Source: Ulman, YI: “Future Vision in Historical Perspective: Introducing the Turkish Bioethics Association”, Workshop (Proceedings) Universal Declaration on Bioethics and Human Rights: Social Responsibility and Health, Bioethics Committee Turkish National Commission for UNESCO, Istanbul 25 April 2011:111-123*.

Future Vision in Historical Perspective:

Introducing the Turkish Bioethics Association, TBA**

Yesim Isil Ulman***

Introduction

This study aims to introduce the Turkish Bioethics Association (TBA) by dealing with its objectives, functions, works and activities as an academic, non-governmental organization in Turkey with a special emphasis on the activities of social responsibility. It will also try to envisage future perspectives of the TBA.

Historical background of the teaching of medical ethics in Turkey

Medical history education in Turkey started at Istanbul University during the 1856-1857 academic year. The medical deontology (ethics) courses were first included in the school curriculum in 1876. Nouridjan Effendi's lectures, the Précis de Deontologie Médicale, Cours Elémentaire Professé à l’École de Médecine de Constantinople (Istanbul, 1877) has been the third coursebook ever published on medical deontology in Europe succeeding Deontology or the Science of Morality (1834) by Jeremy Bentham (1748-1832) and Deontologie Medicale (Paris 1845) by Maxime Simon. Fourth book (Dr. Julius. Pagel’s Medicinische Deontologie (Berlin 1897) could only be published 20 years after Nouridjan’s work.

The two courses were united in 1902. All the medical history and ethics departments established in Turkey have been responsible of teaching both disciplines. Despite some brief interruptions, those courses have continued to be taught together ever since ⁽¹⁾.

Medical history education was dominant over medical deontology issues in the beginning. In parallel with the tendency in the West, medical ethical subjects have gradually prevailed over the debates of classical medical morality and deontology topics in academic teaching and literature. Medical ethics has, in the course of time, freed itself from philosophical morality concepts out of which it evolved. In the meantime medical deontology and ethics have predominated medical history.

The lectures on medical ethics were treated in exemplification with clinical cases supported with medical historical background of the topic and with medical deontological aspects. Interactive character of the physician-patient relationship was much more emphasized than ever lately ⁽²⁾. Istanbul University pioneered with a coursebook on deontology by Sehsuvaroglu in 1975 ⁽³⁾, also with first MA and doctoral thesis on medical deontology by Basagaoglu (1985 and 1988) ⁽⁴⁾ and clinical ethics by Ersoy (1991) and Sehiralti (1993) ⁽⁵⁾.

During 1990’s, Ankara University played a fateful role in this progress where Professor Fuat Aziz Göksel, the doyen of medical deontology, history of science and medicine, reestablished and reshaped the department. He is renown for the emphasis on interactive relationship between the medical history and deontology disciplines as two supportive and cooperative fields of study ⁽⁶⁾. His successor, Prof. Dr. Yaman Ors focused and worked ⁽⁷⁾  more on the philosophy and methodology of science; medical ethics and bioethics in comparison with his predecessor. The two scholars worked first together and then successively and contributed a great deal of the medical deontology and ethics to proliferate in Ankara University Medical School. This induced Ankara Deontology department ⁽⁸⁾ to be the leader of the academical debates of medical ethics by putting forward the medical ethical issues over medical history, and tinging the curriculum with philosophy of science and methodology, and concentrating more on contemporary arguments of medical ethics. Thus bioethics started to become more popular than ever at academic circles in 1990’s. Arda and Ors explain their approach to teaching medical ethics in Turkey as ‘moral sensitization and the development of ethical awareness or consciousness regarding the value problems arising in different aspects of medical activity’⁽⁹⁾.

The Turkish Bioethics Association is the fruit of this preference where Prof. Yaman Ors and his colleagues (Drs Arda, Oguz) created a favourable milieu ⁽¹⁰⁾ by starting to teach contemporary medical ethics, by mentoring postgraduate studies, and by leading the foundation of the first bioethics society in Turkey ⁽¹¹⁾.

Establishment of TBA

TBA was founded in Ankara in 1994. The idea of establishing a bioethics society in Turkey was inspired by Prof. Yaman Ors and Dr. Yasemin Oguz, on their way back from the 1st World Bioethics Congress at Amsterdam where many countries and members were represented by local, national societies ⁽¹²⁾. First steps to the Association were taken by the academics of medical ethics, veterinary medicine ethics, and dentistry ethics. Prof. Berna Arda, the first president of TBA worked to institutionalize the Association just from its inception. In a short while, the Association brought together not only bioethicists from the medical sciences, but also the authors of ethics, history and philosophy with young MA and PhD researchers from the allied disciplines all over Turkey ⁽¹³⁾.

