Strasbourg 10 October 2007 P-PG/Ethics (2007) 6
EXPERT COMMITTEE ON
ETHICAL ISSUES AND PROFESSIONAL STANDARDS
8th MEETING
1 and 2 October 2007
Report and Decisions |
Opening of the meeting and adoption of the agenda
a) The Chairperson of the Committee, Patrick Sansoy (France), opened the meeting and invited the members present to introduce themselves. The agenda was adopted.
b) Mr Sansoy reported briefly on the meeting of the Permanent Correspondents held in Strasbourg on 27 and 28 September 2007. He informed the Committee that the Permanent Correspondents had discussed the expediency of tabling a draft resolution at the next meeting of the United Nations Commission on Narcotic Drugs in March 2008 (see appended report of this discussion).
1. ETHICS AND DRUG ADDICTION
Mr Sansoy presented the draft resolution geared to having drug addiction recognised as an “illness”, which meant that drug addicts should have access to public health services. The draft was based on a declaration by the Secretary General of the United Nations. Mr Sansoy added that the WHO already recognised drug addiction as a “disease” and that WHO member States ought consequently to accept this premise. He lastly reminded members that the proposal had been submitted to the Committee at the express request of the Chairperson of the Permanent Correspondents and that the discussion was geared to ascertaining whether and how the Committee wished to deal with it.
Mr Sansoy stressed that the main focus was drug addiction as a “disease”, and that while not all drug addicts were ill, the long-term treatment should be considered as targeting an “illness”. In France, for instance, provision for drug addiction had a social welfare dimension because drug addicts could be granted disabled person status.
Mr Lackovic confirmed that addiction had long been recognised as a disease in scientific circles. He added that it could even be considered a brain condition because some drugs, particularly ecstasy, caused irreversible damage that was now observable. The recently published work of French and Portugese searchers in this field explained the underlying mechanisms of addiction.
Ms Roelandt considered that the Committee could deal with this subject, but that not all drug addicts could be considered as being ill. A clearer definition was needed of “illness/disease”. Mr Simon said that the toxicomanie had been replaced in French classifications of diseases by “addiction”. Addiction was a complex “illness” with complicated psycho-social implications. Account had to be taken of social determinants, which also played a dominant role in vulnerability to addiction, and of genetic aspects.
Mr Sansoy confirmed that if the principle of a draft resolution was taken on board, the text should develop towards more specific terminology. The Committee noted that it was unnecessary, and indeed dangerous, to reopen the debate on definitions and terminology, and that in any case such a debate was not a matter for an ethics platform. In any case, these constantly shifting issues were extensively discussed in other platforms, such as the WHO.
It would be preferable to include the draft in the work that had already been produced and the aims that were being pursued by the Pompidou Group and the Council of Europe, particularly in terms of protecting human rights and ensuring respect for the fundamental rights and freedoms. For instance, the draft could emphasis the right to treatment, the right to recognition as a patient, and even the right not to receive treatment.
Ms Roelandt stressed the importance of reaffirming the right to treatment for all individuals suffering from an addiction who considered themselves in poor health without having an actual illness. All risk of stigmatisation had to be avoided.
Mr Sansoy said in the absolute that there was a right not to be treated, as long as the person had not been arrested. However, this right was restricted when treatment was offered as an alternative to prison. Ms Voolfson considered that it could not be taken for granted that addicts were able to exercise their freewill or that they could necessarily assess their need for treatment, which meant restricting the right not to be treated.
Mr Tempesta noted that the tendency in Europe was to make medical provision for addiction subject to analysis of the patient’s lifestyle, or specifically the healthiness of the latter. In certain countries, some types of treatment could be suspended if the patient continued to take drugs. A European consensus should be sought on the services responsible for treatment, ie a kind of ethical code for those providing treatment for such patients.
Ms Milukic stressed that provision should not be exclusively medical but should also cover other areas. This raised the question of provision by therapeutic communities which adopted the abstinence approach rather than providing medical treatment.
Mr Simon proposed a fourth right for consideration, namely the right not to be considered mentally ill in accordance with an exclusively symptomatic diagnosis.
