pp. 203-209 in Intractable Neurological Disorders, Human Genome Research and Society.

Proceedings of the Third International Bioethics Seminar in Fukui, 19-21 November, 1993.

Editors: Norio Fujiki, M.D. & Darryl R.J. Macer, Ph.D.


Copyright 1994, Eubios Ethics Institute All commercial rights reserved. This publication may be reproduced for limited educational or academic use, however please enquire with Eubios Ethics Institute.

Attitudes to diseases and therapy in Japan, Asia and the Pacific

Darryl Macer & Yuko Kato*
Institute of Biological Sciences, University of Tsukuba, Japan

Tables are being formatted, and will soon be on-line. *The results presented here come from the joint results and papers of Angeles T. Alora, Jayapaul Azariah, Hilda Azariah, Prasert Chatwachirawong, Ong Chin Choon, Vijay Kaushik, Frank Leavitt, Peerasak Srivines (in Ref. 2).


International society is facing many policy choices for the adoption of new medical, and especially genetic, technology. In every country individual's are facing personal choices in the use of genetic tests, and in the use of new medical therapy. Social interactions depend on individual values that people have, and in medical questions it is the values of disease and health that are most important. However, attitudes to disease also affect the education of different groups of society, and employment of people. People with genetic diseases and neurological diseases face discrimination in every society, which adds to the burden of their disease. If people are labelled handicapped or diseased, it can affect their life in many ways. There are also many questions about the future consequences that the genetic revolution will bring.

Bioethics is the study of decision-making in questions of life. Balancing the ideals of: "do good" and "do no harm" and respecting both "autonomy" and "justice". Do individual people and families in Japan, or other countries, actually make decisions by balancing these ideas, and do so differently? We need to look at the degree of similarity and differences, and determine what level of universalism is possible. At present many countries have their own standards, some of which are based on false assumptions of cultural uniqueness (1). These standards may be challenged by this data, though we also recognise the importance of adopting standards that are suitable to the society. If people are the same then the same standards of bioethics may be applied - Universal bioethics, while respecting the freedom of informed choice and responsibilities to society.

How can we answer the question of cultural similarities? In addition to using our widely open eyes and ears to observe, we can also gain data from opinion surveys. Opinion surveys about bioethical reasoning of public, high school teachers, and medical students in Japan, Australia, Hong Kong, India, Israel, New Zealand, the Philippines, Russia, Singapore, and Thailand, were conducted with collaborators in 1993 (2). The International Bioethics Survey team is shown in Table 1. There were researchers from many countries, with several main collaborators and cooperation from numerous other people. These surveys included open response questions. The results of some key questions which reveal similar attitudes to bioethical decision-making are presented, and further international comparisons to North America and Europe are made.


Table 1: International Bioethics Survey Team

Data Input:
NZ, Australia, Hong Kong, India, Israel, Philippines, Singapore, Thailand Darryl Macer
Japan public and students Yuko Kato
Japan high schools Shiro Akiyama, Yukiko Asada, Miho Tsuzuki, University of Tsukuba
Russia Vijay Kaushik, Russian Academy of Sciences

Data collection (if different from input):
Public samples (collected by)
Thailand Peerasak Srivines & Prasert Chatwachirawong, Kasetsart University
(who also categorised the Thai language comments)
India Jayapaul Azariah, Hilda Azariah, University of Madras
Israel Frank Leavitt, Ben Gurion University
Medical student samples (collected by)
Australia Peter Singer, Monash University
Hong Kong Maureen Boost, Hong Kong Polytechnic
Japan Michio Hirayama, Norio Fujiki, Fukui Medical School; Hideo Hayashi, Tsukuba University
New Zealand D. Gareth Jones, Otago University
Philippines Angeles T. Alora, University of San Theresa
Singapore (Science students) Lim Tit Meng, University of Singapore; Ong Chin Choon, Singapore Polytech

