Commentary on Morioka and Kuhse

- Frank J. Leavitt, Ph.D.

Jakobovits Centre for Jewish Medical Ethics,
Faculty of Health Sciences, Ben Gurion University of the Negev
Beer Sheva, ISRAEL


Eubios Journal of Asian and International Bioethics 5 (1995), 91.
Perhaps we have been stressing Jewish and Christian bioethics a little too strongly in what we hope will be a truly pan-Asian journal. So it was refreshing to see Helga Kuhse's secular viewpoint in the last issue, as well as Masahiro Morioka's discussion of Japanese, including Shinto tradition in this issue.

In my humble opinion, however, Helga Kuhse contradicted herself when she wrote: "religious belief is not a proper basis for the framing of public policy in pluralist and secular societies..." (1). For a pluralist society is by definition one with a plurality of views. So if a society is only secular then it is not pluralistic but a monolithic uniformity where the secular have a monopoly on the right to have their opinions become a "basis for the framing of public policy." This is not pluralism. If a society is truly pluralistic and if religious people are a significant segment of the population, then religious belief will have a full right to fair representation in the debate and in the political manoeuvring which lead to determining a "basis for the framing of public policy." Incidentally there are also people in Israel who want democracy for everyone except those with whom they disagree

Masahiro Morioka's paper in this issue give us a taste of the richness of Japanese culture lying behind the reluctance to allow heart transplants (2). Israel and Japan have a lot in common on many of the issues which Morioka discusses As I noted in an earlier Commentary (3) although heart transplants are legal as well as approved by the Chief Rabbinate in Israel the opposition is quite strong among many religious people. They back up their opinions on reasoned arguments based on clinical data about supposedly "brain dead" patients. They also rely on a definition of death which was formulated by Rabbi Moses Sofer who was a leader of the nineteenth century Jewish community in Hungary. According to Rabbi Sofer someone is dead when he or she is (a) "still as a stone" and there is (b) cessation of breathing and (c) cessation of heartbeat. All three conditions must be present, One or two alone are insufficient. So the many Israelis who still follow Rabbi Sofer's definition are not far from the view of Professor Namihira to which Morioka refers. Jewish tradition also shows great respect for a corpse. The Israeli Army has a special unit whose job it is to identify and reassemble the pieces of each individual for burial after a multiple tragedy. (DNA identification may make this easier in the future.) And at a funeral in Israel the burial team asks the deceased's forgiveness after burial.

We Asian nations have rich traditions which ought not be discarded lightly. And the similarity of some traditions all across Asia suggests there really may be such a thing as an Asian Bioethics. But just as the movement to Westernize Israel is very strong., so Morioka writes of modernization in Japan, the goal of which "is to establish a European-American style of human relationships in medical care."

Personally I have not repented from the "our bioethics" idea, about which Morioka has expressed reservations. I am not afraid of nationalism if it is not imperialistic , if minorities are not oppressed or exploited, if human rights are protected, and if we aim for enlightened tribalism, taking our ancient traditions seriously even though they may be called "primitive" or "superstitious", while being eagerly open minded to learn and respect other peoples' cultures and to participate activity in advancing scientific knowledge. I am proud that in Israel, unlike America and much of Europe, people are not allowed to die just because they have perhaps temporally given up on life. Living Wills have no legal force in Israel at the present time. And I would like to suggest that if you want to die then please don't come to an Israeli hospital because you may find yourself in a situation where the doctors have full authority to save your life whether you like it or not. And many tales are told of patients whose lives were saved against their wills and who thanked the doctors for it afterwards. The serious bioethical work will be to turn these anecdotes into scientific data in a careful study, with proper statistical methods, of people whose lives were saved against their wills. How many of them are now thankful for this? This study, to my knowledge, has not yet been done.

There is also a need for a clear exposition of the present state of Israeli and Japanese law (as well as that in other Asian countries) with respect to coercive treatment. Here in Israel although a physician sometimes has legal power to save a patient's life in spite of the patient's desire to die, the physician does not always have this power. The legal situation is complex. So I shall try to find an Israeli legal expert to write something on this for EJAIB and I hope that others will inform us of the legal situation in their own countries.

References

1. Kuhse H. Voluntary euthanasia: a report from Australia. EJAIB 5 (1995), 66-69 .
2. Morioka M. "Bioethics and Japanese Culture: Brain Death, Patients' Rights, and Cultural Factors", EJAIB 5 (1995), 87-91.
3. Leavitt F.J. EJAIB 5 (1995), 35.


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