O nekaterih etičnih About some ethical zadregah sodobne perplexities of medicine	modern medicine
Akad. prof. dr. Jože Trontelj, dr. med.
Simpozij Medicina in pravo 21 - Odsev medicine in prava v
sodobni družbi. Univerza v Mariboru, 29.-31. marca 2012.
Uvodno predavanje
Cenim povabilo na srečanje s tako ugledno tradicijo. Serija mednarodnih posvetov Medicina in pravo v organizaciji Mariborske univerze je storila izjemno veliko za dialog med dvema področjema, ki imata veliko stičnih mest. Koristi pa presegajo ta dialog. Razprave so bile vedno znova tudi priložnost za samorefleksijo strok in za poglobljen vpogled v bistvo nekaterih pomembnih etičnih in pravnih vprašanj današnjega časa.
Naj spomnim, kaj se je pred nekaj leti zdelo evropskim državam v bioetiki najbolj potrebno razprave in vseevropskega etičnega soglasja. Njihova izbira prav dobro odseva znano, staro izkušnjo o dveh najbolj kritičnih obdobjih v človekovem življenju, ko je človeško bitje posebej občutljivo in odvisno od drugih. Prvo sega od spočetja do rojstva in nekaj dni, tednov ali mesecev potem; drugo pa je doba terminalne bolezni in predsmrtne agonije, ki se konča s smrtjo. V obe se vse bolj vmešava medicina. Malo več kot dve tretjini glasov evropskih delegacij so prejela etična vprašanja, povezana s tema dvema obdobjema. Posebno pravice človeškega zarodka, otroka pred rojstvom in rojenega otroka občuti Evropa kot odprta vprašanja. Ta so v tabeli označena z zvezdicami.
Usmerjevalni odbor za bioetiko Sveta Evrope je želel pripraviti stališča o varstvu človeškega zarodka in vitro kot enega od protokolov k Oviedski konvenciji o človekovih pravicah v zvezi z biomedicino. To je bil največji neuspeh tega telesa doslej. Po nekaj letih dela se je pokazalo, da so nasprotja v stališčih med razmeroma liberalnim Severom in bolj konservativnim Jugom Evrope prevelika in da do uporabnega soglasja o najobčutljivejših vprašanjih ne bo mogoče priti. Delo se je končalo s poročilom, ki je zajelo
Professor Jože Trontelj, MD, PhD
Symposium Medicine and Law 21 - The reflection of medicine and law in modern society. University of Maribor, 29-31 March 2012.
Introductory lecture
I greatly appreciate being invited to a gathering of such eminent researchers. A series of international conferences entitled "Medicine and Law" organized by the University of Maribor has enabled dialogue between professionals in medicine and in law. The benefits go beyond this dialogue. The conferences have been an opportunity for self-reflection in both areas and for in-depth analyses of some of the important ethical and legal questions of our time.
I want to bring up what in bioethics a few years ago European countries felt as priorities for discussion and reaching all-European consensus. Their choice reflects very well experience with the two most critical stages of human life when a human being is especially sensitive and dependent upon others. The first stage is from conception to birth and few days, weeks and months afterwards; the other stage is terminal illness which ends with death. Medicine is increasingly interfering with both. Just over two-thirds of votes from the European delegations were related to ethical questions concerning these two stages. In Europe in particular, the rights of human embryos, unborn and newborn children are a matter of controversies, as shown in Table.
