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Report on Regional Meeting of Experts in Ethics Teachingin Central Europe

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Budapest - 21-22 October 2004

Information about teaching hours, syllabi, reading material, that was presented in the conference, but that is already present in the UNESCO forms for teaching programs is not repeated in this report in full detail. Rather the focus is on further information that was given as well as on the general discussions during the conference. A reference to the forms is made whenever applicable.

21st October 2004

Welcoming and Opening

The first day of the conference being chaired by Judith Sandor, the meeting began with an opening address by Jozsef Hamori, Hungarian National Commission for UNESCO who stressed the importance of bioethics for science and society. He expressed his hope to have a decision, solution, or suggestion at the end of the meeting as to how to proceed after the conference, aiming at an increase in teaching bioethics.

Mr. ten Have, Director of the Division of Ethics of Science and Technology of UNESCO, thanked the Hungarian National Commission for UNESCO to have the opportunity for this meeting in Budapest and proceeded to give an outline of ethics in UNESCO as background to this meeting here.

He explained the place of ethics in UNESCO in the Social and Human Sciences sector with its aim being to understand the current ethical problems in connection with science and technology. An outline of the historical development of ethics in UNESCO followed.

He presented bioethics, science ethics, environmental ethics and space ethics as being the theoretical basis of activities in the Division of Ethics of Science and Technology. Upon this basis, standard-setting actions, capacity building, and awareness raising characterise the work.

As regards standard-setting actions, he introduced the different advisory bodies to UNESCO, and presented the normative instruments that have been created so far. Mr. ten Have then proceeded to guide an outline of further planned declarations and instruments.

Concerning capacity building, Mr. ten Have presented the Global Ethics Observatory and the Ethics Education Programme of the Division, as well as different steps to be taken to implement the normative instruments.

He finally turned to awareness raising, pointing to the series of rotating conferences, Ethics around the World, and to UNESCO related publications and research before finishing the presentation with a summary slide.

Mr. ten Have mentioned the further conferences that are planned to bring together experts in teaching ethics, in Moscow and later on in Croatia and in Latin America. He stressed the opportunities of this meeting here since there is already expertise present in the countries participating in this conference. This creates potential for future cooperation, whereas other countries are at an earlier stage in their development of ethics teaching.

The aim of this meeting here, so Mr. ten Have, is, first and primarily to complete and perfect the forms distributed to the experts in advance of the meeting, aiming at introducing them into a database, as part of the planned Global Ethics Observatory (GEO). The second objective of the meeting is to encourage further co-operations among the experts in this area, supported by UNESCO. As an example of such cooperation, he mentioned the establishment of an international Master programme in (bio-)ethics in Central Europe. According to the guidelines of the Bologna process, a large number of teaching and study hours is required for a Master programmes, which usually extends the possibility of one institute or department. This, so ten Have, creates potential and need for international cooperation.

Mr. ten Have ended his speech by thanking the participants of the conference for attending the meeting, making a contribution to the meeting and having completed the forms in advance of the meeting. He stressed the uniqueness of data that thereby has been provided to UNESCO.

Ethics teaching in Hungary

Josef Kovacs, Semmelweis University Budapest, was the first to give a presentation of his ethics teaching activity. He started his presentation by thanking Mr. ten Have for initiating this meeting and welcomed the other participants.

Mr. Kovacs presented with a PowerPoint show which courses in bioethics are given at his university. They are taught in three languages, German, English, and Hungarian, depending on the curriculum of the students. The courses are taught in three different faculties. A broad meaning of bioethics is used for the courses, thereby going beyond code-ethics only.

Mr. Kovacs started a broader reflection on his teaching by pointing to the fact that his courses are taught in the 7th semester and not earlier. This is the result of his experience that at an earlier stage in their studies, students lack the scientific background to understand where in the medical sciences ethical problems can arise, plus, at an earlier stage in their studies, they are more interested in hard science and have little belief in the "soft" social sciences. At a later than the 7th semester stage, however, they tend to focus on their final research topics and only tend to be a little disappointed about their studies and their knowledge, making them less open to new ideas such as bioethics.