Table 2: Sample Characteristics - expressed as %'s of total respondents (N)

Public
Medical/Biology students
High School Teachers
NZ AJJ91 InTR IsNZA JInT PSHKNZb NZsAbAs JbJs
N329201 352551568 68944650 96110435 325232164 250104206 96251114 560383
%12213 2326-36 43low60 7066- 50708052 612847 213726
Time23/933/93 3/937/917/93 9/934/9311/93 3/933/936/93 7/939/938/93 10/9312/938/93 8/938/938/93 7/937/93
Male4145 525361 48363841 506753 42462345 646248 638892
Female5955 484739 52646259 503347 58547755 363852 37128
Rural32329 27-22 54-2015 115115 4213412 692725 213734
Urban7771 73-78 4690+80 85894985 588796 88317375 796366
Age (years)
Mean47.445.2 41.739.830.6 37.236.333.4 20.818.121.1 21.821.321.1 19.321.040.8 42.541.842.0 40.740.0
<2055 345 0.591138 922922 2036910 749 500
<301819 212455 18283760 87077 80973190 333529 291715
<401520 262322 4328141 011 0.5000 474040 463434
<501415 192513 3117231 00.20 0000 132021 192532
<601512 14124 71190 000 0000 011 12117
61+3329 171210.2 760 0000 000 0000 32
Marital status
single2526 292953 38333495 989997 999999100 9613 162224
Married5962 666645 5954623 012 0.410.4 0838679 707775
Div/wid.139 540.2 31040 000 100.40 665 1011
Other33 0.3120.3 302 2010 00.40 2234 00.6
Children
No child3339 403555 22414897 10010098 9610099 1002215 242430 28
Pregnant1.41 123 20.541 001 000.40 311 111
One86 9141624 2961 000.42 010 881213 1513
Two2625 36321939 24211 0002 000 39383127 3640
>2 child3129 14177 135210 000.4 0000 283832 351818
Education
High school4336 37374 2131629 94547 402371 101 100
2 year

college

1815 19226 3182048 4613 180773 120.4 10.21
graduate2528 313131 35373920 23827 605006 645859 577882
postgrad.916 10752 5928253 0051 134708 303739 412117
other55 3371 400 0225 304 430.40 0.80.3

How important is religion?
Very2723 10-40 46103828 19536 54893221 201742 47710
Some2627 33-27 44381620 411624 38114140 172923 262537
Not too2724 40-15 8283418 203418 702226 333219 104536
Not at all2026 17-18 2241234 204522 0.40513 302216 172317
Religion
None2525 39-2 0.220045 32683 0.402560 --- ---
Christian7071 8-34 0.457049 41524 1.79924 40--- ---
Moslem00 0-4 0.6621 407 0.40110 --- ---
Buddhist0.31 47-0.4 99202 6240 971360 --- ---
Hindu00 0-590 0Jew:0 20650.4 040 ---- --
Other54 6-10.3 1983 15320.4 030 ---- --
Race
Caucasian9291 0-0.2 0-4379 6100 0210 949395 98--
Asian12 100-592 -2311 23100479 989599 0.5031 --
African00 0-0 0-40 000.3 000.41 010 0--
Indian0.30 0-94 0-01 7095 0010 MaoriMaori1 0--
Arabic01 0-0.6 0-40 000.6 0000 120 1--
Other76 0-0.48 -269 90021 030 5410 --
Income4
<200003218 373121 28245625 143624 41525969 001 32727
<350002928 343322 42253510 191727 32242324 939 44747
<500002024 151823 2124717 211425 1612102 475249 641918
50000+1930 141834 927248 463324 111285 444541 2978

1%=response rate of the survey;

2Time that sampling started.

3Indian samples were divided into city, town and rural responses; Russian samples were from three cities, both are described in the analysis of the results for the respective samples.

