Public Acceptance and Risks of Biotechnology


pp. 227-246 in Quality of Risk Assesment in Biotechnology , ed. Ad. Van Dommelen (International Centre for Human and Public Affairs, Tilburg, The Netherlands: 1996).
Author: Darryl R. J. Macer
I. Bioethics and risk assessment

An important part of bioethics is risk assessment, the analysis and prediction of risks. Bioethics combines risk assessment, the concept of avoiding harm, with an assessment of benefits, the concept of doing good or beneficence. There are various risks of genetic engineering, for example the risk of unintentionally changing the genes of an organism, the risk of harming that organism, the risk of changing the ecosystem in which it was involved, and the risk of harming the ecosystem, and the risk of change, or harm, to any other organism of that species or others, including human beings (who may even be the target of change). The concept of risk in biotechnology involves both the potential to change something and the potential to harm. The extent to which a change is judged to be a subjective harm depends on human values, whether nature should be "intransient" or modified. This relates to the fears that technology is unnatural.

The risk to change organisms or ecosystems, which may not involve "harm", the standard meaning of risk, makes genetic engineering more complex. Many want to protect nature, not because of its value or property, but simply because it is there. The concepts and images that the words "life" and "nature" imply are similar in different countries (Macer, 1994a). Related to this is the concept of biodiversity, which is now legally recognised as a good in the Biological Diversity Convention, primarily because of economic potential, but it is also protected because of aesthetic value. Biodiversity is a word used to picture the great diversity of living organisms on the planet. Just as the individual processes of life are dynamic, so is the composite of the lifeforms. The idea of dynamism also implies a balance, and this extends the framework that risk must be pictured in.

Rather than calling the ideas of benefit, risk, autonomy and justice, etc., bioethical principles, we could call them ideals (Macer, 1994a). These ideals all need to be balanced, and the balance varies more within any culture than between any two. Ideals need to be included, together in a balancing act that fits reality. Surveys combined with observations of policy and behaviour in different countries allow us to look at how these principles and ideals are balanced. An examination of history also shows how the balancing act has varied in different times and places. In another paper I have discussed what is ethical biotechnology (Macer, 1995).

Bioethics considers the ethical issues raised in biology and medicine, and especially those raised by human activity in society and the environment using biotechnology (Macer, 1990; 1994a). Bioethics is a concept of "love", balancing benefits and risks of choices and decisions. It considers all living organisms and the environment, from individual creature to the level of the biosphere in complexity. All living organisms are biological beings, and share a common and intertwined biological heritage.

Bioethics in History

The word "bioethics" comes to us only from 1970, yet the ideas and concepts that word encompasses come from human heritage thousands of years old. This heritage can be seen in all cultures, religions, and in ancient writings from around the world. The relationships between human beings within their society, within the biological community, with nature, and God, are seen in prehistory, therefore we cannot precisely define the origins of bioethics. Human civilisation has been tied to agriculture for many millenium, and the concept of bioethics first emerged in the relationships that people had with nature, a nature which could be cultivated to provide for human needs. For example, the decision to burn a forest and plant a crop is a bioethical decision. There is risk in the decision to burn or not to burn, and initially the judgement would be based on practical outcomes. If one area of forest was burnt and the land planted for several years with crops which then later failed, if the population density was low enough the group could move on to burn the next area of forest, and farm that. A gradual circle could be established, if the forest fires were contained. The risk of ecological damage is offset by the risk of lack of food, or by desire for a particular way of life. The decisions of how to use land, and nature, part of environmental bioethics, are not new. Neither is medical decision making, and the questions of abortion and euthanasia are evident in archeology and written records for millenia as well.

In the conclusion of an earlier book, Shaping Genes (1990), I said that we have much to learn from the issues raised by genetic technology, not just the nature of our genes and the effects they have on us and other organisms, but the nature of our thinking about what is important in life. When we consider genetic engineering we can also consider the factors which affect our decision to use a given technology, some of which may have been taken for granted in the use of more traditional forms of agriculture or industry.

There are also lessons to be learnt about concepts of risk assessment, because genetic engineering is a technology associated, and perceived to be associated, with both benefits and risks (Macer, 1992a; 1994a). One class of risks associated with genetic engineering is of relatively high probability but low consequence. For example, the transfer of a gene for insect resistance to a neighbouring wild species of plant is likely if huge areas of land are being farmed, however, it would have little consequence to the farm or agriculture. We also have the risk of insecticide resistant insects, to which better strategies can be used to lower risk. Strategies to lower chances of resistance to Bacillus thuringiensis insecticidal protein include the patchwork farming of treated and untreated fields, and methods to reduce the amount of untreated fields (that may suffer more insect attack!) by computer simulation have been devised (Alstad & Andow, 1995). Another class of risks would be low probability, but high consequence, for example gene transfer to human beings that affected health; or escape of an vaccine-producing animal from a battery farm that contained infectious fatal virus. In the past we have seen numerous examples of new organisms and biological control agents, which have shown us that the most common result is that the agent does not work, however a reasonable number do work (e.g. 10-20%). The risk comes from the few that have unexpected undesirable effects in an ecosystem, which is more common for introduced agricultural production species than for the biocontrol agents. The reason that biocontrol agents have been less risky is that better assessment of the benefits and risks has occured, than from the earlier centuries often blind introduction of new organisms.

Genetic engineering has been a catalyst for thinking about risk assessment and bioethics since its invention in 1974. However, the issues raised are not fundamentally different to those of the past (Macer, 1993) and I would reject the use of the word "Genethics" which has been a recently coined term (e.g. Suzuki & Knudtson, 1993). For example, to chose what plant species would be suitable as an agricultural crop, to select it, and to cross it, has been done for millenia and saw the adoption of a hybrid of three species, wheat, as a staple of one part of the world. The speed at which change in characters can be broad about is faster with genetic engineering than traditional breeding, however, it does not have such a unique power of change as the special term, "Genethics" would imply. The greatest ecological change in the world is the age old agent of change, deliberately set fires. The most powerful force underlying this would arguably be the often unforseen consequences of a growing population of human beings.