He then proceeded to emphasise the importance of seminars and the casuistic approach to ethics in them, but explains that the lack of teaching staff prevents him from focussing on seminars exclusively. As a further problem in teaching ethics he pointing out that the tutors, leading the seminar discussion, are from different backgrounds, i.e., either scientists or philosophers, which has an impact on the topics discussed in their seminars, so that the students' learning experience varies.

With regard to the examination, Mr. Kovacs noticed the special difficulty of evaluating the student's performance in an ethics course, arising from the legitimacy of the student to express his own opinion. He argued for using Multiple Choice examinations that can reveal the student's knowledge of facts.

He went on to present the syllabus of his course, based on the information given in the forms, but in more detail. After presenting the syllabus, he addressed the difference between the implicit and explicit curriculum of ethics in a medical science curriculum, referring the ethical dimension of the entire studies, i.e., of ethics going beyond the bioethics course.

Finally, Mr. Kovacs touched on ethical dilemmas, as he called them, in teaching ethics. Under this heading, he referred to the ethics of teaching ethics, and whether or not a teacher should express and teach his own moral convictions or not. Furthermore, he pointed again to the ethics of examining ethics, referring to the difficulty to evaluate an opinion on an ethical issue.

Mr. Szebik, also Semmelweis University Budapest, gave a short co-presentation, again based on PowerPoint, also focussing on dilemmas in bioethics teaching, as extension of Mr. Kovacs' presentation. He expressed his agreement with Mr. Kovacs, except for the use of Multiple Choice examinations.

As starting point for his presentation, he referred to academic freedom. This he sees as threatened when bioethicists try to publish, competing with the medical science. He pointed out that bioethics is often regarded as offence against medical science. The paradigm of thought in bioethics is different than that of medical science. As reason for the lack of acknowledgment of bioethics, he referred to the greater respect of empirical data and to a source of conflict within bioethics, arising from personal ideological convictions of teachers.

Mr. Blasszauer, University of Pecs, continued the presentation of teaching programs by giving a speech. He started by pointing to the "better" conditions for ethicists under the Communist era, since at that time, ethics was a compulsory part of every student's curriculum and taught with more teaching hours than today. The origin of teaching ethics, thus, was in the Marxist-Leninist departments (later renamed as departments of social sciences).

Following this, Mr. Blasszauer stated that he would like to bring attention to the following issue: what should be the goal of teaching ethics, especially bioethics? He identified then three goals, the first being the passing of knowledge. Second, and more important, so Blasszauer, bioethics should sensitise to ethical issues, preparing them to face challenges in their future professional life. Third, bioethics should make the students better doctors.

He went on to present the situation of ethics teaching at his university, in which only seven hours of medical ethics are included in the medical curriculum. He characterised seminars as being indispensable, however, in his case, constraints are such that no seminars can be given.

Mr. Blasszauer started his appeal to a very practical approach in teaching bioethics by referring to a particular unethical episode that happens in a medicine course. According to him, concrete answers are required from those in practice, as to what they should do.

As a reply to Mr. Kovacs, Mr. Blasszauer pointed to the limits of Multiple Choice examinations arising from the limited quantity of questions and suggested essays as alternative. With regard to the ethics of teaching ethics, in his own opinion, it is extremely difficult to step back from one's own values, nevertheless, it is very important to give the students a many-sided perspective.

With regard to the use of "ethical knowledge", he questioned whether medical doctors can be a moral judge of their patients. He questions on what grounds the medical doctor could pass a moral judgement. According to him, medical doctors should not judge, but help.

Mr. Blasszauer finished his speech by referring to a statement made in one of the forms, perceiving bioethics as means to public control of the health care system. Although he thinks of this as being a too brave statement, something in this direction should be the task of bioethics.

The discussion of Mr. Blasszauer's presentation started with Mr. ten Have reminding the participants of the purpose of the meeting, which is not to debate ethics, but to exchange ideas about the teaching programs. As example of what should be addressed in this meeting, Mr. ten Have pointed to inconsistencies in forms concerning the number of credit points given for courses and the classification of the courses.

Mr. Molnar, Budapest University of Technology and Economics, started by saying that the content of courses is more important than presenting information as requested in the forms.

