Ninth Annual Meeting of Japan Association of Bioethics
Bioethics for the global community: Anthropology, philosophy and social justice

Third International Tsukuba Bioethics Roundtable:
What Asia can offer to International Bioethics


The abstracts and program of the Third International Tsukuba Bioethics Roundtable and Ninth Annual Meeting of the Japan Association of Bioethics. Copyright 1997 Eubios Ethics Institute / Japanese home page. The chair of these meetings was Darryl Macer, and they were held 30 October - 2 November, 1997 in the University of Tsukuba. On-line at

This file contains both English and Japanese, apologies if your server can only read English, you will not be able to read some parts. All titles appear in English.

IAB 4th World Congress abstracts

IAB 4th International Tsukuba Bioethics Roundtable abstracts

Welcome to Tsukuba

Welcome to the Japan Association of Bioethics (JAB) Ninth Annual Meeting and the Third International Tsukuba Bioethics Roundtable. Thank you for coming from all over Japan, and the World, to discuss bioethics in the Science City. I hope that at these meetings we can learn more about the ways Asia can contribute to International Bioethics. Basic to discussion is the need to learn from each other. This is essential for any study. I hope that this spirit of learning can become the aspiration of all here.

The spirit of learning says that what I think is true may not be so. It also says that at the end of the meeting I should have changed my world view. It says that it is OK to learn from each other and make mistakes. During our life we can synthesise a world view, that may mean turning around in circles several times to seek the truth. This debate and discussion is necessary, but Japan would teach us that it should be done politely and gently. These debates may be caught up in power struggles that result in fragmentation. I hope that the JAB will be a place where people of all views are welcome, and we help each other. I have hoped that many non-members could also join this meeting, and come together with the spirit of seeking to learn about bioethics. If this can be done, then the JAB can take its place as an interdisciplinary forum for bioethics interchange.

This interchange should never be oneway. At this meeting we have talks from International Visitors informing us about the situation in different countries, and with lessons for all of us about Japan and Asia. In another parallel set of sessions starting on the 1st November we debate some major issues of bioethics in Japan, like euthanasia, organ transplants and genetics. On the last day will be two sessions on bioethics education. Something that I have been trying to develop at the University of Tsukuba, and we can announce the establishment of the Tsukuba International Bioethics Center, which you are welcome to visit during this meeting. Please return in the future if you wish to see some of the 20,000 papers and other journals and books there.

We also have sessions on anthropology, social justice, environmental ethics, and informed consent. Together with Drs Tejima and Shoji, and members of the organising committee, we have purposely limited the number of simultaneous sessions to two. On sunday morning there is a chance to develop international collaborations for research in case you do not have a chance before then, and please leave messages for each other on the message board. In previous Tsukuba Roundtables we have had an informal atmosphere, and we hope this continues. Informality is not one of the aspects of Japanese society that is well known, however, it is hiding in all of your hearts. However this comes with sensitivity, something we all must learn.

In conclusion I would just like to thank all the helpers at the meeting, and all those who helped prepare the meeting, especially Ms Yukiko Asada, Dr Yutaka Tejima, Prof. Shinichi Shoji and members of the organising committee. Thank you all for your patience, and I sincerely hope you have good memories of Tsukuba and we will see you back again at the Fourth International Tsukuba Roundtable the same time next year.

- Darryl Macer

ようこそ 国際学園都市ヘ










Program for 30-31 October, in Second Cluster of Colleges Room A106. These first two days of the Roundtable are intended to be informal, please dress accordingly.

30 October
8:45-9:00 Registration (受付)
9:00-9:30 Welcome by Darryl Macer. Review of questions brought by participants.
9:30-14:15 Excursion to Tsukuba Shrine on Mount Tsukuba to learn about Shinto (the home of the god and goddess who made Japan...). Lunch is on Mt Tsukuba (Cost extra Y1000).
14:15-16:00 Cross-Cultural Bioethics and Methodology
R1.Bioethics in the former Yugoslavia: The War Tragedy & Recent Trends in Croatia
Nenad Hlaca, Law School of Rijeka, CROATIA
R2. Compassion as common ground
Anne Boyd, Hood College, USA
16:15-18:00 Bioethics Education
R3. Bioethics education efforts in Israeli schools
Frank Leavitt, Ben Gurion University of the Negev, ISRAEL
18:15-20:00 Informal get together (simple meal)

31 October
9:00-12:00 Environmental Ethics
R4. Bounty to Bust: The Ethics of Irreversible Environmental Degradation
Richard Weisburd, University of Tsukuba, JAPAN
R5. Need for Ground Water Laws and Water Abstraction Ethics for Industrial Use
Jayapaul Azariah & T. Jacob, University of Madras, INDIA
R6. Ethical Costs of Tanneries and Textile Dyeing Industries in Tamil Nadu, India
Thomson Jacob & J. Azariah, University of Madras, INDIA
R7. Does Noosphere Evolution Relieve the Forthcoming Biosphere Crisis?
Humitake Seki, University of Tsukuba, JAPAN
Lunch on your own in the University Cafeteria or other Campus Restaurants
13:30-15:30 Genetics, biotechnology and bioethics
R8. The new genetics and its regulation in the UK
David Shapiro, UNESCO IBC Rapporteur; Nuffield Council of Bioethics, UK
R9. The medical genetic services within primary care and formulating the
guidelines in Japan
Hideyuki Nakazawa, Mariko Tamai, Shinshu University, JAPAN
R10. China and eugenics
Ole Doering, Hamburg University, GERMANY
15:45-18:00 6. Conclusions: Contributions of each culture to ideal bioethics
R11. What Post-War Japanユs Philosophy Hopes to Offer to the International
Shinryo N. Shinagawa, Hirosaki University, JAPAN
18:15-20:00 Informal get together (simple meal)

1 November

Opening Session
(Chair: 庄司進一, 手嶋豊) (9:30-11:00 1H201)
 筑波大学学長 江崎玲於奈
   Turning Point of Global Bioethics
 日本大学 坂本百大
基調報告 Europe and UNESCO looks towards Asia
 Mr. David Shapiro, UNESCO IBC Rapporteur; Nuffield Council of Bioethics, UK
大会長挨拶 日本が国際生命倫理に貢献できるものは何か
   What Japan can offer to International Bioethics
  筑波大学 ダリル・メイサー

International Symposium (Third International Tsukuba Bioethics Roundtable)
国際シンポジウム 1. Religion, culture and bioethics
(Chair: 関文威, 庄司進一, Karl Friday) (1H201, 11:15-13:15)
11:15-11:30 1.1. Lessons from Asian Religions for Bioethics
  Karl Friday, University of Georgia, USA
11:30-11:45 1.2. The Bioethically Constructed Ideal Dying Patient in the USA
  Anne Davis, Nagano College of Nursing  長野看護大学
11:45-12:00 1.3. The American and Japanese Responses to Perinatal HIV
Transmission: Ethics, Values, and Policy in Context
  Masaaki Nakashima, School of Int. Health, The University of Tokyo 東京大学
12:00-12:15 1.4. To save or let go? An ethical dilemma for Thai Buddhists
Pitak Chaichareon & Pinit Ratanakul, Mahidol University, THAILAND
12:15-12:30 1.5. Ethical dilemmas in medical decisions concerning the end of life in Japan
  Atsushi Asai, Kyoto University Hospital  京都大学
12:30-12:45 1.6. Dilemmas of Informed Consent
  Carl Becker, Kyoto University 京都大学
12:45-13:00 1.7. Bureaucracy and Bioethics
  Yaman Ors, Ankara University, TURKEY (?)
13:00-13:15 1.8. Can Islamic Texts help to resolve the problem of the moral status of the prenate?
  Sahin Aksoy, University of Manchester, UK (TURKEY)

国際シンポジウム 2. Genetic technology
(Chair: Darryl Macer, 品川信良) (1H201, 14:15-16:15)
14:15-14:30 2.1. International Bioethics Survey in Portugal
  Maria Cristina Rosamond Pinto, Faculty of Medicine Lisbon, PORTUGAL
14:30-14:45 2.2. Reproductive Technology and the Reproductive Rights Of Asian
  Chee Heng Leng, Universiti Pertanian Malaysia, MALAYSIA
14:45-15:00 2.3. An Examination of the "Best Interests of Children" In the Field of Assisted Human Reproduction
  Ken R. Daniels, University of Canterbury, NEW ZEALAND
15:00-15:15 2.4. Ambiguity and Principles, Philosophical Implications of Human Dignity Principle in Bioethics
  Maurizio Salvi, University Maastricht, THE NETHERLANDS
15:15-15:30 2.5. Biotechnology: From Refound Law to Manipulated Law
  Christian Byk, International Association of Law, Ethics and Science, FRANCE
15:45-16:00 2.6. New Biotechnology and Life (Something Great)
  Kazuo Murakami, University of Tsukuba, JAPAN
16:00-16:15 Discussion

国際シンポジウム 3. What Asia can offer to international bioethics
(Chair: Song-yong Sang, 藤本隆志) (1H201, 16:30-18:30)
16:30-16:45 3.1. The application of universal principles as a challenge to cultural integrity
  Leonardo D. de Castro, University of the Philippines, THE PHILIPPINES
16:45-17:00 3.2. Bioethics in Bangladesh: Some Observations?
  Hasna Begum, Dhaka University, BANGLADESH
17:00-17:15 3.3. Why moral values and ethical values are not the same
  V. Manickavel, College of Medical Sciences Bharatpur, NEPAL
17:15-17:30 3.4. Universal Ethical Singularity
  R.N. Sharma, National Chemical Laboratory, INDIA
17:30-17:45 3.5. Recent trends in Bioethics Legislation in India and lessons for Asia
  R.R. Kishore, Ministry of Health, INDIA
17:45-18:00 3.6. Bhagavad Gita on Bioethics and Biodiversity
  K.K. Dua, Dayalbagn Educational Institute, INDIA
18:00-18:15 3.7. Euthanasia in Japan
Noritoshi Tanida, Hyogo College of Medicine 兵庫医科大学
18:15-18:30 Discussion

懇親会 (19:00-21:00) Overdinner Talk: Sabbath Rest and Asian Bioethics
Frank Leavitt, Ben Gurion University of the Negev, ISRAEL

セッション 1. 安楽死と末期医療
(Chair: 谷田憲俊, 藤井正雄) ( 1H101, 11:15-13:15)
11:15-11:32 4.1. 死をめぐる自己決定について−比較法的視座からの考察
Self-Determination upon Death
  五十子 敬子(横浜市)
11:32-11:49 4.2. 遷延性植物状態患者の不可逆性について
Persistent vs. permanent vegetative state
11:49-12:06 4.3. 集中治療施設入院患者の治療決定過程の分析―自己決定主体の不在に対する医師、近親者の態度―
Analysis of decision process in intensive care: attitudes of physicians and families when patients cannot make autonomous decisions
12:06-12:23 4.4. 慢性疾患患者(慢性腎不全・透析患者)の終末期医療、尊厳死に対する意識調査
Survey Research on Terminal Care and Death with Dignity of Chronic Kidney Disease/Dialysis Patients
  三浦靖彦 (国立佐倉病院内科)、浅井篤 (京都大学医学部総合診療部)、福原俊一 (東京大学医学部
国際交流室)、田邉昇 (京都大学法学部)
12:23-12:40 4.5. 「安楽死の類型」とその構成要素
Clinical types of euthanasia and is constituents in terminal care
  羽賀洋一, 田中康一郎, 熊倉伸宏(東邦大学医学部)
12:40-13:57 4.6. 安楽死および尊厳死の定義再考
Reconsideration of the Definition of Euthanasia and Death with Dignity
13:57-13:15 4.7. 看取る者、看取られる者ー仏教史的考察ー
Care and care-givers for Dying Patients from the Perspective of

セッション 2. 臓器移植と脳死
(Chair: Carl Becker, 深尾立)  (1H101, 14:15-16:15)
14:15-14:35 5.1. ”脳死受容”を脳死反対の論拠にできるか?
Can "Acceptance of Brain Death" Play a Ground for the Opposition
Against Brain Death?
14:35-14:55 5.2. 献体動機の多様性
Varied Motives for Donating a Body
14:55-15:15 5.3. 骨髄移植による遺伝標識の変容
Transformation of Genetic Markers by BMT
15:15-15:35 5.4. 脳死・臓器移植における権利と義務
Rights and Duties for Brain Death and Transplantation
15:35-15:55 5.5. 日本の臓器移植に対する危惧
Why Organ Transplantation Remains Taboo in Japan
  Carl Becker(京都大学文学部哲学科)
15:55-16:15 討論

セッション 3. 遺伝学と出生
(Chair: 玉井真理子、青木清) (1H101, 16:30-18:30)
16:30-16:50 6.1 アジア諸国における遺伝と障害に関する意織調査
Opinion Survey on Heredity and Handicapped in Asian Countries
  中崎繁明(武生市保健センター)、平山幹生、藤木典生(福井医科大学)、 Ishiwar C. Verma (全インド医科学研究所)、Pinit Ratanakul(マヒドール大学)、羅曾元(中国協和医科大学)、姜永善(韓国水原大学校)、Victor Bulyzhenkov(WHO)
16:50-17:10 6.2. 羊水検査を受けるか否かの意思決定について
Factors in a Making Decision to Undergo Genetic Amniocentesis
  塚本康子(静岡県立大学短期大学部)、 上見幸司(常盤大学)
17:10-17:30 6.3.遺伝子治療の議論において何を優先すべきか?-7集団の倫理意識パターン分析から
What Should We Give Priority to in Discussing Genetic Medicine?: An Analysis of Patterns of Ethical Decision Making Among Seven Groups
  村岡潔(大阪大学医学部)、 森本兼曩(大阪大学環境医学)
17:30-17:50 6.4. 分子遺伝学と遺伝医学
Molecular genetics and medical genetics
  木田盈四郎, 帝京女子短大
17:50-18:10 6.5. 新しい遺伝医療と日本におけるガイドライン整備
"New Genetics" and formulating guidelines in Japan
18:10-18:30 6.6. ヒトゲノム計画に関する生命倫理教育
Bioethical Education about the Human Genome Project

懇親会 (19:00-21:00) Overdinner Talk: Sabbath Rest and Asian Bioethics
Frank Leavitt, Ben Gurion University of the Negev, ISRAEL

2 November
ワークショップ 1. 生命倫理と人類学ワークショップ
(Chair: 大井玄、武井秀夫) (1H201, 9:00-10:40)
09:00-09:20 7.1. 生命倫理についての人類学的ー考察
An anthroplogical view regarding bioethics
  大井玄 (国立環境研究所)、武井秀夫(千葉大学)
09:20-09:40 7.2. 生命倫理問題の臨床民族誌的構成の意味について
On Meanings of a Clinical Ethnographic Construction in Bioethics Issues
09:40-10:00 7.3. 二正面作戦としての生命倫理
Bioethics as Double-edged Strategy
10:00-10:20 7.4. 仏教からみた人間と優生思想
Human nature and eugenics thoughts from a Buddhist perspective
  佐藤雅彦 (大正大学)
10:20-10:40 7.5. 吾 ―機械人間― は「魂」を持っているのだろうか? バイオテクノロジーとSF小説から見る「物体」と「魂(こころ)」 ステレオタイプ的な文化のイメージ、既存の 使い古された枠組み、を超えて
Do ‘I’, an android, have a soul?: The material body and human soul in terms of biotechnology and of Science Fiction - Looking beyond the stereotypical cultural images-
  佐々木香織(University of Lancaster, UK)

ワークショップ 2. 生命倫理と社会的正義ワークショップ
(Chair: 小原信、樽井正義) (1H201, 11:00-13:00)
11:00-11:20 8.1. 日本とスコットランドにおける児童虐待の現状の比較検討
Comparison of the Present Situations of Child Abuse between Japan and Scotland
  大島徹, 近藤稔和(金沢大学)
11:20-11:40 8.2. 看護業務におけるジレンマと倫理的意思決定
Dilemmas in Nursing Jobs and Bioethical Decision Making
11:40-12:00 8.3. <社会的>正義から<ローカルな>正義へ
From justice to justice
12:00-12:20 8.4. 臓器の「分配」ー社会的正義?
"Distribution" of organs -social justice?
12:20-12:40 8.5. 医療配分における社会的正義
Social Justice in Medical Allocation
12:40-13:00 討論

ワークショップ 3. 環境倫理ワークショップ
(Chair: 森岡正博, Richard Evanoff ) (1H201, 15:00-16:30)
15:00-15:20 9.1. 今日の環境倫理学が直面する諸問題
Some Problems of Contemporary Environmental Ethics
15:20-15:40 9.2. 異文化間倫理に対する構成主義的アプローチ
A Constructivist Approach to Intercultural Ethics
  Richard Evanoff(青山学院大学)
15:40-16:00 9.3. 環境倫理学における所有論の可能性
Property in Environmental Ethics
  鬼頭秀一 (東京農工大学農学部)
16:00-16:30 討論
Poster 9.4.アジアと環太平洋諸国における人間と動物の関係と生命倫理
Human Relationships with Animals in Asia Pacific Countries and
  横山恭子, メイサー、ダリル(筑波大学生物科学系)

セッション 4. 生命倫理教育1
(Chair: 赤林朗, 紙谷克子,小松奈美子) (1H101, 9:00-10:40)
9:00-9:20 10.1. 生命倫理教育の医学教育への組み込みに向けて
Toward the integration of bioethics education into medical education
9:20-9:40 10.2. 介護福祉養成教育における生命倫理教育に関する意識調査
A Study of Bioethics Education in the Training of Care Workers
9:40-10:00 10.3. 生命倫理教育としての臨床人間学
Clinical Anthropology Aimed at Bioethics Education
10:00-10:20 10.4. コ・メディカルのための倫理教育−短期大学における実践報告と提案 Ethics Education for Allied-health Professionals--A report and
proposal on a project at a junior college of health and welfare
  岡本珠代、 吉川ひろみ(広島県立保健福祉短期大学)
10:20-10:40 10.5. 学生が経験した症例をもとにした臨床倫理教育
Clinical Ethics Education on the case of students experienced

セッション 5. 生命倫理教育2
(Chair: 浅田由紀子,小泉博明,大谷いずみ) (1H101, 11:00-13:00)
11:00-11:20 11.1. 日本における高校での生命倫理教育ネットワーク
High School Bioethics Education Network in Japan
  浅田由紀子、 メイサー、ダリル(筑波大学生物科学系)
11:20-11:40 11.2. 健康・病気をテーマとした生命倫理教育
Bioethics Education - Health & Disease Dealt as a Theme
11:40-12:00 11.3. HR(ホームルーム)野外合宿の生命倫理的意義、高校の事例から
Bioethical Importance of School Field Activity with Lodging (High School
Case Report)
  橘 都(羽田高校教諭)
12:00-12:20 11.4. AIDSについてどう教えるか 〜人間の生き方と社会のあり方を考えるために〜
How to Teach AIDS Problems -In Order to Think How Our Life and Our Society Should be-
12:20-12:40 11.5. 山口大学一般教育における生命倫理教育の実践
An Attempt of Bioethics Education in Yamaguchi University
  川崎 勝(山口大学)
12:40-13:00 討論

セッション 6. インフォームド・コンセント
(Chair: 浅井篤, 山田卓生、大林雅之) (1H101, 15:00-16:30)
15:00-15:20 12.1. アメリカにおけるインフォームド・コンセント概念の形成
The Formation of the Idea of Informed Consent in US
15:20-15:40 12.2. 患者の自律とインフォームド・コンセント
Patients' Autonomy and Informed Consent
15:40-16:00 12.3. 日本の小児医療における小児がん患児に対するInformed Consent
Informed Consent for Cancer Children in Japan
16:00-16:20 12.4. エホバの証人の輸血拒絶の特約は公序良俗に違反するか?
The Refusal of a Blood Transfusion by a Jehovah's Witness and the
Breach of the Public Policy
16:20-16:30 討論

Conclusions 総括 (総合討論)1H101,16:30-17:00

赤林朗 青木清 江藤肇 藤木典生 藤井正雄 藤本隆志
浜口秀夫 林英生 紙屋克子 小松奈美子 宮田登 村上和雄
小原信 大井玄 大林雅之 坂本百大 玉井真理子 山田卓生



日本生命倫理学会 年次大会のあゆみ

年次大会      会期       大会長      所属      場所

第1回 1989年11月25〜26日 坂本 百大 青山学院大学 東京
第2回 1990年11月 3〜 4日 古川 俊之 国立大阪病院 大阪
第3回 1991年11月 8〜 9日 瀬在 幸安 日本大学 東京
第4回 1992年11月19〜20日 糸川 嘉則 京都大学 東京
第5回 1993年11月13〜14日 藤井 正雄 大正大学 東京
第6回 1994年10月 1〜 2日 木村 利人 早稲田大学 東京
第7回 1995年10月28〜29日 中谷 瑾子 大東文化大学 東京
第8回 1996年10月23〜29日 竹内 一夫 杏林大学 東京
第9回 1997年11月 1〜 2日 メイサーダリル 筑波大学 つくば


R1 Bioethics in the former Yugoslavia: The War Tragedy and Recent Trends in Croatia

Nenad Hlaca Fax: +385-51-226689
Law School of Rijeka, University Rijecka, Hahlic 6, CROATIA

In some scientific circles bioethical dilemmas in the former state were imported with the new medical technology in the last decades. In the same time there was strong impact of the socialist regime in which collective rights were more important and in which there was no place for what in that time was called メliberalistic and individualisticモ approach in the protection of human rights. Historically an important step in the development of the bioethical approach was the first Course メHuman Rights and Medicineモ organized at the Inter-University Center for Postgraduate Studies in Dubrovnik in 1984. In the last thirteen years, even during the war, the Courses in Dubrovnik were dealing with human rights issues in medicine and health care. In the multidisciplinary approach, participants from Croatia and aborad discussed ethical dilemmas and protection of human rights. The Hastings Center from New York organized the first East-West Bioethics Conference in 1989 in Dubrovnik. Tragic events in the former state during the war focused the interests of the participants on the problems of the war victims, displaced persons and refugees as well on the ethical and legal aspects of the family dysfunction, in the 1994 Course. This year's Course was oriented to the new European reality: on the Convention on Human Rights and Biomedicine. As a tragic war experience it will be stressed the problem of forced pregnancy as a serious violation of the rights to reproductive choice. Forced pregnancy through rape during the armed conflicts is treated as a war crime (UN doc.E/CN.4/1994/5). In the war in former Yugoslavia rape is expressly considered as a breach of international humanitarian law and a crime against humanity in certain circumstances. In the same time during the war there was investigated serious examples of the male sexual abuse. The problem of abortion of sexually abused Bosnian citizen refugees in Croatia was treated according to Croatian law. But the problem was that the raped women reached Croatia usually too late for the medically acceptable abortion.

