Abstracts to be presented at
Bioethics and Informed Choice:
Seventh International Tsukuba Bioethics Roundtable (TRT7)
This page was updated on 12 February.
Internet site provides updates on this information: <trt7.htm>
To trt7 registration form, and more
details
15-18 February, 2002
Hosts: University of Tsukuba, Eubios Ethics
Institute, IUBS, Asian Bioethics Association
Sponsors: Eubios Ethics Institute, IUBS, WHO, GlaxoSmithKline, Sankyo
Pharmaceuticals, Fujisawa Pharmaceuticals.
Cooperating Organisations: University of Tsukuba Institutes of Medical
Sciences, Japan Bioindustry Association.
further sponsors being sought.
Internet site provides updates on this information:
15 February, 2002
8:45-9:15 Registration
9:15-11:30 Session 1: Bioethics and Informed Choice
If I were a Prime Minister! Informed Consent Or Informed Choice or None! ?
- Prof. Dr. Jayapaul Azariah.
Founder President, All India Bioethics Association,
New No 4, 8th Lane, Indiranagar. Chennai 600 020. India.
Email: jazariah@yahoo.com
Bioethics is essentially concerned about the choices that we, human beings,
make with a particular mindset. However, the mindset is created by an internal
framework, which is contributed by many ideologies and belief systems such as
philosophy, morality, spirituality, mysticism, religion and common sense. Even
though positive inputs can be given for the development bioethical mindset, it
is unbelievable that a different behavioral pattern, that is unethical, could
be exhibited. The mindset of some people of 21st century is an example of a
strange misconception, which is a bewildering barrier to balanced understanding
and ethics! A mindset that "looks forward to death" in terrorist
activity is the opposite of the mindset which wants to live and let others to
live. A brand of humanity is emerging which does not want to be under
regulatory bioethical norms and wants to resolve differences by developing a
common understanding of life saving norms. Development of such a mindset is a
critical risk factor for the development of universal bioethics. The concept of
informed choice is based on the awareness of such risks.
Among the many risks that face humanity, risks involved in employing human
subjects in clinical trials in developing countries, growing threat of AIDS,
genetic screening and providing GM food deserve special consideration.
Differences among the mindset of people are bound to occur in solving global
problems that are related to the utilization of natural, man-made and human
resources. Futurology of risk and disaster management of biogeoresources,
especially resources like food, human health and welfare, is of immediate
concern. One such problem area with risks is in the area of GM food. When
Malthus proposed that the population growth would be a limiting factor in food
security, the global population was only around 800 million. During the pre
independence period, India produced about 50 million tons of food to feed its
300 million people. Currently India produces about 208 million metric tons to
feed its one billion people. Indian is now producing food grains, which was
sufficient to feed the then world population that prevailed during Malthus
period. This is due to the First Green Revolution.
The Indian population will be about 1.5 billion people by 2030, when the food
security of India will be less by 45 million metric tons of food grains. The
current position of India, as a food power nation, is started to shift with a
short fall of about 7-8 million metric tons of food grains. We need a second
green revolution. Many people hope that this second green revolution is going
to be in the area of biotechnology, the hi-tech genetic engineering of food
crops. The paper outlines the benefits and many health risks in producing and
consuming GM food and food products. The paper advocates strict health safety
regulations. The paper argues for equity in distributive justice regarding
health safety standards between the developed and developing nations of the
world. Ethical implications of such a philosophy of social divide on the basis
of poverty and food, will be commented upon.
How would people react when the vital resource namely food is in acute short
supply? The paper discusses different options that will be faced by different
social sectors and by persons in decision and policy-making bodies. What would
I do, if I were to be a Prime Minister of a developing country during the years
2030- 2040? What would do, if I were to be the Head of NGO involved in
enforcing regulatory principles? What would I do, if I were a common person?
There is a great need to evolve bioethical global strategies, with a mindset
that permits all people to live to enjoy civilization in leisure.
Health for medically deprived populations is
practical bioethics
- Dr. Frank J. Leavitt
Chairman, The Centre for International Bioethics
Faculty of Health Sciences
Ben Gurion University of the Negev, Beer Sheva, Israel
Email: yeruham@bgumail.bgu.ac.il
Bioethics is not philosophy. Although philosophy used to face the questions of
life and existence, philosophy became an academic discipline and bioethics has
taken its place as the exciting and world-changing occupation. Bioethics is
both theoretical and practical. Theoretical bioethics is when you say that
something ought to be. Practical bioethics is when you get off your seat and do
it.
Principles of bioethics can be interdependent. Beneficence and justice are
interdependent because you cannot say you are doing your best for your patient,
if -- for non-medical reasons like money -- you are doing less for one patient
than for another. Distributive justice can put on a scale from local to global:
justice within your family, your ward, your hospital, your country, or the
entire world. Although one must often put one's own family or one's own people
first, we cannot claim to be bioethical unless we also seek justice for the
entire world, indeed for all of existence.
So if some people can get heart transplants and IVF, and others cannot even get
a nutritious diet, and if we don't get up to try to do something about it, we
are lacking as bioethicists. Of course nobody can do everything. Certainly
those who work in health for medically deprived people may be lacking in other
aspects of bioethics, while those who do not work to help medically deprived
people may be bioethically outstanding in other areas. But by the same token,
it is wrong to say, as some have, that helping medically deprived people is not
bioethics.
This lecture will begin with a philosophical discussion of practical bioethics,
and conclude with a report of the current state of our Bioethics Centre's
project in India.
Informed choice - Croatian perspective
- Dr. Ana Borovecki
School of Public Health, University of Zagreb,
Croatia
An analysis of the situation regarding the concepts of informed consent and
informed choice in Croatia will be given. The presentation will give an
overview of the legal provisions in the area, research regarding this subject
and some civil initiatives. The comparison will be given with other countries
in the region. In our analysis we will use data collected form a survey
regarding the quality control of hospital service in Croatia.
The Confucian person and informed choice
- Daniel Fu-Chang Tsai, M.D., Ph.D.
Department of Social Medicine/Family Medicine, National Taiwan University
College of Medicine; Attending Physician, Department of Clinical Research,
National Taiwan University Hospital, Taipei, Taiwan
E-mail: fctsai@ha.mc.ntu.edu.tw
Modern doctor-patient relationship displays a characteristic of
patient-centred, informed consent/choice procedualism in terms of medical
decision-making. Respecting the wishes of the patients more than merely
amounting concern for their welfare has become the feature central to modern
bioethics theories. Seeing patients as persons, who are rational,
self-conscious beings capable of valuing their own life hence are entitled the
liberty, equality, and rights to choose for themselves, is in general the
backbone of Western bioethical principles.
Nevertheless, Confucius, a representative of Eastern philosophy and culture,
sees persons as deserving dignity and respect not simply because the autonomous
agency they are born with. Confucius' conception of persons, which is best
interpreted by his theories of 'chun-tze' (the morally ideal person)
encapsulating a two-dimensional personhood (the 'autonomous person' and the
'relational person'), provides a more comprehensive model regarding what a
person is and how he should be treated. This two-dimensional approach regards a
person not only as a rational, autonomous agent but also as a relational,
altruistic identity whose self-actualisation involves incessant participating
in and promoting of the welfare of his fellow persons.
This paper will examine the application of informed choice in medical practice
from the perspectives of 'Confucian personhood' and 'models of
physician-patient interaction'. The author will argue that the concept of
informed choice, being scrutinised under the light of the Confucian two-dimensional
personhood, appears to be bleak, detaching, and endorsing merely a politically
correct procedualism. A Confucian person/physician will consider himself a
'friend' or 'teacher' to the patient who is facing the medical moral decisions.
He is willing to engage in the patient's moral discourse and development
contained in the life and death choices in sickness at the risk of himself
being charged of medical paternalism. Informed choice is hence merely a
beginning or a minimal requirement of a meaningful physician-patient
interaction that a satisfactory and fulfilling relationship must incorporate
the other-regarding morality of interdependence and altruism.
Bioethics as a bridge between the public and
scientists
Chika Takeda and Darryl Macer
Institute of Biological Sciences, University of Tsukuba, Japan
Bioethics is a new word that is being focused upon recently by the media as
biotechnology has developed. While bioethics is a trendy new word, the meaning
and function of bioethics is not clear, and in fact it is often a vague
concept. This thesis describes the results of opinion surveys conducted in
Japan among different groups of person to examine their images of bioethics and
biotechnology. By looking at different occupation groups, including the general
public, scientists, academics who are members of the Japan Association of
Bioethics, medical doctors, high school biology and social studies teachers, we
can clarify what bioethics means to these groups.
The comments given in response to the open questions were placed into
categories following the method of Macer. Through re-categorization, two new
categories, concept of life and moral/ethics, were added to those used by Macer
to categorize the original use of the images of bioethics question among school
teachers in the 1993 International Bioethics Education Survey., and academics
in the 1995 surveys. These categories were used to look at the 2000 survey
samples of the general public and scientists. The most commonly cited three
categories of comments as images of bioethics for the public were natural
providence, medical ethics, and environmental concerns. The most common three
images found among scientist responses are natural, moral/ethics, environmental
ethics. In scientist comments, conceptual comments are higher than practical
comments, as in the public, showing that people in different groups have a
variety of views on what is bioethics.
In the public image of biotechnology, the most common images are Cloning and
IVF, Food, Genetic engineering, GM crops. The highest three categories for
scientists were genetic engineering, medicines, and increase variety. In order
that bioethics as a concept act as bioethics as an activity, better
understanding of the views of different persons is important.
From chemically-induced happiness to
depression: Are we making informed choices in our pursuit of instant ecstasy?
- Dr. Irina Pollard,
Department of Biological Sciences, Macquarie University, Sydney, NSW 2109,
Australia.
The impact of mental illness is becoming a
serious public health issue. It is known that one in five individuals will be
affected by a mental health problem at some stage in their life and depression
is estimated to become the second largest contributor to the world's disease
burden by 2020. Despite a plethora of articles outlining what is known about
the cures, diagnosis, care, treatment and predictions of severe depression, we
still have no clear understanding as to its etiology. Research points to the
use of various antidepressant medications, electro-convulsive shock
stimulation, cognitive behavioral therapy and various alternative therapies as
providing, or not providing, hope in the situation. Disturbingly, evidence from
diverse studies suggests that there is an overall increase in depressive
disorders, especially among the most recent birth cohorts. There is also good
evidence that depression (co-existing as it does with anxiety) is linked to a
range of risk behaviors such as smoking, alcohol consumption, illicit drug use
and eating disorders and these behaviors may well be associated with depression
identified as a major disease burden in the young. In this presentation I wish
to explore the possibility that consumer-driven 'happiness', seen as harmless
youthful activities, may in fact induce depression in those with no inherent
genetic risk factors. Such a hypothesis may, in part at least, explain the
observed increase in depressive disorders. There is early evidence that the
real harm from casual consumption of some recreational drugs; such as
ecstasy", is invisible and cumulative. In particular, by artificially
boosting serotonin levels in the brain (vital for happiness and stable moods)
the system may become impaired, increasing the risk of depression in formerly
healthy individuals. The paper will initially highlight the biological
connectedness in the brain between addiction and depression and link this to
the brain's elusive state of 'happiness'. Is the pursuit of instant happiness a
misunderstood form of illness and does society adequately provide the necessary
support for making informed choices in its pursuit?
13:30-18:00 Session 2: Ethical Dilemmas of
Biotechnology and Genetics
What Kind of Questions Should be Asked in studying the Social Acceptance of
Biotechnology?- Moral-Economical Approach
What kind of questions should be asked in studying the social acceptance of
biotechnology? Moral-economical approach
- Ilkka Kauppinen
Department of Social Sciences and Philosophy/Sociology, University of
Jyvskyl, Finland
The purpose of the present paper is to discuss what kind of questions are
appropriate when one adopts the moral economical approach, as developed by
Andrew Sayer, in studying the social acceptability of food biotechnology. Moral
economy suggests that while it is important to explore risks in relation to
environmental hazards and food safety, there should not be neglect of
"older" type of risks either. By this I refer to political economy
risks, like uneven distribution of power through economical practices or moral-political
consequences of contemporary trade laws and intellectual property system. These
kind of risks reflect a notion that isolating bioethics from the context of
conflictual social relations and socio-economical consequences is prone to lead
to misunderstandings concerning the nature of social criticism of food
biotechnology.