He then read out a short paper entitled "Environmental Ethics and Engineering Ethics courses at the BUTE - What kind of ethics do we teach?", distributed to the participants beforehand. This speech was a theoretical perspective on teaching ethics, trying to illuminate the approach of teaching applied ethics at his university. He started by distinguishing different ways in which to teach applied ethics, arguing for a co-evolution of science, technology, and ethics. He proceeded to point to the importance of the concept of risk on science ethics and went on to stress the necessity to discuss ethical aspects of science in the context of a market economy. Next, the importance of a code of ethics for scientists was stressed, before moving on to he case of the space shuttle Challenger, as example for students that ethics is not an appendix of the analysis of science, but an integral part of it. Applied ethics should be integrated into policy making. Mr. Molnar used another case study, this time taken from US legislation on occupational exposure to benzene, as example for the fruitfulness of case studies to bring the students' attention to ethics. He concluded his speech by pointing to the importance of ethical considerations in policy making.

The discussion started with Mr. ten Have pointing again to the focus of the meeting, which is on the forms as future input to the UNESCO database. Mr. Molnar responded by briefly explaining that his courses are optional, each consisting of 30 hours, with students coming from diverse backgrounds. He then stated his intention with giving a theoretically minded speed, by saying that in his view, the connection between risk and ethics is an important subject, just as the focus on policy making. Mr. Blasszauer asked Mr. Molnar whether there is going to be someone to replace Mr. Molnar one day in his ethics teaching, with Mr. Molnar answering in the negative.

Ms. Kapocsi, University of Szeged, next gave a PowerPoint presentation on her teaching activity. The presentation was technical, i.e., based on statistics of her courses. She introduced the department of Behavioural Science, in which her teaching takes place. Courses in medical ethics and bioethics are mandatory and directed to students from three faculties, in their first or sixth semesters. She went on to present objectives of her teaching and the syllabi both a first semester course and a sixth semester course, just as in the forms. She also presented additional courses that are not yet included in the forms, in part taught by a different department. She presented courses that are taught to students in dentistry, health science and pedagogical sciences.

Mr. Balazs, Vice-President of the Hungarian National Commission for UNESCO, shortly presented two courses, one on food hygiene and one, which is in progress only, on genetically modified organisms and their use. Courses comprise 20 hours and consist of a lecture series. These courses were not yet addressed in the UNESCO forms.

Mr. Kosztolanyi, University of Pecs and member of IBC, concluded the session on ethics teaching in Hungary, replying to two comments made by Mr. ten Have and Ms. Sandor. He questions what the purpose of a database is, whether it is meant to reflect the current state of the art of teaching activity, or whether it is more directed to future ethics teaching activities. If the database is addressed to the future, then the possibility to modify the outlines of courses in the follow-up of the conference might be interesting. Mr. ten Have responded by saying that indeed updated versions of the outlines should be provided by the participants after the conference.

Ethics teaching in Poland

Mr. Szawarski, Warsaw University, started by saying that it is not easy to talk about ethics teaching when being involved since such a long time. The content of ethics courses, so Mr. Szawarski, is relative, in his personal experience first being influenced by the Communist era, then by Catholic thought and now he is free to teach whatever he wants. The structure of teaching in semesters stayed the same, however, leading to courses that last one or two semesters only, with today more hours in the philosophy curriculum then in science curricula. He agreed with Mr. Blasszauer on the mandatory place of ethics in the Communist era.

Next he pointed to an ambiguity in the forms, concerning the distinction between theoretical-practical and undergraduate-postgraduate, which is ill-suited to reflect teaching curricula in Poland.

The teaching of ethics today is no longer under ideological constraints, however, financial constraints of non-philosophy faculties forced them to exclude philosophy courses from their curricula in order to save money for their own teaching.

Having an overview of ethics teaching in today's Poland is difficult after the establishment of many private institutions and the shift of many teachers towards bioethics and business ethics after the political change.

The ideal teaching method would be seminars, in reality, so Mr. Szawarski, we are rather lecturing history of ethics, since this is easier to teach and to evaluate. He would like to change towards seminar discussions since this most suitably reflect creative thinking about ethics.

Concerning the examination of ethics courses, he agrees with previous statements that evaluating ethical knowledge is difficult and that essays are the best manner, forcing students to search, use, and criticise literature and to write the essay as input for a final oral examination.

Before finishing his talk, he addressed a new issue, concerning new problems arising from the role of academics in committees and from the possibilities of students purchasing ready-made essays.

