IRAQ UPDATE; MEDICAL ETHICS

Program 9612
March 19, 1996

Guests

Rolf Ekeus, Chairman, UN special Commission on Iraq

Dr. Erich Loewy, Professor of Bioethics,
University of California-Davis

This text has been professionally transcribed. However, for timely distribution, it has not been edited or proofread against the tape.


IRAQ UPDATE

JEFF MARTIN, producer: This is Common Ground. A program on world affairs and the
people who shape events.

ROLF EKEUS, Chairman, UN Special Commission on Iraq: Combine the number of missiles, even
if four or five missiles, with potential biological warhead to be delivered long range from Iraq,
and we are faced with quite a serious problem.

MARTIN: In this edition of Common Ground the continuing struggle to disarm Iraq.

EKEUS: The United Nations has done what is necessary to lift embargoes. We have a system
of control. But, we still await that Iraq fulfills its part.

MARTIN: And then later, medical ethics and human rights.

EKEUS: Starved people really do not care about their freedom to assemble. It’s one loaf
of bread. But once they have some bread, then life becomes meaningless without these other
freedoms.

MARTIN: Common Ground is produced by the Stanley Foundation. I’m Jeff Martin.

At the end of the gulf war, the United Nations created a special commission to oversee the
dismantling of Iraq’s weapons of mass destruction. Five years later, their work is still not
complete. The man in charge of the operation, Rolf Ekeus, recently spoke with Common
Ground’s
Keith Porter.

KEITH PORTER, host: From the beginning and even through recent days, the government of
Saddam Hussein has been a reluctant partner with the UN Special Commission on Iraq. As a result,
the Security Council maintains strict control over Iraqi oil, preventing any chance for
rebuilding the Iraqi economy. Commission Chairman, Rolf Ekeus, is very clear about his role in
this enduring legacy of the Persian Gulf War.

EKEUS: The special commission is set up by the Security Council to supervise the
identification and elimination of weapons of mass destruction in Iraq, as well as long-range
missiles that are nuclear, chemical, biological, and long-range missiles. That is one task. The
other task is to put up a control system and run that control system in Iraq. To prevent that, it
acquires again these prohibited items.

PORTER: And has no role in the humanitarian efforts in Iraq.

EKEUS: No. It’s limited exclusively to this weapons issue. Obviously, there is an
indirect link. And the most important link, in that respect, is that the cease-fire arrangements
of the gulf war contain a rule that the ongoing oil embargo against Iraq should be lifted when
the weapons provisions have been implemented. So there is a very important and decisive link
between the future economic prospects of the country and the weapons issue.

PORTER: Who makes that determination that that has been fulfilled?

EKEUS: It is the Security Council which will do it. But, the council has already
informally agreed that it is on the basis of the report provided by the commission. At least that
is a necessary prerequisite. They cannot lift the full oil embargo without a positive report from
the council.

PORTER: Let me summarize it. They cannot lift the sanctions without a positive report
from your commission.

EKEUS: No, they cannot.

PORTER: OK.

EKEUS: The other cause is that there may be some dispute, in addition, among the members
if there should be additional conditions. Some members very strongly hold that there should be no
more conditions, that should be enough. And that is how it is written in the resolution. Some,
however, (and I guess the United States is one of them) consider that in addition should look
upon something that is called peaceful intentions of the government of Iraq. And that may be more
of a long shot.

PORTER: Can you give us a status report on how far you feel you are along in fulfilling
your mandate?

EKEUS: Yes. One of the most difficult things have been the chemical and biological
weapons, to some degree. However, the chemical weapons we have identified and destroyed very
large amounts of chemical agents like mustard gas, seren, and so on. We have destroyed thousand,
fifty [thousand], sixty thousand of chemical ammunition. But to our dismay, there is still small
set of chemical weapons of the most advanced types, so called VX nerve agent—which is an agent
which is difficult to keep in shape, but where Iraq, according to our findings, have imported all
the necessary precursors for producing it. We have not accounted for that. Iraq’s explanation is
that they destroyed these items unilaterally, in secrecy, sometime in the summer after the gulf
war. But we have no proof of that. We know they imported it, but we have no proof that they
destroyed it. So that’s point number one.

Point number two is very similar in the biological field. We know that Iraq produced and acquired
biological warfare agents like anthrax first of all, and also prepared missile warheads for use
of such weapons. Again, Iraq states that these acquisitions which they recognize had taken place
have been nullified through unilateral destruction, again in the summer 1991. We have no proof of
that, and we need proof. Otherwise, we cannot give a clean bill of health in that area.