R2 Compassion as common ground

Anne Boyd, Hood College, USA Email: boyd@NIMUE.HOOD.EDU

Pinit Ratanakul and Attajenda Deepudong, Mahidol University, THAILAND

The Acquired Immunodeficiency Syndrome (AIDS) global epidemic is an opportunity for pluralistic dialogue and academic debate about ethical standards and principles in an international context. Ethics attempts to guide decisions in which priority is given to the principles of autonomy over paternalism, truth telling over deception, social justice over consumerism, and beneficence over inertia. There is a dialectic between theory and application in every culture where the AIDS epidemic is threatening health care resources, national economy, and political stability. No universal agreement exists about how myriad cultures ought to evaluate the decisions that this epidemic imposes. The AIDS epidemic in Thailand provides a case study for ethical analysis. The Ministry of Public Health must decide how to allocate money and human resources to curtail the AIDS epidemic and to care for those already infected and dying. What ethical standard or principles provide the best formula for public policies?

Buddhism is the fundamental basis of moral education in Thailand and directly influences individual and collective ethical analysis. Ethics, defined as an individual reasoned response to a situating in which a person seeks to do the good thing, means that priori values with ethical reasoning. The assertion is that moral philosophy and ethics philosophy are convergent at the existential level.

The Buddhist concept of compassion is one of loving kindness which embraces the ethical principles of beneficence, nonmaleficence, and justice. Justice is the social form of compassion. Compassion exceeds justice in basic equality and human rights to the point of self-sacrifice voluntarily, equal treatment, giving to each their due. Although people differ in circumstances, they are equal as moral agents. Justice means providing available health care for all, poor and rich. Wat Phrabatnampu illustrates the concept of compassion as the largest AIDS hospice in Thailand.

Compassion as a principle prescribes a prima facie duty as an ethical response to a compelling human need. Buddhist philosophy is ethical, metaphysical, and epistemological. The ancient Greek Sophists proposed ethics as useful to human relationships because it would establish customs and conventions to enhance social existence. Kantian ethicists place a premium on individual human worth and dignity. The debates about what is the philosophical good and how human beings decide what action to take in a given circumstance extend the conversations of ancient philosophy into contemporary topics.

Given the wide variety of opinion about ethics that exist within and among different cultures and different epochs of the same culture, the meta-ethics question of the human capacity for morality remains unanswered. What moral or ethical code has better common ground in the world of human beings than compassion?

R3 Elementary and High School Bioethics Education Efforts in Beer Sheva, Israel

Frank J. Leavitt, Hadas David-Gabizon & Vered Yeflach-Wishkerman
The Jakobovits Center for Jewish Medical Ethics, Faculty of Health Sciences,
Ben Gurion University of the Negev, Beer Sheva, ISRAEL Email:

School bioethics education is important not only because of the ethical questions raised by medicine, nursing, biotechnology and the environment but also as an attempt at an antidote to the moral problems of post-modern society: crime, corruption, violence, etc. Ethics is not taught by preaching but by free and open inquiry into the moral issues, including their scientific background. This requires faith that when young people investigate an issue freely they will certainly come to the ethical conclusion. This article of faith requires examination.

Our school bioethics experience in Beer Sheva began with voluntary enrichment sessions for high school biology students, taught by some of our medical students who had previously studied bioethics as part of their medical education. These medical students gained further experience by teaching bioethics sessions to religious girls doing National Service (an alternative to army duty) by working in the hospital.

More recently, Vered Yeflach-Wishkerman, a Ph.D. student in biology specializing in radiation medicine is teaching bioethics in one high school, concentrating on ethics in genetics and the environment. In another school, Hadas David-Gabizon a philosophy student who emphasizes the philosophical basic of bioethics has been surprisingly successful at teaching bioethics in the lower grades.

Bioethics is a big field with a wide range of sub-topics (medical ethics, environmental ethics, animal rights, etc.) and of approaches to foundations (philosophy, religion, sociology, etc.) We hypothesize that choice of sub-topics and of approaches is best determined by the teachers personal interests and a feel for what excites the pupils. We also hypothesize that success is more a matter of the teachers personality than of a properly planned syllabus.

We try to maintain close communication with similar projects elsewhere in Israel as well as in the Hope Flowers School near Bethlehem, which is under the Palestinian Autonomy. In June 1997 we held a one-day workshop on Israel in Asian Bioethics, part of which was devoted to bioethics in the schools. We hope to devote a full day's workshop to this subject, with our South Asian and East Asian friends, in Israel in June, 1998.

R4 Bounty to Bust: The Ethics of Irreversible Environmental Degradation

Richard Weisburd Email:

Institute of Biological Sciences, University of Tsukuba, Tsukuba Science City 305

The current status of the biosphere and trends in anthropogenic activities and their biogeochemical impacts have some sobering implications for the ability of future generations to meet their basic needs. Indeed, the trends raise some troubling ethical concerns about behavior and lifestyle choices being made today. Whereas most people seem to use ethical principles to govern their behavior and choices, long-term environmental degradation is generally regarded as either not being an ethical issue or being beyond the scope of ethical issues deemed worthy of serious consideration. That irreversible environmental degradation is a bona fide ethical concern can be demonstrated by exploration of a series of scenarios, in each of which, personal gain is achieved at the cost of an ethical violation; these violations progress from direct and intentional causation of grievous bodily harm to a neighbor, to those that increase the probability that the health and welfare of future generations will be impaired. Does knowledge of the ethical implications of environmental degradation impose any obligation to act and/or educate? Would a population more aware of the ethical implications of their actions, alter their behavior by foregoing some level of convenience in return for a more sustainable lifestyle?

R5 Need For Ground Water Laws And Water Abstration Ethics For Industrial Use

Jayapaul Azariah and C. Thomson Jacob Email:

Department of Zoology, University of Madras, Madras 600 025, INDIA

The rapid growth of industrialization and excessive mining of ground water threaten the very availability and quality of ground water. The depletion of ground water resources and ground water pollution has brought about a scarcity in ground water resources in Tiruppur. Tiruppur is a special grade municipality in the Coimbatore district, Tamil Nadu, India with 400,000 inhabitants. It extends to a total area of 27.19 The main industries of the town are hosiery and knitting garments. There are about 187 bleaching and 526 dyeing units making a total of 713 water intensive industrial units which consume a total amount of 91.7 mld of water. Phenomenal industrial growth has generated a huge annual foreign exchange of more than 30 billion Rs per year.

As members of the current generation we may wish to brighten our own welfare, improving during our own lifetime, and treating the needs of the future as less important. As the extent of the general damage increases the question of water rights becomes more urgent. Should future people be treated as if they were already dead? Should this generation care about its actions that will result in a degraded environment in the distant future? If we do care then what should be done? A great deal of thinking and research need to be done to come up with appropriate legal measures with regard to mining and the use of available ground water.

Ground water was not mentioned in any of the lists in the seventh schedule of the constitution of India. This could be because the farmers in their infinite wisdom did not envisage such a water crisis as we are facing today. The fact remains that we are faced with this water crisis. Furthermore all the attempts at action made by the various legislators have only tried to address extraction. None of the bills or acts have sought to deal with the inequity and inequality inherent in the very conceptualisation of ground water. Water should not have been handed out to the regulatory states at the time of the framing of our constitution. The reason why these bills and acts have failed is because the focus of regulation was merely extraction, and the authority vested with this power was based on a political or linguistic divisions of the state.

For an efficient regulatory regime, perhaps we require ecological, and more specifically aquifer-based divisions. The question of rights, those of the landed and those of the landless, need to be addressed within this framework. All attempts that ignore this question remain inadequate, and perhaps we need to look at water and water management more holistically: understanding surface water, ground water and rain water as a common pool of resource or a common world heritage. Segregating/dissecting does not make water management efficient. There is a need to develop a universal bioethics regarding the abstraction of ground water.



 現世代の人間として、私たちは生きている間により明るい繁栄を望み、未来のニーズを軽視して危機にさらしています。ダメージの範囲が広がれば広がるほど、一般に水の使用権の問題の切迫感は増します。未来の人を既に死んだかのように扱っていいのでしょうか? 私たちの世代は、遠い未来の環境を破壊する行動を意識すべきでしょうか? 意識するとしたら、何をしたらいいのでしょうか? 今ある地下水の汲み上げと利用に関する適切な法的措置を打ち出すには、多くの思考と調査が必要です。



R6 Environmental Ethical Cost of T-shirts, Tiruppur, Tamil Nadu, India

C.Thomson Jacob and Dr. Jayapaul Azariah Email:

Department of Zoology, University of Madras, Madras 600 025, INDIA

The Coimbatore-Tiruppur-Erode belt is one of the fastest growing industrial regions in Tamil Nadu, India. Coimbatore and Tiruppur are major industrial towns in Tamil Nadu. The major constraint on the development of this area is the non-availability of fresh water, both for drinking and for industrial use. Improper disposal of sewage and industrial effluent damage the whole ecology of Tiruppur. The untreated effluent from bleaching and dyeing units is released into the Noyyal river, and thus has created major environmental problems, particularly with regards to ground water depletion and deterioration of water-quality. The export of T-shirts fetches a revenue in foreign exchange to the turn of 30 billion Rupees a year, but who will pay for the ecological degradation of this town? Demands placed by the textile industry and individual households have led to the conversion of agricultural wells to commercial use for selling water. There is a flourishing private water-market involving transport of water by tankers and bullock carts to users in the Tiruppur area. All users, including the poor, have to pay if they wish to use this source of water. In Tiruppur 30-60 million liters of water are transported to and sold in the private markets daily. The private supply accounts for 50-70% of water used.

The fast depleting water table in the Coimbatore district has forced some farmers to quit agriculture and become either farm or non-farm laborers. They have been pushed to this extreme step because their efforts to deepen wells or change the crop pattern have failed. There was a steep rise in the number of abandoned wells from 4000 in 1960 to 20,000 in 1996. A conservative estimate has put the cost of digging wells at Rs.50,000 a well and hence, the capital loss amount to Rs. 100 crores. In Coimbatore a large number of open wells have become dry and recently the drilling of borewells upto a depth of 750 feet has become a common feature. The heavy withdrawal of ground water for irrigation purposes has resulted in a marked lowering of the water table.

It has been reported that in many parts of the Coimbatore district the water table had fallen to nearly 200 ft during the last 20 years. In the last 10 years the mean water table has declined significantly. The figures(in meters) are as follows. Avanashi(9), Coimbatore (6), Palladam (5), Pollachi (4) and Vdamalpet (3). The number of wells has doubled from 9 lakhs in 1996. The area under well-irrigation had increased from 600,000 ha. to 1.4 million ha. during the same period. Owing to competition for water among irrigators by the year 2025, it is predicted that 34 countries will face water scarcity and reduction in per-capita water availability between 1990 and 2025, and that for a country like India, this will reach about 39%. This paper discusses certain remedial measures for the preservation of this ecosystem.


 コインバトール、ティルプール、エロードを結ぶ一帯は、タミール・ナドゥ州でも有数のスピードで工業化が進んでいます。コインバトールとティルプールは、同州の主要工業都市です。この地域の発展を妨げる大きな要因として、飲料/工業用の新鮮な水がないことが挙げられます。汚物と工場廃水の勝手な投棄は、ティルプールの生態系全体を悪化させています。さらしや染色の工場からの未処理廃水はノヤル川にそのまま流され、大きな環境問題、とくに地下水の枯渇と水質悪化を引き起こします。Tシャツ輸出は年間300億ルピーもの外国為替取引収入をもたらしますが、生態系悪化のコストは誰が負担するのでしょうか? 繊維産業や家庭からの需要のせいで、農業用井戸は水を売る商業利用に転換されました。民間水市場は活気づき、タンカーや牛の荷車がティルプール地区の利用者に水を輸送しています。貧困層も含めてすべての利用者は、水が欲しければお金を払わなければなりません。ティルプールの場合、1日に3,000万から6,000万リットルの水が民間市場に輸送され、売られています。民間供給は、ティルプールで消費される水の50から70%を占めます。コインバトール地区の急速な地下水面の枯渇により、農民は農業を捨て、畜産その他の仕事に就かざるをえなくなっています。井戸を深く掘ったり耕作物を変える努力が実らなかったため、ここまで追いつめられたのです。放棄された井戸は1960年には4,000基だったのが、1996年には2万基と急増しています。井戸を1本掘るには控えめに見ても5万ルピーかかるので、資本損失は10億ルピーにも上ります。コインバトールでは数多くの蓋なし井戸が干上がり、深いもので200メートルも掘り下げるのが当たり前になっています。潅漑用に地下水を大量に汲み上げるため、地下水面が著しく下がっています。


R7 Does Noosphere Evolution Relieve the Forthcoming Biosphere Crisis?

Humitake Seki Email:

Institute of Biological Sciences, University of Tsukuba, 305 JAPAN

It was about 2 billion years ago when the rise of oxygen from the primordial atmosphere was brought about by photosynthetic activity of newly evolved autotrophic cyanobacters such as stromatolites. One reason for the emergence of these photosynthetic organisms is speculated as a nutrient shortage because the enzyme-mediated consumption rate of organic nutrients by primitive microorganisms is much higher than their physico-chemical production rate. Hence, at this period of the biosphere history, primitive organisms inhabiting the anoxic biosphere faced a great crisis of nutrient shortage, but found the resolution of producing nutrients by themselves through the biological evolution at the hands of God. Although the nutrient shortage was relieved by the photosynthetic activity, the activity caused the rise of oxygen in the primordial atmosphere above the Pasteur point (0.01 PAL), that is the lethal threshold for anaeobic primitive microorganisms. Just like the God rained buring sulfur on the cities of Sodom and Gomorrah and destroyed all the people there, except the survivors Lot and his two daughters. These microorganisms that were tolerant to oxygen eventually acquired respiratory metabolism.

An equivalent great crisis in biological phenomenon in the history of our planet is exactly what we have forced upon ourselves (and all others) to face at present! It must be one of few choices that human acceleration of the Noosphere evolution relieves this forthcoming Biosphere crisis with Great Will, as Sir Alister Hardy has described as "it is God working through men". There, upon anthropogenic acts beyond any purely Scientific reflections in the Domain of God, none can deny the apparent need for interventions of the philosopher and theologian.

R8 The new genetics and its regulation in the UK

David Shapiro Fax: +44-171-323-4877

UNESCO IBC Rapporteur; Nuffield Council of Bioethics, 28 Bedford Square, London WC1B 3EG, UK

The UK is presented as a case study in the development of national policy strategies for the application and regulation of the new genetics. The UK may well be a special case for two reasons: First, the UK has a National Health Service. The public therefore expects that, in health matters, the Government will take a lead. Secondly, professional self-regulation has long been a feature of medical law and ethics in the UK. The development of policy strategies in the UK began with a series of reports from the Royal College of Physicians in the early 1990s. Ethical, social and legal issues were set out in 1993 in the report of the Nuffield Council on Bioethics, Genetic Screening: Ethical Issues. This report was taken up by the House of Commons Select Committee on Science and Technology in its report Human Genetics: the science and its consequences (4 vols, 1995). The UK Government has responded by establishing in January 1996 the Department of Healthユs Advisory Committee on Genetic Testing and in December 1996 an overview body, the Human Genetics Advisory Commission.



1 国民健康保険がある。したがって国民は保健問題については政府主導を期待する。

2 英国の医療法と倫理の特色は、長い間、専門家の自主規制だった。



R9 Eugenics and China: Where is the ethical problem?

Ole Doering Email:

Institute for Asian Studies, Univ. Hamburg; Ahornsteg 8, D-37079 Goettingen, GERMANY

Progress in ethics has nowhere reached a degree of maturity which would entitle to straightforwardly abandon eugenics and Chinese medical politics. What are the criteria for such a mature ethical discussion of eugenics? At first we have to define the problem of eugenics, which is twofold: Its descriptive dimension, 'What can we expect to achieve in health care with our biotechnological skills, and what is mere science fiction or ineffective if we balance costs and merits?' The second dimension is prescriptive, 'What shall we do with our (assumed) medical knowledge and skills, and should we encourage bioscientific progress as such?" Hans Jonas in his popular book on 'Technology, Medicine and Ethics' holds that the very new quality of technological accomplishments is permanently creating new ends of the same new quality we do not quite comprehend. Jonas arguments rely substantially on the notion of a historical Great Leap towards Modernity. This New Age makes him worry whether we might finally end up in a catastrophe due to the exhaustion of our limited capacities, which leave us unprepared for our new challenges. Darryl Macer, on the other hand, reminds us that in principle biotechnology and eugenic ideas are not new but as old as human cultures. Macer still acknowledges the limits of our understanding that some express as the belief in a 'god of the gaps', but encourages us that ethical progress is possible.

I frankly confess that I feel more attracted to the view of Macer which is at least based on a decent reading of the history of medical concepts and sciences, and ready to take the challenge. Though I still have some concern about a new quality of problems which I regard as effects of quantity and complexity. I hold that neither claiming a New Age nor quoting the historical evidence of biotechnological engagement does provide a strong argument. It appears like we are now forced to pay as much attention to empirical facts as we philosophers have seldom done before. I may remind you that even in mainstream ethics it is very often regarded odd to become involved in matters of trivial life as an ethicist. Some colleagues prefer to engage in most abstract conceptual analyses or game theories, disregarding the old tradition of associating the philosopher with the physician.

Eugenics is not simply good or bad. For example eugenics can indicate an attempt to improve the quality of our bodily constitution, which is fine if we think of hygiene or antibiotics. Interference is inevitable for a natural being. It makes a considerable difference to kill a population of bacteria, to reanimate a gene-sequence in charge of health, or to try to design a germline. Obviously, all of these bear a different impact on the concerned persons and society, with the latter also effecting on future generations. But there is no general innate ethical value in any of these.

For an ethical statement we require additional conditions. Track one is to explore the ethical quality of our proclaimed intentions. James Buchanan has suggested a revised spelling of this device for the context of biotechnology, putting it into a paradox: 'Act so that the effects of your actions reflect the fact that you cannot predict the effects'. A concrete specification would be, 'In order to gain a more healthy population, can we wish that sterilization of handicapped persons becomes the regular procedure under all circumstances, at any time, and for every person?'. Track number two is to explore the practical coherence of our applied maxims. We have to look for so-called hypothetical imperatives, which are defined by having not an aim in themselves and also consisting of empirical elements. In light of the sterilization example it may be formulated like this: 'In order to gain a more healthy population, is it effective at all to perform sterilization of handicapped people? And if 'Yes', for which particular cases would this be true. And, subsequently, can we be sure that the respective medical system is effective enough to provide the measure for the whole population? Finally, can the risks and shortcomings outweigh the costs of the respective measure?'.