The Scope of TBA

Turkish Bioethics Association is defined, according to its Bylaws, as a platform to take up and discuss problems arising in health care and medical sciences in an interdisciplinary way. This definition necessitates the explanation of the concept of bioethics which is implemented in its broadest sense by the Association. TBA considers bioethics as a discipline dealing with moral value issues in practice of healthcare professions (such as medicine, nursing, dentistry, pharmacy, veterinary medicine, etc.), and also other disciplines (biology, social sciences, philosophy, law, ...) ⁽¹⁴⁾. TBA is concerned not only with moral problems stemmed from medical-clinical practices, but also with other moral issues originating from the activities influencing the living beings. Biomedical researches, publication ethics, environmental ethics, animal rights, policies affecting health care system, public health issues and related topics are also main concerns of TBA.

Objectives of TBA

The objectives of the Association are: 

·         to contribute to the development of bioethics,

·         to improve the undergraduate and postgraduate education

·         to develop contacts with healthcare disciplines as well as with other relevant areas,

·         to facilitate the exchange of information between researchers in bioethics

·         to organize regular academic, scientific meetings in bioethics;

·         to encourage the development of research and teaching in bioethics;

·         to promote and make known of issues of bioethics to the public.

·         to be alert and attentive on problems of bioethics offending dignity of the discipline ⁽¹⁵⁾.

TBA, as delegate of the discipline on behalf of Turkey

TBA, which was formerly named as Bioethics Association, was authorized as the “Turkish” Bioethics Association in accordance with a decree enacted by the Council of Ministers on June 30^th, 2000. According to Prof. Dr. Berna Arda, the chair, this has been the recognition of TBA as the international representative of the discipline on behalf of Turkey at universal platforms which has been achieved through six year effort ⁽¹⁶⁾. The final recognition of TBA as an institution of bioethics expertise has been internationally confirmed when it became a member of European Association for Centres of Medical Ethics” (EACME) in February 2009. This major step has been fulfilled with the devoted and planned efforts of the Executive Committee (2007-2009) together with the full support of the General Assembly on November 15^th, 2008 ⁽¹⁷⁾.

Membership Profile of TBA

The Association stipulates three categories of membership ⁽¹⁸⁾_:

1-      Resident (full) members: researchers, academics, scientists, graduates and postgraduate students from bioethics disciplines. They should be citizens of Turkey at legal age of majority. They are obliged to pay annual dues

2-      Honorary members: Scholars and academics who can contribute to the main purposes of the Association by their works and activities; senior scholars who have proved themselves by their contributions to the field and allied disciplines of bioethics. Honorary members do not have to pay dues ⁽¹⁹⁾.

TBA possess 106 resident (full) members constituted of medical scientists, healthcare professionals, bioethicists, academics and post graduate students of medical ethics and of the related disciplines.

Web page and e-Bulletin

The official webpage of the TBA (www.biyoetik.org.tr) ⁽²⁰⁾ serves not only for introducing the profile and activities of the Association, but it is also a platform to give information about news and to supply for data on bioethics in Turkey and in the world. It contains rich data on bioethics, and on the allied fields such as medical law, public health, and health policies. An English version of the page is also available.

TBA periodically issues e-Bulletins in which the activities of the Executive Board, various academic articles, announcements, Statements of the Association are published and shared by the members. The latest issue came out in Spring 2010 (No.20) ⁽²¹⁾.  By the decision of the actual Executive Board, the official correspondence of the Board on some critical issues has been placed on the web-site to provide data for the members with information from the healthcare setting and from the activities of TBA ⁽²²⁾.

Reports - Guidelines

Members of TBA attach importance to prepare reports and guidelines on the foremost ethical problems in Turkey at clinical settings such as Informed Consent, Patient Rights, Biomedical Research Ethics. Those reports can be reached through the website ⁽²³⁾. Upon the permission of their authors, the report of Informed Consent has contributed a lot to the preparation of Guideline for Medical Specialty Societies of the Turkish Medical Association ⁽²⁴⁾; and was benefited for the courses given by TBA members at various healthcare institutions and academic meetings ⁽²⁵⁾.   