Point number three is long-range missiles. Where Iraq has been working on various projects
including making a homemade type of the Russian Scud, of which they imported large amounts. They
have imported 819 Scuds worth one million dollars a piece. So, you can imagine what kind of
weapons we talk about. We feel that we have accounted for all of them. But we don’t know if there
are additional. And our concern is that Iraq has made some, indigenously, use in bits and pieces,
spare parts from the one imported stocks. So there is still an open problem. If you combine this
number of missiles, even if four or five missiles, with potential biological warhead to be
delivered long range from Iraq, we are faced with quite a serious problem. This problem, I would
say, is the one that is holding up positive reporting.

PORTER: How do you summarize the Iraqi cooperation with your commission?

EKEUS: It is two levels of cooperation. One can say operational level, which is giving us
tolerating physical access to us. I mean that we can enter in the building or fly over any area
in the country. This physical right is very well established. But there is also a deeper level,
the substantial level. That is giving and admitting—giving data and admitting and explaining
activities. Providing us with documentation and providing us with what remains of the material as
I last outlined. There it is still a declared deficiency in Iraq’s cooperation with us. Even if
we in the early month of this 1996 and also late 1995 after the certain dramatic political
development in Iraq, we have seen something that looks like a better trend. The recent movement
toward more openness. So we may, hopefully, in not too distant future report positive cooperation
there also.

PORTER: That’s really what I was going to ask you about next. The stability of the regime
and whether or not it has a positive or negative impact on your work. How do you rate the
stability of the regime, and how do you expect it to affect your work?

EKEUS: I don’t want to express myself, for quite obvious diplomatic reasons, on the
stability. I can say, however, that it is very top, very guided and governed from the top. It is
a considerable discipline. Know what a serious decision of any significance and consequence is
taken without the top person, the president of the country, makes up his mind. So in that sense,
it is a very solid bureaucratic system, which is not that difficult to work with in the sense
that orders are followed. The question is if that leadership is ready to give up these weapons.
If they don’t, as they have so far not done completely, why are they not doing that? Considering
the link between the oil and weapons, the very large amount of money they would lift from the oil
exports, say before the war, something like fifteen billion dollars a year. That’s a lot of money
they lose by not clearing up the weapons. That gives you an understanding how much they value
these weapons. And that means, what kind of weapons? They are most terrifying weapons—biological
and chemical weapons. It appears that the government of the country sees that it is good to have
these capabilities to terrorize and frighten.

PORTER: If the sanctions are lifted, obviously the Iraqis would be able to generate a lot
of money. A considerable amount of money with their oil sales, but they’re not doing it. I
understand what you’re saying about the value then that they must place on whatever it is they
have left, because the option would be to make the money off the oil embargo. Are we saying then
that there are a few steps left before you can report positively and they all depend on Iraqi
cooperation and some transparency, I guess, on the part of the Iraqis?

EKEUS: Absolutely. I think you put it exactly right. From the United Nations side, we are
satisfied with the control system we have in place. As you know, we have a scientist and
specialist permanently stationed in Iraq—chemists, biologists, missiles specialists, nuclear
specialists. We have systematic coverage of all their known, at least, production facilities.
Where we have a monitoring camera, a real time camera monitoring, all major production pieces
that we took, about several thousands, all tagged by us and put into data system. Where we can,
the whole time, trace that these capabilities—advance machines, machine tools, fermenters,
chemical reactors, and so on, that they are used only for peaceful purposes. So that part is, I
would say, the United Nations. We have done what is necessary to lift the embargo. We have a
system of control, but we still await that Iraq fulfills its part. There we are depending
completely, as you said, on Iraq deciding to move with us. I assured Iraqi leadership repeatedly
that we will not on the United Nations side, UNSCOM and IAEA, delay one day. We have to verify
obviously, but we are very alert. We are ready to clarify and give the green light to the
Security Council as soon as Iraq decides to clear it up. But the burden and onus on the delays
lie squarely and completely in the hands of the Iraqi government. So every consequence of
economic hardship they suffer (so to say, they have to) is drawn from the action of the
leadership.

PORTER: That is Rolf Ekeus, Chairman of the UN Special Commission on Iraq. For Common
Ground
, I am Keith Porter.

MARTIN: When Common Ground continues, human rights and ethics from a doctor’s
point of view.

DR. ERICH LOEWY, Professor of Bioethics, University of California-Davis: You cannot have
a successful community unless it nurtures capacities, and even idiosyncratic values, of its
members.

