Eubios Ethics Institute and the University of Tsukuba invite you to:

Bioethics in and from Asia:

The Fifth International Tsukuba Bioethics Roundtable, and
Intensive Cross-Cultural Bioethics Course (TRT5)

20-23 November, 1999

20 November

9-12am Ethical Dilemmas of Biotechnology

Lessons from seeking a balance of love, politics, ethics of need, and global food and agriculture
Darryl Macer, University of Tsukuba, Japan

This paper will examine some of the conclusions reached from time spent at the United Nations Food and Agriculture Organization (FAO) in 1999. A series of interviews were conducted in July and August with persons across all divisions of FAO, together with the assistance of Minkashi Bhardwaj, Fumi Maekawa and Yuki Niimura. The study showed that although ethics was not openly discussed at FAO until now, many of the programs and policies were founded from the principles of bioethics. There are a number of international guidelines, conventions and projects that are attempts to alleviate fod insecurity and to lead to sustainable rural development. The results show how that we may not be aware that the driving action of our work is based on love, or ethics, but we still find our life moulded by it. Some of the key areas that need urgent ethical reflection in the ethics of food and agriculture, including forestry and fisheries, will be presented. It is high time for a proactive stance to be taken by this intergovernmental organization in issues such as balancing the interests of present and future generations in the conservation and management of natural resources, in biotechnology questions and in the implications of the rapid modernization of agriculture. The participatory approach should be effected by stimulation of persons at all levels in recipient countries, and this is based on the foundation of autonomy and justice. Political obstacles to reaching a real recognition of the right to food need to be overcome if the target of the World Food Summit to half the number of people who are starving by the year 2015, is to be achieved. This impetus may come only by stirring the conscience and love that is found in the hearts of people in all culture, into some practical measures to enable global distribution of appropriate technology that makes people more self-reliant. This and some of the other issues will be raised.

Ethics and genetic engineering
Kazuo Murakami, Emeritus Professor, University of Tsukuba, Japan

I have been engaged in bioscience and biotechnology including genetic engineering for the last twenty years. During these studies, I feel "Something Great" or "Great Nature" which inputs the genetic code so rationally and beautifully in an unbelievably small space. I think the existance and function of "Something Great" may be a base for bioethics.

What's wrong with genetic reductionism
Frank J. Leavitt, Chairman, The Centre for Asian and International Bioethics Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel Email:

Genetic reductionism, the attempt to explain all physical and mental qualities of living organisms on the basis of their genes, is often attacked on the grounds that (1) it ignores environmental and extragenetic biological co-factors, (2) it denies free will, and (3) it denies the spiritual side of life.
The first objection is correct but does not obviate the possibility of reducing these co-factors themselves to molecular or even sub-atomic causes. The second objection begs the question in assuming without proof that we really have free will. Perhaps we can sometimes get free of some causes, but only to fall under the influence of others. The third objection ignores the possibility that continuing research into molecular and even sub-atomic factors in human life may shed more and more light on what the soul really is. Although the Platonic-Cartesian tradition saw the soul as a single, simple unified entity, others -- particularly mystics like Rabbi Itzhak Luria (l6th century Israel)-- saw it as enormously complex and composed of "holy sparks" Perhaps these "holy sparks" are best understood as the sub-atomic particles of which we are composed. If so, then the distinction between the material and the spiritual disappears.

Progress report from a biotechnology and bioethics survey in Japan 1999
Mary An Ng, Tomoyuki Watanabe and Darryl Macer, University of Tsukuba, Japan

There has been much public concern expressed about the application of modern biotechnology, especially genetically modified organisms (GMOs). One way to explore these concerns is by use of surveys to seek people's hopes and concerns. This paper will describe the development of a new survey being conducted on the public and scientists across Japan in the coming months. The results will be compared to previous surveys, especially those conducted by Macer and collaborators in 1991, 1993 (International Bioethics Survey) and 1997 (Eurobarometer). Some example comments from preliminary results will be described from surveys collected during a public science forum held in Tokyo in September 1999, together with the analysis method for examining open comments in general.

Revisiting the Nuffield Council of Bioethics Report on AgroBiotechnology
Willy DeGreef, Novartis, Switzerland*

Developing dialogue over Life and Biotechnology in a focus group in Japan
Fumi Maekawa & Darryl Macer, Eubios Ethics Institute, Japan

This focus group of ordinary citizens meets together in Tokyo to discuss questions raised by biotechnology that face our life. We speak as individuals and not as representatives of our employers or our specialities. Everyone is given a chance to speak at every meeting in an informal atmosphere. We cover a wide range of occupations and experience, but we work together to discuss and learn about the environmental, ethical and social issues associated with the use of biotechnology based on scientific knowledge and practical reality. The group was formed in 1999 and met 6 times in the first year. We met in Tokyo International Forum because of its central location. The group meets for two hours between 5:15 to 7:15pm, usually on friday evenings. The people are working in a range of fields including industry, media, farming, academia, and self-employed persons. We had four meetings on GM food and labelling, and then produced a consensus statement, which is being widely distributed . This statement will be discussed. The next two meetings were on Intellectual property and life, and farmer's rights in the age of biotechnology. Lessons and the process of the group will be discussed.

Novartis Japan's efforts to gain public acceptance
Fumiyo Kitahara, Novartis K. K. Japan

Novartis advocates Labeling but we need to have 1) clear threshold value and detection limits; 2) an authorized central agency for certification and control; and 3) clarification of the purpose of the labeling, not safety issue but the consumers' right to chose. Labelling does not resolve the issue of the lack of high quality consumer information about GMOs and their use in food products.
One of the events we organised to increase understanding was the Novartis Life Science Forum 99 on GMOs and their Opportunities and Challenges, on September 29, 1999 in Tokyo. It was attended by 535 participants including 90 from the media.
Novartis pursues biotechnology because it is one of the key technologies of the 21st century. We want to promote better understanding of gene technology through: Media study meetings and Children's educational programs.

The role of the media in the biotechnology debate in Japan
Yuri Oiwa, Asahi Shinbun, Japan

In the Japanese media, the science is not a priority for coverage. Politics, economics and social issues receive more coverage and emphasis. Therefore, when biotechnology related news are reported, they are usually in a social news section or economic news section and not in a science section. This tendency may have some influence on the debate over biotechnology in Japan.
In general, the Japanese media, especially quality papers have a long tradition to put both pro and cons. This tradition itself is fine, but usually the opposing opinion sounds more appealing to general readers.
People in the biotechnology business or related academic fields or administration often criticize the role of media in not being scientific. Except some tabloids or popular TV programs, that criticism is not deserved. The most critical point is that consumers do not trust coorporations or administrations or researchers from their experience. People in the biotechnology should try to reestablish consumers trust.

1-4pm Ethical Dilemmas of Medical Genetics

Patents: Understanding Morality as a ground for exclusion
Sivaramjani Thambisetty, India & Exeter College, Oxford, UK
Morality over the years has played many strange roles. In patent law it has outlived its cousin "illegality" as a ground for exclusion of certain inventions from patent protection.
Biotechnology has been potrayed as causing certain breaches in conventional patent law doctrine. One of these, it has been pointed out is the move towards taking the moral implications of the use and publication of certain inventions into account.
This view seen increasingly in academic writings on the subject is misleading and represents a fallacious view of the early development of patent law. A study of the origins of the system shows no evidence of the ethically neutral body of law that it is portrayed to be today. Taking morality into account is not a novel develpment. An acknowledgement of this would strengthen the legal basis of exclusionary measures in patent systems.

A Confucian Perspective on ELSI: Genetic Determinism, Eugenics and Gene Therapy
Dr. LEE Shui Chuen
Director, Graduate Institute of Philosophy
National Central University , ROC
At the close of the Twentieth Century, genetics and biotechnology becomes one of the two great achievements, the other is computer technology, which will bring forth enormous impact for the human and non-human world in the next millennium. It is not too far off the mark when James Watson said that the future of humankind lies with genetic studies, which is often overly eulogized as the ultimate panacea of all human maladies. It opens a new horizon upon our self understanding and reveals some of our most intimate and important information. However, the ethical problems related to the rapid development of genetics become very pressing, and very close indeed as the completion of the Human Genome Project is projected to be in year 2003, or in year 2001 as some estimates. Starting from the employment of genetic engineering in the 1970's, there have been vigorous debates on every genetic advancement. However, it is not easy to have definite moral resolutions for many of these genetic controversies, such as the cloning of Dolly, genetic experimentation on human embryos, plantation of human organs in animal bodies, and a host of others.
In this paper I shall first give an outline of a Confucian bioethics as the background and proceeds to give first an overall evaluation of the Human Genome Project and then some critical comments on such issues as genetic determinism, gene therapy, positive and negative eugenics from the Confucian perspective. Though it is not expected that the introduction of Chinese or more precisely the Confucian perspective on these issues could solve them all at one stroke, farther still from reaching consensus by all parties. However, the Confucians have their sayings and as this paper argues, their sayings originate from humanity, they shall eventually get the ears of rational human beings.

The aging gamete, an exploration of the ethics of sexual behavior and congenital anomalies
Irina Pollard, Department of Biological Sciences, Macquarie University, Sydney, NSW 2109, Australia

Culture is a potent factor affecting our biology, just as biological factors put constraints on culture. There has always been a need to control human fertility. The prevention of unwanted babies dates back over 4,000 years with successive ancient civilizations recording recipes for abortifacients, vaginal pastes and medical tampons. Modern insights connecting sex and sexually transmitted disease probably dates from the use of the linen sheath in 1564 used as protection against syphilis. Because of the ovulatory (rhythm) method of birth control's cheapness, there has been increasing pressure during the 1990s to make it a suitable contraceptive choice in the developing, overpopulated world, where natural family planning is the sole method of fertility control for some of the world's poorest couples. Therefore, it is in the interest of couples, and the society they are living in, to be educated and unambiguously informed about the relative risks and benefits of competing artificial contraceptives relative to natural family planning. Major concerns are unwanted pregnancies, fertilization with aged gametes resulting in possible genetic defects, and exposure to sexually transmitted diseases. The presentation reviews the existing literature documenting the gametopathy concept (1). In essence, desynchronized ovulation and fertilization may facilitate reproductive dysfunctions during pregnancy and increase the rate above normal of common congenital anomalies in the children born as a result of natural family planning failures. During irregular menstrual cycles when spontaneous ovulation occurs earlier or later than estimated, the prescribed sexual abstinence does not precisely coincide with peak fertility; that is, the synchronous presence of fresh gametes at the fertilization site. As a result, desynchronized ovulation and fertilization risks the union of "over-ripe" ova, surviving aged sperm, or a combination of both. According to the principles of bioscience ethics (2), it is unacceptable to withhold available scientific insights which may prevent couples from making informed decisions about their sexuality and give due respect for biological law.
1. Jongbloet, P.H. (1985). The aging gamete in relation to birth control failures and Down syndrome. European Journal of Pediatrics 144;343-347.
2. Pollard, I. (1997). Bioscience ethics - A new conceptual approach to modern ethical challenges.
Eubios Journal of Asian and International Bioethics 7;131-135.

Human reproductive cloning prohibition in Japan
Ryuichi Ida, Kyoto University, Japan (Chair IBC, UNESCO)

Reproductive human cloning is prohibited in the Universal Declaration on Human genome and Human Rights of UNESCO, as it is contrary to the human dignity. Such a practice is forbidden by law in some countries or by government decision in others. How is it treated in Japan?
The Sub-Committee on Human Cloning of the Bioethics Committe of Japan have been discussing since 1998 on the possibility of prohibition of the application of cloning technology to human being. The main questions are (1)the objects of eventual prohibition, (2)the reason of prohibition and (3)the modality of prohibition. It has almost reached to the conclusion.
(1)It is generally understood some kind of control, including eventual prohibition, is necessary facing various social, ethical and legal issues which derive from the human cloning. Only the reproductive human cloning should not be permitted, while cloning of human tissue or cell may be acceptable.
(2)The reproductive human cloning is contrary to the human dignity and susceptible to un-safety of the living entity produced through cloning of human cell. The precise meaning of the human dignity has been discussed; the instrumentalization of human being, the pre-setting of the genetic structure, and the violation of right to be an individual are the elements constituting the human dignity.
(3)For the modality, two positions have long been opposing. Those who claim the necessity of a legislation with possible punishment call for the effectiveness of control and limitation. Those who wish to take a more moderate way, like governmental guidelines, advocate the scientists' conscience on this matter.
In addition to the discussion in the Sub-Committee, the results of questionnaire will be presented to show how Japanese intellectual people think of the human cloning issue.