Statements

Executive Board is responsible to present the view of the Association concerned with its main branch and discipline at a specific issue precipitated or caused by diverse institutions or events. Those issues are chosen from the ones which necessitate the Association to make a statement regarding its main field of study or on the grounds of conflicting professional, moral or ethical values.  The draft of the Statement is prepared voluntarily by a member or a group of members assigned by TBA and it is presented to the Executive Board. The texts are discussed, assessed, adopted (if approved) at the regular meetings of the Executive Board and declared on the website. The Statements are produced on the basis of health care policy-making such as on Full-Time Hospital Work Draft of Law (2007 and revised in 2010), Clinical Trials Regulation (2009, revised in 2010), Medical Malpractice and Mandatory Professional Insurance (2010), Draft of the Patient Rights Regulation (2011); or regarding healthcare provision such as the ones on In Vitro Fertilization and ET Centres (1996), Bone Marrow Donation (1999), Violence against the Physicians (2008), Presence of Security Forces during Medical Examination (2011); or concerning medical education such as the ones on The Education of Medical History and Ethics (1996), Academic Appointments and Examinations (1998). In compliance with its Regulation, the moral issues and conflicting values in broadest sense of bioethics are also the main concerns of the Executive Board for making Statement such as the ones on Allionai (2011), Violence against Women (2011).

Recent Publications

The Association has published a number of books, mostly the proceedings of symposia and congresses. One of the recent publications of TBA is the proceedings of the symposium on The Ethical Dimensions of Transformation of Healthcare Provision in Turkey which is a pioneering work to put forward the conflicting professional values, moral and ethical issues in view of healthcare policy making ⁽²⁶⁾. Ethical and Legal Dimensions of the Stem Cell Research followed suit as a handbook to shed light on the latest developments and evaluation about this specific field of study ⁽²⁷⁾.

The succeeding congress book was assigned to the prominent issues of the field under the title Expanding Medical Ethics to Bioethics by putting emphasis to the transition of the ethical debate from medical ethics towards bioethical issues such as dignity, integrity, autonomy, environmental ethics, healthcare ethics and law, patient rights in a larger extent ⁽²⁸⁾. A group of members of TBA fulfilled the Turkish translation of the Bioethics Committees written by the Division of Ethics of Science and Technology of UNESCO. This handbook has been published by the UNESCO National Commission in Turkey for the benefit of the researchers and all stakeholders ⁽²⁹⁾. 

Recent Meetings

On the basis of social responsibility TBA is quite sensible to the hot topics of the health system in Turkey and some of its recent meetings may be exemplified to this aim: Symposium on the Ethical Aspects of Organ Transplantation ⁽³⁰⁾, Symposium of the New Reproductive Technologies and New Motherhood have been realized to provide for a multidisciplinary platform to discuss the issues in view of medicine, ethics, forensic medicine, law, sociology, psychiatry and history ⁽³¹⁾. The Panel of Medical Malpractice has set a good example to this approach by dealing with medical error and the mandatory medical insurance that concern all healthcare workers in Turkey ⁽³²⁾. The meetings mentioned above have been realized in cooperation with the Istanbul Chamber of Physicians as an indispensable stakeholder of the issues at debate. The latest and sixth congress was named after New Horizons in Bioethics in line with the previous congress in 2008 by emphasizing TBA’s mission to hold meeting in a bioethical perspective. 2010 Congress has achieved this goal successfully by integrating the studies of medical ethics and related sciences together with the cooperative branches such as medical education, medical law, sociology, public health, history, biomedical branches in a multidisciplinary vision. It has also given a special emphasis on the rights of vulnerable groups by assuring them a platform of speech ⁽³³⁾.

Turkish Bioethics Association, as a member of EACME, will be organizing the European Association of the Centres of Medical Ethics Annual Meeting for the first time in Istanbul-Turkey on September 15-17^th 2011 ⁽³⁴⁾. The scientific programme will cover a wide range of topics related to bioethics from a cross-cultural perspective, including bioethics and humanities, universal values and cultural diversity, European Biomedicine Convention, human rights and bioethics, and health care policy making. This international platform will hopefully provide a basis for handling the professional and moral values and bioethical issues in conflict. On the eve of the event, Globalising European Bioethics Education Summer School will be held for foreign and Turkish participants in conjunction with TBA-EACME Conference on September 11-14, 2011. The Executive Committee wishes its local members and international colleagues all to experience the international arena for exploring moral and ethical values in a cross-cultural vision leaning on a participatory democratic platform nourished from the ethical discourse.