In the moral economical approach the question of social acceptability of
biotechnology is contextualized to prevailing economical systems. At the same
time, it is sensitive to culturally constructed moral values. Moral economy
gives opportunity to ask both positive and normative questions. On positive
level the basic idea of moral economy is to study the role of moral-political
values and sentiments in influencing economic activities. On normative level
moral economical approach is interested in how economic systems and processes
effect on different interest groups« lives. After short presentation of these
questions I will deliberate usefulness of Ethical Matrix (developed by Ben
Mepham) in developing concrete analysis of ethically important consequences of
food biotechnology in the context of political economy.
EU Regulation on Biotechnology and the Pressure From MNCs
- Dr. Dilek Demirbas
University of Northumbria at Newcastle, School of Social, Political and
Economic Sciences, Division of Economics, NB407, Newcastle upon Tyne, NE1 8ST,
UK
Email: dilek.demirbas@unn.ac.uk
In this paper I examine how civil society can be pressured through big MNBCs
like Monsanto and national governments favour some MNBCs as a result of some
lobbying activities. In that respect I look at the issue from the EU Regulation
System and the trade relationship with the USA. I raise my concerns in this
paper about how we, as consumers, are about to lose a battle against big MNBCs
and their powerful global capital.
Key Words: Biotechnology, MNBCs, the EU Regulation, Lobbying
Bioethical issues that biotechnology
companies face: Results of interviews and a survey
- Makina Kato and Darryl Macer
Institute of Biological Sciences, University of Tsukuba, Japan
This research is aimed at examining how companies concerned with biotechnology
deal with ethical, social and legal issues (ELSI). It is aimed also at
inspecting the hypotheses that these companies need "bioethics
standard" with which they could positively solve and avoid their
bioethical problems and promote their activity in harmony with society.
The methods included: 1) Background literature survey on ELSI issues related to
biotechnology business and companies; 2) Policy and statement of biotech
industry organizations; Interviews with persons in selected 3) Japanese
companies; 4) multinational companies; 5) experts in international
organizations; and 6) academics; 7) Questionnaire survey of selected foreign
biotech companies. In order to examine whether the same range of ideas are
found in literature , policy, survey and interviews, the comments made in the
survey and interviews were examined using qualitative analysis methods,
including the card work method (KJ method). This paper will focus on looking at
methods to compare diverse comments.
To date the initial literature survey has been completed, and some comparisons
of the policies at company, national and UN levels have been made. These were
used to design questions to conduct interviews. Interview responses from 4
groups, 1) experts in international organizations, 2) bioethics academics, 3)
Individual interviews from Japanese and multinational companies concerned with
biotech, 4) Result of group discussion in multinational pharmaceutical
companies were analyzed. Questionnaire responses from 34 foreign companies were
obtained. Some results that will be presented include the findings that
biotechnology companies have diverse bioethical issues and concerns, the
situation of dealing with these issues and the degree of consciousness varies
very widely between companies, biotech companies recognize the importance of
correct information to consumers, some companies think that bioethical issues
cannot be judged uniformly since they are complicated and diverse among
countries and kinds of business, however only 4 companies answered they did not
think that bioethics standards are needed to make their business smoother.
Bioethics dilemmas will however continue to be raised. In a free economy,
activities of companies are inevitable and social standards for their smooth
work increase consciousness on bioethical issues and help avoiding deviating
activities. Also several companies established internal ethical guidelines
after lawsuits. The analysis of the comments will link the practical situation
of company activity and their needs. The two sides, company and society, need
to have better communication.
Thai people increased their fear towards
biotechnology during the 1990s
- Chalobon Kachonpadungkitti and Darryl Macer
Thailand
This paper compares the opinions that people in Thailand have on the impact of
bioethics and biotechnology in the year 2000 with opinions obtained in an
earlier survey conducted by Macer in 1993. Several questions were added to the
1993 International Bioethics Survey on the economic impact of environmental
concerns, given the economic crisis in Thailand during the 1990s. During the
year 2000 sampling was conducted upon a relatively well educated public group,
and on university students, and the open comments that explore the reasoning
people have are being translated into English. A total of 214 public and 84
university respondent questionnaires were gathered to compare with the 689
public and 232 student respondents in 1993. Further analysis of the open
comments in the 1993 survey including translation into English was made for
questions on the images of nature, life, persons with AIDS, and on the
perceived benefits and risks of selected applications of science and technology
(in vitro fertilization, computers, biotechnology, pesticides and genetic
engineering).
In the year 2000 there was less optimism in science and technology than 1993.
In questions on the specific application of technology more persons expressed greater
worry for pesticides, genetic engineering and computers. The results of
questions on specific applications on genetics reveal that there has been a
halving of the support for gene transfer from plant to plant, and even greater
drop in support for animal to plants. There has been a drop in approval of
environmental release of GMOs, as also found in other countries of the world.
There was a doubling of the persons who said that television was the source of
their feelings about science and technology in 2000 compared to 1993. There was
also increased mention of learning about these issues in their education.
In conclusion, we can see that although this sample had a positive view towards
technology, when they come to some environmental issues they show much concern.
This research allows us a better picture of how Thai people balance the
different impacts of science and technology on human life and on protection of
the environment. These are key questions as people grapple with the dilemmas on
how to balance economics, progress of technology, improving quality of life and
increasing the choices for citizens, and preservation of the environment.
Sustainable Industrial Technology towards
Environmental Ethics
- Prof. Dhulasi Birundha Varadarajan
Department of Environmental Economics, School of Economics, Madurai Kamaraj
University, Madurai - 625 021, India
Email: dhulasibirundha@yahoo.com
A Global culture of a primarily techno-industrial nature is now encroaching
upon all the world's milieux, desecrating living conditions for future
generations. We, who are responsible participants in the culture have started
questioning ourselves as to whether this culture and the role which we are
playing in, it,is acceptable to us or are we critical about it. The crisis of the
environment involves not merely isolated and particular problems but also
involves a threat to life on this planet and the quality of this life. The
causes of this crisis are multiple. The misuse of technology to pollute, the
excessive proliferation of the human species and ignorance of casual
relationships in nature.
Technology had good effects as well as bad effects on environment. Science and
technology, and philosophy and ethics must be balanced. Either of them without
the other goes haywire. It is important to realize that the evolution of more
environmentally appropriate technology is not a substitute for population
stabilization and cultural change. Technology is disastrous when it is adopted
by a society with a weak value system and very little sense of collective
welfare.
Technology must always be thought of a part of the psychological cultural and
economic systems within which that technology is embedded and used. No
technology should be considered good technology unless it is environmentally
preferable as possible within its economic and cultural context. So sustainable
industrial practices, which can adhere environmental ethics.
In this context this paper analyses the various dimensions of Industrial
technology and environmental ethics. This is a system approach where the
subsystems, i.e sustainable industrial technology, their environmental friendly
practices and ethical dimensions will be dealt in this paper.
Comparisons of the reasoning of public and
scientists in Japan over specific applications of biotechnology
- Masakazu Inaba and Darryl Macer,
University of Tsukuba,
Japan
Analysis of open comments given by members of the general public and natural
scientists in surveys conducted by Macer et al. (2000) was made for the reasons
given for perceptions of usefulness, a series of four questions on usefulness,
risk, moral acceptaibility and policy for six different applications of
biotechnology. The questions asked the respondents for their positions on the
following applications:
1.Using modern biotechnology in the production of food and drinks, for example,
to make them higher in protein, keep longer, or taste better.
2. Inserting genes from one plant species into a crop plant to make it more
resistant to insect pests.
3. Introducing human genes into bacteria to produce medicines and vaccines, for
example, the production of insulin for diabetics.
4. Developing genetically modified animals for medical studies, such as a mouse
that has genes which causes it to develop cancer that can be studied in the
laboratory.
5. Introducing human genes into animals to produce organs for human
transplants, such as pigs for human hearts.
6. Using genetic testing to determine whether human embryos have a genetic
predisposition for serious diseases such as cystic fibrosis or thalassaemia
The analysis of the reasons given in the open comments was made by placing
ideas into 30-40 different categories, which were compared between application,
and sample. The results indicate that significant proportions of these persons
could give both positive and negative reasons for the development of these
applications. Some trends include that more persons were concerned about human
health safety for Q1 and more for ecological impacts in Q2. For Q2 a
significant proportion also expressed hopes that the products would be safer.
Q3 saw more persons giving the reason that it helps humanity or persons than
the other medical applications. A significant fraction of persons said there
was no need for these applications, or that they were unnatural. Despite the
decreased overall acceptance of pigs for xenotransplants (Q5) compared to mice
for medical research (Q4), the proportion who raised ethical or animal rights
concerns was similar for both miceand pigs. For the animal applications there was
more concern about misuse than for other applications. Q76 asked about genetic
testing, and it found one fifth answered "Consumers choice" while a
similar proportion gave concerns about "abortion or human selection".
These and other concerns will be discussed.
Biotechnology as an informed choice for
bioterrorism and bioethics
Dr. Rev. Baby Joseph , M.Selvanayagam, S.Ignacimuthu
Biotechnology and Environmental Science research Unit, Department of Zoology,
Loyola college ,Chennai-600034, INDIA; Loyola Institute of Frontier Energy,
Chennai 600034, India.; Entomology Research Institute, Loyola College,
Chennai-600034,India.
Email: petercmi@scientist.com
Biological warfare involves the cultivation of pathogenic bacteria, fungi,
viruses and certain chemical compounds specifically to kill people or to
transmit disease. Anti-crop bio-terrorism destroys the harvest and creates
famine. Diseases are due to new, emerging, re-emerging, threatening and
chronic/spreading pathogens. Genomic research and biotechnology have got
constructive and destructive impacts on the sustainability and existence of
life. Transgenic and knock-out technology involves the transfer of DNA into
germline cells, whereas, the somatic gene transfer could be made in to
non-germline cells. Bioterrorism can be prevented through monitoring. To reduce
the possibility of the same, researchers must be able to fingerprint pathogens
at the molecular level and discriminate between naturally occurring and
deliberately introduced outbreaks. Biological or toxin weapons may lead to gene
mutation, gene amplification and gene translocation. The types of strategies to
be adopted could be either preventive or responsive.
18:00 Reception
16 February, 2002
9:00-12:00 Session 3. Cross-Cultural
Global Bioethics and Informed Choice
Social responsibility of physicians and medical education in the 21st Century
- Prof. Shinryo Shinagawa, M.D.
Chairman of Seminar on Health Care, Medicine and Community, Hirosaki, Japan
Email: Shinryo@smile.ocn.ne.jp
There are clear social responsibilities of physicians in a general. This paper
will review statements made in the medical world on the terrorism of 11
September, 2001, in New York and Washington, and also give my own opinion on
terrorism, assassination and war from the viewpoint of a physician.
The main topics that will be presented are as follows:
1. The interests of physicians should be widened from organ, tissue, cells of
the patient to their whole body and person, and from the patient themselves to
their socio-economic and socio-environmental factors.
2. In the education of physicians, more attention should be paid to the roles
of social economic and socio-environmental factors in the health of people, and
the health care system of the community.
3. More attention should be paid to medical education on how to keep peace, how
to prevent war, and on new styled and traditional weapons.
4. More education should be down on the care and treatment of the injured and
dying people and the patients caused by external reasons such as natural
disasters, assassination, terrorism and war, which have been often ignored in
most traditional sophisticated schools of medicine and most hospitals.
5. Some of the statements relating to the terrorist attacks of 11 September,
2001, made in the medical world will be introduced in my speech including the
statements of the International Physicians for the Prevention of Nuclear War
(IPPNW, 13 Sept.), Indian Doctors for Peace and Development (12 Sept.),
Physicians for Social Responsibility (IPPNW-USA, 13 Sept.), IPPNW-Japan (13
Sept.), Public Health Association of New York City (17 Sept.), Physicians for
Global Survival (IPPNW-Canada, 17 Sept.), the Lancet (22 Sept.), Biopolitics
International Organization (BIO, 4 Oct.) and the British Medical Journal (13
Oct.).