Challenges of genetic engineering and the ethical response - On the ethics of human cloning
Park Ynhui, Pohan University of Science and Technology (Postech), South Korea; President of Korean Association of Bioethics

Ethical challenges of cloning technique
To be ethical means to be concerned with, and care for, the well being of others, and to respect them for their own sake. Cloning challenges ethical responses. The challenge is in different order from that of traditional ethics, both anthropocentric and ecocentric, which is about how to share good either among other humans or living beings. The challenge is about creating/inventing or fabricating them artificially.
Traditional arguments for and against cloning
Arguments for cloning include: Utilitarian argument - for whose benefit? Anthropocentric argument - groundlessness of anthropocentrism. Arguments against cloning include: Theological argument - particularly of its metaphysical presupposition; Psychological argument - irrelevance of psychological factors; Sociological argument - it is based on egocentrism-ethnical, regional egoism.
Philosophical arguments against Cloning
Ethics is the matter of value. Value presupposes analytically a subject capable of having experiences (perhaps only human fall into this category), without which the very concept of value is unintelligible. All values are either / instrumental / extrinsic or inherent / intrinsic. Treating others only as instrumental purposes is contrary to the very essence of being ethical. Cloning constitutes an activity if treating other human / animals as object with instrumental values. The intent of human cloning human is logically self-contradictory, hence wrong, and animal cloning is questionable.
There is a likelihod of cloning practice in the near future. The world becomes weird and absurd if it is free from ethics. Can we continue to do anything which is not absurd in such a world? Can we accept to live a life devoid of value and meaning? If not, and if we are rational, can we fight against human cloning in defending the last frontier of ethical Miginot of human cloning?

4:15-6pm Bioethics Education (1)

Importance of bioethics in science education
M.Selvanayagam & Francis P. Xavier, Loyola Institute of Frontier Energy, Loyola college, Chennai-600034, India.

As we are fast approaching the threshold of the new millennium, we are astonished at the technological advancement humankind has made. But we are, at the same time, saddened to experience the decline of ethics at all levels especially social and moral value system in day -to- day's life due to the influence of consumer attitudes which brings in selfishness and invidual prosperity even at the expense of others. Since whatever happens in the society outside is reflected in the educational system, consumer attitudes and exploitation have affected science in general, and science education in particular. Today much attention and emphasis is given to skill-learning in our science education leading to money making without bothering to think that the value system one should have is the leading principle in life whatever be one's profession. The challenge to day, when ethical and moral values are vanishing, is to teach science based on social values such as honesty, integrity, fairness, impartiality, compassion etc, as the students of today are the pillars of the nation of tomorrow.
The medium through which social and moral values should be incorporated in education is through a fundamental course for the science students on philosophy of science in the respective disciplines. The students should be gently led along how initially science grew out of life expectations and experience based on the welfare of the common good and not of a few individuals. This eye-opener should be a window for the students through which they would be able to see how social values originates from moral obligations which in turn are rooted in the religious concept that God has created all human beings equal and all should live in harmony transcending the narrow-mindedness of caste, creed, nationality etc. The teacher, who first of all is convinced of these truths, should make a genuine attempt to bring out the richness of such values in micro as well as macro level evolution and the development of science through the brief history of time. Thus in each student the teacher is not only the desire to discharge their responsibility with such values. This would bring out, in the course of time, the desired impact, namely, a generation of students who would grow up into matured men and women for others having concern and respect not only for their fellow human beings but also to the fauna and flora. Thus the Mother Earth will become more inhabitable in which all created, with human being as the crown of creation, could live in harmony, peace and tranquility.

Bioethics education: New Dimensions
Amit Krishna De, Indian Science Congress Association, India*

A study of bioethics in Indian High School textbooks
Minakshi Bhardwaj & Darryl Macer, Eubios Ethics Institute, Japan

We can define bioethics as the love of life (Macer, 1998). Bioethics involves the balancing of benefits and risks of choices. When we ask people what comes to their mind when they hear the term "Bioethics", we can see two distinct groups of answers. This was seen in the results of the International Bioethics Education Survey. In Australia, New Zealand and Singapore, more people wrote comments about how we should use life, that science raises issues, or how we should apply biotechnology, i.e. somewhat practical issues. However, in Japan and Tamil Nadu, India, the comments were more general, with many about the respect for life we should have.
This paper will focus on presenting the results of text book key word analysis in India, with comparisons to Japan. This study focused on years VI-XII, the Secondary and Higher Secondary Schools. From VI-X General Science is taught, and in years XI-XII Biology is offered as a special course. From year VI private publications may be used but the CBSE syllabus must be followed. Inside social studies, history, civics, geography, economics and political science are taught. The keywords chosen for this textbook analysis were not all encompassing, but can be considered as markers of the breadth of issues discussed.
As a conclusion we have found some discussion of ethical issues in the textbooks used for science and social science in India. Half of the objectives of the Science Syllabus in India are related to the development of ethics. There will clearly need to be better incorporation of ethics into textbooks for these classes than that which exists today. We also could consider the mention of bioethical issues in other subjects. We can hope for integrated ethics education across the curriculum, and there is some evidence for this in environmental education.

The Importance of Medical Humanity in Medical Education
Michael Cheng-tek Tai, Chungshan Medical College, Taichung, Taiwan

The tremendous development of medical technology in the last few decades has changed the face of medicine. Besides caring, medicine today can also cure and even change a person's personality, looks and his genetic structure. We must explore a medicine that is not just reponsive to the body of the patient, but also to his feelings, his mind, his will, his imagination, his creativity, his aspirations, his values, his capacity for making ethical choices-in short, a medicine responsive to the whole life of the person who is a patient.
Rapid progress in the pharmaceutical field, in mechanical devices and medical skills has raised new questions upon us, such as; where and when does human life begin ? what is the moment of death ? what are the limits in the research and manipulation of man ? what is the meaning and the destiny of man ? what kind of biochemical, pharmacological, surgical, psychological and genetic treatments affect the identity of the human person ? Undoubtedly, contemporary medicine bears tremendous responsibility for man's meaning, his well-being and the world in which he lives.
In the past, the doctor enjoyed freedom in his self-chosen relationship with his patients to whom he offered his services and who, in return, honor him. Today most countries' medical systems are socialized. The right to proper medical care is recognized as part of the most fundamental human right. Such a situation inevitably leads to a socialization of medical profession. The doctor has become one of the various social servants working for the government's health insurance bureau. Such a change brings us new concerns, such as unnecessary physical tests, prescriptions and operation, the deteriorating patient-physicians relationship, the unfair distribution of limited resources.... etc
The nature of medical service, medical progress and its responsibility oblige the medical professionals to re-think the purpose of medicine and to ponder on how it can act responsibly. To achieve this goal, medicine cannot isolate itself from the rest of academic world but must act in absolute solidarity with other disciplines by initiating a sincere dialogue with behavioral sciences, philosophy and theology_. Without this new attempt, medicine may lock itself in an ivory tower seeing people only from a narrow diagnostic-prognostic angle. This is the context and perspective in which medical humanity is set.
Because of the broad scope of medicine, preventive, therapeutic and planning for the future, medical scientists must seek a holistic vision of man. The modern physician can no longer approach biological and medical decisions without being ready to raise fundamental human questions and search for answers to them. He must take a courageous step towards an understanding of freedom expressed in terms of social responsibility for the whole of humanity.
These new realities and changes compel medical educators to reconsider the content of medical education. Is our goal simply to train a physician skilled in treating diseases yet unaware of human predicaments and the complicated social fabric that make a person what he is?
The main concern of medicine used to be human physical condition, as it was believed that a person's illness was due to physical problems. But this understanding has been challenged and a new understanding developed that moves from a simple biomedical paradigm to psychosomatic and then biopsychosocial emphases.
Bernard Haring, a well-respected theologian and ethicist suggested that medicine has to pay attention from the present to the future, from an individual personalism of the patient-doctor relationship to a social-collective accountability of medicine and to the whole human society. Robert Veatch, director of Kennedy Institute of Ethics also advocates a medicine which treats not only diseases but also illness of the person. That implies that medicine in the 21st century must be expanded from merely a biomedically-oriented science to a holistic biopsychosocial emphasis. The physicians of tomorrow must know not only how to treat physical diseases with empathy but also to take his responsibility seriously as healers of whole person to the whole Hunan society. To fulfil this mandate, the content of medical education must be re-examined and re-structured.
An emphasis on medical humanity is one of the moves we must take to respond to the new reality of medicine. Medical humanity, literally speaking, refers to those humanity courses having to do with medicine based on a biopsychosocial understanding such as medical sociology, biomedical ethics, medical psychology, history of medicine, communication between physicians and patients...etc. In reality, medical humanity, when properly planned and offered, will enable medical students to develop a new understanding of life and a concern to social justice. It is a design to help students develop a new value theory so that they will become people-oriented physicians. But in order for students to understand the basic human nature, more courses must be consider how social customs, religious beliefs, and cultural traditions all effect our attitutes toward health, life, and even death. Thus, a philosophy of life, religion and cultural anthropology must also be introduced. Medical humanity covers a wide spectrum of social sciences and humanity. The purposes of introducing these courses are no other than:
to cultivate a holistic understanding of personhood
to enable medical students to know the human side of medicine and the effect of environment and life-style on health
to provide students opportunities for continuing reflections on themselves as they grow in medical knowledge
to foster a sense of " Medicine as Vocation"
to study ethical theories and their applications to the clinical decision-making.
to promote a consciousness of physicians' social responsibility.
In one word, medical humanity attempts to equip students with a better understanding of human beings so as to produce physicians of tomorrow who are not only effective healers of diseases, but also restorers of human wholeness ( a person as a harmonious combination of body, mind and spirit) and promoter of social justice.
In an Taiwanese expression : "a superior physician heals the ills of a nations. An ordinary physician heals the brokenness of a person. An inferior physician heals diseases."
"Medical education is to pass on a humanized medicine so that medical students may understand, experience and grasp the humanistic philosophy of medicine and thus establish their own value theory, ethical standard and eventually their own life philosophy. Only when we reach this goal can we say our education has succeeded". ( A quotation from Dr.B.S.Hsieh, Introduction to Medicine. Taipei. Taiwan University Medical College, 1997:85)

Ethical issues related to an indigenous basic education project
Juana Aluning, The Philippines

On-line biomedical ethics education in Korea
Koo Young-Mo, Institute of Philosophy, Seoul National University, South Korea

The Korea's first-ever on-line biomedical ethics education class began in September 1999. The class, one of the 18 on-line lectures offered in the Fall Semester, 1999 by Seoul National University Virtual Campus, allows the Korean general public the opportunity to attend an SNU lecture. Although the discussion sites are limited to the 48 selected students taking the 16-week-long course, any one can read the instructor's lecture on the Internet. ( Of course, the instruction is in Korean language!) The topics of this course include abortion, euthanasia, organ transplantation, human cloning and etc. As one of the three instructors of this unprecedented biomedical ethics education program in Korea, I report the experiences that my team went through both in preparing for and running the course.

Ethics can it be taught?
D. Sultan Sheriff, Salem Medical School, India

21 November

9-12am Clinical dilemmas across cultures

Ethical issues in wholistic health and healing
A.K. Tharien, Christian Fellowship Hospital, India

Health is essentially a function, a quality of life unfolding of a personhood, which is dynamic, comprehensive, complete and forward looking. It has moral, spiritual and ethical values. Health is "SHALOM".
Illness may be described as the disturbance of right relationship, within oneself, with his neighbour with nature and his creator. Besides physical factors, psychological factors like emptiness, fear, self centeredness, resentment, guilty conscience are significant factors.
Healing is concerned with setting right any aspect of a persons life which fall short of holistic health. Remedies may be physical, psychological, spiritual, social or even political.
David Falton's study reveals that AMYGDALA and hypothalamus make up the LIMBIC system which influences one's mid and emotion. James House in Michigan found links between brain and immune system through the production of nuropeptides. New phenomena of Pneumo psycho-neuro immunology has come out.
Ethics plays an important role in the process of healing. Treating patients as persons and not as scientific object. Commercialiation of medical profession both in treating patients and training of students have lost many ethical values. Right of patients should be safeguarded. Tendency for scientific researchers are ignoring human values. All social classes should have access to modern investigation and therapy. Growth of science in isolation has brought in many dynamos, as in factors like cloning, genetic manipulation and embryo experiment etc. This have ignored the human values and human relationships.
A code of medical ethics must be followed by all health professionals and hospitals.

