Establishment and work of ethics committees in central and eastern European countries.

The genuine reform efforts in medicine and health care in Central and East European (CEE) countries have continued to pose important and thought-provoking challenges to the newly reborn disciplines of medical ethics (or bioethics). They are embodied in the bulk of new ethical problems, concepts and quandaries brought about by the developments, changes, clashes, and "real life" issues of the CEE countries' health care systems and biomedical sciences. Certain part, quite variable from country to country, of this bio-ethical endeavour has been confined to the work and activities of ethics committees (ECs) or similar bodies. They have emerged in varying number, shape, composition, competence, legal status, responsibility and time of appearance, in almost all transition countries of CEE. They may be considered as a kind of "field workplaces" of medical ethics/bioethics within the countries' HCSs or biomedical research structures. Despite some shortcomings and drawbacks, a lot has already been achieved. In some countries the progress has been quick and systematic. The major pitfalls were mostly due to the missing, weak or unclear legal backing of ECs' establishment and work; lack of education and training of their members; insufficient support from health care administrators; misconceptions concerning their mission, procedures, scope of responsibility, and reporting; insufficient or missing funding; low profile societal esteem for ECs' work; but some drawbacks were due also to the underdeveloped 'dialogic' culture of the impartial discussion and democratic discourse in the 'post-totalitarian' CEE transition countries. The future of ECs in CEE will be connected to the countries' integration and harmonization efforts towards research, health systems, and other international structures in Europe and beyond. This should need an extensive and non-discriminatory international partnership, exchange and co-operation.