The Council of Europe Steering Committee on Bioethics started to prepare standpoints on the protection of in-vitro human embryos as one of the protocols to the Oviedo Convention on Human Rights and Biomedicine. This has been the greatest disappointment of this body until now. After a few years of work it became obvious that the differences between the relatively liberal North and the more conservative South of Europe were too great to allow any useful consensus on the most sensitive issues. The work ended with a
Vpiašanja	Število glasov
Odločitve o končanju življenja	14
*Genetika, genska tehnologija	13
*Zarodek in vitro	11
Znanstvene raziskave	7
Nevroetika	4
*Križanci Človeka z živalmi	4
Etika delitve sredstev	4
Pacientove pravice	2
Nanotehnologija	2
Question	Numbei of votes
Decisions on ending life	14
*Genetics and gene technology	13
*Embryos in-vitro	11
Scientific research	7
Neuroethics	4
*Human-animal crosses	4
Distribution Ethics	4
Patient rights	2
Nanotechnology	2
Tabela: Anketa Sveta Evrope (2007) o temah, ki naj bi jih kot najnujneše obravnaval Usmerjevalni odbor za bioe-tiko Sveta Evrope. Z zvezdico so označene teme, ožje povezane z etičnimi problemi človeških zarodkov in otrok.
dotlej objavljena znanstvena dejstva in smeri raziskav, ni pa podalo etičnih opredelitev. Odprta je ostala pobuda, da bi pozneje pripravili kak manj ambiciozen pravno-etični instrument, ki bi upošteval vse razlike v stališčih, a vseeno začrtal nekak etični minimum. Nadaljnji potek raziskav in razvoj zakonodaje, posebno britanske, ki je šel v izrazito liberalno smer, je bolj ali manj pokopal tudi to pričakovanje. Odkritje embrionalnih matičnih celic pa je bilo za razpravo o morebitnem splošnem priznanju pravic človeških zarodkov in nerojenih otrok usodno. Močni lo-biji so tradicionalno usmerjenim etikom v raznih deželah skoraj zaprli usta. To se je po pravem baražnem ognju zgodilo predvsem v Britaniji. Sprejeta je bila nova zakonodaja, ki je znanosti dala na področju dela s človeškimi zarodki veliko svobode. Močan argument v teh razpravah je bil interes britanske industrije, ki ni hotela tvegati zaostanka za drugimi pri proizvodnji novih zdravil in medicinskih tehnologij. Britanski znanstveniki so se srdito odzvali celo na evropsko razpravo o tem, kaj naj bo dovoljeno v znanosti početi z zarodki s podporo evropskega denarja iz FP7. Z nekaj zamude se je liberalizacija zgodila tudi v ZDA. Ba-rack Obama je kmalu po izvolitvi odstavil uglednega etika in zdravnika dr. Edmunda Pelegrina, vodjo Predsednikovega sveta za bioetiko, razpustil Svet in dosegel odpravo prepovedi pridobivanja človeških zarodkov za raziskave. Nerojeni, pa tudi rojeni otroci so postali še bolj slaba vest številnih etikov po svetu.
Table: A poll from the Council of Europe (2007) about the most important topics to be discussed by the Council of Europe Steering Committee on Bioethics. Topics marked with an asterisk are closely connected with ethical problems of human embryos and children.
report that contained published scientific facts and research directions but did not give any ethical appraisal. An initiative to prepare a less ambitious ethical-legal document which would consider all differences in views but nevertheless delineate an ethical minimum of some sort remained open. Further research and the development of legislation (particularly UK legislation, which took a distinctively liberal direction) more or less buried even this expectation. The discovery of embryonic stem cells was fatal for the discussion about possible general recognition of the rights of human embryos and unborn children. Strong lobbies almost silenced traditionally oriented ethicists in various countries. Like an artillery barrage this happened mostly in the UK. New legislation was adopted which gave considerable freedom to scientific research on human embryos. A strong argument in these discussions was the interest of the UK industry, which did not want to risk falling behind that of other countries in the development of new medications and medical technologies. UK scientists responded angrily to the European discussion about what research on embryos would be allowed with the support of European funds from FP7. Liberalization also occurred in the USA, although with some delay. Soon after his election, Barack Obama removed the distinguished ethicist and physician Edmund Pelegrino as the head of the Presidential Council for Bioethics, disbanded the Council, and abolished prohibition of production of human embryos for research.