Ethics of virtue and Thai nursing students
- Khannika Suwonnakote, Prapis Chanpuelksa and Sangthong TerathongKum
Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital , Mahidol University,
Bangkok, Thailand
The objectives of this descriptive research are to develop a research tool to assess ethical characteristics of Thai nursing students and to compare the differences of ethical characteristics among nursing students of different years of study in the bachelor nursing program.
A sample of 479 nursing students of Ramathibodi School of Nursing , Mahidol University were selected to be in this study group in 1998. Using document analysis of Ramathibodi undergraduate nursing curriculum , the nusing code of ethics , declaired by Nurses Association of Thailand and Thai Nursing Council , 13 ethical characteristics were selected as the essential ethics of virtue for Thai nursing students and Ramathibodi students. The 52 -items questionaire with 4 - ratings scale of performance indicators was developed by the researcher team to assess the 13 ethical characteristics. Face validity was used and its alpa reliability coefficient was 0.9241.
The study revealed:
1. The 13 ethical characteristics of Thai nursing students of the undergraduate level were Compassion, Kindness, Sacrify, Faithl , Responsibility, Endurance, Endeavou , Shame, Justice, Union, Grateful, Economized, and Discipline.
2. Nursing students , in the average have frequently performed on 13 ethical characteristics .
( Mean = 3.03 , Standard deviation = 0.27, Range = 2.69-3.54 . )
3. The results of comparison of all ethical characteristics among the student groups by using the one way analysis of variance and Scheffe 's test, only the fourth year students showed higher ethical characteristics than the third year students . ( F= 4.165 , p< .01 ). Students in the first, the second years did not show any statistically significant different from the third and the fourth year students.
4. The results of comparison of each ethical characteristics among the student groups by using the ANOVA and Scheffe 's test, it was founded that nursing students at different years of study showed different ethical characteristics on 7 characteristics as the followings: Compassion (F= 3.375, p < .01), Union (F=3.401, p< .05), Discipline (F= 3.076, p
5. Six ethical characteristics of nursing students remained no statistically different at different years of study, these were Sacrify, Faith , Responsibility, Endurance, Justice, Economized.
The results of this research study can confirmed the nursing students ' ethical characteristics at satisfied level. However , the evidence of some ethical characteristics differences among the nursing students at different year of study should be further investigated for any specific changing pattern in a longitudinal study . The cause-effect relation can be explored and useful for the development of ethical characteristics in nursing students.

Anagogy of Autonomy
Ann Lewis Boyd, Hood College, USA and Ole Doering, Germany

The philosophical and ethical concept of autonomy is herein examined, ex post facto, using an existential lens to examine the process of a personal friend's dying. Anagogy, defined as interpretation of a word, passage, or text that finds beyond the literal, allegorical, and moral senses a fourth and ultimate spiritual or mystical sense, is intended to enlarge the understanding of the use of autonomy in this individual case. The idea of personhood linked inextricably to reason is, therefore, understood as empowering an individual to choose among various actions, to define and redefine life goals, and to give priority to selected values and moral tenants, which reveal a moral hermeneutic. Conditions and circumstances, existentially exposed, limit choice in unexpected ways, such that the predicted value of autonomy is vulnerable to misuse or misunderstanding. The intent to respect the dignity of each person is central to the philosophy of Respect for Persons ethics, and assumes that autonomy, as freedom of the moral agent, occupies the dominant position of duty. The assumption is that the reality of freedom is, in a practical sense, essential to being rational agents who can thereby exercise rational choice. The moral law, law of freedom, involves the autonomy of the will and an ultimate end to which all action is directed. Defined as the highest good, morality unites virtue and happiness by ascribing the ultimate end sought as God. The freedom to use rational will finds principles within its own rational nature. The ability to create maxims is autonomy of the will, which equates with the dignity of persons. My recent experience as a companion to a personal friend with a terminal illness inspired me to re-evaluate the concept of autonomy as it is too often interpreted in modern ethical discourse as a individualistic right of choice as opposed to the hermeneutic of dignity of person. This paper describes a shift of position in understanding the paradox of autonomy in this existential context.

Thai nurses and patients rights
Malee Lerdmaleewong, Ramathibodi School of Nursing, Mahidol University, Bangkok, Thailand

The role of the advanced practice nurse is a patient advocate. Health care providers should recognize and respect patient's rights which is one of the indicators for quality assurance or hospital accreditation. The purpose of this study was to examine Thai nurses' opinion in Ramathibodi hospital toward patients' rights. A statement of patient's rights consisted of 10 items was used as a research tool. Each item had a Likert scale which score rating from 1 strongly disagree to 5 strongly agree. Two hundred and fifty questionnaires were sent to the sample in every nursing department, and 198 questionnaires were returned (79% response rate). Data were analysed by SPSS/FW program.
The findings revealed that the sample consisted of nurse instructors, head nurses, nurse supervisors, registered nurses, practical nurses and graduate nursing students. The duration of work experiences ranged from 4 months to 31 years (average = 13 years and 8 months, SD = 9 years and 1 month). Most of the nurses supported all items of patient's rights with strong agreement which the mean scores ranged from 4.23 to 4.80. There were no statistically significant difference in nurses' opinions with position or work experience. Recommendations and further studies are discussed.

Age dependent variation in bioethical issues with reference to AIDS and its cure
N.S. Kavitha & Jayapaul Azariah

In the present investigation, the queries regarding the ethical issues in religion and life, AIDS and its cure, gene therapy, organ transplantation and also on the environmental ethics and their importance were raised among the educated persons.
An opinion survey was conducted among 2 groups of educated people: (1) Students and (2) Teachers located in and around Madras. The participants of this survey were 41 college students in the age group of 19 to 26, and 30 college professors, in the age group of 26-40. In both the cases, they belong to different religions such as Hindu, Christian and Muslims. A questionnaire was administered, where the participants expressed their opinion on a five-point scale (1) Strongly agree; (2) Agree; (3) Don't know; (4) Disagree and (5) Strongly disagree. The frequency and the percentage of their opinions were calculated.
Out of the 5 topics discussed, AIDS and its core were assessed for the present investigation. Some of the significant points to this topic are: 1) The majority of participants were well informed that AIDS is not a contagious disease like common cold or tuberculosis. 2) College students perceived a correlation between declining morals and increasing AIDS. 3) The community feels that some social regulatory norms must be strictly maintained in order to control the spread of AIDS. 4) Most respondents believed that reports of AIDS patients must be kept in confidence but their spouses/ fiancees must be informed. 5) The level of aspirations to discover scientific remedies for curing AIDS is higher among the students. 6) The younger generation is of the opinion that the premarital AIDS diagnosis is necessary.
It is interesting to note that the student community was better informed than the teachers. Also, it is highly discouraging that, teachers did not recognize the social factor of AIDS. It is encouraging that the educated community has proper understanding in treating AIDS patients. However, more than 20% of the teachers were ignorant in the area of informed consent. Hence it is necessary to evolve suitable teaching modules in this area. The Indian community feels that prevention of AIDS infection is better than its cure.

Emerging Health Pluralism, Legal Debates and the Visions of Tomorrow
Dr. R. R. Kishore, Ministry of Health and Welfare, India

Diseases claimed nearly 50 million lives in the world, in 1996. (1) Ten million children do not have health insurance in the United States(2) More than 76 countries spend less than 2% of their G.N.P. on public health. (3) Malnutrition and communicable diseases are still the major killers and the poverty-health nexus continues as ever before. Many biotechnological feats have been shelved for fear of moral miscarriage as the ethico-legal paradigms on vital issues are not clear. What is legal in one country constitutes an offense in the other. The world slips into 21st century with loud thinking, utopian goals, and health-starved people.
Fast advancing biotechnology, increasing quest for well-being, longer life-span, changing life styles, demographic transition, wider human interaction, growing commodification of human body, entry of corporate sector in the health delivery system, greater institutionalization of services with higher dependence on managerial and bureaucratic setups, evolving moral concepts, lay adjudicators, judicial unpredictability, and a host of other factors have imparted unique plurality to the concept of human health and in today's milieu it carries far greater meaning and expectation than the earlier times when it was confined merely to somatic intervention. In this scenario medicine is not just a clinical science. It includes subtle appreciation of social, economic, cultural and religious aspects of individual and societal life. There have been many attempts at the national and international level to evolve an ideal legislative strategy in order to address the problems emerging out of advancing biotechnology but the conflicting perspectives and multidimensionality of the issues involved continue to defy the solution. The biggest challenge emerges out of the respect granted to the living matter which being an end and the purpose per se is far beyond the discovery-invention, sale-purchase, and profit-loss notions. Inspite of its biology and
chemistry being clear the living material is never seen as a physical object. Life is the Absolute embodied. This is a universal perception, regardless of cultural or religious affiliations, and is the biggest challenge in the process of legislating the advancing biotechnology.
A new cultural era has begun in the field of health and medical care. Over 5000 different human diseases are known or suspected to have been caused from defects in single gene. The screening of genes has become a practical possibility and the potentialities of genetic intervention extend to humanizing the animals and creation of new life forms. The transplantation technology holds the promise of producing persons out of unborn mothers, besides replacing the diseased organs. Humankind who have so far known only life and death are face to face with third eventuality namely, the P.V.S. (Persistent Vegetative State). On top of this is the "Utility" with its vast potential of making the life worthless and misconceived, compelling one to search new meaning
in the objects and the phenomena. Erosion of individual's autonomy and the possibilities of biological exploitation of human species have created new ethical dilemmas contemplating highly evolved conceptual formulations. On the economic front increasing globalisation and privatisation has disturbed the individual - community relationship and a new social order is fast emerging imparting enhanced vulnerability to the individual in the garb of accomplishing 'positive' social goals. The community perspective, founded on mutuality, reciprocity, complimentarity and optimisation of resources, imparting freedom, security and orderly conduct to the people for ages is rapidly disappearing. In these emerging dimensions of life, biotechnology, and human relationship the ancient and medieval doctrines are no longer able to hold the field and there is an urgent need to functionalise aptly conceived juridical principles, which throws a big challenge to the legal systems and the cultivators of law.
The medical and health care is no more a straight dealing between physician and patient, based entirely on fiduciarism. Many players have descended on the scene and, in today's milieu, medical and health care is a composite activity involving many disciplines and faculties. The competing -- and sometimes conflicting -- interests have enhanced the possibilities of litigation and the judicial inconsistency has further compounded the situation. Conceptual inadequacy on the issues like legal status of embryo/foetus, maternal rights, abortion, surrogacy, withholding/withdrawing life support
from the terminally ill, privacy, confidentiality, informed consent, donation and allocation of organs and tissues, end of life decisions, advance directives, proxies, presumed/substituted consents, legal status of incapacitated/incompetent individuals, trial of drugs and medical research on human subjects, genetic intervention, and many more, has led to functional exiguity which needs to be urgently overcome by addressing the following essential issues
1. Definition of human health and health rights of the people
2. Minimum and maximum limits of health protection and promotion 3. Can the health rights be curtailed, and if yes, under what circumstances and to what extent?
4. Health obligations of individual towards himself, his family and the community
5. Health obligations of the state towards individual and the community
6. Order of priority of human health amongst the manifold commitments of the state
7. Inter-relationship between health care and other developmental activities and core sectors in the context of human health
8. Health obligations of the developed and the developing nations towards each other
9. Extent of personal rights in one's own tissues and genetic traits
10 Inter-relationship between the rights of the present and future generations

Health does not recognize boundaries, religions and political affinities and as such the global village needs universal ethico-legal paradigms in order to address the above issues. The saga of human endurance displays a continuous quest to win over vulnerability and ignorance by pooling of knowledge, experiences and resources and this creates a compelling need for entering into a continuing trans-cultural dialogue.

1. Uton M. Rafei. "The Challenge of Health in the 21st Century", The Times of India (New Delhi) 9.13, Col. 3-7 (26 November, 1997)

2. Steven Miles. The Role of Bioethics and access to US Health Care: Is Bioethics one of Kitty
Genovese's Neighbors? Bioethics Examiner, Summer 1997, Vol.1, Issue 2 p.1

3. U. Chandler, "Improving World Health: A Least Cost Strategy" (Worldwatch Paper 59) 5 (July 1984)

Cultural determinism and patient autonomy
Y. Manickavel, Nepal

Cultural determinism is a strong undercurrent in shaping-up the political, social, and spiritual nature of a community. In this essay cultural aspect which influences the decision making process in the clinical treatment is analyzed. Some of the positive aspects of this cultural determinism are discussed against the autonomy principle of the so called Georgetown Mantra of bioethics in the modern health care.

