East Asian Association for Bioethics EACB'95 Conference Abstracts (3-5 Nov. 1995)

Eubios Journal of Asian and International Bioethics 6 (1996), 8-16.

This list which will also be on Internet, like all of EJAIB, includes the abstracts of those who were at the meeting, a number of persons who had abstracts accepted were unable to come). Conference Program
SURVEY ON AIDS - Angeles T. Alora, Southeast Asian Center for Bioethics, Manila, the Philippines

250 adult Filipino health and non-health professionals were interviewed. The following were the leading responses:

I. AIDS frightens me because: 1. it kills - 158; 2. it can affect anyone - 148; 3. it has no cure - 140; 4. it has affected so many people - 123; 5. it is painful - 94.

II. The most affective way to control AIDS is by informing all on: 1. how to avoid AIDS - 185; 2. how many are affected by AIDS - 132; 3. how AIDS hurts one's body - 131; 4. how AIDS hurts innocent victims - 129; 5. how many have died from AIDS - 128.

III. The most convincing person to talk about AIDS is: 1. a knowledgeable AIDS patient - 138; 2. my private MD - 134; 3. a knowledgeable health professional - 128; 4. my knowledgeable parent - 99; 5. a knowledgeable teacher - 87.

TRUTH-TELLING ABOUT DYING AMONG FILIPINOS - Angeles T. Alora, Southeast Asian Center for Bioethics, Manila, the Philippines

A survey of adult Filipinos revealed that the majority want to know if they are dying, and for their physician to be the one to tell them. A survey of Filipino doctors revealed that the majority of doctors do not wish to be the one to tell the patient he/she is dying; and usually tell the patient's relative before or rather than the patient. The gap between patient's wishes and doctor's attitude and action is partially explained by cultural values of withholding bad news and close family ties.


One area that has attracted particular attention is organ transplantation, and the paper reviews relevant developments in various countries and jurisdictions. In many respects, the debates in Hong Kong and Singapore on diverse aspects of organ transplantation policy and legislation have been particularly significant. A draft law on organ transplantation is pending in Japan, where there has been considerable debate on matters relating brain death in particular. In the field of human experimentation, countries and jurisdiction known to have relevant legislation include Hong Kong, Japan and the Philippines. The paper describes current and anticipated work on diverse other aspects of bioethics in East Asia, with particular reference to: "Death and dying" issue; institutional mechanisms for dealing with ethical issues; ethical aspects of reproductive health including artificial reproductive technologies; ethical issues in genetic technology, with particular reference to gene therapy.

DRAWING THE LINE IN GENETIC ENGINEERING: THE ARGUMENT FROM HUMAN DIGNITY - Gerhold K. Becker, Centre for Applied Ethics, Hong Kong Baptist University, Hong Kong

It is a thesis of this paper that ethical evaluation of human biotechnology usually blend consequentialist considerations of high pragmatic plausibility with fundamental moral intuitions whose theoretical status remains dubious while their emotional impact on the process of ethical decision making is extremely high. Instead of analyzing the theoretical components of this process separately and in isolation of each other, the conceptual clarification of their epistemological status and their logical relationship seems a more promising approach.

In this paper, it will be argued that even pragmatic consequentialist considerations are grounded in moral intuitions which delineate the ethical frame of reference and provide basic (cross-cultural) criteria for the evaluation of the presumed consequences of our actions. One of the most persuasive of such intuitions centres in the idea of "human dignity" which was given a prominent place in the KantÍs moral philosophy as well as in the German constitution. It is hoped that the careful analysis of this concept and its function in the interplay with other structural components of moral decision making will provide useful standards for the ethical evaluation of modern biotechnology.

WHAT ARE WE TO DO WITH CARING AND COMPASSION? - Alvin L. Bowles, Henry Ford Health Systems, Detroit, USA

From the modified Oath of Maimonides: "May I never forget that the patient is a fellow human creature in pain. May I never consider the patient merely a vessel of disease."

Do the skills that doctors possess or claim to possess mean that they are morally obligated to care and if so why? Is this concept of caring different in various cultures? Is the capacity for caring universal?

The science of medicine to a large extent has been unrestrained and there is evidence that the lack of moral precepts can lead to destruction. Louis A. Buis has stated safe ground can be found in what he calls the universally of the affections, i.e. empathy and compassion. We need to be concerned about the ethics of care because it involves certain traits not unique to the "caring professions", but are required for effective care-giver/patient relationships. In some cultures, there has been too little emphasis of the understanding of the complexities of caring, curing, and healing.

There is no need for inertia and paralysis concerning the moral value of caring as this notion of caring binds all persons everywhere because it also has affirms our fundamental human worth and dignity. This value as well as others has objective and demonstrable worth in that it can promote the good of the individual and the good of the whole community, i.e. 1. Healthy personal development, 2. Effective therapeutic relationships, 3. A humane society, 4. A just and peaceful world.

Despite cultural differences and differences in the delivery of healthcare, it seems clear common ground can be found in the analysis of the virtue of caring, empathy, compassion, and yes, even love.

EUTHANASIA AND THE PRINCIPLE OF JUSTICE - Alastair V. Campbell, Bioethics Research Center, University of Otago, Dunedin, New Zealand

Proponents of voluntary euthanasia have frequently appealed to the principle of autonomy as a moral justification for a change in laws forbidding homicide. However, individual autonomy is always in tension with the equal consideration of the rights of all (justice). In this paper I argue that, on grounds of justice, it is inadvisable to legislate for voluntary euthanasia.

JAPANESE DEATH FACTORIES AND THE AMERICAN COVER-UP - Chen Yuanfang, Peking Union Medical College Hospital, Beijing. China

During the Japanese Aggression War some death factories were built for human experimentation on biological warfare (BW). The most notorious one was Unit 731, or Ishii Detachment, in Ping Fang, Heilongjiang Province, Northeast China. It composed of more than 100 buildings including human experiment laboratories, autopsy building, laboratories for mass production of pathogenic bacteria and infected fleas, animal house, and a crematorium. Horrifying experiments were conducted on human beings, mostly "anti-Japanese elements" (Chinese patriots), as well as the homeless, the opium smokers, the mentally handicapped, etc. Experiments included: (1)forced infection of humans with plague, anthrax, gas gangrene and typhoid bacteria; (2)vivid dissection of infected human beings in order to collect their blood, fresh tissues and organs for further examination; (3)freezing test in combination with bacterial bombs in cold weather in the field; and so on. Mass biological warfare field test were also conducted based on experience in the laboratory. At least 3,000 people were killed in Unit 731 during 1941-1945, 5,000-6,000 people were killed in other death factories during the war, and, even in the immediate postwar years, about 40,000 people died from plague epidemics in Ping Fang area and Harbin which were believed to be directly related to spreading of bacteria from Unit 731 during Japanese retreat.

It is beyond any controversy that what the Japanese BW experts did in Unit 731 had violated all of the known laws of war, they should be denounced by any moral standard, and should be prosecuted for their war crimes. However, for some shameful reasons, the US Authority concealed these crimes completely from the public with every bit of effort, they hungrily urged the Japanese BW doctors to hand over their data, slides, and photographs of human experiments, and cautioned that these information should be retained strictly in intelligence channels. Moreover, as a bargain, the US Authority promised in return to give immunity grant to Japanese BW experts, they promised that the Japanese testimony would never be used as evidences for war crimes.