If one or more of the answers is negative, as we know it is true for our example, we have reason to revise the questioned means. This double track method provides mere evidence for the value of one maxim. There occur cases of a lethal collision of maxims, which have been found to be consistent within themselves, like the clash between legitime interests of individuals and of society. Still it is possible to solve these problems if we again go through the enlightened double track process, but this requires lengthier explanations than I may perform here.

This ethical approach can be very promising but it also requires a very high level of interdisciplinary sophistication, at least some skills in systematics and a high degree of social and psychological sensitivity. We are far from educational systems and scientific practice which would encourage this sufficiently, not to mention the very poor back up in society and politics.

Historical experience teaches every European that eugenics is a very dangerous approach, at least under the guidance of narrow minded interests, and it has almost every time been abused for ill purposes. Even recently it was revealed that Sweden among others has been following a eugenics policy of coercive sterilization adopted in the thirties. The more the eugenic's proponents urged that a 'better race' required stern means for a few the worse the effects on more and more people turned out, with no countable gain left in the end. This is an insight the whole mankind will profit to share, and hopefully this convinces others, in China and elsewhere, to avoid trapping into the same pitfall of human hybris, of reshaping what does not seem to fit, instead of showing humaneness and understanding. Asia also has had its 1984 Singapore experience of social engineering, which is a relatively mild form of eugenics but still influenced by some naive biologism which raises concern. The shaping of genes by biotechnological, social and even legal force should be held away from the toolbox of politics, where we cannot expect pure ethical arguments to be too influencial.

A general welcome to technological improvement and innovation, which has often be ascribed to Asian societies, should not hamper us to be extremely careful and open to face, name and calculate risks, and, in case, to accept the modest conservative course of interference into peoples lives, which is an advice of an ethical understanding Asian traditions are proud of.

All of this has a massive impact on present day's China with its practice of sterilization, selected abortion, underdeveloped infrastructure, education and a widespread poorly sophisticated body thinking. The eugenics issues have neither been thoroughly discussed nor embedded in proper practical and legal frameworks yet. The problem appears not to be a special one for China, but again a challenge for humanity. Eugenics in China is primarily a political problem. This entails at the same time an ethical concern, but this ethical concern is neither restricted to China nor to politics. We ought not to confuse these two levels of discussion.

R10 Medical Genetic Services Within Primary Care and Formulating the Guidelines in Japan

Hideyuki Nakazawa Email:

Mariko Tamai Email: Fax: 0263-39-1140 Department of Psychology, School of Allied Medical Sciences, Shinshu University

Asahi 3-1-1, Matsumato Nagano 390

Keywords :Medical genetic services, Guidelines, Common disease, Primary care

The aims of medical genetic services have been clearly extended to multifactorial or common diseases. Single gene disorders are now considered as the objects of the narrow sense of medical genetic services. The current medical genetic services appear to be a part of primary care.

PS. Harper said, "until very recently, most concerns and applications were focused on genetic tests for rare, although important, disorders with Mendelian inheritance patterns. The emphasis is now shifting to the common chronic diseases that make up the major health burden in most Western countries", suggesting that all of the diseases are now practically within the command of growing medical genetic services as their objects. Medical services have dealt with genetic and environmental factors, both of which interact and create sick conditions. Recently, however, greater efforts are being made to analyze genetically the epidemiology of common diseases.

With the recognition of such a crisis, the ethical, legal, and social issues of medical services are growing more controversial these days. In the worldwide perspectives, the Declaration on the Protection of the Human Genome of UNESCO and Guidelines on ethical issues in medical genetics and the provision of genetic services (draft) of WHO are prominent examples.

The social and ethical implications of these guidelines are identical. These guidelines: 1) presuppose that genetic information is so special that it belongs to all of the family members regardless of their generation; 2) include particular consideration of the human rights, so that any social discrimination shall not be derived from the genetic information; 3) guarantee an adequate informed consent process, a process to provide sufficient information and to support self-decision either to agree, to deny, or to choose; 4) improve facilities to support patients including a system to provide genetic counseling; and 5) keep any discussion about formulation of such guidelines cross-sectional and wide-open to supporting groups for patients.

Medical genetics tends to aim at common diseases and to play a role in primary care and public health services. This tendency should encourage Japanese society to formulate ethical guidelines and, for this reason, interdisciplinary discussion should be provided openly. The ethical guidelines (draft) of the Japanese Society of Familial Oncology was released in May 1997. This shall provide a model of such guidelines, including its developing process in Japan.

R11 What Post-War Japanユs Philosophy Hopes to Offer to the International Community

Shinryo N. Shinagawa Fax: 0172-32-8053

Institute on Public Issues Relating to Health Care and Medicine; Hirosaki University, Hirosaki

From a viewpoint of a Japanese who experienced Pre-War Japanユs education and World War II, seven topics relating to Post-War Japanユs philosophy will be presented. They are:

1. Idealistic pacifism which desires peace (and disarmed society and international relationship) for all time. (Preamble and Article 9, Constitution of Japan, 1946)

2. All people shall be respected as individuals. (Article 13 Ibid.); From a country of メHuman Torpedo and Kamikazeモ to a country of メHuman life is heavier than the globe.モ

3. All of the people are equal under the law. (Article 14, Ibid.)

4. From a country of Nationalistic Shintoism to a country of a Museum of Religions: Freedom of religion is guaranteed to all, and at the same time, no religious organization can receive any privileges from the State nor exercise any political authority. (Article 20, Ibid.)

5. Protection of socially and economically disadvantaged persons: All people shall have the right to maintain the minimum standards for wholesome and cultural living. (Article 25, Ibid.)

6. Elevation of the living standard; From a country of メSaving is a virtueモ to a country of メAffluence is a virtue.モ

7. Peaceful and harmonious coexistence with the Emperor and His family minimizing their privileges: The Emperor shall be (no more the ruler but) the symbol of the State and of the unity of the people. (Article 1, Ibid.)

O-4 What Japan can Offer to International Bioethics

Darryl Macer Email:

Institute of Biological Sciences, University of Tsukuba, Tsukuba Science City 305, JAPAN

I wish to share a few thoughts about Japan. I am not a historian but it is obvious that bioethics did not start when the word was made, but the ideals of doing good and avoiding harm, and of choices from autonomy versus social justice, have been with us since the beginning of civilisation. Yet it seems we have to reinvent the wheel very often. Let me give a few examples from Japan.

I think the concept of "informed choice", should replace the concept of "informed consent". Both concepts are found early in Japan. Last century Hanaoka Seishu records informed consent for breast cancer operations in Japan. Why do we use Informed Consent in katakana, not kanji? Japanese like to introduce new words which can be a positive trait, but why are new ideas better than the same idea in an old name? Of course, if it really is the same idea is a question for us to examine.

It is said that death is a taboo in Japan, but actually more elderly people live at home with the family in the sometimes depressing years of fragility that old age brings, than in the West. The daily experience of death and futility may be more common in Japan, yet discussion of death is said to be less common than overseas. Maybe in America they talk about futility but put the elderly in separate care. In independent care they can pretend that they are young, and on the positive side keep a cheerful active life. However, this is also avoiding to see death by the family.

If we look for bioethics in literature we can find stories of the beauty of dying in nature, as in many countries. We can also see stories like "Ubasuteyama", which could be translated as "Grand-mother throwing mountain". This practice was relatively well known before the Meiji era, and involves the son carrying the mother up to the mountain to leave her there to die. It was made famous in a film "Narayama bushiko" which won a Cannes film prize. The reason was usually the shortage of food. This unpleasant practice is reported to still occur in Korea, and is also shared with Siberian tribes such as the Yakuits and Mongolians, who are close to the Koreans and Japanese in origins.

Mabiki is another practice that involved pulling out extra rice seedlings, used for killing of unwanted babies. This we can see more broadly across cultures, and it also relates to the dilemmas of prenatal testing. We also see a very interesting practice of Mizuko statutes, water-children, which is a griefing process for remembrance of aborted fetuses, miscarried children, and babies who died very young. It is a Japanese response to a universal dilemma.

Japan is a country where you may get a warning time before a parking ticket is given. There is less involvement of law in medicine, and more consensus then confrontation. This I believe to be a plus of Japan, as long as individuals can be protected if this harmonic system fails.

There are good and bad points of all cultures, the neighbourユs grass can be refreshing but it is not always greener. All societies are a mixture of opinions, and survey data show there is not one view of any culture on one issue. We should build societies that respect diversity and tolerate choices that people make.









S1.1 Lessons from Asian Religions for Bioethics

Karl Friday Email:

Dept. of History, University of Georgia, Athens, GA 30602, USA

That responsibility for the bulk of the world's ecology and environment-related problems can be laid at the feet of something called "Western Culture" has become almost an article of faith for the political and academic left. Taken at face value, this charge is, of course, tautological, in as much as "Western Culture" can be defined such that it includes--or does not include--virtually anything the accuser has in mind. Nevertheless, the accusation itself raises an intriguing set of questions: Is modern man's unrepentant rape of the world's ecology an accidental artifact of history, of the emergence of a particular society or civilization? Have human interactions with the environment, in particular the use or overuse of natural resources, been significantly determined by elements of culture, such as religious or philosophical worldviews? Are there worldviews alternative to those underlying modern European civilization that are intrinsically healthier for the environment? And would the more prominent ascendency on the world historical stage of one of these alternative worldviews have left us with a better ecological legacy today? The answer to the third question, at least, would seem to be a qualified yes. The answers to the others, however, are far less clear.

This paper briefly contrasts the ecological implications of the "Western," Judeo-Christian worldview with that of traditional Japan. It then tests the latter against the historical record, in an effort to draw some preliminary conclusions about the relationship between human environment- related philosophies and human environment-related behavior.

S1.2 The Bioethically Constructed Ideal Dying Patient in the USA

Anne J. Davis Email:

(University of California, San Francisco) Fax: 0265-81-5156

Nagano College of Nursing, 1694 Akaho, Komagane, Nagano 399-41

In the USA, there is now more cultural diversity than at any time in the country's history. Furthermore , this diversity has reached into most regions of the country and not just in large coastal cities. In California, where this research took place over a three year period , the so-called minorities now constitute the majority and in San Francisco every third citizen is Asian while there is also a large Spanish speaking population.

Despite these demographic realities in California and other states, ethical issues associated with cultural diversity have been mostly ignored in health care. Those in the bioethics field as well as the health care field have assumed the universal applicability of bioethical principles that have been drawn from the Wwestern philosophical tradition.

The bioethically constructed ideal dying patient is self-governing, future oriented, and willing to engage in open and frank discussions about his/her own death. From these research data it is clear that the implications of cultural differences for bioethics practices at the end of life are significant. This research report, with a sample of dying cancer patients and their families from four ethnic groups living in San Francisco, provides some examples of this fact.

S1.3 HIV母子感染をめぐる保健医療政策の日米比較

The American and Japanese Responses to Perinatal HIV Transmission: Ethics, Values, and Policy in Context

中島理暁 (Toshiaki Nakashima) Email: Fax: 03-3980-2373

東京大学国際保健学講座, 〒113 東京都文京区本郷7-3-1

Dept. Community Health, School Int. Health, Univ. Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 113


Keywords :Perinatal HIV transmission, Public Health Policy, Ethics, USA

This paper will compare and contrast the reactions to perinatal HIV transmission in Japan to those in the United States, relating variations to both differences in social and cultural values and in the history of public health policy in the two nations. In a democratic culture, public welfare and individual liberties are often in a state of tension in public health policy. The communal public health goal of preventing the birth of HIV-infected newborns comes into conflict with the reproductive freedom of HIV-infected individuals. Although both Japan and the United States are industrialized democracies, the difference in their initial responses to the issue of perinatal HIV transmission is striking. Due to the lack of controversy over abortion and the historical absence of women's need to struggle for reproductive rights, reproductive freedom of an HIV-infected pregnant woman was seriously challenged in Japan. By locating public health and medical authorities' responses to the issue of perinatal HIV transmission in the broader historical and sociocultural context of public health, this paper will address how social and cultural values have significantly shaped the response to this ethical dilemma posed by the AIDS epidemic.

S1.4 To save or let go? An Ethical Dilemma for Thai Buddhists

Pitak Chaichareon, Pinit Ratanakul Fax: +66-2-246-2123

Mahidol University, 45/3 Ladphrao 92 Bangkapi, Bangkok 10310, THAILAND

Euthanasia is an agonizing problem of Thai society as more and more high-tech treatments are being used by doctors. It has raised many unresolved ethical problems as witnessed by the case of Venerable Buddhadasa. The issue is further complicated because of the increased practice of organ transplantation. The question being raised now is whether Buddhist compassion as practiced by doctors should go beyond their concern for their own immediate patients to those patients whose lives could be saved by their own dying patients' organs, as Buddhist compassion is impartial and is directed to all involved in a given situation. There should be extensive dialogue between members of the public and medical profession about this issue. Doctors' patients and the public alike will be benefited by this discussion of the reality and possibility of organ transplantation.

It is clear that active euthanasia including assisted suicide is against Buddhist teaching. But passive euthanasia presents a complex ethical challenge to Buddhist morality. Doctors cannot prolong the use of life-support systems indefinitely because of complicated factors involved such as medical cost for family members, scarce medical resources, medical uncertainty, and the resulting quality of patients' lives saved or sustained. Contemporary emphasis upon patients' autonomy, that the patient should have the right to choose and refuse treatment, and the possibility of conflicts between patients and doctors, doctors and family members are the other factors that complicated the issue. But the situation is even more aggravated when cases involve incompetent patients such as seriously defective infant (e.g. spina bifida babies, and anencephalics) who may be spared the agony of short but futile life by stopping life-sustaining treatments. In this case it is not the length of life that is really significant in making life and death decision it is the infants' own agony and the futility of treatment that matter.

Suggestions are given by some Thai Buddhists that one can draw a distinction between "killing" and "letting-go-of-life" is worthy of serious consideration because in Buddhist ethics the motivation and intention behind actions are morally significant factors not simply the end result. If there really is such distinction, Thai Buddhists may feel that letting-go-of-life does not constitute a breach of the Buddhist first precept, and Buddhism can offer a "middle way" between the two extremes, i.e. active euthanasia including assisted suicide and the position of sustaining life at all costs and under all circumstances. However for the general public there is still uncertainty about distinguishing between "killing" and "letting-go-of-life", and passive euthanasia remains problematic for them. It is even more problematic for the doctors who strongly believe that sustaining the lives of their patients is their primary duty and obligation. Therefore the question of to save or let-go-of-life is a continuing ethical issue as Thai Buddhists grapple with the reality of existence in the modern world and the need to be faithful to Buddhist teachings. Like Venerable Buddhadasa more and more elderly Buddhists, monks and lay people alike, express their wishes to be allowed to die in the last stage of their lives accepting death as a natural end simply because, they believe, this is the Buddhist way of facing the inevitable death.

S1.5 Ethics Dilemmas in Medical Decisions Concerning the End of Life in Japan

Atsushi Asai Email:

Dept General Med. & Clinical Epidemiology, Kyoto University Hospital, Sakyo-ku, Kyoto, 606-01

Co-reseachers: Yasuhiko Miura , Shunichi Fukuhara, Noboru Tanabe, Minoru Kurihara

Medical decisions concerning the end of life (MDEL) have been the subjects of sustained ethical debate recently in Japan. However, no study has provided us with a picture of what kind of ethical dilemmas Japanese physicians have in their care for the terminally ill. We therefore conducted a national survey on Japanese physicians who are involved in medical care for terminally ill patients in everyday practice in this regard.

A postal questionnaire was sent to 500 physicians who are members of the Japan Society of Cancer Therapy. Their experiences were sought on ethical dilemmas at the end of life. 339 (68%) physicians participated. Of these, 11% answered that they were always perplexed, 26% often, 39% sometimes perplexed by ethical dilemmas in MDEL. A total of 386 dilemmas were reported by 267 respondents as the most perplexing. They included decisons about life-sustaining treatment, patient's family's demand or request about medical care, patient's refusal or demand of medical care, truth telling to a terminal cancer patient including requests of patient's family not to inform a true diagnosis and prognosis to patients. Many respondents asked whether cardiopulmonary resuscitation should be performed for a terminal patient, in what situation should be life-sustaining treatment withheld, and whose wishes for medical care should be prioritized in the face of disagreement between a patient and family.

Our study revealed Japanese physicians are facing various perplexing ethical dilemmas and alternative ethical norms replacing traditonal ones should be considered.

S1.6 Dilemmas of Informed Consent

Carl B. Becker Fax: 075-753-6647

Integrated Human Sciences, Kyoto University, Yoshida Nihon-Matsu-cho, Sakyo-ku, Kyoto 606-01

"Informed Consent" has been touted in the States as a way to strengthen patients' rights, to improve patient-physician communication, and to reduce the crippling costs of medical litigation. Now Japan's Ministry of Health is about to impose informed consent procedures on Japanese medical practitioners. This paper proposes that in the absence of other Western cultural presuppositions, informed consent will become a formal but largely meaningless procedure. Indeed, the re-revaluation of informed consent from a Japanese perspective demonstrates that (a) even where it is widely practiced, informed consent fails to provide the information and understanding that it seems to promise, (b) in order to be effective, physicians' re-education in communication skills as well as medical techniques would be required, and (c) if this re-education were possible, the need for formal informed consent procedures in Japan would be obviated.

S1.7 Bioethics and Bureucracy

Yaman Ors Fax: +90-312-310-6370

Unit of Medical Deontology, Ankara Medical Faculty, Sihhiye 06100, Ankara, TURKEY

Whether within the state machinery or in a private enterprise, bureaucracy has apparently two main or basic characteristics which would be worth mentioning in general terms: a hierarchical order and the preparation and circulation of written texts within its structure. To be sure, all the inter-human relationships in a bureaucratic order do not solely depend on hierarchy, and what we might call the paper exchange is certainly not limited to the interior of a bureaucratic institution.

The quality I would like to mention as regards bureaucracy in the present context may be due to a recent development - as so many aspects of human life, the bureaucracy of our time has apparently been under the impact of internationalization. Add to this the advance specialization in our time, possibly in the case of every main profession and/or academic field, and we have such a high number of knowledgeable people, whom you would possibly meet in every corner of the world. And in addition to the national and regional or local institutions, above all the states, there exists basically political international organizations such as UN, EC, UNESCO, WHO, and the multinational companies as gigantic economic powers, all of which are full of "technocrats".

The already highly internationalized field of bioethics appears to be a good example whereby you would definitely witness a variety of technical bureaucrats - a variety represented by nationalities, creed, ideologies, professions, and so on. Their approach to bioethical issues, however, an so far I have been able of observe, do have certain common aspects - seemingly moralism... as the case may be. And a confusion seems to underlie such an attitude - a confusion worth considering, and involving the concepts and activities of deontology, law preparation of regulations, establishing standards, and ethical debate.

S1.8 Can Islamic Texts Help to Resolve the Problem of the Moral Status of the Prenate?

Sahin Aksoy Email:

Centre for Social Ethics & Policy, Manchester University, Oxford Road, Manchester, M13 9PL, UK

The moral status of the prenate is one of the central issues in bioethics, which is extremely relevant to the moral assessment of in vitro fertilization (IVF), embryo research, prenatal testing and abortion. This issue has been explained from different perspectives, and various criteria have been employed. In this article I will examine this issue in Islamic texts and compare them with other major philosophical understandings and religious teachings.

One of these criteria maintains that the human person is more than a mere physical entity, and several inquiries have been made to define his metaphysical nature. From the time of Pythagoras (c. 580-497 BC) onwards many philosophers, including Aristotle, believe that the human individual consists of body and soul. When divinely revealed religions are examined it will be observed that there are similar arguments concerning the human individual.

Although in Jewish law, full human status is not acquired until birth, several distinct stages in the evolving status of embryo are mentioned which have some common features with other religious teachings and philosophical understandings. In Christianity due to the lack of relevant information in the scriptures concerned with animation (the relation of the soul to the human person), there is an uncertainty about it. However the arguments of some prominent Christian theologians are similar to ancient philosophers' understandings and the teachings of other monotheistic religions.

In Islamic texts the creating of human individual, and fetal development are referred to in various contexts, and in this paper these texts will be examined to find out whether they can help to resolve the problem of moral status of the prenate.