Conclusion

The teaching of ethics owes a great deal to the medical school curriculum in Turkey and has rooted in the steps of 19^th century modernization movement in medical education. The emergence of the Turkish Bioethics Association can be better evaluated in line with this historical past that has given rise to the making of a bioethics society. As an academic and non-governmental organization, Turkish Bioethics Association has substantiated itself both at local and international platforms as a promising society based on this rich tradition. It will keep on contributing to the academic literature, collegiate teaching and current debates in healthcare system in view of bioethics by its functions briefly depicted in this study.

Acknowledgements: I deeply appreciate the immense support of my colleagues in the Executive Board; and the contributions of the members of Türkiye Biyoetik Derneği without whom a real teamwork would have never been accomplished.

REFERENCES

1-      Yildirim N, Ulman YI, “The Historical Development of the Education of Medical History and Deontology-Ethics at Istanbul University”. 37th International Congress on the History of Medicine Proceedings (ed: Burns, O’Neill, Albou, Rigau-Perez). Texas-USA: 2000:237-243.

2-      Yildirim N, Ulman YI, “A Review of Medical History and Ethics Education at the Istanbul University”. Bulgarian Historical Review-Revue Bulgare d’ Histoire 2005; (3-4):119-126.

3-      Sehsuvaroglu BN. Medical Deontology Istanbul Univ. 1975 (Turkish), cited by N. Sari, in “Tip Deontolojisi”, Tıp Dallarindaki Ilerlemelerin Tarihi, ed .EK Unat, Ist. 1988:423. N. Akdeniz Sari has been the author of the first doctoral thesis on history of deontology by: Physician and Deontology in the Ottoman Empire PhD. Istanbul Univ. Cerrahpasa Faculty of Medicine, İstanbul 1977 (Turkish).

4-      Basagaoglu I. An assessment of deontological cases inferred at Istanbul Chamber of Physicians, (Turkish)  MA. Istanbul Univ. Cerrahpasa Fac. of Medicine, 1985 and Judicial and deontological assessment of deontological cases inferred to the Ministry of Justice in Turkey PhD. IUCerrahpasa Fac.of Med. 1988 (Turkish).

5-      The two PhD dissertations supervised by A. Altintas at Cerrahpasa Fac. of Medicine are by N Ersoy Ethical problems concerning Informed Consent in Clinical Treatment Istanbul 1991 (Turkish) and M. Sehiralti Medical Ethical problems in clinical setting concerning Family Planning, Istanbul 1993 (Turkish).

6-      Goksel, FA, “Etikten Deontolojiye Bağlayıcı Kuralların Oluşumu”, Tıbbi Etik, 2(1), 1994:1-2; Goksel, FA, “Tıp Dünyamızda Yeni Bir Gereksinim: Mesleki Değerler Forumu”, Tıbbi Etik, 1(1),1993:1-4.

7-      Ors Y. Teaching medical ethics in the subjunctive mood. Bulletin of Medical Ethics 1993;93:31–6

8-      As a matter of fact Ankara Deontology Department. preferred to exclude the term “medical history” in their  name and this set an example to a number of new departments all over Turkey.

9-       Oguz Y, Arda B: Medical ethics in Turkey. Bulletin of Medical Ethics 73: 13 - 17, November 1991; Arda B, Ors Y. Teaching medical ethics with an ethics to teach. Bulletin of Medical Ethics 1996;116:19–22; Arda B, Sahinoglu PS. Bioethics in Turkey Eubios Journal of Asian and International Bioethics 1995;5(3):64–65.

10-  Kadioglu FG, et al. “The 10^th Year of Turkish Bioethics Association and its Significance for Bioethics in Turkey”, Challenges for Bioethics from Asia. Ed. D. Macer. Eubios Ethics Institute. 2004; 505-507.

11-  Interestingly enough the first congress on medical ethics and deontology was organized in 1977 by BN Sehsuvaroglu, chair of the department in Ist. Univ. Medical Faculty, while the first symposium was held by the mutual efforts of Ankara University and Istanbul Univ. Cerrahpasa deontology departments at Cerrahpasa in 1994. See: Nil Sari, “Inaugural Speech of the Symposium”, Tıbbi Etik;19942(3):105; Y Ors, ibid:107-108.