Zato sem izbral za svoje predavanje tale podnaslov: Zakaj se za nerojene in rojene otroke celo etične razprave tako pogosto končajo slabo? To presenetljivo vprašanje izstopa v vrsti žgočih etičnih dilem. Tu omenjam samo nekatere:
•	Ugotavljanje spola zarodka zaradi selektivnega abortiranja deklic;
•	osporavanje pravice ženske, da donosi prizadetega otroka;
•	OBMP brez medicinske indikacije in nadomestno materinstvo;
•	oploditev pomenopavznih žensk z darovanimi zarodki;
•	pridobivanje človeških zarodkov za proizvodnjo embrionalnih matičnih celic;
•	pridobivanje človeško-živalskih križancev, hibridov in himer;
•	pridobivanje otrok-rešiteljev z zunajtelesno oploditvijo in izbiro zdravih, tkivno kompatibilnih zarodkov za presaditve v bolne brate in sestre;
•	dopustnost »porojstnega splava« - usmrtitve novorojenčka na podlagi istih indikacij kot za splav;
•	dopustnost usmrtitve otroka do dopolnjenega 2. leta starosti;
•	genitalna mutilacija otrok zaradi plemenske tradicije ali religiozne prakse.
Naj se nekoliko zadržim le ob nekaterih od teh vprašanj (napisanih s poševnimi črkami). Pri večini gre za dejanja instrumentalizacije, za uporabo otroka kot sredstva za zadovoljitev interesov nekoga drugega. To večini etikov ni sprejemljivo, saj ima ali utegne imeti za otroka slabe, pogosto pogubne posledice. Začel pa bom z enim, ki je nekoliko drugačno.
Osporavanje pravice ženske, da donosi prizadetega otroka.
Na mizi imam pretresljivo pismo matere in njenega soproga, ki sta doživela travmatsko izkušnjo v eni od slovenskih porodnišnic. Do nekaterih porodničarjev kot da ni prišlo evropsko stališče, priporočilo Sveta Evrope, kako ravnati v takem nesrečnem primeru. Če se mati odloči hudo prizadetega otroka splaviti, jo je treba v tem podpreti. Če se odloči donositi, jo je treba podpreti tudi v tem in po rojstvu otroka obema pomagati po pravilih stroke. V zadnjem primeru gre za globoko čustven, pa tudi globoko etičen odnos do človeškega življenja. Zdravniki smo ga dolžni spoštovati. Tem materam se je v časih, nenaklonjenih spoštovanju človekovega dostojanstva, pred pol stoletja javno poklonil naš
Unborn and born children have caused guilty consciences in many ethicists around the world. This is why I gave to this lecture a subtitle: "Why do ethical discussions often end badly for unborn and newborn children?" This question arises from several pressing ethical controversies, some of which are mentioned in Table 2.
Table 2 Some ethical controversies concerning children
•	Establishing the sex of the foetus for the purpose of selective abortion of females
•	Denying a woman's right to carry a disabled child to term
•	Medically assisted procreation without medical indication and surrogate motherhood
•	Fertilisation of post-menopausal women with donated embryos
•	Producing human embryos for the procurement of embryonic stem cells
•	Producing human-animal crosses, hybrids and chimeras
•	Creating saviour siblings by means of in vitro fertilisation and selection of healthy embryos to acquire tissues for transplantation into sick siblings
•	The permissibility of an "after-birth abortion"(killing a newborn on the basis of the same criteria as used for abortions)
•	The permissibility of killing a child up to 2 years of age
•	Genital mutilation of children as part of tribal tradition or religious practices.
I will ponder for a while on the questions written in italics in Table 2. Most concern instrumentalisation: to use children as a means for meeting the interests of someone else. For many ethicists, this is not acceptable because it may have bad, often devastating consequences, for the child. However, I will start with an ethical dilemma which is somewhat different.
