Australia and New Zealand are new countries with a mixed population of mainly Europeans, and some Asians, combined with indigenous peoples, the Maori in New Zealand and the Aborigines in Australia, and other more recent immigrants. The living standards in both countries are relatively high in the world, and both have experienced economic recession in recent years. The population of New Zealand is 3.5 million, and Australia 17 million. About 10% of New Zealand claim some Maori blood, and there are 265,000 Aborigines in Australia. The aborigines have significantly higher mortality rates than the general population.
Both countries have economies based on agriculture, and are beginning to utilise new genetic techniques, like genetic engineering to improve crops and livestock. In recent years the economies have been aided by tourism, with the largest group of tourists being from Japan, making comparisons with Japanese and Asian attitudes interesting.
New Zealand (NZ) was the world's first so-called welfare state until the last few years, when it has changed to a user-pays idea, and has become the first "post-welfare state". A current trend of reducing costs is challenging the philosophy where the whole community accepts responsibility for accidents, of genes or disease, which inevitably afflict a proportion of its members, changing it to a philosophy which says users will pay if they can. Special benefit cards for low earners allow some access to health care, though they may have to wait for long periods - establishing a two-tiered health system, with those who can pay having immediate access to health care - arguably the quality of both public and private medicine is similarly high. Australia is going through many of the same issues, and these are also major bioethical questions, though not directly addressed in this survey.
Public questionnaires were distributed by hand into letter boxes chosen at random in different areas of NZ and Australia, by driving around the countryside and selecting random streets and delivering into every second letterbox. Farming areas were also selected, and 23% in NZ and 29% in Australia were from rural areas. In NZ the South Island was well covered throughout, whereas most of the North Island samples were from areas around Wellington or Auckland. In Australia, there were replies from all states, but most questionnaires were delivered in New South Wales, Queensland, and Victoria. Mail response using enclosed stamped and addressed envelopes was requested. The public response rate was 22% in NZ (N=329) (the same as in Japan), but was only 14% in Australia (N=201), the lowest of any country, suggesting a difference in aptitude of response to questionnaires. The age, sex, marital status, and number of children of the public sample were mixed and representative of the population, therefore the results allow extrapolation to general views, with an uncertainty of about 5%.
Student samples were chosen in NZ with the cooperation of Prof. D. Gareth Jones, Otago University Medical School, among mainly 2nd - 3rd year medical students (N=96), and in Australia with the cooperation of Prof. Peter Singer, Monash University among the 1st year medical students (N=110). Their kind assistance is appreciated. The students were asked to take the questionnaires home, and 60-70% returned completed questionnaires. The medical students were younger, and single, and from more urban areas.
In both countries about 70% of the public said they were Christian, and 41-49% of the students. The New Zealanders were rather more religious than the Australian sample. About 90% of the public were of European descent in both countries.
Some of the questions about biotechnology have been asked before in NZ in a survey arranged by the DSIR in 1990 (Couchman & Fink-Jensen, 1990), which allows comparison. However, that survey used interviews. Interviews allow a high response rate, but do not allow long answers to open questions, a feature of the International Bioethics Survey. 130 New Zealanders and 70 Australians requested summaries.
All samples in all countries valued the contribution of science and technology to life, with 94% (A) and 95% (NZ) agreeing that "Science makes an important contribution to the quality of life". 52% (NZ) and 55% (A) agreed that "Most problems can be solved by applying more and better technology", and 27% and 23% disagreed. They were generally interested in science, with only 3% (A) and 7% (NZ) saying they were not interested.
The views of the NZ students and public were the same for these questions, which is interesting. The perception that science contributes to the quality of life in the NZ public sample was higher compared to the 1990 values (Couchman & Fink-Jensen, 1990), however, the number of people who said it did not contribute was similarly small in both samples.
