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

To trt7 program

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,
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 JyvŠskylŠ, 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
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,

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
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
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

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
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)

To trt7 registration form, and more details

To Eubios Ethics Institute