Denying a woman's right to carry a disabled child to term
I received a sad letter from a mother and her husband who had a traumatic experience in one of the maternity hospitals in Slovenia. It seems that some obstetricians have not been reached by the recommendation of the Council of Europe on how to treat such unfortunate cases. I quote: "If a woman decides to abort a heavily handicapped child, she
ugledni etik akademik Janez Milčinski. Lepo je bilo brati v Naših razgledih o njegovi spoštljivi hvaležnosti za plemenito sporočilo, ki ga zgled teh čudovitih mater predaja Slovencem. - Naši današnji kolegi pa so v omenjenem primeru žal mislili in ravnali drugače.
OBMP brez medicinske indikacije in nadomestno materinstvo.
Prejšnjo nedeljo smo opravili referendum o družinskem zakoniku. V času javne razprave se je na pozive z raznih strani oglasila tudi Komisija Republike Slovenije za medicinsko etiko (KME) z opozorilom, da bo sprejeti zakonik lahko prikrajšal otroke za enega od roditeljev, če se bodo za rojevanje v istospolne pare uporabljali postopki oploditve z biomedi-cinsko pomočjo (kar je v nasprotju z veljavnim zakonom). Izjava se je zdela sporna enemu od naših liberalnih tednikov. Ne zato, ker smo se zavzeli za pravice otrok, ampak zato, ker smo izrazili mnenje o nečem, kar nas menda ne bi smelo zanimati, nadalje ker smo se oglasili prav v času pred referendumom in nazadnje, ker smo dovolili, da je (tedaj že javno) izjavo natisnil neki katoliški tednik. V istem prispevku se je oglasil še ugleden zdravnik liberalnih nazorov, ki je KME očital, da je že pred leti pomagala prikrajšati samske ženske za pravico do oploditve. Tudi njega ne moti, da bi z oplojevanjem žensk brez partnerja spravljali na svet otroke, ki nikoli ne bodo imeli očeta. Bolj se zavzema za pravice teh žensk in istospolnih parov. Prav to stališče se je zdelo najbolj sporno Usmerjevalnemu odboru za bioetiko Sveta Evrope, v katerem so razpravljalci ocenili, da ima otrok močan in legitimen interes, da ima očeta in mater in da dve materi ali dva očeta ali mati samohranilka tega interesa ne morejo polnovredno zadovoljiti.
V	istem prispevku je bila KME nepošteno obtožena tudi tega, da je pomagala ustvariti pojem neplodnosti para kot nekakšen medicinski konstrukt, da bi opravičila krivično obravnavo prosilk za OBMP.
Pomembno in potrebno je, da imamo v državi tudi liberalno misleče ljudi in liberalno usmerjene medije. Nedvomno imajo legitimno pravico, da mnenju KME nasprotujejo s svojim.
V	primeru citiranega tednika pa razočarani ugotavljamo, da slabo pazijo na svoj ugled kot poštenih razpravljalcev in da jih ne skrbi za dobro ime glasila. Še posebej smo bili presenečeni zaradi nenavadnega pogleda na svobodo govora in tiska.
should be supported in her decision. If she chooses to carry to term, she should also be supported in this and after the child is born both should receive appropriate help." This is a deeply emotional and deeply ethical attitude towards human life and, as physicians, we must honour it. A tribute was made 50 years ago (at a time when human dignity was not greatly honoured) to such mothers by the distinguished ethicist Professor Janez Milčinski. It was a good feeling to read in Naši razgledi about his respectful gratitude for the noble message these wonderful mothers were giving to the Slovenian people. Our colleagues today, sadly, thought and acted differently in the case mentioned above.