S2.1 International Bioethics Survey in Portugal

Maria Cristina Rosamond Pinto Email:

Faculdade medicina de Lisboa, Rua Amilcar Cabral No. 21-R/C メHモ, 1700 Lisbon, PORTUGAL

A National wide survey to analyze the attitudes of the Health Staff regarding Advances in Biotechnology and attitudes towards Science was conducted in Portugal from late 1996 to early 1997, based on questions from the International Bioethics Survey of Macer (1994).

The survey was conducted through the medical magazine ANAMNESIS, freely distributed to the 12,000 general practitioners listed in the Portugal Medical Boards files. The magazine was also displayed at the Primary and Secondary Health Centers making the survey accessible to other specialized physicians as well as nurses and paramedics. The survey was published at a monthly rate and in separate magazine numbers. The issues focused on various subjects such as Attitudes towards Diseases, Prenatal Diagnosis, Genetic Engineering, Patenting in Biotechnology, Human Genome Project, Gene Therapy, among other topics. The first issue displayed an Editorial about the purposes of the questionnaire, emphasizing advantages and disadvantages of these types of surveys with a general positive feedback obtained in other countries where the survey was conducted.

The majority of answers were from physicians ranging from 30-66 years of age and with no experience with genetic pathology. The vast majority was not familiar or less familiar with the topics of focus although most favoured Reproductive Genetics and Genetic Engineering applied to Agriculture, Industry and Medicine. There was a high degree of agreement regarding concerns on ethical and moral issues raising from Biotechnology approaches to Medicine.

The Survey on "Medical Attitudes Towards Advances in Biotechnology and Sciences" displayed consistency of opinions referring to topics like Genetic Engineering, Prenatal Diagnosis, Attitudes towards Diseases. Disagreements or disapproval concerning Gene Therapy, progresses in the Human Genome Project and Eugenics are discussed within age, religious and other factors of the participants.

S2.2 Reproductive Technology and Reproductive Rights of Asian Women

Chee Heng Leng Email:

Fakulti Ekilogi Manusia, Univ. Pertanian Malaysia, 43400 UPM Serdang, Selangor Darul Ehsa, MALAYSIA

In the strongly patriarchal cultures of Asian societies, women's position is low in many respects; although some communities, particularly those in Southeast Asia, have more egalitarian folk traditions. In many countries, women's subjugation is reinforced by state policies and practices. State population policies, backed by international aid programmes, have viewed women as pawns, whose fertility rates are to be manipulated in order to achieve some state-defined objectives. The histories of abuse have been varied: from the dumping of unsafe contraceptive technology to the practice of deception and lack of informed consent in the sterilisation of women. The availability of reproductive technologies have not necessarily led to greater choices for women. In the case of amniocentesis, for example, it has been argued that women feel pressured to use the test even though they may not want to. Women's weak position means that their interests are often subsumed by the interests of the state, community, or simply, by the more dominant groups in society. In the current AIDS crisis, for example, researchers have warned that Asian women are particularly vulnerable because of their centuries-old subjugated position. Yet there is evidence of women's agency, women having notions of entitlement, and women exercising reproductive decision-making power. This paper explores these issues; as well as whether or not bioethics addresses them, and if so, how may Asian women's position be strengthened.

S2.3 An Examination of the "Best Interests of Children" in the Field of Assisted Human Reproduction

Ken R. Daniels Email:

Dept. Social Work, University of Canterbury, P.O. Box 4800, Christchurch, NEW ZEALAND

All government or government appointed committees set up to review and advise on developments in assisted human reproduction (AHR) devote attention to the consideration of the children/offspring of AHR. Reports from professional bodies and independent organisations have adopted a similar approach. This paper will review the different ways in which children's interests are presented in these reports, focusing particularly on the "rights" based and "needs" based arguments. In this respect, this area reflects the interplay of ethical, policy and legal thinking. It will be shown that the membership of the report teams and the time at which the reports were published have an impact on the way the arguments are constructed and presented. One particular area impacting on children/offspring - the sharing of information when donated gametes have been utilised - will be examined to show how children's rights and needs, although espoused in most reports, is not reflected in recommendations concerning access to information concerning their genetic backgrounds or the possibility of meeting the donor.

S2.4 Ambiguity and Principles, Philosophical Implications of Human Dignity Principle in Bioethics

Maurizio Salvi Email:

Dept. Philosophy, Univ. Maastricht, P.O. Box 616, 6200 MD Maastrichit, THE NETHERLANDS

In 1996 the International Bioethics Committee (IBC) of UNESCO メPresentation of the Preliminary Draft of a Universal Declaration on the Human Genome and Human Rightsモ defined メhuman dignityモ as a fundamental element for evaluating the moral meaning of human genetic. The purpose of my talk is to examine the philosophical implications of Human Dignity -HD- as メthe principle by that it should be possible to clarify the moral meaning of genetic therapies. I shall present an analysis of the philosophical implications linked to the HD view in Bioethics. If we accept this principle we have a whole of problem to clarify as: Which relationship exists between th HD and the gene transformations of a patient who has a genetic disease? Which relationship exists between the HD and Human Health? Which value may we tribute to HD: an intrinsic or a メinstrumentalモ value? Which ethical problems are involved in the HD acceptance? My talk is focused on the examination of these questions, and has as purpose to analyse the relationship between Human Dignity and Human Health.

S2.5 Biotechnology: from Refound Law to Manipulated Law?

Christian Byk Fax: +33-1-4337-4710

General Secretary, Int. Ass. Law, Ethics & Science, 62 Bvd. de Port-Royal, 75005 Paris, FRANCE

"AIDS bring us back to the most radical spects of men and women in their bodies: blood, sperm, vaginal secretions...": the bishops of France did not hesitate to problain this in a document in which they ask themselves - and they ask us- "how can we unite in one word the highest meaning of life and the most original realities?".

Biotechnology also refer us back to original realities: genes, genetic code, the species, which although primary, were long unknown to humans because we had no science to understand them (genetics) and no technique to identify them and analyse them (molecular biology). Today, while these realities make their mark on the unfolding of all life, including human life, individuals and collective, they are also the essential elements of the boom in genetic engineering techniques used for industrial purposes. How then can we unite in one sense this human economic activity with the nature, which is sometimes equally human, of these original realities?

This question is not only philosophical. It is also legal and topical. At a time when French legislation has thought it good to introduce into the Civil Code "a status of the human body", at a time when the Council of Europe has introduced the convention on bioethics, the European Union is thinking of having a text of harmonization concerning the patentability of biotechnology adopted.

So it seems more difficult to agree to engage the human body in new legal relations when these relations are situated outside the framework of medical activity. It is no doubt because the legal nature of the body seems different here: invented and no longer discovered, but also because some people see an opportunity to assert the primacy of the ethical order over the legal order.

S2.6 Biotechnology, Biosafety and Bioethics: Ethical Challenges from an Islamic Perspective

Anwar Nasim Email:

Advisor on Science, COMSTECH Secretariat, 3 Constitution Ave, G-5/2, Islamabad, PAKISTAN

Revolutionary breakthroughs in genetic engineering, molecular biology and bioetchnology have led to novel ways of manipulating the genetic material. These advances have also led to the construction of transgenic plants, genetically engineered microorganisms and food items. The envionmental impact and the associated risks to human health are both complex ad challenging. One very important consideration in this whole debate is that each society will deal with these issues in the specific cultural, social and religious background, with the prevalent values and moral considerations. The present paper will examine these issues from the point of view of a Muslim society and discuss how patent laws, sequencing of the human genome, production of pharmaceutical products and hormones using transgenic animals, cloning of Dolly and the potential for experiments using human material will be viewed in the light of Islamic principles. This is certainly an added and relatively new dimension to the discussions which will provide an opportunity for sharing these views with researchers representing other societal makeups.

S2.7 New Biotechnology and Life (Something Great)

Kazuo Murakami Fax: 0298-53-4605

Institute of Applied Biochemistry, University of Tsukuba, Tsukuba Science City 305

I have been engaged in life science research using new biotehcnology including genetic engineering, cellular engineering, transgenic- and knockout- techniques. At first, I will summarize some of our results. Secondly, I speak about my impression of DNA and Life (Something Great). The entire DNA sequence of some bacteria have been completely decoded and the human entire DNA sequence will be in the near future. The speed of sequencing is much faster than expected in the past. The genetic aspects of disease will be understood more clearly after the complete sequesnce of human DNA is known.

However, the amazing thing is that about three billion base codes are lined up in order in a submicroscopic human DNA which weighs only 0.00000000002 grams. Moreover, from the human DNA 50,000-70,000 proteins can be produced in a beautiful harmony. The imput of all human genetic information in such a small place and the work of all the genes in the harmony had not been brought about by human being but by the (great) nature.

So, what is nature? It is a kind of メNatureモ that shifts from chaos, disorder and diffusion to one of a unifird system and works together with other system in a concerted manner, keeping its organic relationship intact. This suggests a scientifically unimaginable great power, a kind of will may exist which I call メSomething Greatモ.

S3.1 The Application of Universal Principles as a Challenge to Cultural Integrity

Leonardo D. de Castro Email:

Dept. Philosophy, University of the Philippines, Diliman, Quezon City 1104, PHILIPPINES

Notwithstanding the existence of controversy regarding what some have called the "Georgetown Mantra," universal principles provide a shared mechanism for rational communication and debate among peoples coming from different nations on matters of bioethics. Agreement concerning such universal principles makes it possible for peoples of varying cultures to discuss common concerns using the same instrument for evaluating situations, justifying decisions and resolving conflicts. Aside from providing a tool for rational communication, universally accepted principles also serve as a catalyst for integrating culturally-rooted values and norms, mainly through the use of a common language. But the process of integration could be costly as it poses a challenge to the integrity of cultures.

Universal principles do not have universal interpretations. They take their meanings from particular cultural contexts. Outside the unique context that gives it a meaning, a principle may have no more than nominal significance. Hence, bioethicists must make an honest effort to understand the meanings of principles within their natural setting. Principles are made meaningful not by their being held in common but by their being understood in their uniqueness."

S3.2 Bioethics in Bangladesh: Some Observations

Hasna Begum Email:

Dept. Philosophy, Dhaka University, 6 Dhanmondi R/A, Rd. 9, Dhaka-1205, BANGLADESH

Bangladesh, like most other third world countries in Asia, is tradition oriented. It is hence not easy to infiltrate new ideas among its people. Only the survival instincts can prompt them to accept new ideas. People generally are tempted to adopt reproductive technologies to control reproduction through free distribution of food and money as incentives. In this way the ethical dilemma becomes a reality. In the case of infertility technologies can be implemented as in Islam adopt is not allowed even though there are many undernourished and uncared for children available for adoption. The scenario of bioethics is very different compared to Western developed countries due to cultural and religious traditions as economic backwardness, e.g. the bioethical problem of genome mapping and health insurance policies does not exist as there is no health insurance system in Bangladesh.

S3.3 Why moral values and ethical values are not the same

V. Manickavel Fax: +977-56-21527

Immunology Dept, College of Medical Sciences, Post Box 23 Bharatpur, Chitwan District, NEPAL

There is a lot of confusion in the synonymous use of the term moral and ethics. Here, and attempt is being made why a distinction is necessary and also it is shown, how it can be done? In all the societies to regulate the kinship certain values are established and followed. There values were concerned only about that particular society. Thus these intersocietal values were restrictive in their application and regulative immediate benefits only and understood at a particular time and space. Because of this limitation, their currency becomes valueless whenever intersocietal interaction are met with. Hence, there is a need for values which regulate intersocietal relationship and accepted by other societies at all times. This difference in the value system has to be recognized in all of the ethical discussions. Also, in the discussions of modern medical technology applications and in the resource intensive industrial developmental projects the differences between the transcendental and immediate effects should be acknowledged. It is proposed here, that, morals refer to the values of limited nature restricted by time and space and regulative of immediate benefits. In contrast ethics is about the values of transcendence. To illustrate, so case studies are discussed here, arguments are also given that technology transfers should have the appropriate ethical value consideration of that particular technology rather than the moral value consideration.

S3.4 Universal Ethical Singularity

R.N. Sharma Email:

Deputy Director, National Chemical Laboratory, Pune-411008, INDIA

The genesis of God in human cultures seems to be undeniably linked to fear of uncontrollable forces of Nature, and uncertainity of individual destiny, which have been innate to the human ethos ever since the very emergence of modern man. Two opposite concepts of poly and mono-theism exemplified by Hinduism and Christianity are analysed. Search for enduring and Universal values and truisms through history of the two systems is deployed to identify commonalities. How far is plurality fissiparous, and partisan singularity unifying, is also compared. It is argued that progressive transcension must form the goal of all spiritual systems irrespective of regional or ethnic backgrounds. Realities of the one world concept dictated by the inescapable Space ship Earth paradigm unequivocally lead to one species, one people, and one kind, how-so-ever anomalous the current trends. This inevitability must necessarily entail a unifying, single ethicality, with or without notion of Godhead. In essence, all spirituality stems from the need for individual or personal salvation and satisfaction. Group or species obligations come next, although it may be expected that with further human evolution these may supersede the selfish propensities predominant hitherto. It is concluded that the evolutionarily transcendent human suscribe to a universal ethical force which must necessarily belong to the genre of a singularity embracing the whole human kind.

S3.5 Recent Trends in Bioethics Legislation in India:

Lessons for Asia

R.R. Kishore Fax: Int+91-11-6876621

Ministry of Health and Family Welfare, Government of India; Indian Society for Health Laws and Ethics (Ishle), D-II/198 Kidwai Nagar (West), New Delhi-110023, INDIA

The world has always been under transition but it was never as fast as it is today. Fast advancing biotechnology has turned fiction into reality and the humanity is on the verge of losing its identity. The erosion of individual's autonomy and the possibilities of biological exploitation of human species have created new ethical dilemmas. This is because we can understand Nature at a much deeper level, and it means we should develop matching ethical formulations. The biological link between the past, present and the future was always present but in the contemporary milieu it has assumed new dimensions as a part of "Common Heritage of Humanity". Genetics, in its attempt to understand biology in molecular terms has led to objectification of human subjects. Fortunately (!), till today we have not been able to synthesize life and the capability is limited to synthesizing and putting together the twenty amino-acids present in living matter. What will be the scenario when we learn the art of imparting vitality to those amino-acids? Who will control whom? The Creator or the Created?

At the same time there is enormous therapeutic promise of biotechnology. The genetic knowledge carries vast potential for ameliorating human suffering and improving quality of life by diagnostic, therapeutic and preventive measures. Nearly 5000 different diseases are already known or suspected to result from defects in single genes and the screening of defective genes has become a practical possibility. Transplantation technology holds the promise of producing persons out of unborn mothers, besides replacing the disease organs.

Advancement breeds controversy. Achievements in genetic science and technology have generated controversies relating to individual's identity, autonomy, liberty and equality; commodification of the human body; humanization of animals; damage to biosphere; patentability; alteration of priorities; economic impairment; and a host of other issues. Humankind face the third form, not only life or death but PVS (Persistent Vegetative State). The rights of the mother and the embryo/fetus interfere with each other increasingly. Utility has a vast potential of making the life worthless and misconceived, compelling one to search for new meaning in objects and phenomena. Thus today's medicine is not just a clinical science. It embraces far greater meaning and expectation than the earlier times when it was confined to somatic intervention. It includes subtle appreciation of social, economic, cultural, and religious aspects of individual and societal life.

The Indian panorama presents a blend of variable trends and expectations. The country's large population of nearly 960 million, racial heterogeneity, geographical diversity, rich biosphere, economic disparities, cultural, linguistic and religious differentiation, plurality of therapeutic systems, and demographic transition, call for evolution of multi-faceted and indigenous policies in order to ensure adequate medical care to all sections of the society. Owing to the Government's limitations private enterprise has entered the health sector in a big way. This has created an urgent need for protecting the people's rights against commercialization of their medical needs. In the view of these realities, inspite of the federal system of Governance with complete autonomy to states in the matter of human health, the countries central legislature (Parliament) is case with a de-facto responsibility to set guidelines for regulation the health care and related activities. Consequently, there is perceptible attempt to streamline the country's laws by means of fresh enactment and by updating the existing laws. The international experiences are being monitored in order to assess their suitability in the Indian conditions and in certain areas there has been positive legislative crystallization.

Although there has been no statutory enactment in India in the area of human genetics, the perceptions seem to be quite clear i.e., genetic medicine should go hand in hand with conventional medicine and research in human genetics should be confined, for the time being, to specific areas which pose major health hazard to the population and in which the genetic intervention carries definite preventive or therapeutic potential, and the development of genetic medicine should not be encouraged at the cost of primary health care. As regards genetic patentability, there is distinct concern to safeguard the country's rich biodiversity against possible attempts at its exploitation by foreign entrepreneurs and the need is being increasingly felt to enact suitable statutory provisions in this regard. But this should not in any manner cause obstruction in the scientific interaction or positive exchange of information with the developed countries. It must however be remembered that the Indian responses have not been uniform and the issue of bioethics legislation in India is an open question contemplation appreciation of immediate and long-term national perspectives.

The oriental philosophy is blessed with a deep sense of universality and holism, necessary to evolve ethical paradigms on fundamental issues. For this reason I think the Asian approaches, particularly the Indian perception, can provide conceptual clarity and erectness on the emerging ethical intricacies. In this context two important statutes, recently enacted in India can be cited, namely, "The Transplantation of Human Organs Act, 1994" and "The Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994". Both the statutes reflect country's legislative wisdom and maturity by aptly reconciling the intrinsic sense of values as enshrined in the Indian cultural thought and the emerging imperatives of fast advancing biotechnology and globalisation.

In the current paper I have endeavored to analyze the Indian legislative responses in the field of advising biotechnology from different perspectives and to evaluate their merit in the wider Asian context.

S3.6 Bhagavad Gita On Bio-Ethics and Bio-Diversity

Dua Kamal Kumar Fax: +91-562-351845

Department of Zoology, Dayalbagh Educational Institute, Dayalbagh, Agra 282005, INDIA

Biological resources provide the basis of life on earth. The fundamental social, ethical, cultural and economic values of these resources have been recognised in religion. The latter has not only also advanced the remedy which includes the application of ethics to protect these from further decimation. Ethics provides the basis to know what is good or bad, right or wrong. The importance in helping to make good choices concerning nature is well recognised. The World Charter for Nature, adopted by UN in 1982 states, メEvery form of life is unique, warranting respect regardless of its worth to man, and, to accord other organisms such recognition, must be guided by the moral code of action. The Earth Summit is also one such step in this regard.

Bhagavad Gita (BG) has not only identified the cause for the loss of biodiversity but also put forward the solution. Further, it exhorts the decision makers to take up the challenge and act in a righteous manner. They have a great responsibility (BG II-31). They to act in a right direction and righteous war has to be launched against the demoniac persons (BG-XVI 4 to 16). The action line includes the path of knowledge. メYour right is to work only, but never to the fruit thereof. Be not instrumental in making your actions bear fruit, nor let your attachment be to inactionモ (BG II-47).

S3.7 Euthanasia in Japan

Noritoshi Tanida Email:   Fax: 0798-45-6661

Dept. Internal Medicine 4, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663

Discussion regarding euthanasia has begun openly since the Tokai University and Keihoku Hospital euthanasia cases and disclosures of non-voluntary passive euthanasia in nursing homes. However, the discussions on these issues are rather confusing. End-of-life issues including euthanasia primarily stem from patient's autonomy in Western countries. On the contrary, the survey of Japanese people has indicated that the acceptance of euthanasia is not from autonomy principle but from cultural backgrounds. Japan has a long history of practicing euthanasia. The Bioethics Counsel of the Japanese Medical Association put it "there is no way other than allowance of euthanasia in very exceptional occasions as it is practiced currently". The autonomy principle has been gaining an important position in Japanese medical practice. Presumably, confusion in euthanasia issues derives from the process of introducing the autonomy principle in Japanese life and death.

Overdinner Talk: Sabbath Rest and Asian Bioethics

Frank J. Leavitt Email:

Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, ISRAEL

The Israeli Sabbath, a day when we are to refrain from work and remember Gods work of creation is not just a lazy day but means of achieving a detached concern with respect to the world just as a good physician will take a detached concern with respect to a patient. As pollution, modern warfare, noise and perhaps also recombinatury genetics are changing the world beyond recognition, bioethics will have to teach us not only what we ought or ought not do but perhaps more importantly how to live sanely and morally in a world which is not as it ought to be. A cross cultural Asian bioethics will encourage a dialogue seeking the common ground of West and East Asian spirituality - Israeli Sabbath rest, Zen and Tao meditation - to work together to learn how to live in the new world.

