ACTIVITIES OF INTERNATIONAL ORGANIZATIONS IN THE DEVELOPMENT AND IMPLEMENTATION OF UNIVERSAL BIOETHICAL PRINCIPLES IN HEALTH

Bioethical principles are considered in the prism of the UNESCO Universal Declaration on Bioethics and Human rights in the paper. Analyzing the modern activities of global organizations, the author comes to the conclusion about the internationalization of principles as a tool in shaping the activities of international structures such as UNESCO, the EU, etc. Considering the similarities and differences in profile structures, the author comes to the conclusion about the significance of the universal bioethical principles of UNESCO from the point of view of unification of health care systems around the world.

The development of health policy is a dynamic process, and there are no uniform standards for its formation. National health systems are formed depending on socio-economic, political, and other conditions. However, the development and implementation of universal bioethical principles in national public health systems is a kind of connecting link in the joint work of international structures and states in this area.

UNESCO
UNESCO is one of the key international organizations that took on the role of promoter of bioethics by adopting the Universal Declaration on Bioethics and Human rights [1]. That declaration internationalized bioethical principles, significantly expanding their scope, and going beyond medicine. With the adoption of the declaration, UNESCO has become a platform that allows creating conditions for international dialogue in this field.
Although bioethical principles are declarative in nature, they have become a kind of unified guide for the development of countries not only in the field of biomedicine and healthcare but also in science. That is, if the role of the UN is to create space and conditions for cooperation in the field of bioethics, then UNESCO is precisely the basis for the development and subsequent implementation of bioethical principles at the international level. UNESCO has prepared the Bioethics Core Curriculum, which was further used as a guide to educational activities. Many institutions have used the curriculum as a textbook during the courses in the field of bioethics. Thus, the program of the course on Bioethics and Medical law for Law school students in Azerbaijan was developed precisely on the basis of the curriculum [2; 1].
The establishment of the UNESCO Chair in Bioethics at the University of Haifa in Israel in 2001 became an important tool of UNESCO in the development of bioethics [3]. The International Network of UNESCO Chairs in Bioethics allows coordinating the cooperation of scientists and monitoring the implementation of the goals set for the dissemination and introduction of ethical principles into everyday practice.
Assistance in the establishment of national bioethics committees is provided by UNESCO through the Assisting Bioethics Committees Program. National bioethics/ethics committees cover areas of health sciences, innovative health policies that are developed through global meetings and exchanges, etc. UNESCO provides member countries with the necessary scientific and technical base for the development of ethical standards of bioethics at the national level.
The International Bioethics Committee (IBC) and Intergovernmental Bioethics Committee (IGBC) -UNESCO structures -were involved in the processes taking place against the background of the coronavirus pandemic by preparing recommendations. Thus, in 2020, the IBC and COMEST issued a joint statement on the «ethical aspects» of the pandemic, which emphasized the dependence between states, for example, in the distribution of funds such as ventilators [4], etc. The very first paragraph of the document concerned national and international health policies, and it contained a call for their formulation, «based on global ethical considerations». In February 2021, COMEST (Commission on the Ethics of Scientific Knowledge and Technology) and the IBC also issued a joint statement calling on countries for «equality and solidarity» on vaccination and other issues amid the pandemic, such as recognizing the vulnerability of people during such periods [5], etc. Obviously, even in the documents of a bioethical nature in the field of healthcare, there is often a call for political decisions, actions, without which the implementation of recommendations is impossible.
In general, thanks to the activities of UNESCO, local and national committees on bioethics are created and function. There are ethics and bioethics committees in the Russian Federation, the EU countries, etc. Thus, UNESCO provided active support to the creation of the National Bioethics Committee in the Republic of Belarus in 2006. The main activities of the structure, among other things, indicate the development of a policy for the «bioethical development of the republic» and the promotion of research activities in the field of healthcare.

The WHO
The WHO is the second key international instrument for disseminating bioethical values. As an organization dealing directly with medicine and other health issues, it promotes the implementation of bioethical principles through the preparation of practical recommendations, guidelines, various reports, and the collection of statistical data. WHO monitors the performance of national health systems through interaction with ministries of health.
WHO also has its bioethics network. Thus, within the framework of WHO in 2009, the Global Network of WHO Collaborating Centers for Bioethics was established [6], which ensures the international activities of the organization in this direction. Through this network, WHO also provides bioethical education at the national level. The Network holds biennial summits to ensure the exchange of information and experiences on ethical health issues. WHO is working with the Global Network to expand its capacity to integrate bioethical principles into national health systems. Although the standards set by the WHO, as a rule, are advisory in nature, their role is extremely high. It is by how widely the internationally accepted norms are implemented in the national legislation that one can judge the level of development of the country's healthcare.
With the support of WHO, the Strategic Initiative for Developing Capacity in Ethical Review (SIDCER) is functioning, which provides capacity development in the field of ethics of biomedical research at the national level. The regional partner forums of ethics committees operating under the initiative include the CIS. Thus, the Forum for Ethics Committees in the Confederation of Independent States (FECCIS), together with the Inter-Parliamentary Assembly of the CIS Member States (IPA CIS), developed and adopted in 2005 a model law «On the protection of the rights and dignity human in biomedical research in the CIS member states» [7]. This law pointed to the need to harmonize the legislation of the member countries, including in the field of biomedical research.
An example of cooperation between UNESCO and WHO is the Council of International Organizations for Medical Research (CIOMS). This international non-governmental non-profit structure, created jointly by two organizations in 1949, has designated the improvement of public health through the preparation of recommendations and guidelines for the development of research in this area as the main direction of its activity.

