The 2nd Ethics Crossroads Town Meeting

March 11th 2005 12:30~15:30
at KIT Tokyo Campus

Program

1. Lecture
   "Bioethics in Asia, a Bioethics in non-European/U.S. values"
   Ryuichi Ida(Prof. Kyoto University of Graduate School of Law)
2. Progress Report of Projects
   
   1. Toward the development of a Global Code of Science and Engineering Ethics
      Hidekazu Kanemitsu(KIT)
   2. Studies on Agora
      Fumihiko Tochinai(KIT)

Lecture

1. Introduction: Why bioethics in Asia?

[Objectives of the Project]

Major theories and doctrines of bioethics originated in Western countries in the 1960s. These bioethics theories are based mainly on Western values and norms. For example, the principle of autonomy is based particularly on Euro-U.S.individualism. In contrast to Euro-U.S individualism, the values of family, society and community are given importance in Asia. Is it possible to discuss bioethics in Asia using western concepts of bioethics?

Two objectives of the Project are: 1) to clarify a bioethics theory that includes Asian elements. 2) to introduce Asian elements of bioethics into global discussions of bioethics theory.

[The Situation in Asian countries]

Research in Life Sciences in Asian countries is at approximately the same level as the Europe and the U.S. Consequently, bioethics issues are occurring in each country.

Sale of organs(Philippines),human cloning(South Korea),prenatal diagnosis and abortion, and transplantation from prisoners (China),gene examination (Thailand), etc.

National bioethics Committees are already established in China, India, Korea, and Nepal. China, India, Korea, and Singapore have legislation or governmental regulations on bioethics (Malaysia is preparing now).

Western bioethical values and concepts might not be always applicable to Asian countries having different concepts of human life. Application of western concepts to bioethical issues in Asia may hold back the development of life science in Asian countries and may block international joint research.

[What should we do in Asia?]

We will address the topics below:

1. Promote an understanding of bioethics and life science
2. Establish a national bioethics committee and IRB (Institutional Review Board)
3. Develop standards of bioethics
4. Articulate an Asian Bioethical view -> enter it into a universal bioethics standard

2. Methods

We studied Bioethics in Asia through discussions in sub-regional workshops and the Asian Bioethics Congress.

The Asian Bioethics Congress was held in Sep. 2003 in Kyoto. Participants included 32 from Asia (Philippine, Korea, India, Singapore, and so on) and 4 from Europe and U.S. The agenda was to understand the situation in Asian countries, present and discuss various bioethical issues in each of Asian countries, and introduce Asian elements of bioethical consideration to the world community. The participants' backgrounds are law, bioethics, science, science communication, and so on.

3. Basic Ideas

The situation of Asian bioethics in each country is unclear. Information was collected about the current conditions from each country.

Concretely, we invited theoreticians (bioethicists, lawyers) and practicing specialists (responsible ministries, researcher institutions, medical institutions)

Our conclusion is "Asia" is "ONE", but not "ONE". Asia is so large geographically, and has diversity in history, religion, development, ideology, and so on. However, they have a common identity as Asia, not Euro-U.S.

4. Diversity of Asia

[Diversity of Asian Countries]

Asian countries have major differences in their domestic circumstances. These include political stability, economic status, level of life science, medical research, health care, and so on.

There are large differences in values. They have diversity in social values on family, community, human rights and ethnic groups. Religious diversity can be said to be the largest.

The main religions in Asia are: Buddhism, Christianity, Islam, Hindu, Confucianism, Hinduism, indigenous religion, folk beliefs, and so on.

Three of the largest civilizations were born in Asia: Yellow River(China), Indus Valley, and Mesopotamia; so, it is easy to imagine that they developed unique cultures and civilization.

These differences influenced and gave diversity to the relevant conceptions of bioethics.

[Religion as the Predominant Source of Diversity]

Religious precepts play an important role in bioethics in Asia, directly or indirectly. However, the religious influence is not the same depending upon the country, religion and issue.

The clearest case is Islamic countries, which always refer to the Koran, and bioethics are substantially defined by it.

In some countries, the Catholic Church plays a dominant role in dealing with assisted reproduction and embryo research and other life issues.

Buddhism, in some countries, especially in Thailand, is very influential, although it does not seem to require very severe constraints. In some other countries, Buddhism is relatively silent on bioethical issues. There are significant differences between Hinayana Buddhism in southern countries and Mahayana Buddhism in northern countries.

In China, Japan and Korea, Confucianism is rooted deeply among the people. We should understand Confucianism as a philosophy of daily life rather than religion. ･ There are cases where religion is separate or a sort of bioethic minimum standard that crosses all religions is established.