Descriptive and prescriptive bioethics

There are two basic ways to approach bioethics, one being descriptive and the other being prescriptive. One describes how people make decisions, and the other recommends the process that can be used to make decisions, and/or the range of decisions that can be made. Descriptive bioethics includes the use of observation, and surveys, to describe the choices that people make. To make good choices, and choices that we can live with, improving our life and society, is certainly a good thing. However, what is good for one person may not be good for the broader society, and the global nature of agricultural economics and environmental impact, mean we have to think far beyond the small field trial of a genetically modified organism (GMO). The choices that need to be made in the modern biotechnological and genetic age also extend from before conception to after death - all of life.

Prescriptive bioethics involves calls for certain factors to be included in decision making, certain groups of people to be involved, and even for certain decisions to be made, or at least a range of socially tolerable decisions. When it comes to risk assessment, the same distinction applies. We can describe the ways risks are perceived, and we can also call for certain risks to be included in an assessment, and for certain weight to be given to these risks. Different groups of people and countries may call for different levels of risk assessment, and in what constitutes a significant risk (von Schomberg, 1995). The legal tolerance limits of acceptable risk and harm are already broadly outlined in international covenants such as the Declaration of Human Rights, and international treaties on environmental protection which include limits on the permitted damage to the common environment, such as the convention on ozone-damaging chemicals, and on deep sea dumping.

There are calls for global laws on genetic engineering to join this list of international laws, to strengthen the weak consensus found between international regulations on GMO release. Agriculture is dependent upon water, and environment, which are sometimes shared resources between different countries. Most maritime nations have declared 200 mile limits within which they claim prior rights to exploit marine resources, and the many examples of over-fished species illustrate the need for international fishing strategies, and also makes us especially cautious about the use of genetic engineering in marine aquaculture. Even on land, weeds and pest animals may spread rapidly in many cases.

Surveys are useful for descriptive bioethics, in fact they are one of the most reliable methods if performed and analysed carefully. However, their role in prescriptive bioethics depends upon a number of factors: does the group surveyed represent the population, should the opinions of that group make decisions, can we trust that group whether it be the public, product consumers, scientists, politicians or farmers? Also, there are some principles which may be commonly perceived to be good, but are commonly ignored in daily life, for example, equal human rights, looking after the poor, and respect for the environment. Even the interpretation of surveys is clouded by the fact that leading questions can be used by surveyors who want to make different points.

To examine whether global guidelines are useful, and representative of descriptive bioethics, we can attempt to look at basic universal ideas that people use in deciding these issues (Macer, 1992a; 1994a). Differences and similarities in risk perception are seen within any group of people within every society. Data from opinion surveys and observation suggests that the diversity of thinking within any one group is much greater than that between any two groups. In other words, in every group we may find the complete range of opinions from yes to no, and the reasoning behind these decisions. The diversity of comments is therefore a microcosm of the total picture. Furthermore, the social environment that people grow up in, and the education strategies in different countries, are becoming more similar making the shared environment more similar. This suggests that a universal approach to regulation which is consistent with people's values is even more representative now than it was a century ago.

II. Descriptive bioethics and perceptions of risk

There are several ways to observe or describe bioethics. Observations of culture and society are useful, but to avoid the dangers of mixing the descriptive and prescriptive elements of bioethics through the biased interpretation of subjective experiences, random surveys allow somewhat more quantification. World-wide there have been quite a number of surveys focusing on biotechnology (Zechendorf, 1994). There are some consistent national tendencies over the degree of risks that people perceive from biotechnology even in Europe (Eurobarometer, 1991; 1993), so it is interesting to ask the questions among more diverse countries. In 1993 an International Bioethics Survey was performed across ten Asian-Pacific countries of the world (Macer, 1994a). The degree to which actions of individuals, and also society, can be both described and predicted by surveys can only be determined after surveys are conducted. A written survey allows more thinking on issues, than an interview. Also multiple choice answers can be leading, hence the use of many open response questions. The use of surveys is only one part of the overall approach we can use to look at cultures, however, the data from surveys must be explained by any description of the real world.

Another part of the data that we can use for evaluating public perceptions is the use of the products, and we can see current practices in agricultural biotechnology by the preferences of farmers, consumers and what sort of products companies produce. Analysis of the factors relevant to these groups that are behind their perceptions is important. For example, the consumption of products of new biotechnology can be best seen from the results of the sales of these products in supermarkets, and their acceptance by the farmers who first use them. However, the factors involved in their decisions require surveys to evaluate, for example why they chose to use them over other alternatives, and why people chose not to use them.

Survey strategies

There are various survey strategies. The first type is the use of fixed response questions, to chose from set answers, and this has been done in the USA (OTA, 1987; Hoban & Kendall, 1992); and Canada (for the Canadian Institute of Biotechnology by Decima, 1993). There has also been comparative studies of scientists in USA and in Europe, looking at their perceptions of the public image of genetic engineering (Rabino, 1991; 1992). The Eurobarometer is a regular public survey in Europe, including different questions each time, and is conducted in all 12 countries of the European Community. In 1991 Eurobarometer 35.1 looked at biotechnology and genetic engineering, and in 1993 Eurobarometer 39.1 repeated the same questions. The Eurobarometer poll is limited because of the relatively small number of questions, and also the set format of the questions, but is the most comprehensive in terms of sample response, randomness, size, and number of countries. There is some diversity within Europe, in biotechnology policy, public acceptance, and regulations.

Recent survey strategies in Europe attempt to look at reasoning more than just statistics (Hamstra, 1991; 1993) which may shed more light on the factors which will affect policy development. There has been attention on qualitative survey approaches to look at factors used in decision-making, which can be useful to identify the range of factors that people use. Ideally they need to be combined with some quantitative measurement to discover which are the most common issues. However, by finding all the issues that people can think of, one can trace out key issues which are behind concerns. There is also a question of which group within society is involved in policy and opinion-making. Martin and Tait (1992), conducted surveys of selected groups of the UK public. They conclude that groups with an interest in biotechnology have probably already formed attitudes to it, which are unlikely to significantly change these. They looked at industry and environmental groups, and local communities, which are major players in the development of policy at both national and local levels. They also suggest that people with the least polarised attitudes are most open to multiple information sources.

