- L.S. Rothenberg
Division of Medical Genetics, UCLA Department of Medicine,
Box 95-1736, Los Angeles, CA 90095-1736, USA Eubios Journal of Asian and International Bioethics 7 (1997), 46-47.
As Ruiping Fan has noted in a discussion of the differences in moral vocabulary and fundamental moral principles, whereas "[i]ndividual rights, liberty, autonomy, self-determination, equality, justice, fairness, etc. are integral to the moral vocabulary of modern Western people....for the Japanese people, the key moral concepts include 'Wa' (harmony)..., 'Amae' (dependence)..., and 'Taijisokuin' (great mercy)...." (Fan, 1997:192). Thus, for Fan, the crucial issue is "the standards by which one system determines how morally right-wrong distinctions are to be drawn and [are] not the same across systems," and that the two systems of Confucian ethics and of current Western ethics are so different and divergent that they are in fact not capable of being compared. (Fan, 1997:193). Fan concludes that "most Westerners and most Chinese or Japanese can be defined as moral strangers to each other." (Fan, 1997:197).
Leaving aside the statistical question of whether one can properly generalize about Japanese attitudes toward euthanasia on the basis of this small sample, it doesn't strike this Westerner as surprising, therefore, that Tanida should conclude that the degree of social acceptance in Japan of euthanasia is not related to an acceptance of the principle of autonomy. Indeed, the opposite finding would have been more surprising, but for the observations of Prof. Gen Ohi and others that, to use Prof. Ohi's words: "As Japanese society is increasingly exposed to heterogeneous cultures, it is beginning to accept cultural diversity with unprecedented speed." (Ohi, 1997:159; Hattori et al., 1991:1014-1015). This suggests that there is much value in Dr. Tanida's suggestion that the relationship between acceptance of euthanasia in Japan and the autonomy principle should be studied further since, among other reasons, it may serve as an indication of the extent to which Western moral principles are influencing Japanese culture and decision-making. The hypothesis has been offered that "Japanese families, as other families in urbanized and industrialized societies, are not as cohesive as in the past, and the economic affluence of Japan as well as Western influences have led to a more autonomy-focused ethical approach." (Rothenberg et al., 1996:351).
In conclusion, Masahiro Morioka has written
that "whether Japanese medical customs are restructured on
the basis of 'autonomy' and 'informed consent' in the future
or not will depend on how much Japanese society outside the hospital
is going to change toward a 'Western' style civil society."
(Morioka, 1995:89). Studies such as this one by Dr. Tanida assist
us in understanding the nature and rate of such changes, but cannot
answer the important question of whether such changes are desirable
from a Japanese perspective.
Fan R. Three levels of problems in cross-cultural explorations of bioethics: a methodological approach. pp. 189-199 in: Hoshino K (ed). Japanese and Western Bioethics: Studies in Moral Diversity, (Kluwer Academic Press, Dordrecht, 1997).
Hattori H, Salzberg SM, Kiang WP, Fujimiya T, Tejima Y, Furuno J. The patient s right to information in Japan: legal rules and doctors opinions. SSM 32 (1991), 1007-1016.
Morioka M. Bioethics and Japanese culture: brain death, patients rights, and cultural factors. EJAIB 5 (1995), 87-91.
Ohi G. Ethos and its changes: a commentary on Facing Death the Japanese Way - Customs and Ethos. pp. 155-159 in Hoshino K (ed). Japanese and Western Bioethics: Studies in Moral Diversity, (Kluwer Academic Press, Dordrecht, 1997).
Rothenberg LS, Merz JF, Wenger NS, Kagawa-Singer M, Macer DRJ, Tanabe N, Fukuhara S, Kurokawa K, Fuenzalida-Puelma HL, Figueroa P, Meran JG, Bernat E, Hosaka T, Marshall GN. The relationship of clinical and legal perspectives regarding medical treatment decision-making in four cultures. Annual Review of Law and Ethics 4 (1996), 335-379.