Some of the experts wondered about the difficulties which the text would encounter in terms of both translation and the prospective objections to which it would give rise in many countries. The concept of a boundary between freedom of action and pathology varied widely. Some courts might hold that since drug taking was illegal and the drug taker was considered ill, then treatment was mandatory. It would be difficult to obviate the illness-offence dichotomy. Moreover, there was a risk of individual states providing a simplistic response to such a resolution, eg by organising vaccination campaigns, and there was also a risk of the debate on addiction being confined to its biomedical and neurological dimensions.
Mr Padieu added that the legal dimensions of the problem should also be mentioned (trafficking, crime, etc) in order to anticipate reservations on the part of states which concentrated more on combating drug trafficking than on reducing demand.
The aim pursued by this text should therefore be clearly set out and any consequence had to be anticipated and taken into account.
Lastly, in connection with the practical implementation of the draft, several experts expressed their concern about the complexity of the subject and the shortage of time for an in-depth analysis, and agreed that the Committee should continue to concentrate on completing the current work on drug testing.
In conclusion, Mr Sansoy stressed that the discussion had highlighted the main ideas to be followed up in this draft: avoiding any discussion of definitions, which was a matter for other bodies, and assessing the aims to be achieved in terms of rights. The four rights identified above - the right to treatment, the right to recognition as a patient, the right not to receive treatment and the right not to be considered mentally ill - might serve as a guide for drafting such a text.
He would take account of the comments made in preparing a flexible drafting procedure in line with the fundamental spirit underpinning all the Pompidou Group’s work. Rather than adopting a totalitarian medicalised approach to the problem, it was a case of helping enhance recognition of the population group in question, encouraging the rest of the population to look at this group differently, reducing the moral prejudices and providing practical help by introducing healthcare mechanisms.
2. DRUG TESTING IN THE WORKPLACE
This document reflected its author’s views and was to be included in a “technical” appendix to the final opinion to be adopted by the Committee, together with the reports by Ms Ambroselli, Mr Rodriguez and Mr Martins.
The discussion brought out the points to be explained, developed or fleshed out. The Secretariat would append a list of relevant conventions with the state of signatures. Ms Roelandt would be emailing a corrected version of the text incorporating the items emerging from this discussion.
Ms Ambroselli’s document on text quality and reliability, which the Committee had not yet examined, would also be sent to Committee members for comment, with an eye to adoption at the next meeting.
3. DRUG TESTING AT SCHOOL AND AT WORK
The Committee went through the text making comments and suggestions, which Ms Roelandt would incorporate into the French text. The Secretariat would look after the English version and forward the revised version to Committee members, who would be invited to react to the text and put forward any suggestions. Mr Simon was invited to produce a paragraph on the proportionality principle (para. 2 after “our national legislations”).
The new version of the text would be approved at the next meeting and might be submitted to the Permanent Correspondents in April.
The Secretariat was instructed to number the appendices and add them to this draft opinion; the appendices were document P-PG(2006)6 by Ms Ambroselli, document P-PG(2006)4rev2 by Mr Rodriguez and Mr Martins, and document P-PG(2006)1rev by Ms Roelandt for drug testing in the workplace, and documents P-PG(2005)7rev and P-PG(2005)3, which were the draft recommendation on the practice of drug testing at school and its appended technical report.
Chris Luckett suggested that this text might be put to various other experts next year, such as the members of other platforms or individuals from the world of work, or even national ethics Committees. The Secretariat would make a proposal to this end at the next meeting.
4. ETHICAL ISSUES RELATING TO RESEARCH
Patrick Sansoyobserved that the Committee had been invited to consider developments in research in order to pinpoint any ethical issues liable to arise from the latter.
Ms Nilson said that Mr Muscat’s publication was an excellent starting point for discussing developments in science. She considered that the platform’s role was to inform policy-makers and governments about the myths and manipulations in this field. She proposed identifying a number of themes and organising a conference in order to exchange viewpoints on these matters with other experts.
Mr Papadopoulos noted that all the experiments referred to by Richard Muscat in his publication involved chimpanzees and rats. He wondered how far the results could be extrapolated to human beings, without ignoring the affective and psychic dimensions. Mr Sansoy recalled that research in the neuroscience field mainly involved animals because experiments could not be conducted on human beings. Nonetheless, for the purposes of some experimental protocols, specific groups of users were recruited and administered certain illegal substances liable to cause addiction.
Ms Roelandt stressed that the fact of possessing a genetic risk of developing an addiction did not mean that an addiction would necessarilly develop. There were different kinds of drug addicts, and some were not unhappy. This was why it would always be a sine qua non to secure the person’s consent to any kind of therapeutic approach, such as transforming the addictive behaviour through electroshock therapy, etc.