4Income for NZ, A, Is, S, P in $; Japanese Yen, (Y500,000; 800,000; 1,000,000; Russian in rbl; T in bahts (125,000; 250,000; 500,000); In in rupees.

Abbreviations used in all tables: NZ=New Zealand; A=Australia;J=Japan; J91 from Japan 1991 survey (Macer, 1992); P=Philippines; S=Singapore; HK=Hong Kong; T=Thailand; R=Russia.
Other surveys that are compared in data tables include: NZ90 (Couchman & Fink-Jensen 1990, N=2034); US86 (from the Office of Technology Assessment Survey 1986, N=1273); US92 (from March of Dimes Survey 1992, N=1032).


Open questions on the meaning of life and nature, and other questions relevant to environmental and agricultural biotechnology issues, were also included, which are not discussed here.

Three population samples were chosen for these International Bioethics Surveys, public, university students and high school teachers. The questionnaires consisted of 6 A4 size pages with a 1 page introductory letter including a form for the public and teachers to request a summary of the survey results. The public and student questionnaires were identical. The teacher's survey included some similar questions, but half of the questions were about teaching and curriculum in bioethics and genetics. The native language of the country was used, unless otherwise stated.

The samples are summarised in Table 2. These public and high school teacher surveys were national, using randomly selected mail response. Public questionnaires were distributed by hand into letter boxes chosen at random in different areas of Japan, New Zealand, and Australia. Mail response using enclosed stamped and addressed envelopes was requested. Mail response has one advantage over interviews in that lengthier comments were written to the free response questions and at other points in the questionnaire. The characteristics were representative of the population in each country. The public samples in India, Thailand and Israel included more people with higher education than the national average.

Student samples were chosen from the institutions shown, with the kind cooperation of collaborators shown previously. The funding for these surveys comes from the Eubios Ethics Institute, with some assistance from the ELSI group of the Ministry of Education, Science and Culture Human Genome Project, and The Universaity of Tsukuba. The high school samples in Japan are partly funded by the Ministry of Education as part of a longer term project we are working on, to develop high school materials to teach about bioethical issues in the biology and social studies classes.


Perceptions of genetic and mental disease and of people suffering from them

In this paper we consider some of the results related to the question of genetic disease, which will illustrate the approach we have been using. The results of the question, "Do you know anyone with a genetic disease or mental disease?" (Q19, 24), are shown in Tables 3 and 4. These show some interesting geographical differences in the number of people who said that they knew someone with a genetic or mental disease. If they said yes, they were also asked to openly cite what disease, which is also interesting to see their perceptions of what is genetic or mental disease.

One of the interesting results in Japan is the high number who said they knew someone with colour blindness, as a genetic disease. The incidence of all types of colour blindness in total in Japan is about 5% of men, whereas it is 8% in Caucasians. However, many Japanese said they knew someone and few Australasians or other samples. Colour blindness is a high school example of a genetic disease in Japan, and it appears that this stays in people's minds. This should make us think carefully about the way that genetic disease is discussed in schools.

Open comments about people suffering with muscular dystrophy are Table 5. Most people expressed sadness or compassion, but in Japan more included a comment like "they would be happy about therapy". This may be only a matter of language, and all these comments are sympathetic. However, there were more comments suggesting people are the same, no matter what disease they have, in Australasia. Only 2% admired people with muscular dystrophy, though for other diseases no one expressed admiration. For mental disease, such as depression (Table 6), more people considered the diseases their own fault, in all countries. People were more afraid of people with neurosis (Table 7). The results of attitudes to people with other diseases are discussed in the following paper by Kaushik and Macer, and more fully in ref. 2.

To ensure the categorisation of open comments was consistent between countries, all comments in English were categorised by D. Macer, and all in Japanese by Y. Kato, and the Japanese comments were translated into English to recheck the consistency.