A survey of Korean physicians' attitudes toward some medico-ethical problems

- Sang-Ik Hwang and Ivo Kwon,
Seoul National University, South Korea

In Korea there have been few studies conducted on physicians' perceptions and attitudes toward the medical ethics problems, including especially informed consent, euthanasia, artificial abortion and problems relating to human reproduction. Therefore we administered a survey to find out the current attitudes and perceptions held by Korean physicians in this particular area. We sent a self administered questionnaire to 1,000 randomly selected members of the KMA (Korean Medical Association). We received responses from 208 out of them and analyzed the data.
The survey shows that more than half of the respondents thought it is possible to withdraw the treatment from the hopeless patients if they or their proxy demands, even to do PAS (Physician Assisted Suicide) in certain situation. 42% of the physicians surveyed answered that the artificial abortion should be allowed for the purpose of family planning. This phenomenon must be related the high abortion rate in Korea and government supported family planning history. On organ selling, 35% of them thought it permitted if non-critical to life like kidney or cornea, while 58% prohibited in any case.
However, the professional ethics problems (fees and charges, advertisement, gender discrimination) are more serious to Korean physicians rather than biomedical issues. Many respondents were sorry for their peer's wronging and said the current medical ethics education and their general capacity in this field is far from satisfactory.

1-4pm Clinical dilemmas at the end of life in different cultures

Do the Terminally Ill Elderly Have a Duty To Die?
Anne J. Davis & Emiko Konishi, Nagano College of Nursing, Japan

Over the past decades in the west, much discussion has centered on the right to die. The latest specific focus within this discussion has included physician assisted suicide. In Japan, discussions have focused more on disclosure of information to the terminally ill. These discussions in Japan display certain assumptions and values that differ from those underlying the right to die argument.
Both Japan and the industrialized countries of the west have a growing elderly population who uses more health services than other age groups. Do these societies need to discuss more about the terminally ill elderly person's right to die and their duty to die? If so, what ethical justification would be used to support the right to die and the duty to die?

Ethical dilemmas on high tech units: What are they and how are they resolved?
- Eli Haugen Bunch,
Institute of Nursing Science, University of Oslo, POB 1120, 0317 Oslo, Norway.
E-mail: e.h.bunch@sykepleievit.

The purpose of this study was to collect empirical data on which situations nurses and doctors identified as ethical dilemmas and how they were resolved in high tech. units. The study was done at two high tech units at one of Norway's university hospitals.
The method used for collecting data were field observations combined with planned and spontaneous interviews with nurses and doctors. Data were collected on neurosurgical intensive care from the fall of 1995 and from September 1997 on a trauma unit and are ongoing. The planned interviews with providers explored ethical dilemmas in depth while spontaneous interviews occurred when observations were unclear. Grounded theory as described by Glaser and Strauss (1967) and Glaser (1978 and 1992) was used to analyze field observations and interviews. A total of about 100 hours of field observations were collected along with about 50 interviews.
Findings from field observations on the neurosurgical intensive care unit (1995-1996) identified the core theme as "delayed clarification_ while the second theme of assumed composure dominated the second unit (!997-1999). Delayed clarification explained how providers and relatives needed time before deciding whether to terminate treatment or not. The obligation to take the needed time was identified as a critical factor. The process of delayed clarification provided the actors with time and resulted in a type of consensus before decisions were made. To obtain a clearer picture of when to continue treatment also had a temporal dimension in terms of collecting and interpreting clinical data continuously while assessing the patient situations.
Assumed composure, the second theme, dominated the intensive care and trauma unit. On the surface, the unit was calm when in reality the majority of the patients were struggling to survive and many died.
Ethical principles like beneficence, autonomy and justice were observed. Beneficence was revealed through actions like doing good for all patients, while autonomy was respected in terms of including patient/relatives in decisions made. The principle of justice was identified in terms of staff never questioning resources allocated for individual patients. The providers strived to uphold veracity in that most clinical data and information were passed on to the relatives. The physicians were careful to document all actions and included nurses when talking with family member, sometimes they served useful as witnesses to the conversations with the relatives.
Staff label situations as ethically difficult when patients are kept on respirators awaiting organ donations, when providers must request organs when they themselves question organ donations. When staff were requested to transfer critical patients to other units due to the unit's trauma status, were also labeled as ethically difficult.
Data analyses of field observation from the trauma unit (from October 1997 and ongoing) have generated a core theme of "assumed composure". Practically all the patients are on respirators and have a minimum of 4 machines hooked to the body. The noise level is high with the hissing from the respirators and ticking from kidney or heart machines. Despite the complicated technical equipment and the patient acuity levels, the unit appears composed with clearly defined routines. The ethical principles of beneficence, autonomy and justice are identified here as on the first unit.
Situations the nurses identify as ethical and problematic are when patients do not follow the expected trajectory and linger on. When relatives requested continued treatment and staff cannot see any beneficence in continuing were also labeled as ethically difficult, as were situations when doctors on call from other units changed treatment decisions and disagreed with the nurses assessments of the situations. Data continues to be collected and analyzed.

Japanese Religious Organizations' Views on Terminal Care
Noritoshi Tanida, Department of Internal Medicine 4, Hyogo College of Medicine, 1-1 Mukogawacho, Nishinomiya, Hyogo 663-8501, Japan.
Religion may be relevant to ethical problems such as the care of terminally ill patients. Therefore, a questionnaire survey was conducted on the attitudes of Japanese religious organizations toward the terminal setting to see if there was any difference among them.
A total of 388 religious denominations, including 143 Shinto, 157 Buddhist, 58 Christian and 30 Miscellaneous religious groups who were listed on the Annals of Religion 1998 as inclusive juridical persons were asked to answer questions based on their religious faith. Questions were raised from a story of one terminally ill patient regarding decision-making at each event in the disease process. Answers were chosen from one of 5 items; "agree strongly," "agree," "neutral," "disagree," "disagree strongly." Recovery and response rates of questionnaire were 73% and 43%, respectively.
Results showed that Japanese religious groups tended to accept the idea of a living will and the concept of "being natural." The introduction of life-sustaining measures was greeted unfavourably when medicine became futile. The trends between Kyoha-Shinto and Protestants, and those between Shin-kyoha-Shinto and Catholic were similar regarding attitudes toward modern medicine and life-sustaining treatments. Though there was only a small difference in attitudes toward modern medicine among religious groups, differences were observed in attitudes toward decision-making for life-sustaining treatments. Christian organizations respected the patient's decision, whereas Shinto and Buddhist organizations tended to leave the decision to the family and doctor. The Catholic policy regarding extraordinary treatment was approved of by about three fourths of Shinto and Buddhist organizations.
The present survey indicated that the attitudes of religious organizations were mostly modest and sensible. The general public will have a chance to think of this important issue through different opinions from religious representatives, if they speak of life and death publicly.

Spiritual care and a practical suggestion
Alireza Bagheri, Center for Medical Ethics; #16, 4th Alley, Nemati St., Dolat Ave. Pasdaran,19396 Tehran, Iran

In this article three issues will be discussed:1) The necessity of spiritual care as one of human needs; 2) The need to define spirituality on religious grounds; 3) A practical suggestion.
If we review the evolution of medicine from the ancient times of "Metaphysical theory of disease " to the development of subspecialities in medicine called " Modern medicine" (1900), and finally the " Health for all in 2000" slogan (1981), we find that humankind has always tried to maintain the quality of health care, constantly improving the health of his society.
In addition to our primary needs "physical living" which is fairly fulfiled by the advancement of technology and medicine, we have higher demands or spiritual needs, especially when terminally ill. Spirituality is a concept that people from any nationality, culture and religion are living with and appreciate the consequences of such a perception in their daily life.
Consideration of the spiritual dimension of the human being is appreciation of our search for eternity and perfection. Consideration of all human dimensions enable us to pay more attention to human factors which are less measurable than other health indexes. In the WHO report, spiritual care includes forgiveness, reconciliation and affirmation of worth. Also the word "spiritual " is not considered the same as "religious", but it has been accepted that the spiritual aspect of human life for many people includes a religious component.
Therefore it is difficult or maybe impossible to present a definition of spirituality without a religious ground. Can one believe in spirituality without believing in metaphysics? How can one consider the creation as vain and futile, and at the same time believe in spirituality?
"Spiritual" finds meaning in the light of nonmaterial world, (as in the WHO report has been declared). Perhaps any author (religious and nonreligious) conceives of spiritual care in a different manner but all of them would accept that spiritual care brings peace and comfort to the patients. So the third part of the article focuses on the purpose of using spiritual care as a means to make peace and enhance adaptability and tolerance of the patients. Presenting the patients with a positive dimension on the sufferings of human life can be regarded as a helpful suggestion to achieve that goal.

Spiritual Care
Hui ying Li, Yamaguchi University School of Medicine, Japan

Human beings have benefited from well-developed medical technology. But during this medical development, there are still so many dying people whose treatment is unsatisfactory. Hence spiritual care will be increasingly valued in hospices. The important point of hospice care is not only reducing physical pain, but also comforting the spirit of the patient and family members. In a comparison between hospice care in Japan and Taiwan, we realized the great importance of religious spirit in the spiritual care of a hospice.

Concepts of death and good death among Filipino indigenous communities
Leonardo de Castro and Peter A. Sy,
Department of Philosophy, University of the Philippines, Diliman, Quezon City 1101, Philippines

All too often, discussions of ethical issues regarding euthanasia or assisted suicide take for granted a modern setting where biomedical technology is made available to the patient. These discussions also presume, for the most part, a homogenous cultural context where settlement can be arrived at by appeal to objective standards or universally accepted principles. On many occasions, religious perspectives also come into the picture but the related discussions tend to focus on questions of autonomy and paternalism. It would not do justice to the people involved if biomedical deliberation and decision-making were to be limited to those issues and themes that have acquired universal attention. Hence it is important, in dealing with Filipino cases of euthanasia, to understand the concepts of good death that are imbedded in the world views of various Filipino ethnic groups.
Filipino medical culture is characterized by diversities in worldview and tradition. What is sometimes collectively called "Filipino indigenous culture" is actually made up of pluralities, of differences in medical traditions and religious beliefs. Thus we can see why the moral dilemmas engendered by biomedicine require a search for categories, meanings, and discourses that have the capability to restore a people from the alienating tendencies of biomedical discourse. For this purpose, we need to take stock of the rich indigenous concepts and practices that lend an understanding of the Filipinos' collective culture and help them respond meaningfully to issues brought about by biomedical technology.
Among many Filipino indigenous groups, death and dying largely belong to a language different from biomedical discourse. In other words, death as something that is technologically determined is insufficient where its determination is hardly about precision but about something socially decisional and transitory. This does not mean that there is no room for modern biotechnology in indigenous bioethical discourse. In practical terms, what this indicates is that caregivers should pay more attention to the culturally laden moral reasoning involved in each case than to the technical non-traditional criteria that usually come bundled with modern life-saving biotechnology. For there is always a danger that the patients will be reduced to mere medical projects when the problems addressed by the health care providers are not defined in terms of the values that are meaningful from their own culturally informed perspective. The suffering or death from which biomedical technology hopes to redeem a person does not necessarily constitute an evil from the point of view of the pertinent culture. We have to do more that explain death and dying in terms of modern biomedical criteria if we want to avoid an alienating experience for families or societies that are attuned to an entirely different worldview and whose understanding of death is hardly the cessation of life.

Ethical issues in the management of patients in a mere biological state
Atsushi Asai, Department of General Medicine and Clinical Epidemiology, Kyoto University School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 615-8507, Japan

Many ethical issues have been raised regarding the appropriate care of patients in mere biological state. In this paper, I would like to discuss and analyze ethical beliefs that Japanese physicians expressed in this regard. My normative position will also be presented.
Questions to be discussed will include sanctity of life, medical futility, advance directives, a patient's wishes, dignity as a person, just resource allocation, and social policy. The findings used in this article are based on the results of a survey on 317 representative members of the Japan Society of Apoplexy in 1997.