Mr Tempesta highlighted the dangers of a “simplistic” approach to the problems, and stressed the need to incorporate psychological aspects into the neurosciences. He suggested that the Committee deal with the vulnerability of young people and adolescents to illicit substances, drawing on the latest research projects and studies. Another problem to be addressed was communication and the ethics of communication in prevention, ie the way in which research results were used in public prevention policies.
Ms Roelandt stressed that the problems arose not from research itself but from the political use made of it. Mr Sansoy explained that the results of certain research projects and the fact the some were ignored could lead decision-makers to make the wrong choices, which could harm the population groups concerned. He quoted the example of “light” cigarettes, sales of which had been encouraged by politicians without taking account of the fact that they changed the smoker’s method of inhaling the smoke which made them more harmful, causing more serious types of cancer. With illicit drugs too there was a risk of users who had been weaned from one substance switching to another. Research into addictive behaviour had highlighted this particular risk.
Chris Luckett suggested that the Committee could make its contribution by listing the specific questions addressed or encountered by researchers in their work, and then investigating how policy-makers exploited the results.
Mr Sansoy took note of the new ideas identified during the discussion and recommended interaction with other platforms. He proposed dealing with the link-up between the sometimes rather narrow thematic or disciplinary productions of research and the need to incorporate the latter into a broader ensemble, taking a longer-term perspective.
5. OTHER BUSINESS
a) Participation in other activities
The Bulgarian and Croatian experts would be attending the conference on quasi-coerced treatment in Bucharest on 12 and 13 October, and might report briefly on this event at the Committee’s next meeting.
b) Next meeting of the Committee
The next meeting was scheduled for 6 and 7 March in the Council of Europe Office in Paris (subject to meeting room availability).
6. LIST OF DECISIONS
Mr Sansoy would prepare a new wording of the draft resolution, to be sent to Committee members for comments.
Ms Roelandt would incorporate the points emerging from the discussion into Documents P-PG/Ethics(2006)1rev and P-PG/Ethics(2007)5 and forward them to the Secretariat, which would then submit them to Committee members for comments.
Mr Simon would submit a suggested paragraph to Ms Roelandt for inclusion in Doc. P-PG(2006)1rev. The Secretariat will add a list of relevant conventions as an appendix to this document.
Ms Ambroselli’s document on test quality and reliability would also be sent to Committee members for comments, with an eye to its adoption at the next meeting.
The Secretariat would number the appendices and add them to the final draft opinion (Documents P-PG(2006)6, P-PG(2006)4rev2 and P-PG(2006)1rev for drug testing in the workplace, and Documents P-PG(2005)7rev and P-PG(2005)3 for the practice of drug testing at school).
All the texts adopted might be put to various other experts next year. The Secretariat would present the Committee with a proposal to this end at the next meeting.
A list would be drawn up of themes to be addressed as part of the work on research. Mr Tempesta had been asked to take on this task using the points emerging from the Committee’s discussion.
