In The Shadow of the Past Atrocities: Research Ethics with Human Subjects in Contemporary Japan

- Takashi Tsuchiya, M. A.
Associate Professor, Department of Philosophy
Faculty of Literature and Human Sciences
Osaka City University, Osaka 558-8585, JAPAN

E-mail: tsuchiya@lit.osaka-cu.ac.jp

Eubios Journal of Asian and International Bioethics 13 (2003), 100-2.


I will point out the main characteristics of research ethics in Japan after World War II, introducing some postwar cases in which human subjects were abused by researchers. I would stress the importance of looking in the face the historical truth of the medical atrocities performed by Japanese doctors in China in 1930s and early 1940s (1), since reflection on this truth must lay the foundation for Japanese research ethics.

Of the contemporary situation of research ethics in Japan, there are at least three characteristics. First, research ethics is hardly regarded as a matter of 'human experimentation.' Second, guiding principles for human research are not explored on the basis of historical reflection. Third, there is little discussion on ethics of behavioral research.

1. It seems that only a few people in Japan regard ethics of medical research as relating to the matter of 'Jintai-Jikken' ('human experimentation' in Japanese). It is inconsistent, since progress of medicine can never be made without experiments on human beings, and medical researchers are performing them routinely. This inconsistency has been produced by a social mechanism that prevents serious discussion on human experimentation.

When Japan invaded and militarily ruled parts of China in 1930's and early 1940's, many Japanese medical doctor-researchers performed or concerned with deadly experiments and vivisections at Unit 731 and other facilities. However, after the war most of these researchers escaped accusation, mainly because the United States made deals with their leaders (like Lt. Surgeon General Shiro Ishii) and covered up this medical atrocity in order to monopolize the data of human experiments for biological warfare. The experimenters who had come from universities to the "factories of death" soon became prominent figures in the medical profession--professors, deans, and presidents of medical schools (2). Therefore, in Japanese medical academies, in which boss professors hold supreme power over their disciples, speaking of human experimentation might lead to touching boss professors' "secret of secrets" that may kill the speaker's own academic career. Thus the issue of human experimentation has become a taboo (a subject of which we must never speak or discuss) in Japanese medical profession after the World War II.

In addition to the lack of domestic sources, since revealing information of the murderous experiments came only from the U.S.S.R. (3) and People's Republic of China (4), the major mass media suspected and sometimes neglected it as communist propaganda in the Cold War. So, before the 1980s, when historical studies in this issue greatly developed, ordinary people in Japan had little knowledge about the medical atrocities commited in China during the wartime.

Probably those are the reason why human experimentation framework is absent in Japan. But, without this framework, discourse on research ethics must be ad hoc and fragmental. The framework has played a central role in contemporary western medical ethics. Actually, bioethics has developed in the investigations of human experiment scandals (like the Nazi experiments, the cancer research at the Jewish Chronic Disease Hospital, the Willowbrook hepatitis study, the Tuskegee syphilis study, the nationwide human radiation experiments, and so on). Setting aside the problem of animal experimentation, research ethics is mainly interpreted as ethics of experimentation with human subjects. Nevertheless, in Japan the term 'Jintai-Jikken' (human experimentation) has always been a pejorative, human experimentation is often regarded as very deviant practice performed only by evil doctors and not as a main issue of 'I no Rinri' (ethics of medical practice).

However, there have been a bunch of cases in which human subjects were abused by leading professors. Here I introduce some of them. All of these ones were abuses of inmates, either of psychiatric hospitals or of infant nurseries.

In March 1951 Professor of psychiatry Hiroshi Utena of Tokyo University published a paper titled "Studies on the Carbohydrate Metabolism in Brain Tissue of Schizophrenic Patients" [Utena & Ezoe (1951)]. In this study Utena let a surgeon operating lobotomy take a small piece of brain tissues from 70 inmates of a psychiatric hospital. The subjects consisted of 42 schizophrenic patients, 21 "controls" including psychopaths, manic-depressives, compulsive neurotics, postencephalitic character abnormalities, epileptics, and general paralysis, and 7 "diagnostically questionable" patients including two "paranoid-hallucinatory" drug abusers. At least three subjects died after the lobotomy, and medical records testified that two of them probably died of excision. No subjects and their families were asked to give informed consent to excision. Moreover, several patients were forced to have general anesthesia against their will. Nevertheless, nobody had criticized this experiment until 1971, when a resident Dr. Kiyoshi Ishikawa of Tokyo University Hospital accused Utena to the Japanese Society for Psychiatry and Neurology. Finally JSPN's General Assembly resolved to condemn Utena in terms of possibly harming subjects and not attaining consent.

From November 1952 to January 1956, Professor Juko Katsura of Niigata University and his disciples injected rickettsia tsutsugamushi to 118 inmates of a psychiatric hospital. The subjects suffered high fever around 40 degrees centigrade. Doctors also removed a piece of skin from 9 subjects. 8 subjects died after these experiments, one of them killed himself. Several employees of the hospital accused Katsura to the Human Rights Protection Committee of the Japan Federation of Bar Association, and JFBA set up a special committee and investigated the case. Katsura and his disciples insisted that injections were fever therapy, but it was revealed that there were no medical records, no fee was demanded for this "therapy," all injections were done by Katsura and his disciples, and Katsura gave a letter of gratitude to the hospital. In 1957 JFBA's special committee declared that it was surely an experimentation, not therapy, and severely denounced Katsura [Nichibenren (1968), pp.126-134]. This Katsura's experimentation was a part of a big research project on rickettsia funded by the U.S. Army [Takasugi (1973)].