Two aspects of a brain-dead being
Masahiro Morioka, CIAS, Osaka Prefecture University, Japan

Japan's first heart transplantation was performed in 1968. This transplantation was accused of murder, and heart transplantation from brain dead donors has not been performed until this year. On February 28, 1999, in Kochi prefecture, a man was diagnosed brain death. As he carried the donor card, the physicians called the transplantation coordinator, and donor's heart, lever, and other organs were removed. There have already been three transplant caes from brain dead donors after the Kochi case this year.
People have been wondering why Japanese have refused brain death and transplantation for 31 years since the first heart transplant. I wrote about this elsewhere(1). Anyway, during this period, Japanese people have discussed and debated on this topic repeatedly on the front page of nation wide newspapers, weekly magazines, and TV shows. Numerous books on brain death and transplantation were published, probably more than a hundred. Some of them became a bestseller. During the discussion curious arguments were presented which have not necessarily been argued in English literatures.
Among these, there is the problem of "the two aspects of brain dead being." This theme was first presented by journalist Michi Nakajima's book "Invisible Death"(1985)(2). She stated that most family members did not accept the patient's death when he/she was diagnosed to be brain dead, but that they for the first time accepted death and burst into tears when the patient's heart stopped beating, and the body became cold. This book was widely read and shocked people. Takero Sugimoto, a physician living in Kyoto, experienced a brain death case when his 12-year-old son was diagnosed to be brain dead. As a physician he perfectly understood the medical situation of his son, however, as a father he could not accept his son's death. He could not help thinking that his brain dead son was still alive and he continued intensive care to his son. When his son's heart stopped, Dr.Sugimoto for the first time realised his son was truly dead. In his book, "Uniform my Son might Wear"(1986)(3), the discrepancy between "scientific rationality" and "humane emotions" which simultaneously occurred inside Sugimoto's mind was vividly descrived.
In 1989 I published a book, "Brain Dead Person,"(4) arguing that the death of humans should be considered from the viewpoint of human relationships. That is to say, the question whether brain death is human's death deeply depends on the relationships that the brain dead person has had with each surrounding person on the bedside. As in the case of Sugimoto, a father who has had deep intimate relationships with his son may hardly accept his son's death as long as the body is warm and moist. However, a physician who saw the boy's body only a week ago may easily believe his death because the physician has never had long intimate relationships with the boy. In that book I argued that the essence of the concept "brain death" in terms of ethics lies not inside the brain, but just in the human relationships the brain dead person has had between him/her and the surrounding people. This theme "brain death as human relationships" was widely discussed in 1990s.
After publishing that book, a medical student, 29 years old, became brain dead. Her name was Yoshimi Fujiwara, whom I met twice when she was alive(5). She was dead when I was in the United States. A year after her death, I met her mother, Yasuko Fujiwara, and talked a lot about Yoshimi's brain death. In this case, too, the mother and father did not accept their daughter's death when her brain death was confirmed. They were taking care of her body on the bedside until her heart stopped beating. When the father left the room, he stood by the door calling his daughter "Do your best!" Her mother put perfume on her daughter's brain dead body. They never thought their daughter was dead. And at the moment her heart beat stopped, they realized death really occurred on their daughter, finally accepting she would never come back.
I think there are two aspects, or realities, concerning human's death; one is scientific/medical aspect that requires uniform criteria of death, while the other is philosophical/relationship-oriented aspect in which human's death depends on the human relationships between the dying patient and the surrounding people. Of course both aspects are important, but I want to emphasize the importance of the latter because our modern medicine and "rational" bioethics sometimes miss the latter reality in which most ordinary people actually live. Medical staff, particularly doctors, have to pay special attention to the relationship-oriented reality. In my experience, nurses easily understand what I mean, but doctors and "bioethicists" are the last to accept this.
(1) I analyzed some of the theories in the following paper. Masahiro Morioka "Bioethics and Japanese Culture: Brain Death, Patient's Rights, and Culture Factors" EUJAIB 5 (July 1995):87-91. See the EUJAIB website,
(2) Michi Nakajima "Mienai Shi(Invisible Death)" Bungei Shunju, 1985.
(3) Takero Sugimoto "Kita kamo Shirenai Seifuku(Uniform my Son might Wear)" Yomiuri Shimbun, 1986. In some Japan's junior high schools, boys and girls wear special uniforms.
(4) Masahiro Morioka "Noshi no Hito(Brain Dead Person)" Fukutake Shoten, 1989.
(5) Masahiro Morioka 'Noshi to no Deai(Encounter with Brain Death)' in Yanagita (ed.) "Shi no Hen'yo(Transformation of Death)" Iwanami Shoten, 1997:93-116.

Are the brain dead really unconscious?
Tetsuo Furukawa, Tokyo Medical and Dental University, Japan

Although lots of discussions have been done on brain death, the one completely neglected so far is whether the patients diagnosed brain death are really unconscious. Today organs are transplanted from the brain-dead on the assumption that they are undoubtedly unconscious. However, there are several phenomena suggesting that consciousness remains in some of the patients diagnosed brain death. I will present some of the data and reconsider the problem.
Many experimental studies were performed on various animals to delete the brain. The symptom common to all these animals without cerebrum was: Input was retained, but output was entirely or nearly entirely lost. Therefore, when uncomfortable stimuli hurt them, they could hardly express their displeasure. Even when surface EEG is flat, active waves may be recorded from nasopharynx or intraventricular leads, which suggests that the brainstem may be still alive even in brain death patients. Yanagida described a feeling only his family can understand with his son in brain death. We clinicians observe similar phenomena and we have nothing to deny the presence of such a feeling. Morphine is injected to brain death or near death patients to take out organs. Why opium is used to brain death patients, if they are totally unconscious? Diagnosis of brain death is done by scientific method, but today's science cannot deal with consciousness, which never means that consciousness does not remain in brain death patients.
I am afraid that we mankind are comitting an unpermissible, grave sin.

4:15-6pm Bioethics Education (2)

The moral development of physicians: Lessons from Czarist Russia and post-war Japan
Gordon Greene & Seiji Yamada, University of Hawaii, USA

Despite the many difficulties involved, it is imperative that medical students be able to learn ethics in a fashion that is responsive to actual clinical situations. To do this, clinical ethics can not be considered apart from the realities of the individual, the family, the health care setting and the social framework. In other words, students need to learn that moral issues emerge within the context of actual occurences, not from applied principles.
Since 1996, we have been teaching a 6-week seminar on the patient/physician relationship to third-year medical students, that being their first year of significant exposure to clinical training within the four -year American system of medical education. One of our objectives is to foster development of skills for discerning this "context of actual occurrences" through guided discussion of two works of fiction: a short story by Tolstoy (The Death of Ivan Illich) and a film by Kurosawa (Ikiru).
The value of this use of fiction is many fold. In both cases we have a master storyteller capable of taking the students inside two lives- that of a Russian magistrate of the 1880's and that of a Japanese bureaucrat of the mid- 1950's. The richness of detail in these works of fiction helps students to understand not only the unique trajectory of lives, a key objective mentioned above, but also provides a glimpse of the common foundations of human lives. From here, the students often recognize that the "context of actual occurrences" includes themselves and not just their patients.
By examining these two works in detail, one can generalize methods of using works of fiction from all languages to foster a similar approach training in clinical ethics.

How to teach about AIDS in High School Ethics Class - to think how society should be and how human beings should live
- Izumi Otani, Kokubunji High School, Tokyo, Japan

I have been involved in developing and practicing bioethics education for these ten years. Considering this experience, I want to propose a class program that contains not only gaining precise information about HIV/AIDS but also thinking with high school students how society and human beings should be in this era when we have to deal and live with AIDS.
As the "present-day plague", HIV/AIDS has been discussed sometimes with fear, sometimes with curiosity, and in many cases with prejudice. But after several panics happened, in Japan AIDS education in health education classes at elementary, junior high, and high school become popular, little by little now. And as civics classes of high school, in 'present society' and 'politics and economics' classes, AIDS is taught as a medical accident. But many worry that in this context the essential problems of AIDS have not been discussed.
In this presentation, I want to report a teaching program of ethics in civics taking AIDS as a main topic, with universal issues of HOW people and society should be. It includes issues such as the cultural history of disease, psychological structure of prejudice, information and panic, alienation and evasion, politics of sexuality.

How to consider the balance between environmentalism and liberalism in the class
Kazuo Inoue, Omiya-chuo High School, Japan
Based on practical experience in teaching bioethics in high school classes, I will consider how to teach the balance between environmentalism and liberalism/individualism. The numbers supporting each view are similar. There can be sharp differences of opinion between both sides, so I believe it is necessary to give students an opportunity to think or discuss the topic more deeply by presenting them with viewpoints seeking the possibility of the coexistence of the two.

Clinical anthropology classes for education of bioethics
Shinichi Shoji and Katsuko Kamiya, University of Tsukuba, Japan

For education of bioethics, we propose using a Clinical Anthropology class. This is an educational method considering humans through birth, aging, illness, and death. This Clinical Anthropology class is conducted through presentation of a concrete clinical case or scenerio, requiring decisions relating to birth, aging, illness or death. The learning strategy of the Clinical Anthropology class is as follows: this class is elective. The timing of this class is whole year. The class is done once a week, 75 minutes each time and the total period is 30 weeks. The number of students who are enrolled for this class was 199, 259 , 268, and 326 for 1996, 1997, 1998, and 1999, respectively.
Following breif presentation of typical opinions, essential information, questions and answers, free discussion in small groups with or without tutors is conducted, then general discussion, then presentation of tutors' private opinions, and students write down their own words and opinion. At Tsukuba University this program has been conducted as a course open to first or second-year students of any subject.
The specific behavioral objectives of the Clinical Anthropology class are as follows, 1) extract problems from information, 2) speak one's own opinion clearly in plain language, 3) listen intently to other's opinion, 4) play as a chairperson of small group discussion, 5) record abstract of discussion, 6) present abstract of group discussion, 7) write sentences on one's own opinion. Results will be discussed.

The UNESCO Declaration as a tool to gather the Biology and the Law departments at the University of Cergy-Pontoise
Florence Hardy, University of Cergy-Pontoise; Catherine Bourdon, University of Lyon and Georges Kutudjian, Unit of Bioethics and Information Technologies, UNESCO, France

The University of Cergy-Pontoise (France) was created very recently (1991). Bioethics was not planned to be a discipline to be taught. However, in 1997, students of a biotechnology course (4th year) implicitly requested some kind of bioethics teaching when the cloning of Dolly was reported. Students attended one lecture, and were very impressed by the universality of bioethics, "Everybody/tout le monde is concerned". This community of young people is multiethnic (originating from Europe, Asia and Africa essentially).
So, last year, we offered the biology students to work and discuss together with law students around an international document: The UNESCO Declaration. This small meeting was organized in three steps (1) a discussion session with a biologist and a law specialist as teachers, (2) use of web sites, (3) the lecture given by an anthropologist. Here, we report the lessons from this small experience and the desire we have to pursue a project designed by students.

22 November

9-12 am Methodology in Cross-Cultural Global Bioethics

Enlarging the Range of Bioethics Across Cultures
a Report about the Methodology of a Project on Aspects of Medical Ethics in China
Ole Doering, Institute for Asian Affairs, Germany

This paper intends to contribute some new aspects to the discussion of Methodology in Cross-Cultural Global Bioethics by introducing an interdisciplinary, international research project in medical ethics, together with its underlying theoretical and methodological framework. This project has been conceptualized and organized by myself at the Institute of Asian Affairs in Hamburg (Germany) since 1996, and it includes two symposia so far, held in Hamburg and Shanghai, which will be focussed on in the presentation. Advancements in the field of biomedicine have been plenty, prompting new challenges which cannot be answered by means of isolated attempts only, neither by disciplines nor by cultures or nations. This observation suggests that we should seek for comprehensive approaches of humanity. The new complexity of biotechnological achievements, together with the related chances and risks for individuals and societies in our globalizing world, calls for an integration of multidisciplinary and cross-cultural efforts to develop new approaches on all relevant levels of scientific, cultural and ethical understanding, in order to join capacities, and to make them available for the sake of ourselves, our fellow humans and future generations. Creating not totally new ethical perplexities, this complexity itself raises fundamental considerations which amount to an intrinsic imperative of bioethics to transcend disciplines and cultures.
This imperative is rarely acknowledged in a systematic and methodological way by mainstream bioethicists. The project presented at the TRT 5 is meant to explore the prospects of a "human bioethics" from a methodological view.

The Concept of "Third Cultures" in Intercultural Ethics
Richard Evanoff, School of International Politics, Economics, and Business, Aoyama Gakuin University, Japan

The paper reviews the concept of "third cultures" as it has been developed in the field of intercultural communication and attempts to show how it can be applied to cross-cultural dialogue on ethics. The paper critiques existing views of cultural adaptation, which suggest that it is the sole responsibility of sojourners to adapt themselves to the cultural norms of their host cultures, and argues to the contrary that host cultures also have an obligation to adapt themselves to the needs of sojourners. The ethical norms we initially bring with us to cross-cultural dialogue tell us how to deal with people in the context of our own culture, not with people from another culture whose norms are different. Cross-cultural encounters create an entirely new context, however, in which the rules that will govern the relations between cultures do not yet exist and hence must be created. The paper advances a constructivist approach to cross-cultural ethics which suggests that if ethics is indeed a matter of social construction, then there is no reason why ethical principles and norms cannot be constructed across cultures as much as they are within cultures. New ethical frameworks can be negotiated through a process of cross-cultural dialogue which draws on, but does not remain bound by, the ethical insights contained in any one tradition. Reaching agreement requires a dialectical process of reflection in which the participants attempt to critique existing ethical norms, to integrate positively identified norms in new ways, and to create entirely new norms to effectively deal with mutually shared problems.