Mr. Szawarski ends by stating that science as a whole has a moral dimension and that the personal example of the teacher is important for the students. He agrees with earlier comments on dangers caused by corruption in the health sector, by financial powers of private enterprises and scientists taking over moral authority. This is why raising sensitivity is so important.

The discussion of Mr. Szawarski's talk focuses on the following issues: Ms. Sandor pointed to the difficulty of measuring quality of teaching, especially in the time after the political changes. She also introduced to the others the Curriculum Development Centre at the Central European University, Budapest, aiming at assessing courses and thereby allowing the participants to evaluate others' courses by attending those courses. Furthermore, the discussion clarified the terms "class" and "seminar" in Poland, the former referring to what is meant by "seminar" in the forms, the latter referring to a specialised reading course. Mr. Szawarski illustrated this by given a brief outline of a syllabus of a class.

Mr. Wisniewski, University of Torun, explained that contrary to others' experience, at his university, there is a high demand of philosophy and ethics courses in other faculties. This led him to teach 400 hours per year. His teaching focus is on business ethics, social ethics, and public ethics. He expressed his regret that business ethics is no issue for UNESCO, pointing to many business related issues in medical ethics.

Next, Mr. Wisniewski presented a syllabus, as he did in the forms, focussing on three parts in his courses, which are first, a historical perspective, then the main normative problems and some more applied issues in the end. He disagreed with Mr. Szawarski that teaching the history of ethics is a waste of time, but understands his main idea.

As an emphasis in his teaching, he focuses on inductive ethics and pluralist ethics. He shared the dangers that Mr. Szawarski sees with regard to the professionalisation of ethics.

Ms. Sieminska, University of Szczecin, presented a course in psychology and sociology of medicine, by presenting a written text entitled "Pathways of patient the pathways of doctor", focussing mainly about the theoretical background of the course. The theoretical background, as presented by her, consists of a psychological, anthropological perspective on patients and doctors and their relationship. The focus is on the subjective and multi-dimensional reality of the patient and the concepts imposed upon him by doctor-patient relationships and medical science. The goal of the course is mainly to sensitise students of the reality of a patient.

She went to present topics of lectures and seminars, as in the forms provided by her before the conference.

As a special element of her course, he mentioned a guided interview of a patient by a student, on which part of the student's assessment is based. However, the course - though being interesting - does not seem to be a typical ethics course.

The discussion of her contribution concerned first further information about the interview and stated the uniqueness of this course.

Mr. Szawarski welcomed the existence of such a course, stating that communication is a very important issue. However, he did not perceive the course as having an ethical component. It might be enlarged so as to include an ethical component.

Ms. Sandor stated two issues, first, that unfortunately, such important programs as ethics and communication often have to compete against each other for being included in a curriculum. Second, in some cases, still, after having taken such courses, students lack the practical skills when confronting the patient.

Mr. Blasszauer stated that no syllabus presented so far contained the topics confidentiality and etiquette, which should be included in order to increase the practical skills of the student. This led to a discussion of whether etiquette has to be included in an ethics course, respectively, under which heading of ethical principles it might be included.

Related to this issue, Mr. Kosztolanyi noted that it might be necessary to distinguish between educating to teach ethics and educating to act in practice. The database should address this issue.

22nd October 2004

Ms. Szczesna, University of Lodz, with Mr. Blasszauer being the chair on this second day of the conference, begins her presentation with some introductory comments about the university landscape in Lodz, where ethics is taught since fifteen years, the number of hours changing. Crucial to the university has been the merger with the local Military Medical Academy.

She presented a sheet with four courses in bio-medical ethics and professional ethics, based on the information provided in the forms. Students are from multiple backgrounds, thus not all having a background in philosophy. She presents as in the forms the syllabus of lectures and seminars, stressing the importance of teaching pluralist positions in ethics. The extended list of bibliography presented is not present in the forms yet and leads her to stating that she cannot require all students to read English materials. Ms. Szczesna finished her presentation with the presentation of a student feedback forms, highlighting the positive feedback on her courses therein. There are, so Ms. Szczesna, some publications about teaching ethics at her university.