Appendices
|
Report of the platform's 7th meeting |
P-PG/Ethics(2007)2 |
|
Ethical considerations in connection with drug testing in the workplace (M. Roelandt) |
P-PG/Ethics(2006)1rev |
|
Drug testing in the workplace, the issues involved (R. Padieu) |
P-PG/Ethics(2006)2rev |
|
Drug testing in the workplace: Inventory of national legislations by MM Rodrigues and Lourenço Martins |
P-PG/Ethics(2006)4rev |
|
Psychological drug research: current themes and future developments by M. Roelandt |
P-PG/Ethics(2006)5rev |
|
Quality, availability and reliability of drug screening tests used in the workplace and Appendices (C. Ambroselli) |
P-PG/Ethics(2006)6 |
|
Draft final opinion on drug testing at school and in the workplace by M. Roelandt |
P-PG/Ethics(2007)5 |
|
Ethical issues raised by research in the field of drugs (Working Document) |
P-PG/Ethics(2007)3 |
|
Publication on biomedical research in the drug field by Richard Muscat |
ISBN-13 :978-92-871-6017-1 |
|
Psychological drug research: current themes and future developments by Jorge Negreiros |
ISBN-13 :978-92-871-6032-4 |
List of Participants :
BELGIUM / BELGIQUE
Ms Micheline ROELANDT F
Vice-Présidente du Comité de la Bioéthique tel : +32 2 648 9941
27 rue des Fleuristes fax : +32 2 648 9941
B – 1000 BRUXELLES [email protected]
BULGARIA / BULGARIE
Dr. Emil Grashnov E Tel: +359 (2) 832 51 67
Lagera 37ª Fax: +359 (2) 832 91 45
BG – SOFIA 1612 Email: [email protected]
CROATIA / CROATIE
Mrs Sanja MIKULIĆ E
Head of Department for general programs and strategies
Office for Combatting Narcotic Drug Abuse Tel: + 385 1 48 78 125
Preobraženska 4/II Fax: + 385 1 48 78 120
CR – 10 000 ZAGREB [email protected]
Prof. Zdravko LACKOVIC
Professor of Pharmacology
Medical School of Zagreb University
Zagreb
CYPRUS / CHYPRE
Mr Michalis PAPADOPULOS F tel : + 357 22 44 29 60/9
Member of the Cyprus Anti-Drug [email protected]
Cyprus Anti Drug Council [email protected]
32 Strovolos ave mobile : +357 99 441 345
Magnolia Center
CY- 2018 Nicosia
CZECH REPUBLIC
Mrs Kamil Kalina E (apologised/excusée)
FINLAND / FINLANDE
Mrs Ritva Halila (apologised/excusée)
FRANCE
Mr René PADIEU F
Inspecteur Général honoraire de l'INSEE
4 Rue du Cloître Notre-Dame tel : +33 1 43 54 57 39
F-75004 Paris [email protected]
M. Patrick SANSOY F
Chargé de mission – MILDT tel: +33 1 44 63 20 90
7 rue Saint Georges fax: +33 1 44 63 21 01
F – 75009 PARIS [email protected]
Ms Claire AMBROSELLI F (apologised/excusée)
GERMANY / ALLEMAGNE
Mr Werner SIPP E / F (apologised/excusé)
GREECE / GRECE
Mrs Mata Markellou (apologised / excusée)
HUNGARY
Mr István Gábor Takács E apologised / excusé)
ITALY / ITALIA
Prof. Enrico TEMPESTA E
Presidente Laboratorio Scientifico tel: 00 39 06 60 50 77 41
Viale di Val Fiorita 90 fax: 00 39 06 591 29 10
I - 00144 Roma [email protected]
LITHUANIA / LITUANIE
Mrs. Viiktorija VOOLFSON
Ministry of Health of the Republic of Lithuania
Vilnius Str. 33 [email protected]
LT-01506 Vilnius
PORTUGAL
Dr Joaquim Augusto RODRIGUES F
Consultant
Instituto da Droga e da toxicodependencia
Av João Crisóstomo 14 tel : 00 351 21 415 32 23
P – LISBON [email protected]
ROMANIA / ROUMANIE
Dr Gabriel CICU (apologised / excusé)
RUSSIAN FEDERATION / FEDERATION DE RUSSIE
Mr Mikhail SAPOVSKIY E (apologised / excusé)
Mrs Victoria TIMOSHCHENKOVA E (apologised / excusé)
SWEDEN / SUEDE
Ms Elisabet SVEDBERG (apologised / excusé)
SWITZERLAND / SUISSE
Dr Olivier SIMON F
Psychiatrist, Head of Clinic
Centre Sain-Martin tel: +41 21 316 16 16
7 rue Saint-Martin fax: +41 21 316 16 26
CH – 1003 LAUSANNE [email protected]
UNITED KINGDOM / ROYAUME UNI
Mr John WITTON E (apologised/excusé)
EMCDDA /OEDT
Mrs Margareta NILSON F
EMCDDA tel: +351 (21) 81 13 007
Rua Cruz da Sta. Apolónia, 23-25 fax: +351 (21) 81 30 615
P – 1149-045 Lisboa [email protected]
POMPIDOU GROUP SECRETARIAT
Mr Christopher LUCKETT E/F tel: +33 3 88 41 21 93
Executive Secretar fax: +33 3 88 41 27 85
Council of Europe [email protected]
F – 67075 STRASBOURG Cedex
Mme Sabine ZIMMER E/F tel: +33 3 88 41 25 97
Administrator fax: +33 3 88 41 27 85
Council of Europe [email protected]
F – 67075 STRASBOURG Cedex