In 1952, pediatricians of Nagoya City Medical School administered a special type of coliform bacillus to infant inmates of the Nagoya City Infant Nursery. The babies had severe diarrhea, and one of them died [Nichibenren (1968), pp.134-136]. In 1958, pediatric doctors of Kobe Medical School inserted a long plastic tube into infants from their mouth to anus, in order to take and analyze the contents of their intestines. That was a research procedure to know the best density of lactose in artificial milk, and doctors found that we must keep it less than 10%. But some baby subjects suffered from high fever, diarrhea, and vomiting. The parents and guardians of the babies were never informed of it, as the nursery completely shut them out [Shimizu (1979)].

These cases were reported in newspapers, journals, and TV news. But public discussion occurred merely on a case-by-case basis. Consequently, politicians have never proposed a blanket act for medical research, and the government has never issued general guidelines. Recently the transplantation law and the law prohibiting human cloning were enacted, and guidelines for human genome research and stem cell research and guidelines for clinical research were issued, but all these are individual and isolated regulations. This means Japan has no general policy on human research so far (5).

2. As the result of the absence of human experimentation framework, Japanese medical ethicists have hardly explored their own guiding ethical principles for medical research by themselves. Of course most of them know the Nuremberg Code and the Declaration of Helsinki, and many Japanese books in bioethics cite these documents in their text or appendix. But without reflecting their nation's past deeds, authors often explain these ethical codes only superficially and cannot understand how these codes have heavy, important, and essential meanings to themselves. Serious pursuit of ethical principles for medical research has not yet begun in Japan.

Seemingly the only exception was the case of "the Committee Investigating Mr. Ishikawa's Criticism of Mr. Utena" of the Japanese Society for Psychiatry and Neurology [Seishin Iryo Henshu Iinkai (1973)]. This committee was organized to investigate Professor Utena's experiments that I mentioned above, and issued "the Proposed Principles for Human Experimentation" in 1973 in its final report. Though JSPN's General Assembly did not adopt them, these principles were important in terms of including not only general principles but also principles for experiments on patients with mental disabilities. However, most of its general principles were cited from the Nuremberg Code and the Declaration of Helsinki, and there is no reference to Japanese murderous experiments in China. Probably due to the taboo and shortage of information, the committee avoided reflecting on the medical atrocities committed by their fellow professionals. These principles were not derived from the lessons of their shameful past.

Looking into one's own deeds is one of the primary essentials of ethics. If we miss it, we can never be ethical in a true sense even though we declare good 'ethical principles.' To our regret, this is just what happened to the single case of proposing principles for human research in Japan, the JSPN's investigating committee's proposal.

3. There is little discussion on ethics of human research in behavioral sciences. There have been no press reports on problematic cases, and only a few societies of behavioral sciences have their ethical code on human experimentation. However, this does not mean that there is no problem in Japanese behavioral sciences. Rather, the press and most of the societies merely do not recognize problems in behavioral research. But as subjects might be badly abused, both public and professional recognition of this issue is urgently needed in Japan.

In conclusion, I would repeat that in Japan 'human experimentation' is still a taboo in the medical profession and not regarded as an appropriate issue for academic analysis. So, Japanese medical profession has not learned anything from their past deed. Public discourse on research ethics remains fragmental and superficial, due to the absence of human experimentation framework and the lack of historical reflection. Therefore, serious reflection on the past medical atrocities is urgently needed in order to change this poor state.

Acknowledgments

The previous versions of this paper were presented at the 7th International Tsukuba Bioethics Roundtable, February 17, 2002, Tsukuba University, JAPAN (under the title "The Contemporary Situation of Ethics of Human Experimentation in Japan") and the 4th Annual Meeting of the American Society for Bioethics and Humanities, October 26, 2001, Nashville, TN, U.S.A. I am grateful to the participants for their heartful comments.

Notes

1) On the medical atrocities by Japanese doctors in English literature, see Tsuchiya (2000) and Harris (1994).

2) See Tsuneishi (1994). English translation of this book is now proceeding.

3) By the early 1980s the only comprehensive document on the deadly experiments by Japanese doctors was the materials of the military tribunal at Khabarovsk, U.S.S.R., in 1949 [Materials (1950)]. This tribunal was run solely by the U.S.S.R. The United States then insisted that it was communist propaganda and the materials were not reliable source of information.

4) Most of Japanese soldiers and army surgeons who were released from prisons in the People's Republic of China and came back to Japan in late 1950's and early 1960's have recognized their crime and kept speaking of their experiences in public. But sometimes they were regarded as being brainwashed by Chinese communists, and they were even suspected as "spies." Of their testimony, see Chinese Central Archive et al. (1991), Yoshikai (1981), and 731 Kenkyukai (1996).

5) As of April 6, 2003 the Japanese Ministry of Health, Welfare and Labor is making guidelines for clinical research in general. But the Ministry has never referred to the past research abuses. It seems to be only making a patchwork of articles transferred from international guidelines such as the Declaration of Helsinki.

References
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