12-  http://www.biyoetik.org.tr/history.htm (accessed: 14 April 2011)

13-  Kavas, V. “The history of the Turkish Bioethics Association as a sample organization and thoughts on getting organized and taking act”, Turkiye Klinikleri Journal of Medical Ethics, 2004;12:256-262.

14-  Civaner M, et al, “Medical Ethics Organizations in Turkey”, 3rd Balkan Congress on the History of Medicine., Thessaloniki Greece 29 Nov.-1 December 2007.

15-  http://www.biyoetik.org.tr/tüzük.htm (Accessed 14 April 2011).

16-  Kavas, op.cit. 257.

17-  Register Book of the Turkish Bioethics Association page no. 66, 71.

18-  Regulation of the Turkish Bioethics Association:  http://www.biyoetik.org.tr/tüzük.htm (Accessed: 14 April 2011)

19-  The position of the honorary members is under revision by an ad hoc committee due to the decision of the General Assembly held on November 15th, 2010.

20-  The internet page was first set up by Dr. Murat Civaner and transfered to TBA in 2005 under his moderation. It has been administered by the Executive Board with professional aid since 2010.

21-  http://www.biyoetik.org.tr/files/TBD_e-Bulten_No.20.pdf (Accessed: 14 April 2011).

22-  http://www.biyoetik.org.tr/kurulduyuruları.htm ( Accessed: 14 April 2011).

23-  http://www.biyoetik.org.tr/dernek_tar_hazır_rap.htm (Accessed 14 April 2011).

24-  TTB-UDEK Etik Kilavuzlar, TTB Yayinlari Ankara 2010. http://www.biyoetik.org.tr/files/TTB-UDEK%20Etik%20Kilavuzlar.pdf . (Accessed 14 April 2011).

25-  http://www.biyoetik.org.tr/egitim.htm (Accessed 14 April 2011).

26-  Sağlıkta Donusumun Etik Boyutu, Turkiye Biyoetik Dernegi VI. Tip Etigi Sempozyumu (28-29 Nisan 2007),  Turkiye Biyoetik Dernegi Yayin No. IX, Ankara Mart 2008. (The design of the meeting and the edition of the book were carried out by Dr. Murat Civaner, former member of the Executive Board).

27-  Kok Hucre Arastirmalarinin Etik ve Hukuk Boyutu, by Turkiye Biyoetik Dernegi Kok Hucre Arastirmalari ve Uygulamalari Kurulu (S Gorkey, N Kutlay, TB Gul, T Guven, G Sert, M Gun, C Erzik), Ankara, Nisan 2009.

28-  Tıp Etiğinden Biyoetiğe (Expanding Medical Ethics to Bioethics), editors: YIUlman, TBGul, FGKadioglu, G Yildirim, Z Edisan, Ankara 2009.

29-  Establishing Bioethics Committees, Guide No.1 and Bioethics Committees at Work, Procedures and Policies Guide No.2, published in France 2005; Biyoetik Kurulların Oluşturulması, Kılavuz No. 1, Biyoetik Kurullar İş Başında: Çalışma Biçimleri ve Politikalar, UNESCO Birleşmiş Milletler Eğitim, Bilim ve Kültür Kurumu Türkiye Milli Komisyonu, translated into Turkish by TBA members ( NO Buken, M Civaner, O Ilgili, C Izgi, N Oguz, V.Kavas, edited by YIUlman), Ankara 2008.

30-  Organ Aktarimi ve Tip Etigi, 14 Mart Tip Haftasi 2008,İstanbul Tabip Odasi, Nisan 2008: 139-159.

31-  Turkiye Biyoetik Dernegi VII. Sempozyumu: Yeni Ureme Teknikleri Yeni Annelikler, Istanbul 9 Nisan 2009.

32-  The paper presented at this panel are provided in TBA’s internet page by e-Bulletin No. 20: http://www.biyoetik.org.tr/files/TBD_e-Bulten_No.20.pdf (Accesssed 14 April 2011).

33-  Turkiye Biyoetik Dernegi VI. Tip Etigi Kongresi: Biyoetikte Yeni Ufuklar, Bildiri Ozetleri Kitabi, Istanbul 25-26 Kasim 2010 (Abstract Book).

34-  www.eacme2011.org