In New Zealand there was a study using both set and open questions in 1990 (Couchman & Fink-Jensen, 1990). In Japan there have been several studies, the most comprehensive of these being a study that I did in 1991, among public, academics, scientists, and high school teachers, in which I also reviewed all the previous studies in Japan (Macer, 1992a). From the results of open questions, it was found that some arguments that are often used in biotechnology debates, such as eugenic fears or environmental risk, are not the most common concerns voiced by people in open questions. The more common concerns are interference with nature or general broad fear. The use of open comments also found a great diversity and depth of comments were seen among the public, with as much diversity as those expressed by scientists. The survey found that many people perceive both benefit and risk simultaneously, they are attempting to balance these, which suggests that factors which alter this balance will change the depth of net support or rejection of a technology. Also I found that educated people show as much concern, in fact biology teachers considered there was more risk from genetic engineering than the ordinary public (Macer, 1992b, 1994b). The risk perceptions among scientists had some tendency to be more concrete than in the public, but all groups expressed a considerable variety of concerns.

International Bioethics Survey

The International Bioethics Survey was performed in 1993 in ten countries of the world, in English in Australia (A), Hong Kong (HK), India (IN), Israel (IS), New Zealand (NZ), The Philippines (P) and Singapore (S); in Japanese in Japan (J); in Russian in Russia (R); and in Thai in Thailand (T) (details and collaborators are in Macer, 1994a). Public and student questionnaires were identical. The teacher's survey included some of the same questions, but half of the questions were about teaching and curriculum in bioethics and genetics (Macer, 1994a). The randomly distributed surveys to public and teachers were sent with stamped return envelopes, and people were asked to respond within each country with no reminders.

The International Bioethics Survey focused on agricultural biotechnology, and medical genetics, with some other questions looking at environmental attitudes and attitudes to disease. The questionnaires included about 150 questions in total, with 35 open-ended questions. The open questions were designed not to be leading, to look at how people make decisions - and the ideas in each comment were assigned to different categories depending on the question, and these categories were compared among all the samples. In total nearly 6000 questionnaires were returned from 10 countries during 1993 (Macer, 1994a). General information gathered in the surveys included sex, age, marital status, children, education, religion, importance of religion, race, income and rural/urban locality, and some data are in Table 1.

Results of the other questions, further background, and more examples of open comments have been published (Macer, 1994a). In this paper the word "significant" implies a statistical significance of P<0.05. The funding for these surveys came principally from the Eubios Ethics Institute, with some assistance from the ELSI (Ethical, Legal, and Social Impact issues) group of the Japanese Ministry of Education, Science and Culture Human Genome Project, and The University of Tsukuba. The high school samples in Japan are supported by the Ministry of Education, and are part of a longer term project to develop high school materials to teach about bioethical issues in the biology and social studies classes.

Table 1: Awareness of biotechnology and genetic engineering

%'s of total respondents
Public
Medical/Biology students
High School Teachers
NZ A JJ91 India ThaiR Israel NZ AJ India ThaiP S HKNZb NZs AbAs Jb Js
N (returned questionnaires) 329 201352 551 568689 446 5096 110 435325 232 164250 104 20696 251 114560 383
Response rate (%) 22 1323 26 5736 43 <20 6070 66 6550 70 8052 61 2847 21 3726
Sex Male 41 4552 53 6148 36 3841 50 6753 42 4623 45 6462 48 6388 92
Female 59 5548 47 3952 64 6259 50 3347 58 5477 55 3638 52 3712 8
Urban 7771 73 -78 54 90+80 85 8949 85 5887 96 8831 73 7579 63 66
Age (years)
Mean age 47.4 45.241.7 39.8 30.637.2 36.3 33.420.8 18.1 21.121.8 21.3 21.119.3 21.0 40.842.5 41.8 42.040.7 40.0
Marital status
Single 25 2629 29 5338 33 3495 98 9997 99 9999 100 96 13 1622 24
Married 59 6266 66 4559 54 623 0 12 0.4 10.4 0 8386 79 7077 74
Other 1612 5 52 3 134 2 20 1 10 1 08 8 814 1 2
Children
No child 33 3940 35 5522 41 4897 100 10098 96 10099 100 2215 24 2430 28
Education
High school 43 3637 37 42 13 1629 94 547 4 023 71 10 1 10 0
2 year college/technical 18 1519 22 63 18 2048 4 613 18 077 3 12 0.4 10.2 1
graduate degree 25 2831 31 3135 37 3920 2 3827 60 500 6 6458 59 5778 82
postgraduate degree 9 1610 7 5259 28 253 0 051 13 470 8 3037 39 4121 17
other 55 3 37 1 40 0 02 2 53 0 44 3 0.40 0.8 0.3
How important is religion?
Very important 27 2310 - 4046 10 3828 19 536 54 8932 21 2017 42 477 10
Some important 26 2733 - 2744 38 1620 41 1624 38 1141 40 1729 23 2625 37
Not too important 27 2440 - 158 28 3418 20 3418 7 022 26 3332 19 1045 36
Not at all important 20 2617 - 182 24 1234 20 4522 0.4 05 13 3022 16 1723 17
Awareness of Pesticides
Not heard of 2 53 4 50 2 42 5 56 0 17 13 00 0 00.4 0.3
Heard of 48 4761 58 4434 54 6060 56 7341 59 7667 78 56 5 1024 40
Could explain to a friend 50 4836 38 5166 44 3638 39 2253 41 2326 9 9594 95 9076 60
Awareness of Biotechnology
Not heard of 23 196 3 102 8 1813 25 57 6 130.4 8 06 0 81 1
Heard of 62 5665 65 5357 62 6254 54 6953 71 6845 74 1251 11 3811 50
Could explain to a friend 15 2529 32 3741 30 2033 21 2640 23 1955 18 8843 89 5488 49
Awareness of genetic engineering
Not heard of 9 99 6 1713 14 80 3 810 17 41 7 04 0 11 15
Heard of 62 4974 68 4658 60 8226 43 6740 63 6051 79 741 9 4325 67
Could explain to a friend 29 4217 26 3729 26 1074 54 2550 20 3648 14 9355 91 5674 18

1J91 from Japan 1991 survey (Macer, 1992a, 1992b).