The responses to the question "Overall do you think science and technology do more harm than good, more good than harm, or about the same of each?" were positive with Australians being the most positive of all countries, with 4% saying "more harm" (5% in NZ); 66% saying "more good" (57% in NZ); 27% saying "the same" (34% in NZ), and 3% saying "don't know" (5% in NZ). Australians seem to have a somewhat more positive outlook compared to a 1989 survey in which 10% said "more harm". Among other countries, the UK has the most negative view, and China the most positive. Indians had a similar view to New Zealanders, and Thai and Japanese were less positive with 45% saying "the same", similar to Russians.
A series of questions looking at the awareness of specific areas of technology, and the perceptions of benefit and risks and open questions on the reasoning was more revealing. The most unfamiliar terms were biotechnology, 23% (NZ) and 19% (A) said they had not heard of it, and gene therapy, 26% (NZ) and 23% (A) had not heard of it. The awareness of biotechnology, genetic engineering and in vitro fertilisation in NZ is higher in 1993 compared to 1990. Genetic engineering was least familiar among the other areas, with pesticides, in vitro fertilisation, computers and nuclear power being most familiar.
In NZ it is striking that despite the high interest in science, the sample were significantly less positive about the developments that had been asked in 1990, as was also true in Japan. This may be due to being asked to give a reason for why the development was worthwhile. In response to the question "Do you personally believe these areas of science and technology are a worthwhile area for scientific research?", 85% (NZ) and 90% (A) were positive about computers, and all countries were over 85% support. In response to the question, "Do you have any worries about the impact of research or applications of each development?", about half said they had no worries about computers, with another 22% (A) and 28% (NZ) saying they had a few. Very few had a lot of worries. The worries were mainly unemployment. The main benefit seen was doing things faster or more efficiently.
63% (NZ) and 65% (A) were positive about in vitro fertilisation (IVF). The main reasons given for agreement were that it helps infertile couples (about 35% in both countries said so), and 7% (A) and 11% (NZ) said it was not worthwhile because it was unnatural or playing God, while 6% (NZ) and 14% (A) said it was not needed. In another question, 55% (NZ) and 58% (A) approved of surrogacy using IVF, with 28-29% against.
Thai people were more positive about IVF, than Russians, than Australasians, with 57% of Indians, and 47% of Japanese agreeing. Students in all countries were somewhat more positive, but students in the Philippines were equally divided for and against, and were opposed to surrogacy.
62% (NZ) and 69% (A) saw pesticides as worthwhile, similar to Israel and Thailand, and less than in India and in Japan. The most negative samples were in Russia and the Philippines. In NZ and Australia 16% and 19%, respectively, had no worries, and 27% and 33%, respectively, had a lot of worry. There were slightly more environmental concerns than health worries.
46% (NZ) and 59% (A) saw biotechnology as worthwhile, less than 72-75% in Israel, Russia, Japan and India; and about 90% in Thailand. About one third of all samples had no worries, one third had a few worries, and the rest had some or a lot. Interestingly, although Australians were more positive about biotechnology, they also had more worries, with 17% having a lot of worries, compared to 10% in NZ. About a half did not say any benefit, and there was a variety of benefits given, with general hopes for humanity being the major reason. Only 2-5% saw it as unnatural, the major worry being human misuse (13-14%).
The attitudes to genetic engineering were also different between the two countries, with 41% (NZ) and 62% (A) seeing it as worthwhile, and 39% (NZ) and 34% (A) having a lot of worries. 13-14% in NZ gave reasons that it was unnatural or playing God, compared to 9% in Australia, in both the benefit and risk question. However, as we will see later, people were more positive about specific examples.
They were most negative towards nuclear power (Q7), with 47% (NZ) and 54% (A) seeing it as worthwhile and 43% (NZ) and 30% (A) disagreeing. Only 12% (NZ) and 16% (A) did not have any worries, and 53% (NZ) and 48% (A) had a lot of worries. There was similarly high levels of worry in Russia and Israel, but less concern in Japan and India - though it was still significantly more feared in all samples.