Ethical Decision Making In the Dilemmas Related to Nursing Care
Aiko Sawada, Toyama Medical & Pharmaceutical University, Japan

Nurses are sometimes worried about ethical dilemmas in nursing care. When they meet with such dilemmas, how do they solve them ? However, until now we have not discussed much such a problem in spite of its importance.
Today, nurses in U.S. are interested especially in the concept of ' nursing advocacy '. It means advocacy of patients' best interests and rights by nurses' duties. In this concept, nurses tend to be called as ' patient advocate ', and their main ethical responsibility exists in accomplishing it. This concept is now introduced in the ethical code for nurses of American Nursing Association. What kind of method can nurses as ' patient advocate ' have in order to solve ethical dilemmas in difficult cases ? What should they do for the advocacy of both best interests and autonomy of patient ? How can they achieve bioethical decision making in ethical dilemmas ?
To solve these problems, Bioethical Decision Making for Nurses by Thompson J E and Thompson H O will be useful for nurses. In this book, these authors present ten steps to ethical decisions: 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
In this presentation, I would like to explain this theory model concretely through dementia of an old woman's case in Japan. I would like to show how to solve a dilemma and how to reach a ethical decision in this case with the theory mentioned above. I am sure that we can make an ideal method of carrying out ethical nursing care by reviewing today's issues of decision making in nursing care.

Why Japanese doctors performed human experimentation in China?
Takashi Tsuchiya
Department of Philosophy, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka 558, Japan

From 1933 to 1945, in China, Japanese doctors performed thousands of cruel experiments on Chinese, Russians, Mongolians, and Koreans and killed all of them. At the Unit 731 only, at least 3000 people were tortured and killed. In addition, at 4 branches of the Unit 731, 4 other "Boeki Kyusui Bu (Anti-Epidemic Water Supply and Purification Bureaus)," the Manchuria Medical School, and military hospitals, similar human experiments and vivisections were done. Those experiments and vivisections can be classified under 4 categories: (1) vivisections for training newly employed military surgeons; (2) intentional infection of diseases; (3) trials of unstandardized treatments; and (4) knowing tolerance of human body.
These "factories of death" were run by military surgeons following Lt.Surgeon General Shiro Ishii. But, except at military hospitals, most of the doctors who performed human experiments and vivisections were academic researchers, who had been lecturers or associate professors at Japanese leading medical schools and were temporarily employed by the Japanese Army. Why did they joined those "factories" and become murderers? Was it impossible to stop the atrocities, or at least to avoid participation? I have found three circumstances.
First, then in the Japan, there was prevailing pressure for their participation. As it was in wartime and they lived in the fascistic country, it was very common to cooperate with the army. They would be blamed as "Hikokumin (traitors)" if they refuse to participate. They accepted their fate without trying to resist it, even when they knew what they were scheduled to do in China.
Second, they were ordered by their boss professors to go to China. In Japanese medial schools, even now, professors exercise supreme power over their students. Usually, there is only one professor in each department, and even after taking doctoral degree, researchers devote themselves to the department, hoping to be nominated as the successor. They cannot resist their professors if they hate to abandon their academic carrier. Being in short supply of research facilities at Universities in that wartime, professors werewilling to be cooperative to the army and Lt. Surgeon General Ishii. The professors promised Ishii to send their best disciples to the Ishii's factories, and in return Ishii and the army supplied enough research equipment (andsometimes even the data and chances of human experimentation) to them. Thisfact tells us that the atrocity by human experimentation in China was impossible without support of the leading medical professors, and that not only Ishii and the army but also the Japanese medical profession is guilty of the crime. That is the reason the term "Jintai Jikken" (experimentation with human beings) have been under taboo in the Japanese medical profession since then.
Third, even for the reluctant researchers came from the Universities, the Ishii's factories were so luxurious place. For example, the annual budget of the Unit 731 was 10 million yen at that time (about 9 billion yen [about 86 million dollars] at the present value). The half of it was for research, and another half was the labor cost for about 3000 employee. The salary was considerably high, the dishes served there were wonderful. And the Unit 731 had the most luxurious laboratories in Japan then. Surely, there were atrocities; there was a hell. But for those who could concentrate themselves in research, it was a heaven. There was no restriction on their research--- -they could even treat human subjects truly as guinea pigs! In addition, there were patients with diseases that they could hardly see in the homeland of Japan, for example, epidemic hemorrhagic fever, plague, typhus, and severe frostbite. They could produce brilliant scientific achievements for Japanese medicine, although these achievements could not publish internationally. Owed to these achievements, they could gain good positions in the Japanese medical academy after the war.

Right to rule one's own life and body
Tsuyoshi Awaya, Japan

Recently, the situation to surround human life and body is changing drastically. Technologies of life and body have been highly developed. Life is becoming controllable, and body is becoming utilizable and changeable. And that the technologies about life and body are changing the meaning, values, ethics, etc. of the life and body.
For example, as for the commencement of life, technologies of artificial insemination and in-vitro fertilization have been developed, and as for the termination of life, technologies of life-prolonging treatment and life-support treatment have been developed. As for the termination of life in particular, the absoluteness and inviolability of biological life have begun to be doubted due to the development of those technologies. Concretely speaking, the issue of euthanasia and death with dignity has come under closer scrutiny.
As for the utilization of the body, technology of organ and tissue transplantation and biotechnology have been developed, and as for the transformation of the body, the technology of artificial body and the technology of organ and tissue transplantation have been developed. In particular, as for the technology of organ and tissue transplantation, the issue of thorough utilization and commodification of the body (organ, tissue, cell, gene) have come under closer scrutiny due to the development of those technologies.
By the way, there is an issue of the information about life and body, for example, the issue of DNA testing. Here, I propose "the right to control one's own." To whom does life, body, and their information belong? My life, body, and their information belong to me. I own them. I have the property right of them. I have the right to control my life, body, and their information, and you have the right to control your life, body, and their information. As technologies of life and body have been highly developed, and life is becoming controllable and the body is becoming utilizable and changeable, as mentioned above, I think the establishment of the right to perfectly control the life, body, and their information is needed urgently. Concretely speaking, It is desirable that international convention about the right to control one's own is concluded and the right is placed in the constitutional law of each country.
The right to control one's own is divided into three categories. They are the right to control one's own life, the right to control one's own body, and the right to control one's own information about the life and body. The right to control one's own information is recognized as the right of privacy in many countries. In Japan, it is recognized as one of the right to pursue happiness on the constitutional rights. I describe the right to control one's own life and the right to control one's own body below.
The right to control one's own life is divided into two parts. They are the right against life infringement and the right to dispose one's own life. The right against life infringement is the result of both of the property right of life and the inviolability of life, which is derived from human dignity. This right against life infringement is almost established in many countries. The right to dispose one's own life is the result of both of the property right of life and the possibility to dispose life, which is derived from the principle of autonomy. The principle of autonomy is derived from individualism and liberalism. However, this possibility to dispose life comes into conflict with the impossibility to dispose life which is derived from human dignity. Here is just an ethical dilemma. This right to dispose one's own life has been hardly established in the world currently. I think the establishment of this right is needed through overcoming the ethical dilemma. This means recognition of the right to determine one's own death (the right to suicide), which is the extension of the so-called right to die.
The right to control one's own body is divided into two parts. They are the right against body infringement and the right to dispose one's own body. The right against body infringement is the result of both of the property right of body and the inviolability of body, which is derived from "human body dignity." This right against body infringement is almost established in many countries.
However, recently, this right against body infringement has begun to be partially attacked by the human experiment, including clinical test of medicine with human being without informed consent, removal of organs from executed prisoners in China without consent, organ theft in India, removal of tissues and cells in USA without consent, etc. In Japan, the case of insertion of a catheter to the living kidney donor (patient) without consent in Kansai Medical College and the case of removal of organs and tissues from the dead without consent for the investigation of environment hormones in Tokyo coroner office occurred.
Usually these are treated as simply ethical issues: violation of informed consent, but I think those should be treated as a legal matter: issue of the right against body infringement. Concretely speaking, it should be treated as the issue of bodily injury or theft on the criminal law.
The right to dispose one's own body is the result of both of the property right of body and the possibility to dispose body, which is derived from the principle of autonomy.
I would like to study the fundamental issue why the property right of life and body can be brought up, and to analyze the relationship between the property right of life and body and the self-property right on the philosophy of law in the near future.

2-6pm Methodology in Cross-Cultural Global Bioethics

Global bioethics and Potter's criticism of the concept of human progress
Ivan Segota, University of Rijeka, Croatia

Van Rensselaer Potter II, the 88 year old American oncologist, did not only "coin" the term bioethics 30 years ago, but I think he is its real "father", since bioethics, after its initial narrowness in the frames of medical ethics, today regains Potter's global dimension as "a new science ethic required for long term human survival." Already in 1962 - nine years before the term ethics was created- Potter was questioning the concept of human progress and where the advances in science and technology were leading Western Culture, as well as, what kind of future humankind was facing and if humans have any possibility of choice. Today, when approaching the end of his life, he warns that "the medical ethics presently carried on with bioethics as its label is a short-term tactic" and that " global bioethics calls on medical ethicists to consider the original meaning of bioethics and to extend the thinking and activiites to public health issues world-wide."
Besides presenting Potter's brief biography, the author provides Potter's original understanding of bioethics and of his recent terms: " global bioethics", "bridge bioethics" and "deep bioethics", as well as the historical background in which first visions of bioethics developed in the United States in the early 1960s.

Bioethics: What kind of Discipline?
Bioethics: What Kind of Discipline? - A Dilemma
Insok Ko, Institute of Philosophy, Yonsei University, South Korea

Bioethics today seems to have two jobs to carry out that are intrinsically related to each other but not to be easily integrated into one and the same task. On the one hand, bioethics as a branch of applied normative ethics is expected to play the role of a problem solver, or at least of a mediator that helps us to balanced solutions to the emerging practical problems entangled with the progress of bio-medical sciences and technologies. On the other hand, bioethics includes a set of open philosophical discussions on various fundamental questions. For instance: What is life? What is birth and death (especially of a human being)? Do we have right on other lives (including other biological species)? Are there circumstances under which manipulation of life is justified? It is to note here that the unceasing debates on those fundamental questions, such as the definition of life, killing, etc., and further on the foundation of normativity would keep bioethics from giving prompt answers to concrete problem situations. This constitutes a dilemmatic situation for bioethics. Neither of the two aspects of bioethics -philosophical reflections on the fundamental concepts and criteria on the one hand and timely reactions to practical problem situations on the other- is dispensable, while it seems hard to fulfill both tasks satisfactorily at the same time.
If bioethics would not fail to do its function as normative ethics that is urgently needed in our societies, it should assume some standpoint as (tentatively) accepted for the discussions on the matter. I suggest for such a starting point a following motto, seemingly harmless but certainly not indisputable: "For the sake of effective survival of human-kind".

Transcendental evolution of Trans-cultural Ethical Systems into an holistic ambience
R.N. Sharma, National Chemical Laboratory, India
Human society has spawned many ethical systems in different regions and times. Some of these have diffused into the fabric of humankind, and stabilised as major religions. Whereas the underlying principles of all are unifying and universal in the embodiment of love, compassion, peace and spiritual uplift/salvation; historical, geographical and socio-economic factors have distorted their form and content into anachronisms totally incompatible with progressive human aspirations. Deep thinking, and conscious, concerted efforts, as well as high courage are needed to transform the common as well as distinctive tenets of these systems into an holistic paradigm. The latter would then be able to blend the diversity of human religious beliefs into a morality which would, of necessity, be anthropocentric. However, such a universal, trans-global cultural and spiritual unitary Ethics would have a pragmatic conceptual ambience capable of assimilating diverse streams of thought for universal transcendental evolution of a primordial Human Nation co-existential with other Life as well.