Table 2: Perceptions of benefit (Q6) or risk (Q7), and open comments about genetic engineering

Gen.eng.
Public
Medical or biology students
High school teachers
NZ AJIndia ThaiRIsrael NZsAsJs IndiaThaiP SHKNZb NZsAbAs JbJs
Q6. Do you personally believe genetic engineering is a worthwhile area for scientific research? Why?...
Yes4162 57657765 747660 69767155 806092 60946990 74
No2917 10857 16916 46530 7124 201144 9
Don't know3021 332718 28101524 271824 1513284 20517 617
N321197 334523682 4565095 108423314 231158249 10520495 250113554 378
Not stated39.637.6 53.950.740.8 75.872.027.4 30.651.836.9 33.340.559.4 60.021.035.8 26.831.047.5 55.8
Science5.39.6 6.04.619.4 4.84.04.2 1.99.53.8 23.83.82.0 1.98.36.3 10.08.916.3 9.0
Cure disease7.88.1 9.09.02.1 0.710.027.4 25.012.815.0 2.611.79.2 15.318.56.3 18.811.58.5 4.5
Humanity5.67.1 9.914.16.5 6.7010.5 10.29.921.0 4.49.514.8 9.515.29.5 13.28.03.6 1.6
Good for Environ0.61.5 00.40.6 0.901.1 2.800.6 0.91.30 1.01.00 0.40.90.7 0.5
Help if careful7.211.2 2.43.15.0 1.710.09.5 3.71.73.2 2.27.63.2 1.914.612.6 15.618.613.2 12.4
Agr/economy5.38.6 2.712.116.6 2.605.3 5.61.915.6 21.23.83.4 2.914.67.4 11.66.23.8 1.6
Misuse5.93.5 5.40.41.7 1.106.3 5.62.60 2.61.30.8 1.92.47.4 2.07.13.3 6.1
Dangerous4.01.0 1.21.01.5 1.74.02.2 3.71.40.6 0.81.91.6 1.01.06.4 0.81.81.3 2.7
Playing God14.08.6 4.51.11.2 0.905.3 10.22.40.3 0.912.73.2 1.92.07.4 0.45.30.7 2.1
Don't need2.20 0.60.20.6 001.1 2.80.70 0.900.8 1.0000 00.41.1
Unknown2.53.1 4.53.44.1 3.200 0.95.42.9 6.53.81.2 1.91.51.0 000.92.7
Q7. Do you have any worries about the impact of research or applications of genetic engineering? How much? Why?...
No worries1419 224842 26171116 205137 10251113 91110 1515
A few 2321 392332 23172719 442338 25232934 112312 4434
Some2426 241919 28303333 241719 30364238 383929 2829
A lot3934 15107 23362932 1296 35141815 422749 1422
N 309195 316500670 4564795 107422310 230155245 10420494 250112555 379
Not Stated31.133.3 58.955.445.4 79.574.524.2 26.257.454.8 34.451.065.7 61.523.042.6 29.629.553.3 59.1
Don't know2.93.6 1.96.05.7 1.700 04.03.6 10.40.72.0 1.9000 00.71.9
Interfere Nature13.39.2 2.93.81.8 0.92.110.5 11.24.71.9 1.77.73.3 3.92.95.3 4.06.31.3 6.1
Fear/feeling5.24.6 6.76.08.7 5.800 0.96.65.8 5.25.23.7 3.94.44.3 3.27.13.4 2.1
Ethical4.23.6 3.21.21.0 1.109.5 13.14.01.3 0.94.51.6 5.85.97.5 5.612.56.3 5.0
Social effect bad1.61.0 1.01.00.3 0.400 0.92.40.7 0.40.70.8 0000.8 1.82.03.7
Insuff. control2.64.1 2.20.83.0 1.705.3 1.92.80.7 6.53.21.6 4.810.35.3 11.28.08.3 9.0
Bad health1.01.5 1.03.01.8 0.42.12.1 01.03.2 1.72.61.6 3.91.02.1 0.80.90.9 1.6
Dangerous3.62.6 2.20.62.1 1.903.2 5.61.42.6 3.03.20.8 1.91.51.1 0.81.81.4 1.1
Ecology2.31.0 1.92.62.8 0.901.1 1.91.22.3 3.50.72.9 1.96.91.1 6.81.813.2 4.2
Waste1.60.5 1.00.40.8 0.201.1 001.0 0.91.30.4 1.00.50 0.4000
Human misuse19.420.5 11.75.66.1 4.110.620.0 15.012.36.8 5.77.76.5 4.827.516.0 23.617.95.6 4.2
Eugenics6.57.2 0.62.42.2 08.519.0 19.6012.9 4.88.43.7 3.98.311.7 1.610.71.6 0.8
Can control4.97.2 4.111.218.4 1.32.14.2 3.72.12.6 20.93.35.3 1.07.83.2 11.61.82.0 1.3


Knowledge of science and risk perception

One of the factors that may relate to risk perception is knowledge of science, and the claim that increased knowledge is correlated to decreased perception of risk has been suggested in some other studies (OTA, 1987), and is a commonly held view in academia and industry. In this 1993 study most respondents answered that they had some interest in science and technology, with few saying they did not. Another measure may be the response rate, which was generally between 20-30%, significantly higher than commercial mail box response. The 1991 Japan surveys suggest that knowledge of science is not so closely correlated with response rate (Macer, 1992a; 1994a). An indirect measure of the depth of knowledge were the comments that were given in response to open questions.

The results of the awareness question for pesticides, biotechnology and genetic engineering in the International Bioethics Survey are shown in Table 1. It is interesting that biotechnology was generally one of the most unfamiliar terms, next to gene therapy, except in Japan, where it was one of the most familiar, consistent with other surveys (Macer, 1992a). The awareness of gene therapy was the lowest among the eight developments included. Genetic engineering was generally the least familiar among the other areas, with pesticides, in vitro fertilisation, computers and nuclear power being most familiar. Awareness was significantly related to educational attainment in most samples. The samples with the greatest awareness were generally biology teachers, next were medical students (New Zealand, Japan, Australia and the Philippines), followed by the other groups, social studies teachers, biology students and the public. For all developments and in all samples, there was a positive correlation between awareness and the expressed level of interest in science from the results of the earlier question.

