Bioethics in Latvia: Current Situation

Introduction

Since Latvia regained independence on 4 May 1990, the field of bioethics has undergone substantial change in terms of legislation, education, ethical review and academic research. For instance, Latvia has signed a Convention on Human Rights and Biomedicine (Oviedo Convention) in 1997, then ratified it and it came into force in 2010.¹ It also signed and ratified (in 2009) the Additional Protocol on the Prohibition of Cloning Human Beings. However, the process of adapting current international regulations is far from complete—Latvia has not yet signed several related documents such as the Additional Protocol on Transplantation of Organs and Tissues of Human Origin, the Additional Protocol concerning Genetic Testing for Health Purposes, and the Additional Protocol on Biomedical Research.

The transition towards Western-type ethical standards is taking place against the background of “medical deontology”—a standard of ethical education and conduct practised in the Soviet Union. In the first part of this article, we will give a brief outline of how this old standard was taught and practised, and how it is getting replaced by more contemporary approaches to medical ethics.

The second part of the article will focus on the system of ethical review of human research—the types and functions of research ethics committees in Latvia. While it can be said that the system of safeguarding the interests of research subjects is generally in place and functioning, there are still many problematic areas—insufficient information, conflicts of interest, issues of training and payment, as well as non-equivalent stringency of ethical review for different types of research.

The third part will cover developments in academic research and publications in the field of bioethics. It will list the main sites of academic activity and name the most prominent academic publications in both Latvian and English.

Education and Practices

Deontology was an essential element of the medical education system in Latvia till the middle of 1990. It was a Soviet deontological approach delivered as a specific field for different medical specialties, for example, deontology in anesthesiology, clinical reanimatology, experimental medicine, surgery, etc. The core textbooks for nurses and doctors in training were Introduction in Medical Deontology written by Kaņeps V., Vīksna L. (1981)² in Latvian, and Deontology in Medicine (1988) written by group of authors, edited by B. Petrovsky³ in Russian.

Soviet “deontology” was hardly a classical version of deontological theory. Physicians’ duties are rarely clearly specified in detail, and the only two discernible principles are: non-maleficence and “everything for the benefit of the patient”. In practice this approach has more resemblance with virtue ethics, where the proper character (decorum) of the doctor is of primary importance. According to Kaņeps and Vīksna, a Soviet doctor must be ready to take extreme measures: “Heroic action, self-sacrifice has always been a norm of medical conduct” (Kaņeps and Vīksna 1981, 18).

Ethics was taught not by representatives of the humanities, but by medical specialists who were at the same time delivering one of the medical courses, for example, in surgery. Therefore it was a subject presented from the viewpoint of the medical specialist and conclusions were largely derived from their personal experience, sometimes very subjective, but always based on the belief that the doctor knows better what is best for the patient. Professionals were portrayed as selfless individuals who are always ready to help the patient: “Without true calling and love of the sick person, it is difficult and sometimes even impossible to subordinate one’s interests to the physician’s duties. No matter how tired a doctor, whatever his mood, whatever is happening in his family, whatever the weather, or whether it is day or night—the doctor must be ready to provide the patient with the necessary assistance” (Kaņeps, Vīksna (1981), p. 26). This highly-coloured personification of the medical profession as heroic is an attempt to show the moral ideal of a communist doctor rather than an accurate depiction of reality. From a contemporary perspective it seems wildly exaggerated; however, in the Soviet medical...