Bioethics and Informed choice in Croatia and
what Asia can learn from recent history
- Prof. Ivan Segota and Iva Rincic
Department of Social Sciences, Medical Faculty - University of Rijeka, Brace
Branchetta 22, 51000 Rijeka, CROATIA
Email: ivans@medri.hr, marinko.lerga@ri.hinet.hr
Serious discussions about informed choice have started in Croatia only
recently, and mostly in academic circles, owing to efforts of staff at Medical
Faculty - University of Rijeka. Ten years ago this school started lecturing
bioethics, emphasizing topics of informed consent.
The most important step forward in this field was made in May 2000, when
Department of Social Sciences of Medical Faculty at the University of Rijeka
and then newly established Croatian Bioethics Society joined in organizing
interdisciplinary discussion . That was in fact the first Croatian roundtable
on bioethics, which brought together ethicists, doctors, sociologists,
theologians, jurists and members of Jehovah's Witness, Christian religious
group directly concerned with the topic of rejecting blood transfusion. Their
example was used to discuss, from variety of standpoints - medical, legal,
religious, ethical and others, the patient's right to be informed and to
personally decide on his/her medical treatment. This is opposed to the
traditional role of doctor in Croatia and elsewhere in Europe. After that
event, Jehovah's Witness became patients whose wishes and decisions about
medical treatment have become accepted in Croatian hospitals. The complete
edition of proceedings was out of print within two or three months, so there's
a need for a new edition. At the same time, Croatian experience is being shared
with neighbouring Bosnia and Herzegovina, until recently affected by war.
Discussions about informed choice will probably start in other countries of
ex-Yugoslavia in a similar manner. Croatian experience might be useful to Asian
countries, where there are Jehovah's Witness groups established.
Key words: informed choice, Jehovah's Witness, Croatia, bioethics.
Sharing Knowledge, Experience and Resources
for International Agricultural Biotechnology Applications: Examples from CGIAR
(Consultative Group on International Agricultural Research)
- Prof. Kazuo N. Watanabe,
Gene Research Center and Institute of Biological Sciences, University of
Tsukuba, Japan
Email: nabechan@gene.tsukuba.ac.jp
Agricultural biotechnology is the one of alternative tools for alleviating the
problems in food security and poverty, by improving the food production in
quantity and quality and cash-making opportunity in the developing world.
Sustainable agriculture is subjected to the appropriate combinatorial use of
traditional knowledge and modern sciences, technology and natural resources
that include biological resources, soil, water, energy sources and atmosphere.
The choices and decisions of such approaches depend on various ways of
scientific and individual thinking, creeds, religions, cultures, traditions,
ethnic groups and community besides the science and technology associated with
the matters. Socio-economic factors are also of importance as well as the
policy encumbered with the rural development. Thus, these elements should be
carefully considered and case studies should be implemented before
disseminating a large-scale agricultural biotechnology application. Successful
adoption of an agricultural biotechnology in an agriculture-farm community
would be totally up to the careful analyses and feedbacks from potential
end-users during small scale testing of a technology at a rural community
rather than just with a simple problem-solving approach by an immediate
dispatch of a technology. The most important aspect in the adoption of
agricultural biotechnology in developing countries would be multilateral
communications among scientists, policy-makers, regulatory agencies, donors,
commercial sector, aid agencies like philanthropic organizations, mediators
such as international organizations, and the end-users at a rural community. It
is also cardinal that scientists should talk each other and inter- and
multidisciplinary approaches should be made alleviating the confronting
pitfalls and be leading to the peaceful development.
Very little funds are allocated to public research in the agricultural
biotechnology for international development, particularly for the assistance of
lesser developed countries: the fund for the international agricultural
research managed by CGIAR is yearly around US $ 350 million, in contrast, the research
expenses spent by the international agricultural private sector would be as
much as US$ 2 billion for limited number of specific commodity crop species.
Substantial achievement could be made on a small-scale biotechnology
applications to landraces of locally important crop species with far smaller
investment than what have been made to industrial crop cultivars. Although the
social status of these under-utilized crops are regarded somewhat low in terms
of modern commercial markets, however, their contributions as crops for food,
health and cash-making opportunity, should not be under-estimated to the
subsistent farmers and to the production at the marginal lands and/or at a
harsh climatic condition.
Some ethical questions facing Mongolian
scientists
Minjuurpass Altantsetseg and Chogsomjav Altantsetseg
National Biological Institute, Mongolia
Some current bioethical dilemmas in Indian
policy making
Minakshi Bhardwaj
Japan; India
India is the world's biggest democracy and second largest in population. It is
multiethnic with diverse cultures. Although ethics is based on some fundamental
principles, but its values are shaped by culture, knowledge and experience and
needs of people. Biotechnology in India has its own dimensions; mainly it is
being applied with special preference to medical research and followed by
agriculture and food. This paper gives an overview of the bioethical concerns
expressed by some government officials working in the biotechnology sector in
various ministries and government institutions like Ministry of Health and
Family Welfare, Indian Council of Medical Research, Department of
Biotechnology, All India Institute of Medical Sciences, Ministry of
Agriculture, Ministry of Food Processing, FAO (India) during my visit to India
in November 2001. Some of the issues raised were universal and some that are
especially relevant to Indian context. Although there is a general positive
attitude for applying biotechnology in medicine and agricultural research,
still there are issues that make biotechnology difficult to reach common people
in India. This paper highlights some of the issues at stake in policy making
for biotechnology research in India specifically in: infrastructure
availability, equity, disease burden and the use of new genetic technologies in
health care. Also issues related to general organization of medical research,
private versus public system, and insufficient ethics base in medical research,
genetic modification research in agriculture, and issues of commerce which
plays a significant role in research will be discussed.
The Doctor Patient Relationship and Patient
choice In Iran
- Alireza Bagheri, M.D.
Department of Neurology, Institute of Clinical Medicine, University of Tsukuba,
Tsukuba 305-8575, Japan ; Iran
Email:bagheri@sakura.cc.tsukuba.ac.jp
Physicians have a moral obligation to provide care for patients with whom they
have had a preexisting relationship unless emergency treatment is required and
no other physician is available. The doctor patient relationship is formed on
the basis of mutual agreement on medical care for the patient. Although the
physician's primary commitment is to the patient's well being and does not
change over time, the mutual agreement can sometimes undergo changes. As the
patient-centered care, dominated by a Paternalistic model, and patient autonomy
become more important, patients have a principal role in making decisions and
planning the course of treatment.
The Iranian medical system is no exception to this, with the relationship
between physicians and their patients undergoing significant changes. Medical
care is becoming more participative but giving information to the patients and
patient's role for decision making is different depending on variations in
inter-cultural, cross-class and inter-personal factors. It can be claimed in
general that from the view point of patients, a medical doctor is a benevolent
and competent professional who seeks the patient's welfare, therefore based on
the confidence in the physicians, the patients usually ask their doctor to
accept all responsibility to chose the course of treatment.
In this paper the current situation of the doctor patient relationship and
patient choice in Iran will be discussed and into which DPR model the Iranian
system may be considered to fall into.
Distribution of STD Clinic Patients Along a
Stages-of-Behavioral-Change Continuum -- Selected Sites in Japan, 2002
- Prof. Kevin P. Kavanaugh, Ph.D.,
University of Tsukuba, Japan; USA
Email: KavanaughK@aol.com
Human immunodeficiency virus (HIV) counseling and testing are important
components of the public health effort to contain the acquired immunodeficiency
syndrome (AIDS) epidemic. Project HARMONY is a multicenter randomized trial
being conducted by the University of Tsukuba at five sexually transmitted
disease (STD) clinics to evaluate the efficacy of HIV counseling interventions
in preventing HIV and other STDs. Because consistent and proper use of latex
condoms is one method to substantially reduce the risk for transmitting HIV and
other STDs (1), the HIV prevention interventions being evaluated focus
primarily on increasing consistent condom use with primary and other sex
partners during vaginal, oral and anal sex. Before initiating the randomized
trial, pilot studies were conducted to better characterize the population and
to develop an operationally feasible enhanced intervention. This report
describes the results of one pilot study. This is an interim report of an
ongoing project.
13:30-18:00 Session 4. Ethical Dilemmas of Medical Genetics
and Reproduction
Ethical dilemmas and consent for release of GM mosquitoes for disease control
- Prof. Darryl Macer
Consultant to World Health Organization
UNDP/World Bank/WHO Special Programme for Research and Training in Tropical
Diseases (TDR), CH-1211 Geneva 27, Switzerland
(The views expressed here are those of Darryl Macer not of TDR or WHO)
Genetic engineering allows genes to be exchanged in a controlled manner between
different species. Since its invention in 1974 it has conjured up images of
hope and dread. Public opinion is mixed, as will be reviewed below. With the
emergence of genomic sequencing we now have the DNA sequence of human beings,
that of dozens of pathogens, and some disease vectors. It is therefore not
surprising that molecular entomology, the study of the DNA and proteins that
they encode, in insects, is emerging as a serious scientific approach for
insect control in agriculture and medicine.
The ethical role of the UNDP/World Bank/WHO Special Programme for Research and
Training in Tropical Diseases (TDR) is to prevent disease that causes harm and
loss of human life. The ethical principles that lie behind the idea of
preventing disease is that human life is something worth saving. We could say
that one of the fundamental human rights is a right to health, and working
towards giving every person a chance to grow up free of disease is the ethical
foundation of public health. Working towards better global equity is a goal
that attempts to level; the lottery that people are born into, so that all have
a chance to be born and grow up in an environment free of infectious diseases.
One of the ethical traditions seen in TDR is the effort to free children from
the burden of often forgotten tropical infectious diseases. Under any ethical
theory, diseases that threaten the lives of not just one, but more than a
billion people in the world, provide a compelling need for efforts to eradicate
them.
The ethical principle of beneficence supports the development of science and
medicine, and its provision to those who suffer in the world. The ethical
principle of non-maleficence would make us balance reasonable caution about
premature use of a technology when risks are not understood. Recently some
persons have advocated a total precautionary principle for genetic engineering,
which would mean no technology that has more than 0% risk be ever attempted.
Because no human action has 0% risk, the principles of benefit and risk are
used in technology assessment, and are central to any public health programs.
TDR molecular entomology division has outlined a three prong effort towards
developing genetically modified mosquitoes for malaria control. A similar
approach can be also envisaged in the near future for other diseases, like
dengue. First is to study the host parasite interaction, secondly methods to
transform mosquitoes, and thirdly to look at population ecology and how to
replace harmful vector insects with non-harmful insects as a population. This
work had been developing since a 1991 meeting on the use of GM mosquitoes to
replace disease vectors. The study of mosquitoes has found that among the 4000
species of mosquitoes only about 50 carry human Plasmodium and only a quarter
of these are good vectors for Plasmodium. Most species are not anthrophilic
(literally, human-liking). It is predicted that within several years an
Anopheles mosquito resistant to malaria may be made, by one of many approaches,
and by the end of this decade the population genetics and ecology will be
understood enough to use these for public health purposes to prevent malaria.
The approach to genetically modify pathogens or vectors for disease control
raises few intrinsic ethical issues, however, there are important environmental
and human health concerns that need to be assessed. In the future we could also
imagine genetic modification of pathogens themselves, and even the human host,
as methods for resistance to disease. There is a need for policy guidance for
ethical genetic engineering of micro-organisms, plants, animals and ecosystems
to be decided in each country before release of GMOs. The policy advice in each
country should be the product of an open social dialogue including all sectors
of society. However the question is not whether to release GMOs, the question
is how to release them and what type of GMOs are safest and most effective.