Is Monotheistic Theology an Obstacle to Universal Bioethics?
Avi Gold, Ben-Gurion University, Be'er Sheva, Israel

The first time I spoke on this topic was at the bioethics conference in Be'er Sheva, Israel, last summer. More recently, I developed the topic further at the bioethics conference and student seminar in Chennai in January 1999.
Since then, six months have passed, and I have had some time to think over the topic further. I have been examining more sources and discussing the content of these talks with many people of several religious backgrounds: Jewish, Christian, Muslim, Buddhist and most recently Hindu. Now, I would like to present an updated paper on monotheism in the context of universal bioethics, and specifically the tradition of the Seven Laws of Noah, and their relevance to this topic.
Initially, the question asked was: Is Monotheism an Obstacle to Universal Bioethics?
In the context of universal bioethics, the discussions are often quite secular, but if bioethics are to be universal, then religion must be taken into account. Millions of people worldwide are members of various religious groups, and their attitudes towards bioethics and opinions must somehow fit into the scheme of universal bioethics. Religious systems which are polytheistic are more accepting of multiple approaches, so I focused on monotheistic religions to see how they could function with a universal bioethics model. As a representative of monotheistic religions, I concentrated on Judaism, although obviously the same issues need to be examined in other religious traditions as well.
Judaism is a monotheistic religion, and in it there is a strict belief in One God. Numerous laws and regulations exist in the Torah, and other Jewish scriptures, prohibiting the worship of multiple gods, and distancing from contact with such practices. It is therefore interesting to see how Judaism deals with the outside world, and with various groups which do not share its theological system. This, of course, has implications for universal bioethics in a world which includes many different religions and faiths.
The rabbis over the centuries have had to deal with this very issue. It is not an issue which came up only in modern times. In various contexts, various policies were practiced, but two details must be kept in mind: 1) It was always held to be important that tradition be maintained, even in difficult situations (and this is still the case). 2) It was (and is) recognized that interaction with the outside world is necessary. Complete isolation was rarely possible, and when possible, it did not really provide a long-term solution.
Some would advocate discarding traditional practice and its theological system in order to eliminate barriers from international contact and interaction. While this approach holds appeal to some, obviously tradition cannot be maintained in this way, and if the purpose was preserving tradition, then this approach is self-defeating. Others attempt the path of discarding the outside world in favor of preserving tradition. This approach has been taken by some, but it is clear that total isolation is not an option in the long term, especially in the 21st century.
Therefore, some other approach must be examined. The rabbis of the Talmud mentioned a tradition which contains within it just such an approach to the outside world. This is the tradition known as the Seven Laws of Noah, a tradition which appears in the Talmud and in a few other ancient Jewish sources. I think the framework of the Seven Laws of Noah has tremendous potential as a method of approaching the outside world, and that it has a great value within the context of universal bioethics.
The topic of the Seven Laws of Noah and their function has been discussed in detail in various sources, although until modern times, most of the discussion has been mainly theoretical. It is now, in recent decades, that various people are considering how this tradition can be translated into practice, outside the realm of theory.
Briefly put, the tradition of the Seven Laws is as follows: After the Great Flood which destroyed the world, and with it, all of humanity except for Noah and his family, God gave Noah and his family seven laws. These seven laws were to serve as the basis for human society, and to be followed always by all of Noah's descendants (i.e. all of humanity). The seven laws are: 1) Prohibition of idolatry; 2) Prohibition against cursing God; 3) Prohibition of murder; 4) Prohibition of adultery and other illicit sexual relations (such as incest, etc.); 5) Prohibition of theft; 6) Prohibition of "ever min ha-Hai" (against eating a live animal or eating a part of an animal while it is still alive) ; 7) Commandment to set up courts of law

The importance of this framework of seven laws is in at least two things: 1) Since it is defined as applying to all of Noah's descendants, and all of humanity is included in this definition, this framework can be used as a way of viewing the world as a whole in its most inclusive manner. Because, we are all, descendants of Noah. So, no matter what religious systems exist, all of humanity has a common link as descendants of Noah. If the world is viewed from this angle, some of the foreignness of the "other" disappears. 2) These laws are, for the most part, moral definitions, and so it is interesting to examine this framework of moral principles within the discussions of universal bioethics, and within discussions of genoethics, as defined by Prof. Shinagawa (1).
Obviously, there are details to be discussed in each of the Seven Laws, but in general, the basic principles of these can be found in cultures and traditions worldwide.
The one law of the seven which causes the greatest issue is that of idolatry. Therefore, this law must be examined carefully, because it holds a key to multi-religious discussion. The next question which follows then is: What is the meaning of idolatry in the context of the Seven Laws of Noah? As is usually the case, there is disagreement as to exactly how this law should be interpreted. However, according to some rabbis, there is a distinction between what is considered idolatry within the Seven Laws and what is considered idolatry for purposes of Jewish observance. The main difference is in the concept of "shittuf". This word does not have a standard translation in English, but I would recommend "associationism". I have already suggested a Japanese translation for this term as "rensou-shinron". (2) The basic meaning of "shittuf" is connecting someone or something with God, either in worship or in oaths. By practicing "shittuf", one makes use of an intermediary to reach God, rather than approaching God directly. The difference between this and idolatry is that in practicing "shittuf" one affirms the existance of the One God, while in idolatry the many gods believed in are taken to have independant authority. The discussion of "shittuf" in rabbinic literature was primarily a discussion of the status of Christianity, whether the issue was belief in a trinity or prayer to saints. Either way, according to those who distinguish "shittuf" from idolatry, a Christian is engaging in shittuf and therefore is not an idolater. The question then is: What about the status of other religions in terms of this "Seven Laws" framework? After all, the main discussion in rabbinic literature about other religions is on Christianity. Other religions are hardly ever mentioned. The way to approach other religions is by the same set of guidelines. If the theological framework in a given religion is purely monotheistic or engages in "shittuf" then such a framework would not be idolatrous within the Seven Laws. This is why it was a special challenge for me in India. In January 1999, when I presented in Chennai, the audience was multi-religious, and for the first time, it was possible for me to discuss the Seven Laws with Hindus. I found a high degree of agreement, and indeed Hindu scriptures speak of an underlying Unity in the universe. Whether or not they use the term "God" is irrelevant, because terminology is culturally-based anyway. The description of God in Jewish sources is a Unity over everything without shape or form, and this fits well the Hindu descriptions.
However, even in the case of a religious system which does not practice "shittuf", but rather idolatry itself, there are still principles existing within Jewish sources that allow for co-existance.
The most important of these is the Talmudic statement "minhag avotam beyadam". (3) This means "the traditions of their ancestors are in their hands". This statement was said about the various nations living in other lands outside Israel. In other words, despite the fact that some of these religious systems are contrary to the Jewish concept of God, nonetheless, the rabbis stated that those nations received their traditions from their ancestors, and so it was seen as an internal matter for those nations. So coexistance with other systems can exist, even when the starting point is a strict monotheistic system.
In conclusion, I would like to say that monotheism need not be an obstacle to universal bioethics, and that the Seven Laws of Noah provide an interesting framework for discussing universal bioethics from a monotheistic viewpoint.
(1) Prof. Shinryo Shinagawa, An Essay on the Standardization of Ethics, Journal of Health Care, Medicine and Community No. 12, November 1997, pp. 42-53
(2) Personal correspondence to Prof. Shinagawa, Oct 25, 1998
(3) Babylonian Talmud, Tractate Hullin, 13b.

The role of cultural determinism in the practise of allopathy medicine in Nepal
Dsouza Johnson Gerard Savio Alphonso and V.Manickavel, College of Medical Sciences, Kathmandu University, Nepal

Universally Medical Councils and World Medical Associations code of conduct prevents the association of physicians with drug dispensing. This paper attempts to reason out for a way of Co-practise, especially because of the traditional beliefs and cultural determinism of doctor, patient and pharmacists relationship.

The role of cultural determinism in the health care delivery in Nepal
Krishna sagar sharma and V.Manickavel, Nepal

Nepal is the only Hindu kingdom in the world and Hinduism is the state religion. The over wholming majority of population, 90%, (1991) has been and continue to be Hindu. Buddhism the second largest religious group (5%) and a minority is Tibetoneplese, then Muslim (3%) and Christian and others (2%) of population .
Medicine in old days are purely depended on the Hindu cultural facts. Going on quest of fact first reference to the modern system of medicine or to allopathic practitioners in Nepal is 1966/67. The conclusions of a study of the real situation are:
1. Different medical system can co-exist . Each whilst having its own expertise will generally cater for the commor ailments.
2. People may adopt behavioral aspects of medical systems without fully understanding the theories involved.
3. people's actual health behavior in situation results after considering the probes and cons that exist.
4. Another factors the costs of health behavior in relation to what people can afford and to the quality of services that they will get.
5. PHC as such failed to appreciated to the values of the villagers and the perceived needs. Whilst authorities stressed on health education the villagers wanted modern curative services .
6. PHC Implementers view the rural culture disparagingly as a barrier of health education.
7. More attention needs to be paid to the villagers' ideas, about health care and the existing traditional cares.
8. Modern concept of health care delivery system by involving more village health workers and health volunteers is failed, because such poor villagers can not expend their time without money.

23 November

9-12am Animals and Bioethics

Thinking about animal rights
Sang-yong Song, Hallym University, Chunchon, South Korea

Animal rights are quite a recent discovery though there were some forerunners who considered them seriously. What prohibited us from thinking about them earlier? Let us examine theological and philosophical factors among others for neglecting them.
According to Lynn White, Jr. a historian of medieval technology, the rise of technology in the Latin West in the Middle Ages was accelerated by the new attitude toward nature. A common feature of the religions in the ancient Greece was the belief that all natural objects possessed spirits. The Judeo-Christian religion, however, maintained that spirit was separate from nature and ruled over it from without. Only man possessed spirit. By destroying pagan animism, Christianity made it possible to exploit nature in a mood of indifference to the feelings of natural objects. Man and nature were two things, and man was master.
In Europe there were societies in which the axeman or the slaughterer, before taking up his axe or knife, would first have begged the tree's or the animal's pardon, explaining the necessity which forced him to destroy it. Such an attitude was not necessary for Jews or Christians, for nature was not sacred. St. Francis of Assisi, the greatest radical in Christian history proposed what he thought was an alternative Christian view of nature and man's relation to it. He tried to substitute the idea of the equality of all creatures for the idea of man's limitless rule of creation. However, the Judeo-Christian view of nature combined with the idea of conquest of nature in the modern era resulted the negligence of animal rights.
Descartes is the most important philosopher concerning animal rights. Animals, in his view, are thoughtless brutes, automata or machines. Humans are also machines, but they are distinct from animals in that they have soul, i.e., "ghost in the machine". Animals are, like clocks not conscious. The belief in animal consciousness, according to him, is a prejudice to which we are accustomed from our earliest years.
It was La Mettrie who challenged Descartes. He denied the fundamental difference between humans and animals. The superiority of man over animal was attributed to the surprising effect of education. He said : "Man is not moulded from a costlier clay ; nature has used but one dough, and has merely varied the leaven." Descartes had regarded linguistic behaviour as a kind that only humans can engage in. La Mettrie was anxious to show that apes are able to speak. Inspired by Amman's work in teaching deaf-mutes to speak, he asked : "Why then should the education of monkeys be impossible?" La Mettrie is remembered as a philosopher who extended beast machine to man machine. But he demolished the Cartesian dualism between man and animals.
Later evolutionary theory provided a significant different approach to the question of animal awareness than one offered by Descartes. Darwin emphatically denied a privileged status to human beings. For him there was no fundamental difference between man and mammals in their mental faculties. Thus wrote Darwin in The Descent of Man : "The difference in mind between man and higher animals, great as it is, certainly is one of degree and not of kind." Evolution provided a theoretical basis for attributing a mental life to animals.
Reflections on the Judeo-Christian view of nature, the downfall of Cartesian dualism and the establishment of evolutionary theory give powerful support to animal rights. There is a sign of increasingly favourable climate for animal rights.

Morality in nature -A new approach to thinking about altruism
Michael C. Morris, Faculty of Systems Engineering, Dept. of Environmental Systems, Shibaura Institute of Technology, Fukasaku 307, Omiya-shi, Saitama-ken 330-8570, Japan

Altruism is defined as any act which raises the Darwinian fitness of the recipient at the expense of the giver. Previous generations of biologists have assumed that altruistic animals and plants are acting for the good of the group or species as a whole.
This idea has given way to the view that altruism can be explained solely in terms of Darwinian selection pressure favouring genes "for" altruism. Altruistic individuals are therefore acting in the self interest of their genes, whether they are consciously aware of this or not.
Many people feel uncomfortable with this view. In this presentation I review the Darwinian mechanisms used to account for the evolution of altruism. I also propose that in some cases, Darwinian selection pressure alone would act against the evolution of altruism because of the selection of "cheat" alleles.
My conclusion is that the presence of altruism and cooperation in general is part of an overall design plan for living systems. Current education in ecology emphasises the role of competition as an evolutionary driving force. The benefits of competition in promoting economic efficiency also appears to predominate political thinking today.
A new emphasis on the role of co-operation using scientific examples may help us realise a more just society. We would learn that "nature red in tooth and claw" has a gentler side, and may be obeying the wish of a beneficent creator that all living things "love one another as I have loved you".