Here arise some serious ethical questions: Should any country make use of science for its own advantages at the expense of devastation and torture of other countries or people? Should any doctor use his/her scientific knowledge or medical skills to do harm to patients or healthy subjects? Should they under any circumstances become voluntary tools of killing machines? Should "interests of the nation" override all ethical principles? Should any country keep these BW data as top secret instead of disclosing them to the public to alarm the people and to learn some historic lessons? Should any country make use of data obtained in such an inhumane and criminal way for a similar BW program of its own?

Let us get the answers.

DEMOCRACY, EDUCATION, AND BIOETHICS - James Dwyer, New York University , New York, USA

In this paper I consider three reasons why bioethics education is especially important in a democracy. The first reason concerns suffrage. In a democracy, citizens will vote directly on a number of bioethical issues - issues like assisted suicide or universal health care - and they will elect representatives who will decide other issues. Hence a democracy needs citizens who have a critical understanding of bioethical issues. The second reason concerns rights. Since democracies typically recognize a range of individual rights, including patients' rights, people need to learn what their rights are and how to exercise them in a responsible way. The third reason goes beyond the emphasis on autonomy and rights. At best, a democracy is more than a form of government. It is a form of social interaction that places a premium on different people sharing experience in order to resolve problems. This sharing of experience requires that patients, families, nurses, and physicians learn to engage in certain kinds of conversation.

TOWARDS A CONFUCIAN BIOETHICS: ITS STRUCTURES, PERSPECTIVES, AND IMPLICATIONS FOR CURRENT CHINA - Fan Ruiping, Center for Ethics, Medicine and Public Issues, Baylor College of Medicine, Houston, USA

This presentation takes Confucianism as both an ethical system in general and a bioethical doctrine in particular seriously. Specifically, instead of admitting the fundamental moral teachings of Confucianism to be determined by, contingent on, or varying with historical, social, and economic conditions, it suggests that Confucianism, being the major Chinese faith tradition, carries with it the eternal human values. Confucianism had not only dominated the ethical life of the most Chinese people for the past two millennia, but also has reshown its irreplaceable functions as a cultural and spiritual force in the current time of China, though the most time of this century has witnessed Chinese intellectuals' voluntary and involuntary attacking and abandoning of it.

The discussion argues for a Confucian Bioethics because the author concedes, though regrettably, the fact that there are fundamentally different understandings of Confucianism as well as its bearings on particular bioethical issues. Nevertheless, mainly basing on Confucius' Analects, this presentation offers one substantial interpretation of the Confucian ethics and bioethics - its structures, perspectives, and implications for current China.

The author demonstrates why Confucian ethics, put in broadly-used western ethical terms contexts, is neither a sort of deontological doctrine, nor a kind of teleological theory. It is rather a concrete theory of human perfectionism. In other words, it is a particular virtue theory. Adequately understood, Confucianism in this way has significantly enriched forms and structures that ethical theories could take.

The particular moral teachings of Confucianism, under my interpretation, is characteristic of a relationalistic universalizability, in contrast to the individualistic universalizability of Christianity. This character has to a great extent shaped the Confucian way of thinking through life, health, disease, suffering, and death.

The current time of reforming provides the Chinese intellectuals a good opportunity of re-considering and re-assessing the economic, social, bioethical, and political implications of Confucianism. The Confucian ethicists and bioethicists should not claim Confucianism to restore to its apparent status of being an orthodox state-faith in many past centuries. Instead, they ought to work for the Confucian community, as one moral community in the modern large-scale state of China, to pursue its own peaceful and moral goals. In such a community, Confucianism will be taken very seriously.

A CASE FOR VOLUNTARY EUTHANASIA - Fu Ping, Department of Philosophy

Peking University, Beijing, China

Euthanasia is a responsible decision and a choice of the way of dying made by the hopelessly and terminally ill in order to avoid unbearable pain and suffering. It is a particular way of dying or of an assisted suicide. It concerns whether these kind of patients have the moral right to the choice of painless dying, and whether physicians have the moral obligation to assist them to die painlessly. So (1) those to whom is practiced euthanasia are hopelessly and terminally ill with unbearable pain and sufferings; (2) the primary purpose of euthanasia is to relieve those patients' pain and sufferings; and (3) euthanasia must be practiced on the basis of patient's voluntariness and by physician with appropriate method.

The arguments against voluntary euthanasia mainly come from religious tradition; and consequentialism: its ethical approval or legalization will lead to negative consequences. The arguments for voluntary euthanasia come from the principle that each individual has the right to self-determination of his/her own body and life including the right to death, and nobody has the right to prevent it. Other arguments include that the right to life is not absolute, can be waived by the owner of the life. The justification of voluntary euthanasia should be that it is a humanitarian action and the individual can make the decision on how to end his/her right to life.

MEDICAL GENETICS SERVICES AND ITS BIOETHICS - Norio Fujiki, Masaru Kuriyama, Mikio Hirayama, Takeshi Azuma, Department of Medicine, Fukui Medical School, Japan

Through the clinical application of human genetic knowledge, early diagnosis, neonatal mass screening, prenatal diagnosis followed selective abortion as well as carrier detection for genetic diseases and genetic counseling together with such preventive measures as the prohibition of inbreeding in eugenic laws and promotion of family planning, have been most effective.

For 40 years, we have performed these services in 3 different units and collected over 3,500 cases and follow-up study, which showed our counseling was accepted and had good result.

Our domestic and international opinion surveys told that limited knowledge of the heredity and handicap might lead to misunderstanding and prejudice, and compared the attitude in different countries with different religious and cultural backgrounds.

It is the duty of medical geneticists as special advisers to cooperate with the people in mass media and to provide information that is accurate and easy to understand for general public. We, with MURS and UNESCO-IBC, agree our scientific knowledge should be used only to promote the human dignity and preserve the integrity of scientific knowledge.

TOWARDS A GLOBAL ETHICS - AND BIOETHICS - Fausto Gomez, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, the Philippines

There is today a growing and widening concern for a global ethics, or an ethics to be accepted by all humans. In this context, it is worthwhile to consider seriously the Declaration on a Global Ethics (Parliament of the Religions of the World: Chicago, 1993). Its basic condition: Every human being ought to be treated in a human way. Its four required orientations: A culture of nonviolence and respect for all life, of solidarity and a just economic order, of tolerance and a coherent style of life, and of equality and camaraderie between man and woman.

Hopefully, Bioethics will also promote this universal declaration and apply it to bioethical issues and concerns. After all, Bioethics is also searching for basic principles and values to be accepted by most, if not all, healthcare professionals: an ethics of life focused on the respect for human life and dignity, justice and solidarity: an ethics of the life-sciences that searches for the meaning of pain and suffering and death and happiness. Haberwas said that one of the functions of ethics is to help our inevitable vulnerability.

BIOMEDICAL ETHICS AT THE UNIVERSITY OF SANTO TOMAS, MANILA - Fausto Gomez, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, the Philippines

The Faculty of Medicine and Surgery of the University of Santo Tomas offers a four-year program in Bioethics. Our first year medical students consider the basic categories of Bioethics including the human person, freedom, law and conscience, and the fundamental principles, such as autonomy, non-maleficence, justice and solidarity. Our second year students take up the physician's relationships, in particular, doctor/patient relationships, doctor/doctor relationships, doctor/other healthcare professional relationships, doctor/society relationships. Third year students discuss curing and caring for patients, underscoring the bioethical issues connected with the beginning and the end of life: IVF, ET, abortion; euthanasia and allowing to die; organ transplantation; genetic engineering; human experimentation and research. With their respective consultants, our medical clerks present clinical cases and analyze them from a medical/ethical perspective.