Following questions, discussed below, asked them whether they thought each development would have a benefit or not, and their perceptions about the risks of technology by asking them how worried they were about each development. The areas of science and technology included: In vitro fertilisation, Computers, Biotechnology, Nuclear power , Agricultural Pesticides, Genetic engineering. The results for genetic engineering are shown in Table 2. For this question, the comments were assigned into categories, and the results are shown. Both benefits and risks were cited by many respondents.

There was more concern about genetic engineering and pesticides, despite the lower familiarity with biotechnology. The degree of concern depends upon what people know. People do show the ability to balance benefits and risks of science and technology, consistent with earlier surveys (Macer, 1992a; 1994b).

Bioethical maturity

People do not have a simplistic view of the positive or negative face of science and technology, and can often perceive both benefits and risks. Overall we do find a positive view, but for different applications there are quite different opinions. This balancing of good and harm is necessary for bioethics, and I have called this one indicator of the bioethical maturity of a society (Macer, 1992b; 1994b). The use of surveys can provide us with some indicators of the degree to which society can make well-thought out "mature" decisions, rather than impulsive "childish" decisions based on immediate gain.

The types of concern that were expressed over genetic engineering give us some picture of risk perception (Table 2). What is a risk? The idea of interference with nature is an aesthetic, religious or moral concern. It presupposes that it is bad to change nature, and is related to the risk of playing God, that we are changing God-given nature or that we are exerting God-like powers in the modification of nature. Eugenic, ethical and social impact concerns are risks related to the most common category of general human misuse. These extend from the type of ethical concern that we should not modify animals, a type of interfering with nature concern, through the concern that we should not violate human rights, which is more universally accepted in law as a risk. More vague concerns of risk are seen in the categories of fear, and danger. The concerns of insufficient controls, it is a waste of resources, or conversely that we can control technology so we don't need to worry, are more concrete. Ecological and health concerns are also more concrete.

By dividing up the concerns that people have in such a way, we can form a better picture of what risk assessment means in their minds. The same type of analysis was done in 1990 in New Zealand (Couchman & Fink-Jensen, 1990), and in 1991 in Japan among scientists, students, teachers, and the public (Macer, 1992a). There is a trend for scientists to give more concrete concerns, though in related questions on the risks of genetic engineering of animals and humans, in that survey still 16% gave concerns that it was interfering in nature.

Therefore greater awareness of a technology may not mean that the perceived risks are only technical. Risk assessment in the minds of people includes aesthetic, religious and moral concerns which are often vague. Rather than saying that one class of risk perception is mature and another immature, we could actually say that to appreciate the wide range of risks is more mature than to only think of one or two.

We can expect the awareness of both benefits and risks of products will grow with the increased use of biotechnology products, and about 70-80% were already aware that genetically modified organisms are being used to produce foods and medicines. In all countries of the International Bioethics Survey there was an overall positive view of science and technology, it was perceived as increasing the quality of life by the majority in all countries. Less than 10% in all countries saw it as doing more harm than good (Macer, 1994a).

When specific details of an application are given there is generally greater acceptance, suggesting that people have some discretion, another indicator of bioethical maturity. It also suggests that if details of a technology are given, for example by the company or government related to the release of a GMO, the public will show greater acceptance of an application (Macer, 1992b; 1994a; Macer et al., 1995) This is illustrated in questions looking at environmental release of genetically modified organisms (Q31) which were taken from the OTA (1987) survey, with comparisons to a question of Hoban & Kendall (1992). The results are in Table 3. The approval of the Calgene FlavrSavr modified tomato which has delayed ripening for general cultivation in the USA was given by the USDA in 1993, and it was approved for general commercial food consumption by the FDA in 1994, and sold in the summer 1994 in some parts of the USA. The results show that it would be generally supported around the world.

The healthier meat question is relevant to efforts to make less fatty meat, both by hormones in pigs, and other animals. In the USA in 1992, 45% said "acceptable", 32% "unacceptable" and 23% "don't know" to a similar question (Hoban & Kendall, 1992). In a related question on cows with increased milk, and in the USA in 1992, 36% said "acceptable", 41% "unacceptable" and 23% "don't know" to a similar question in 1992. This has become reality in 1994 with the general use of bovine growth hormone (BST - bovine somatotrophin) in the USA dairy industry, a hormone made by genetic engineering that can increase milk yield by 10-20%. It also received less support in the International Bioethics Survey than the goal of less fatty meat, which is consistent with the widespread questioning of the need given the existing milk surplus in some countries.

Animals have long been used for agriculture, and are likely to continue to be used. The moral status of animals, and decisions about whether it is ethical for humans to use them, depends on several key attributes; the ability to think, the ability to be aware of family members, the ability to feel pain (at different levels), and the state of being alive. Causing pain is considered bad, and it is the major guiding principle for animal treatment. If we do use animals we should avoid pain. Animals are part of the biological community in which we live, and we have to consider the ethical implications of whether they possess autonomy. People will continue to eat animals, and practical ethics must improve the ethical treatment for all animals. This is a further area of risk assessment that applies to animal use, the risks of unethical treatment of organisms. People need to decide how much more they are prepared to pay for better treatment of animals, such as the costs of eliminating battery farming, or the costs in not using new animal treatments that produce cheaper milk or meat such as bovine growth hormone.

The highest degree of support among the applications of genetic engineering that were given was seen for disease-resistant crops, and bacteria to clean oil spills (Table 3). The sports fish is an example of genetic engineering for fun - and it is reassuring that many people reject such genetic engineering. The highest degree of support for the sports fish is in the USA where 53% approved in a 1986 survey, while 73% approved of bacteria to clean oil spills or disease-resistant crops (OTA, 1987). The general support for products of genetic engineering seems to be high, especially if they are claimed to be more healthy. In the Canadian study comparisons between chemicals and genetically engineered organisms usually found less support for chemical methods (Decima, 1994). In the 1991 survey in Japan an open question looking at awareness, benefits, and risks of genetic manipulation of microbes, plants, animals and humans, was asked (Macer 1992a; 1992b). The responses made by the public, teachers and scientists were compared with results from New Zealand (Couchman & Fink-Jensen, 1990), and few differences were observed. As in the USA, human genetic manipulation is associated with the most risks, and plant genetic manipulation with the least, but unfortunately they didn't compare open comments (OTA, 1987).

