pp. 169-171 in
Bioethics in Asia
Editors: Norio Fujiki and Darryl R. J. Macer, Ph.D.
Eubios Ethics Institute
Copyright 2000, Eubios Ethics Institute
All commercial rights reserved. This publication may be reproduced for limited educational or academic use, however please enquire with the author.
4.7. Survey of Portuguese Physicians, Medical Students and Other Health Professionals on the Impact of Science and Biotechnology in Society
M.C.Rosamond Pinto*., M. Pires Bicho*., D. Macer**.
*Faculty of Medicine of Lisbon, Portugal **University of Tsukuba, Japan
A national survey to probe the attitudes of physicians, medical students and health staff viewing "Advances in Biotechnology and Modern Sciences" was conducted in Portugal. This survey was based on the principle that ethics is considered to extend a duty on the part of medical practioners and health workers to re-contact when and if new developments modify the perspective on problems connected to bioethics.
Method and Response
The survey was based on the International Bioethics Survey conducted by Macer and collaborators in 1993 (Macer, 1994). This survey was conducted through the medical scientific publication Anamnesis from July l996 to March l997. Anamnesis is a member of the International Federation of Audit Bureaux of Circulation (I.F.A.B.C.) with an average circulation of 12900 issues per edition distributed freely and nation-wide in Portugal, mainly to general practitioners through mail sent to Health Centres and to the physicians home addresses. The survey was published at a monthly rate and in separate issues always preceded by an editorial according to the subject of focus. These subjects in order of publication were: Impact of Sciences and Technology, Screening and Attitudes Towards Diseases, Genetics Engineering, Prenatal Diagnosis, Patents in Biotechnology, The Human Genome, Gene Therapy and Ethics in Genetics. The first issue also included an editorial about the purposes of the questionnaire, emphasising advantages and disadvantages of these types of surveys, and the generally positive feedback obtained in other countries where the survey was conducted (Macer, 1994).
Surveys No. I to III generated a response of 1070. The majority of answers were from physicians ranging from 30-66 years old being general practitioners with a moderate knowledge of genetic pathology, meaning non-geneticists. About 300 of the answers were from medical students who were provided with photocopies of the surveys. As the Genetics Course is taught in the third year of the medical curriculum covering a total of 6 years, these medical students have a fair knowledge of medical genetics although lacking clinical experience.
Surveys No. IV to VII had a lower feedback response (around 600 answers) as the responses did not include medical students (Genetics is considered as a first trimester course). However, survey No. VIII dedicated to ethical dilemmas in genetics generated 1000 responses meeting concerns expressed by medical associations, communication media and political parties.
Knowledge and attitudes to biotechnology
The least familiar applications that were listed were: pesticides (26% said they knew nothing), gene therapy (31%), computers (34%), genetic engineering (35%), nuclear energy (36%), biotechnology (37%), in vitro fertilization (IVF 39%) and AIDS (41%). These results suggest more conservative answers to personal knowledge than in most countries of the 1993 survey, though the familiarity of Portuguese persons to biotechnology is one of the lowest in Europe as found in the Eurobarometer survey 46.1 conducted in 1996, with 61% of persons in the general public saying that had not heard of biotechnology in the past three months on the media, compared to 45% in the UK (EC, 1997). The figure of 37% not hearing of biotechnology compares to 4% in Japan, and 18% in a sample of Mexican physicians (Casanueva et al. 1998).
When asked whether research in six of these areas was legitimate and then whether they had worries, 45% agreed with IVF and 43% were very worried and 22% a little worried, 80% for computers with 13% very worried, 81% for biotechnology with 21% very worried, 67% for nuclear energy with 37% very worried, 77% with pesticides with 40% very worried and 81% agreed with genetic engineering with 40% very worried. The specific rejection of IVF is similar to Japan (47% agreed in 1993), but Portuguese were more supportive of genetic engineering. It could be also a feature of Catholic countries, given that only 45% of Philippine medical students agreed with IVF in 1993 (Macer, 1994).
A question on cross-species gene transfer to improve lactic nourishment with cereal genes from wheat saw 62% accepting, 15% disagreeing and 24% saying they did not know; while only 4% accepted improving plant-based baby food with genes from an animal, 73% rejecting. The respondents were significantly more enthusaistic about animal gene manipulation than respondents in any other country, with 99% accepting making chicken meat less greasy with an animal gene, and 93% accepting if a human gene was used. When asked if they would have problems about consuming products from GMOs, 73% said they would have no problem with milk products, 22% with meat, 82% with drugs and the product of least concern with 86% having no problem was vegetables. This is similar to the other countries surveyed in 1993.