RIGHTS ISSUES OF CHINESE PATIENTS IN THE PRIMARY CARE - Gu Yuan, Department of Social Medicine, Capital Medical University, Beijing, China

1. Patients' rights in the primary care: Contents and scopes of the primary care; Two kinds of models of health service: disease-centered (specialized doctors) vs. patient-centered (general practitioners). Meaning of 'the degree of patient's satisfaction' and its role in the assessment of the quality of primary care. 2. The present situation of the exercise of Chinese patients' right in the primary care (analysis of the results of a survey). 3. The claims made by Chinese patients in the primary care (analysis of the results of the survey). 4. The way of the exercise of patients' rights in the primary care - enhancing the consciousness of human rights and developing the general practitioners system.

WHAT JAPANESE BIOETHICS MAY LEARN FROM WESTERN BIOETHICS AND POLITICAL PHILOSOPHY - Kenzo Hamano, Department of Foreign Language, Nagoya Institute of Technology, Nagoya, Japan

It is often said that Western bioethics is too individualistic and right-oriented, while Japanese culture is group-oriented and has a better understanding of the importance of a variety of social relationships. Nevertheless, in this paper I would like to argue that Japanese bioethics can and must still learn from Western bioethics and political philosophy. Japanese society does not have a deep-rooted tradition of respect and support for individual efforts against various social pressures. It has yet to incorporate a real understanding of the transcultural core pertaining from Western individualism into its social structures, including medical institutions. This does not mean that Japanese bioethics should go so far as to ignore the undeniable fact that human beings are essentially social beings. Therefore, I will argue that Japanese bioethics can learn a lot from the liberalism versus communitarianism debate in the West.

BIOETHICS AND CONFUCIANISM - He Lun and Xu Mingzhou, Unit for Medical Humanities, Nanjing Railway Medical College, Nanjing, China

It is one of the background in which bioethics emerged in the West that modern medicine seems to lose its human spirits and lead to dehumanization with the application of advanced technologies in medicine and the penetration of scientific thinking into the healthcare field. This is a lesson we who come from East Asian countries have to learn. Confucian medicine closely combines medical technique with humanistic spirits. "Medicine is the art of humanness" is an accurate expression of the relationship between medicine and Confucianism.

In the East Asian countries that are influenced by Confucianism, some concepts or principles raised in the West may conflict with Confucianism, such as brain death, euthanasia, autonomy, informed consent, reproductive technology and hospices, etc. For example, medical decisions used to be made not by the patient him/herself, but by his/her close relatives. In the Regulation of Hospital Management drafted by the Ministry of Health it is stipulated that surgical operation will not be performed unless the informed consent is obtained from the relative. So great importance is put on the human relationship but not on individual autonomy.

Bioethics in East Asia must have and certainly has its own characteristics, one of which is that Confucian ethics and philosophy would become a part of the theories of bioethics in East Asia, e.g. taking ren (humaneness, benevolence, kindheartedness) as the kernel of the theory of interpersonal relationship, including physician-patient relationship; respecting human life and extending it to all forms of life; taking the doctrine of the mean - not going to extremes - as a way of finding the solutions of some moral dilemmas. Confucian thoughts will be not only necessary for the bioethics of East Asia, but also enrich bioethics in the world.

CROSS-CULTURAL VALUE JUDGMENTS IN TERMINAL CARE ETHICS - Edwin C. Hui, Regent College, University of British Columbia, Vancouver, Canada

Futility determinations are complex and difficult decisions for lack of universally accepted criteria. Physiologic (Youngner SJ, JAMA 264, 1988), qualitative (Bedell et al., NEJM 309, 1983), and quantitative (Schneidermann et al.. AIntM 112, 1990) criteria have been proposed; all have some usefulness, but none can be considered value-free, morality-neutral guides. Value judgments of both physicians and patients are involved in all futility determinations. Autonomy favors giving priority to patient values in futility determinations (Lantos et al., AmJM 87, 1989); many argue for physician priority on basis of physician's qualification, duty, moral obligation and autonomy (Murphy DJ, JAMA 260, 1988; Tomlinson/Brody JAMA 264, 1990). A model of shared decision-making (Am. Thoracic Soc., 1991) in context of socially sanctioned standards may be a viable alternative, particularly in a cross-cultural setting where physicians and patients may hold widely divergent views regarding patient informed consent, disclosure of ill-fated information and death/dying issues. For example, whereas the West is preoccupied with autonomy and individualistic self-determination, East Asian cultures emphasize family participation in decision-making, especially in terminal illnesses of the elderly. Filial piety also obligates the children to be the primary decision-maker. Full disclosure of poor prognosis to the sick is considered a maleficent act, and may be interpreted as a form of abandonment by the physician. The patient and family may have radically different reactions towards death: depending on their allegiance to either Confucianist, philosophical Taoist, religious Taoist or Buddhist teaching, it may respectively be resistance, acceptance, desperation and resignation. Conflicts arise when western medicine fails to consider Asian cultural values which must be understood and taken into consideration in medical decision-making especially futility determinations (Muller/Desmond, WJM 157, 1992).

CONFUCIAN PERSONHOOD AND BIOETHICS - P. K. Ip, School of Arts & Social Sciences, Open Learning Institute of Hong Kong, Hong Kong

Though it is said that Confucianism endorses a relatively rich notion of a moral person, how that notion of moral personhood relates to bioethics has seldom been clearly articulated and critically scrutinized. The paper tries to articulate a notion of Confucian personhood within the bioethical context and to examine how the notion relates to areas of doctor-patient relationships; experimentation on human subjects; abortion, human reproduction, euthanasia, and organ transplantation.

It is argued that the familial collectivism entailed by Confucianism is either incompatible with, or too weak to sustain, a right-based notion of personhood. The Confucian moral architecture as represented by the Ren-I-Li normative system largely underdetermines a notion of a right-based personhood which is vital to bioethics as I see it. Institutionally, the family, society and the state as basic institutions provided the major institutional factors which functioned as external (social) inhibitors for the development of a right-based person. They failed to provide the necessary social niche within which the right-based person could be developed. It is claimed that the meshing together of these conceptual and institutional factors has constituted a fatefully inhibitory barrier to the development of a right-based moral person in Chinese culture. The paper tries to examine the ramifications of this Confucian non-right-based notion of personhood in the above-mentioned bioethical areas.

CHINESE TRADITIONAL CULTURE AND GOALS OF MEDICINE, Jin Dajie, Peking Union Medical College & Qiu Renzong, Chinese Academy of Social Sciences, Beijing, China

The goals of medicine transcend medicine itself. The establishing of goals of medicine has been influenced by economic, political, religious and cultural factors. The influence of Chinese traditional culture on the goals of medicine in China cannot be ignored.

There is a naturalistic view of human life and death in Chinese traditional culture. Human life is the assembly of chi and human death is the dispersion of chi. Life is the follower of death and death is the beginning of life. So both life and death are seen as a happy thing, so-called "Red and White happy events" which should both be celebrated. The transformation from life to death or from death to life is a natural process like the change between day and night. It also means that we should view life and death from a cosmological perspective, not an individual perspective.

This view entails that we should not be pleased with life and disgusted with death. Both life and death are inescapable. So we have to look at life as work and death as rest. From an individual perspective the death of someone is a loss, but from a cosmological perspective, there is no loss at all - Nothing to be worried about.