MARTIN: Audio cassettes of Common Ground are available. Listen at the end of the
broadcast for details on ordering. Common Ground is a service of the Stanley Foundation, a
nonprofit, nonpartisan organization that conducts varied programs and activities meant to provoke
thought and encourage dialogue on world affairs.

MEDICAL ETHICS

MARTIN: Human rights activists often debate which is more important, political rights
like free speech or basic necessities like food and shelter. In this interview, Common
Ground’s
Mary Gray Davidson talks with an ethicist who says that the two types of rights need
not compete with each other.

MARY GRAY DAVIDSON, host: Eric Loewy is a medical doctor who uses health care as a model
for surveying the overall condition of society. When he was a boy, Loewy and his family fled
their native Austria just prior to World War II. He finished his education in the United States
and has just taken an endowed chair in bio-ethics at the University of California-Davis. I asked
Dr. Loewy to begin our conversation by giving some examples of how medical ethics can vary from
country to country.

LOEWY: First of all, if you want to talk about individual problems of medical ethics, say
informed consent or involvement of patients in decision making, there are vast cultural
differences. It’s changing. For much of the Mediterranean Basin, especially in the rural area, it
is predominantly the husband who decides for the wife or the family who decides for the patient.
It’s not a decision that perhaps somebody would make in Padoca, Iowa, but the decision somebody
in the Abruzzi of Italy would be comfortable with. There’s stark differences in the way it’s
handled. Medical ethics, for example, is not taught at all in Austria. It’s taught very, very
spottedly and only rudimentarily in Germany. It is taught widely in Holland and Denmark. It is
less wide, but coming up, in France. The way it is taught in Italy is very much controlled by the
church, of course—that’s not really medical ethics. But that has fostered a different set of
problems. In the United States, it’s a predominant problem. It is, in my view, the problem of
social justice—access to medical care. The way individual problems are handled, such as speaking
to patients and informed consent, is certainly “better” [here], if by better you mean
communication. It’s better that patients are more involved in the United States than it would be,
say, in Vienna. On the other hand, when push comes to shove, if I am ill and I have a choice
between an arrogant doctor who doesn’t happen to speak with me at length or no doctor at all, I
will, with a heavy heart, choose an arrogant doctor who doesn’t speak to me. But, it need not
have to be a choice. It’s entirely ludicrous that one should have to choose between these two
systems.

DAVIDSON: Here in the United States, I think we put a great emphasis on what we consider
political rights, rights to freedom of speech. Whereas in other countries in the world, there is
an emphasis on the rights of physical well-being. Where does that fit in to the whole study of
medical ethics?

LOEWY: Very good question. I think political rights are subsequent and not a prior
consideration. Starved people really do not care about their freedom to assemble. They just want
a loaf of bread. But once they have some bread and once their stomach is halfway full, then life
becomes meaningless without these other freedoms. One is not in competition with the other, it’s
the basis of the other.

DAVIDSON: So you kind of look at Maslow’s Hierarchy of Needs and start with the basics of
physical well-being?

LOEWY: Yes. Dewey makes a point in my next book, I’m using it extensively, that you
cannot have political democracy which is a sham unless it is underwritten by a different type of
philosophical underpinning and democratic underpinning. Namely, at least, the cost of democracy,
where I’m willing to listen to you and to respect what you say. Secondly, what he calls
industrial democracy and what I would call economic democracy, in which he says [there is] not
such a disparity of income; where at least all people are assured their basic needs. And thirdly,
educational democracy, where everybody has access to full education, which we do not. My students
are invariably heavily in debt. In other parts of the world, education is free and people are
well educated.

DAVIDSON: Even medical education?

LOEWY: Even medical education. All education. It is said that we can’t afford this. I
don’t know why not, if most other nations on earth in fact do afford this. I don’t know why the
United States cannot. It doesn’t want to afford it. But that’s quite a different issue from not
being able to afford it.

DAVIDSON: In much of your recent work you use the word community, and that’s a word that
could have many meanings. I’d like to turn to that topic right now in your work and ask you to
define what you mean by community.

LOEWY: On the simplest level, a community is an association of people. An individual is a
member of a community. You cannot define cause unless you have a notion of effect, or effect
unless you have a notion of cause. You cannot identify individuals unless you have a notion of
community or community unless you have a notion of individual. They are not in conflict. So you
really have different types, shapes, and constellations of community. Going from the very
smallest group of people, perhaps the family, to [a] larger group of people who are united for
only one particular purpose—making shoes or playing Beethoven’s string quartets, or something of
this sort. They are not particularly dynamic, because they have just one purpose. Then you
develop to larger communities, that you might want to call societies, which have many purposes
and which can only be fulfilled in that community. Part of [whose] purpose is to evolve new
purposes and to evolve new common goals.