Council of Europe and European Union
Organizations of regional nature that pay significant attention to the development of bioethics are the European Union (EU) and the Council of Europe (CoE). Within the framework of these organizations, norms/recommendations, sometimes legally binding, are developed for compliance by European countries.
The European region is of exceptional importance in the context of the development of bioethics, since the Nuremberg Tribunal resulted in the development of a code that affirms the importance of legally securing the rights of research participants. Subsequently, the Helsinki Declaration adopted by the World Medical Association (on the ethical principles of human experiments, 1964), together with the Nuremberg Code, laid the foundations for the future development of the universal principles that were adopted by UNESCO.
Moreover, long before UNESCO, back in 1985, bioethics became one of the activities of the Council of Europe, when the Ad hoc Committee of Experts on Bioethics (CAHBI) was established [8]. Since 2012, it has been functioning as the Committee on Bioethics (DH-BIO), providing intergovernmental contacts on the protection of human rights in the field of biomedicine. The most important legally binding document in the field of bioethics within the framework of the CoE is the «Convention on Human Rights and Biomedicine» [9]. The Council of Europe has become an influential platform for the implementation of bioethical principles in the healthcare systems of European countries. Thus, within its framework, ethical education HELP courses -the program «Education in the field of human rights for representatives of the legal professions» are conducted [10]. As part of HELP, specialists get acquainted with the principles of bioethics and the legal aspects of their observance. For example, in Ukraine the program was launched as part of the annual advanced training courses for prosecutors on matters of international cooperation.
Although the Council of Europe mainly carries out activities on lawmaking, the development of recommendations, as well as holding conferences, etc., in the context of bioethics, it also carries out significant educational work. Moreover, National Ethics Committee Forum functions within the framework of CoE in order to promote cooperation between national ethics committees, exchange of experience, etc.
Health law is a significant layer of European legislation. Foremost, in the EU, the development of bioethical principles is considered in the context of the ethical conduct of biomedical research. It was within the framework of the European Commission that back in 1990 a project called the Biomedical and Medical Research of the European Union (BIOMED I) was adopted and funded that explores ethical principles in bioethics and relevant legislation in Europe [11]. The development of coordinated research in the field of prevention, care and health systems was one of the main areas of the project, which was carried out in two phases up to 1998. Analyzing the project, J.D. Rendtorf concluded that one of the most important results of the study was the adoption of the Barcelona Declaration as a unique «philosophical-political» agreement between experts in the field of bioethics and law [12]. Thus, in the EU, long before the adoption of the 2005 UNESCO Bioethics Declaration, started to harmonize ethical standards in relation to medicine, bioethics and law among member countries. EU policy currently does not provide for the development of a single law on bioethics. However, within the EU, dozens of legal documents have been adopted that address various issues closely related to bioethics, such as the «Charter of the European Union on Human Rights», adopted in 2000.
Another significant structure in the field of bioethics is the European Network of Research Ethics Committees (EUREC). This structure is sponsored by the European Union and brings together national associations in the field of research ethics, the Forum of National Ethics Committees and other bodies that are part of the system of ethical review of the European Commission, etc. This structure is involved in the development of unified solutions to problems arising from the emergence of new technologies, in the development of science and research in the field of bioethics, etc.
The President of the European Commission chairs an independent advisory body, the European Group on Ethics in Science and New Technologies (EGE), established in 1991, which helps to provide a scientific basis for EU policy development, including on bioethics. The group prepares various reports, identifying the most significant problems and presents recommendations, including those of a political nature.
The structure that closely interacts with the EU in matters of bioethics is the Commission of Bishops' Conferences of the European Union (COMECE). The main task of this organization is to monitor political processes within the EU and prepare its recommendations reflecting the position of the Catholic Church on various issues, establishing a dialogue with both politicians and various EU institutions. Although the commission supports the development of science, it warns of the importance of observing ethical principles. Numerous recommendations prepared by the Commission allow the development of bioethical principles and their wider implementation in EU policy and legislation.
Thus, both the CoE and the EU are structures of a regional character. However, since European countries tend to harmonize their legislation, this allows the implementation of bioethical principles at the national level.

Conclusion
In terms of global impact, both UNESCO and WHO, which are UN agencies, have the greatest resources for the development of bioethics. In this context, both organizations have an international character and their activities allow creating a platform for dialogue and interaction between specialists in the field of bioethics. However, since UNESCO is an organization of a scientific nature, the development of bioethics within its framework is more focused on the development of ethics in biomedical research, the importance of bioethics in the development of science in general. The activities of the WHO are more focused on the application of bioethical principles in the development of medicine and the healthcare system in practice, ensuring equal access for all to the benefits of medical science. WHO has a wider range of interaction with national health systems, with its offices in certain regions. WHO specialists have more extensive statistics on the problems of individual countries' health systems and are developing ways to address them in the form of recommendations and other documents. UNESCO, in turn, is more focused on solving the issues of potential danger to humanity, which can be generated by research conducted not in accordance with bioethical principles, new challenges of scientific and technological progress and the search for their ethical regulation. Thus, WHO is more concerned with finding a bioethical solution to the problems that arise in health systems, and UNESCO is more concerned with theoretical research into possible problems in the course of scientific development. But both organizations define the protection of human rights as the main goal of their actions.
Summarizing, we can conclude that WHO protects human rights to health, to equal access to scientific achievements in the field of medicine, while UNESCO protects human rights as a subject of biomedical research. UNESCO develops bioethics at the global level, while WHO is interested in identifying problems in individual countries and providing assistance to improve healthcare of low-income states. In terms of structuring, both organizations have their own specialized networks. If in UNESCO it is the International Network of UNESCO Chairs in Bioethics, in WHO it is the Global Network of WHO Collaborating Centers in Bioethics.