Q29 found the highest trust among the 8 groups to be in medical doctors; followed by university professors in both countries. The least trust was shown in companies, government, and farmers were also not well trusted. Environmental groups, dietitians and consumer agencies formed a middle group. Students were even more trusting of medical doctors and university professors, but similar to the public for others.
Q30 on the approval of copyrights or patents on different materials found 90+% approval of patents for inventions in general, 80-82% approval for books, but 60% approval for a cure for AIDS. 63% (NZ) and 55% (A) approved of patents or copyright for new plant varieties, 48% (NZ) and 45% (A) for new animal breeds, 31% (NZ) and 38% (A) for genetic material from plants or animals and 23% (NZ) and 31% (A) for human genetic material. Students were similar. Japan was intermediate, but other countries showed less discretion between the subject matter.
There was strong agreement, 80% (NZ) and 73% (A) with the statement that the natural environment has a valuable property that humans should not tamper with (Q1c), and 72% (NZ) and 69% (A) supported the animal rights statement (Q1i). These values were less then most countries, but when it came to the questions on practical aspects of environmental concern both NZ and Australia were among the highest values. 94% said they had saved energy (more than in Europe; though this could also be for economic reasons); 82% (NZ) and 85% (A) said they had sorted out household waste for recycling (similar to Europeans); 63% (NZ) and 70% (A) said they had stopped buying a product because of environmental concerns; 60% (NZ) and 54% (A) said they had contributed money to an environmental cause; and 48% (NZ) and 61% (A) said that they had changed their lifestyle in significant ways to protect the environment.
The question on nature (Q15) followed several questions on genetic engineering, so it is not surprising that 38% (NZ) and 37% (A), included a comment that nature is something that should not be touched by human beings. The next most common idea, 25% (NZ) and 32% (A) gave, was the idea of harmony, or they gave different words describing various features of nature. 12-13% included scenery, 9-10% included forests; 9-10% including living organisms; 9% ecological problems; and 7% God. Other ideas were less common; and the full range was rather similar in different countries. 6% (NZ) and 9% (A) used pictures to answer the question, with students in all countries using more pictures than the public.
In the introduction I said a simple definition of bioethics is "love of life". Love includes the concept of doing good for others, and avoiding harm, as well as respect for other life - all the basics of bioethics. The question on the images of life came at the end of the questionnaire, and there were several common reasons, reflecting the wide use of the word "life" in English. 13% (NZ) and 20% (A) mentioned ideas of life and death; 13% (NZ) and 15% (A) mentioned health; 14% (NZ) and 16% (A) included ideas of enjoying it; 15% (NZ) and 9% (A) said it was precious or should be saved; 11% (NZ) and 20% (A) mentioned living things or animals; 10% (NZ) and 7% (A) mentioned God; 8% mentioned babies or baby plants or chicks hatching from eggs; and a variety of other comments were made. Only 4% used pictures to answer these questions. The question is difficult but the answers revealing, and the best way to look at the results is to read the comments in the book.
The specific questions on genetic engineering (Q9-12) found in both countries 56% accepted plant-plant gene transfer and 29% (NZ) and 40% (A) accepted animal-animal gene transfer, while 19% (NZ) and 23% (A) accepted animal-plant and 10% (NZ) and 16% (A) human-animal gene transfer. A high proportion gave reasons supporting these applications in their open comments, and the most common reason against them was that they were "unnatural", as in the other countries. The values were rather similar to those from the USA. The values in Australia were the same as India, whereas Japanese were more negative than New Zealanders. The students were more supportive in all countries.