Part of this process is for a society to set values for consensus on risk
assessment. There is a need to attempt to find a universal minimal standard of
risk assessment applicable to disease vectors, as these diseases cross national
and continental borders. This paper will discuss the recommendations below in
order to seek responses on how the following issues in this practical example
of the use of modern genomics. In all issues of genomics there needs to be an
international response, and development of model guidelines:
a) Before field release of transgenic insects, researchers must assess all the
scientific issues associated with GM vectors and develop safety precautions to
address potential risks.
b) The risks should be minimized through careful design and laboratory
experience.
c) Even if there are not perceived to be any realistic risks, a procedure for
their evaluation should be set up, so that new information can be gathered and
interpreted.
d) There should be prior environmental and health studies for site selection,
and based on this data the most appropriate site should be chosen.
e) Information should be openly provided as broadly as possible in a two way
process.
f) Consent should be obtained from the communities involved. The specific
mechanisms to obtain individual and group consent need to be specifically
developed for public health interventions.
g) There needs to be a contingency plan for aborting a field trial.
h) Commitment to the local communities involved in field trials should be made
that they will be the first beneficiaries of a more permanent attempt at use of
a GM vector should the results indicate that its use is appropriate.
i) Intellectual property concerns should not be barriers to implementation of
public health measures using GM pathogens or vectors, and prior negotiation,
including possible involvement to allow access to the latest technology, is
preferable to confrontation.
j) To avoid any suspicion by the public that could result in public rejection
of this approach, TDR and member governments should not involve partners from
any military research establishment in these projects.
k) The data should be made open to all so that it can benefit from global expertise
and develop an international consensus.
There is a need for an ongoing and active process of ethical analysis, through
a variety of forums. UN agencies are called upon to take a lead in the
elaboration of ethical and scientific standards for research in this area, but
we need global dialogue. TDR is called upon to take the initiative in
coordinating these programs because release of GM vectors is a question for the
global community, and the consequences potentially impact many generations to
come. There is a moral mandate for these studies to progress rapidly, but
carefully.
Embryonic Stem Cell Research in Japan and the U.S.: Comparing Public Policy
Responses
- Dr. Steve Collins
Program in Interdisciplinary Arts and Sciences, University of Washington,
Bothell, WA 98011-8246, USA
Email: swcollin@u.washington.edu
Growing interest in the potential medical applications of human embryonic stem
cells has provoked lively debate about the ethical implications and the need
for new regulations. Acknowledging the lack of consensus on the moral status of
the embryo and the widespread opposition among Americans to human cloning, U.S.
President George Bush announced in August that federal funding of stem cell
research would be limited to research on existing cell lines. Researchers,
moreover, would be barred from using federal funds to destroy new embryos as a
means of obtaining stem cells. In contrast with the U.S., Japan's government
has issued guidelines allowing basic research on embryonic stem cells, whether they
come from existing or newly created cell lines, so long as they are provided
free of charge as excess embryos from fertility treatments. How can we explain
this difference in policy response? This paper ventures an explanation. First,
it will describe and compare the emerging policy frameworks intended to
regulate embryonic stem cell research in the two countries. Next, it will
examine the political context of the debates over policy directions. Finally,
it will explore the extent to which ethical concerns have informed the debates.
The hypothesis to be tested is that bioethical concerns have had a considerably
greater influence on policy debate in the U.S. than they have in Japan.
Preliminary conclusions as to why this is so will also be explored.
The Inception of the Korean ELSI Program
- Prof. Jeong-Ro Yoon,
School of Humanities and Social Sciences, Korea Advanced Institute of Science
and Technology, Kusong-dong, Yusong-ku, Taejon, 305-701, Korea
Email: jryoon@kaist.ac.kr
The bioethics has become a "social" issue in Korea. In recent years,
the investment in the development of biotechnology has been rapidly expanded as
a strategic leverage for national competitiveness in the future. On the other
hand, however, there has been growing awareness of the potential risk attendant
upon the development of biotechnology. The attempts to legislate the bioethics
regulations, initiated respectively by the Ministry of Health and Welfare in
2000 and the Ministry of Science and Technology in 2001, have not been realized
in a swirl of controversies. The research into the ethical and social
implications of biotechnology in Korea is in its nascent stage.
The Center for Functional Analysis of Human Genome, funded by the Ministry of
Science and Technology, has started to support an ELSI program since June 2001,
in which I participate as the principal investigator of the core
("appointed") research team. The core team consists of specialists in
sociology, bioethics, law/medicine, education, communication, social survey,
and NGO activities. With a view to raising the public understanding and
facilitating ELSI research, the program aims to concentrate on the following
projects in its first stage: (1) preparation of a guideline to protect the
privacy and human rights involved in the human genome research and its clinical
applications, (2) development of programs in education, communication and
public participation to raise the public awareness and understanding, (3)
social surveys on the public perception of human genome research and
biotechnology allowing for comparative analysis, (4) operation of website
reference center of the ELSI research, (5) cooperation with the international
ELSI community and planning of the Korean ELSI programs.
The concepts of brain life and brain death
- Seiji Ootaka and Darryl Macer
University of Tsukuba, Japan
This research has been conducted by reading literature in English and Japanese
to examine the concepts of brain life and death. Concepts about what is human
life have been changing recently. Human death was one, a simple concept in the
past. It is impossible to control the range of death process. But now, with the
development of medical technology, some patients can stop at certain extent of
the process. Herein there appears to be an inconsistency between biological
life and human, personal life. Consequently brain features have been emphasized
as a criteria of redefining of death.
On the other hand, similar change has come to the fore at the context of the
beginning of human life because of human embryo research. Originally in
Christian countries, there was powerful opposition to abortion because of the
strong belief that embryo is person from the time of conception. Thus embryo
research also provokes similar opposition. Therefore it is proposed to make new
criteria for embryo research according to development of brain under the
influence of brain death argument.
What is a life of human is an essential point to argue for brain death. Brain
function can be divided into two categories, mind and body-maintenance. Of
course, body-maintenance also includes brain-maintenance. Here, to conclude
that mind superior to body is too hasty a decision. There is debate over how to
define brain death, whether the whole brain should be included, as in most
countries, or only the brain stem. Because brain death criteria emphasizes
body-maintenance rather than mind function of brain, moreover in the UK their
is no mention to cerebral cortex.
It seems to be more complicated when arguing about surrounding people. For others
the patient is just his or her expression for them, and body also expresses the
patient's existence. But a brain death is invisible for others, there are few
expressions of death. Many writers argued about the acceptance of their family
member's death.
In the context of human embryo research, the problem is whether the embryo is
worth being protected. There are three points. First is that if the embryo
obtains a certain function, which implies the embryo is a rights-holder in the
course of development, the embryo should be protected. Second is that if there
is potential for some degree of development, it should be protected. Third is
that the appearance of some certain features make the embryo be protected
without arguing the relation between the feature and some function.
Related to third point, in the context of religions like Christianity or Islam
there is the concept of ensoulment. This means the injection of soul into body
by God. The presence of soul represents the sanctity of human being. Thus the
embryo that has undergone ensoulment should be protected. This sanctity seems
significant not only for followers of those religions, because we cannot handle
an embryo roughly.
If what is significant is not argued, scientific criteria has no force, because
scientific fact cannot define value. But on the other hand, the progress of
science makes some values relative, and the world looks for new value. If it is
true, there should be creation of new value along with a progress of science.
For centuries people have looked at a person through their personality, and
will, not through their physical characters. Perhaps the focus on the brain in
determination of life and death is a modern trend, however, conceptually it is
not so new. The reason why the attempts to relate brain feature to human value
are so controversial is that there is so much variety of values between every
person. It is a moral dilemma for society whether individuals should have
freedom to decide themselves on their own criteria of death (as in Japan),
because public policy may need to fix a definition.
Human cloning: Are we justified?
- Kaustuv Nayak
Dept.of Plant Biology & Biotechnology, Loyola college, Chennai, India-600
034
Email: kaustuv_nayak@yahoo.com
Biotechnology has paved the way for many application in near future to
alleviate human suffering to a large extent. Now we are one step close to
playing god with this. In what was predicted soon after dolly the sheep was
cloned, researchers now have been able to clone a human embryo- a step close
that would take them closer to becoming creators of human life. Although it
gives a impression of far reaching advantages but the dangers are also not
ruled out, which are now unimaginable. The ethical an social aspects are not to
be forgotten.
Genetics and Social Justice
- Prof. Ann L. Boyd
Dean of the Graduate School and Professor of Biology, Hood College, 401
Rosemont Avenue, Frederick MD 21701, USA
Email: boyd@hood.edu
With the flood of genetic information at hand, individuals and societies must
redefine the "normal" phenotype. Data from the Human Genome Project
is the property of the human commons and it is the moral responsibility of
persons to make good use of the knowledge. Efforts of philosophers for
thousands of years have wrestled with the Socratic question, "What is
good?" Science overreaches its epistemological limits when it genetically
defines or seeks to control human nature. It is certainly not wrong to pursue
new ways to reduce human disease and suffering but how priorities are set requires
the collective wisdom of the public commons. The rapid pace of technological
progress offers amazing results and yet promise (implicit perhaps) of
large-scale amelioration of genetic defects is unrealistic. Biology cannot
equalize talents, endow everyone with the same physiological benefits and
eliminate all ills from human nature. Human persons are more than their genetic
profile. The distinction between normal and abnormal is more subjective than
analytical. One person's "disability" may be the inspiration for
great achievements for another person. We must remember to take individual
differences seriously. Suffering is an integral part of the human condition as
it points to our finitude. All suffering cannot be eliminated without
sacrificing the relational and compassionate aspects of human existence. If
humans fail to be sensitized by the suffering of another and have no tolerance
for a diverse range of talents and capacities, how can communities flourish?
The wealth of knowledge mined from the Human Genome Project may prove a source
of poverty for individuals and nations unless compassion and humility guide our
policy formation process.
Views of the public and academics in China on
healthy babies
- Baoqi Su (China) and Darryl Macer
Japan
For more than 50 years, significant success has been achieved in hygiene and
health care for Chinese women and the general health level of childbearing
women has greatly improved. However, maternal and children's health especially
in rural areas are still affected by various factors. This thesis examines
women's reproductive and healthy babies in China from an ethical and social
perspective: (1) reproductive policies and their effects on the lives of woman
in China, (2) how traditional culture affects reproductive health concepts,
particularly those of childbearing women, (3) comparison the health of women in
rural and urban areas, and (4) the differences in the views of Chinese maternal
and child health inside and outside of China, and their relationship to differences
in economic and social development and actual population conditions.
It is a common desire for everybody, to have a healthier baby than a diseased
one. The methods used to examine these issues start with descriptive bioethics,
with interviews being conducted with both the general public and bioethics
researchers in cities and countryside with an emphasis on qualitative study,
and interpretation of the results considering ethical principles. The subjects
of interviews with the general public were 28 women and 8 men aged between 20
to 65 years. A range of persons in different positions were interviewed, rather
than just focusing on married or not married persons, or those who had boys or
girls. The interviews with experts were with 23 persons including 10 bioethics
researchers; 4 gynecology and obstetrics doctors; 3 health workers for maternal
and children health; 3 policy bureaucrats; and 3 members of the All-China
Women's Federation.
In particular, attitudes to the one child family policy and the Mothers and
Infants Health Care Law, abortion and gender selection are discussed, and
analysis made of the various reasons for preferring healthy or male children by
the general public and academic. The Chinese people's attitudes towards
handicapped and genetic diseased children are examined, and the social and
ethical issues explored in light of the interview results. There was some
difference found between rural and urban areas.
Human remodeling due to technologies and the
limitations
- Prof. Tsuyoshi Awaya
Medical Law and Bioethics Office, Department of Economics, Tokuyama University,
Tokuyama, Yamaguchi, 745-8566 Japan
Email HGG00435@nifty.ne.jp
While in the past humans have thoroughly remodeled the natural environment,
animals and plants, nowadays humans have begun to remodel themselves. Human
remodeling includes three directions; cyborgization, chimeratization, and
genetic modification. Of course, the tool of this human remodeling is
technologies.
Human cyborgization means a human becoming a cyborg. There are many synthetic
structures being implanted into people today, including artificial hearts,
artificial bones, artificial teeth, dental amalgam, silicon for breasts, etc.