Individual perspective is a layman's perspective, and the role of philosophy is to educate laymen to view everything with a sage's vision. Everybody can be a sage. A sage's view is a view getting rid of the boundary of his own self, and overlooking everything from Nature - nature and man are unity. And for a sage life is valuable, only the life is meaningful, i.e. to live in conformity with ethical norms. If there is an alternative between life and humaneness/righteousness, we should chose the latter not the former. The difference between human being and animal lies in that the former care for others, and the latter only for itself.

The implication of this view for the goals of medicine is: Medicine should not pretend to help people to escape death or conquer death, only to prevent them not to die a natural death. It means that the life should not be artificially extended, or dying should not unnaturally proceed, also any action which deprives the patient of natural life is wrong. But a meaningless life should not be extended. The priority is put on the quality of life over the length of life.

Holistic socio-political philosophy in Chinese traditional culture puts priority on community or society over individuals, and views the human being not as an atom, but as a drop of the sea. One consequence is more emphasis on duty but less on rights. People are always trained to consider community's or society's interest not his own. So to respect patient's autonomy should never be an ethical principle in medicine. And beneficence is calculated on the balance of individual, family, community, society, the planet and the universe, not solely on individual basis. On the one hand, individual interest is easily ignored in the allocation of resources; on the other, the balance of interests between individual, family, community and society is easily considered too.

NURSING ETHICS AND DIALOGUE BETWEEN PHILOSOPHICAL AND RELIGIOUS BIOETHICS - Frank J. Leavitt, Jakobovits Centre for Jewish Medical Ethics, Faculty of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel

Nurses sometimes face a conflict between their duty to give a patient the best care, and their loyalty to their employing physicians and institutions. When a nurse feels ethically obliged to complain about negligence or malpractice, there may also be a serious risk of loss of employment and income. This ethical problem may be approached from the standpoint of religious authority. This paper describes my experience as a philosophical bioethicist in trying to achieve harmonious Asian-style dialogue with Israeli religious authorities on this specific issue. Conclusions will be drawn for cross-cultural West and East Asian bioethics. In particular: 1. Is moral autonomy desirable and possible for employees in a hierarchical institution such as a hospital? 2. Does the nurse-patient relationship require special inter-cultural understanding? 3. In societies where a large percentage but not all of the people accept religious authority, what strategies are available for cooperation and dialogue between philosophical and religious bioethics?

A SURVEY ON THE PRACTICE OF EUTHANASIA IN WUHAN URBAN AREA - Liu Xinhui, Wuhan Public Health and Anti-Epidemic Station, Wuhan, China

To find out the practice of euthanasia in Wuhan urban area, a sample of 501 cases was drawn from all deaths in 1993 in Jiang'an District of Wuhan City and a questionnaire sent to dead person's family members, 302 responses were received. At the terminal stage of life, 4(1.3%) of patients died of active euthanasia, 35(11.6%) of non-treatment, 55(18.2%) were administered only by general infusion (such as N.S., glucose, antibiotic, etc.), 30(9.9%) by high doses of analgesic in order to alleviate pain and symptoms. 173(57.3%) were treated actively till death. When patients were asked about medical decision, 13(4.3%) of all cases requested euthanasia, 19(6.3%) refused to continue treatment, 119(39.4%) were no comment, so arranged by his/her family or doctor.

During the nursing, 63(20.9%) of cases requested to euthanasia, the times of request was 1-21(x = 4.84), the time during twice requests was 1-90 days(x = 16 days), 34(56.7%) among them have committed suicide: 75% had once, 8.8% twice, and 17.7% had more than three. 15(46.9%) died of suicide. The most frequent reasons for the request to euthanasia include: 77.6% of all cases for avoiding sufferings, 61.7% avoiding being a burden to his family or the society, 51.7% for unwilling to meaninglessly prolong dying and wait for the coming of death, 25.9% for tiredness of life, 20.7% for losing the dignity, and 25.5% for other reasons. When patients requested euthanasia, they were in a sorry plight. 70.7% of all cases knew that it was difficult to recover from the illness, 61.8% plunged into disability, 78.6% could not bear the sufferings, the family economic condition getting worse was 31.4%, the relation between the patient's family members being tense 28.8%.

The results suggest that in the urban area not only passive euthanasia but also active euthanasia have been practiced, although active euthanasia is not legal in China. The request of patients who were at the terminal stage of life was serious, after all 4.6% of all cases left the world by suicide.


Objectives: To assess the current terminal care management patterns in a university hospital surgical ICU; to explore the ethical, medical, legal and economic issues in making medical decisions for the hopelessly ill patients in the unit.

Design: The charts and the ICU flow sheets of all patients who died at the surgical ICU during a consecutive 9 year period were reviewed. The patient information that was collected included age, sex, TISS, length of ICU stay, primary and secondary diagnosis, terminal care management, method of payment. According to the terminal care management patients were divided into 'Full treatment group' and 'Treatment forgone group'. Statistical analysis of data was by analysis of Chi-square test and Student's t-test.

Setting: Surgical ICU in a 1,200 bed university teaching hospital.

Patients: Consecutive 102 patients who died at the surgical ICU during 1985-1994 period. Brain-dead patients were included in the study.

Measurements and main results: A total of 90 (88.2%) of the 102 patients who died during the period had a full life-support terminal care (Full treatment group), while 12 (11.8%) had some decision to forgo (withhold or withdraw) life-sustaining treatment (Treatment forgone group). There were no significant difference in age, sex, TISS, length of ICU stay, primary and secondary diagnosis between the two groups, only the method of payment had significant difference (p>0.05); 'Treatment forgone group' had higher percentage of private payment (50% vs. 26%). A total of 26 (25.5%) of 102 patients who died were brain-dead patients, among hem 21 (20.6%) had received full life-support treatment.

Conclusions: The terminal care management pattern in this surgical ICU is still a traditional one: almost all terminally ill patients, including brain-dead patients, in the unit had a full life-support treatment until death, and there was no change in that behavior over the 9 year period. The possible reasons for this situation are: 1. The lack of law and institutional policy on the care of the hopelessly ill patients. 2. The imperfection in the current medical service system in the country. 3. The culture, ethics, traditions and people educational level all have big influence on decision-making for the terminally ill patients.

I-CHING (THE BOOK OF CHANGES) AS A SOURCE OF WISDOM FOR EAST ASIAN BIOETHICS - Lo Ping-cheung, Centre for Applied Ethics, Hong Kong Baptist University, Hong Kong

Central to many bioethical issues is a fundamental issue, viz., how should human beings relate to nature (biological nature in particular)? A related issue is: to what extent should we employ biotechnology? When we come to such a fundamental issue as the relationship between human beings and nature, East Asians need to drink from their own well. They need to draw on the spiritual resource in their cultures; to be a slavish copy cat of the west is undesirable.

I-Ching (The Book of Changes) has a tremendous influence on the way of thinking of east Asian people. The basic units of I-Ching are the eight trigrams. Each trigram is symbolic of the entire cosmos -- Earth, Human Beings, and Heaven. Different trigrams and hexagrams represent different interactions among the triad. No matter how the interactions change, what is not changed is that human beings never decide and act all by themselves, but in constant interaction with Heaven and Earth. The Tao of Earth, the Tao of Human Beings, and the Tao of Heaven are in a comprehensive harmony.

I think this vision of the relationship between human beings and nature, upon careful reformulation, will be a fountain of profound wisdom for East Asian bioethics. I shall illustrate this claim by discussing some issues in artificial reproduction (AID, AIH, IVF, surrogate motherhood, etc.).