Table 3: Approval of environmental release of GMOs

Public
Medical or biology students
%NZ AJ In TR Is NZA JIn T PS HK

Tomatoes with better taste
Yes49 5469 7383 3540 5453 7177 8868 7458
No35 3520 2010 4544 2136 1517 527 1732
DK16 1111 77 2016 1511 146 75 910

Healthier meat (e.g. less fat)
Yes54 6057 6684 3544 7471 6568 8875 7262
No30 3126 229 4342 2023 1818 421 1727
DK16 917 127 2114 66 1714 84 1111

Larger sport fish
Yes22 1922 4858 1320 2823 2450 6454 4442
No61 6554 2725 6158 6365 5231 2040 3937
DK17 1624 2517 2622 912 2419 166 1721

Bacteria to clean up oil spills
Yes75 8271 7487 6370 9289 7674 8578 8670
No11 1113 145 2012 14 1013 619 623
DK14 816 128 1718 77 1413 93 87

Disease resistant crops
Yes70 7866 7891 5450 8181 6781 9182 8372
No16 1317 134 2528 713 1311 515 814
DK14 917 95 2122 126 208 43 914

Cows which produce more milk
Yes36 3944 7584 2338 5544 4972 8670 5754
No45 4232 197 3840 3135 2919 526 2534
DK19 1924 69 3920 1421 229 94 1812

Environmental concerns

Some environmental concerns were seen in the responses to the general questions on genetic engineering and biotechnology (Table 2). In the 1991 survey in Japan (Macer, 1992a) 49% of the public agreed that genetically modified plants and animals would help Japanese agriculture become less dependent upon pesticides, while 49% of teachers and 56% of scientists agreed. 71% of the company scientists agreed with this statement. Only 7% of scientists and the public disagreed with this, while 13% of teachers disagreed. This is a major argument of those calling for the development of genetic engineering in agriculture, and the result suggests that it is supported by a majority of people, though still many people are not sure about how they feel. This statement was also supported by a majority of respondents in the countries in the International Bioethics Survey (Macer, 1994a).

In 1990 European public opinion poll conducted in the U.K., France, Italy and Germany, by Gallup for Eli Lily (Dixon, 1991), the respondents were asked to choose the largest benefit that they saw coming from biotechnology, between one of four possible benefits from biotechnology. Over half rated cures for serious diseases as the most important benefit. Another option was reducing our dependence upon pesticides and chemical fertilisers, which 26% of Italians, 24% of French, 22% of British and 16% of Germans, chose as the largest benefit. The respondents were asked a similar question about their largest concern. 40% of French, 35% of Germans, and 25% of British and Italian respondents chose eugenics, and slightly lower proportions overall chose environmental harm, 34% in Britain, 33% in France, 22% in Italy and 21% in Germany. Potential health hazards from laboratory genetic research were named by 29% in Italy, 17% in France, 11% in Britain and 10% in Germany. Overall one third of respondents feel that biotechnology is ethical and one third feel that it is unethical, and one third think it is in between, "neither".

Therefore, it appears that in all countries medical advances, and the ability to cure genetic diseases are the major benefits people see from genetic engineering and biotechnology. Environmental concerns are a close second, and this is consistent with the International Bioethics Survey when we consider concrete concerns. However, from the results of the open questions, we also see lower proportions of the public cite these concerns, and there are other common concerns including what is natural, or ethical, as discussed above (Table 2). The benefits are divided depending on the organisms that are considered. Microorganisms are seen for both medical use and general use to produce useful substances through fermentation. Plants and animals are seen for their obvious agricultural importance, and genetic manipulation is perceived for its ability to aid the breeding of new varieties, and to increase production of food (Macer, 1992a).

There were also two open questions asking what images people had of life and nature. The question on nature followed several questions on genetic engineering, so it is not surprising that many (about one quarter) included a comment that nature is something that not to be touched by human beings, and about one tenth mentioned ecological problems (Macer, 1994a). The ethical limits of genetic engineering may in the end be decided by subjective perceptions of "nature" rather than objective environmental risk itself. Subjective concerns are very difficult to define and this survey is an attempt to begin a search among ordinary people around the world on what these limits might be. We all have some limit, whether it be blue roses or chicken with four legs - and we also realise these limits change through time. A simple definition of bioethics, as I said earlier could be love of life. It is essential to understand the images people have of life in order to develop understanding of the bioethics that people have. Public acceptance depends at least as much on these types of concerns as on ecological or health risk, which is an important point in discussion of risk assessment.

III. Risk assessment, bioethics and trust in authorities

One of the central issues of ethics is decision-making, that is who should make decisions, and who do people trust? A question on the level of trust that people had in authorities for information on the safety of biotechnology products was asked in the International Bioethics Survey, as shown in Table 4. There was most trust in the government in Hong Kong and Singapore, and least in Australasia, Japan, Russia, USA and Europe. Despite the lower trust shown in the government in Russia, they had a level of trust in medical doctors. The result is most striking when we compare it to Japan, in which doctors were not trusted. In fact it appears Japanese do not trust anyone very much, but the biggest difference with the other countries was that doctors and university professors were mistrusted, especially so by medical students. Whereas Russians show great trust in doctors and environmental groups, and a high level of trust in professors. Companies were least trusted everywhere. Farmers were also not trusted (unlike the USA, where in 1992, 26% had a lot of trust, 68% had some trust, and 6% had no trust in farmers (Hoban & Kendall, 1992). In hindsight it would have been interesting to ask whether consumers or the public can be trusted, and do people trust such crude transparent democracy.

The lack of trust in companies or governmental regulators is also seen in European (Eurobarometer 1991, 1993) and North American surveys (OTA, 1987; Hoban & Kendall, 1992; Rothenburg, 1994). This lack of trust is a concern. The most trusted source of information are environmental groups. The main source of information is the media in all countries (Macer, 1994a), but people are becoming more selective in what they believe.

