Political sea changes and bioethics--Prague 1991.

The Hastings Center's three bioethics conferences in Eastern and Central Europe have been increasingly dramatic. We first met in July 1989 in Pecs, Hungary. Twenty-five colleagues gathered to plan our new international work and to introduce ourselves to health care realities and bioethical issues in the then "Eastern bloc." We heard about the "tipping" of Hungarian doctors, the "disappearance" of public funds earmarked for health care, and patients' mistrust, in Russia and elsewhere, of their health care providers. Yet many Eastern European colleagues, especially the young, were reluctant to speak frankly and openly, no doubt fearing recriminations. Despite glasnost and perestroika no one had an inkling of the enromous political, liberating events that would begin in Eastern Europe a few weeks hence. We were merely trying to build a community of the few isolated and embattled bioethicists working in the several Eastern bloc countries. By August 1990 when we met in Dubrovnik, Yugoslavia, democratic movements had swept over many Eastern European countries. We had now grown to over fifty conference participants. The mood was of elation and newly found freedoms, mixed with anxiety over what might come, including social chaos and new cultural oppressions. Whatever the apprehensions, a young Czech Minister of Health boldly told us to get things straight: there is not and never was an "Eastern Europe." Czechoslovakia in particular had its roots in Western Europe and the Austro-Hungarian Empire. The "Eastern past" was over and done with. By late August of this year as nearly 100 of us met in Prague, Czechoslovakia, in the wake of the abortive Soviet coup, the future--both the new freedoms and the new chaotic events--had begun to materialize. Despite our fears and against our expectations, two colleagues arrived from post-coup Moscow. One had been among the defenders of "the Russian White House" (Parliament Building), having returned to Moscow deeply depressed by the news of the coup only to be "respirited" by the people who spontaneously took their stand with Boris Yeltsin. Yugoslavian colleagues from Zagreb arrived to tell about the tragedy taking place in Croatia and about their unsuccessful efforts to marshal international humanitarian and medical aid for the victims of the ongoing violence. The Czechoslovakian Minister of Health, chastened by a year in office, informed us of the stark fiscal and political realities facing the Czech health care system. During an impromptu public dialogue, he enlisted our support in making bioethics an integral part of his efforts to overhaul and humanize the Czech health care system. The mood in Prague was marked not by airy, youthful freedom, but rather by muted anger and sober realism, despite the relief and joy over the failed Soviet coup. To the immediate political events were added reports of the corrosive effect of morally degraded and bankrupt societies. Indeed, the one theme underlying the separately convened environmental and bioethics meetings was the systemic moral and cultural havoc wrought by forty-plus years of Communist hegemony. Bulgarians and Czechs spoke about systematic disregard of environmental and plublic health concerns and the withholding and misuse of vital information in service of heavy industrialization. They spoke of bureaucratic obfuscation, in which no one was held accountable and all went unpunished for "crimes" against the human community and nature. …