As one of a cycle of conferences planned during 2006, the Victor Grifols I Lucas Foundation organised on May 26th a seminar entitled How to approach the problem of patient competence which aimed to analyse the problem of patients’ capacity to be able to value adequately their own informed, voluntary consent for treatment. One of those attending was James Drane, a 76 year old U.S. expert in this field and considered to be one of the founding fathers of Bioethics. Since the 1960s, this professor of Edinboro University of Pennsylvania has contributed enormously to the development of this science. Drane followed part of his training in Madrid and he still maintains a high level of Spanish. His visit provided us with an excellent opportunity to interview him and analyse in greater depth the fascinating world of Bioethics and of the competence of patients.

What is Bioethics and where did the idea first arise from?

Bioethics is the concept used nowadays to refer to contemporary medical ethics. Since its early days, medicine has always been closely involved with moral values but it was particularly after the Second World War that the term “Bioethics” began to occur in frequent use. Once the war was over, the rapid development of technology enabled doctors to use new techniques that in turn posed new ethical problems. In the ‘60s, various different American professionals felt the need to get together to discuss moral questions and so they created the first ever Institute of Bioethics.

What is the role of Bioethics today?

Bioethics plays a vital role in today’s society, as health is most people’s principal concern and here the pharmaceutical industry is of special relevance. We all have in mind the recent case of Jorge León (a pentaplegic man from Valladolid who died recently. After various years in this condition, he was found dead one morning disconnected from his life support machine and with a glass of sedative by him.) Cases like this generate a lot of public interest because they could happen to anybody.

In your opinion, do we currently respect patients’ wishes?

Yes, I think so, although in critical cases, this respect often proves to be more complex. In the United States last year, we had the case of Terry Schiavo, a 41-year old woman who had been in a vegetative state for fifteen years. There was a dispute between her husband, who was in favour of switching off her life support machine, and her parents, who fought for her not to die. In the end, the courts agreed with the husband. She no longer had any power of decision and the case was taken to court instead of consulting experts in bioethics and reaching an agreement in a more private/medical context.

Do you think that patients have the necessary information at their disposal to evaluate the risks involved in their decision?

This is the doctor’s job. The medical professional is obliged to protect and inform patients about the consequences of their choices.

In your opinion, what attitude should a professional adopt when a patient wishes to make a decision that is medically not advisable?

Let’s pose a specific case: a young sportsman in his twenties has an accident and we need to amputate his leg to save his life. Let’s imagine he refuses to allow the amputation. He is legally completely within his rights to decide about his condition but when it comes to taking the decision, he is depressed and refuses to discuss the matter. Medically, the young man has ceased to be competent due to emotional and intellectual deficiencies. Given this situation, the doctor should meet with the family and if necessary, consult a team of experts, but his first obligation is to save the patient’s life.

What role does the family play during the patient’s decision-making process?

The family’s role depends mainly on the cultural environment of each society. In Western cultures, there is a trend towards individualism, meaning that in these cases, we tend to respect the patient’s wishes. In other societies, the family is much more significant and has an enormous influence over the patient’s final decisions.

The Spanish government does not feel it is necessary to debate euthanasia and prefers to centre discussions on the quality and accessibility of terminal health care. Why do you think this is?

Historically, societies used to be very homogeneous but nowadays, there is far greater cultural heterogeneity and it is very hard for everyone to be in agreement. Perhaps that’s why countries like Spain, with a wide diversity of cultures, prefers to focus the problem from a more traditional standpoint: that of terminal health care. However, it is always necessary to establish legal limitations to euthanasia if the majority in a country chooses that option.

If a law were created to regulate euthanasia, do you think Catalan and Spanish society would be prepared to make use of their “supposed right”?

No society is truly prepared but all societies will have to confront the question of euthanasia, sooner or later. Euthanasia is a complex issue that also has an important social repercussion. The situation is complicated in most countries, and Catalonia or Spain are no exception, given that society tends to be very divided over questions like euthanasia.

After over half a century dedicated to this profession, Drane has finally decided to retire and in his own words, it has not been at all easy. One of his last legacies before retiring has been the creation of an Institute of Bioethics at Edinboro University of Pennsylvania so that young Latin Americans can study this fascinating area.