There are a variety of arguments calling for public involvement in policy making. If we respect autonomy of human beings we should respect their right to have at least some property, or territory, and control over their own body. In agriculture this means respect for freedom of growing what crops a farmer chooses, and eating what food we like, within social constraints (e.g. human flesh is a general taboo in most cultures). People's well-being should be promoted, and their values and choice respected, but equally, which places limits on the pursuit of individual autonomy. We want to give very member in society equal and fair opportunities, and equally share the risks in the application of technology, this is justice. Utilitarianism (the greatest good for the greatest number) is useful for general proportions, but it is very difficult to assign values to different people's interests and preferences. The concept of "society" includes the future of society, future generations are also an essential part of society, and ethically speaking we should protect the environment for the future generations.

One of the underlying philosophical ideas of society is to pursue progress. The most cited justification for this is the pursuit of improved medicines or increased stable food supply, which is doing good. A failure to attempt to do good, is a form of doing harm, the sin of omission. This is the principle of beneficence. This is a powerful impetus for further research into ways of improving health and agriculture, and living standards. It is therefore unacceptable to hold up the progress of a potentially useful technology, unless the harms it may bring are likely to be significant when compared to the benefits. Biotechnology is challenging because, like most technology, both benefits and risks will always be associated. A fundamental way of reasoning that people have is to balance doing good against doing harm. We could group these ideals under the idea of love, love means to do good to others and not to harm others. We need to share benefits of new technology and risks of developing new technology to all people.

People in developing countries should not be the recipients of risks passed onto them by industrialised countries, despite the economic pressure to allow this. We can think of the dumping of hazardous wastes to developing countries, in return for financial reward, but the environmental and human health consequences of dumping toxic waste cannot be measured. Testing of GMOs is a similar case, though we must note the developing country that is growing GMOs over the largest area is China which is doing so for its own reasons. Industrialised societies have developed safeguards to protect citizens, and some of these involve considerable economic cost. While it may not be possible for developing countries' governments to impose the same requirements, they should not accept lower standards - rather all can use data obtained in countries with strict and sufficient safeguards of health, with the aid of inter-governmental agencies. Any basic human right should be the same in all countries, and this is one of the roles of the United Nations. Ethically this would support the implementation of minimum international standards for regulation of biotechnology (Krattiger & Rosemarin, 1994). This suggests that risk assessment methods should become systemised and standard, though as discussed in other chapters in this book, and as seen in international comparisons, how to effect a system is still contentious.

The precise outcome of interventions in nature or medicine is not always certain. It has taken major ecological disasters to convince people in industry or agriculture of the risks. Introducing new organisms to the environment is also associated with risk. If we introduce very different gene combinations into the environment they could have major consequences, which may be irreversible (Macer, 1990; see other papers in this book). The new genes may enter other organisms, or the new organisms themselves may replace existing organisms in the ecosystem. The ecological system is very complex, minor alterations in one organism can sometimes have effects throughout an ecosystem. Field trials and experimentation are an ethical prerequisite before full scale use of new organisms, as is the scheme used by the USDA in the USA, and quarantine regulations used throughout much of the world.

In most interventions in life there are slippery slopes. The idea is that because we perform some action, we will perform another. Controls which were adequate for initial exploration may fail under increased pressure. While we may not do any direct harm with the application in question, it could result in progressive lowering of standards towards the ill-defined line beyond which it would be doing harm. The inability to draw a line is no measure of the non-importance of an issue - rather some of the biggest fundamental questions in bioethics and life are of this nature.

With precautionary laws to prevent risk because of insufficient scientific knowledge, like the regulations on field trials of GMOs, we could expect gradual weakening of control as experience is gained to support reduced controls. However, Jager and Tappeser (1995) in this book would argue that the data from field trials does not support a relaxing of guidelines, as has occured in the USDA and is being called for in Europe. In this case it may be a slippery slope of increasing familiarity, combined with an absence of dramatic incidents, rather than maintenance of the same scientific objectivity as in the initial trials. It may also be led by bureaucratic overload, and pressures for commercial releases. In this case there are differences in the interpretation of risk assessment data. It should also be noted however, that the real safety test of GMOs is large scale commercial releases, and some releases could be justified if a substantial monitoring system was established to track the genes and ecological impacts. In this case, an intermediate phase between large experimental trials and full commercial release that was over the period of several years would seem wise.

Some people, from all countries, say that some developments of science and technology such as genetic engineering are interfering with nature because "nature knows best". However, we have some good reasons to interfere with parts of nature, for example, we try to cure many diseases that afflict humans or other living organisms and we must eat. A negative science fiction image has been easily promoted and is appealing to the human imagination. The fascination with creating "new forms of life" is coupled to a fear of how far it might be taken. There are many movies which play on scary themes, from Frankenstein to the 1993 blockbuster movie Jurassic Park brought genetic engineering into the imagination of many. These are thought to be very powerful in shaping public acceptance and perceptions, though just how influential is a question for research.


Table 21: Trust in authorities

(Q29) Suppose that a number of groups made public statements about the benefits and risks of biotechnology products. Would you have a lot of trust, some trust, or no trust in statements made by...?

Public
Students
TrustNZA JIndiaThai RIsraelNZ AJIndia ThaiPS HK
Government agencies
A lot58 825335 2477 4252820 3437
Some5261 484763 39386568 374966 625855
No4331 4428456 382825 5926618 88
Consumer agencies
A lot2413 122343 3328288 82341 17625
Some5861 655754 44425854 605155 686358
No1826 2320323 301438 3226415 3117
Companies making biotechnology products
A lot54 62186 2034 5251315 78
Some4452 434770 31284953 385475 576657
No5144 51322263 524843 57211228 2735
Environmental groups
A lot2120 1547- 53541814 752- 573545
Some6864 6044- 37367373 5237- 426050
No1116 259-10 10913 4111-1 55
University professors
A lot2530 123842 35425054 104729 463047
Some6560 615357 50484843 623969 526547
No1010 279115 1023 281422 56
Medical doctors
A lot3330 124860 55465558 105555 684248
Some6064 584338 35504440 643744 295449
No76 309210 412 26813 43
Farmers or farm groups
A lot69 6-7- 2866 772718 66
Some6969 50-67 -507070 501576 715443
No2522 44-26- 222424 43131711 4051
Dietitians or nutritionists
A lot2421 6-25 -402821 56825 422020
Some6669 54-67 -506569 561865 536671
No1010 40-8- 10710 3914105 149

IV. A future with public involvement in risk assessment

We must ensure that efficient and sustainable agriculture is encouraged, but recognise it is only part of a broader solution. Sustainable agriculture could be defined as the appropriate use of crop and livestock systems and agricultural inputs supporting those activities which maintain economic and social viability while preserving the high productivity and quality of the land. We need to improve agricultural efficiency to succeed, however current research interests in biotechnology are not necessarily the best way to provide sustainable agriculture. Large corporations are developing new techniques that may require constant application. For example, biological weed control is more cost effective and has a higher success rate than that achieved in searching for useful agrochemicals, yet development is limited because it may not make commercial profits.

