pp. 285-288 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.

Post-modern bioethics and medical genetics

Hyakudai Sakamoto
Professor, Department of Philosophy, Aoyama Gakuen University, Tokyo, Japan

1. Bioethics as the spirit of the post-modern age

Bioethics is a newly born research field, and it has little more than twenty years history. It first appeared in the end of the 1960s. Perhaps, V.R. Potter used this word first in his book "Bioethics - Bridge to the Future, 1971", and since it has spread rapidly all over the world.

The reasons why this term emerged in this period of time, can be traced to several background events. I want to point out two remarkable facts. First, that strain of dualistic European culture that sprung from Cartesian Philosophy had reached a peak, and a major philosophical paradigm-shift was required. Under the influence of Cartesian dualism, modern science was established as the science of "matter", and through the modern age, mainly natural science has developed, and finally it has grown up to the level that it can claim to explain life and mind as material phenomena. Now, the study of life typically means biochemical research of life. However, there remains some expectation that human life is something more than a mere physical event, and this idea forms the focus of the present day philosophical "mind-body problem". This problem is now discussed generally in the monistic way. Bioethics is another name of the attempt to overcome Cartesian dualism in the form of "Ethics"

Secondly, this movement gained impetus as an assessment of the technological innovations which dominated the 1960s. At that period of time, the development of new technology in the fields of space technology, atomic energy technology, and artificial intelligence, etc., were developed rapidly on a world wide scale. But the fear that the extraordinary rapid development of these technologies may cause some fatal influence, also gave birth to the influential movement of "technology assessment". Clearly, bioethics emerged as part of the technology assessment of this time, and therefore, bioethics holds from its beginning the hue of "environmental ethics" and anxiety about our human future. This is also clearly shown in the content of Potter's book Bioethics.

Therefore, bioethics is different from traditional "medical ethics" which focuses on the etiquette of medicine or physicians. In short Bioethics is a product of the spirit of the present day, namely, the post-modern times. However, in 1970s, bioethics disguised itself as if it was medical ethics. This is the result of rapid application of scientific technology to the field of the medicine, and as an effect, the ethical issues considered were mainly in the medical domain. The central topics included the problem of artificial control of human birth, the problems of death related to terminal care and brain death, and genetic manipulation. Development and application of science and technology in these fields is very rapid and widespread, and therefore, its assessment was severely required at this time. Of course, this does not mean that bioethics itself changed to medical ethics.

2. Ethics as a technique of social tuning and negative humanism

Bioethics is naturally, a part of ethics. Then, what is ethics? There are two mutually opposing essentials of ethics. One direction is to identify ethics as some sort of virtues, or "categorical imperatives" of a priori reason, which are spontaneous, universally valid, and eternally unchanged. Another direction is to take human beings as "desire machines", who necessarily produce the state of war of all people against all people. In order to stop this state of war and to bring peace to society, so ethics is necessary as a social tuning technique, which is fundamentally based on self restraint from hedonistic desire. What is expected for the present day bioethics is clearly the latter point of view, which is hoped will supply social tuning technique(s) to soothe the various antagonisms in human society.

This view point, however, necessarily casts a big doubt on the modern idea of "humanism". Humanism originally comes from the belief that within the human being something which makes the human being valuable can be found, opposing suppression by various religious or royal systems, to find human dignity as a citizen. "Reason" was found as an entity in the human mind which matches this requirement, and by the force of this concept of "reason" I think the concepts of freedom, equality, value, and rights of human beings (citizen) were established.

However, "reason" might be only a fictional concept. At least, it involves undue "human-centricism" or anthropocentricity, i.e. excessive glorification of human nature. The anthropocentricity of the modern humanism should be swept away from the view point of identifying ethics as a social tuning technology. Presumably, we can see, for instance, in the recent environmental ethics movement, criticism and opposition towards the modern anthropocentric way of thinking. Therefore at present, we have to stand with the view point of "negative humanism" without belief in the universal virtue of the human reason.

3. European principles of bioethics

Issues of bioethics are being discussed not only in the realm of medicine but also in the context of wider philosophical and social problems. In these arguments several guiding principles have been shown, but most of them are founded on the European principles which have been influential in modern European society and thought.

