One Attempt at Bioethics Education in a High School Ethics Class

- Otani Izumi
Kokubunnji High School,
3-2-5, Shin-machi, Kokubunji-city, Tokyo 185-0004 Japan
Fax: +81-42-325-9833
Eubios Journal of Asian and International Bioethics 9 (1999), 78-79.

I have been teaching ethics at public high school for 16 years, and I have given lectures centred on bioethics for 12 years. Though we are still seeking the best style of lectures about bioethics, I would like to introduce my attempts briefly.

The bioethics that was developed in Europe and North America, proposed to study many issues concerning 'life' not only from the standpoint of medicine, but also from various perspectives such as law, economics, sociology, ethics, philosophy, religion, anthropology, etc. This interdisciplinary bioethics makes ethics a basic component of general studies, because issues concerning our life should never end in a game of abstract thoughts. They are issues of today which appear in the newspapers everyday. These require not only each individual to make decisions on their own way of life, but also the political leaders and bureaucrats to make decisions on public policies and assess the options, considering social acceptability. The ancient and familiar question "What are human-beings??" is very important. Because the improvement of medical treatment techniques demands us to clearly define the beginning and the end of human-beings' life.

In the ethics curriculum in high school there are themes like the dignity of human beings and reverence to life. In this discussion the word 'life' doesn't indicate biological 'life' but usually personal 'life'. Given this background, we can easily find the influence of theory of person of Kant. About personality he thought the human being was like a conductor who has self-consciousness and is rational and should be treated as an end in themselves. A conductor who has self-consciousness is self-determining and is entitled to receive respect from others. Self decision-making power, accepted as a basic principle in bioethics, is based upon the notion that the subject of the decision is the very 'est' who has self-consciousness. Also, this conductor is a moral agent who can act with responsibility. Thus, I think personalities, the existence who can take responsibility for their acts, bear infinite rights and obligations.

However when Kant considered the dignity of 'human beings' to mean they are respected as merely 'existent' having an end in themselves, he did not think of embryos, or, brain death or of vegetative state patients who don't have self-consciousness. Thus they may not be considered as a person whose life is to be prolonged but also could be considered as experimental objects and other medical resources. When we confront such problems like whether brain death is the death of a human being, so should we remove respirator from brain dead patients or not?, or in the treatment of Alzheimer's disease, is it permissible to use the brain tissue of aborted embryos ?, many questions arise. For example, How should human beings live? What is it for human beings to live? , What is human dignity? These go beyond the questions of 'basic human rights'.

Not all people confront these problems, but everybody could be confronted by them in a certain period of one's life. So, every person is required to have their own standard of selection or judgment on these issues. Each individual, is engaged in decision-making on public policies and evaluation including the acceptability to society. This needs objective understanding of human existence and value. The question "What is life?", lies between the 'quality of life' and 'sanctity of life ', and gives up-to-date and real meaning to Kant's personalism. It also stimulates consideration of inner reasoning. Considering the theory of the person of Kant in the context of bioethics, we can think the meaning of studying Kant today and the metaphysical meaning of studying bioethics. Similar attempts could be made in the study of other thinkers. I have used these as a basis for the construction of my teaching materials. If these thinkers who worked on the questions about humans and world were alive now, they would certainly work on issues concerning 'life'. By considering the basic patterns of thinkers in the context of we can find new insights.

There are different definitions of bioethics. But most bioethics in Japan has not developed beyond the imported logic of Western thinking. Although the Organ Transplantation Act in October 1997 made it possible to transplant organs from brain dead bodies, there are very few reactions from Buddhism or Shintoism, though this is deeply related to the conception of death and life of the body. While people can understand in thought, they often reject organ transplants emotionally, as in other countries. A number of patients who have no time left, go abroad, benefiting from the fact that Japan is an economic giant. I believe we should establish patients' rights, but it cannot solve problems only to enlighten Japanese on the Western theories.