Medically assisted reproduction without medical indication and surrogate motherhood
Last Sunday we had a referendum on the Family Code. During public discussions, the National Medical Ethics Committee (NMEC) received requests for opinion from different sides and responded with a warning that the adopted legislation could deprive children of one parent if homosexual partners were allowed to use medically assisted procreation (which is not permitted in current legislation). This statement seemed disputable to one of our liberal weekly newspapers, not because we took a stand defending children's rights but because we: (i) expressed an opinion on something which apparently should not interest us; (ii) voiced this opinion just before the referendum; (iii) allowed the statement (which was already public) to be printed in a Catholic weekly newspaper. In the same article, a distinguished physician with liberal views reproached the NMEC by stating that years ago this same Committee had deprived unmarried women of the right to medically assisted procreation. He, too, was not concerned by the fact that artificially fertilised women without partners would give birth to children who would never have a father. Instead, he was just keen to support the wishes of these women and homosexual couples. This particular viewpoint was considered most questionable by the Steering Committee on Bioethics of the Council of Europe. They felt that a child has a strong and legitimate interest to have a father and a mother, and that two mothers, or two fathers, or a single mother cannot fully satisfy this need. In the same article, another unjust accusation was made: that the NMEC helped coin a novel term "infertility of the couple" as a kind of a non-existing medical entity, in order to justify unfair treatment of applicants for medically assisted procreation.
Prehajam na zadnjo etično temo te vrste, to je • predlagana legitimnost infanticida - »porojstnega splava« - usmrtitve novorojenčka na podlagi istih meril, kot so v rabi za splav; vključno z usmrtitvijo otroka do dopolnjenega 2. leta starosti.
Obžalujem, da moram svojim liberalnim kolegom v mednarodni etični srenji ugovarjati še pri tem, za marsikoga šokantnem stališču. Zahtevana pravica do umora novorojenčkov (kot se posebno naglaša, tudi zdravih), je vznemirila bralce ugledne revije Journal of Medical Ethics (ureja jo kontroverzni praktični etik Julian Savulescu iz Oxforda, ki se med drugim zavzema za to, da bi zdravnikom odvzeli pravico do ugovora vesti, iz njegovega poklicnega dela pa izgnali tudi vest samo in jo preprosto nadomestili z zakoni in smernicami), šokirala pa je tudi drugo javnost po Evropi. Avtorja Alberto Giubilini z Univerze v Oxfordu in Francesca Minerva z Univerze v avstralskem Melbournu v članku z naslovom After-birth abortion: why should the baby live? (Porojstni splav: zakaj naj bi dete živelo?) zagovarjata stališče, da sta si zarodek oz. nerojeni otrok in novorojenček v prvih tednih po rojstvu enaka v tem, da nobeden od njiju nima nikakršnega moralnega statusa in zato tudi nobene pravice do varstva življenja. Moralni status pomeni priznani položaj bitja, do katerega imamo moralne dolžnosti. Če torej novorojenček tega statusa nima, ga je dovoljeno umoriti, na primer iz istih razlogov kot opraviti splav. Povod je kot pri splavu lahko tudi nemedicinske narave, na primer slabše socialno stanje družine, psihološke težave staršev, drugi interesi ljudi iz okolice, ki bi jih novi otrok na kakšen način motil, če bi ga pustili živeti. Dovoljeno je torej usmrtiti tudi zdravega novorojenčka. Kaj pa, če bi ga oddali v posvojitev? Avtorja to dopuščata, a ne priporočata. Matere, ki so izgubile otroka, imajo pogosto resne psihološke težave pri premagovanju žalosti. Tiste, ki žalujejo zaradi smrti otroka, morajo sprejeti dokončnost izgube. V primeru oddaje otroka v posvojitev pa matere pogosto še dolgo sanjajo, da se bo otrok vrnil k njim. Če naj prevladajo interesi aktualnih ljudi, mora biti usmrtitev otroka dopustna izbira za žensko, ki bi jo oddaja otroka v posvojitev prizadela. Neki drug filozof gre celo malo dlje in zagovarja pravico do usmrtitve otroka vsaj do drugega leta starosti, spet zato, ker tako mlad otrok še ni sposoben polnega zavedanja, presoje in smiselnega odločanja (Tooley 1983, cit.v Fllesdal 2009). Vse to se sliši navadnemu človeku bizarno,
It is important and necessary that we have liberal-thinking people and liberal media. Undoubtedly they have a legitimate right to oppose to NMEC's opinions. In the case of the cited newspaper, however, we were disappointed to find that they did not care about their own credibility as honest participants in the discussion nor about the good name of the journal. We were particularly surprised at their unusual view regarding the freedom of speech and press.