The most fundamental European principle is the "autonomy" principle. This can be also said to be the principle of "freedom". It acknowledges highest value on the autonomous freedom of (human) reason. Being led by this idea, Europe modernized through various social revolutions. According to this idea, social conflicts and opposition can be solved by the principle of autonomy of reason, which is supposed to universally exist in the human mind. Thus, ideas such as "self determination" and "informed consent" are recommended as the guiding criterion in bioethical decision-making.

The second European fundamental principle of bioethics is "fairness" or "equality". Namely, in order to keep social order, resources should be distributed fairly, and equal fundamental rights and qualifications should be given to all human beings. Freedom and equality were two guiding principles of the French Revolution and these principles led the idea of the "fundamental human rights". Since then the protection of fundamental human rights has been deemed as social justice, and in the later Europe, this idea of justice has been applied to ethical problems concerning medical and technological issues, and has supposedly helped solve them.

In the last few years however, cases which throw doubt on the international validity of Western bioethics have appeared. The Peter Singer affair is one of them. This can be called an anti-bioethics movement, opposing bioethics based on the western humanistic theory of "person". Another case is the dissension in the Japanese Prime Minister's Committee on Brain Death (to be considered later). Thirdly, the Tian-an Mien Square incident in China. These cases indicate the need and urgency for bioethics to broaden to reconsider the validity of the concept of human rights based on "autonomy" and also to broaden in scope to include Asia, especially, East Asia.

4. The possibility of Asian Bioethics

Now let us consider the situation of bioethics in Asia. In Japan, Western bioethics was promptly introduced. In 1974, Potter's book was translated. Bioethical conflicts have been treated in the Euro-American way.

In Japan, however, recently there have been a series of anti-Western Bioethics events. One is the debate concerning heart transplantation from brain death donors. The government set up a Prime Minister's ad hoc Committee specially on this problem. But, after more than one year of discussion, the concept of brain death was still not accepted unanimously as human death in their final report. This means that some Japanese people will not easily accept the Euro-American redefinition of death. This reveals the heavy influence of Asian thought and ethos on Japanese thinking.

Chinese society keeps some traditions not compatible with Western principles of ethics, much more strongly than Japan. Following, I will point out some of the features of the traditional East Asian way of thinking.

a) Holistic thinking. The Asian way of thinking is in general, holistic and non-analytic. They tend to treat a human being as a whole. There is little idea of dichotomy of mind and body. They do not regard the human body as a mere aggregate of bodily parts. Traditionally they are not familiar with a mechanistic view of the human body such as that based on Descartes' dualism. Therefore , they may not easily accept the idea of the "brain death" with a "living" heart.

b) Naturalistic tendency. Another characteristic of the Asian principle of thought is "naturalism". They do not intend to conquer nor destroy nature, rather, they want to try to be in harmony with nature. Therefore, medical treatment is a means to return the sick mind and body to the natural unity, and medication is essentially to take natural things, grasses or trees, in their natural states. The best way of life is therefore to live in nature, in the natural way.

c) Anti-rationalistic view of human being. This nature-oriented inclination rejects the rationalistic view of human being that only human beings are given innate "reason", and because of it, humanity is exclusively dignified. In reality, human beings may have a non-rationalistic existence like other animals.

We should notice that in these points of thinking, the Western idea of "autonomy" is naturally very weak. The "ego" claim is kept to a minimum level, and the idea of "fundamental human rights" is kept weak. Here, instead of personal rights of individuals, harmony in society or with nature is more esteemed.

d) The Confucian idea of "Jin" (human benevolence) and the Buddhist idea of "Mu-shi" (self-annihilation). In the cultures of East Asia, the spiritual influences of Confucian and Buddhism are both very strong. Confucianism is said to be undergoing a revival now in modern Chinese thought. Confucianism is an ethical theory rather than a religion. One of its central precepts is "Jin" (human benevolence). "Jin" is simply morals based on social relations, and it is also wisdom to bring peace and order to human society. Importantly, in the background of this wisdom, there is no idea of "Reason", no belief in "human autonomy", and no "human rights". Here we may find the possibility of Asian bioethics that are entirely different from Western thought.

