pp. 100-102 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.

Discussion on Foundations of Asian Bioethics

Sakamoto: This session is aimed to explore the foundations of Asian bioethics. Thank you to the first speaker is Dr. Chee, and we have some time for discussion.

Pinto: You mentioned genetic screening is performed in Malaysia, is this neonatal screening?

Chee: The techniques are available, but are not compulsory, but voluntary. PKU is done in hospital, other tests are performed if the parents seek them.

Pinto: You mentioned privatization had begun due to the problems in the lack of funding of the public heath scheme. Is the government moving towards a semi-private health care system? In Canada, there is discussion of a fully private system like the USA.

Chee: In Malaysia it is not fully clear, there is a lot of discussion behind closed doors. The government idea is corporization, so that all large hospitals will become corporate entities, and function in that way. The word corporization is used rather than privatization because the ownership still resides with the government. What is unclear is how the hospitals will be managed, and whether communities or local governments can have representatives, it is up to the political environment, and negotiations to determine this.

Verma: You have a multiracial society, a majority Muslims, then Chinese, and some Indians. What are the laws for abortion? I have been involved in thalassemia genetic screening, which is a common disease in your country, and the current strategy is to avoid by aborting an affected fetus. What is the current situation in Malaysia?

Chee: This would not be the official government policy, but I am not sure. Abortions are legal if the continuation of the pregnancy endangers the health of the mother, it can include physical and mental health. Among international abortion laws it is one of the more liberal ones according to Dr Kishore, but it was the result of a very long campaign by womenfs organizations against violence in women. Before 1989 when the current law was introduced, abortions were only allowed if the life of the mother was at stake. However, after the campaign, the law was changed.

Qiu: I would like to know whether Asian values play any role in shaping bioethics in Malaysia, and if they do, in which aspects.

Chee: I am not sure what you mean when you say Asian values? From what I have heard about these values, it is something to do with Confucianism or Islam, and if it is so, in my opinion, these thoughts do not represent all of Asian society. In my paper at the University of Tsukuba, I used some data from women in a low income community, in a Confucian society. I looked at their reproductive decision making, and they voiced some strong values, like abortion is bad or immoral. However, they would go ahead and do it anyway with their own justification. This may be an alternative foundation for bioethics thinking also. Asian society is so diverse, and there are so many groups, ethnic groups and social classes, men and women, so I do not know how we can find Asian values truly representative of everyone.

Sakamoto: Thank you. In relation to Prof. Quifs question, one of the objectives of this session is to try to clarify whether there are any fundamental differences between Euro-American Bioethics and our Asian ways of thinking and living, in a philosophical approach. If possible we will try to find a way to harmonize both bioethics. From that point of view, I ask you one question. Your prime minister always seems to be against fundamental human rights, but in Western standard, if there is some problem of genetics, they always refer to fundamental human rights.

Chee: I would hate to say something different to my prime minister, but perhaps coming from the feminist movement in Malaysia, in our circles, we are saying that womenfs voices have been hidden for so long, and these subterranean voices are different to the voices of philosophers, government, which are in most cases male voices. We should make more effort to listen to the womenfs voices, which are important in the community. Women should have a place within the Asian Bioethics Association.

Sakamoto: The next speaker is Dr Sharma. Thank you, before opening up for discussion, I would like to ask one question. In your abstract, you referred to gimpersonal humanismh, what is this?

Sharma: In Asian societies we are often too emotional, whereas the humanism of the Western person is more inclined to be impersonal.

Sakamoto: Yes, I understand. Any further questions?

I.P. Singh: I was pleased with your paper, but you have painted a bleak picture of Indian society, I wonder if you have any solutions?

Sharma: No, this is just the thought of an analysis, we should not be depressed, but rather we have to think of progress. Why are we the way we are? This has become a focus of national debate for Indians.

I.P. Singh: I agree with your analysis, I wonder whether you have any answers?

Sharma: It takes time to work out the suggestions.

Pinto: I was not sure on how much genetic technology was spread, because I was impressed when attending the American Society for Human Genetics meeting by Indian work in applying genetics.

Sharma: I meant we have too many laws, UNESCO Declaration is expected. The human being will be respected, but there is a possibility that genetic engineering will be extended to humans. I would be against improvement by genetics, I think we can improve ourselves on the basis of culture and education, persuasion and the bioethics movement, rather than manipulation of the genome.

Sakamoto: The next speaker is Dr Manickavel. We have some time for questions.

Pinto: You said that 20% of the students were selected and have a right to free education, and the others have to pay. Is medical education restricted to an elite, or can they obtain loans to pay for their tuition.

Manickavel: The situation is different, because most banks are too small to have extra money to lend. The compromise solution was to select 20% on the basis of exams, and take these with fee exemption. It is better than the previous situation when only financially privileged could attend.

