Testing ethics in practice

The German Ethics Council advises politicians and the public on sensitive topics, from vaccination strategy to prenatal diagnostics. The moral theologian Professor Franz-Josef Bormann from Tübingen helped shape the Council's opinions for eight years, until the end of his term of office in April. We ask Professor Bormann about his experiences during his term.

On which topic was the German Ethics Council particularly in demand during your term?
Franz-Josef  Bormann: The public awareness of the Ethics Council was undoubtedly greatest during the years of the coronavirus pandemic. In the years from 2020 to 2022, we issued seven statements on the management of the pandemic, on behalf of either the Minister of Health or other ministries. We also co-authored a paper on vaccination strategy with the Leopoldina and the Robert Koch Institute for the first time. This proposed very specifically the order in which people should have access to the vaccine which was initially scarce. 

And then came the discussion about mandatory vaccination …
FJB: We published a statement on mandatory vaccination for certain occupations. The question was: Are staff in hospitals and elderly care facilities morally obliged to be 
vaccinated? In this case, the Ethics Council was unanimously convinced that a mandatory vaccination could be justified ethically for certain occupations. 

The topic was discussed very controversially in public. 
FJB: Not among ethicists. In 2019, before the pandemic, the Ethics Council dealt with this issue in the context of measles vaccination, where vaccination rates were and are 
declining. Children can die from a measles infection. So we wondered whether teachers in schools, for example, should not have an obligation to vaccinate against measles.

The opinions aren't always so unanimous, are they? 
FJB: No. We saw this during the discussion on a general legal obligation to vaccinate. There was a smaller group of seven people, including me, who were generally in favor of an extension of the vaccination requirement, but wanted it to be limited to a very specific group of people with a high risk. The intensive care units filled up towards the end of 2021. Older people in particular had to reckon with a severe to fatal course of their illness after an infection. We argued that such high-risk groups must be vaccinated in order for other high-risk groups to have a chance of an intensive care bed. For example, people who had already had a heart attack or suffered from other diseases. However, the majority of the Ethics Council saw it differently. 13 people spoke out in favor of mandatory vaccination for all adults. Some even wanted compulsory vaccination for children. This is hard to imagine today.

Has the responsibility to make specific recommendations on such important topics burdened or irritated you?
FJB: Both. Work isn't always fun and games. Intensive discussions like these take a lot of time. I sometimes had a weekly meeting in Berlin or elsewhere and was heavily involved in writing the statements. But I have pleasant memories of a trans- and interdisciplinary collaboration that I had never experienced as intensely before. The Expert Council is a multi-professional expert panel of natural, humanities and social scientists. Collaboration has developed across specialist boundaries and even beyond the Council. 

Do the German Ethics Council and their expertise receive enough attention? 
FJB: There is a jungle of policy-making bodies in Germany. Competition weakens the effect of the recommendations. For example, three federal ministries – the Federal Ministry of Family Affairs, the Federal Ministry of Justice and the Federal Ministry of Health – recently set up a working group to advise on the future of Section 218 of the German Criminal Code (StGB). Abortion is now undoubtedly a subject that falls under the jurisdiction of the German Ethics Council, which was founded to advise politics and the public on life science and medical ethics issues. However, these ministries wanted to see certain results for political reasons. Such calculated competition naturally weakens the effect of the German Ethics Council which shouldn’t be the case. Another problem is that the Council deals with issues beyond its original remit, for example climate justice. And there are so many pressing problems in the health sector that fall under its original responsibility.

Can you tell us more about these problems? 
FJB: We are an aging society and are heading for everincreasing healthcare costs. There are also many problems in the nursing sector. Long-term care insurance is completely underfunded and requires fundamental reforms. We are on the verge of a total collapse of our care system in the coming years. I would strongly advise that the new council term addresses this structural issue.

Do recommendations from advisory boards such as the Council have an impact on science and research? 
FJB: Not enough. Opportunities are often missed. In 2013, even before my time, the German Ethics Council wrote a well-founded statement on the question of genetic diagnostics which foreshadowed many developments. More and more genetic markers and hereditary diseases are being identified. This has a dramatic impact. Many fetuses never see the light of day due to the new technological possibilities. These are hidden eugenic dynamics. We Germans should actually be particularly sensitive to the topic due to our experience in National Socialism. The German Ethics Council has formulated recommendations for the protection of unborn life to the legislature and also to scientific research. However, corresponding research projects were not approved. There is no money for them. In my view, this is a research policy scandal. 

Does that mean you are against prenatal diagnostics?
FJB: I am not generally against it. Prenatal diagnostics can have positive effects when combined with therapeutic options. But we are increasingly diagnosing without a therapeutic consequence – which ultimately leads to automatic termination according to questionable criteria. We are ultimately judging the value of a life here – however the legal context might address it. We don’t say anything about the worth of the child’s life, only whether a mother might be reasonably expected to bear this child. 

How effective do you think the statements you have co-written are?
FJB: There are examples where the legislature has completely ignored the recommendation of the Ethics Council, as in prenatal diagnostics. And there are examples where 
the recommendations have been implemented exactly as proposed, such as the vaccination strategy. In summary, I would say: Efficacy ranges from 0 to 100.

Author: Tilman Wörtz