The reason why I did not want to talk today is my attempt to observe the Israeli Sabbath, resting on the seventh day as Holy Scripture, the Bible, commands us to do: not lighting a fire, not cooking, not traveling, not manufacturing any products, not even writing. This day of rest might seem to you like taking a day off from bioethics, being a little lazy. But actually the opposite is true because I think that Sabbath rest can be a much truer devotion to the ethic of life than is all the running around which we do during the week to compete for professional promotion or to publicize our egos. But in order to explain what I mean, Ill first ask your permission to explain two different approaches to bioethics.

Medicine, nursing and biotechnology are making the world change very fast. Bioethics is supposed to talk about morals and meaning in this changing world. One approach to this is to do what Darryl Macer often calls descriptive and prescriptive bioethics. In descriptive bioethics we conduct surveys to find out what people think and how they act. And then in prescriptive bioethics we try to tell people what to do or what not to do. During the coming week in Kobe and Fukui we shall probably do a lot of prescriptive bioethics, meeting with important people from around the world and perhaps voting on some declarations about human cloning or germ line gene therapy or who has the right to do research into the genomes of indigenous peoples.

But there is another approach altogether. I think we have to be humble enough to admit that our well meaning ethical declarations might not have all that much effect anyway. One example is that five years after vast resources were spent to fly all sorts of distinguished people to Rio de Janeiro, breaking up who knows how much ozone on their way, many still refuse to reduce emissions of greenhouse gases or to set quantitative goals for emissions of carbon dioxide (BMJ (1997) 315: 3-4). I think we have to learn how to live with the fact that whether we like it or not the world is getting horribly polluted, and unbearably noisy, and bizarre genetic experiments will be performed, and researchers will pry into the genomes of innocent people with barely a pretense at informed consent, and governments will pressure less-favored citizens to have fewer or no children. It is the job of bioethics to teach us how to live meaningfully, deeply meaningfully, in this crazy new world. This is what I mean by the second approach to bioethics.

But I promised and shall now try to discuss specifically Asian bioethics. I live in Israel, the Far West of Asia. You have deeply honored me to allow me to speak at this meeting of the Japan Association

of Bioethics here in the Far East of Asia. Many people think of Israel as western, and American influence is so great that Prof. Shinryo Shinagawa, after a recent visit, wrote me that he was writing an article in Japanese calling us an American made country. And Judaism is thought of as a western religion, primarily because of the efforts of Jews who lived in Germany and tried, with tragic failure, to appear the same as their hosts. But we Israelis are really only a West Asian Semitic tribe. And our mystical, prophetic tradition has a lot more in common with East Asian mysticism than many people think. Our awareness of this fact is largely due to the scholarly researches of the late Rabbi Aryeh Kaplan ( Meditation and Kabbalah.York Beach, Maine, Samuel Weiser Inc., 1982).

I would like to dwell for a moment on a point of Asian mysticism, and then try to apply it to bioethics. I do not pretend to know much about East Asian mysticism but I have been reading books for several years about Buddhism and Zen and the Tao, and I have even started to try to learn Aikido, and even though I always feel like a total ignoramus, I think we have to risk making mistakes and try to understand one-anothers traditions if there ever is to be cross-cultural understanding in Asian bioethics.

In books on Asian mysticism I keep seeing references to non-being and emptiness. In a book called Kyudo: The Art of Zen Archery, Hans Joachim Stein discusses Tao and wu-wei. He says that Tao is the creative principle of life out of which all things are generated and that wu-wei is non-doing. (pp. 24-26). But he explains that this non-doing is not laziness or sluggish passivity or laissez-faire (just as, I might add, the Israeli Sabbath is not a lazy day), but a spontaneous activity with no craftiness or egotistical ambition, natural action without reflection. I will talk about this and other examples.

If this simplicity, this virtual separation from the world of getting and spending, could be brought to some degree into our weekday lives, if we had fewer desire for material luxuries, then mightn't our temptation to be dishonest in order to obtain these luxuries be correspondingly reduced ? Might the need for research ethics not be reduced in direct proportion to our learning to live simply ? Of course I have been discussing an ideal, which is far from our reality. And this ideal is hard enough to realize perfectly even on the Sabbath, not to mention our weekday lives. But sometimes if we keep our ideals and dreams in mind, then even if we cannot make our daily lives perfect at least we can make them a little better.

4.1 死をめぐる自己決定について−比較法的視座からの考察

Self-Determination upon Death

五十子 敬子 (Keiko Irako) Email:

〒241 神奈川県横浜市旭区中沢3-48-8

Nakazawa 3-48-8, Asahi-ward, Yokohama-city, Kanagawa 241


Keywords :Euthanasia, Self-Determination, Death with dignity, Paliative care, Right to die

 今や二一世紀を目前にして,先進諸国においては,自然死(Natural Death),尊厳死(Death with Dignity),臨死介助(Sterbehilfe),安楽死(Euthanasia, Euthanasie)という概念構成をもって,生きている自己に自己の死をかかわらせて,死が論じられる様になった。勿論そこでの「死」は死に方の選択という態様をとるが,それはまた「死」を自己主体の領域内にかかえこむということにつながる。「死ぬ権利(Right to die)」という概念は最も端的にそれを示している。死に方の選択あるいは死ぬ権利を論ずることに対しては,「死」から神聖を奪うものという反発も起きているが,自己の死に自己決定を関わらせることは生の拡充を意味するものとなり,そこから生命の尊重に新しい地平が開けてくるとも言い得るのである。こうした基本の認識の上で,主として比較法的視座から概観し,死をめぐる自己決定についての歴史及び現状を考察する。


With the 21st century almost upon us, concepts such as natural death, death with dignity, sterbehilfe (assisted death), and euthanasia are being discussed throughout developed countries. These concepts involve matters related to death in our lives. The death being discussed is not death itself but rather the concept of choice in dying. There is recognition of the fact that we may have control over our death as a part of our life. The concept of the right to die highlights this recognition most directly. Some may refuse to accept such ideas as the choice of dying or right to die because they deprive a person of the sanctity surrounding death. But choice in dying by self-determination may also mean extension of life. According this concept, I am researching the history and the present situation from the view of comparative law.

Voluntary euthanasia was already discussed in United Kingdom at the end of the 19th century. In that country, the Select Committee of the House of Lords recommended that there be no change in the law to permit euthanasia, and strongly commended the development and growth of palliative care services in January 1994. The government approved the Committee's findings in May 1994. I also am researching four other countries, Germany, the Netherlands, Australia, and the United States of America, from viewpoints of historical development and comparative law.

Moreover I have investigated the problems in our current world which surround the concept of self-determination in relation to artificial prolongation and termination of life, in an attempt to answer the question of whether euthanasia should be legalised.

4.2 遷延性植物状態患者の不可逆性について 

Persistent vs. Permanent Vegetative State

塚本泰司 (Yasushi Tsukamoto) Fax: 03-3420-3829 関東中央病院 脳神経外科, 〒154 東京都世田谷区新町2ー35ー24  

Dept. Neurosurgery, Kanto Shuo Hospital, 2-35-24, Aramachi, Setagaya-ku, Tokyo 154

キーワード:遷延性植物状態,permanent vegetative state,不可逆性,リビングウイル

Keywords :persistent vegetative state, permanent vegetative state, irreversibility, living will

 1972年,JennetとPlumは,外的刺激に対する反応の欠除する状態の継続する脳障害の患者について,PVS (persistent vegetative state)と命名した。彼等はこの状態は継続するが,永続性(permanent)であるか,不可逆性(irreversible)であるかは,断言できないとして,遷延性 (persistent)という語をもちいた。しかし今日,意識障害が12ケ月継続したものについて,その障害は不可逆的であるとして(Bland 事件etc.), PVS にたいしpermanentを用いる識者がおり,PVSにおいては大脳皮質の機能はpermanentに喪失している(Institute of medical ethics)などの記述が見られる。また,そのことが脳死問題における大脳死説や,植物状態からの栄養補給停止の論拠とされることがある (Truog 1997)。

 日本においては日本脳波学会が1974年,遷延性植物状態の定義をし,意識障害の継続が6ケ月以上続いたものとしている。またPVSの訳語としては遷延性植物状態が一般的ではあるが,`持続性`植物状態,`不可逆的遷延性`植物的生存状態(生命倫理懇談会)などの用語もみられ統一がとれていない。persistentも permanentも P で始まるため,PVS の解釈に混乱があるものと思われ る。

 米国のMulti-society task force によると,意識障害が12ケ月つづけば不可逆であるとする。が、その不可逆性は経験的,確率的なものであり,科学的に証明されたものではない。例えば Higashi 他(1981)は110名の脳波学会の基準を満たすPVS患者について,5名の意識回復患者があり,そのうち1名は3年後,他の一名は5.5年後に徐々に意識の回復が始まった症例を報告している。

 もちろん,不可逆性が担保されていないからといって,正確な知識に基づいた living will や,医療資源の問題からの医療中止の議論は成り立たぬことはなかろう。しかし今日の新聞報道などにみる植物状態に関する議論をみるとき,permanentという用語の使用は不適切で誤解を招き, living will などを不正確な知識で作成させる心配があると憂慮する。

In 1974, Jennet and Plum proposed the name "persistent vegetative state" to describe the patient's condition with severe brain damage due to trauma or ischemia and with prolonged unresponsiveness. They used the term "persistent" instead of "permanent" or "irreversible" as they are not sure about the irreversibility of consciousness. Recently, the term "permanent vegetative state" appeared, when the unresponsive state continues more than 12 months (BLAND case in England). Some author dares to discuss the possibility of using a "permanent vegetative state" patient as a donor of heart transplantation (Truog,1997).

American multi-society task force on PVS also uses "permanent vegetative state" to describe patients whose unresponsiveness continues more than a year, and says "permanent means irreversible, though it is empirically based".

We believe that the irreversibility of PVS patient is still not assured yet, and that the term of permanent vegetative state is misleading. As Japanese doctors reported PVS patients who gradually recovered consciousness, one after 3 years and another after 5.5 years among 110 PVS patients. Moreover,"persistent" and "permanent" both start with "p" and I wonder some people take PVS means "permanent" vegetative state.

Japanese EEG society defined PVS in 1974, in which the duration of unconsciousness should be more than 6 months. Obviously it can not be taken to be permanent.

Even though PVS is not assured to be irreversible, there may exist the possibility of withdrawing food from such a patient upon his or her "living will" or upon financial bases, we must be careful in discussion of PVS, as the irreversibility is only empirically based, not scientifically assured, even when the unconsciousness continued more than 12 months.

4.3 集中治療施設入院患者の治療決定過程の分析―自己決定主体の不在に対する医師,近親者の態度― / Analysis of Decision Process in Intensive Care: Attitudes of Physicians and Families When Patients Cannot Make Autonomous Decisions

立石彰男,福本陽平,東玲子 Email: (Akio Takeishi)
(Akio Tateishi, Yohei Fukumoto, Reiko Azuma) Fax: 0836-22-2687

山口大学医学部附属病院総合診療部,医療技術短期大学部, 〒755 山口県宇部市小串1144

Department of Integrated Medicine, Yamaguchi University Hospital, Yamaguchi University,
The School of Health Allied Sciences, 1144 Kogushi, Ube, Yamaguchi 755

研究協力者:山口大学付属病院総合治療センタ− 石井はるみ,吉若知英子,羽嶋則子

Cooperators of the study: Harumi Ishii, Chieko Yoshiwaka, Noriko Hajima


Keywords :Intensive care, Terminal stage, Autonomy, Advanced directive


【調査方法と結果】1)全国大学病院ICU医師にアンケート調査を行なった。改善傾向のない肝不全を含む多臓器不全の症例を示し,医師の対応を質問した。「治癒困難な状態での延命処置の中止を希望する」という患者の事前指示を想定した。約80%の医師が事前指示にいう状態に相当するとしながらも,その70%は事前指示に従うのではなく,近親者の死の受容を優先すると答えた。2)ICU で死を迎えた患者の遺族に対しアンケート調査を行なった。漠然としたものであれ,終末期に関する事前の意思表示があったものは約20%で,大多数は近親者が家族などと相談して治療方針を決定した。「医師の意見を重視した」,「患者自身の元来の意思に沿った」のはそれぞれ10%であった。


In the terminal stage of a critical illness which has neccesitated treatment in an intensive care unit, it is difficult for patients to express their own will because of the involvement of cerebral function and/or administration of sedative drugs (in order to relieve stress response to uninterrupted therapeutic interventions). We tried to analyze how physicians and patients' families make decisions regarding withdrawal and withholding of life-sustaining treatments in such occasions, where patients themselves cannot make autonomous decision.

1. Questionaires were sent to staff ICU physicians in 81 Japanese University Hospitals. Their attitude in decision-making was asked for an imaginary patient who had received mechanical support for multiple organ failure including intractable liver failure. The patient's advance directive was assumed, which said "I wish discontinuation of life-sustaining measures in the case my illness is revealed incurable". Although 80% of physicians answered that the patient's condition was equivalent to that mentioned in the advance directive, 70% of them attached greater importance to the families' intention than to termination of the patient's undesired life.

2. Questionaires were sent to 51 bereaved families of patients who had died in our ICU. Only 20% of patients had in advance expressed his/her thoughts on life-sustaining treatments for terminal illness to family members. In most occasions the key person in his/her family, with or without other members, had made decision. Only 10%, respectively, "followed physicians' view" or "met the patient's own wish".

In the terminal stage of intensive care, patients themselves cannot make autonomous decision on withdrawal and withholding of life-sustaining treatments. In such occasions, attitudes of physicians and patients' families agree in considering meaning of patients' death for other family members rather than regarding it as the entirely personal event. Increasing popularity of the idea of autonomy in Japan, such as the spread of living will, may reduce the mental burden of other members of patients' family accompanying playing the role of a surrogate. On the other hand, a dilemma may arise about a loss of the patient when they would obey his/her directive.

4.4 慢性疾患患者(慢性腎不全・透析患者)の終末期医療,尊厳死に対する

意識調査 / Survey Research on Terminal Care and Death with Dignity of Chronic Kidney Disease/Dialysis Patients

三浦靖彦(国立佐倉病院 内科) Miura)

浅井篤(京都大学 医学部 総合診療部) Fax: 043-486-8696

福原俊一(東京大学 医学部 国際交流室)

田邉昇(京都大学 法学部)  

〒285 千葉県佐倉市江原台2-36-2 国立佐倉病院  

Yasuhiko Miura (Internal Medicine, National Sakura Hospital)*, Atsushi Asai (Kyoto University), Shunichi Hukuhara (Tokyo University), Noboru Tanabe (Kyoto University)

*National Sakura Hospital, 2-36-2, Eharadai, Sakura, Chiba 285


Keywords :Chronic renal failure, Dialysis, Terminal care, Death with dignity, Advance Directive


【対象及び方法】通院中の血液透析患者500名(千葉県腎臓病患者連絡協議会の会員)および連続携行式腹膜透析(以下CAPD)施行中の100名(国立佐倉病院,東京慈恵会医科大学,東海大学,日立総合病院のCAPD患者)に,自己 記入式無記名アンケートを施行した。

【結果】余命1年の重症疾患に罹患し,呼吸器につながったまま,激しい痛 み,寝たきり,ぼけ,昏睡,の各状態が続くと仮定すると,60%以上の者が延命治療を希望しないと回答した。また,延命治療に対する事前指示(Advance Directive)を必要だと考える者は81%で,実際に何らかの形で意思表明している者が36%だった。しかし,事前指示の利点はという問に対しては,自己決定を尊重するためよりも,家族の負担を軽減するためと回答した者の方が多 かった。

【考察】昨年施行した透析医の意識調査で,患者から事前指示を受けた医師は 非常に少なかったが,患者側は,かなりの高率で事前指示を行っていること, また,終末期医療において,自己決定を尊重する欧米に対し,残される家族を重んじる傾向があることが明らかとなった。

4-5 「安楽死の類型」とその構成要素 / Clinical Types of Euthanasia and Its Constituents in Terminal Care

羽賀洋一, 田中康一郎, 熊倉伸宏 Email: (Yoichi Haga)

(Yoichi Haga, Koichiro Tanaka, Nobuhiro Kumakura) Fax: 0467-25-5117

東邦大学医学部公衆衛生学教室, 〒143 東京都大田区大森西5-21-16 

Toho University School of Medicine, 5-21-16, Omori-Nishi, Ota-ku, Tokyo 143


Keywords :Terminal care, Physician-assisted suicide, Voluntary active and passive euthanasia


【結果及び考察】I.安楽死の類型:まず日米の文献から安楽死の類型を以下のように整理した。つまり日本で論じられている安楽死は主として,1)積極的安楽死,2)消極的安楽死,3)間接的安楽死であった。一方,米国の文献で論じられている類型は主に,1)Physician-assisted suicide,2)Voluntary active euthanasia,3)Voluntary passive euthanasiaであった。両者を比較すると名称も概念も微妙に異なっている。そこで一度,各類型の構成要素に注目して類型を見直すことにした。



4.6 安楽死および尊厳死の定義再考 / Reconsideration of the Definition of Euthanasia and Death with Dignity

境原三津夫 (Mitsuo Sakaihara) Fax: 0152-54-3754

常呂町国民健康保険病院 産婦人科, 〒093-02 北海道常呂郡常呂町字常呂477番地 

Dept. Gynecology, Toromachi National Health Ins. Hosp., Toromachi, Toro-gun, Hokkaido 093-02


Keywords :Euthanasia, Death with dignity, Natural death

 安楽死および尊厳死を国民のレベルで議論する場合,その概念が曖昧であると議論は体をなさない。安楽死,尊厳死についての考察が医学,法学,宗教学等様々な分野でおこなわれているが,果たしてその概念は一致しているのだろうか。これが国民レベルの議論となった場合はなおさらである。わが国における安楽死,尊厳死の概念は一般的には以下のように考えられている。安楽死は現代医学上不治の傷病者の激烈な肉体的苦痛を除去することによって安らかに死にいたす行為とされ,生命の短縮をもたらさない純粋安楽死,好ましくない副作用として生命の短縮をもたらす狭義の安楽死,生命の短縮を手段とする積極的安楽死,延命措置を施さないという意味での不作為による安楽死の4つに分類される。また,尊厳死は現代医学上不治の傷病者の死期をいたずらに引き延ばすに過ぎない医療干渉を差し控える行為とされ,これには医療拒絶と生命維持装置の撤去が含まれる。わが国においては,従来,安楽死という言葉は骨折した競走馬を薬物で死に至らしめたり,保健所が捕獲した野良犬を薬物にて処分するときに使用していたものであり,安楽死に4つの分類があること自体混乱をまねくと思われる。従って,安楽死という言葉は上記4分類のうち積極的安楽死を意味するものとし,純粋安楽死,狭義の安楽死,不作為による安楽死は尊厳死に含めるのが妥当を思われる。医学が進歩し苦痛緩和療法が必ずしも死期を早めないようになった今日では,尊厳死とは本人の意思に基づき,単に死期を延ばすだけの医療干渉を拒否し,自然な死を迎えることと表現でき,その意味では自然死(natural death)という言葉の方がその本質を正確にとらえていると考える。

4-7 看取る者,看取られる者ー仏教史的考察ー / Care and care-givers for Dying Patients from the Perspective of Buddhism

池田容子 (Yoko Ikeda)

佛教大学専攻科仏教看護コース, 〒603 京都市北区紫野北花ノ坊町96

Buddhist Nursing Course, Bukkyo University, Kita-ku, Kyoto 603


Keywords :Death, Terminal Care


 ターミナルケアを必要とする時期に,逆に看護者はその患者から“足が遠のく”。頻繁に患者を訪れるのだが,そこに居辛いのはなぜか。看護者のほとんどはこの時期,強いストレスを感じる。科学万能の世の中で,科学の至上の形態と見なされてきた医学,その医療現場で“死”という絶対的なものに直面したときの閉塞感は,余計顕著なのである。しかし,この閉塞感は,人々が宗教の内で実践してきた看取りの伝統を考察することで,軽減の方向を見いだせるのではないだろうか。 人間の“生死”を神仏の加護に頼るほかなかった古代から近世の日本では,近親者や寺院の僧達が死にゆく人を看取る。現在,各地の伝承習俗として多少の変化は見られるものの,押しなべてその由来や意味に共通性が見て取れる。往きかけたいのちを呼び戻す蘇生にまつわる習俗,穢れを祓うという神道的な儀式,そして,安楽に往かせるという浄土往生の願いが込められた仏教の儀式,これらの共存が見られる。現代でも“死後の処置”として,それらの儀式は遵守されているが,形骸化している。かつてはその各々の行為は,「死の準備」,つまり死の受容への目論見であった。これは,看取る側が“死”を忌み嫌うのではなく「己の死」に向き合う時でもある。看取る者と死に往ゆく者の間には,“死”という克服できない現象の前に共に居続ける謙虚さのみが存在している。“死”をいわば共にすることによって心理的距離は消滅していく。それは仏教で説くところの「善知識」の姿でもある。


5.1 ”脳死受容”を脳死反対の論拠にできるか?/Can "Acceptance of Brain Death" Play a Ground for the Opposition Against Brain Death?