80% (NZ) and 78% (A) of the public were aware that genetically modified organisms were being used to produce foodstuffs. In 1990 75% of New Zealanders had heard of them, so the level may have increased a little. Four products were given as examples and the highest degree of concern was seen with meat, followed by dairy products and vegetables, with medicines having the least concern. New Zealanders expressed more concern than Australians, though among teachers they had less concern, and biology teachers less concern than social studies teachers. A range of reasoning was given, both for and against the use of these foods. The most common reason (18-20% in NZ and 14-16% in Australia) for concern about the foods was that they were unnatural, while about 11% in both samples for each product considered that the safety measures should be adequate.
There was strong support for the specific examples of environmental release of genetically modified organisms. The highest level of support was seen for bacteria to clean oil spills and disease resistant crops, with over half supporting tasty tomatoes or meat with less fat. There was less support for making milk from cows, which may be because we ask whether we really need more milk, and least support for the sports fish.
In the general case of abortion 38% (NZ & A) approved and 45% (NZ) and 39% (A) disapproved. Teachers and students were somewhat less willing. In the case of "a 4 month old fetus that has congenital abnormalities", 69% (NZ) and 72% (A) approved, and 18% (NZ) and 14% (A) disapproved. Students and Australian teachers were somewhat less willing, but NZ teachers were similar to the public. There was 79% (NZ) and 82% (A) support for making prenatal genetic screening available under government funded medicine. Only 12% (NZ) and 8% (A) rejected this, and these attitudes were similar in the other countries of the survey, and the USA. 66% (NZ) and 73% (A) said that they would personally use it, and 18% (NZ) and 15% (A) said that they would not.
In the general question on government funding of prenatal genetic tests, 17% (NZ) and 21% (A) included the comment "health care is a right", or "should be available to all". This was similar in Japan, India and Israel, but less in Russia or Thailand said so. 13% (NZ & A) gave economic reasons given like it would "save the country's health care system money". In Japan only 1% gave economic reasons, and it may be that the economic recession in NZ and Australia has forced people to think in terms of saving money - it is also true that if taxes are high people have had to face the fact that taxes are redistribution of wealth according to the ethical principle of justice. Most other reasons were also given for the personal use of genetic screening, and more people say "don't know" or "it depends on the case", than in the general question. 17% (NZ), 23% (A) and similar proportions in Japan, India and Israel, said the testing would help the family or parents, and other reasons included a desire to know, the quality of life of the child-to-be, and saving the life of the fetus. Only 1-2% in Japan said the fetus had a right to life; 3-4% in Australia and 4-8% in NZ. There were very few fears of eugenics expressed.
Australian respondents appear to be slightly more positive about prenatal genetic screening and more willing to abort fetuses with congenital abnormalities than New Zealanders, Japanese or North Americans. There was not really a statistically significant difference, however. This question is rather independent of sample education, and there is no difference in Japan between public and academics as seen in the data from my survey in 1991 (Macer, 1992). In the Philippines there was support for genetic screening, but rejection of abortion, but in most countries there was not significant religious difference in attitude. 47% (NZ) and 44% (A) said that they knew someone with a genetic disease, but only 30% (NZ) and 39% (A) said that they knew someone with a mental disease, significantly less than the 68% of Japanese respondents who said they knew someone with a genetic disease (the highest among the countries) and the 59% who knew someone with a mental disease. This trend was also seen in medical students.
The responses to questions about privacy (Q21 and Q23) were similar to those in the USA and Russia, with Chinese, Japanese, Philippines and Thai tending to agree to share more with the family, while Indians were against it. In Australasia, 95-96% thought that the spouse deserved to know both about genes and 98% about HIV; and 74% thought that the immediate family deserved to know about genes and 77-81% about HIV. The trend to regard HIV as more serious (as it can present danger to others, unlike most genetic diseases), is seen even more in the responses to insurers and employers. 39% (NZ & A) agreed that an insurer deserved to know about genetic disease, while 57-58% thought so for HIV.