The consequences of these decisions on the different communities involved in agriculture also needs to be considered, with a variety of social risks of new technology, which could in the end be the greatest risk of manipulation of life, as it will shape future public acceptance about the limits to the type of interventions humans can make in nature. This could be called social risk assessment, and it is an area that social scientists will explore, using the tools of descriptive bioethics.

Some of the criticism is against technology in general, and needs balanced consideration. For example, there are valid criticisms about the development of herbicide-tolerant plants, that biological control is better, but they do have immediate environmental advantages in some cases. For example, maize growers make 4-6 herbicide applications a season, but if the crop was tolerant to a broad-spectrum post-emergence herbicide only one application would be needed. Reducing herbicide use and switching to biodegradable products is consistent with sustainable agriculture and is an important practical step in that direction, as long as the powerful commercial interests do not prevent the eventual widespread use of the ideal, biological control.

The ethical role of scientists is defined by several levels of moral community: the scientific community itself, the local community, the national society, and the global society. Scientists are involved in a number of different relationships, but first they are participants in society, having the same responsibilities as any citizen. Scientists are also part of a profession, which includes some moral responsibility. If the scientific profession or community does not censor themselves others will do so. We can see the trend for different groups or professions to lay out their ethical codes, as written codifications of etiquette, if not always ethics. When scientists fail to regulate their activity, laws and regulations will be made stronger to ensure that they do, this is a risk that scientists take when they go beyond what is publicly acceptable.

Other groups are involved in the application of science in the world. Companies have been responsible for about 80% of the releases of GMOs in the world (Krattiger & Rosemarin, 1994). The risks that companies take include investment into unprofitable products, risks of environmental and/or medical legal claims, and risks of unwelcome legal restraints. As commercial seeds and animals are passed on to farmers the farmers will assume increasing responsibility for sensible farming practice, which is usually in their long term interests also, e.g. monitoring of pest resistance to insecticidal proteins. The risks to the farmers include, crop failure, unprofitable products, damage to their land or their health, and even possible legal claims against them.

Each of the groups, or players, involved in the release of GMOs also has their own set of benefits. Ideally, all may share the goal of human progress, but they also share the benefits for their own progress. All three have economic interests, perhaps scientists less than the other two groups if the scientists have the luxury of financial support unlinked to research application. The general public also shares these benefits, but may have a longer term economic and environmental framework, and has the benefit of being consumers. Variety or alternatives can give choice, if such a variety is available, and many people may also welcome a variety which is lower cost. In fact, when we consider this factor the public may also have short term economic sights, when it enters the supermarket. Nevertheless, as discussed above, there are a number of ethical reasons to give the general public the major role in deciding what risks and benefits are acceptable for technologies which do have broad implications, in fact global implications in the case of genetic engineering. This means that risk assessment strategies need to be developed from public concerns as well as the concerns of specialists. The broad nature of a technology also suggests that social and ethical impact issues can be included as "risks", and methods to assess these types of risks would be needed. Genetic engineering is certainly not an special case, but it has made people wake up to the fact that many technologies have such broad potential impacts, and we need to think of risk assessment and technology assessment in general. In this respect the decision by the 1995 US government to virtually dismantle the Office of Technology Assessment is surprising and short-sighted.

However, unless the broader dimensions of applied science are taught, society will be unable to make balanced decisions about the use of technology. In all countries in the International Bioethics Survey there is strong support for teaching students about the ethical and social issues associated with science and technology (Macer, 1994a), and such issues are already introduced into the curriculum to varying degrees in Australia, New Zealand and Japan, as measured in the International Bioethics Education Survey. The general attitudes to the teaching of bioethics were extremely positive. It is interesting that more biology teachers thought bioethics should be taught in biology classes, while social teachers thought they should teach it.

There is more inclusion in Australia and New Zealand teachers than in Japan. There is now some research into how these issues are being best taught, the most suitable issues, the suitable classes and the most effective delivery. They are relevant to both science and social studies classes. The next stage in the education project is the development of materials to aid the teaching of these issues, and the responses obtained were used to make such materials. Teachers are testing some on-line materials, and developing them for use at appropriate times in existing courses.

Public education is a special responsibility of scientists, who have the best knowledge of the technology, even if they may not know of the impact so much. People who have high familiarity with such techniques, such as scientists and high school biology teachers, are also concerned about such technology (Macer, 1992a). Rather than attempting to dismiss feelings of concern, society should value and debate these concerns to improve the bioethical maturity of society. The data suggests that the public is already informed enough to be trusted in the formation of policy, and there needs to be inclusion into policy making. Several countries including Denmark, the Netherlands and the UK have had public consensus conferences as new methods to involve the public in decision-making. Public forum, and public notification, and chance for response, are assumptions of democracy that are still being excluded in some genetic engineering applications.

In some discussions of the impact of biotechnology safety and risk are considered separate from bioethical concerns. However, as shown above, the origin of concern about safety and impact is the ethical principle of do no harm. People of various cultures, ages, educational training, occupation and outlook on life perceive both benefits and risks from developments of science and technology. People do show the ability to balance benefits and risks of science and technology. People in the countries surveyed do not have a simplistic view of science and technology, and can often perceive both benefits and risks, which calls for public involvement in the process of risk definition and assessment.


Endnote

I wish to thank Ad, the editor, for numerous useful comments on this paper. On-line materials for teachers, books, papers, the Eubios Journal of Asian and International Bioethics, and up-to-date news are available from Eubios Ethics Institute (http://eubios.info/index.htm").

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