TRADITIONAL CHINESE MEDICINE AND GOALS OF MEDICINE - Lu Weibo, Chinese Academy of Traditional Chinese Medicine, Beijing, China

Treating the diseases and promoting the health of mankind , are the common goals of medicine of both traditional Chinese medicine (TCM) and modern Western medicine (WM), but the difference lies in their viewpoints about the health and diseases as well as the methods to treat them, hence the result varied.

As it enters a new country or region, the WM that has been integrated with modern science usually despises and discriminates against the local traditional medicine, eventually takes its place. It was the same for TCM in China. However, since 1954 a situation of two medical systems' coexistence has been formed and consolidated.

TCM and WM belongs to the Oriental and Western culture respectively. A long-term coexistence inevitably yields mutual permeation and complementation to produce new frontier sciences. The advantage of WM is in its methodology. Using modern scientific, biological, patho-physiological knowledge with sophisticated equipments for observation, as well as the meticulous analytical method, that greatly elevated the cognition level of the human body, the health and diseases. TCM also benefited by these means in knowing more about the above-mentioned aspects. But it has shortcomings: Surplus in analysis and deficient in synthesis; the cognition progresses from cytological to molecular level, it becomes more and more precise, buy insufficient in holistic approach; it stresses on the pathogen, but neglects the patients the pathogen invades; it makes differential diagnosis of the diseases, not the Syndrome differentiation in TCM; it pays too much attention to the general character of patients, while ignores the individual specificity of each patient. The efficacy of WM on acute diseases which are pathogen dominant would be better, but not so good effect in treating chronic diseases, in which the internal disturbance plays the dominant role. The diagnostic-therapeutical model of combining the differential diagnosis of disease in WM and Syndrome differentiation in TCM is prevalent in clinical practice in current China.

The pathogenesis of a disease is not only due to the pathogen, the most important is that the pathogen-vitality (Xie-Zheng) balance is responsible. The same pathogen, whenever it is stronger than the vitality, disease occurs; but if the vitality is strong, disease would not happen. Such a Xie-Zheng balance hypothesis could explain the acute disease, the fulminant disease, the mild disease, the subacute disease, the chronic disease, the atypical disease and bacteria carrier. To introduce the concept of patient into pathogenesis is vital. To consider the pathogen together with patient in pathogenesis is significant both in diagnosis and treatment, treat the patient individually would certainly enhance the efficacy.

The potentiality of human being (ability of spontaneous cure) is tremendous. Simply extermination of pathogens is one of the treating methods, but not the only one, also not the best one. It is better to remove the pathogens through enhancing the vitality, or combine the enhancement of vitality with removing the pathogens, so that it not only elevates the efficacy, reduces the side-effects, but also could integrate the disease treatment and health promotion, therefore it is a wise approach to medical treatment.

Is it necessary to eliminate the pathogens completely during treatment? Or is it possible to promote its conversion from pathogenic to non-pathogenic, so as to reach a state of co-existence with mankind? Therefore it is less expensive with less side-effects. the carrier state is not harmful to the host, also a normal and common phenomenon in daily life. To such a non-aggressive organism, it is not necessary to eliminate it.

Promoting the internal balance and prevention: Mass immunization is a good preventive measure. But TCM takes that in order to carry on the individual prevention strategy, one should promote the health with every means such as acupuncture, Qigong, Chinese massage, breathing therapy, etc. So as to strengthen the ability to maintain the internal balance of Yin-Yang, to reach "Whenever the vitality exists, the pathogen becomes non-pathogenic". Such a state is the real prevention of disease.

Huam body is extremely complicated. The development of modern physiology, pathology and immunology provides abundant and precise knowledge on circulatory, digestive, neurological and endocrinological systems, but it is far from reaching the peak of cognition. There are too many phenomena that were unable to elucidate. It is necessary to absorb every piece of useful viewpoint and concept from different sources.

Therefore, the viewpoint of integration of TCM and WM is to take the advantages of both medical systems, so to produce new "species of hybridization". It is a correct approach to dealing with the relationship of disease and health, to promoting the conversion of various diseases to the healthy state, as well as the effective measures to solve the problems of Goals of Medicine and medial crisis.

BIOETHICS: DESCRIPTIVE OR PRESCRIPTIVE? - Darryl Macer, Institute of Biological Sciences, University of Tsukuba, Tsukuba Science City, Japan

There are two ways to think of the term bioethics, one is as descriptive bioethics - the way people view life and their moral interactions and responsibilities with life. The other is prescriptive bioethics - to say what is good or bad, what principles are most important, or that people have rights and therefore others have duties to them. The word "bioethics" means the study of ethical issues arising from human involvement with life, and I have called it simply the "love of life".

The International Bioethics Survey performed in 1993 in Australia, Hong Kong, India, Israel, Japan, New Zealand, the Philippines, Russia, Singapore and Thailand will be used to consider the issue of how universal bioethics is. The topics included attitudes to science; environmental concerns; genetic engineering; privacy; genetic diseases and AIDS; prenatal genetic screening; gene therapy; assisted reproductive technology; and education.

The future of bioethics and universality are major issues in bioethics in Asia today. The role that bioethics networks such as the Eubios Ethics Institute and the bimonthly Eubios Journal of Asian and International Bioethics (EJAIB) will be discussed. (EJAIB and many other papers and books are on-line on the Internet: http://eubios.info/EJAIB.html) (Paper in EJAIB 5 (1995), 144-6.

ETHICS EDUCATION IN MEDICAL SCHOOLS IN 15 ASIAN COUNTRIES - AN OVERVIEW: QUESTIONNAIRE SURVEY - Michio Miyasaka, Akira Akabayashi, Ichiro Kai, and Gen Ohi, School of International Health, The University of Tokyo, Tokyo, Japan

An overview survey was conducted to study the current state of medical ethics education in Asia. Deans of 427 medical schools in 22 countries were asked to fill out a questionnaire regarding ethics-concerned courses at their schools and their attitude towards medical ethics education. The response rate was 60 to 100% in 11 countries, 10 to 50% in four countries. Out of the medical schools in 15 countries, almost 90% reported to have courses in which ethical topics were dealt with. Around 70% specified the courses as Medical Ethics ( including Bioethics, Biomedical Ethics, Ethics in Medicine, etc.), but in countries like Japan, ethics was more often taught as a unit of other courses. The course schedule varied greatly; 38% of medical schools offered only pre-clinical courses while 46% provided ethics courses during clinical training years. Diversity was also considerable as to the characteristics of ethics courses they favored (e.g. length of course, training backgrounds of teachers, demand for medical ethics specialists, and ethical topics to be prioritized, etc.). The survey suggests wide spread aspiration for ethical training among Asian medical schools. However, the course content and type of provision are diverse.


In order to see the ethical sentiments of public health workers in eight countries in Asia-Pacific region, we conducted a questionnaire study regarding a hypothetical situation: An AIDS vaccine phase III trial to be conducted in each country.

Results: 1. In every country, the majority favored obtaining a documented consent from the volunteers for participation in the project. However, in Southeast Asia the consent of community leader and family members was also regarded to be important. 2. There were marked regional variations in the attitude towards truth disclosure to participants as to HIV infections and procedures to prevent possible discriminations against HIV infected individuals. 3. Acceptability of the trial appeared to grow in parallel with the size of HIV epidemic in the country.

Conclusion: Ethical sentiment favoring autonomy of an individual appears on the rise among the public health workers in the areas where traditional mutual support is still dominant. The magnitude of AIDS epidemic appears to enhance the acceptability of the project.

