Earlier this year the Journal of Medical Law and Bioethics, a peer-reviewed journal of the Academy of Sciences of the Czech Republic, published an article which took a positive view of infanticide. The author, a senior university lecturer and a Czech government adviser, Miroslav Mitloehner, advocated euthanasing severely deformed new-born babies. He also used the term “monster“ interchangeably with “severely malformed beings“ and never referred to these children as “persons”.
Even though Dr Mitloehner’s opinions are far from exceptional in other countries, debates about infanticide in the Czech Republic had been confined to a very small circle. So, when the article was picked up by the mainstream media, there was a fierce reaction from many bioethicists and journalists. And the public was aghast.
When the editorial board reviewed the article it discovered that it had already been published in another journal back in 1986. It disowned the article, but the editors stressed that they were open to controversial views like this and they defended Dr Mitloehner against many of his critics.
In fact, for an academic journal, Dr Mitloehner’s article was substandard. It ignored the past 30 years of debate. The only substantial changes he had made to his original were to delete links to the Marxist ideology which was dominant at the time. The upshot was that Dr Motloehner lost his job at a university while his fellow academics distanced themselves. Within university circles, one side is calling for an end to a witch-hunt, while the other is insisting that academia cannot tolerate certain ideas.
But what is really interesting about this case is what it reveals about the Czech society. Back in 1986 no one objected to Dr Mitloehner’s ideas. Now they do. What happened?
It is true that under Communist rule debate was very limited. The original article assumed a socialist concept of society and individual’s place in it. The Czech National Disability Council chairman Václav Krása writes that the article “fit into the ideology of happy healthy citizens of the socialist society“ who should not be disturbed by any exceptions. Significantly, one characteristically Marxist sentence in the original version had been deleted: “The main value is not our own existence, but the benefits of our lives for society.“
It is from this starting point Dr Mitloehner derived his other views, including one of the most controversial: that, taking into account “a priority of the interest of society,“ severely malformed new-borns should be euthanized without parental consent and that in some cases abortion could be obligatory.
Thankfully, such ideas are no longer mainstream. After 1989, the Czech Republic became a liberal democratic country defending the human rights of disabled persons. It has rejected euthanasia, although it is as liberal on abortion as it was under Communism.
But what has changed in practice?
In the opinion of Dr Tomáš Doležal, a chief editor of the Journal of Medical Law and Bioethics, nothing much. Dr Jaromír Matějek, a bioethicist from the Institute of Ethics of the Third Faculty of Medicine, Charles University, says: “Medical ethics seems to have stopped in the rooms of medical schools. It has been taught for 20 years and I don’t think it would have any significant influence on practice in hospitals“.
To be sure, informed consent plays an incomparably more important role than it did 20 years ago and medical personnel are no longer so paternalistic.
But most doctors just go on gut feel. “An average physician solves ethical questions intuitively“, says Dr Matějek, and Dr Doležal adds: “The doctors are more aware of the principle of autonomy, but in practice it does not have a big influence on their actions. In the end, they make an ethical decision, but they do so being motivated rather by the fear of sanctions. Even though ethical thinking exists, the practice is not very different from that of the 1980s“.
Bioethics still remains a very minor interest in the Czech Republic. The first bioethics seminars appeared immediately after the Velvet Revolution in 1989 but its development has been very slow. Even now, there is only a very modest number of experts. “In Germany, institutes of ethics at medical schools normally have 50 scholars“, explains Dr Matějek. “At our Institute, there are only four of us“.
Communism has left its mark. Although individualism trumps socialism, Czechs are still pro-choice. Fundamentally they are still utilitarian, esteeming the greatest good of the greatest number. Approaches based on human dignity are regarded as sentimental and irrational. The notion of sanctity of human life seems very odd.
Why, then, the concern about disabled? They are indeed much less stigmatized and much more visible in public than some 20 years ago. But the views of man in the street on core pro-life issues remain the same. It is only a sliver of society, a few bioethicists, journalists, intellectuals, social workers and so on who support pro-life issues and for some this is merely a political gesture. Since lobbying for the disabled would have been almost impossible under the old regime, now it must be a good cause.
The world view gap
So there is a big gap between these circles and the rest of society. To investigate why we should now focus on the question of Czech medical ethics.
Being so new and small, Czech bioethics has a Catholic background. Other philosophical schools are not well represented. In one of the world’s least religious countries, where only-one third of inhabitants claim religious affiliation (of whom the majority is Catholic), this is rather surprising. Bioethicist Adam Doležal comments: “It is a paradox that the loudest voices are pro-life, while the society is pro-choice.“
The gap between bioethics discourse and the opinion of both general and medical public is huge. According to a recent poll, 69 percent of Czechs state that “woman has a right to decide whether she would undergo abortion“ (for whatever reason) and 67 percent are in favour of euthanasia, 24 percent of whom “strongly agree“ with legalization.
So here is what puzzles me. If bioethical discourse is generally pro-life, why is it so incapable of influencing public debate? There seem to be two ethical universes in the Czech Republic: a small pro-life enclave and an indifferent public. In a sense, it is almost the inverse of debate in the United States, where the public is more or less religious while the bioethics enclave is basically secular and even anti-religious.
Most critics of Dr Mitloehner’s article were indeed thinkers in some way connected with religious circles and their reaction was naturally negative: like the head of the Institute of Ethics of the Third Medical School and a Catholic priest, Marek Vácha, Václav Krása and the philosopher Lukáš Novák. Consequently, the religiously indifferent man in the street often believes that religious people only follow their Church’s stances. It is an easy way to reject their arguments.
Dr Tomáš Doležal even complains: “The discussion is distorted for there are no secular ethics.“ On the other hand, Dr Matějek, himself having a doctorate both from medicine and theology, is equally pessimistic: “Each opponent of euthanasia is automatically considered a believer, thus the very basis of his argumentation must be irrational, because God is irrational… that is, in a nutshell, how the debate in the Czech republic is being led.“
An American would probably find discussion of bioethical issues here very odd. Instead of a robust boxing match between two skilled fighters, there is only one boxer in the ring, throwing punches at the air. In the meantime, the public is watching soap operas on overhead screens. Theoretically he wins the match, but nobody cares.
The Czech public simply is not very interested in the rights and wrongs of abortion and euthanasia, the two biggest issues at the moment. Most people support abortion but have never asked why. Most people support euthanasia but know nothing about it and are bored if they are asked to discuss it. On the other hand, most people reject infanticide, but can’t explain why.
Dr Adam Doležal points out that “the personal status [of the infant] has never been discussed here, not even when the abortion legislation was being adopted.“ Never really questioning what exactly happens during the process in which the zygote slowly develops to make a crying baby nine months later, most people are strongly in favour of a free access to abortion while they consider killing a healthy new-born the most serious crime. This is exemplified by Human Rights League activists who opposed Dr Mitloehner’s proposals with the same enthusiasm with which they normally promote the right to abortion.
This detail also highlights another fact. Indifference to bioethical issues is not only a problem of general public but, apart from a very few experts, virtually everyone. Occasionally a scandal hits the newspapers provoking a sudden wave of emotions, but there is no serious discussion. There are still too few ethicists who are courageous enough to debate issues in the public square at the risk of exposing themselves to ridicule and scorn.
This indifference to moral issues is a legacy of the Communist era and its deadening materialism. It rinsed out of the social fabric not just religion, but also an interest in reasoned discussion. Sadly, it may take another couple of generations to make people realise the importance of ethics in public life.
Martin Solc studies law at the Charles University in Prague, Czech Republic, where he also obtained a bachelor’s degree from political science and international relations in 2014.