The acceptance of specific applications of GMOs for environmental release saw 92% accepting increased fish production or bacteria to clean oil spills, 100% approving plants resistant to disease, 83% supporting cows with increased production of milk, 82% supporting meat with less fat and 73% accepting tastier tomatoes. The level of acceptance was higher than other countries, especially the lack of any resistance among respondents to the form of genetic manipulation to make insect resistant crops. Comparisons with Eurobarometer data suggest that this data may be too optimistic, however Portuguese saw the greatest benefit from biotechnology applications of all European countries in 1996 (EC, 1997).
Among the possible products of biotechnology that could be patented, least support was for patenting plant or animal DNA, while human DNA was acceptable for patents by 80% of respondents, but there was little difference given between products, unlike the results in other countries. Most respondents suggested international or national bioethics committees should decide about awarding patents, but only 33% considered this issue should be included in the grounds of work of the national ethics committee.
In survey II respondents ranked a list of diseases in terms of seriousness. Then they were asked if several services should only be provided for the case of mortal or serious diseases, and the percentage whho responded restrictively (yes) was: 0% for prenatal diagnosis, 11% for preimplantation diagnosis, 13% for screening of gamete donors, 74% for screening of carriers and 43% for access to gamete donors. From a list of five options from government, medical association, individual physicians and the person themself, the national bioethics committee was the predominant choice for the responsible body to make decisions on which disease was serious or fatal. The majority considered a 2% risk of genetic disease as a high risk. When asked over who should have access to genetic information that a healthy person is a carrier of a recessive normal gene, 100% denied the employer, 56% denied insurance companies (with 11% accepting), 8% denied the spouse or fiance (with 91% saying yes), and 22% denied other close family (with 60% saying yes). The results for employer were the strongest of any country, with inter-family privacy also regarded highly like USA. Many did not know about insurance companies but none were uncertain in the case of spouse or employer.
Access to prenatal diagnosis was examined, and 82% agreed with prenatal diagnosis being available in medical institutions. 63% said they would personally have an abortion if the fetus had a serious or fatal disease. A variety of cases were offered and up to 25% would recommend an abortion in the case of achondroplasia or anencephaly, while a similar proportion would recommend carrying the fetus to term for Turner’s syndrome, hemophilia or phenylketonuria.
65% of the respondents to survey VII said they were aware of the difference between somatic cell and germ cell manipulation, and they all approved of somatic cell manipulation but only 34% approved of germ cell manipulation. 69% said that gene therapy was acceptable for treating disease.
When given a choice of different cases under which gene therapy was performed, 81% strongly agreed to cure a usually fatal disease, and 19% agreed. 29% strongly agreed to reduce the future risk of developing a fatal disease, 60% agreed and 11% disagreed. 50% strongly agreed to prevent a child from inheriting a generally fatal disease, 30% agreed, 10% disagreed and 10% were unsure. 51% strongly agreed to prevent a child from suffering from diabetes, a non fatal disease, 40% agreed and 9% were unsure. 30% strongly agreed to improve the physical hereditary characteristics in a child, 11% agreed, 50% disagreed and 19% strongly disagreed. 20% agreed to improve the hereditary intelligence in a child, 11% agreed, 50% disagreed and 19% strongly disagreed. 30% agreed to make people more ethical, 30% disagreed and 29% strongly disagreed while 11% were unsure. 52% strongly agreed to prevent AIDS, 11% agreed, 8% disagreed, 9% strongly disagreed and 20% were unsure. The support of enhancement genetics was higher than in Australia, Japan, New Zealand (Macer, 1994), being closer to Mexico (Casanueva et al. 1998), Phillipines or Hong Kong, but still less than Thailand or India (Macer, 1994).
This is a brief report of the survey, which was not a random public mail survey but one based on replies of readers of a medical magazine, and must be considered as a sample of persons more educated than the general public. The results suggest a positive view of biotechnology and genetics in Portugal, consistent with the Eurobarometer survey. Overall most of the responses favoured genetics and genetic engineering applied to agriculture, industry and medicine. There was a high degree of agreement regarding concerns on ethical and moral issues arising from biotechnology approaches to medicine.
The survey displayed consistency of opinions in topics as genetic engineering, prenatal diagnosis, attitudes towards diseases. Disagreements or non approvals concerning gene therapy, progress in the Human Genome Project and eugenics were considered given the professional, social, age, religious and other factors of the participants. There was specific concern expressed about in vitro fertilization, which may be related to Catholic views on that technology. However many other attitudes were similar to the general attitudes to science and technology found in the Asia, Pacific countries of the International Bioethics Survey.
Casanueva, E. et al. “Opinions of Mexican physicians on the use of genetic engineering”, EJAIB 8 (1998), 6-9.
EC, European Commission. The Europeans and Modern Biotechnology. Eurobarometer 46.1 (ECSC-EC-EAEC, Brussels-Luxembourg, 1997).
Macer, DRJ. Bioethics for the People by the People (Eubios Ethics Institute 1994).
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