BIOLOGICAL ISSUES OF PATENTING HUMAN GENES - Miyako Okada-Takagi, Toyoko Gakuen Women's College, Tokyo, Japan

The human genome projects aim to sequence all this DNA. The research results will provide new knowledge about the importance of the genes to characteristics and diseases in man. When inventions pertaining to the human genome are patented, the biological issues may arise as well as the legal and ethical problems. Primarily there is the difference between the physical concept and informative content of the gene. For instance, should the entire gene be patented? This means how to treat non protein coding DNA. Besides how about RNA as a information source instead of DNA? The use of such molecule no longer provides special protection as a patent on a DNA sequence. Since several combinations code for the same amino acid, the same information can be contained in many different DNA molecules. In a patent context, it may cause problems of interpretation.

CREATE MEANING IN CARING WORK: CARING SCHOLARS IN CHINA - Mei-che Samantha Pang, Department of Social Sciences, The Hong Kong Polytechnic University, Hong Kong

Whilst literature related to nursing as caring is proliferating in the West, China's nurses rarely got their voice heard beyond the Chinese border. In reviewing the recent nursing publications in the Mainland, it is found that there are regularly journal articles discussing issues related to professional morality in the referred nursing journal Chinese Nursing Journal in the past fifteen years. Caring is regarded as the moral foundation for nursing practice and a virtue to be cultivated in nurses. The Chinese term hu-shi is used to denote nurse when nursing was first introduced in China in the early 20th century. It is meant to reflect the idea of nursing as scholarly caring activities professed by knowledgeable and skillful nurses. Nonetheless, it is ironic to note that the term nurse means 'caring scholar' in Chinese but caring for the sick is regarded as low status work. The whole structure of traditional values also discourages women of good education to enter the profession. Confronting a society with a great demand but one that gives no due respect to people who engage in caring work, China's nurses meet the challenge by endeavoring to transform nurses' concept of care by creating meanings to the caring work. Three themes are identified in the literature: Self sacrifice as core value; Treating patient as one's family member; and Nursing as therapeutic work. The concerned effort aims to lift the caring work on a plane of moral obligation to become a respectable occupation in which the most unpleasant work can be ennobled by a sense of devotion to great cause.

THE GOALS OF MEDICINE AND PUBLIC HEALTH - Peng Ruicong, President, Beijing Medical University, Beijing, China

Recently many scholars trace the schism of medicine and public health since 1916 with the establishing of schools of public health supported by Rockefeller Foundation in USA.

At that time the schools of public health were established for enhancing the research and training programs in public health. But one of the unexpected consequences is that it seems the mission of medical schools is limited to curative medicine and basic medicine. The goals of medicine seem to be avoiding death, decreasing the morbidity and rehabilitation. Disease prevention, health promotion, and health protection are less related to medicine. So many scholars advice that it is the right time to integrate medicine with public health.

Dating back to about 100 years ago, public health has had many encouraging success including the improvement of sanitation, living conditions, nutritional status, and education, especially the maternal and child care programs led to sustained drop in infant mortality rate and maternal deaths, and EPI led to better control of communicable diseases. Later the clinical medicine is well developed in the past 50 years, so to the public it seems only clinical medicine covers the whole field of medicine. But 'medicine care crisis" has happened in some developed countries. The contemporary treatments for chronic diseases and degenerative diseases and elderly's quality of life is quite unsatisfactory. So some health professionals anticipated that there will be a second health revolution with the focus on the preventive measures. We must put more stress on health rather than disease, on the group rather than individual, on care rather than cure. To reach the goal of medicine, the reorientation of medical research, education and health delivery system is on schedule.

ON ACTIVIST ATTITUDE TOWARD DEATH - Qiu Renzong, Chinese Academy of Social Sciences, Beijing, China

The prevailing attitude toward death affects the goals of medicine in any culture. Our primitive ancestors had no concept of death, because consciousness of death requires a separation of individual identity from that of the tribe. Later they saw death as the result of evil powers inflicted by human or spiritual enemies, and believed that death is unnatural, avoidable or reversible even after their death. In pre-modern era there has been a long-standing philosophical struggle to come to terms with their own deaths: death is a total annihilation of life, or there is some form of life existed after death: transmigration and ultimate release from the world, immortality of soul, or resurrection of body.

Modern spirit characterized as instrumental activist has a new attitude toward death. Modern people tend to focus on the active and rational control of day-to-day events. This orientation is basic both to technological society and to the biomedical attack to death: this activist approach to nature produced the biological revolution, which in turn has made possible the attack on death.

From activist viewpoint, death is natural. However, death has to be conquered as well as nature has to be. Both death and nature are treated as enemy. And its technological optimism or its belief in the omnipotence of science makes it believe that death can be conquered.

It has been recognized that there are two aspects of death: inevitable and adventitious, including "premature" death that can be avoided by human measures and deliberately imposed death such as war or capital punishment. The death which is potentially subject to some kind of human control comprises the "uncertainty" of death, as distinguished from its "inevitability". Instrumental activism's rational orientation of control cannot apply to the "inevitable" aspect of death. Scientific biomedicine has been successfully preventing premature death and extending life, but the line between them is ambiguous. The activist approach tends to push the line from the inevitable pole back to premature pole. However, together with the power to extend life, we have the equally potent capacity to dilute the quality of life beyond recognition, countless hopelessly ill and suffering patients literally cannot avoid and are tormented by the painful, intolerable death-prolonging intervention or simply we lost the fight in the battlefield of inevitable death and at the same time left many hopeful patients in helplessness.

More important is that not one piece of medical research has ever told us a thing about the meaning of death which is necessary for defining attitudes regarding both the deaths of others and the prospect of one's own death. We have responsibility not only to prevent premature death, but also to care for a patient dying with dignity and in peace.


(1) Making decisions and giving directives in advance is part of prudent personal and professional risk management.

(2) Advance Medical Directives are rarely accepted by patients or potential patients and even more rarely accepted by health care professionals, there is an individual and cultural reluctance to deal with issues of personal suffering, weakness, dying and death in Eastern and in Western cultures; physicians tend to avoid such issues by providing best care following objective standards without individualized patient care.

(3) Anglo-American bioethics bases the quest for Advance Directives on the principle of Autonomy; but modern medicine has many options to provide individualized patient-oriented treatment even at the end of life, therefore it is primarily a question of best clinical care to integrate the patient's `value status' with her or his `blood status' for intervention decision making.

(4) Traditional Advance Directives, written primarily by legal experts (for other legal experts) are difficult to be translated into clinical practice. A validated narrative form of Advance Directives will be presented and its use in different cultural, familial, and individual settings discussed.

(5) While the principle of individual autonomy is not the prime principle for many individuals, traditions and professional cultures, the principle of `best clinical care' is indispensable in all professional and public cultures.

(6) Traditional cultures might prefer to give the family a more essential role in decision making and directives.

(7) Surrogate decision making plays an important role in caring for the incompetent and incapacitated, medical and cultural issues will be discussed from a cross-cultural perspective.

(8) A well tested and validated culturally sensitive universal instrument, containing a proxy, a value amanuensis, and a medical directive will be presented.

AN APPROACH TO BIOETHICS FROM THE PERSPECTIVE OF BUDDHIST PHILOSOPHY: Japanese Patients' Attitude towards Self-determination As Related to the Basis of Their World Views - Masahiko Sato, Taisho University, Tokyo, Japan

When we consider the premises of the East Asian world view, the influence of Buddhism cannot be ignored. Even at present, Japanese people are not familiar with the posture of self-determination, and the relationship of patients and their families to medical care providers in Japan tends to be based on the dependence of patients and their families on their medical care providers. This has been attributed to some extent to the traditional sense of morality of Japanese people, who tend to be particularly respectful of specialists such as physicians.