Another approach to looking at the attitude people have to the handicapped and eugenics is to examine their attitudes to genetic screening and selective abortion. In the previous paper in this book (Macer, p. 114), we can see the acceptance of prenatal genetic screening under national health insurance is high in Japan (76% yes, 8% no). Less people say they would not personally use it than in the USA. Abortion of a handicapped fetus is supported in all countries. There is high support in Japan, only 12% are against it. The reasons shown for genetic screening were also given before, (Macer, p. 115). They include a right to choose, to save the parents stress, and health care is a right. Very few people said the fetus had a right to life.


Table 3: (Q19) Do you know anyone who has a genetic disease?

Public
Students
NZ AJIn TRIs NZAJ InTP SHK
% who knew4744 683957 75584350 733642 381643
N who knew162 104106 159386106 295254 1126596 594045
Not stated175 131537 18610 18615 632
Diabetes146 831104 9253 21123 541
Hemophilia1910 112123 122116 12107 324
Muscular dystrophy2016 1066 1245 1531 213
Depression30 120 0010 000 000
Schizophrenia21 210 11010 100 000
Neurosis00 042 0000 021 100
Alcoholism10 000 3100 000 000
Mental handicap14 81629 0010 146 211
Huntington's63 000 0042 100 000
Asthma61 1311 1111 014 011
Spina bifida95 000 0001 000 210
Cystic fibrosis1311 000 01108 000 000
Heart disease63 616 0000 010 233
Down's3824 81928 1191428 3085 321010
Dwarfism10 200 0100 000 200
Physical deformity57 547 0011 101 000
Parkinson's11 000 0001 100 000
Epilepsy10 726 8100 001 000
Alzheimer's10 000 0000 000 000
Colour blindness01 30717 -033 32514 107
PKU50 000- 110 0100 01
Deaf/blind22 132 -010 011 000
Thalassemia-- -043 -0-- -02 058
Cancer-- -219 -1-- -12 11-
Albino-- -54 -0-- 213 010
Sickle cell anemia00 034 -000 000 010
Others3429 224478 2513149 201925 171214
Personal84 102 0*010 010 000
Several43 4515 4500 600 210


Table 4: (Q24) Do you know anyone who has, or has had, a mental disease?

Public
Students
NZ AJIn TRIs NZAJ InTP SHK
% who knew3039 595341 70464169 673428 361622
N who knew219 116137 217280128 235634 1376163 543923
Not stated2411 222142 22720 2977 896
Depression11743 586841 732615 66127 894
Schizophrenia5145 333163 512219 45617 1526
Neurosis156 214787 7310 61114 1031
Alcoholism01 011 12000 100 100
Handicapped65 92717 0131 5107 522
Huntington's00 010 0001 000 000
Down's84 033 2110 000 470
Parkinson's01 000 0010 000 111
Epilepsy10 310 13021 220 000
Alzheimer's2113 100 0476 001 000
Other1214 53368 123135 51916 764
Personal126 312 0001 200 000
Several86 792 0034 400 200


Table 5: (Q20) How do you feel towards people that have the following genetic diseases? Muscular dystrophy;

Muscular Dystrophy
Public
Students
% of respondentsNZ AJIn TIsNZ AJIn TPS HK
N329201 352419 6845096 110435 184232161 235104
Not stated7.46.6 30.035.816.2 427.418.4 26.928.810.3 29.934.923.1
Don't know1.96.6 6.38.85.0 06.311.1 8.011.43.9 1.33.07.7
Sad or Compassion51.2 43.923.829.1 51.02846.3 33.031.430.1 61.231.940.0 24.1
Want to help7.15.6 6.33.812.6 24.22.8 12.610.38.7 7.62.65.8
Happy for therapy3.7 5.615.97.6 4.2101.1 0.98.25.4 3.02.61.3 2.9
People are same15.716.8 5.24.12.2 823.219.3 7.36.04.3 16.611.58.7
Unlucky1.94.1 0.91.70.7 01.14.6 0.21.10.4 1.907.7
Admire2.51.5 0.600.3 02.12.8 1.90.50.4 2.600
Helpless2.21.0 1.42.91.3 83.21.8 2.34.43.0 4.53.013.5
Other2.85.6 1.44.81.9 201.8 0.54.41.3 0.60.94.8
Rejection1.51.0 0.300.2 01.11.8 0.50.50.9 0.600
Can't understand0.30 00.50.2 01.10 0000 0.41.9
Own fault/depends 00 0.600.3 01.10 00.500 0.90
Afraid & Risk1.2 1.000.7 2.502.1 1.800.5 1.700.4 0