5. National Framework of Bioethics

[National Framework of Bioethics]

In almost all Asian countries, legislation or governmental regulation and guidance on bioethics were made during the last 5 years (in particular, after 2000). The majority of cases are governmental guidelines. The responsible ministry or agency is spread among agencies, in Japan MEXT, MHWL, and METI each has responsibility for bioethical issues. In Asian countries, Min of Health, Min. of Biotechnology, National Institute of Health, National Medical Council and similar agencies have authority.

Asian countries share a common perception that they should have a National level bioethics committee. The committee would not be a final decision-making body but a consultative body and should be inter-disciplinary.

In some countries, the division of authority among relevant ministries and agencies prevents appropriate and efficient control over the whole range of bioethics.

[Public Awareness of Bioethics]

In Asia, public awareness of bioethics is generally low, since problems of insufficient health care are more serious. In these situations, science and technology are deemed "GOOD" per se and education and training for bioethics are not a main concern for researchers or for the government. "Democratic" or "Individualistic" thought are not a characteristically Asian product. The value of the "Society" or "Community" is usually a priority. However, certain issues such as organ transplantation or human cloning are sometimes vehemently opposed by the public,.

6. Organ Transplantation

In almost all Asian countries, organ transplantation is practiced. Religions are not a serious barrier for organ transplantation. Some religions seem to support or encourage transplantation.

The definition of death (brain or heart) varies. Kidney transplant is widely practiced, and even more recommended than dialysis.

Transplantation from living donors is practiced in many countries. For example, in Vietnam, for kidney transplantation, only transplantation from a living donor is recognized.. Unlike Japan, in some countries, donation from non-related donors is permitted.

Sales of organs are not officially permitted in any country; however, the practice varies.

So, in Asian Countries, organ transplantation is permitted though they have some differences in detail.

[Organ transplantation: Situation in each country]

1) Philippines

• They have the organ transplantation guideline.
• Neither sales of organ nor brokerage are permitted.
• Transplantation from living related donor is permitted only when transplantation from brain dead donor is impossible.
• Over 25 years old
• Incentives: compensation benefits for absence from work for living donor
• Sale of organs in the black market is a source of income for the poor.

2) India

• Character of Indian society:wide gap between rich and poor
• Personal expenditures for health care is high, so only rich people can choose their own approach to therapy.
• Sale of organs is a source of income for the poor.
• Organ transplantation from wife to husband is frequent, however few transplantations occur from husband to wife (male-dominant society).
• People have a faith that blood donations make a person weaker and organ transplantation prevents reincarnation, so they tend to dislike donating organs.

3) Korea

• In 1999, an organ transplantation law was enacted.
• In 2000, KONOS(Korean Network for Organ Sharing), which manages organ transplantation from brain dead donors, was established.
• They will promote transplantation from brain dead donors through the easing of regulations in 2003.
• Presently, 90% of transplantation is from living donors.

4) China

• The number of organ transplantation is in the top 2 in the world.
• They are positive about organ transplantation from intentionally-aborted fetuses or from death row convicts. Organ transplantation from death row convicts is based in the concept of "Jen" ("humanity" in Confucian teaching).
• People have feelings of resistance toward organ transplantation since they do not like to harm one's body. Today, transplantation from parent to child is common; however that from child to parent is rare, under the effects of the one-child policy.

5) Muslim countries

• Organ transplantation is be accepted as a part of lifesaving.
• Brain death is death of person; euthanasia is homicide; with-holding of life-support treatment for transplantation is not homicide.
• Fee reward to a donor is permitted(the sale of organs is not permitted).

6) Buddhist countries

• Organ transplantation is accepted as benevolence, as far as it is free from avarice. Sale of organs is not permitted.
• In Buddhist culture, living is defined as breathing. So the change of definition of death (including brain death) causes social anxiety.

7. Human Genetic Research

In many countries, human genetic research is done on a high level. China, Japan, Korea and Singapore are the most developed in this field. In Vietnam, the regulations concerning this research are generally set in the form of guidelines.

Each country develops its genetic research following its country interests. (Ethnic origin, HIV/AIDS, cancer, and others). For example, HIV/AIDS in Thailand, cancer in Malaysia and Indonesia.

In the four above-mentioned countries, a human genetic database is being prepared. Japan has already begun its large scale Biobank project (300,000).

It appears that human genetic research is not easy to get the public involved in a public discussion. Human genetics is not a field that has attained a general understanding.

The Patient-Dr.relationship is often influential, if not coercive.

Informed consent is the accepted principle, but the practice shows that the information given is not always sufficient. In Asian countries including Japan, people have confidence in doctors, and may tend to feel the base to be trust and community in the Dr-patient relationship.