Some people misunderstand the basic Buddhist idea as pursuit of a completely ego-free state and denial of all expression of one's self. I, on the other hand, think that individual self-determination can be regarded as consistent with essential Buddhist philosophy. I will report on the current relationship of Buddhism to Bioethics in Japan, and discuss what we should do to have this approach understood and adopted by people in East Asia and other countries around the world.

TO HAVE A VIRTUOUS BIRTH AS WELL AS A VIRTUOUS DEATH - AN OBJECTIVE SET BY SOCIAL NORM - Shen Mingxian, Department of Philosophy, Shanghai Academy of Social Sciences, Shanghai, China

The well-known philosopher Xun Kuang two thousand years ago once said: "Birth is the beginning of human life, while death its end. If both take place with virtue, then the objective set by social norm is realized." (Xun Zi) The statement reflects the deep insight into life and death in ancient China and its proper claim can be developed into a philosophical foundation of East Asian Bioethics.

As compared with western culture, Chinese traditional culture has laid emphasis on life but with little attention paid to death. It also upheld the philosophy of life superiority and life sanctity.

Such a view on life and death is much concerned with physiological and psychological elements of human beings, the idea of filial piety and the philosophy of fatalism.

In addition, the ancient Chinese sages had already understood that life and death belong to natural phenomena and governed by natural law which possesses the value transcending life and death. For instance, we can find such a statement by ancient sages: life and death is something quite natural. No one can live an eternal life. But it is not easy to have virtuous life.

Though obviously up to now these thoughts still have the splendor of wisdom, they are not directed to the field of medicine. If they are to be introduced into medicine, it is necessary to give them some innovative interpretation and what is the most important is to absorb the concept of right to, and value of life. Only by taking it as the medium of relation and transformation between the right to, and value of life and death it is possible to realize the objective mentioned in the title.

There are many reasonable elements in Chinese traditional view of life. If we can develop new understanding about it, it surely will be full of new vitality.

TERMINAL CARE IN RURAL AREAS IN CHINA - Shi Rong, Shanghai Medical College, Shanghai, China

It was estimated that by the end of this century China's population will amount to 1.27 billion, and the percentage of the elderly among it will be 10.4%, i.e. 130 million. At present the population in rural areas amounts to 900 million, about half of the elderly live there. Traditionally, the majority of Chinese people in rural areas died at home. A survey on 813 dead shows that 52% of them died at home, the percentage increases with the older age. The elderly between 70-80 years old all died at home. Almost all elderly hope that they could be cared for by their family members. The Confucian principle of filial piety plays a great role in it.

All over China including the poorest areas the cases of communicable diseases steadily decrease. Now the main killers are chronic diseases. Among 813 dead surveyed 675 died from cardio- and cerebro-vascular diseases, cancer and respiratory diseases in the order of incidence. 377(56%) of them died at home. Although there has been a rapid development of rural economy in recent years, but the input of resources is not sufficient to establish a great number of hospitals for the elderly. The family terminal care will be a way of less input and more output in rural areas. The family terminal care in rural areas has to rely on country doctors (former bare-footed doctors) who amount to 1.20 million working in 700 thousand villages. However, the family terminal care should be incorporated into the comprehensive programs for elderly's health care, and has an effective and ethical policy.

THE BIOETHICS EDUCATION AT SAGA MEDICAL SCHOOL - Masashi Shirahama, Mituse National Health Insurance Clinic, Department of General Medicine, Saga Medical School, Japan

Bioethics education at Saga Medical School is as follows:

(1) Overview of Medicine Course for the first year medical students: Students spend one full day at an institution for handicapped children or at mental hospital to help in the care of patients. From this year, we incorporated workshops to have students debate on controversial medical topics such as "Brain death and organ transplantation", "Truth telling to cancer patients", "Surrogate mother" and "Normalization of handicapped".

(2) Clinical Exposure Exercise for third year medical students: students spend one evening assisting nurses on duty at the University Hospital.

(3) Introduction to Clinical Medicine Course for 4th year students: mandatory unit before starting bedside learning of 5th year. This includes lectures on "How to develop a good patient-doctor relationship", "Terminal care", "Clinical ethics", and exercises on "Interviewing training" as well as on physical examination.

(4) Elective Course in "Clinical Ethics" for 6th year students: students use 4-Box (Medical Indications, Patient Preferences, Quality of Life, Contextual Features) analysis by A. Jonsen (University of Washington) to analyze the dilemma which they encountered during their bedside assignments. Not only the physician staff of general medicine but also a lecturer of law and professors of sociology and philosophy join the discussion. Cases and their analysis are sent to bioethicists in Japan and USA by e-mail and fax to obtain their comments.

The goals of our Bioethics Education are summarized as follows: (1) To notice ethical dilemmas in daily medical practice. (2) To analyze the dilemmas by the method of clinical ethics. (3) To know the origin of the dilemmas and to solve them by using the method of Clinical Epidemiology and Critical Reading of Medical Literature. (4) To appreciate various aspects of the problem through inter-disciplinary and international discussion. (5) To encourage students to express their opinions and listen to another person's opinion (most clinical ethical problems are rooted in lack of communication).

THE CHINESE THEOLOGY OF LIFE AND MODERN CHRISTIAN ETHICAL SPIRIT - Sun Muyi, Center on Applied Ethics, Southeast University and Nanjing Railway Medical College, Nanjing, China

Theological consideration of Chinese Christians on science began in 1950s. They always think praxis is more important than faith, for the texts and dogmas are sacred only because they save all lives in the world. They emphasize that what biotechnology should and could do is to make all people enjoy peace and not suffer from calamity. This is the very ideal of theology, as it was said that return to the world and look after the planet and all lives. Chinese theologians interprets that not all things have to be decided by the God, and He fully respects human freedom, what He gives to people is love and hopes them live happily and pleasantly with sufferings. Biotechnology can help to realize the purpose - make people have a more happy life.

There were some cases in China in which Christian patients refused treatment because of their faith. This is due to a dogmatic interpretation of religious doctrines. Some surveys on issues of abortion and euthanasia among Christians show that the majority of Chinese Christians hope that people could have more meaningful, more valuable life without violating Christian doctrines.

A kind of awakening theology can make religion and medicine go to a new type of cooperation and complementarity. It views human beings as the center of the world, so should do biotechnology. This theology has produced a new impact on biotechnology. Bioethicists should work together with theologians to assess the consequences of biotechnology on human beings, and help it to take a human-centered approach.

RIGHT OF SELF-DECISION VERSUS PROFESSIONAL RESPONSIBILITIES IN INFORMED CONSENT - Toshiaki Takasu, Department of Neurology, Nihon University School of Medicine, Tokyo, Japan

To our patients we tell diagnosis and present ways of treatment. When we present only one way, our patients ask us if there is any other way. Then we explain to them the reason why we think that there is no better way. Our patients consider our explanation, then decide to accept our recommendation or not, instantly or after some time.

Some patients appear to have understood well what we explained to them, but others appear only to have believed us. This is the way we doctors usually take. Upon our request our patients sign on a form where the process taken before then sign is stated.