Some comments on logic and ethics of the whaling and anti-whaling movements
Shinryo Shinagawa, Hirosaki, Japan

Besides a brief history of whaling and anti-whaling movements, four general issues will be discussed on the logic and ethics of these movements. Whale problems have been so specific and confused because whales have no national borders; they migrate freely across and through the waters of national jurisdiction. Too many questions remain unsolved on the biology and behaviour of whales. Whales are important animal protein resources and a cultural component for the people with a long history of whaling. Whales are endangering other precious fish resources and likely threaten the food/ population balance in many countries. Whales are becoming one of the symbols of the environment protection movement.
On whaling today there are four main options: 1) Sustainable whaling, including sustainable pelagic, should be accepted. 2) Small type coastal subsistence whaling should be accepted. 3) Scientific research whaling should be promoted. 4) Whaling should be prohibited absolutely.
Why is killing whales wrong? 1) Life is always intrinsically sacred (But the whale is eating an enormous great number / amount of fishes.); 2) The whale is with high intelligence (But there may be other animals with higher intelligence than whale.) 3) The whale is not a fish but a mammal (But cows, pigs, and sheep killed and eaten also in anti-whaling countries.); 4) The whale is the largest creature on the globe (But the larger is not necessarily better than the smaller since the larger needs more oxygen and water, and consumes more food.)
My personal views on whaling and the whale are: Whale/ human relationship should be restudied not only eco-sentimentally as well as eco-potentially but from view points of demography and traditional diet culture. Methods of whaling, more exactly killing of the whale, should be more humanized. Scientific pelagic research whaling should be promoted for the development of whale biology and marine science. Definition of coastal whaling should be widened to the "200-mile zone". Both Scientific pelagic research whaling and coastal whaling should be sustainable, if necessary under the supervision of IWC (International Whaling Commission). Whale biology is one of the most important specialties in marine biology. And, studies in euthanasia, sterilization, and contraception of whales are all urgently necessary. IWC should be more globalised. In other words, I hope the IWC becomes more neutral and it is possible to cover all whaling countries.

1-5pm A Healthy Global Environment

A comparative study on the values represented in Japanese primary school songs
Shoichi Kuroda, Japan
The subject of this study is to select values of Nature, Society and Humanity represented in Japanese and Korean Primary School Songs Words and to find how they reflect the environment, with comparisons by area and time. In Western areas like Europe and USA, there are a few if any school songs, except for some private schools. But, they are popular in Asia particularly in Japan, Korea and China. The existence of school songs is said to be the Culture of Japan.
In Japan, every public and private school has their own school songs in spite of the fact that there have not historically been any kind of guidance directed by the authorities concerned, even during World War. School songs have typical characteristics which generally celebrate a natural view and history of their neighbour and state their educational spirit which may proudly include a historical big figure.
As a whole, school songs words seem to be affected by the values dominant in the area and time, and I have studied 7000 in total. The songs words have already been analyzed by some other papers limited from the view point of the landscape structure and educational spirit and/or objective. In school songs words, the latter is often personified in the former. Compared with other papers mentioned above, the subject study includes not only the above analysis but also classifying the school songs words connected with history, culture, society, ideas and morals.
For this study, statistical analysis was performed using a computer for a selection of words in the school songs. Environmental factors included landscape [ Nature(landmarks, praise of others, air personified expression and educational expression); cityscape and industrialized(both landmark, praising other); animals and plants(praising others, personified expression and educational expression); seasonalities like weather (praise others, personified expression and educational expression); five senses, e.g. colour (praised others). Except for five senses, all other factors were studied in terms of history, culture and society, ideas and morals. Human relations factors were also studied including teachers, forefathers, fellowship, sexuality, man oriented, woman oriented, and youth; with respect to history, culture and society, ideals and morals. Other associations of these factors were also identified.
In the paper I will present here, areas are classified into five characterised groups where one city is selected respectively as listed below:1) Urbanized: Yokahama city; 2) Industrialized: Yokkaichi city; 3) Suffered A-bomb: Hiroshima and Nagasaki cities; 4) Harbours prosper: Kobe and Yokosuka cities. The era is divided into two, before and after World War II. The latter is further divided by ten year intervals. A total of 253 school songs were analyzed, excluding Korea as shown [ for each city there are two numbers (before and after the war)]: Yokohama (5, 38); Yokkaichi (1, 28); Hiroshima (13, 44); Nagasaki (10, 47); Kobe (8, 35); Yokosuka (0, 24); total (37, 216).
According to the analysis by area, the moral ideals and the hope for future are frequently found in the personified expression of the songs words as indicated [For each city there are two variables (morals and future; using a three point scale of most, many, few): Yokahama (most, many); Yokkaichi (few, few); Hiroshima (many, many); Nagasaki (most, few); Kobe (few, few); Yokosuka (many, few).
The major concern of the total songs words by area included three ideas (peace, world, self) to the following degrees: Yokohama (many, many, many); Yokkachi (many, many, few); Hiroshima (most, many, many); Nagasaki (many, few, many); Kobe (few, most, few); Yokosuka (many, most, any).
Extra regional concerns included for example, industrial complex ideas in Yokkaichi, history in Hiroshima, culture in Nagasaki, mind and development in Kobe. Trends over time will be presented. For example landmark gradually decreases over time, while praising others and fellowship increases. Overall school songs that are not appropriate in the current environment in terms of the word meaning are still to be found. it is recommended that school songs words are adopted or utilized in education for environment and ethics purposes.

A Bountiful World for Posterity? Why Care?
Rick Weisburd, University of Tsukuba, Japan

A Bountiful World for Posterity - Why Care? Richard Weisburd, University of Tsukuba, Institute of Biological Sciences
Many people are concerned about environmental degradation that will persist long beyond the lifetimes of those humans living today. Yet many other people seem to not care about environmental quality in the world we leave for our descendants. Why do some people care? From where in our biology or culture does such caring arise? Exploration of this question might yield insights that facilitate coming together as a global society to deal with our environmental predicaments in a rational, coordinated and effective way.
Let us consider and discuss the various possible motivations to care about environmental quality on the Earth after we, as individuals, have died:
Among the possible sources of caring about posterity are the following:
Biology - Evolution
a. Selfish genes -- success is propagation into the future with increasing numbers of descendants. Are we hard-wired to perceive Darwin's 'struggle for existence' as crossing generational boundaries?
b. Biophilia - love of life. An evolved affinity for other members of our own Quarternary biota. Clearly an association with an entire biota can cross generational boundaries.
c. Altruism - We inherited a rich natural world; in fairness, our descendants deserve no less of an inheritance.
Socialization -- Culture
d. Religion & Spirituality - Most religions recognize beauty and grandeur in nature as an aspect of the divine. As the divine is generally considered to be eternal and sacred, preserving nature can be seen as a spiritual imperative.
e. Secular Education - Environmental education provides a perspective on our world that can lead to shifts in attitudes and values of societies over time.
f. Art - As expression of beauty often derives inspiration from nature, so to can works of art inspire caring about nature.
g. Law - Although the timeframe considered in legislative processes is usually too short to prevent some serious long-term environmental degradation, laws do alter behavior and can restructure societies. Clearly new laws will be needed to translate ethical imperatives related to the environment into changed behaviors and condition.
h. Peer pressure & Fashion - The importance of fashion in shaping behavior should not be underestimated. Marketing works effectively to change behavior, often by appealing to fashion consciousness.

Please consider your own culture and beliefs. Where do you think caring that extends beyond your own lifetime comes from?

Some perspectives on a healthy global environment
Aruna Sivakami, University of Madras, India

A healthy global environment produces all round development and happy human faces in all the parts of the world. This requires balanced and sustainable economic development so as to benefit all people of all societies and all nations in the world. But human development is not a concomitant effect of economic development. When the links of economic growth and human development are understood and appreciated and properly understood and implemented, with policies and programmes and perseverance and determination, they can become mutually reinforcing and the economic growth would effectively and rapidly improve human development expressed as healthy and happy human beings. Thus human development perspective has moved into the mainstream of healthy global environment and development debate.
But this requires a drastic change in international and global production and consumption relations and patterns that are conducive for human development. Human development paradigms, which aim at enlarging all human choices, must aim at enlarging and improving consumer choices too, but also be expressed in ways that promote human life, in short "Love of Life". Globalisation should reverse and minimize human impacts of environmental damage, particularly the unequal impacts on the poor people and ensure environmental sustainability. The future need not be gloomy if only declared countries cut down their demand on energy and control environment, prevent loss of biodiversity and other international environmental problems that aggravate the burden on the poor with a host of health problems. In all experiments on human life, ethics and moral should be adopted and observed scrupulously.
All this raises a number of important policy questions and ethical judgments on the part of developed countries on behalf of humanity. Addressing all these issues will result in effective and healthy global environment. This paper describes and analyses different problems related to it and recommends proper perspectives humankind should have for a humane world.

Agriculture and energy in Japan - 2000 to 2050
Tony Boys, Shion Junior College, Japan

Energy will perhaps never be as cheap and abundant in Japan as it is today. But the era of cheap and abundant energy (primarily oil) is drawing slowly to a close. In twenty to thirty years' time it will probably not be possible to rely as we do today on cheap and abundant energy sources to help grow, process and transport food, or to make fertilizers and other agricultural chemicals. Japan will have to rethink its agricultural policies, and its eating habits. By looking at agricultural and lifestyle statistics over the last 120 years, it should be possible to discern what Japan needs to do to carry out the transition (return) to a sustainable way of life.

Degradation of keratinous wastes by environmental friendly technology
N.S. Kavitha, Hilda Azariah
Centre for Advanced Studies in Botany, University of Madras, Guindy campus, Chennai - 600 025 (India)

An enormous quantity of keratinous waste materials such as feathers, hairs and nails are thrown into the surrounding habitat. Decay of keratin wastes in nature, causes ill health to the environment, as they harbour pathogens and produce foul odour. Hence the ethical value of the ecosystem is challenged.
In the present investigation, an attempt was made to clean up the environment by ecofriendly technology. About 15 species of keratinophilic bacteria were isolated. These isolated species were identified and characterized based on their biochemical properties. Among the 15 bacteria, the highly potent Bacillus pumilus, Bacillus laterosporus and Bacillus licheniformis were used for their keratinolytic potential. The major component of feathers, hairs and nails are keratin, is an insoluble fibrous protein. Keratin are not degradable by proteolytic enzymes such as trypsin, pepsin and papain because of their high degree of cross-linking by cystine with disulfide bonds (-S-S-), hydrogen bonding (-S-H-), salt cross bridges and hydrophobic interactions.
The keratin degrading enzymes from these three species of Bacillus were purified and used for the degradation of keratinous wastes. With the help of such ecofriendly technology the keratinous wastes could be degraded. The catabolic products such as protein, amino acids, cysteine and cystine were released during degradation. Changes in pH and percent utilization of keratin wastes suggest the possible waste disposal in the ambient environment.
Hence, it is possible to degrade the keratinous wastes accumulated in the ecosystem and clean up the environment by using keratinophilic bacteria.

Environmental Ethics of Chlorine in Marine Biome

Dr. Jayapaul Azariah,
Director, School of Life Sciences, University of Madras, Guindy Campus, Chennai 600 025, India

Modern science considers the oceans and its wealth as a natural resource. Oceanic water has been used as an industrial resource. Electric power generating plants are mostly situated along the coast line due to free availability of a massive volume of sea water. Such power stations use sea water as a cheap source of coolants in nuclear /thermal heat exchangers. Any such industrial application of sea water in power plants has an inbuilt and hidden cost. Therefore, it is to be understood that there is no development with any destruction.
Realizing the importance of the health of the oceans, the UN designated the year 1998 as the year of the oceans since signs of stress are already visible in the marine biome.
The present paper takes into account (i) the total volume of sea water present in the biosphere, (ii) the number of nuclear power plants already existing and proposed to be constructed (iii) the extent of industrial use of sea water in relation to the units of power generated, and (iv) the amount of chlorine added annually to sea water as an antibiofoulant agent so as to assess the health of the oceans as the sea water passes through the once through flow system in power plant situations.
The paper points out that under the current scenario of nuclear power generation, it will just require a mere one and a half years for the global sea water to be chlorinated. Since chlorine has the property of combining with humic substances, formation of trihalomethanes (THMs) is inevitable. These THMs are known promoters of carcinogen and currently there is no information on the metabolic pathway and movement of THMs in the marine biome. As far as the Bay of Bengal is concerned there is growing evidence to suggest that the sustainability of the marine ecosystem is on the decline. Chlorination is considered as one of the main reasons. Before the sustainability of the global marine biome is destroyed it is suggested that NGOs like the All India Bioethics Association (India) , Eubios Ethics Institute (Japan), Center for Asian and International Bioethics (Israel) and Eco-Ethics Center (Germany) must evolve a global program to impart marine science education with moral and ethical content.

Secretariat: Darryl Macer, (B515) Institute of Biological Sciences,
University of Tsukuba, Tsukuba Science City, Ibaraki 305-8572, JAPAN
Tel: Int+81-298-53-4662
Fax: Int+81-298-53-6614
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