It seems that many of us are at least partially artificial. This
artificialization of the human body leads to human cyborgization. High-tech
artificial legs controlled by a computer, implanted artificial inner ears, etc.
have already been developed. In addition, while robot technology has been
progressing by leaps and bounds, it will contribute to this human cyborgization
greatly.
Human chimeratization means a human becoming a chimera. Human chimeratization
is performed by two means. One is transplant technology, and another is gene
manipulation technology. Xenotransplantation of an animal organ into the human
body is one example of human chimeratization due to transplant technology.
Human chimeratization due to gene manipulation technology means chimeratization
that is performed in the form of introduction of an animal or plant gene into a
human.
Human genetic modification means eugenic human remodeling due to gene
manipulation to a germ cell, fertilized egg, embryo, fetus or human. Usually
this kind of gene manipulation is called "Gene Enhancement." Current
gene therapy for genetic diseases is the first step of human genetic
modification.
Incidentally this human genetic modification leads to becoming so-called
"Gene Rich" substantially. "Gene Rich" means the person who
has many useful genes as the result of gene manipulation according to Prof. Lee
Silver, geneticist at Princeton University. The person, who is not, is called
"natural."
In the meantime, as for ethical and social limitations in human remodeling in
general due to technologies, I think that next two principles, which are based on
a traditional body-view therefore human-view, have been valid so far.
One is the principle that negative remodeling is acceptable, but positive
remodeling is not acceptable. Here, negative remodeling means remodeling the
purpose of which is medical treatment of an existing disease or injury, or
prevention of a probable disease. Contrary to this, positive remodeling means
remodeling the purpose of which is an addition of a structure or a function
which humans do not yet have, or the amplification of ability or performance in
one structure or one function._
Another is the principle that remodeling without the semantically important
change of human appearance is acceptable, but remodeling with it is not
acceptable.__
According to these two principles, only negative remodeling without the
semantically important change of human appearance is acceptable ethically and
socially. What is the semantically important change will be judged in each
case.
Concretely, for example, transplant of an animal organ into a human, so called
xenotransplantation, as medical treatment for diseases is acceptable because it
is negative remodeling without the semantically important change of human
appearance. But, in principle, transplant of an ape's arm into a human as
medical treatment for diseases or injuries is not acceptable though it is
negative remodeling, because it is remodeling with the semantically important
change of human appearance.
While it seems that ethical and social limitations of human remodeling still
exist at least for the time being, how long do the limitations continue to
exist? Human remodeling is based on human desires. Of course, technology is the
means of fulfilling these human desires. We live in the society to pursue
desires thoroughly; the "Explosion of Human Desires" is happening. In
the first place, civilization itself is a system by which human desires are
fulfilled. And technology and market economy are the driving force of modern
civilization. If so, fundamentally human remodeling will continue to progress.
It would seem that we humans have begun to walk towards "Artificial
Evolution."
I forecast that ethical and social limitations of human remodeling will
disappear soon. I think, first, the principle that negative remodeling is
acceptable, but positive remodeling is not acceptable will disappear; not only
negative remodeling but also positive remodeling will become acceptable
ethically and socially. Recent popularity of cosmetic surgery, which is
positive remodeling, suggests this.
Second, another principle that remodeling without the semantically important
change of human appearance is acceptable, but remodeling with it is not
acceptable has the possibility of disappearance also. Performance of sex change
surgery, which may be the semantically important change of human appearance, is
opening the way to the possibility, even if it is negative remodeling.
It is natural that sense of value about the human body will vary with the
passing of time. In the future, a person may appear who wants wings as parts of
his or her body in order to fly in the sky like a bird by his or her own
ability. What will happen if the technology that enables to do so is
established?
Now or in the future, do we need to stop the stream of human remodeling due to
technologies as mentioned before? As for human remodeling due to technologies,
against the idea that criticizes human remodeling on the basis of a traditional
human-view (including a body-view), adversely, the idea is possible that
criticizes the traditional human-view on the basis of both the new human-view
that supports human remodeling and the technology that supports it. These ideas
are in the conflict and rivalry with each other.
Title to confirm
- Prof. Hyakudai Sakamoto
Japan
Trends in attitudes of Japanese towards genetic testing
- Chihiro Ando and Darryl Macer
University of Tsukuba, Japan
This paper will describe results of an interview questionnaire about genetic
diagnosis and bioethics, which obtaining responses from 175 persons interviewed
at random, mainly in parks in Tsukuba. 47% of people knew of genetic tests,
less than half. When asked "Do you want to do genetic diagnosis? "26%
had the opinion that "Even if you can know about an incurable genetic
disease, I want to do. " and 35% said "If it is a curable genetic
disease, I want to do.", while 39% said they don't want to do. The reasons
why people hoped for this test were asked in an open question, and 13% said,
"Save life " , 13% said "Right to know" , while 10% said
" Feel very bad" and 7% said "Do not need to know", for
example.
Regarding prenatal diagnosis, 58% of people knew of this test, higher than for
genetic diagnosis. When asked "Do you want to do the check when you or
your spouse will become pregnant? " , 47% answered "Yes" and 20%
"No " , while 33% said "I don't know." The main reasons why
people why people hoped for this test were: "Right to know" ( 23%) ,
"Save life" (11%) , "Parent's convenience " (7%) , etc. The
other hand, many people don't hope for this test and answered reasons like
"Feel very bad "(7%) , "Do not need to know "( 5%) , etc.
Moreover when asked whether people hope for this test "If your baby has a
genetic diseases, what will you do? ", and the results were as follows :
"I will bear. "(36%) , "I will have an abortion. "(33%) ,
"Depends on situation "(25%) , "Don't know "(20%) . The
trend over the 1990s has been to have more negative comments about prenatal
diagnosis.
Four questions were asked on how to take genetic diagnosis. The first was
"Is this application useful in society? ". 24% agreed and 22%
disagreed, with 41% saying they don't know. The main reasons were "Right
to know ""Save life" "Depends on situation",
"Eugenics / misuse". The second question was "Is this application
dangerous in society? ". 45% said it was "dangerous "and 17%
"not dangerous" , with 40% saying "Don't know ". The main
reasons were "Ethics / discrimination ""Eugenics / misuse
""Fetus right to life ". The next was "Can this application
be received morally? ". 31% disagreed, 16% agreed and 39% said "Don't
know ". The main reasons were "Depends on situation
""Ethics / discrimination ""Fetus right to life ". The
last was "Do you think this application should be recommended? ", and
20% agreed and 30% disagreed , and 37% said "Don't know ". The main
reasons were "Depends on situation ""Right to know
""Save life ""Ethics / discrimination ".
When asked "If there are people having genetic diseases close to you , how
do you come in contact with the people ? ". Many people answered about
this question "People are same "and some people answered "Don't
know ", a few people answered "Rejection ".People who answered
those questions had some certain opinions about these tests. Some allowed these
tests to be useful and recommended more and more on this "Saving life
"point. But many had also thought we mustn't misuse these tests and some
thought to use was to discriminate against a minority. So, many didn't accept
these tests easily, and had exercised and thought "Depends on
situations". Actually, we can diagnose the genetic diseases, but we can't
treat the diseases easily at present. How much can we save our life? About
discrimination, even if we do screening for fetuses, it is near to
impossibility that we control birth frequency of sick genes. The issue is
divided in society, as found in earlier surveys by Macer, for this survey, the
answers, "I will bear. "or "I will have an abortion. ",
"If your baby have a genetic disease, what will you do? "were similar
proportions.
While there were few people with negative answers about people with genetic
diseases. Some Japanese conceive a prejudice against words such as hereditary
and hereditary diseases. The counseling system for patients with genetic
diseases and their families is also still very under - developed in Japan and
the number of qualified counselors is still low. The answers "Right to
know "and "Do not need to know ( Right not to know ) ",
conflict. If one person hopes to do the test, she can't do it easily because
the result is related to her family. Perhaps there may be may be persons, for
example children, who don't hope to know the result. So, this problem is
difficult. Even if we can know the result, can we bear to know the fact we may
get a serious genetic diseases someday at the earliest opportunity? And in this
respect, how can we know this personal latitude? There are still many problems
we have to solve. It is dangerous that these tests become popular though we
don't have sufficient knowledge about the tests. Under these situation, it is
natural that we can't take kindly to these tests. So, we have to know about
these tests and we have to tell certain knowledge. We have to have the right
ethics and we have to judge on the basis of the right ethics. Then we need to
accept diversity.
18:00 Reception
17 February, 2002
9:00-12:00 Session 5. How to apply informed choice in the clinic across
cultures
Japanese autonomy is different from individualistic autonomy: Hard evidence
- Dr. Noritoshi Tanida
Department of Gastroenterology, Hyogo College of Medicine,, 1-1 Mukogawacho,,
Nishinomiya, Hyogo 663-8501, Japan.
The autonomy principle, which was introduced to Japan from Western
individualism, has been spreading into medicine as a form of informed consent.
However, there are many narrative literatures indicating that the notion of the
autonomy principle is different from that in individualistic culture. In a
questionnaire survey conducted among 388 inclusive religious corporations in
Japan, religionists were asked who would be in an appropriate position for
decision-making regarding the introduction of artificial respiration or
antibiotics administration at the stage of terminal dying process. The result
showed that with regard to the introduction of artificial respiration, 17
(11%), 38 (24%), 72 (45%) and 31 (20%) respondents thought that decision should
be made by "doctor," "family," "patient" and
"combination of these," respectively. Corresponding figures for
antibiotics administration for end-stage pneumonia were 81 (50%), 9 (6%), 50
(31%) and 20 (13%), respectively (significantly different between these
interventions). Accordingly, when the autonomy principle was examined in
logistic regression analysis using decision-making on medical interventions by
the patient at the terminal setting as a dependent variable, odds ratios of
answers in each question showed opposite directions with respect to the results
in decision-making regarding artificial respiration and antibiotics treatment.
Japanese Christian organizations were not exceptional in this regard. A similar
attitude was observed in laypeople before. Thus, decision-making in medicine
was dependent on the means of therapeutic interventions among Japanese, which
indicates that the autonomy principle is not measured by the patient's
decision-making in Japan. Then, the problem arises as how to measure Japanese
autonomy. As it has been pointed out, individual's decision is often prevailed
by commmunity's decision, and the individual appears to accept such situation.
Presumably, a gradual time-taking process may be necessary for solving this
issue of the autonomy principle in the framework of Japanese tradition.
The contemporary situation of ethics of human
experimentation in Japan
- Dr. Takashi Tsuchiya
Associate Professor, Department of Philosophy, Faculty of Literature and Human
Sciences, Osaka City University, Osaka 558-8585, JAPAN
Email: tsuchiya@lit.osaka-cu.ac.jp
I will point out the main characteristics of research ethics in Japan after the
World War II, introducing some postwar cases in which human subjects were abused
by researchers. Of the contemporary situation of research ethics in Japan,
there are at least three characteristics. First, only a few people in Japan
regard ethics of medical research as relating to the matter of 'Jintai-Jikken
(human experimentation).' It is very curious, since progress of medicine can
never be made without experiments on human beings, and medical researchers are
performing them routinely. This curiousness has produced by a social mechanism
that hides the issue of human experimentation from the public and prevents
discussion on it. In Japan' human experimentation' is still a taboo in the
medical profession and not regarded as an appropriate issue for academic
analysis, since Japanese doctors performed deadly experiments and vivisections at
Unit 731 and other facilities in China in 1930's and early 1940's but escaped
accusation. Consequently Japanese medical profession have learned nothing from
the lessons of their own past, and Japanese bioethics lacks 'human
experimentation framework.'
Second, guiding principles for human research are not explored on the basis of
historical reflection. Due to the absence of human experimentation framework,
public discourse on research ethics remains fragmental and superficial. Third,
there is little discussion on ethics of behavioral research. I would stress the
importance of looking the historical truth of the past medical atrocity in the
face, since reflection on this truth must lay the foundation for Japanese
research ethics.