Mr. Zalewski, Jagiellonian University Krakow, is the next speaker. Based on a PowerPoint presentation, he embarks to talk about ethics teaching in the Medical College. At the request of the Medical College, the philosophy staff is teaching more than just ethics, focussing also on general philosophical issues and logic.

Mr. Zalewski first addressed the historical background of ethics teaching at his university, focussing on the hard times for ethics teaching during the Communist era. Medical faculties were transformed into Medical Academies, separate from the universities. Ethics was reintroduced as "Marxist sermons", medical ethics reappearing as the medical doctors own experience. The window opened for medical ethics with the Medical Academy rejoining the university in 1993.

The current state of the art in teaching ethics is reflected in the forms, Mr. Zalewski's presentation was based on them. In addition to these courses, he introduced further courses taught in the last year in Medical Deontology by an expert in forensic analysis.

As issues affecting ethics teaching today, he stressed the importance of tradition and conservatism in the teaching activity at his university and the rise of many disciplines such as nursing and physiotherapy to higher education status.

His next focus was on general conditions of teaching ethics today. Bioethics teaching is caught in between a humanistic culture and a medical culture, between the need for moral reflection and moral indifference, between the belief in a hard body of knowledge only and ethics as intellectual entertainment, and between the post-Communist era and the invasion of the church and the change of former Marxist teachers.

As prospects for ethics teaching, he identified the elapse of time as source of hope for bioethics. Mr. Zalewski stressed again the impact of institutional inertia. The change in medical culture, paternalism and omnipotence becoming unfashionable, will affect bioethics just as changes in society towards a strong civil society and citizens claiming for their rights.

Mr. Zalewski finished his presentation with some ideas on what should be done. On the domestic level, a review of programs and teachers as well as establishing standards and a core curriculum are necessary. He stressed a necessary protection of professional integrity of bioethics. On the international level, he stated that he does not actually have more ideas than those being presented by UNESCO.

The discussion clarified first the terms deontology and cultural bioethics. The first term being clarified as tied to a narrow understanding of bioethics, restricted to duties of doctors and to norms and codes. The second term being contrasted with non-cultural and political bioethics. Mr. Blasszauer reminded the purpose of the meeting as being focussed on the forms.

Ethics teaching in Slovenia

Mr. Lampe, Faculty for Postgraduate Studies, Slovenia, began his presentation by welcoming future cooperation.

According to Mr. Lampe, ethics is taught in four higher education institutions in Slovenia. He started with presenting the courses taught at University of Ljubljana, which are medical ethics and health law including a focus on nursing ethics. Prof. Balažic and Prof. Dolene teach these courses here.

He proceeded to present ethics teaching at the University of Maribor where Prof. Zwitter tried to introduce a connection between medical law and medical ethics in the fourth or fifth year of the curriculum, with debates and case studies being the main teaching method being used. The course has a focus on human rights. Another course on ethics and human rights is taught in the Faculty of Criminal Justice, which according to Mr. Lampe is an important opportunity for developing ethics and research on bioethics, and which might be interesting to be included in an international cooperation.

Mr. Lampe presented the new University of Primorska as being a place for future activities. He presented the course on nursing ethics and human rights, in which he sees the opportunity to include bioethics.

He finished the presentation of courses by turning to the Faculty of Postgraduate Studies. Here, a general course on ethics is taught as well as a course on human rights with a focus on bioethics.

Before ending his talk, he stressed the connection between ethics and human rights and identified bioethics in his country as being very practically focussed. As further possible developments he stressed the importance of national committees and patients ombudsmen. He mentioned an annual international conference in Maribor on medicine and law and welcomed further cooperation with international organisations and cooperation with further institutions in others countries.

The discussion of Mr. Lampe's presentation clarified first the terms medical law, health law, and biomedical law, the scope of the latter being most closely connected to the domain of bioethics.

Ms. Sandor and Mr. Lampe agreed that bioethics should take into account the present legal framework, Ms. Sandor stressing the necessity of this for bioethics to increase its credibility and Mr. Lampe stressing the educational potential of this link.

Answering a question of Mr. ten Have, Mr. Lampe clarified that the program in Maribor has not yet started due to problems with the implementation of the Bologna process, with Mr. ten Have replying that only existing programs should be included in the GEO database.