In any case doubt arises that they have not been able to understand the explanation fully because they have not been systematically educated. Even systematically educated persons may take wrong ways for themselves when they are sick. If so, all our patients must have only believed us; although they may have started to believe beyond different reaches. If this is the case too much emphasis on self-decision may burden our patients with excessive tasks and hinder us from taking professional responsibility fully, that will be a substantial loss to our patients.

PATIENT'S AUTONOMY VS. DOCTOR'S PROFESSIONAL INTEGRITY - Yasushi Tsukamoto, Kanto Central Hospital, Japan

In recent years there is world-wide tendency to stress the patient's autonomy, instead of doctor's paternalism, in daily medical practice. This tendency must be appreciated as `every human being of adult years and sound mind has a right to determine what shall be done with his own body'. But this autonomy sometimes conflicts with the doctor's professional integrity which is essentially a pro-life one.

In some western countries autonomy is legally admitted even in life-shortening procedures such as abortion (mother's autonomy) or the euthanasia in terminally ill patients. This year in Japan, the Science Council made a declaration about the terminal care of patient, including the admittance of the withdrawal of foods from PVS patient under the name of death with dignity. In a criminal case, the criteria of active euthanasia in a very ill patient were proposed, which must be done under doctor's hands.

These life-shortening procedures might be appreciated for the autonomy of patient, but the conscientious objection of doctor to become an actor of these procedures must be also accepted. Personal philosophy is different from doctor to doctor as it is in lay person.

WOMEN'S RIGHT TO REPRODUCTION IN THE CASE OF PREGNANT WOMEN WITH DRUG USE - Wang Yanguang, Department of Philosophy, The Graduate School, Chinese Academy of Social Sciences, Beijing, China

An ethical dilemma is: When a woman exercises her right to reproduction, and it will impose heavy burdens to herself, her future child, her family and the community, what is the solution? From the deontological viewpoint the principle of respect requires to respect the woman's right to reproductive autonomy. If the woman with drug use wants to conceive and even deliver the child, her decision should be respected. However, the principle has to be applied to child, who may or may not claim the right to being born from a drug use mother. From the consequentialist viewpoint conception and delivery of a child will do harm to herself, her child, and the third parties - her family and the community. To encourage her to take contraceptives will do good to her and others concerned. However, it may violate her right to reproduction, if she is very eager to have her own child, and all others insist that she has the responsibility to take contraceptives even against her own will. The better resolution of this dilemma could be found in the feminist theory of caring or care ethics. This dilemma should and could be resolved in a context in which the drug use woman and others concerned care each other. However, it cannot avoid them to reach an irrational decision, and it is also difficult to define who and what has to be cared. More emphasis on the principle of beneficence and integration of it with care ethics, the dilemma could be resolved on the basis of informed consent and shared decision-making.

GENETICS, ETHICS AND SOCIETY: PROCESS AND POLICY - Michael Yesley, Los Alamos National Laboratory, USA

Advances in genetics raise many ethical, legal and social issues related to such matters as privacy and discrimination, access to genetic services, pre-onset diagnosis of untreatable disorders, somatic and germ-line gene therapy, eugenics, gene patents, protection of human subjects of genetic research, and "geneticization" of social problems. Several organizations - public and private, national and international - are considering these issues and drafting declarations of principles to guide the development and use of genetic technology. But the different conditions and values of the peoples of the world impede the achievement of international, or even national, consensus in this area. Furthermore, most discussions of genetics issues are conducted without empirical data. Consequently, agreement about guiding principles may not be reached except at a level of generality and abstraction that serves little practical purpose.

Rather than devising broad, conclusory declarations, it would be more useful to address genetics issues with greater specificity, taking into account the varying conditions and values of those who will be affected by genetic technology. The resolution of issues in genetics, as in other areas of bioethics, will require consideration of both relevant facts and guiding principles. Even when there is agreement about principles, which will often be the case, their application to differing factual circumstances may produce different resolutions of the issues.


The rights approach to the problem of abortion formulates the controversy as a clash between the mother's right to her own body and the fetus' right to life. This approach captures the relationship between the mother and the fetus in an inadequate way, and is not very helpful in determining the rightness or wrongness of abortion in specific case. In this paper, the author considers how the recent individualism-communitarianism debate can shed light on the problem of abortion. The family is taken as a community in which the mother and the fetus are tied to each other in a special way. From this approach, the mother and the fetus are not considered as competitors but as fellows that have common interests. In many cases, whether an abortion is justified can be determined by asking if it is to the best interest of the mother-fetus unity as a whole. What the rights approach regards as an insoluble problem can sometimes be easily solved by communitarian approach. However, the author goes on to argue that the communitarian approach also reveals only a part of the whole picture. The mother and fetus have common interests but they also have conflicting interests sometimes. The (individual) rights approach is inadequate but we cannot dispense with the rights approach completely. The rights approach and the communitarian approach are complementary rather than adversary.

A HISTORY OF MEDICAL ETHICS IN CHINA AND THE WEST: A CROSS-CULTURAL PERSPECTIVE - Zhang Daqing, Center on History of Medicine, Beijing Medical University, Beijing, China

A comparative history of medical ethics between China and the West is studied from a cross-cultural perspective. This paper reviews historical evolution of medical ethics in China and the West in order to explain the effects of science and technology, cultural tradition, and socio-economic development on the thoughts of medical ethics.

The ethical dilemmas caused by modern technologies and healthcare system might be divided into two groups: those universal in all cultures and relative or culture-specific. The former is mainly caused by technologies and healthcare system, such as brain death, reproductive technology, allocation of health resources, and organ transplantation etc. The latter is mainly caused by the effects of cultural tradition on thoughts of medical ethics, such as different approaches to universal ethical issues and different interpretations of universal medico-ethical principles in different cultural context. However, there are conflicts between universalism and relativism, but it is necessary to keep a tension between them.

EUTHANASIA: LEGAL AND ETHICAL PERSPECTIVES - Zhu Wei and Liu Benren, Shanghai Medical University, Shanghai, China

Euthanasia is no longer a rare happening in China now. However, our recent study of 19 cases of active euthanasia shows that there are some troubles in its actual practices. We find out that the 19 cases of active euthanasia that we have investigated were all carried out secretly, and most of them only with the wishes of the family and the approval of the individual doctor. How can this medical act take place? Is it in accordance with the best interest in the patient? Does it mean that the patient has become terminally ill and euthanasia is the only possible way? What about the motive and the ultimate goal of the family and the individual doctor? All these questions remain unanswered. Therefore, we have come to the conclusion that euthanasia in China is still at a random and disorderly stage.

We feel that the fundamental reasons here are: 1. Legislation lagging behind. According to the present law, any form of euthanasia will be declared as illegal. But the fact is that euthanasia is now more and more practiced in our hospitals, and there simply are not any new legislative rules which can be carried out overtly and whether it is desirable to apply euthanasia to a certain patient or not mainly depends on the subjective wishes of the family and the individual doctors. 2. Ethical misconception. For a long time, we have believed that it is the duty for the family and the individual doctor to choose and decide medical treatment for he patient. Now they are abusing this power to even make decision on the matter of euthanasia for the patient. The biggest question here is: Does their decision reflect the best interests in the patient? Or rather the decision violates the patient's right?

Here are some suggestions that we think are essential in changing the situation. 1. We must make a new law to regulate the practice of euthanasia. The law must stipulate clearly and supervise the whole process of the practice of euthanasia. 3. Moreover, in order to help ordinary people walk out of the shadow of conventional ethics, the authorities concerned must set out to clarify and publicize the concept of euthanasia and its operational procedure.

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