谷田憲俊 (Noritoshi Tanida) Email: Fax: 0798-45-6661

兵庫医科大学第4内科, 〒663 兵庫県西宮市武庫川町1-1 

Dept. Internal Medicine 4, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663


Keywords :Brain death, Nerve cell secretion, Human experiment






The Brain Death Organ Transplant Act has been enacted in Japan. This event has flared up arguments toward brain death. Among the arguments against brain death, there is always such a statement which says "brain death is not human death because there is a secretory response in brain cells of brain death patients." This research was by no means pathological autopsy, because seeing any response of the brain was an "experiment". Providing that brain death meant human death, this experiment was acceptable only when there was ample purpose for such research using dead bodies. It would be a problem ethically if informed consent was not obtained from these patients.

If "brain death was not human death", this research would mean experiments using living patients. Patients surely would reach death because the brain was used. In other words, the concept of "brain death is human death" was an absolute prerequisite for this research. When one relied on the result of this brain experiment as evidence against brain death, it would mean the approval of fatal human experiment using "living person". I urge to anyone not to use the idea that "brain death is not human death because there is a secretory response in brain cells in brain death patients" as evidence against brain death.

5.2 献体動機の多様性

Varied Motives for Donating a Body

福川敏機 (Toshiki Fukukawa) Fax: 0297-78-0409

芝浦工業大学企画部国際交流事務課, 〒302 茨城県取手市戸頭7-7-25-203

Shibaura Institute of Technology, 7-7-25-203, Togashira, Toride-shi, Ibaraki 302


Keywords :Donating a body, View of death, Personal autonomy


 かつて,この実習に必要な遺体の不足の深刻な時期があったが,近年,献体希望者が増え続け,事態は大きく変化している。篤志解剖全国連合会に加盟する大学を主とした全国百余校の医歯科系大学の調査集計によると,献体の登録者は95年度で15万3千名を超え,85年度と比べるとほぼ倍増している。篤志献体による解剖数が,実行された解剖の過半数を占めるようになったのが86年度(51.1%) ,95年度のその割合は 73.2%であった。



    (1) 現代の日本人の「死生観」

    (2) 献体動機に作用する「自己決定」の考え


5.3 骨髄移植による遺伝標識の変容

Transformation of Genetic Markers by BMT

池本卯典 (Shigenori Ikemoto) Fax: 03-3370-8042  (Also Poster)

〒166 東京都杉並区西荻北3-14-9

Research Institute of Evolutionary Biology, Nishiogikita 3-14-9, Suginami-ku, Tokyo 166


Keywords :BMT, Blood group, HLA, DNA polymorphisms

5.4 脳死・臓器移植における権利と義務

Rights and Duties in Brain-Death and the Transplantation

江崎一朗 (Ichiro Esaki)

九州大学法学部, 〒836 福岡県大田市本町4-5-1

Faculty of Law, Kyushu University, Honmachi 4-5-1, Ota-shi, Fukuoka 836


Keywords :Brain-death, Transplantation, Rights, Duties


5.5 日本の臓器移植に対する危惧

Why Organ Transplantation Remains Taboo in Japan

カール・ベッカー (Carl B. Becker) Fax: 075-753-6647


Integrated Human Sciences, Kyoto University, Yoshida Nihon-Matsu-cho, Sakyo-ku, Kyoto 606-01


Keywords :Organ Transplantation

 最近日本でも臓器移植法案が可決されたものの,臓器提供者は皆無に等しい。西洋医学を勉強した医者は移植を当然とみなすかも知れないが,歴史的,心理的,及び精神的な理由によって,殆どの日本人はそのように考えないからである。これを情報や意識向上の問題であるとする医者は,文化や歴史,或いは宗教的世界観を十分に考慮に入れていないのである。歴史や宗教研究の立場からすれば,大衆の世界観はそう急速に変容するものではない。本発表では,日本に於ける臓器移植に反対する文化的な背景に焦点を当て,又未解決な課題を取り上げる。就中,(a) 年配者や身体(遺体)に対する尊敬の念,(b) 日本の医療制度の構造的・倫理的問題,を明確に提示したい。

Neither now nor in the foreseeable future will there be many Japanese donors of hearts and livers for organ transplantation. Doctors who have studied in the West may think of transplants as normal operations. There are deep historical, psychological, and even spiritual reasons that most Japanese people cannot think so. Doctors consider this a problem of publicity. But doctors are not experts in culture, history, and philosophy. From cultural, historical, and philosophical viewpoints, the entire attitude of a country cannot be changed so radically or so quickly.

This paper explores some of the cultural differences between Japan and the West which complicate the adoption of brain-death criteria for the facilitation of organ transplantation in Japan. There are several reasons why the Japanese people have been slow to adopt Western practices of organ transplantation, among them: (a) Philosophy of social respect for bodies and for elders; (b) Structure and ethics of the medical profession in Japan. This paper briefly examines each of these areas in turn.

6.1 アジア諸国における遺伝と障害に関する意織調査 / Opinion Survey on Heredity and Handicapped in Asian Countries


*〒915 福井県武生市国高2-26-4-1 武生市保健センター Fax:0778-23-5448

Shigeaki Nakazaki (Takefu Public Health Center)*, Mikio Hirayama, Norio Fujiki(Fukui Medical School), Ishiwar C. Verma (All India institute of Medical Sciences), Pinit Ratanakul (Mahidol University), Wilson H. Y. Lo(Peking Union Medical College), Yung Sun Kang(Suwon University), Victor Bulyzhenkov(WHO)

*Takefu Public Health Center, 2-26-4-1 Kunitaka, Takefu, Fukui 915

キーワード:意識調査,遺伝 ,障害,アジア,生命倫理

Keywords :Opinion survey, Heredity, Handicapped, Asia, Bioethics








6.2 羊水検査を受けるか否かの意思決定について / Factors in a Making Decisions to Undergo Genetic Amniocentesis

塚本康子(静岡県立大学短期大学部) Email:

上見 幸司(常磐大学) Fax: 054-263-8480

静岡県立大学短期大学部 〒422 静岡市池田1844 A-101 

常磐大学 〒310 水戸市笠原町1393-1 

Yasuko Tsukamoto, Shizuoka University, Shizuoka Junior College & Koji Kami, Univ. Tokiwa


Keywords :Amniocentesis, Prenatal Diagnosis of Chromosomal Abberations, Decision Making





6.3 遺伝子治療の議論において何を優先すべきか?ー7集団の倫理意識パターン分析から / What Should We Give Priority to in Discussing Genetic Medicine?: An Analysis of Patterns of Ethical Decision Making among Seven Groups

村岡潔 (Kiyoshi Muraoka) Email:
森本兼曩 (Kanehisa Morimoto) Fax: 06-879-3923

大阪大学医学部環境医学教室, 〒565 大阪府吹田市山田丘2-2

Dept. Hygiene & Preventive Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565


Keywords :Genetic tests, Genetic therapy, Decision making

【目的】 わが国でも,出生前診断等の遺伝子診断や遺伝病や悪性腫瘍等に対する遺伝子治療の臨床研究が進められている。演者らは,その倫理的社会的問題を考える一環として,遺伝子医療(診断・治療)に対する人々の倫理意識がその選択の意思決定に与える影響について研究してきた。今回は,遺伝子医療の代表的項目に対する賛否の程度を指標にして,集団の倫理意識のパターンについて調査・検討した。

【対象と方法】1)次の7集団672名に無記名自記式アンケートを施行した。1.阪大附属病院医師研究者119 名;2.外来患者・家族160名;3.医学部学生76名;4.他学部学生61名;5.大阪府の看護学生65名と6.高校生56名[以上1996年];および7.遺伝医学研究者(第5回遺伝医学セミナー参加者)135名[95年]。2)出生前診断や受精卵診断などの遺伝子診断に関する9項目と遺伝子治療・操作に関する5項目(【結果と考察】参照)を用い,賛否を問うた。

【結果と考察】 1)各集団ともに過半数の賛成を得た項目は出生前診断(遺伝家系や高齢出産)と重篤な遺伝病の発症前診断(治療法あり)であった。2)ヒト遺伝子の解明,悪性腫瘍やAIDSなど重篤な疾患の遺伝子治療は,看護学生を除く6集団で過半数の賛成を得た。3)臓器移植用動物へのヒト遺伝子導入は賛否両論だった。4)保険加入や雇用の条件としての診断,ヒトの体格・容姿や知能「改善」のための遺伝子操作および「クローン人間」を産み出す基礎実験としての受精卵分割は賛成が30%未満であった。5)こうした倫理意識のパターンに基づくならば,一般に議論されやすい上記の4)の項目よりも,賛成度の高い1)から3)の諸項目のほうが実際の遺伝子医療の選択・決定において影響力が大きいことが推測される。従って,その倫理社会的問題として後者の検討はより現実的で優先すべき課題であると思われた。

6.4 分子遺伝学と遺伝医学

Molecular genetics and medical genetics

木田盈四郎   (Mitsushiro Kida) Email: Fax: 03-3363-1717

帝京女子短大, 東京都中野区東中野2-16-12

Teikyo Womans's College, Nakano 2-12-12, Nakano-ku, Tokyo

キーワード:小児科学、人類遺伝学、 遺伝病、分子遺伝学、臨床奇形学 

Keywords :Pediatrics, Human genetics, Genetic disease, Molecular genetics, Clinical teratology

 最近DNA学が著しく発展して、医学以外の分野で分子遺伝学が取り扱われるようになると、本来の遺伝医学の啓蒙が疎かになる弊害がでてきました。遺伝医学では、従来からメンデル式遺伝病 (Mendelian Inheritance)、多因子遺伝病 (polygenic disease)、染色体構造異常 (chromosomal structural aberration)、染色体数異常(chromosomal number aberration) を取り扱っており、それらの疾患の患者patients が存在します。それらの患者の存在を無視することは、重大な「患者差別」となるおそれがあります。その証拠として、若干の資料をあげます。(1) Harold Chaen, Medical Genetics Handbook, Warren H Green, Inc. St.Louis Mi., U.S.A. 1988. Table of Contents: 1. Introduction to Human Genetics; 2. Introduction to Human Cytogenetics; 3. Introduction to Molecular Genetics; 4. Introduction to Population Genetics; 5. Selected Topics. (2) Dorland's Illustrated Medical Dictionary, 24th Edition. 1965. Genetics: The study of heredity. Heredity: 1. Organic resemblance based on descent. 2. The genetic transmission of a particular quality or trait from parent to offspring. Cytogenetics: The branch of genetics devoted to study of the cellular constituents which are concerned in heredity, that is, the chromosomes and genes. Clinical cytogenetics: the scientific study of the relationship between chromosomal aberrations and pathological condition. (3) 遺伝病の診断基準:臨床遺伝学(clinical genetics)や医学遺伝学 (medical genetics) の分野では、遺伝病は、Victor A. McKusick, Mendelian Inheritance in Man, A Catalog of Human Genes and Genetic Disorders, 11th ed.1994,の中のTable 4. Number of entries representing loci identified by Mendelizing phenotypes and/or molecular genetic methods.には 6678の形質 trait が掲載されています。内訳は、AD:4458, AR:1730, X-linked:412, Y-linked:19, Mitochondrial:59です。

6.5 新しい遺伝医療と日本におけるガイドライン整
Medical Genetic Services Within Primary Care and Formulating the Guidelines in Japan

玉井真理子 (Mariko Tamai) Email: Fax: 0263-37-2370

信州大学医療技術短期大学部心理学研究室, 〒390 松本市旭3-1-1

Dept. Psychology, Sch. Allied Med. Sci., Shinshu University, Asahi 3-1-1, Matsumoto, Nagano 390


Keywords :Medical genetic services, Guidelines, Common disease, Primary care

 従来の遺伝医療(genetic services)は,単一遺伝子病(single gene disorders)と言われる疾患,すなわち狭義の遺伝性疾患をその対象とすることが多かった。しかし,そもそも疾患とは,広い意味では「遺伝」と「環境」の相互作用の結果であると言うことができ,その意味において遺伝医療とは,本来狭義の遺伝性疾患のみを対象とするものではない。また近年,主に分子生物学分野における技術革新を背景とし,様々な疾患の病因・病態が遺伝子レベルで解明されるということが急速に進展している。このようなふたつの点から,現代遺伝医療とは,とりわけ90年代において,すでに「common diseaseをも射程内に入れた遺伝医療」として成立している,と言うことができる。

 西欧先進諸国では,こうした一般的慢性疾患が遺伝医療(とくに遺伝子診断)の実質的対象となってきたことを見据え,遺伝情報の特殊性を考慮したガイドライン作りが進んでいる。国際的なガイドラインとしても,世界保健機構(WHO)が草案を検討中の「臨床遺伝学および遺伝サービスの提供における倫理的問題に関するガイドライン:Guidelines on ethical issues in medical genetics and the provision of genetics services」がある。このガイドラインは,家族計画(family planning)の文脈,とりわけ遺伝病の予防(prevention of hereditary disease)と同じ枠組みのなかで登場してきたものである。また,草案起草の段階で優生学に関連する記述が大幅に削除されるなど,「個人の選択」としての選択的人工妊娠中絶と「社会の選択」としての優生政策は違うものであることが強調されている。

「公衆衛生(public health)」や「一次医療(primary care)」,さらには「家族計画(family planning)」などの文脈で語られるようになってきた遺伝医療における国際的潮流を見定めつつ,国内おいても実効性のあるガイドライン等の整備が急務の課題として広く認識されるよう,学際的議論の場が必要であろう。


6.5 ヒトゲノム計画に関する生命倫理教育

Bioethical Education about the Human Genome Project

井上兼生 (Kaneo Inoue) Email: Fax: 048-773-5984

埼玉県立大宮中央高等学校, 〒362 埼玉県上尾市浅間台2-15-3-302

Omiya Chuo High School, Saitama, 2-15-3-302, Asamadai, Kamio, Saitama 362


Keywords:Human Genome Project, Human Genome Diversity, Common Heritage of Humanity






7.1 生命倫理についての人類学的一考察

An Anthropological View Regarding Bioethics

大井玄 (Gen Ohi)1、 武井秀夫 (Hideo Takei)2 Fax: 0298-51-2854

1 国立環境研究所 2 千葉大学

1 National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba Science City 305

2 Chiba University, Chiba


A view that ethical principles such as autonomy, beneficence, non-maleficence and justice derived from deontological or utilitarian ethical philosophy are valid in making judgment on moral problems in the health care setting is gaining popularity among those involved in medical ethics in Japan. One salient feature of this view is the assumption of a person as an agent capable of rational thinking and the individualism which respects his decision-making as an autonomous right based on rational thinking. For instance, a notion which regards withholding of truth disclosure to a cancer patient as メa negative cultural heritage of Japanモ or promotes メdisclosure to all cancer patientsモ seems to presuppose a person perenially capable of rational thinking. However, there are critiques who challenge the applicability of ethical philosophy to moral problems in health care and argue that morality in medicine is rather embedded in the endeavour of those engaged in the actual setting to find the best solution within the particular context but not derived from relevant ethical principles. We present here anthropological observations which suggest that morality in these medical care settings is not extracted by the application of ethical judgment based on ethical philosophy.

7.2 生命倫理問題の臨床民族誌的構成の意味について / On Meanings of a Clinical Ethnographic Construction in Bioethics Issues

松澤和正 (Kazumasa Matsuzawa) Email: Fax: 0489-64-5059

東京武蔵野病院看護部, 〒173 東京都板橋区小茂根4-11-11

Department of Nursing,Tokyo Musashino Hospital, 4-11-11, Komone, Itabashi-ku, Tokyo 173


Keywords :Clinical ethnography, Participant observation, Thick description, Illness as experience, Suffering



7.3 二正面作戦としての生命倫理

Bioethics as Double-edged Strategy

庄司俊之 (Toshiyuki Shoji) Tel: 0298-53-7932

〒305 茨城県つくば市天久保2-6-9 第一天久保寮101

Daiichi-AmakuboRyo 101, Amakubo 2-6-9, Tsukuba Science City, Ibaraki 305


Keywords : Sociological point of view, Kantism, Benthamism, Modern medical system, Double-edged strategy





This report could be summarized as: 1) classification of bioethical princiles into two opposite sub-principles, e.g., Kantism and Benthamism; 2) to indicate, according to sociological point of view, the inseparable linkages between these two principles and the systematic basis of the modern medical system; and 3) a conclusion that, it is impossible to select one of the two principles exclusively or compromise between the two, followed by a suggestion that the only possibility is a "double-edged strategy" corresponding to each principle.

The contrasting characteristics of the two principles, Kantism and Benthamism, could be found in terms of legitimacy, when the former is the "dignity (sanctity) of a person" while the latter is the utility, and in terms of actual behaviour, when the former is the motivation and the latter is the results. However, it is also evident that Benthamism is difficult to legitimate without a basis of Kantism and Kantism is related to Benthamism when it (Kantism) subjectify the matter "community of persons". So, two principles are inseparably related. Still then, it is not possible to theorize them under one bioethical principle because their relations are inconsistent.

Sociologically, principled values are embeded to systematic structures which is the accumulation of complex systems of values. Two principles, under consideration, are also embeded to modern medical system. Again, in the modern age, due to complex division of labour in society, a person is always with a background of multiple roles, and the modern medical system, developed through subjectification of "Body-a physical basis", is also expected to unify these multiple roles of a person. That is to say, the modern medical system has two aspects: one is the various functional systems composed of exchangeable role acts and the other is the particular system that targets the "unity and dignity (sanctity) of a person". These two aspects are, in one hand, exclusive and, at the same time, inseparable, thus, cannot be unified. Hence, there are two opposite aspects in existence.

According to the above discussion, a possible move for bioethics should not be the selection of one principle value rather, it should be a "double-edged strategy" which accommodates both criticize and defend of subjectivity and opposes Benthamism's oppression through Kantism and Kantism's oppression through Benthamism.

7.4 仏教からみた人間と優生思想 / Human Nature and Eugenics Thought from a Buddism Perspective

佐藤雅彦 (Masahiko Sato) Fax: 03-3811-1954


The Institute for Comprehensive Studies of Buddhism, Taisho University, Tokyo


Keywords :Buddhism, Eugenics thought, Human's nature





7.5 吾 ―機械人間― は「魂」を持っているのだろうか? バイオテクノロジーとSF小説から見る「物体」と「魂(こころ)」 ステレオタイプ的な文化のイメージ,既存の使い古された枠組み,を超えて

Do ‘I’, an Android, Have a Soul? : The Material Body and Human Soul in Terms of Biotechnology and of Science Fiction - Looking Beyond the Stereotypical Cultural Images

佐々木香織 (Kaori Sasaki) Email:


Dept. Sociology, Lancaster University, Lancaster, Lancashire, UK

 この小論文は物体と魂がどのような関わりを持っているのか?という人々の認識とバイオエシックスの問題(例えば脳死,臓器移植,人工受精,妊娠,出産の技術)との 関連性をサブカルチャー(漫画等)における描写,表象から考察する。日本におけるサブカルチャーメディアにおいては,サイボーグ,アンドロイド(人工生命体),遺伝子にまつわる技術(例えば遺伝的に優生な人間,クローン,キメラの製造)を扱ったSF物が広く流布しているために,若者はたいていその一つく いは知っている状況である。人工生命体の感情は「心」なのかそれとも,作成者が予め定めた「プログラム」なのかをこれらの作品は問うていることが多い。注目すべきは人工生命体自身がこの問い―アイデンティティの形成―に苦しんでいることである 。「私は何ものなのか?」

日本の読者はこの問いも,このジャンルもごく普通に受け入れている。このような 認知は,人々の物体と魂に関する価値観の所産ともいえるが,それだけでなく影響をもその価値観に与えているといえよう。例えば,日本人の脳死や臓器移植への抵抗感 が欧米のそれよりも強いのも,日本人に共有された上記ような認識と関連性があるだ ろう。欧米のサブカルチャーにも人工生命体の存在意義を問うことがある。しかしその枠組みが幾分ずれているのである。ピノキオは超越的存在から肉体と魂をもらう結末であり,ロボコップ(完全な人工生命体ではなくサイボーグ)の心は人間の脳の部 分によるところが大きいのだから。

 以上のような観点から筆者はサブカルチャーによって,如何にバイオメディカルテ クノロジーが影響を受けたか,且つそこにおいて如何にバイオメディカルテクノロジ ーを解釈したかを分析する。つまりは,この発表は一つ違った観点,ことにステレオタイプ的なイメージ――西洋的,ユダヤキリスト教的文化と神秘的でエキゾチックで オリエンタルな日本文化――とは異なる視点 から文化的にバイオエシックスを考え ることを提案していきたい。

This paper will examine the possible correlation between factors such as people's cognition of the relationship between material body and mind, and bioethical issue (e.g. brain death, organ-transplants and reproductive technology) as seen in various representation of subculture publications (e.g. comic books).