Cancer Disclosure in Japan looking at recent
medical malpractice cases
- Dr. Sumiko Takanami
The college of medical technology,, Hokkaido University,, Sapporo 060-0812,
Japan
Email: staka@cme.hokudai.ac.jp
Courts have held that cancer disclosure was one of the medical practices which
were within the physician's discretion in clinical setting. However, in recent
medical malpractice cases on cancer disclosure, courts have limited the extent
of the physician's discretion by the following factors. First was by requiring
physicians to confirm the patient's wishes for cancer disclosure. It can be
said that courts have regarded the patient's wishes for disclosure as a very
important matter from the viewpoint of patient's right. The second was by
asking whether or not medical institutions had human and material facilities
for providing patients after being informed with mental and physical care. This
means whether or not a medical institution is prepared for comprehensive care
to cancer patients has become an important consideration in judging the
appropriateness of cancer disclosure. From these decisions, we can see that our
attention has been paid to care for patients after being informed rather than
the issue of whether or not patients should be informed of cancer diagnosis.
Hospice and Palliative care has recently been discussed as an adequate care for
a terminally ill patient and these care units for cancer patients in an
advanced stage have gradually increased. These also show that there is a change
in the society from denying the cancer to recognizing it and interest has
turned to care for patients after disclosure.
Ethical issues confronted by nurses in taking
care of terminal patients in Taiwan
- Dena Hsin-Chen Hsin,
Taichung Medical College, Taichung, Taiwan
Email:
This paper attempts to uncover the ethical issues that nurses encounter in
their experience of caring for terminal patients. Qualitative data were
collected from 71 nurses in their class reports upon completion of a course in
biomedical ethics I taught. The nurses who provided these data currently work
in hospital. Four themes has been categorized from participants' description of
their caring experience of terminal patients, namely:
1. Hiding the truth of patients' condition as disrupting the patient-nurse
relationship
2. Subjective bias of medicine as a hindrance of complying with the patient's
will
3. Ignoring the reality of death as failing to promote dying with dignity
4. Ambiguous attitude of humanism to diminish the sanctity of life.
These findings reveal the overall picture of Taiwanese society with regards to
the care-taking of the terminal patients. It also motivates self-examination of
nurses to reflect the four ethical concepts for nursing practice, namely:
advocacy, accountability, collaboration and caring. I conclude that the
clinical ethics curriculum should firstly, encourage students to voice their
insights gained from the clinical caring experience and secondly, the ethical
curriculum should be problems oriented to reflect on multitude dilemmas of the
real world.
Theme I Hiding the truth of patients' condition as disrupting the patient-nurse
relationship: Hiding the truth of patients' condition was defined from the
descriptions as to withhold information related to the diagnosis, condition or
prognosis of illness from the patient, which nurses consider to be a barrier to
build the nurse-patient relationship. According to the descriptive data, there
are at least four problems caused by hiding the truth (including Nurses
distress from the competing demands of patient, families, and other medical
staff.; Problems of faithfulness within nurse-patient relationship; and Patient
can not make their own choice).
Theme II Subjective bias of medicine as a hindrance of complying patient's
will: The decision of end-of-life managements is inherently subjective from
medical convention about what is best for the patient, which nurses assume to
be a reason to go against patient's will. Issues include: Performance of
aggressive-treatment procedure under the consent of the family; chemotherapy
and radiotherapy and other destructive operation; Stop cure-oriented treatments
on doctor's own initiative; Provide life-sustained treatment at the end stage.
(tracheo tube, respirator, HD, TPN, blood transfusion, NG tube...); An advance
directive of DNR is ignored; Fail to meet the will of those passing away in
their own place.
Theme III Ignoring the reality of death as failing to promote dying with
dignity: Families' or patients' attitude of denying the reality of death and
expected miracles of medicine or alternative therapy, would delay to provide
palliative care which is assumed by nurses as a doorway to realize dying with
dignity. Issues include: Restrict all the enjoyable hobbits and activities(such
as alcohol, smoking, food and social activities ,..); Insufficient symptoms
control (pain management, .. ); Suffer from prolong dying manipulates
(hospitalization, provide expensive medicine,...); Close communication to stop
any conversation of death ; Have no advance directives of end of life decision.
Theme III Ignoring the reality of death as failing to promote dying with
dignity: Families' or patients' attitude of denying the reality of death and
expected miracles of medicine or alternative therapy, would delay to provide
palliative care which is assumed by nurses as a doorway to realize dying with
dignity. Issues include: Restrict all the enjoyable hobbits and activities(such
as alcohol, smoking, food and social activities ,..); Insufficient symptoms
control (pain management, .. ); Suffer from prolong dying manipulates
(hospitalization, provide expensive medicine,...); Close communication to stop
any conversation of death ; Have no advance directives of end of life decision.
In our presentation for TRT7, along with the issues pointed out above, we will
emphasize the mechanisms through which it might be possible to inform and make
the people understand the guidelines obtained through the simulation results in
order for them to choose the option that they find most suitable.
Frameworks for information disclosure to the
terminally ill in Japan
- Anne J Davis, RN, PhD & Emiko Konishi RN, PhD
Nagano College of Nursing, Komagane, 399-4117 Japan
Email: ekonishi@nagano-nurs.ac.jp
This paper uses findings from studies that the authors conducted in Japan
regarding ethical issues in terminal care and attempts to raise the debate
beyond the descriptive level about issues of information disclosure to
terminally ill patients. Essentially, these remarks take the next logical step
and present four possible frameworks for information disclosure to families and
patients within an ethics of relationships. Since information disclosure, or
the lack of it, stands as a pivotal point in decisions about terminal care and
what does or does not follow thereafter, the focus here limits the discussion
to this topic. Findings from the studies are briefly mentioned and based on
these data, the four possible frameworks for information disclosure are
developed. These four frameworks might be used in differing situations where
decisions need to be made. The basic ideas and questions central to the
development of these frameworks are described.
A surgeon's views on the Japanese organ
transplant system
- Kenji Yuzawa, M.D., Ph.D.
Department of Surgery, Institute of Clinical Medicine, University of Tsukuba,
1-1-1 Tennodai, Tsukuba Science City, 305-8575, Japan
Email: kyuzawa@md.tsukuba.ac.jp
Japan is a developed country in many medical fields, but it is a developing
country in the field of organ transplantation. The law on organ transplantation
was established in 1997, and "brain death" was specified legally for
the first time. However, this "brain death" is the special concept
which can be diagnosed, only when premised on organ donation. Although four
years after the law establishment passed, only 19 brain death donors appeared,
and donation of the kidney from cardiac death donors has decreased. The patient
who should be saved if an organ transplant is possible was dead in Japan. Thus,
in Japan, the organ transplant from the cadaveric donors progresses reversibly,
but the kidney and liver transplantation between relatives or between husband
and wife is progressing. Whenever few brain death organ transplantations are
performed, mass communications thronged donor hospitals and reported
competitively. On the other hand, mass communications frequently reported the
patients who went abroad to receive heart transplantations using much
fund-raising, like heartwarming stories, in Japan. The miserable present
condition of organ transplantation of Japan and the unusual correspondence of
mass communications will be discussed.
Key words: organ transplantation, donor, brain death
Emotional Reaction of Male Partners to
Donor-insemination Pregnancy in Japan
- Dr. Naoaki Kuji
Keio University, Tokyo, Japan
Email : naoaki@sc.itc.keio.ac.jp
To examine the emotional reaction of the male partner to childbearing through
donor insemination (DI) in Japan, the husbands of recipient mothers were
questioned by mail through a multiple-choice, anonymous questionnaire. Out of
190 couples who underwent DI and raised children during 1993-1998, 146 husbands
(77%) replied. Although the majority (78%) of the subjects did not tell anyone
about the DI, the persons most frequently told were the husband's parents
(17%). The most frequent motivation to start DI was the subject's desire for
children; some subject confessed that the decision was necessary "to
maintain their partnership" (14%) or because they were "reluctant to
choose adoption" (19%). Many husbands (67%) had anxiety about their
children's physical resemblance to themselves, but most of the husbands (80%)
felt great sympathy with their new family and hoped to raise another children
in the future. Almost all (145/146) husbands did not intend to tell their
children about DI. In conclusion, DI seemed to have no adverse psychological
effects on husbands and their families in Japan. However, most couples tended
to keep DI confidential.
13:00-15:00 Session 6. Bioethics Education and
Informed Choice
Disability, Feminism, and Technology: What did Japanese Disability Movements
Offer to Bioethics and Life Studies?
- Prof. Masahiro Morioka
CIAS, Osaka Prefecture University, Gakuencho, Sakai, Osaka, 599-8531 Japan
International Network for Life Studies http://www.LifeStudiesNetwork.com Email:
pbi01055@nifty.ne.jp
People in "Aoi Shiba (blue grass)," a self-help group of Cerebral
Palsy, started its independent living activities in the 1960s. They criticized
the traditional Japanese value system, and insisted that disable people had the
right to live an independent life in the town. In 1972, they criticized the
Government's bill that a fetus with severe disabilities might be encouraged to
be aborted. A harsh debate on selective abortion began not only between the
disabled people and the Government, but also between the disabled people and
the women's lib groups. Japanese bioethics began at this moment. Such minority
groups as disabled people and women's lib groups founded it in the early 1970s.
I will show some important discussions among them, which are sure to contribute
to the contemporary bioethical forum concerning disability, feminism, and
technology.
Current Ethical Issues in Japanese High
Schools
- Miyako Tachibana
Haneda High School, Haneda, Japan
In general concern, the strength of the Japanese people is based on the school
system, however the systems cause problems we have to consider. I will give
some information and present a certain proposal.
Methods to assess the teaching of bioethics
- Fumi Maekawa and Darryl Macer
University of Tsukuba, Japan
As technology advances, people are becoming more aware of the impact of science
in their daily life. There have been calls for bioethics education in order to
empower people to face moral dilemmas from numerous organizations, from UNESCO
to students themselves. Teachers and scientists throughout the world have
recognized the need for bioethics education, as can be seen from the results of
the 1993 International Bioethics Survey conducted by Macer. Attempts and
continued interest to educate high school students have led to a High School
Bioethics Education Network in Japan since 1996, and similar approaches can be
seen in other countries, too.
Some of the central questions of bioethics education are, "Does education
actually work?", "What impact does education have on the minds of the
receivers, and providers?", "When is the best time?", and
"What is the preferable way to teach bioethics?" Despite the interest
in the subject, and consensus on the need, the answers to these questions are
elusive and varied. In order to examine these questions, analysis of the
homework and comments that students gave in all the bioethics classes of Darryl
Macer, since 1990, in the University of Tsukuba has been conducted.
To examine whether students are becoming more discerning about technology, the
most objective record is a complete set of photocopies of all homework made.
The common ideas and thoughts expressed in student reports will then be
compared with the teaching materials and method used. The comments will be
discussed anonymously to respect privacy.
In this paper both thematic comparison and personal moral development seen in
the undergraduate homework reports is presented. Titles for each year and class
where firstly identified. Next, to investigate personal moral development, the
focus has been on students who have taken both the required English class and
the optional Bioethics classes. Reports with similar themes are analyzed to
investigate opinion changes through time, and with teaching materials and
methods. Some of the themes that are analyzed over time include: GM foods, when
is it ethical to do prenatal diagnosis?, personal views on predictive genetic
testing, animal rights and experiments, gene therapy, surrogacy, scientific
responsibility, AIDS, organ transplants and brain death, patenting of
biotechnology. From the analysis, it is clear that report themes influence the
ideas student express, which is logical since it is more difficult to connect
an environmental issue when the topic is more related to human medical
practice, for example. Also, individual students have the tendency to argue
from preferred viewpoints. Some students like to mention every position's
rights, while others prefer to argue from utilitarian views.
Many students seem to feel that if it is properly used, technology is a useful
tool for human society. As in most bioethical questions given in the past 10
years, students take either a positive or negative view, with a few expressing
both and some actually discussing both. Generally over the course of a year,
the variety of arguments used is extended, and more mixed attitudes are seen.
The focus up to this point was on undergraduate students. Still it will be
interesting to compare their writing to that of graduate students, to see if
experience or age makes some change in their way of expressing themselves,
which is our measure of the extent of their bioethical reasoning. This is
central to the question of what age is most suited to moral education.