Ethics teaching in the Czech Republic

Mr. Kure, University of Brno, was next to present his teaching activity. He started by presenting the information provided in the forms, i.e. presenting the teaching activity in bioethics in his university.

After repeating the information present in the forms, he embarked on some more general reflections. According to his experience, it is better to teach elective courses that the students choose if interested because in this case, their motivation is higher. Further, he stressed the merit of interdisciplinary courses. Learning about bioethics is not only receiving information but also learning about oneself as moral agent. He stressed the importance of the topic of bioethics and that it should address a broad target group.

The discussion started with Mr. Lampe considering Brno to be a prime example of the Bologna process with according to him further opens the possibility for students to choose courses according to their interest. Mr. ten Have asked about the distribution of Credit Points at the university in Brno, with Mr. Kure answering that the points are distributed according to the request of the different faculties.

Mr. Zalewski made a comment about the Bologna process. He considers the approach to be alien to university teaching in these countries here and submitted that according to him, the adaptation of the system is only done on a superficial level. He expressed his doubts about the possibility to count the number of hours that the students spend on a course. Mr. ten Have defended the Credit Point system by drawing an analogy between the student and the patient and the emancipation of the student leading him to require this system from the university institutions. Ms. Sandor pointed to alternative ways to count the workload of students by focussing on pages to be read or pages to be written. Mr. Zalewski and Mr. Kovacs still expressed their doubts about the system.

Ms. Munzarowa was next to present her course. She gave a passionate talk about her courses, starting with explaining how she as a doctor became interesting in bioethics, her main interest being in the issue of paternalism. Her approach is to argue from the side of the patient. She considered her program to be similar to those of Mr. Kovacs.

She presented two courses that are taught in her curriculum by giving a short repetition of the information provided in the forms. She stressed a focus on historical roots and the perspective of different religions on bioethics before presenting the syllabus of her course in detail.

Ms. Munzarowa next addressed the PhD program in medical ethics at her university, clarifying that the "courses" mentioned in the forms are not to be considered as courses in the proper sense but rather as areas that the students have to gain expertise in. Many teachers are invited to lecture in the program.

The discussion of her talk centred on her strong position on teaching objective values. Mr. Szawarski appreciated the talk and then told the audience how he changes his view on bioethical issues, arguing that changes are possible and teaching should be relativist in this regard. Not the authorities would be decisive, but reasons for a position. Mr. Kovacs agrees with Mr. Szarwarski and stressed the legitimacy of different opinions in ethics. He expressed his doubts that the students in Ms. Munzarowa's classes are able to express their own opinion. Ms. Serbulea stressed that the goal of teaching bioethics should be to enable students to defend their own opinion. Mr. Zalewski explained in this context what he meant by arguing for professional integrity of bioethics, saying that bioethics should attempt at finding agreement among premises. Mr. Molnar reminded of the plurality of ethical theories and the need for tolerance.

Ms. Munzarowa replied by agreeing with what has been said, nevertheless, she believes in the possibility to say what is right and what is wrong.

Mr. ten Have inquired about cooperation in bioethics within the university in Brno between the ethics centre of Ms. Munzarowa and that of Mr. Kure, with Ms. Munzarowa replying in the negative.

Mr. Simek, Charles University Prague, thanked everybody for the stimulating and interesting debate and noticed that many participants face similar problems.

He started talking about the historical context of ethics teaching at his university, stating that in 1990 all former Marxist-Leninist chairs were replaced with new people. Today, all Prague universities have one or two semesters of bioethics in their medical curricula. International help to promote ethics teaching was provided by the Nuffield Foundation and by the Hastings Centre. Domestic support was given by establishing a chair and an ethics committee.

Next, Mr. Simek provided a short outline of length, level and background of students in his bioethics courses. He stressed the need to differentiate students as addressees of the courses, according to the background of the students.

A newly established PhD program in bioethics was the next item on his agenda; it is the second one in the Czech Republic.

He described content and methods of his courses as being similar to those of Mr. Kovacs, dilemmas in teaching ethics are similar to those identified by Mr. Szebik. The main goals of his teaching are sensitivity of students towards ethical issues and practical skills of the students.