Table 6: (Q25) How do you feel towards people with the following mental diseases?* Mental depression;

Mental Depression
Public
Students
% of respondentsNZ AJIn TIsNZ AJIn TPS HK
N329201 352418 6835096 110435 183229161 235104
Not stated9.79.6 30.226.319.8 4010.420 34.728.414.4 31.623.430.8
Don't know2.57.6 5.64.14.7 25.210 9.97.72.6 1.34.38.7
Sad-Compassion36.132.5 19.124.230.8 2631.228.0 10.421.929.3 29.743.816.3
Want to help14.112.7 7.922.224.3 1010.410.0 10.126.221.0 16.86.812.5
Happy for therapy8.5 8.116.111.2 3.887.3 6.410.68.2 3.56.53.8 0
People are same10.010.2 4.41.73.7 414.69.1 8.51.16.6 7.710.211.5
Unlucky2.21.5 2.91.91.8 22.10 1.21.10.9 0.701.0
Admire00 000.6 0000 00.90 00
Helpless2.22.0 0.91.40 01.02.7 0.20.60.9 03.03.9
Other0.91.5 1.83.10.6 01.00.9 0.22.20 0.71.31.0
Rejection1.62.5 2.40.53.1 61.01.8 3.805.2 1.33.03.9
Can't understand4.71.5 0.61.02.8 02.10 2.106.1 00.91.9
Own fault/depends 3.8 6.15.60 1.308.3 3.64.50 2.21.90.9 1.9
Afraid & Risk2.2 4.12.61.4 1.625.2 5.52.12.7 4.91.94.7 2.8


Table 7: (Q25) How do you feel towards people with the following mental diseases?* Neurosis

Neurosis
Public
Students
% of respondentsNZA JInT IsNZA JInT PSHK
N329201 352418 6835096 110435 182229161 235104
Not stated13.513.8 31.530.420.4 4411.525.5 34.836.814.9 32.926.035.6
Don't know8.210.7 4.76.74.0 212.523.6 8.611.01.8 3.28.917.3
Sad or Compassion31.8 31.118.522.7 28.01228.1 23.612.022.0 27.926.540.9 10.5
Want to help12.07.1 6.214.819.2 68.35.5 11.217.017.0 13.63.810.5
Happy for therapy7.6 5.616.512.4 4.166.3 3.610.75.5 3.17.72.6 1.0
People are same7.69.2 4.41.43.8 210.45.5 8.11.13.9 6.59.86.7
Unlucky1.33.1 3.21.71.6 64.20 1.70.60.9 1.30.41.0
Admire00 000.4 0000 00.90 00
Helpless1.62.0 1.21.40.4 000.9 0.50.60.4 04.31.9
Other0.61.5 2.43.30.7 01.00 0.72.80 1.30.90
Rejection1.92.0 2.71.24.8 42.10.9 3.80.68.3 2.63.04.8
Can't understand3.12.0 01.24.5 03.10 1.00.64.8 0.71.31.9
Own fault/depends 6.3 6.65.60.2 2.503.1 2.75.50 3.51.30 0
Afraid & Risk4.4 5.13.23.8 4.239.4 8.22.21.7 10.02.63.0 8.7