The claim that "after-birth abortion" (killing a newborn) should be permissible in all the cases where abortion is, including children up to 2 years of age .
I regret having to oppose to my liberal colleagues in the international ethics community on this viewpoint. The right to murder newborns (even healthy newborns) has upset the readers of the distinguished Journal of Medical Ethics. (The Editor-in-Chief is the controversial practical ethicist Julian Savulescu from the Oxford Centre of Neuroethics, known for his appeals to cancel physicians' right to conscientious objection and to substitute conscience as well as value-driven medicine with laws and guidelines. His ideas have shocked the European public.) Alberto Giubilini (University of Oxford) and Francesca Minerva (University of Melbourne) in their article "After-birth abortion: why should the baby live?" discuss the moral standing of embryos and unborn children. They state that the moral status of an infant is equivalent to that of a fetus, that is, neither can be considered a 'person' in a morally relevant sense. "Moral status" means the acknowledged status of a human being towards whom we have moral obligations. Hence, if a newborn does not have this status, we are allowed to kill him/her for the same reasons as an abortion is done. The reason, as with an abortion, can be non-medical (e.g., poor social conditions of the family, psychological problems of parents). Therefore it is permissible to kill even a healthy newborn. What about giving it up for adoption? The authors would allow it but do not recommend it. Mothers who have lost a child often experience serious psychological problems due to the inability to cope with their grief. Those who grieve a death must accept the irreversibility of the loss, but natural mothers who gave the child up for adoption often continue to dream that their child will return to them. If interests of actual people should prevail, then
tega najbrž ne bi slišali od običajnih zdravnikov ali psihologov. Vendar ideje niso niti nove ne osamljene. Najdemo jih v objavah znamenitega utilitarnega filozofa-etika Petra Singerju (1985) in kolegov, ki priznavajo pravico do varstva življenja zavedajočim se človeškim bitjem, sposobnim razumevanja in odločanja o sebi.
Podobno nas presenečajo oni, ki zahtevajo odpravo pravice do ugovora vesti, ko se od zdravnikov zahteva, da opravijo medicinsko neindicirani splav, in tisti, ki se potegujejo za svobodno ustvarjanje človeških zarodkov za raziskave in proizvodnjo zdravil, morda celo vključno s pridelavo križancev med človekom in živaljo. Zahtevati, da se bioetika ali medicinska etika vzame iz rok zdravnikov in se vrne filozofom kot prvotno filozofska disciplina, v luči teh idej zveni tvegano. Zdi se, kot da pri utilitarni etiki ne gre več za tekmovanje med legitimnimi etičnimi vrednotami. Namesto tega imamo tekmo med interesi.
Naj odgovorim še na vprašanje iz mojega podnaslova: Zakaj se etične razprave o otrocih tako pogosto iztečejo prav zanje slabo?
Moj poskus odgovora je, da so v tekmovanju interesov pač šibkejša stranka. Pogosto so šibkejša stranka tudi njihovi zagovorniki.
Za tem pa slutimo neko večje dogajanje. Interesi za podiranje tradicionalnih etičnih norm so vse močnejši, ljudje, ki stojijo za temi interesi, pa vse uspešnejši. V slabih dveh desetletjih, odkar se zanimam za bioetiko, opažam razločno rastoče premike. V etiki je znana prispodoba hoje po spolzkem klancu. Ko ste enkrat stopili nanj, je verjetnost, da vam ne spodrsne, majhna. Ko ste zdrsnili, pa bo šlo neizprosno navzdol, in to vse hitreje. Sprašujem se: ali že drsimo?