In Japan, several Science-Fiction genres involving cyborg, android (i.e. artificial life), genetic technology (e.g. producing eugenic humans, clones, chimeras) have so pervaded this type of media that a young person knows at least one of these stories. The main theme of these narratives is if in the emotion that an artificial life form derives from his/her/its mind or program which is originally set by the creator. It is worthwhile considering that an artificial life himself/herself/itself is tormented by the determining his/her/its own identity. ‘Who am I?’Japanese readers take these types of questions and genres for granted, which may have not only a cause but also an effect on their insight of their own concepts concerning material body and soul. I am interested in this perception shared by many Japanese because the issues of bioethics should be linked with this perception. For instance, there may be a linkage between these perceptions of the Japanese and their greater reluctance than the Euro-American to accept both brain death as the criterion for ascertaining human death and organ transplants. More noteworthy is that while the famous fable of this genre in Euro-American also questions the existential meaning of an artificial life, the framework is somewhat different. Pinocchio is given flesh and a soul from the supernatural being; and the heart of Robo-Cop (i.e. a cyborg) is sustained by his human brain. I will analyze how the biomedical technology has been influenced by and interpreted in sub-cultures from the above perspectives. In other words, this paper aims to indicate a different viewpoint other than the stereotypical images of both the Western, Judeo-Christian culture and the mysterious exotic Orientalese culture.

8.1 日本とスコットランドにおける児童虐待の現状の比較検討/Comparison of the Present Situations of Child Abuse in Japan and Scotland

大島徹 (Tohru Ohshima) Fax: 076-234-4234 

近藤稔和 (Toshikazu Kondo)

金沢大学医学部法医学教室, 〒920 石川県金沢市宝町13-1 

Dept. Legal Med., Kanazawa Univ. Faculty of Medicine, Takara-machi 13-1, Kanazawa 920-8640


Keywords :Child abuse, Child neglect, Retrospective study, Forensic medicine

8.2 看護業務におけるジレンマと倫理的意思決定

Dilemmas in Nursing Jobs and Bioethical Decision Making

澤田愛子 (Aiko Sawada) Fax: 0764-34-5179

富山医科薬科大学, 〒930 富山市五福末広町2556-4 五福宿舎3-204

Toyama Medical and Pharmaceutical University

3-204, Gofukushukusha, 2556-4, Gofukusuehiro-cho, Toyama-shi, Toyama 930

キーワード:患者・看護者関係,ナ−シング・アドヴォカシ−,ジレンマ,自己決定権, 倫理的意思決定

Keywords :Patient-nurse relationship, Nursing advocacy, Dilemmas, Self-determination, Bioethical decision making


 Thompson,J.E.とThompson,H.O.による〈Bioethical Decision Making for Nurses 1985〉の中には,倫理的ジレンマを解決するための10段階のプロセスが提示されている。即ち,(1)状況の振り返り,(2)補足的情報収集,(3)倫理問題の明確化,(4)個人的及び専門職的価値観の明確化,(5)鍵を握る個々人の価値観の明確化,(6)価値葛藤の明確化,(7)意思決定者の決定,(8)さまざまな選択肢と予測結果の確認,H行為の決定とその実践,I結果の評価,等々である。ジレンマが生じた時,このようなプロセスに沿って問題を明確にしてゆき,その上で患者本人の意思の尊重をベ−スに,最善の意思決定をなし,ジレンマを解決してゆくことが求められる。この理論を臨床の場で応用してゆく時,まず私達に求められるのは,何が倫理問題になるのか,という認識を十分に持つことであろう。そのために,看護者は日頃から生命倫理の基礎的な問題領域を知っておく必要がある。さらに専門職としての看護職に求められる倫理や価値観,さらに看護者個人の人間としての価値観等も再確認しておくことが望ましい。そうすれば問題が生じた時にあわてる必要はなくなろう。発表では,事例をこのプロセスに沿って展開させる形で説明を試みてみる予定でいる。特に,第7段階の意思決定者の決定においては,患者の自己決定の重要性もさることながら,それに医療者,家族も含めた合意形成の必要性を強調してみたい。それはお互いが納得した上で行為を決定することが,この国の精神風土の中では重要であると思われるからである。

Nurses sometimes experience ethical dilemmas in caring to their patients. Most of these dilemmas are related to the issues of life and death. Therefore, they are serious problems. It is necessary for nurses to know how to solve them with an idea of "nursing advocacy". Thompson, J.E and Thompson, H.O. presented us the ten steps to solve them in the book, Bioethical Decision Making for Nurses: namely, 1. Review the situation, 2. Gather additional information, 3. Identify the ethical issues, 4. Identify personal and professional values, 5. Identify the values of key individuals, 6. Identify the value conflicts, if any, 7. Determine who should decide, 8. Identify the range of actions and anticipated outcomes, 9. Decide on a course of action and carry it out, 10. Evaluate the results.

When they find out a dilemma in some nursing care, they are asked to solve it through these steps and to make the best ethical decision. What is necessary for them to put this theory into practice is knowledge of bioethics. They are expected to understand the main issues of bioethics, to know the ethical code of nursing profession and to examine their own's sense of values. If they are getting ready for solving dilemmas, they can deal with difficult issues with composure.

In this presentation , I will give an account of this theory through some real case. Especially, in step seven, I will stress that making consensus of decision among patients, their families and medical and health care staffs is more important than patient's self-determination, because this way in decision making seems to fit to the spiritual climate of Japan.

8.3 <社会的>正義から<ローカルな>正義へ

Justice to Justice

川本隆史 (Takashi Kawamoto) Email: Fax: 022-217-5998

東北大学文学部, 〒980 仙台市青葉区川内

Faculty of Arts and Letters,Tohoku University, Kawauti, Aoba-ku, Sendai City, Miyagi 980



 白書は続いて,医療技術に対する評価が■安全性や臨床的有効性を検討する「医学的評価」および■費用と効果の間の効率性を問う「経済的評価」,■「社会的評価」,以上の三つの観点から「包括的」に行われ,「技術に対する社会的合意の形成を目指すものへと発展してきている」と分析している。ところが肝腎の「社会的評価」は「生命倫理や文化,歴史などの観点からの評価」と言い換えられているだけで,その中身については次のような記述で済ましている――「このような評価に当たっては,評価の方法や手続きについての合意が重要である。このため,遺伝子治療研究に関しては,専門家による会議の議論を経て行われている」。「社会的評価」といっても,結局は専門家が決めてしまうことなのだろうか。 白書の第2部第1章(社会保障の構造改革)では,私がかねがね奇異に感じている業界用語が堂々と使われている。それは「社会的入院」である。これは「病院に診断と治療のために入院した患者が,その目的は達したが自宅に介護態勢がないなどの理由で,退院できずに入院していること」を指すものだが,この不本意な入院がどうして「社会的」と形容できるのか。さらにこの種の入院の解消を目指して創設されようとしている「介護保険制度」が「介護を社会的に支える仕組み」だと謳われる場合,この「社会的」とはどのような連帯の質を表わしているのか。




Elster, Jon 1992. Local Justice: How Institutions Allocate Scarce Goods and Necessary Burdens, Russel Sage Foundation.

Elster, Jon and Nicolas Herpin (eds.) 1994. The Ethics of Medical Choice, Pinter Publishers.

8.4 臓器の「分配」ー社会的正義?

"Distribution" of Organs - Social Justice?

嶋津格 (Itaru Shimazu) Fax: 043-290-2386

千葉大学法経学部法学科, 〒271 千葉県松戸市南花島6-61-17-501

Faculty of Law and Economics, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba-shi 263








 ちなみに,それを回避するとすれば,論理的にいかなる方途があるだろうか。@医療内在的選択 A贈り主の選択 B市場的解決 C技術進歩とコスト低下 D需給の緩和 E忘却 F籤‥‥。ここには一部グロテスクな選択肢も含まれるのは事実だが,哲学である限り一見無駄な考察も許される,という前提で考えてみたい。

8.5 医療配分における社会的正義

Social Justice in Medical Allocation

小原信 (Shin Ohara) Fax: 03-5485-0780

青山学院大学国際政経学部国際コミュニケイション学科, 〒105 東京都渋谷区渋谷4-4-25

School of Int. Politics, Economics & Business, Aoyama Gakuin University, Shibuya, Tokyo 150


Keywords :QOA, Seelsorger, QOH, Second best

9.1 今日の環境倫理学が直面する諸問題

Some Problems of Contemporary Environmental Ethics

森岡正博 (Masahiro Morioka) Email:

大阪府立大学総合科学部人間科学科, 〒593 堺市学園町1−1

CIAS, Osaka Prefecture University, Gakuencho, Sakai, Osaka 599


Keywords :Environmental ethics, Desire, Discrimination, Technology

 このセッションでは,今日の環境倫理学が解決しなければならない諸問題を議論したい 。

(1)「欲望」の問題:今日の環境破壊と資源の過剰消費は,できるかぎり長く快適な人生を送りたいというわれわれの欲望が生み出したものである。人間は基本的な欲求充足なしには生きていけない。しかし,われわれの「欲望」を適切にコントロールする方法を,われわれはまだ見 出していない。

(2)「差別」の問題:環境問題の中核には南北問題がある。「北」の国々に住む人々は,「南」の国々の人々を犠牲にして,満ち足りた商品とエネルギーを消費している。同じ構造は,国内の大都 市と地方のあいだにも存在する。これをどう考えればいいのか。

(3)「技術主義」の問題:多くの科学者たちは,今日の環境問題は,科学技術の改善と飛躍的発展によって解決され得ると主張している。たとえ今日のテクノロジーがこれらの問題を生みだしたのだとしても,将来のすすんだテクノロジーはきっとこれを解決するであろう。この考え方は 正しいのか?


In this session I want to discuss some major problems contemporary environmental ethics should face.

(1) The problem of "desire": Today's environmental destruction and over-consumption of natural resources have been brought about by our desire to have as long and comfortable life as possible. Humans can not live without fundamental needs. But it seems that we do not have a sound way of controlling our desire.

(2) The problem of "discrimination": Environmental problems include the south-north problems at its core. People in "north countries" live with affluent goods and energy at the sacrifice of people in "south countries." The same structure exists between big cities and rural areas in a number of countries. How do we think about this?

(3) The problem of "technologism": Many scientists insist that today's environmental problems will be able to be resolved by the improvement and/or brake through of scientific technology. Even if today's technology has created these problems, our future progressed technology will be sure to solve them. Is this really right?

Let us discuss together, how should we think about these three problems.

9.2 異文化間倫理に対する構成主義的アプローチ

A Constructivist Approach to Intercultural Ethics

リチャード・エバノフ (Richard Evanoff) Fax: 03-5485-0782

青山学院大学国際政治経済学部, 〒150 東京都渋谷区

School of Int., Economics & Business, Aoyama Gakuin University, Shibuya, Tokyo 150

キーワード: 環境倫理学

Keywords :Environmental ethics



 本論は,John Rawlsの政治的構成主義の広義の解釈に立脚した第3のアプローチを提唱する。なるほど倫理的対話は特定の文化的脈絡から生じるものではあるが,それでもなお,文化的背景を異にする人間が有意な異文化間の対話をすることは可能であることを主張したい。倫理的対話を静的,本質主義的な観点から捉えることを放棄することにより,文化の境界を越え出現している世界的な問題に対処する全く新しい規範をダイナミックに構成する可能性が開かれるのである。対話は,既存の文化的規範を批判し,さまざまな文化的ソースから派生する価値観を創造的に統合してゆく弁証法的過程を通して行われる。

Many contemporary problems, including concerns about the environment, human rights, development, and economic justice, are global in scope. Global institutions, such as the United Nations and the World Trade Organization, have provided an institutional context in which such issues can be addressed, but ethical debate on these issues is often based on the unquestioned modernist assumption that foundational values and norms can be universally applied to all cultures irrespective of differences. This approach is typically grounded on an ethical realism which sees values and norms as natural and objective, eg., as the product of an essential "human nature."

Cultural relativists, to the contrary, argue that values and norms cannot be naturally grounded, seeing them instead as arising out of specific cultural discourses and therefore as contextual rather than universal. The conclusion is that since normative discourses are incommensurable across cultures there can be no meaningful cross-cultural dialogue on ethics. The postmodern emphasis on difference renders joint action on problems of mutual concern difficult.

The paper develops a third approach, based loosely on the political constructivism of John Rawls, which argues that while ethical discourses indeed arise out of specific cultural contexts, it is nonetheless possible for people from different cultures to engage in meaningful cross-cultural dialogue. By refusing to regard ethical discourse in static, essentialist terms, possibilities are opened up for the dynamic construction of entirely new norms to address emergent global issues across cultures. Dialogue proceeds through a dialectical process which involves both a critique of existing cultural norms and the creative integration of values derived from various cultural sources.

9.3 環境倫理学における所有論の可能性

Property in Environmental Ethics

鬼頭秀一 (Shuichi Kito) Email:

東京農工大学農学部, 〒183 東京都府中幸町3-5-8 Fax: 0423-67-5589

Dept. Regional Ecosystem, Tokyo Univ. Agr. & Technology, 3-5-8 Saiwai-cho, Fuchu, Tokyo 183

キーワード: 環境倫理学

Keywords :Environmental ethics


10.1 生命倫理教育の医学教育への組み込みに向けて/Toward the integration of bioethics education into medical education

宮坂道夫,山内春夫,出羽厚二 (新潟大学医学部法医学) Email:

櫻井浩治(新潟大学医療技術短大部) Fax: 025-229-5184

〒951 新潟県新潟市旭町通一番町757 新潟大学医学部法医学教室

Michio Miyasaka, Haruo Yamanouchi, Koji Dewa (Dept. Legal Med., Niigata Univ. School of Medicine), Koji Sakurai (Coll. Biomedical Technology, Niigata Univ.), Asahimachidori, Ichibancho757, Niigata 951


Keywords :Bioethics education, Medical ethics


A growing number of Japanese medical schools are now teaching bioethics / medical ethics in the formal curriculum. Bioethics education seems to share the fundamental problem that Japanese medical education has been criticized for; too much stress on the acquisition of knowledge, a lack of theoretical and organizational basis of interdisciplinary fields extending over medicine, humanities, and the social sciences. Lectures in medical ethics have generally covered 1) medical outline, 2) liberal arts, 3) medical subjects. However, in all cases, bioethics teaching is a small unit. Independent medical ethics education taking in the element of bioethics seems to be expanding. What is important in the present situation is to clarify the goal of medical ethics teaching, and to draw a blueprint of curriculum and educational method suitable for that goal. In many countries, medical ethics teaching is recognized as practical knowledge, and structural integration extending over the whole curriculum is therefore examined.

We propose three strategies to integrate medical ethics education into the medical curriculum; 1) the formation of a core organization of study and information exchange, 2) the formation of an academic network extending over medical fields, humanities, social sciences, and natural sciences, 3) the promotion of understanding and support for bioethics education of the dean and the college.

10.2 介護福祉養成教育における生命倫理教育に関する意識調査 / A Study of Bioethics Education in the Training of Care Workers

板谷裕子 (Hiroko Itatani) Email: Fax: 0297-64-7286

東京福祉専門学校 介護福祉学科, 〒301 茨城県竜ヶ崎市4393-12

Tokyo College of Welfare, Ryugasaki 4393-12, Ibaraki 301


Keywords :Bioethics, Care, Watch the dying person, Reverence for the life





10.3 生命倫理教育としての臨床人間学

Clinical Anthropology Aimed at Bioethics Education

庄司進一 (Shinichi Shoji) Email:

紙谷克子 (Katsuko Kamiya) Fax: 0298-53-3192/3224

筑波大学臨床医学系,社会医学系, 〒305 茨城県つくば市天王台1ー1ー1

Inst. Clin. Med., & Inst. Social Med., Univ. Tsukuba, 1-1-1 Tennohdai, Tsukuba, Ibaraki 305


Keywords :Bioethics, Clinical anthropology, Small group learning

  生命倫理教育の方法として臨床人間学を実践している。生老病死に関連する判断が必要な具体的臨床症例や場面の提示や自分自身の場合を想定した演習,その判断に対する代表 的意見や必要な情報と質疑,10人前後の小人数でそれぞれセミナールームに分かれ,司 会と記録係を互選して,自由討論,各グループの記録係が討論の概要を報告,全体討論,教官が個人的見解として自分の考えを簡潔明瞭に語り,各自が感想文を書いて提出,以上が臨床人間学授業の概要である。全学を対象に総合科目として1996年度26回(75 分/回,1回/週)215人の選択で行った。最終回にアンケート調査(125人)の5 段階評価では,人間について考える機会をもてたか(平均4 .42),個人個人の 人の価値観の違いに気付いたか(4.65),自分自身の人生について考える機会は持てたか(4.30),人生を生きていく意義・生きがいについて考える機会を持てたか(4.3 9),であった。一つのテーマを7人のグループで週1回(75分/回)2〜3週間で討 論を深め,調査研究を行い,各自がレポートを提出する方法で,1996年度医学専門学 群の1年生100人で1〜2学期21回必須で行った。最終回99人のアンケートによる5段階評価では,医学の勉学へのモチベーションが湧いたか(3.66),医療の心への 理解が得られたか(3.78),学問の楽しさを経験できたか(3.09),学問への取り組み方に慣れたか(3.66),であった。取手市教育委員会との共催で大学公開講座を1997年4月〜5月に5回(2時間/回,1回/週)で一般市民27人を対象に行っ た。修了後参加者の希望で月1回で通年で続けることになった。いずれの参加者も,「日々の生活の中では,授業で扱ったような課題を熟慮することはあまりない。その機会を提供しているという点で,とても意義のある授業であったと思う。」や「いろんな人の意見を聞けて良かった。」という感想を書いた者が多数いた。

10.4 コ・メディカルのための倫理教育−短期大学における実践報告と提案

Ethics Education for Allied-health Professionals - A Report & Proposal on a Project at a Junior College of Health & Welfare

岡本珠代  (Tamayo Okamoto) Email:

吉川ひろみ (Hiromi Yoshikawa) Fax: 0848-60-1226

広島県立保健福祉短期大学, 〒723 広島県三原市学園町1-1

Hiroshima Prefectural College of Health & Welfare, 1-1 Gakuen-cho, Mihara City, Hiroshima 723

キーワード:チームアプローチ,倫理教育,事例検討,グループディスカッション, コ・メディカルの役割と責任

Keywords :Team approach, Ethics education, Case studies, Group discussion, Role and responsibilities of allied-health professionals




 現在,総合演習の第1日のみが終了し,後半の授業の準備の途上である。現段階で生じ ている問題について以下に報告する。まず,チームの構造の考え方の基本は,クライエン トを中心として,ケアに関わる各専門職が対等な立場で周りに位置することが望ましいと 思われるが,医師の位置はどこか,チームリーダーは誰かというコンセンサスが得られない。次に,グループディスカッションをするための既存の教材がない。倫理的ディレンマ については,各職種別にまとめられている事例集は翻訳を含めてあるにはあるが,チームアプローチに関するものはほとんどみられない。最後に,通常,別々に授業を受けている異なる学科の学生の混成グループが活発なディスカッションを始めるまでに,かなりの時間を要するという問題があった。良い教材の開発と教官自身が良いチームワークで授業運営をすることができる教育内容を探っている。

At a three-year prefectural junior college with five departments, namely, nursing, radiology, physical therapy, occupational therapy and speech therapy, we have an ethics study group formed with the purpose of studying how to incorporate ethics in the education for future health care professionals. Each department is represented by a couple of faculty members engaged in collecting information, exchanging views and conducting surveys on ethics education in other institutions of Japan. This effort is bearing fruit in providing resources to a newly established course called "An integrated seminar for third year students" at this college which is designed for preparing them for team-oriented medicine.