The attitudes to people with genetic and mental diseases were generally similar, among the sympathetic countries. The highest level of rejection was seen for persons with HIV, another common comment being that it depends on how they got it. Combined, 18% (NZ) and 25% (A) thought so, the greatest degree of rejection among the public samples.
There was strong support in another question about gene therapy, with 72% (NZ) and 77% (A) willing to undergo it themselves (Q26), and 82% (NZ & A) willing for their children to undergo gene therapy to cure a usually fatal disease (Q27). The results are the same as in the USA, India, Israel, and Japan. Thai people were just as willing for children, but less willing (59%) for themselves, and Russians were the most undecided with one third saying they don't know.
33-44% of the respondents wrote a comment saying that they wanted to save their life or their child's life as a reason for gene therapy, the most common reason. Very few said they wanted to improve their genes, but 13-15% said they wanted to improve their quality of life, and 19-23% said that they wanted to improve the quality of their child's life. Less than 1% were afraid of eugenics, and 5% (NZ) and 7% (A) said they thought it was unnatural or playing God, for themselves, but only 2% (NZ) and 5% (A) did so for children. 8% (NZ) and 10% (A) were afraid of bad health for themselves, and 4% (NZ) and 8% (A) for their children. The comments were generally similar to other samples.
The attitudes of New Zealanders and Australians were very similar, as could be expected. It was interesting why the response rate of the Australian public and high school teachers (see the later paper) was significantly lower than the New Zealanders, and other countries in the survey.
The people were all supportive of science and technology in general, and appeared to balance benefit and risk quite well, showing discretion over the use of genetic engineering for enhancement, and realistic reasoning in responses to questions. They had relatively high levels of concern about the environment, and especially in the practical measures of changed lifestyle. The images of life and nature were diverse as in other countries.
Bioethics is familiar in both countries, both as a specific term, and in the high profile of environmental groups for a number of years. The medical systems are advanced, and social welfare has a long history, which may have instilled some sense of ethics into the cultures. They are facing economic cutbacks and restructuring, and efforts to do this in an ethical way. For example, a New Zealand National Advisory Committee on Core Health and Disability Services released a discussion document in 1993 to look at the distribution of health care. It asked the public the questions: "What are the benefits?", "Is it value for money?", "Is it fair?", and "Is it consistent with the community's values and priorities?". The answers to these questions will affect the future social consequences of genetic testing. They have said, they will not make a list of certain conditions that receive public support and others which do not, as in the priority lists of Oregon in the USA. Australia also has a national bioethics committee, in addition to a range of bioethics centres around the country.
Among the life comments a number of people wrote something about euthanasia, this is another ethical issue that needs to be faced. Opinion surveys suggest that there is growing support, but this issue was not addressed in this survey. The future looks relatively encouraging given the results of the education survey (Macer et al., p. 177), with many classes already having discussion of these issues - something which is important to develop the decision making ability of the population. One of the main problems facing Australian health care is the dramatic contrast between Aboriginal health and other Australians. The statistical measures, such as infant mortality rate have not improved for two decades, despite efforts to improve it. Despite the advanced state of medical technology in the region, from organ transplantation to reproductive technologies, there are some basic problems that need to be fixed.
I wish to thank Mrs Olwyn Bannister, Mrs Jenny Gordon, Ms Joanna Hammonds, Mrs Eileen Macer, Mrs Nobuko Macer, Mr Jack Macer, Dr Tania Prvan, Mrs Betty Rawlings, Mr Doug Rawlings, Ms Rosemary Rawlings, Mrs Yolande Rich, Mr Ron Rich, Mrs Chie Yasuhara and Mr Susumu Yasuhara for help with the distribution of public surveys, and Prof. D. Gareth Jones and Prof. Peter Singer for distribution of medical school surveys. I also thank Shiro Akiyama, Yukiko Asada, Yuko Kato, Minako Teramoto, Miho Tsuzuki, Keiko Wakao, and Mihoko Yamanishi for assistance with the preparation of the surveys.
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