolerated and even promoted. Each year since 1999 the Chinese government’s financial
investment in scientific research has increased with more than twenty percent. Chinese
government was funding more research than Japan making Chinas monetary commitment to
research second highest in the world.
1.5 Conclusions
Majority of African countries that were colonized suffered a great deal of humiliation and lack of
respect for humanity. Ethics and morals were unheard of in these African states. After
independence, these countries continued to suffer neocolonialism in the hands of their own
leaders. A good example is that of Malawi under president Banda who humiliated his own states
men in the name of single party state. The Roman Catholic Church played a very important role
in the liberation of this country from the grasp of dictator ship.