O tem, da se zahodna civilizacija pomika v liberalno smer, ne priča samo doslej povedano. Tu je še vrsta drugih pojavov pri nas in drugod. Naj omenim vse bolj toleranten odnos do evtanazije, prizadevanja za liberalizacijo prostitucije in legalizacijo trgovine s človeškimi organi, pritiske za sprostitev tržišča z drogami, za uporabo za sedaj še ilegalnega dopinga in za že legalno rabo zdravil za pospeševanje kognitivnih sposobnosti zdravih ljudi, spodbujanje igralništva kot gospodarske panoge brez ozira na vse bolj razširjeno pogubno odvisništvo. Še mnogo širši pojav je propadanje
after-birth abortion should be considered a permissible option for women who would be damaged by giving up their newborns for adoption. Another scholar went further and advocated the permissibilty to kill even older children, as long as they have not developed capacity for self-reflection, which happens at around 2 years of age (Tooley 1983; cited in Fllesdal 2009). These views are bizarre to most people, and one would not expect to hear such suggestions from physicians or psychologists. However, these ideas are neither new nor exceptional. They also appear in publications of the well known utilitarian philosopher/ethicist Peter Singer (1985) and his colleagues, who acknowledge the right to protection of life to conscious human beings capable of understanding and decision-making.
Similarly we are surprised by those who demand the abolition of conscientious objection of physicians to undertake abortions without medical indications and those who strive towards free creation of human embryos for research and pharmaceutical industry (including the creation of human-animal crosses). To demand that bioethics and medical ethics are taken out of the hands of physicians and are returned to philosophers certainly appears risky in the light of the ideas mentioned above. It appears as if utilitarian ethics is no longer competition between legitimate ethical values, but rather a competition between interests.
Let me answer the question from my subtitle "Why do ethical discussions often end badly for unborn and newborn children?" Firstly, unborn and newborn children are the weakest party in the competition of interests. Often even their advocates are on the weak side. However, it seems that something bigger is taking place in the background. The interests in breaking traditional ethical norms are growing stronger and the people behind these interest are getting more successful. In a little less than two decades since I became involved in bioethics, I have observed a distinct change in attitudes. In ethics, the metaphor of "slippery slope" is well known. When you step on such a slope, your chance to avoid slipping is small. Once you slip, you slide down unrelentingly, faster and faster. I am asking myself: are we already sliding? What has been said so far suggests that western civilization may be moving in a liberal direction. There are several other examples, both domestic and international. One might
koncepta socialne države in razrast liberalnega kapitalizma s ponovno naraščajočim izkoriščanjem delavstva. Najdalj-nosežnejši pa je brezobzirni, primitivno koristoljubni napad na lokalno in planetarno naravo. Tu besede etika ne bom omenjal več, saj je skorajda ni. Skupni imenovalec teh pojavov je boj za prevlado interesov, bitka za denar. Tekmovalnost, konkurenčnost, optimizacija in racionalizacija proizvodnje in trženja so bojne zastave, pod katerimi umirajo humanistične vrednote včerajšnjega dne. Tu ni več niti veliko razuma, saj spoznanje, da so vojskujoči se interesi kratkovidni in destruktivni tudi za njihove protagoniste, ne spremeni nobene odločitve. Isti boj slutim v ozadju poskusov, da bi zavrgli koncept človeškega dostojanstva. Kajti prav ta koncept je filozofski temelj za človekove pravice, ki so koristoljubnim interesom v največje napotje. Poskus pogleda v prihodnost me ne navdaja z optimizmom. Ne pomirja mi skrbi, da smo se znašli pred koncem neke romantične dobe spoštovanja etike. Bojim se, da se bližamo temeljiti reviziji človekovih pravic. Prav to zahtevo smo slišali v zadnji predvolilni kampanji v Britaniji.