DAVIDSON: I was wondering how community fits into your vision of medical ethics?

LOEWY: First of all, hospitals a typical community. And treating a patient nowadays,
which is really a team effort, is a typical community in which not the least of which a patient
is a member. That’s one thing. The other thing is when it comes to allocation schemes, for
example. How do you give away kidneys? How do you decide what goods and services should be made
available to whom? You can have various models. You can, for example, have the physician as
gatekeeper. Which puts physicians into an awful quandary, because actually they ought to be doing
for their particular patients the very best thing that can be done for that individual. They
can’t, at the same time, gatekeep for the community and say, “But we won’t give you that or that
would not be useful because it’s too expensive.” But the community can say, “Here are those
things that we’re going to make available for your further allocation.”

DAVIDSON: Early on you said that the individual is part of the community. Obviously, you
don’t see individualism and community as being mutually exclusive, do you?

LOEWY: No, I see them as homeostatic. You cannot have a successful community unless it
nurtures capacities and even idiosyncratic values of its members.

DAVIDSON: So you don’t need to give up what you prize as an individual to be part of a
community?

LOEWY: You can’t, in fact, if the community is to flourish. Look at the Soviet Union,
which was in many respects an embodiment of community. It allegedly had great value for community
and little value for the individual. It went defunct. Unless you support individual talent and
nurture it, you’re going to have lots of unhappy, miserable, and unfulfilled people. Now look at
the opposite example. Look at a starkly capitalistic nation. Look at the United States,
unfortunately. Lots of unhappy, unfulfilled people, who cannot meet their life plans in spite of
our talk of individualism. Show me what individual aspirations someone living in the ghetto can
have?

DAVIDSON: Being a doctor, what is your prognosis for the international community? What’s
the condition of the international community?

LOEWY: Depends on what preventive measures we take. To me, there are individuals and
there are corporate individuals.

DAVIDSON: Corporate individuals?

LOEWY: Yes. A given society should have the same relation to the world community as an
individual has to that particular society. We have to see that some thing is done about the Third
World nations, if for no other reason because the West has traditionally raped and exploited
them. We need to live in the world together, and we need to equalize and compensate. We have a
big job.

DAVIDSON: Compensate, you say.

LOEWY: Pardon.

DAVIDSON: Did you say compensate?

LOEWY: Yes. We need to hold down, for example, the birth rate. If we don’t do this, all
other ethical problems become almost ridiculous. You’re going to run out of space. Again,
basically that’s a function of poverty and education. The moment poverty is alleviated and
education goes up, the birth rate falls. I see the social problems of the world and especially in
this country. There’s an immediate problem we need to deal with. I realize the importance of
balancing the budget, but in the long term you won’t have a budget left to balance if we have
that many poor and if we increase the number of poor.

DAVIDSON: In one of your works you use the words of the philosopher Primo Levi and you
talk about the “latent infection of otherism,” how you’re able to get one group against another
group. Are we making any strides in overcoming this “infection,” to use the medical term, of
otherism?

LOEWY: It’s going to sound funny. Basically I’m an optimist. The point is that people
have asked me, “You must be schizophrenic, because on the one hand you see these terrible things
happening and on the other hand you seem to be an optimist.”

DAVIDSON: I don’t think you could deal with, or think about, these issues if you didn’t
have some optimism.

LOEWY: That’s number one. But number two, in reality, is that at the beginning of the
century in the United States or Western Europe working single people rarely had a home let alone
an apartment. They rented a bed for eight hours a day. That’s unthinkable today. Fifty-two years
ago in many parts of this world, I would have died. Simply for being…

DAVIDSON: You would have died.

LOEWY: …me. Sure. As I told a German audience who was asked this question.

DAVIDSON: You came from Austria?

LOEWY: Yes. I told the German audience, I was holding a lecture and asked this question
about optimism. I said look, fifty years ago if I or my father had lectured to you we both would
have died. Forty years ago I had virtually no black students and almost no females. Today, though
they are much too few and getting fewer by the way, I do. The point is that right now, like all
progress, it’s not a straight line. It’s a zigzag line. But right now we’re taking a bad dip
downward.

DAVIDSON: For Common Ground, I’m Mary Gray Davidson.

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