Sakamoto: Our next speaker is Prof. Becker, who will speak in Japanese. Could I ask what is WASP?

Becker: WASP is White Anglo-Saxon Protestant.

Shapiro: Could you please explain more if you are against principles in general. I think there is some hypocrisy and we need to think about the principles, and WASP principalism, but part of the Georgetown mantra is justice. We need to apply it more. Even a casuist does not take decisions on the basis of what his wife said at breakfast that morning. There are going to be principles, and I do not think there is any fundamental disagreement on this. An attack on principles has to be specifically clarified.

Becker: Personally, I am not against principles. However I am not sure that principles that readily translate into all languages of the world exist. We can evolve the languages of Africa or Asia, or elsewhere, so that they become overtime able to translate concepts such as liberty, equality, equal opportunity, non-maleficence, beneficence, etc., whatever you like, even the Georgetown mantra. But many languages lack the words, though this does not mean that they lack the concept in dealing with other people, necessarily. Although some of them may lack the concept as well. In addition, many languages, like Hindi, Japanese, and Korean, make it impossible for two people to be equal. It is necessary for one person to be superior to the other, in order to speak grammatically to the other. It is possible that those grammars can be changed over time, but while the constitution of many countries says we are all equal, it also legislates in the official language of the country, which means we cannot be equal. We have serious theoretical problems here, from previous discussions with you I agree we should seek to move towards principles, but after living in the East for many years I am suspect whether a Japanese or Chinese or African, intuitively resonates to the terms we use.

Leavitt: I was told a few years ago that the Japanese translation of informed consent is ginformed consenth in katakana. It may make your point. What troubles me about your talk, is while I agree with you in being critical of Western ethics, and am also in favour of Asian ideas, but criticism should be fair. I am not sure the criticism is fair. You spoke about feminist ethics and ethics of caring, which has become a big movement in nursing ethics, all over the world. However, most of the people who started the feminist movement were WASPs. What really troubled me was that you said medical schools tend to teach resources should not be squandered on high risk populations. I teach in a medical school in Israel, where if anyone was to teach that students would physically throw them out of the class. I cannot believe that is being taught at a medical school, do you have any evidence of that being taught?

Becker: I want to make it clear that I am compiling many arguments that have been made, not all of these I completely agree with, but should be debated. The evidence about high risk populations, came out of work of Carol Saunders, and others in a book called gPrincipalismh. She said it was taught at her medical school.

Zion: I want to know which East and which West you are talking about, because I have never been to either of them.

Becker: Thank you, the point is well taken. There is no such thing as a West or an East, and it is too simplistic to use these terms. I do however, think that we can find people among us who represent an enlightenment tradition who say gWe know the truth and we have to bring it to the rest of the worldh.

Zion: By dissolving all the different narratives together, you are making an idea of a Western paradigm for us to engage with, of rather egotistic or selfish autocratic people, but you seem to be doing exactly what you are arguing against. There are many narratives, especially in the twentieth century with the rise of migration, which would seem to solve your problem.

Becker: You are quite right, thank you.

Asada: Though you talk about WASP, and I agree with some of your thoughts, within countries we can also see differences. People think of the North South problem, but there is the same structure within a country and a community. The smallest picture is within a family. Although you talked about Japanese, that we cannot talk between two persons as equals, but I am not sure. If I started to talk to you in Japanese, I have to use a polite sense because you are a Professor and I am a student. But among teachers, students or family it is possible to use the equal argument.

Becker: I think you represent the new Japanese. The idea that Japanese cannot be equal is not my idea, it a famous linguist who said those who can think they are equal to the other person have not mastered Japanese. You are of a different generation. My paper did what it intended too, to provoke discussion. I do not believe it all, and it is not intended as complete, but if you start to think about these issues then I am happy.

Sakamoto: The discussion is very exciting, but we have to stop, and proceed to the next speaker. I will change the chairperson.

Song: We are twenty minutes behind schedule, so please keep the time. I am sorry we do not have time for discussion. The speakers this afternoon are Dr Dua, Dr Doering, Dr De, Dr Kishore and Dr Ratanakul. We may have a few questions.

Miyasaka: Can you please explain why are IVF techniques unacceptable from Buddhist perspectives?

Ratanakul: As I understand, the technique involves disregard of the unused embryo, because the embryo or fetus is a human being.

Miyasaka: This may be for a fertilized egg. What about somatic cells?

Ratanakul: For a Buddhist life begins at fertilization.

Miyasaka: So you can kill somatic cells, like on the finger.

Ratanakul: The ethics also depends on the size of the fetus as well.

Song: We have to conclude this session, thank you to all the speakers and audience.


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