Mr. Simek stressed the shared views and goals of the participants, which opens the possibility for future cooperation. However, with regard to UNESCO proposals, establishing a "Central European School of Ethics" implies a need for rooms, teachers, and students, which are all obstacles according to him. He pointed to the age of many of the participants and the problems of having competent people to replace them one day. He also urged to be modest about one's own teaching competence for such a program. The PhD program at his university is good, according to him, but very small. He expressed his doubts about who will come to study in a new program, tuition fees and accommodation being obstacles for students to enrol. Raising interest in bioethics among students is crucial to him.

Concerning possible ways in which UNESCO could help, he approved in general the ideas of UNESCO. However, he had doubts about the usefulness of the ethics database, pointing to previous futile attempts to create useful databases. He characterised the idea of a joint MA program as ambitious, stressing that grants would be needed. Another idea about what UNESCO could do is to pressure national governments to educate the members of their ethics committees. He finished by saying that with all ideas, money is a crucial factor.

The discussion of Mr. Simek's presentation started by Mr. Blasszauer questioning whether ethics committee expressed interest in being educated. Mr.Simek responded that at least the European Commission was to some extent open in this regard. In any case, even without demand, the supply should be provided.

Mr. Blasszauer praised the presentation by Mr. Simek and understands the problems that Mr. Simek sees in establishing a new program, however, he suggest to start with a small program with 20-30 students.

Ms. Sandor brought the attention to the dilemma in bioethics between low attendance to classes and high public interest, saying that the competence of medical ethics has to be acknowledged stronger, and that this together with capacity building will increase student enrolment. Mr. Simek responded that he assumes that enrolment is low because trust in academics being able to give guidance on these issues is low.

Ethics teaching in the Slovak Republic

Ms. Bohunicka, University of Bratislava, was the last speaker to present an ethics teaching program. She gave a short presentation of her teaching activity, presenting first her department, in which a strong focus is on the history of philosophy. She went on to present syllabus and objectives of her courses, just as in the forms.

She provided information about future plans at her university to create a BA program in ethics and to establish further courses in ethics. As a problem for further development, she identified the constrained availability of resources. Limits in the language skills of her students lead her to use mainly translated material.

Further development of ethics teaching - how can UNESCO contribute?

Mr. ten Have thanked the participants for their contributions and turned towards the issue of what UNESCO could do. He stressed that ethics is one of the principal priorities in UNESCO, endorsed by the member states. He also stressed the long-term perspective of promoting ethics activities, giving as example the changes in the Netherlands during the last 30 years, leading to the expansion of bioethics and its inclusion in all medical curricula nowadays. He expressed his hope that also in Central Europe, such changes are possible.

The reason to bring together experts from the five countries in Central Europe is that in these countries, expertise is already there. Nevertheless, the expertise is vulnerable because to this meeting, the "usual suspects" came. How to educate a new generation of bioethicists in these countries will be a major challenge.

Mr. ten Have then gave a PowerPoint presentation, entitled "How can UNESCO contribute". He presented the Ethics Education Programme and the COMEST report on "The teaching of ethics" as framework and basis for further activities in ethics education.

The steps to be taken in this context are to be seen in a long-term perspective. As the first of six steps, the mapping of existing programs, as done in this meeting, is crucial. Following this, secondly, the existing program descriptions will be introduced into the GEO database. Thirdly, international cooperation in whatever form should be encouraged. Mr. ten Have stated his experience from the Netherlands, saying that the only way to sustain ethics teaching of mostly individual experts is to cooperate. Concerning a possible lack of demand for such programs because there would be no jobs, he said that this is like the story of the egg and the hen. In the long term, certainly a larger demand for educated bioethicists will emerge. Fourth, a core curriculum should be developed, and fifth, UNESCO might initiate a certification for bioethics courses. Finally, sixth, UNESCO might use its well-known reputation to raise funds for fellowships.

The implication of this, so Mr. ten Have, is to focus first on the infrastructure of teaching. Mapping of experts, sampling of teaching programs, creation of networks, the establishment of documentation centers as in Vilnius and the reconsideration of the work of the UNESCO chairs in bioethics are on the agenda. Following the focus on infrastructure, the net step will be program development, transforming networks into "schools", disseminating sample collections of teaching programs, establishing UNESCO chairs and creating an advisory body. Next, educational resources should be developed and a fellowship fund established.