Vendar še ni čas za resignacijo. Morda za odrešilno streznitev, ki bo vsem dokazala, da se moramo začeti obnašati drugače, potrebujemo le še eno globalno krizo, ki pa bo verjetno morala biti hujša od sedanje. Na dvoje najbrž smemo računati. Na modrost, ki se je med ljudmi vendarle nabrala in ji je samo treba dati več besede. In na samoohranitve-ni nagon. Tega pa bo treba preusmeriti od kratkovidnega prizadevanja za obvarovanje posameznika k vedenju, ki naj človeštvu pomaga preživeti.
mention the increasingly tolerant views upon euthanasia; the pressure to liberalize prostitution and legalize the trade in human organs; the suggestions to decriminalise certain types of illicit drugs; the use of medicines for enhancement of the cognitive capacities of healthy people; and state supported investment in casino industry as a profitable economic sector, in complete disregard of the severe ill effects to individuals and the society. A much wider phenomenon is the weakening concept of social state and the growing strength of liberal capitalism with increasing exploitation of the working class. This negative development is topped by the thoughtless, greedy, barbaric abuse of local and global natural resources. I will not mention the word "ethics" here because it is almost non-existent. The common denominator of these concepts is the struggle for domination: "the battle for money". Competitiveness, optimization and rationalization of production and marketing are battle flags under which the humanistic values of yesterday are dying. Very little reason is involved because even understanding that the battling interests are short-sighted and destructive even for their protagonists does not change their decisions. I suspect a similar struggle behind the attempts to discard the concept of human dignity because this particular concept is the philosophical basis for human rights, which are getting in the way of egoistic interests. A look into the future does not fill me with optimism. It does not calm my worry that we have found ourselves at the end of a romantic era of honouring ethics. I am afraid that we are close to a thorough revision of human rights. This particular demand has been heard in the last pre-election campaign in the UK.
However, this is not the time for resignation. May be it is a time for sobriety that will prove to all that, to start behaving differently, we need another global economic crisis, which will probably have to be worse than the current one. We can probably count on two things: (i) wisdom, which has become more widespread than ever and just needs to be given more voice, and (ii) self-preservation instinct. This will have to be redirected from the short-term need of protecting oneself to behaviour that will help humankind to survive.
REFERENCE
1.	CDBI (2007) 2. Responses to the Questionnaire on the relevance and added-value of the Council of Europe's activities in the field of bioethics. [cdbi/plenier/docs travail/2007/CDBI (2007)2ef questionnaire activities].
2.	Fllesdal D. 2009. The potentiality argument and stem cell research. V Lars Ostnor (ur.): Stem Cells, Human Embryos and Ethics. Springer, str. 137-47.
3.	Giubilini A., Minerva F. After-birth abortion: why should the baby live? J Med Ethics, doi:10.1136/ medethics-2011-100411.
4.	Kuhse H, Singer P. 1985. Should the baby live? Oxford University Press, Oxford.
5.	Tooley M. 1983. Abortion and Infanticide. Oxford, Clarendon.
REFERENCES
1.	CDBI (2007). Responses to the questionnaire on the relevance and added-value of the Council of Europe's activities in the field of bioethics [cdbi/ plenier/docs travail/2007/CDBI (2007)2ef questionnaire activities].
2.	Fllesdal D (2009). The potentiality argument and stem cell research. In: Ostnor VL (ed), Stem Cells, Human Embryos and Ethics. Berlin: Springer, 137-47.
3.	Giubilini A and Minerva F. After-birth abortion: why should the baby live? J Med Ethics doi:10.1136/ medethics-2011-100411.
4.	Kuhse H and Singer P (1985). Should the baby live? Oxford: Oxford University Press.
5.	Tooley M (1983). Abortion and Infanticide. Oxford: Clarendon.