It is also notable that in Asia, especially in East Asia, the deep tradition of Buddhism is pervasive. In Buddhism, there is some sort of egalitarian view of life, of all sorts of animals or even of plants, which is not compatible with the view of life of Western science. But here, I will emphasize the idea of "Mu-shi" (non-ego, or self-annihilation) which is found specially in the Japanese Buddhist tradition. It is a view of human life, developed through the course of the Japanese religious Reformation of the 13th century by Shinran and Dogen, and it teaches that only by annihilating oneself can one obtain "Satori" (spiritual awakening). This idea of self-annihilation clearly denies the "autonomy" of the self and also the idea of "fundamental human rights". And this idea influences tacitly the thoughts of Japanese people even now.

Now, in the beginning of the post-modern age, considering bioethical issues, we should stand with a sufficiently wide and international view point, especially including an Asian point of view, and therefore, taking Asian traditional or ethnic values into account, rather than only considering the Western concept of reason, autonomy and fundamental human rights. We should pursue research on what human beings are. Ethics must be formed through the system of value concepts based on the ethos of each ethnos or people, respectively. We should allow a variety of value concepts and value systems because we have a variety of nations all with their traditional ethoses. There is no reason at all that all nations and all ethnic groups in the world should hold one standardized bioethics. Asian people can have their own bioethics if they think differently. As a matter of course, however, it will be required for harmonisation of Asian bioethics with Western or international bioethics. Currently in Asian countries, Western science and technology is rapidly developing, and as a result, Asian thought and ethos may change on a large scale. Asian people should become much more familiar with Western paradigms of reason, human freedom, human autonomy and human rights. In this way, we can hope to find a new post-modern, international bioethics. And it is also necessary and urgent for cultural and social development of Asian countries to try to find Asian bioethics that provides the technology to harmonise the East and West.

In fact, the possibility of founding a new Asian bioethics and establishing a new association for Asian Bioethics, has been recently explored by some Japanese and Chinese bioethicists. It is tentatively scheduled to hold the First International Congress for Asian bioethics, perhaps in Beijing, China, in 1995.

5. Bioethics and Medical Genetics

In conclusion I will make a short comment on the relation between the possible post-modern bioethics and the present day medical genetics.

In 1982, the European Parliament issued a recommendation that guaranteeing the "inviolability of genetic characters", should be a fundamental human right. There is a serious connotation of this advice, that human genetic engineering not designed to cure disease should be acknowledged as an infringement upon human rights, and therefore its clinical application might be largely limited.

This advice seems to be homogeneous with the Oriental ethos and also to have similar implication to the Asian thought of mui-shizen ( ) "natural life without human artificiality". In reality, in Japan, the cases of medical decision being made by this sort of Asian sense of value are increasing. For example, not a few pregnant women decide to bear a Down's syndrome baby because they see artificial abortion as non-natural. Also among the aged or middle aged people, there is a mood among some that appears to be spreading that they would not receive a transplantation operation. They reject it as artificial. Rather they would die in a natural way without any kind of unpleasant treatment.

On the other hand, patients with a distressful genetic disease must be relieved. Thus, we should ethically and legally determine the permissible limits of medical invasion while protecting any human right to inviolability of genetic characters. Perhaps it is relatively easy to show the legal grounds for justifying this sort of medical invasion, because Western science and the Western legal system stemmed from the same roots. However, legal systems should be based in ethics. I think that ethics should broaden its scope so that it can cover Asian thought and ethos. Thus a basis for justification of medical genetic interventions could come from some Asian ethical idea such as the concept of "Wa" ( ) (harmony) and "Jin" ( ) (human benevolence), both somewhat paternalistic, in addition to the Western idea of "autonomy", "person", "moral", and "human rights", and these might effectively act in harmonizing and internationalizing Bioethics. Also, it could act as a world wide social tuning technique in the present post-modern age. We now stand at a critical turning point of bioethics urged to introduce the wide view of Asian value to unify the East and West.

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