An advisory expert committee, so Mr. ten Have, will help to achieve the objectives of UNESCO. Ethics capacity building needs a broader focus than teaching programmes only, including also moral consultation services, ethics committees in hospitals and on the national level.

As an example of international collaboration, Mr, ten Have presented the MA program in "Health, Human Rights and Ethics" in Zagreb and the "European Master in Bioethics", a joint program of universities in Nijmegen, Padova, Leuven, and Basel. A fellowship for one person for a similar program in Central Europe, so Mr. ten Have estimated, would cost 7000 Euros.

Finishing his presentation, he stressed that UNESCO cannot set up such a program, but initiate such activities, disseminate information and resources, and reinforce certification and fellowships.

The discussion of Mr. ten Have's talk began with a comment by Mr. Kosztolanyi. He considered Mr. ten Have's presentation to be helpful to clarify what the goal of this conference is. He reaffirmed the usefulness to support the teaching of ethics and to debate on how to teach ethics. He praised Mr. Kovacs's focus on the efficiency of teaching ethics, which might lead to focus on teaching ethics in continuous education programs.

As a professional physician he urged ethicists to be careful when opposing medical science activity and argued for a better interaction of both.

He finished his comments by praising the UNESCO activity, especially with regard to funding opportunities.

It followed a discussion on the scope of ethics under the UNESCO mandate, with Mr. Wisniewski and Mr. Zalewski arguing that other branches of applied ethics, such as business ethics, and a focus on the theoretical foundations of ethics would be desirable to train future ethicists. Mr. ten Have replied by reminding the mandate of UNESCO which is concerned with science and technology. This discussion later continued with pointing to the difference between educating future ethics teachers and educating future doctors to be aware of the ethical dimension of their work. The focus on theoretical issues should be adapted accordingly, so Mr. ten Have and Mr. Simek.

Many suggestions on what UNESCO and the participants could do followed:

  • A monthly electronic newsletter sent to all ethics teaching experts to get informed about what colleagues are doing, sent by either UNESCO or one of the experts (Mr. Szawarski).
  • Information about free posts for graduates in other countries (Mr. Szawarski)
  • A permanent consultation service for ethical questions in UNESCO (Mr. Kozstolanyi)
  • A UNESCO publication on "how to create a bioethics centre" with standards, examples, in which faculty to set up the centre, what should be in library, how many hours to teach at minimum (Mr. Kovacs and Mr. Blasszauer)
  • An international discussion group on bioethics in Central Europe (Mr. Kovacs)
  • A web-based information exchange forum helping to keep in touch (Mr. Kovacs)
  • Stronger UNESCO recommendations on what to do than just a database (Mr. Kovacs)
  • Since there is lack of financial resources in most institutions, the library resources are limited as well. Exchange of what the different experts and their institutes have available could help all, if this information is exchanged. (Mr. Zalewski)
  • Each experts might write some pages about the situation of ethic teaching at their university as a starting point (Mr. Simek)

The next item in the discussion was the difficulty in publishing for bioethicists in Central Europe. The reason for the difficulty, so several experts stated, is the use of impactt factors to count publications in medical schools. Mr. ten Have suggested that the profession of bioethicists in these countries should propose standards to measure scientific output and quality. Also publications in the national languages should be taken into account. Mr. Blasszauer stated the small size of the community as obstacle to establish a new system.

Mr. ten Have then suggested that UNESCO as intergovernmental organisation can mobilize support for initiatives to establish a Central European School of Ethics as forum for future cooperation. He encouraged the experts to go a little further in their ideas so as to create opportunities. Ms. Sandor pointed to the interest of the Member States to implement UNESCO instruments.

As response to the proposal, several experts expressed their tiredness now at the end of the meeting, stating that now "reality is coming in". Doubts were uttered about the willingness of national governments to cooperate. Ms. Sandor expressed her hope that if several countries are addressed at the same time, the mutual control among those countries might lead them to support ethics activities. Mr. Blasszauer expressed his hope that UNESO will be able to make a difference.

Mr. ten Have and Ms. Sandor closed the meeting by saying that UNESCO will contact the experts soon again with specific questions in order to perfect the forms, otherwise, UNESCO will wait for further ideas on future cooperation. They thanked the participants for their input to the meeting and encouraged them to submit proposals for future cooperation.

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