Reasons for support for gene therapy

Table 8 shows the high level of support for personal use of gene therapy. There was also a high level of support for children's use of gene therapy. The support in Japan is growing. The reasons for gene therapy being supported that people gave are shown in Table 9. The major reasons were to save life and increase the quality of life. Few people gave a reasons like "improving genes". There was very little concern about eugenics, confirming the results of a different open question in 1991 (3-5). All peoples showed significant discretion over therapeutic and cosmetic applications of gene therapy, as presented earlier (Macer, p. 116). The support for specific therapeutic applications of gene therapy in Japan may be higher than in other countries (Q28), and the overall support as measured in Q26 and Q27 (Table 8) significantly increased between 1993 and 1991. This we suspect is due to increased media attention, particularly during the last year. It increased much more than over the period 1986-1992 in the USA. This survey is being conducted among US medical students, which will be reported later (2).


Table 8/9: High support for personal or family use of gene therapy* Acceptance and reasoning about gene therapy

%
Public
Students
US86
US92
J91
NZ
A
J
Ind
T
R
Isr
NZ
A
J
Ind
T
P
S
HK

Q26. If tests showed that you were likely to get a serious or fatal genetic disease later in life, how willing would you be to undergo therapy to have those genes corrected before symptoms appear? Why?
++ 35 30 25 4750 42 6135 23 5452 43 4460 34 4349 40
+ 43 49 29 2527 24 1620 24 1634 44 3014 30 3534 38
- 12 9 18 96 15 511 6 43 2 112 11 116 6
-- 9 9 12 44 6 424 13 03 2 54 16 32 3
DK 2 2 16 1513 13 1410 34 267 6 1020 9 89 13
N 318 195335 529 684414 50 96110 421 310230 151 249104
Not stated 16 1432 37 2360 58 1517 29 3815 38 3835
Don't know 2.5 0.52.7 1.1 3.17.0 0 00 3.3 1.92.2 1.3 0.40
Saves life 34 4326 41 1913 24 5238 38 4121 39 3943
Saves family 4.4 5.63.3 4.7 2.60 2 2.10 0.2 3.231 1.3 2.01.9
Improve quality of life 15 139.6 3.4 5.61.2 4 7.315 4.5 5.216 5.9 3.61.0
Depends on situation 19 259.0 4.3 124.8 12 2838 11 3.99.5 3.3 6.411
Improve genes 1.9 0.55.4 5.5 8.60.2 0 2.10.9 1.9 6.16.0 2.6 2.83.8
Other benefit 7.0 4.111 1.1 2.92.7 0 2.11.8 2.9 3.20.9 0 0.82.9
Economic comment 1.9 1.00 1.3 1.31.4 0 01.8 0 1.30.9 0.7 1.60
Eugenics/Misuse 0.9 01.8 0.4 0.90.5 0 00 1.7 00 0 00
Playing God/unnatural 5.3 7.25.1 4.5 150 2 9.35.5 5.2 1.620 2.0 5.26.7
Against ethics 0.6 00.3 0 0.30.5 0 00.9 1.0 00 0 00
Health risk 8.0 105.7 2.8 3.45.1 8 3.13.6 10 4.20 12 6.411
Other harm 3.1 2.13.6 1.5 0.23.4 2 00 2.4 0.30 1.3 1.21.9