Change of the opinion on problems of
bioethics after small group discussion type ethics education in joint medical
student and nursing student classes
- Prof. Shinichi Shoji
Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
Email: sshoji@md.tsukuba.ac.jp
Purpose: The evaluation by the learner of the small group discussion type
ethics education of the congruence of medical students and nursing students,
which was done for the first time in the Tsukuba University. Object and Method:
The ethics education of the congruence of medical speciality science group
annuals (elective) and nursing family 2 graders in the Medical Technology
College division (required subject) of Tsukuba University, was done for the
first time in the third term in fiscal 2000. Every time the problem of
bioethics was presented in the classroom. Students were divided into 20 small
groups. Free discussion was done in the small groups. They returned to the
classroom. 3 groups announce the discussion outline. The whole discussion was
done. Each student arranged and submitted his/her own opinion in 240 Japanese
characters. The questionnaire was done for the last class. The questionnaire
was analyzed.
Results: The respondent number was the medical students of 40 and nursing students
of 71 persons. There was no significant difference on degree of interest on the
discussion problem (surrogate mother, euthanasia, production of a child as a
sibling bone marrow donor candidate, organ transplantation of an anencephalic
infant, child birth of the homosexual couple, irreversible sterilization of a
demented sibling, mercy killing (Takase-bune), sexual selection in child birth,
emergency operation of a HIV-positive patient) in medical student and nursing
student. The distribution of the opinion in the presentation and last class end
of the discussion problem is significantly different between medical student
and nursing student, in the presentation of irreversible sterilization of a
demented sibling and both in the presentation and last class end of emergency
operation of a HIV-positive patient. Or medical student denied in 73.2% for
83.8% of the nursing student in the presentation of irreversible sterilization,
the opinion that priority is given to the contagion prevention from the privacy
was more frequent for medical student than the nursing student in the
presentation (87.8% to 60.9%) and last class end (91.4% to 69.2%) of emergency
operation of a HIV-positive patient.
Conclusion: There was no significant difference on degree of interest on the
discussion problem of bioethics. There was a significant difference of
distribution of opinion between medical student and nursing student in the
presentation of two problems and one (one of the two problems in the
presentation) problem at the last class end. Through this class, difference of
opinion between medical student and nursing student disappeared in part, and
continued in part.
Roles of biologists in bioethics education
- Dr. Kazuto Kato,
Research division for History of life forms and human culture, Institute for
Research in Humanities, Kyoto University, Kyoto 606-8501, Japan
Email: kato@zinbun.kyoto-u.ac.jp
15:20-18:00 Session 7. Environmental Ethics
Extending the Concept of Informed Choice to Environmental Decision-making
- Dr. Richard Evanoff
School of International Politics, Economics, and Business, Aoyama Gakuin
University, Tokyo, Japan
Email: evanoff@sipeb.aoyama.ac.jp
Although the concept of informed choice is usually discussed in the context of
doctor-patient relationships, many of the same issues arise in connection with
environmental decision-making at both the local and global levels. Among the
key questions this paper will seek to address are the following: When economic
activities (e.g., development projects, transportation systems, power plants,
waste disposal facilities, new technologies, etc.) are being conducted which
have a discernible effect on local peoples and environments who should be
permitted to participate in the decision-making process regarding these
activities? Should environmental decision-making be left to experts with
specialized knowledge or should they also involve democratic input from the
general public? How can citizen participation in environmental decision-making
processes be effectively implemented? Are citizens sufficiently informed to
give (or withhold) their consent for such activities? What role does the media
play in disseminating information about economic activities and their likely
social and environmental consequences? The paper will seek to answer these
questions by drawing on insights from both discourse ethics and communication
studies, and will conclude that economic activities indeed cannot be conducted
unless the citizens affected are sufficiently informed about the likely
consequences of the proposed activities and consent to their implementation.
Attitudes towards farm animals in Japan by
farmers and the public
Sakae Kishida and Darryl Macer
Masters Program in Environmental Sciences, University of Tsukuba, Japan
Farm animals have been historically tied up with human society. While the
relationship between them and us has been so common that few people seem to
stop to reflect it, they are also lives, which deserve to be given ethical
consideration. Ethical discussion over the relationship is necessary, and
earlier surveys have explored some of the relationships that Japanese people
have to particular animals, both pets and farm animals. To further examine in
detail how people perceive the relationship an ongoing survey of farmers and
the general public is being conducted, and some preliminary results and example
responses will be discussed.
Personal interviews were conducted using a written questionnaire to both the
general public and farmers and farm managers who are directly facing animals.
Some questions are asked to both groups in common to find out the similarities
and differences in their tendency of the perception between the two. The
interviews are being conducted in the Kanto region (around Tokyo) and Kinki
region (around Osaka) for the general public, and Ibaraki Prefecture (a part of
Kanto region) for farmers and farm managers. The target numbers of samples are
200 for the general public, 50 for farmers and farm managers.
Comparisons will be made to some earlier surveys in the responses to questions
that were borrowed from previous surveys. Respondents are presented with a list
of 23different animals, and asked whether they think each has emotion.
Differentiation of animals is seen, with few thinking insects or fish have
emotions. This distinction is interesting given the traditional Buddhist
philosophy that all lives are equal. It is clear that daily life habits and
relationships have affected people's views.
The results to be discussed at TRT7 will be primarily from the general public.
Most people think that some kinds of farm animals possess feelings or emotion,
however they still think that farming of these animals should continue and
there is nothing we can do about the ethical conflict of using them. Most said
that they would like to see less stressful ways to farm animals. When asked
about awareness of a December, 2001 prosecution of a farm manager in Nagano
Prefecture for abusing horses very few had heard of this. A few respondents had
heard of other cases, suggesting there is not much consciousness of these cases
in the general public. However, most respondents said they would be willing to
pay 10-25% more for animal products if the animals were reared in a stress free
environment. Similarly people are also happy to pay more for healthier food.
In a philosophy of bioethics to love life and have good relationships with
other organisms, it is essential for this discussion over treatment for animals
to spread to every corner of the society, beyond the walls of Academia. Some
implications of these results for animal rights debates will be raised.
Arsenic Contamination in Ground Water in Bangladesh: A Socio-economic Approach
to Providing Safe Water to a Badly Arsenic Affected Village Through Informed
Choice
- Wardatul Akmam and Yoshiro Higano
Institute of Agricultural Sciences, University of Tsukuba, Japan; and
Bangladesh
Email: akmamprottoya@hotmail.com
People in Bangladesh are habituated to drink water from tube wells. However,
since 1993, it has been observed that more and more tube wells are becoming
contaminated with arsenic at a much higher level than is permissible (0.05
mg/liter). As such, about 85 million people in Bangladesh are exposed to the
risk of being attacked by diseases (e.g., melanosis, keratosis, gangrene,
cancer of the skin, lung, kidney, bladder and liver) caused by high level of
ingestion of arsenic and dying within a 5-15 year period. For our research, we
have selected a badly affected village (Taranagar) in Meherpur district. In
December 2000, we carried out a survey among the inhabitants of the village to
know about their awareness regarding the problem, preferences, willingness to
pay to get safe water, willingness to walk to procure safe water, etc.). We
have also collected information on the different options available (e.g., cost,
durability, effectiveness, environment-friendliness etc.). We have developed a
mathematical theoretical model and are currently running relevant data through
simulation in order to find the guidelines to how the inhabitants can choose an
option by making a trade-off between the risks involved, the amount of money to
be paid and the distance to be covered in order to procure safe water for
drinking and cooking.
In our presentation for TRT7, along with the issues pointed out above, we will
emphasize the mechanisms through which it would be possible to inform and make
the people understand the guidelines obtained through the simulation results in
order for them to choose the option that they find most suitable.
The Myth of the Sustainable Lifestyle
- Michael J. Vandeman, Ph.D.
California, USA
Email: mjvande@pacbell.net
"Sustainability" is the Holy Grail of the twenty-first century.
Everyone and his brother claim to have found it, or at least to be able to
describe what it would look like. We are told that sustainable recreation,
agriculture, fishing, hunting, and even logging are within reach. But, like all
such "campaign promises", they aren't fulfilled, and, in fact, cannot
be fulfilled! What is missing from all of those claims is an understanding of
the finiteness of genetic diversity and the fact that all killing of living
organisms risks depleting that finite set -- i.e., reducing diversity below the
species level. The best that we can say about sustainability is that it is a
worthy goal, approachable, but not actually attainable.
Environmental Education- A holistic approach
- Dr. Rev. M. Selvanayagam and Francis P. Xavier
Loyola Institute of Frontier Energy (LIFE), Loyola College, Chennai - 600 034,
India
Today more than ever conscious-education plays an important role, and vital
role, in our life because the future of humankind depends on the type of
education one receives today. At present environmental education is very
essential and of utmost importance since it plays a pivotal role in human
growth and development. It directly affects the environment, which encompasses
our life and the deterioration in the quality our milieu results in the
unhygienic conditions leading ultimately to various epidemics and other
terminal diseases.
Environmental education should be given
importance over other subject in order to high light its values and
significance. In order to make the content more relevant, interesting, applied
and meaningful we should introduce more practical topics and issues related to
our immediate surroundings so that students will be effectively motivated and
appreciate the subject so that they will not have any compulsion in studying as
well as practicing what they have studied. Therefore it is imperative to
introduce more life oriented concepts like declaring our campuses more eco
friendly, plastic free. The other Environmental issues like disposal of solid
wastes and its management, water conservation and rain water harvesting,
converting the so called waste in to resource by wormicomposite, converting
brownery in to greenery are discussed.
Above all the ecoethics or environmental ethic should form an important
component of our Environmental education, so that the values and value system
can be inculcated from the childhood, thus our future citizens will have
education of holistic nature. The need of holistic approach regarding
environmental education is not only stressed but an outline for a systematic
education is indicated.
Air pollution monitoring cooperation among
East Asian countries
- Richard Weisburd
Institute of Biological Sciences, University of Tsukuba; and USA
People living in modern societies release harmful substances that degrade the
environment and harm people and other living things. By knowingly inflicting
harm through pollution, we violate the fundamental bioethical principals of
non-malevolence and justice. Many people ignore the harm they individually
inflict on others through pollution. However, the collective environmental
degradation caused by a country's pollution is often not only large, but
damaging to neighboring countries as well; these characteristics make ignoring
such transnational pollution difficult. Transnational air pollution imposes
ethical responsibilities on emitting countries. I present as a case study, the
development of international cooperation to address transnational acid
deposition problems in East and Southeast Asia. Although this region is already
the world's largest source of air pollution by acid deposition precursors, the
process of developing consensus about the state of acid deposition is in an
early phase, and consensus building about collective action to alleviate the
problems has yet to begin. Experiences of other regions, notably Europe, offer
valuable lessons that may help the countries of this region to address
transnational pollution problems.
Towards a New "Global Bioethics"
- Prof. Hyakudai Sakamoto
Tokyo, Japan
Email: sakamoto@chs.nihon-u.ac.jp
1) Introduction
In 1995, the East Asian Association of Bioethics (EAAB It changed the name to
the Asian Association of Bioethics - AAB in 1997) was founded in Beijing with
the common understanding that, in the East Asia, studies in bioethics stand far
behind the Western standard in many aspects, and also bioethics in the East Asian
region might be fundamentally different from the Western pattern in its
cultural, ethnological and also philosophical basis, reflecting the present-day
multi-cultural post-modernism. I myself, in these few years, have expressed my
view of this at several occasions of the international conferences and
congresses, including the keynote speech at the Inaugural meeting of the EAAB
in Beijing, the UNESCO Asian Bioethics Conference in Kobe, the 2nd, 3rd and 4th
World Congresses of the International Association for Bioethics in Buenos
Aires, San Francisco, and Tokyo respectively. In some cases my view was
sympathetically welcomed but in some other cases it was doubted. In the
following, I will discuss my philosophical ideas on the foundations of the
possible Asian bioethics together with their controversial points.