We often say 'Western' rather roughly, the information concerning bioethics introduced to Japan both in academia and media, are overwhelmingly from the United States. While the US has a strong background of pragmatism and commercialism, Europe, and in particular, Germany, has a history where Nazism and medicine cooperated. Thus they have different developments in bioethics. I compose a discussion based on broad information, not only US cases.

In Japan, concepts such as 'individual', and 'self-determination' are not completely popularized. Confirmation of the person's will, which is the core of bioethics and the embodiment of self-determination on grounds of one's freedom and responsibility, are quite ambiguous. For example in the Organ Transplantation Act, and in the proposal on the acceptance of death with dignity by the Science Council of Japan. In the Organ Transplantation Act, the person's will is respected. It creates a new conflict caused by guaranteeing one's self-determination, a Western value which sometimes becomes extreme, or do we let public value take precedence, which may result in restriction of a lower-valued life. The development of bioethics which is based upon Japanese culture, climate and social background should appear.

I have practised bioethics as teaching material since 1987, and what I feel daily is the ethical responsibility of those who engage in bioethics education. This, of course, can be said about education in general, for bioethics tries to prove the dignity of human life, so the responsibility cannot be measured.

As an example of teaching materials, in theme study III-4. or IV-1 (see below) I discuss the "Right to Die", questioning whether "the right to die" is the person's subjective decision or forced decision. After considering students reactions, I found without this question, it would only have the effect to propose to students the problems in bioethics, ultimately, it may classify the people worthy to live and those not worthy to live, and without questioning such thought as "worthy / not worthy to live", to eliminate those who are "not worthy to live" from society.

As for the effects of education, I still don't know what effect a few hours of classes, merely one scene in a long life, can have. But, when dealing with the agreements and disagreements on the technique of vitro fertilization (IVF), of the problems of death including Brain Death, Euthanasia and Death with Dignity, many students take these topics into their families, and discuss with parents. The parents themselves engage in taking care of their own parents, and as a period to look back over one's own life, the parents often show the greatest interest. I hear remarks through homeroom teachers like "we talked in detail about our own death preparation as a couple".

To do classes, never forget the speculation of students responses nor the reaction after one's own course, as well as their consideration of class material. In bioethics, only "to say" is not accepted. Classes should not end in teachers' games of intelligence. If so, it is to make the same sin as scientists who create various scientific technology but turn their back to the ethical responsibility as the scientist, or the engineer who created them. Bioethics has problems which can provoke ethical inspection at a higher level. But again I say, it should never end as a game of words and logic. It must relate to students needs.

TEACHING CURRICULUM (April-December, 1998)

Izumi Otani, Kokubunji High School, Tokyo

I prologue

What is a "human being"?

Homo sapiens, Homo faber, Homo ludens

II artificial reproduction and family

1. biotechnology and manupilation of life

Bacon, Descartes,

2. assisted reproduction technology; AIH / AID / IVF


3. the case of "baby M"; the point of the issue; surrogate contracts and equality

What is a family? family sociology

4. divided fatherhood and motherhood; Is assisted reproduction good news? Is infertility unhappy? Is infertility unnatural?

5. alternative choices; life without children; life with an adopted child

liberation from prejudice; idora / Bacon

III brain death, euthanasia, death with dignity

1. re-definition of "death"; brain death, vegetative state patients; "economics" of brain death

medical economics

2. background of brain death, organ transplanation; mind-body dualism / Plato, Descartes; theory of human machine; Christianity; Japanese views of death, life,and religion

medical anthropology

3. euthanasia and death with dignity; Hippocrates's oath; paternalism; informed consent

SOL vs. QOL ; Kant; Heidegger, Buddhism

4. escalation of the right to die; death with dignity, living with divnity

social welfare ; normalization

5. thanatology


IV prenatal diagnosis

1. human genome project; eugenics / Nazi medicine; heredity and circumstance

social Darwinism

2. the North and South problem about "life"

V epilogue

the right of self-determination under social pressure

theory of social contract; liberty and responsibility

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