Reply to Masahiro Morioka's Commentary on Seewald

- Ralph Seewald
Kyushu Institute of Design, Fukuoka, Japan

Eubios Journal of Asian and International Bioethics 10 (2000), 184.
Morioka (July 2000, EJAIB) stresses the importance of human relationships between a brain dead person and his/her family members, because these relationships have an influence on family members' judgement on the death of the brain dead person. From this point of view, the closeness of family-patient relationship is the point.

I agree that this is an important reason for not filling out a donor card or not obtaining the consent of the other family members. A brain dead person looks like a living person, and due to artificial life support, the person is in fact living.

However, when answering the open question as to why the 368 Japanese hospital workers and the 696 students did not fill out a donor car, the participants hardly mentioned that "brain death is not equal to human death". Only four students and about ten hospital workers gave this as a reason for not filling out a donor card. This is quite surprising, because in the mass media the brain death issue dominates the organ transplant discussion in Japan.

When asked if the permission of the family is necessary many hospital workers and students answered that the body is not just something of the person himself, but also something of the family. This applies not only to the brain dead body, but applies also to the heart death body.

The Japanese law on organ donation lacks a clear definition of the family. The word kazoku is used throughout the law, but kazoku can include many people even people who are not blood related to the family. Cutting in the death body of a family member disturbs the harmony that is always pursued for not only on the family unit level but also in the Japanese society as a whole. One can imagine how the harmony is disturbed when a doctor asks for the removal of organs from a family member.

On the contrary, living organ donation is a completely different story. If a family member decides to donate a kidney or a part of the liver, it restores the harmony in the family. The receiver regains much of his health again, the donor will receive some kind of emotional compensation for the extracted organ.

Western commentators are often surprised why Japanese so easily accept abortion, but have some aversion against post mortem organ donation. Well if we look from the perspective of the above mentioned wa (harmony) it can be understood that abortion restores the harmony that was disturbed by the socially unwanted pregnancy. That from a Christian/Islamic view maybe a life is terminated is of second concern.

I mention the Christian Judeo tradition as a main force behind the acceptance of organ donation in the West. Morioka says that I should not talk about their philosophy, but what they are actually doing in clinical settings. Just look at the world map. In countries with a Christian tradition, people are much more prepared to donate than in Islamic countries (Middle East) or in Confucian countries like Japan and Korea.

The small seminar we had in June together with the Buddhist priest Shuku Tesshuu in Osaka, made me realize that the discussion is not yet finished. Especially more attention should be paid to the kodawari (adherence) the Japanese have towards the bones of a deceased family member.

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