2) Bioethics as a technology assessment of modern scientific innovation
To begin with I will examine the essential nature of the Western bioethics. In
the Western world, bioethics, distinguished from the medical ethics, emerged
only in late 1960's, when at the culmination of "Innovation" of
science and technology, the movement of "Technology Assessment (TA)"
was promoted in the advanced nations, especially in the U.S.A., being afraid of
unexpected harmful effects of modern or contemporary development of sciences
and technologies including, especially, biosciences and biotechnologies. This
movement of Technology Assessment came to Japan, but did not reach China at
that time.
Now, what was the criterion to assess science and technology at that time, i.e.
1960's to 70's? I assume the criterion in the Western world (different in
Japan) was clearly criterion of "modern humanism", thus some sciences
and technologies were rejected because they were anti-humanistic. Now, however,
what is the nature of humanism here? Historically speaking, the
"humanism" in the Western world was rather
"human-centricism" which was, as its natural consequence, backed up
by the human "frontier mentality" according to Daniel Chiras's
naming. Also, this humanism was fortified by the modern idea of
"person" and "human dignity" of 18-century- philosophy of,
say, I. Kant. Thus, "person" is identified as a rational being and
therefore a human being, as a person, is free and given the human rights,
especially the fundamental human rights, such as heroic freedom to conquer
Nature.
At the first stage of the Technology Assessment, the criterion of the
assessment was clearly to protect "human being" from technology
disaster, and this aim was easily identified with protection of human rights.
This general mood reflected on the bioethics of the first stage describing
"bioethics" as "the way to protect human rights from the
invasion of bio-technologies" and through the course of debates on this
issue, the traditional paternalism was severely rejected, and "self
determination", "informed consent", "patients' right"
etc. were recommended, and therefore, paternalistic attitude of medical doctors
were severely criticized. In this stage, almost all issues of bioethics were
treated by this principle, i.e. "protection of human rights". For
instance, in the U.S.A., "bioethics" meant the "establishment of
legal system about bioethical issues from the view point of human rights",
as Professor Alexander Capron suggested me in Buenos Aires at the occasion of
IAB2.
3) A Turning Point of Bioethics in 1980's
However, bioethics came to a big turning point in 1980's. This was brought by,
firstly, the extremely rapid development of genetics and secondly, by the rise
of environmental approach to bioethics, and thirdly, by the participation of
Asian (or non-European) paradigm.
First, in the end of 20th century, we almost obtained the ability to manipulate
human gene or genome, by the way of recombinant DNA, i.e. the ability to alter
the genetic character of human body artificially. And also very recently, we
almost established the possibility of human cloning, showing the omnipotence of
bodily cells of all animals. These may imply the possibility of "artificial
evolution" to alter humankind to another kind than it is, or on the
contrary, not to alter it (by using the cloning technology) and reject the
possible natural evolution, according to our manmade objectives of our own
value system. Here, I propose to introduce a new concept "Artificial
Evolution" contrasting to the term "Natural Evolution". But how
is this idea of "artificial evolution" justified bioethically?
The first apparent bioethical attack against bio-technologies was made by the
Council of Europe of EC in 1982 by its Recommendation 934 on genetic
engineering from the stand point of Human Rights. It says "Human rights
imply the right to inherit a genetic pattern which has not been artificially
changed." However, we are now going to admit "gene therapy" which
necessarily change the human genetic pattern artificially by names of medical
treatment, which promises "human happiness". Here, human happiness
has become contradicting concept to the concept of the protection of human
right eventually.
Secondly, there occurred conflicts between the two different types of concepts
of "protection of environment". One is to protect environment in
order to preserve the best living condition for human being of its present or
future generation. The other is to protect Nature for its own sake. The former
is typically human-centric, and it has been gradually replaced by the latter
under the influence of recent developments of ecological knowledge together
with the severe regret and criticism on the "frontier mentality" of
modern humanism. People now tacitly confirming the value of Nature itself,
instead of value of human being.
Thirdly, the range of vision to look at bioethics has been expanded to the
region outside Europe and America, especially to Asia. Many bioethical incidents
happened in Asia which were quite strange to European mentality. For instance,
Japanese rejection of heart transplantation from the brain dead body was quite
odd for Euro-American minds. Also many incidents which suggest Asian hostility
to the sovereign idea of the "fundamental human rights", such as the
Tian An Men incident in China, and other events in Singapore and in Malaysia.
People has begun to notice the peculiarity of Asian minds in considering
bioethical issues. Something is fundamentally different. First of all, in many
countries in East and South East Asia, the sense of "human rights" is
very weak and foreign, and they have no traditional background for the concept
of human rights. Rather they are concerned with overcoming of the starvation and
poverty not by the human rights but by mutual aid. Recent introduction of the
European idea of human rights rather caused ethical and moral conflicts in
Asian societies. The view of Nature is also historically heterogeneous from
European. Nature is something not to be conquered but something to live
together with. Generally speaking, they hold holistic way of thinking instead
of European individualism. Therefore, they, Asian people put higher value on
the holistic happiness and welfare of the total group or community to which
they belong rather than their individual interests.
Now, in the present post-modern age, it is quite necessary for our human
society to globalize bioethics for its future development. But it is almost
impossible to do this by insisting on the universality of human rights, hence,
universality of Euro-American bioethics. Here is the reason why the new Asian
proper bioethics is needed.
4) Characteristics of the Asian Ethos
Then, what is the nature of the possible Asian Bioethics? First, it should be
built upon the Asian own "ethos" (borrowing Max Weber's terminology)
with its variety, which forms the core of unifying their own communities , and
at the same time, it should be reformed to be compatible with ethos of other
region (including Europe) of the world.
Generally speaking, Asian ethos is said to be holistic harmonism in contrast to
European dualistic individualism. Their world view and their general way of
thinking have the following remarkable characteristics.
(a) They put higher estimation on total and social well-orderedness than on the
individual interests or individual rights and dignity, and this
well-orderedness is considered to be accomplished by the well-assignment of
social roll and fulfillment of the corresponding responsibility to the people
(individuals, groups or classes). This "orderedness" depends on the
social system of each respective period of time. In the traditional
Confucianism, it was feudalistic as a matter of course. However, people could
equally enjoy peace of the society and their ordinary life. Here,
"peace" means not only state of non existence of war, but also it
means mental peace as well.
(b) Social justice is interpreted in the very realistic way, as , for instance,
a social tuning technique or the like. There were no unique and absolute God,
no categorical imperative, no free will, no autonomy to deduce justice and
precepts to control people 's behavior except to pursue social peace. Every
ethical and moral code is essentially relative to times and regions.
Eventually, there is no room for the idea of the "fundamental human
rights"
(c) Fundamental naturalism is pervasive in every Asian thought. According to
this sort of naturalism, our, prima facia, non-natural and artificial human
activities are ultimately included in nature as its small parts. Thus "to
be natural" and "to be artificial" are not contradictory
concepts at all, and the distinction is always blurred. Evolution used to be
thought to be natural in the past. But now, the "artificial evolution"
would be also thought to be natural in the Asian meta-level of the word
"nature". In short, there is no antagonism between nature and human
being in the depth of Asian way of thinking, and way of living.
(d) They are inclined not to believe or pursue any "invariance" or
"eternity". Especially, Buddhist precepts always show that
"Every thing will change". Contrary, western culture has always
sought "invariance" and "eternity" which remain identical through
every change. Thus various "conservation law" has been established in
the history of sciences, such as "law of energy conservation" and the
"parity conservation" etc. In the same fashion, they introduced
"personal identity" which remains invariant through all possible changes
as a human being. This idea of invariance is somewhat foreign to traditional
Asian ethos. This is the most significant difference between Eastern and
Western ways of understanding human being.
5)The Nature of the Possible Global Bioethics
Then what is the nature of the possible Global Bioethics? First, the new Global
Bioethics should stand on the new philosophy concerning the relation between
Nature and human being. At least, "frontier mentality" of
human-centricism of 18th-century-type-humanism must be abandoned. Also the
simple minded naturalism of "laissez faire" is impossible, for we
already acquire the ability and technology to control the human future and
human evolution. We should now establish a new humanism without
human-centricism, and also cultivate a new methodology to compromise this new
humanism and the modern science and technologies to control human evolution.
Secondly, we should reconsider now the nature of human being apart from the
theory of the 18-century philosophical anthropology of I. Kant and other
idealists, which gave a ground for the idea of universality of human rights.
However, why is only humankind bestowed such kind of "rights", and
why are those rights universal? Kant might refer to "person" or
"personhood" which is essentially rational and free. But the concept
of "person" is, as its etymology (persona) shows, only a fictional
masque socially given to humankind, therefore, it cannot be universal, and a
priori either. On the contrary, human genetic character is a priori and
universal. Therefore, "personal identity" is completely different
from "genetic identity". Also, why can we discriminate
"non-human being" in reference to some sort of natural rights such as
"non-human rights" or the "rights of non-human being" of
animals or trees? At the same time, the idea of "dignity of human
being" should be reconsidered. Why is human being exclusively dignified?
At least, in some traditional ways of thinking in Asia, there is no idea of
human dignity distinguished from animal and others. We must take the standpoint
of the "value relativism", which is a challenge to ongoing Western
bioethics.
At the same time, we have to appreciate the fact that in Western societies,
most people, even professional ethicists are still inclined to believe the
absolute universality of "human rights" and therefore, that of
bioethics, and also, this idea properly functions in leading and controlling
their social systems, especially their "law systems" in the Western
world. Our urgent task here is to find the way to make both positions concerning
"human rights" and "global value relativism" compatible in
order to find a new refined methodology of the global bioethics.
Thirdly, we have to investigate the new philosophy for the foundations of the
Global Bioethics. I believe it must be grounded on the traditional Ethos of
each region which may be fully various, and sometimes fundamentally different
from the European one in many aspects, and has experienced a different history
from the European one, especially in the modern age of these few centuries. It
is not easy work to unite these varieties. However, this work is the most
crucial part of the Global Bioethics, which is expected to harmonize and to
bridge over all kinds of global ethoses, east and west, south and north. In
this sense, the new Global Bioethics should be "holistic" in contrast
to European "individualistic". Taoism, Confucianism, Buddhism are all
overwhelming on the Ethos of Asian world in its depth still now. Their
doctrines and precepts are all holistic in general. They tend to put higher
value on nature, society, community, neighborhood and mutual aid than
individual ego. It is a sort of severe anti-egoism. But it is not necessarily
altruism either. It always seeks some sort of holistic harmony of the
antagonists.
One might be afraid that this kind of holism is a sort of paternalism which was
already rejected in the beginning of recent bioethics by the honored name of
"personal autonomy". However, we should notice that some new
bioethical issues such as issues of genetics and environmental crisis
necessarily require some sorts of communitarian way of thinking of, may-be,
non-Western type, but typically of Asian type. Here, "harmony" is the
key word. The Global Bioethics will begin now with the effort not only to deny
the European idea of individual autonomy, but also harmonize it with the new
holistic communitarian way of thinking from the global point of view.
18:00 Reception
18 February, 2002
9:00-11:30. Session 8. Cross-Cultural Global Bioethics
9-10am General discussion on TRT statement, and preparation for student
interaction
10:10-11:30 Participation in a student lecture on ethics and genetic
engineering presenting views from different cultures
13:30-18:00. Concluding session. Preparing a TRT Statement on Bioethics in
Asia
Discussion and development of a TRT statement, based on discussions from TRT1
to TRT7
Secretariat for all meetings (return the
registration forms to):
Prof. Darryl Macer, Institute of Biological Sciences, University
of Tsukuba, Tsukuba Science City 305 - 8572, JAPAN
Fax: Int+81-298-53-6614 Email: asianbioethics@yahoo.co.nz
Come and see more of Japan, while meeting in a
cross-cultural setting. The focus is on interactive bioethics debate so every
speaker is limitedto ten minutes, followed by roundtable discussion.
Seventh International Tsukuba Bioethics Roundtable (TRT7) - return
registration form copied from the www.
Registration (Y20,000) (includes lunch)
TRT7 Day registration (Y7000)
Student day registration (Y2000)