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Between Legislation and Bioethics: The European Convention on Human Rights and Biomedicine

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Ethics in Psychiatry

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 45))

Abstract

The chapter explores the role that regional legislation plays in framing human rights and ethical principles in psychiatry by considering the Council of Europe’s Convention on Human Rights and Biomedicine. The chapter identifies the Convention’s contribution to an emergent legislative, regulatory and discursive formation, which is characterized by its alloy of human rights and bioethics. The author draws attention to articles within the Convention that have implications for psychiatry as regards its engagement with patients, with those on whom it depends to conduct research, and with the public. As well as indicating how various States within the Council of Europe have responded to the Convention, the author considers how the Convention attempts to align human rights and ethics through the regulation and formalisation of the relationship between doctor and patient, and researcher and research participant. This alignment is taking place at the same time as biomedicine is putting pressure on concepts (such as autonomy and informed consent) central to bioethics and human rights discourse.

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Notes

  1. 1.

    In full, the Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine, CETS No. 164; hereafter referred to as the Convention on Biomedicine). See http://conventions.coe.int/treaty/EN/Treaties/Html/164.htm

  2. 2.

    Consider, for example, pharmacogenetics/genomics, non-Mendelian models of genetic risk and pathogenesis, genome-wide association studies, the use of animal models within behavioural genetics, and the development of biobanks and epidemiological databases.

  3. 3.

    We should not forget that the presence of coercion within psychiatry acts as a forceful counterweight to the logic of choice and that of the autonomous consumer.

  4. 4.

    The Convention entered into force on 1 December 1999, when Spain became the fifth State Party to ratify.

  5. 5.

    There are very different reasons lying behind these decisions not to sign. The United Kingdom finds certain articles of the Convention in conflict with its national legislation – most notably Article 18, which prohibits the creation of human embryos for research purposes. Germany had expressed grave concern throughout the drafting process of the Convention, particularly in relation to articles concerning research involving those unable to give consent. Germany’s opposition to the Convention has a complex history, and demands an understanding of the very particular place that bioethics holds within Germany.

  6. 6.

    For example, Recommendation No. R (81) 1 on regulations for automated medical data banks; Recommendation No. R (83) 10 on the protection of personal data used for scientific research and statistics; Recommendation No. R (97) 5 on the use of medical data; Recommendation No. R (90) 13 on genetic screening diagnosis and counselling; and Recommendation (1235) 1 on psychiatry and human rights.

  7. 7.

    See http://conventions.coe.int/Treaty/EN/Reports/Html/164.htm

  8. 8.

    I am leaving to one side those parts of the Convention that focus on specific biomedical clinical and research practices (e.g. predictive genetic testing, interventions on the genome). Article 18, which addresses research on embryos in vitro, has been subject to vociferous debate and has probably received most commentary in print (e.g. Braake 2004, Hansen 2004, Reuter 2000, Walin 2007).

  9. 9.

    Unjustified discrimination would include, I contend, the hostile and/or exclusionary responses that people with particular psychiatric diagnoses (e.g. personality disorders) often receive from mental health services, as well as the ignoring or under-treating of the physical health care needs of those with psychiatric diagnoses.

  10. 10.

    Cf. Tannsjo (2004), who appears to discount Article 26.

  11. 11.

    The extensive commentary regarding this article includes Lötjönen (2005, 2006), Welie and Berghmans (2006).

  12. 12.

    This Centre is issuing a series of European Ethical-Legal Papers. These evaluate the efforts and progress of individual Member States of the European Union to promote and protect the rights of patients and users of health services in relation to the Convention on Biomedicine (for details, see Katholieke Universiteit Leuven/Centre for Biomedical Ethics and Law 2009).

  13. 13.

    This has been most evident in relation to the heated discussions concerning the Universal Declaration on Bioethics and Human Rights (UDBHR), which was adopted by UNESCO in October 2005.

  14. 14.

    Article 2 specifies that ‘The interests and welfare of the human being shall prevail over the sole interest of society or science’.

Abbreviations

CAHBI:

Council of Europe Ad Hoc Committee of Experts on Bioethics

CDBI:

Council of Europe Steering Committee on Bioethics

CIOMS:

Council for International Organizations of Medical Sciences

CPT:

Council of Europe European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment

GCP:

Good Clinical Practice

ICH:

International Conference on Harmonisation (of Technical Requirements for Registration of Pharmaceuticals for Human Use)

ICH–GCP:

ICH Harmonised Tripartite Consolidated Guideline for GCP

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Acknowledgments

The author acknowledges financial support from the National Institute for Health Research (NIHR) Specialist Biomedical Research Centre for Mental Health award to South London and Maudsley NHS Foundation Trust (SLaM) and the Institute of Psychiatry, King’s College London. She thanks Dr Dula Rušinović-Sunara of the Croatian Association of Patients’ Rights for providing her with material on the Association’s attempts to reform patients’ rights legislation in Croatia.

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  1. Health Service and Population Research Department, Institute of Psychiatry, King’s College London, PO 34 Service User Research Enterprise, Institute of Psychiatry, De Crespigny Park Road, London, SE5 8AF, UK

    Felicity Callard

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  1. Felicity Callard
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Correspondence to Felicity Callard .

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  1. Charité Campus Benjamin Franklin, Klinik für Psychiatrie/ Psychotherapie, Universitätsklinikum Berlin, Eschenallee 3, Berlin, 14050, Germany

    Hanfried Helmchen

  2. chemin Colladon 14, Geneve, 1209, Switzerland

    Norman Sartorius

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Callard, F. (2010). Between Legislation and Bioethics: The European Convention on Human Rights and Biomedicine. In: Helmchen, H., Sartorius, N. (eds) Ethics in Psychiatry. International Library of Ethics, Law, and the New Medicine, vol 45. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-8721-8_5

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