Q27. If you had a child with a usually fatal genetic disease, how willing would you be to have the child undergo therapy to have those genes corrected? Why?
++ 51 52 37 60 5753 73 6735 62 5849 51 7079 57 6759
+ 35 36 29 22 2521 10 1624 18 2639 25 913 24 2426
- 7 5 11 3 210 3 25 2 54 7 31 7 34
-- 4 4 7 2 21 3 56 0 11 2 42 3 03
DK 3 3 16 13 1415 11 1030 18 107 15 145 9 68
N 317 196335 527 675436 50 96110 417 309230 150 173104
Not stated 16 1329 41 2362 62 1616 32 3915 39 6035
Don't know 1.0 0.52.1 1.3 3.94.8 0 00 2.6 1.32.2 1.3 0.40
Saves life 42 4436 42 2417 22 4947 40 4321 37 2743
Saves family 1.6 2.62.7 2.1 8.40 2 3.10.9 0 0.631 0 1.20
Improve quality of life 23 1913 8.3 170.9 6 1316 5.0 9.116 11 7.62.9
Depends on situation 20 3113 2.3 335.5 10 2733 16 2.90.9 4.0 2.014
Improve genes 0.3 02.7 5.7 9.90.5 0 00.9 1.2 4.97.4 0.7 0.40
Other benefit 6.0 2.06.6 1.3 2.52.5 0 1.01.8 1.2 1.90.9 1.3 0.41.0
Economic comment 0.9 1.00 1.1 0.91.4 0 00.9 0 0.70 0 00
Eugenics/Misuse 0.6 01.2 0.4 0.30 2 00 1.2 01.3 0 00
Playing God/unnatural 2.2 4.62.1 2.3 2.20 0 1.02.7 2.4 0.30.9 1.3 0.81.9
Against ethics 0.3 00.3 0.2 00 0 00.9 0.7 00.4 0 00
Health risk 4.4 7.75.7 2.1 3.64.4 6 6.32.7 8.9 4.50.9 9.9 4.88.7
Other harm 0.6 0.52.4 1.1 0.31.6 2 1.00 1.2 1.01.7 0.7 0.42.9

++ Very willing + Somewhat willing -Somewhat unwilling -- Very unwilling DK Don't know
Abbrevations: J91 - Japan 1991 (Macer, 1992a, N=532); US86 (OTA, 1987, N=1273); US92 (March of Dimes Survey, 1992, N=1032).


Conclusions

The full results are published in the book Bioethics for the People by the People, including chapters from each region describing the background circumstances, examples of open comments and explanation of the categorisation (2). This provides some data that allows us to actually look at the bioethical decision-making of ordinary people, and to examine the question of the universality of responses to genetic disease. This data generally finds most of the total diversity in all samples is found in any one country or group. In every society there are people who want to use new genetic techniques such as prenatal genetic screening, and there are some who reject the concept of selective abortion. In all societies we see high support for gene therapy, as could be expected. These are two examples of new medical technology that will expand as human genome research proceeds.

Attitudes to people suffering from disease may be affected by the use of genetic screening, but further studies over time will be needed to see whether there are significant attitude trends. In most countries the majority of respondents express sympathy, however, in practise we may not always see such an attitude. This type of study is one approach to address some of these questions. The results are also being used in an attempt to develop a method for assessing the general "bioethical maturity" of different societies (2, 5).

The most important message of this survey is that people in different countries share very similar views on most of these issues of bioethics associated with genetics. The main difference may be in the acceptance of selective abortion, but even people saying they were very religious also supported this. The question is a difficult dilemma, and not simply resolved by dogmatic respect for a right to life. Any universal ethics must include some respect for informed choices of people, and the range of choices people desire is transcultural. Whether or not policy will reflect that is a matter of hope, but we must be realistic and consider the legacy of our past.


References

1. Macer, D. (1992) The 'far east' of biological ethics. Nature 359: 770.
2. Macer, D.R.J. Bioethics for the People by the People (Christchurch, N.Z.: Eubios Ethics Institute 1994).
3. Macer, D.R.J. Attitudes to Genetic Engineering: Japanese and International Comparisons (Christchurch: Eubios Ethics Institute 1992).
4. Macer, D.R.J. (1992) Public acceptance of human gene therapy and perceptions of human genetic manipulation. Human Gene Therapy 3: 511-8.
5. Macer, D.R.J. (1993) Perception of risks and benefits of in vitro fertilization, genetic engineering and biotechnology. Social Science and Medicine 38: 23-33.

Statistical Note: The word "significant" when used in this paper means it was significant at least at P < 0.05.


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