The seminar is a three day-long intensive course. The first day is scheduled prior to the students' clinical training period and the remaining two days are purposely scheduled after the clinical training ends. One part of the session is a discussion of the medical aspects of a case presented in a video program. The last day is devoted to a discussion of an ethical dilemma in a case for which a textbook is being prepared by our ethics study group.

Several problems have come up. One of them concerns how each future team member, including a doctor, is situated in the medical team. The question is how equal partnership is established in a group with members from different disciplines. The lack of ready-to-use textbooks for the team-oriented approach is another problem. Collections of cases in each different field do exist, especially in nursing, but none are available for team-oriented approach. Our final problem is the students' slowness in getting self-expression in such a mixture from different departments, as they usually do not mix otherwise. We need to have a good textbook and a curriculum in which instructors can have a good relationship with each other in the administration of the course. We, nonetheless, are certain that this sort of attempt is unique in this country and should be introduced in other similar institutions for the sake of future health-care professionals working in a team setup.

10.5 学生が経験した症例をもとにした臨床倫理教育 / Clinical Ethics Education with the Cases that Students Experienced

白浜雅司 (Masashi Shirahama) Email: Fax: 0952-56-2912

三瀬村国民健康保健診療所, 〒842-03 佐賀県神崎郡三瀬村大字三瀬2615 

Mitsuse National Health Insurance Clinic, Department of General Medicine, Saga Medical School,

2615 Mituse, Mituse mura, Saga ken 842-03


Keywords :Clinical ethics, Case study, Interdisciplinary education, Internet


 4年次には臨床実習前の臨床入門系統講義の中の2コマ3時間を使って,ワシントン州立大学のJonsen教授らが開発した医療倫理の4分割法(医学的適応,患者の意向,QOL,周囲の状況)を説明した後,筆者が臨床で経験した倫理的ジレンマを含む症例を渡し,「その症例でどのような倫理的問題が考えられるのか」,「その問題を考えるためにどのようなことを知る必要があるのか」,「自分が症 例の主治医であったとしたら次にどのようなことをするか」ということを各自で考え,小グループごとに検討したうえで全体討議を行っている。また討議には学内外の医療倫理に関心のある方や患者ボランティアにもコメンテーターとして加 わってもらっている。

 6年次では,さらに深く学びたいと思う学生を対象にした選択コース「臨床倫理」を設け,2,3人の学生が毎週2時間ずつ4週間にわたって,彼らが臨床実 習などで倫理的ジレンマを感じた症例を取り挙げ,臨床入門で用いたような臨床 倫理の4分割法をもとに考えている。この検討にも医師だけでなく,学内の一般教育の法学,倫理,社会学,心理学の教官などが適宜参加して学際的な討議を行っている。また症例はインターネットを使って国内外の医療倫理に関心のある医師 や生命倫理の専門家にも送って意見を求め,討議の参考にさせていただいている。 学生は臨床倫理的な課題に気付き,自分なりに分析して考え,他の人の色々な見方を知り,必ずしも一つの結論が出るわけではないが,現時点で最善の方法を見い出して行く過程を体験している。このような教育を通して臨床倫理的な問題に関心をを持ち,医師になって難しそうな倫理的症例に出会った時にも,積極的 に考えて行こうとする医師を一人でも多く育てたいと願っている。

In Saga Medical School, I started to teach Clinical Ethics for the 4th year medical students in their introductory course to clinical medicine. In this course, students were taught about the 4-Box (Medical Indication, Patient Preference, QOL, Contextual Features) analysis of Clinical Ethics by AR Jonsen (Univ. of Washington).

We also started the elective course "Clinical Ethics" for the 6th year medical students. In this lecture, the students choose the case of ethical dilemma which they have encountered during their bedside assignments. This case discussion was done not only with the physician but also teachers of law, sociology, philosophy and psychology in general education. The cases and their analyses were sent using Internet to the bioethicist and doctors and the lawyers in Japan and also in the foreign countries to ask for their comments. This case study is interdisciplinary and international education. We can learn from the difference and the similarity. We should understand the uniqueness of Japanese culture and the Japanese feeling in the ethical situation.

The students evaluated this experience was so exciting and practical. We hope they continue to think of ethical dilemmas in the future as a physician.

11.1 日本における高校での生命倫理教育ネットワーク

High School Bioethics Education Network in Japan

浅田由紀子 (Yukiko Asada) Email:

メイサー,ダリル (Darryl Macer) Email:

Fax: 0298-53-6614

筑波大学生物科学系, 〒305 茨城県つくば市

Institute of Biological Sciences, University of Tsukuba, Tsukuba Science City 305


Keywords :Bioethics, Education, High Schools, Networks


 生命倫理教育をどのように始め,深めていくかを模索している教師に応えるべく,1994年に私たちは,生命倫理教育に関する補助教材を作成し,500部を,先の調査の要約を希望した教師に配布した。教材の使用に関する追跡調査と,数名の教師らとのインタビューをもとに,1996年に,改訂版補助教材を作成した。日本全国の高校(5000校以上)に改訂版教材の無料配布の情報を郵便かファックスで提供し,これまでに,要望のあった800校以上の高校に改訂版教材を配布した (。お互いに意見や情報を交換する場を設けることによって,孤立感を味わいつつ生命倫理教育を進めている教師を支援するために,1996年,学校における生命倫理教育ネットワークを発足した。現在,14都道府県から,生物科,社会科の40名強の教師が,このネットワークに参加している。ネットワークでは,1996年12月から,2カ月に1度のペースで勉強会を開いており,毎回,12〜20名ほどの教師が参加している。環境教育,開発教育などでよく用いられる討論形式を導入することにより,教師らは徐々に,活発に意見を交換するようになりつつあり,生命倫理における教育の役割と教育における生命倫理の役割を探っている。


Bioethics education is essential to satisfy one of the goals in bioethics, how to develop a broader picture for inclusion of science and technology in democratic discussions. The International Bioethics Education Survey conducted in 1993 supported this notion: over 80% of the biology and social studies teachers from Japanese high schools who responded thought bioethics education is needed. In response to call from teachers to begin or deepen bioethics education, in 1994 we developed teaching materials and distributed these to about 500 teachers, who had requested summary of the survey. Based on the follow-up survey for the material use and several interviews with teachers, we revised the teaching materials in 1996. Announcing the revised teaching materials for all high schools in Japan (over 5000) by fax and post, we have dispersed them to over 800 teachers ( TM.html). The materials are also available in English, and were distributed in Australasia.

With the hope that teachers will be encouraged by exchanging ideas and information with each other, we formed a High School Bioethics Education Network in 1996. About 30 teachers from 14 different prefectures have joined in the network. The network has bimonthly meetings since the end of 1996, and 15-20 teachers participate each time. Applying some skills in environmental education and development education, the teachers now actively exchange opinions, exploring the roles of education in bioethics, and the roles of bioethics in education. The results of these meetings, and the potential for this activity to promote bioethics education in this and other settings, for example among groups of different ages, and within society will be discussed.

11.2 健康・病気をテーマとした生命倫理教育

Bioethics Education - Health and Disease Dealt as a Theme

小泉博明 (Hiroaki Koizumi) Fax: 03-3265-8777

麹町学園女子高校, 〒102 東京都千代田区麹町3-8

Kojimachi Gakuen Girl's High School, 3-8, Kojimachi, Chiyoda-ku, Tokyo 102


Keywords :Health, Disease, Symbiosis




11.3 HR(ホームルーム)野外合宿の生命倫理的意義, 高校の事例から

Bioethical Importance of School Field Activity with Lodging (High School Case Report)

橘 都  (Miyako Tachibana) Fax: 03-3821-7460

羽田高等学校, 〒110 東京都台東区谷中3-1-14-201

Haneda High School, 3-1-14-201 Yanaka Taitou, Tokyo 110

キーワード:宿泊行事,支援体制 ,問題意識 , 意欲的参加

Keywords :School activity with lodging, Supporting system, Consciousness, Participation with consciousness

 日本の多くの中学校,高校で一,ニ年生をを対象に林間学校,臨海学校,HR合宿といった,新入生に対するトレーニング的行事が行われている。その大半は,学校外の野外施設において,3泊までの宿泊を伴って行われるのが普通である。これらの宿泊行事を今日の日本のティーンエイジャーに行うことは,教師にとってはかなりの過重労働であり,種々のリスクを回避して実施しなくなった学校もある。にもかかわらず,核家族化,少子化がすすみ,さらに都市部においては,自然環境に接する機会が減少している中で,このような行事が学校教育で実施されることにより, 教師と生徒が生活時間を共有し,







11.4 AIDSについてどう教えるか〜人間の生き方と社会のあり方を考えるために〜

How to Teach AIDS Problems - In Order to Think How Our Life and Our Society Should be-

大谷いづみ (Izumi Otani) Email: Fax: 0425-34-5449

東京都立国分寺高等学校, 〒185 東京都国分寺市新町3-2-5 

Kokubunji High School, Shinmachi 3-2-5, Kokubunji, Tokyo 185


Keywords :Education, AIDS education, Prejudice, Poverty, Sexuality




11.5 山口大学一般教育における生命倫理教育の実践

An Attempt of Bioethics Education in Yamaguchi University

川崎勝 (Masaru Kawasaki) Fax: 0836-31-1543

山口大学, 〒755 宇部市常盤台2557 山口大学常盤台宿舎B-202

Yamaguchi Univ., B-202 Yamadai Tokiwadai Syukusya, Tokiwadai 2557, Ube-shi, Yamaguchi 755


Keywords :Bioethics Education, General Education, Debate

 医療従事者の養成課程における生命倫理教育の重要性は改めて指摘するまでもないが,現代社会においては,一般の非医療従事者に対する生命倫理教育もまた重要である。演者は1994年度と1995年度に山口大学の一般教育の枠組みの中で全学部の1・2年生を対象として生命倫理教育を行った。ちょうどカリキュラムの改変期に当たったため,それぞれ,1994年度は旧カリキュラムの総合科目(旧一般教養のうち,人文・社 会・自然の3分法に従わない科目をそう総称していた)の「人間環境論」,1995年度は新カリキュラムの主題別科目の「“いのち”の問題を考える」というタイトルで授業を行ったが,取り扱った内容はほぼ同一である。授業内容の計画を練る段階で,日頃の学生たちとの会話から,彼ら・彼女らが最近 の医療事情に著しくうといこと,「正解」を欲する傾向が強いことを把握していたので,できるだけ情報を提供することに徹し,問題について自ら考える姿勢を涵養する点に重点を置くことに決めた。具体的には,ビデオなどの視覚教材をできるだけ用い,また,毎回授業の最後に10分ほど用いてその回取り扱った問題に関する意見を記させ(うち数回は比較的長文のレポートを書かせた),それへの応答を基に授業通信を刊行した。また,最後に取り扱ったテーマである「脳死・臓器移植」においては,授業全体のまとめも兼ねたディベート形式の授業を導入し,総合的な問題の把握力と自 己表現能力,判断力の養成に努めた。


12.1 アメリカにおけるインフォームド・コンセント概念の形成

The Formation of the Idea of Informed Consent in US

長岡成夫 (Shigeo Nagaoka) Email: Fax: 025-262-6403

新潟大学教育学部, 〒950-21  新潟市五十嵐2-8050

Niigata University Faculty of Education, 8050 Ikarashi-2, Niigata 950-21


Keywords :Informed consent, Self-determination, Information disclosure




In Japan, it is often assumed that the idea of informed consent is well received by the American public, who have the tradition of self-reliance. If we look into the series of verdicts which established the idea, however, we find that the courts' concern is not only with the patient's self-determination based on information disclosure, but also includes the patient's well-being.

The latter concern, it could be contended, arouse out of the fact that patients may find the uncertainties inherent in medical practices, especially various risks accompanying medical procedures too overwhelming and hard to cope with. It should be emphasized that this factor had a major influence on the formation of the idea of informed consent in the United States.

12.2 患者の自律とインフォームド・コンセント

Patients' Autonomy and Informed Consent

柴田恵子 (Keiko Shibata) Fax: 096-366-1319

九州看護福祉大学設立準備財団, 〒865 熊本県玉名市繁根木163

Kyushu University of Nursing and Social Welfare, 163, Haneki, Tamana-shi, Kumamoto 865

キーワード:自己決定 ,自律 ,インフォームド・コンセント, パターナリズム

Keywords :Self-determination, Autonomy, Informed consent, Paternalism


12.3 日本の小児医療における小児がん患者に対するInformed Consent

Informed Consent for Cancer Children in Japan

掛江直子(早稲田大学人間総合研究センター) (Kakee Naoko)

恒松由記子(国立小児病院) Fax: 0429-47-6840

〒359 埼玉県所沢市三ヶ島2-579-15 早稲田大学人間総合研究センター

Naoko Kakee*, Yukiko Tsunematsu

*School of Human Sciences, Waseda University, Tokorozawa 359


Keywords :Informed consent, Human rights, Human dignity, Communication

 近年の小児がん治療の飛躍的な進歩によって小児がん患者の生存率の改善がなされてきた。これに伴い,患児のケアを行う際の患児のQOLに対する考え方についても変革が要求されてきているのではないだろうか。つまり,従来の患児はインフォームドコンセント(以下IC)の対象にしないというネガティブな姿勢から「小児医療の主役はあくまでも患児自身である 。そして患児にとっての最善の利益として,より高いQOLを考える際には ,たとえ子どもであっても,患児に対し患児自身に関する全ての真実を伝え,真実の共有を基盤としたオープンなコミュニケーションをとることが 必要である」というBioethics的な考え方へと意識を大きく転換する必要性があるのではないかと考えるのである。

 今回,ICの必要性について論じるにあたり,まず日常的にインフォーム されている小児がん患児たちが,実際に自分の病気や置かれた状況についてどの様に理解しているか,また自分の周囲の状況や他の患児たちの病気 についてどの様に理解,認識しているかという点について,bioethicsの視点を交え,観察とインタビューの手法を用いて調査を行った。この調査の結果から,小児医療において患児たちはインフォームされた情報をかなり正確に理解しており,また自分のおかれた状況ならびに周囲 の状況についても非常によく理解していることが明らかになった。このことから「子どもは医療情報を理解できないのでICの対象とする必要はない」といった患児に対してICを行わない従来の理由づけは正当化され得ない という結論が導かれた。また,患児に自身に関する情報をインフォームす ることが,患児のHuman Dignityを尊重することにつながることについても確認した。さらに,Bioethicsの視座から,ICによる真実共有の必要性,ならびにそれに基づくオープンなコミュニケーションの必要性についても言及する。

12.4 エホバの証人の輸血拒否と公序良俗違反

The Refusal of the Blood Transfusion of a Believer of the

Jehovah's Witness and the Breach of the Public Policy

大嶋一泰 (Kazuyoshi Oshima) Email:

岩手大学, 〒020  岩手県盛岡市黒石野3-19-44 Fax: 0196-21-6715

Iwate University, Kuroishino 3-19-44, Morioka, Iwate 020


Keywords :Doctor's Dilemma, Blood transfusion, Jehovah's witness, Public policy, Religious profit

 東京地裁は,本年3月12日肝臓の腫瘍の手術に際して,患者の強い輸血拒否の懇請を分かりましたとして承諾しておきながら,この患者との特約を無視して輸血した医師に対して為された損害賠償請求事件において,輸血以外 に生命の維持が困難な事態に至ったときは,患者及びその家族の諾否に拘わらず,輸血を行うというエホバの証人 の信者に対する東大医科研の治療方針は直ちに違法であるとか相当でないとかいうことは出来ないとした上,いかなる事態になっても輸血をしないとの特約は,それが宗教的信条に基づくものであったとしても,公序良俗に反して無効であると解されると判示して,原告の請求を棄却した。しかし,このような形で,裁判所が特定の宗教の核心的な信仰内容の当否を判断し,それが公序良俗に違反するとまで言うことは,憲法の保障する「思想・良心の自由」及び「信教の自由」に対する重大な侵害であると考える。蓋し,患者の信仰上の理由に基づく輸血拒否の意思表示は「生命利益放棄の意思表示」ではなく,正に自己の信仰する宗教上の戒律を破ってまで「生命」を維持する価値があるか,それともたとえ生命を失うことになろうとも,自己の信仰する宗教上の戒律を守り,来世の幸福を望むかという宗教上の価値選択の意思表示であり,正に信仰の表明だからである。この利益衡量と価値選択は本人にしか為しえず,しかもその価値決定は,取りも直さず当人の信仰の核心的内容であり,正に憲法が保障している「信教の自由」ないし「思想・良心の自由」という基本的人権の尊重要求に外ならないからである。医師の直面したジレンマの故に,輸血拒否を公序良俗に違反するとか,自己決定権の濫用であるとするのは誤っている。医師の特約違反の債務不履行の違法性は明白であり,又東大医科研の治療方針は,患者の意思を無視するもので,憲法に違反する疑いがあると思う。

The Tokyo district court dismissed on May 12, 1997 the demand for compensation for damage of a plaintiff. The outline of the case is as follows. A patient, who had a heavy liver tumor, is a Jehovah's Witness. She was operated on in the hospital of the medical research institute at Tokyo University. She requested doctors before the operation not to give her a blood transfusion by any means. Doctors consented to her request. But the doctors gave her a blood transfusion after the operation.

The court said that the principles of the medical treatment of the hospital for Jehovah's Witnesses can not to be said immediately to be either illegal or improper. The principles says that when there is no means to save the life of a patient without a blood transfusion, doctors must give a blood transfusion into the patient, whether the patient and its families agree to it or not. And the court said that a special contract not to give her any blood transfusion even in the case of life crisis without the transfusion is invalid, because this contract is a breach of the public policy.

But I think, it is a serious violation of the freedom of thought and conscience and the freedom of religion. The constitution guarantees these freedoms. On the judgement whether the core part of the belief of the specific religion is right or wrong, the court said that this specific contract is a breach of public policy. But the declaration of intention of the patient for the refusal of a blood transfusion on the religious grounds is not the declaration of intent to abandom her life interest. It is just a declaration of her religious belief and her religious value choice between the value of the life support with the violation of religious precept and the value of the hope for the happiness of life after death by the practice of the religious orders, even if she will die with the refusal of a blood transfusion. Moreover, her value choice is her demand for the respect of human rights, especially the freedom of thought and conscience and the freedom of religion. It is false to say that this special contract is a breach of the public policy or the abuse of the right of self-determination for the reason of the dilemma that the doctors faced. The illegality of non-fulfillment of the obligation of the doctors is clear and the principles of the medical treatment of the hospital for the Jehovah's Witness patient is unconstitutional. But the responsibility of the doctors can be reduced for the reason of the inevitability of a blood transfusion for the life support of the patient.

P-1 アジアと環太平洋諸国における人間と動物の関係と生命倫理

Human Relationships with Animals in Asia Pacific Countries and Bioethics

横山恭子 (Kyoko Yokoyama) Email:

メイサー,ダリル (Darryl Macer) Fax: 0298-53-6614

筑波大学生物科学系, 〒305 茨城県つくば市 

Institute of Biological Sciences, University of Tsukuba, Tsukuba Science City, Ibaraki 305


Keywords :Bioethics, Animals, Relationships, Nature, Life





An analysis of comments made by respondents to the International Bioethics Survey conducted in 1993 in 10 countries of the Asia-Pacific region that mentioned animals was made. There were more comments including animals in response to the open question on images of nature than images of life. The proportion of the total comments that included animals ranged from 12-56% for nature, and from 5-28% for life. Russian respondents were the least likely to mention animals, and Australians most likely.

Among the images of nature which included animals, the most common types of relationships were: aesthetic (36%), neutralistic (27%), discussing pollution (17%), ecologistic (13%), biocentric (9%), harmony including humans (9%), humanistic (6%), utilitarian (4%), scientific (1%), with moralistic, negativistic and doministic comments less than 1%. Among the images of life which included animals, the most common types of relationships were: biocentric (32%), ecologistic (17%), aesthetic (16%), discussing pollution (11%), naturalistic (10%), humanistic (8%), harmony including humans (7%), moralistic (6%), scientific (6%), utilitarian (2%), negativistic (1%), and doministic (0.3%). There were few differences between countries, for example, there were more naturalistic comments in India, Hong Kong, the Philippines and Singapore; more ecologistic in Australia; more biocentric comments in Australia and Japan; and more comments with the idea of harmony including humans in Thailand. In general, respondents who mentioned animals were more supportive of the statement that メanimals have rights that humans should not violateモ; and less positive and more negative in perceptions of science; and less willing to approve of genetic engineering of a sports fish. However, there were very few differences in environmental attitudes. Rural respondents had a tendency to express more comments about animals in their image of life, and expressed the idea of harmony including humans more.

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