The importance of personal genetic information is not well understood. People may not easily imagine potential disadvantages or damages caused by the abusive use of genetic information.

8. Human Cloning

Human reproductive cloning is banned in all Asian countries(by law, regulation or declaration). From religious points of view, human reproduction by cloning technique is too far from the natural way of human reproduction.

Therapeutic cloning receives both pros and cons. The majority is not totally against therapeutic cloning (Philippines is clearly against it). However, such differences of position in not because of Asian countries, but depends on which religious consideration is predominate in the country.

9. Human ES Cell Research

This is the area that religious concern has the largest influence.

• Catholic Church: totally against ES cell research
• Buddhism: Supports ES cell research, because of its beneficial nature for human beings.
• Jews: Surplus embryos are not considered as an actual person.
• Hindu: unclear
• Confucianism: Against embryo research, but follows the statutory regulation.
• Islam: Embryo under 4 months are not considered to have begun human life.

In general, creation of new embryos only for research in not permitted in any of these religions. Only surplus embryos may be used for ES cell research.

No country in Asia permits creation of embryos for research.

Only China allows ES cell research with: aborted dead fetal tissue, frozen embryos or gametes remaining after IVF, voluntarily donated gamete, and embryos from therapeutic cloning (Sep.2003).

Today, Human ES Cell Research is permitted in Korea; Japan, which is under a moratorium, also will permit Human ES Cell Research subject to development of a research system.

10. Concluding and Prospective Remarks

["Asian bioethics" or "Asian elements of bioethics"]

Asia is very diverse; it is difficult to say that there is a unified Asian bioethics. However, I think it is possible to say that there are Asian elements of bioethics.

Examples of Asian Element of bioethics:

• metempsychosis (transmigration of souls)
• we should not harm our body because our bodies are gift from our parents
• the role of family is so important that decisions are made with family
• a community oriented decision-making style

It is important to take Asian elements of bioethics into account in the discussion of universal bioethics.

[Topics to be discussed]

1. What are the main difference between countries: religion or life customs?
2. Are there any common factors of bioethics between Asia and Western elements of bioethics?
   • Basic concepts and large principles may be the same.
     Ex. Respect of human beings, protection of patients
   • At the level of actual practice, there may be differences.
3. How to integrate both Asian and European elements into an universal bioethics?
   • Through constant assertion of Asian values of bioethics.
   • Discussion with a spirit of mutual respect and tolerance.

[New methodology for research]

Proposition for a new methodology for research: We aimed at a problem-solution oriented research rather than theoretical research, in which we did a lot of interviews and discussion in meetings and conference rather than text-reading, the usual methodology of ethics.

Interdisciplinary approach: each discipline has different research systems and cultures, so we had some difficulties in doing collaborative research. We need core members for the project, from 4 to 10 members.

This was an international society oriented research project, so most of our outcomes are in English. We succeeded in taking a leadership role in this area, though transmission of information was not sufficient.

The outcome of the project was mutual understanding and a human network.

The future challenge is how we can continue discussion of Asian bioethics after the formal period of the project is finished.

Q&A

1. Who takes initiatives in this area, scientists or non-scientists.

Q) In Japanese Society, persons with a social science background tend to take the initiative; however in this area persons with a natural science background should take the initiative. What do you think?

A) In this area, persons from natural science discipline have taken the initiative, however I think it is important to discuss from both natural science and social science backgrounds.

2. How to introduce Asian elements of Bioethics to the international society ?

Q) My background is German Philosophy, and now I am studying and teaching Bioethics and Science and Engineering Ethics in University. I have dilemma in studying, teaching, and introducing them. I feel discomfort with Western Bioethics in daily life as a person; however I tend to use Western vocabulary or concepts to discuss or introduce Bioethics in Asia as a scholar. Would you give me some advice about this dilemma?

A) I have similar experiences. I think the expression of basic concepts or rules such as respect for human being are similar in both areas, Europe and Asia. However we have differences at the everyday practical level. As I said in the conclusion, mutual understanding and tolerance are important. With an awareness of differences and carefully considering each position, we can proceed. The declaration of universal bioethics drafted by UNESCO does not specifically say "Asian" but includes the words "cultural diversity". "Cultural diversity" are not the perfect words to express the idea mentioned above, however I do not have other words than this to express the idea.

Q) How are you going to clarify and introduce the Asian elements of Bioethics in the future?

A) We reached the conclusion that Asian people have different beliefs and norms such as metempsychosis, community oriented decision-making style and body as a gift from our parents. However, we have not covered how such Asian beliefs effects to bioethical problems at the practical level, or what the origin of the differences is, religion or indigenous faith. We should study these remaining problems and take Asian elements of Bioethics into account in universal bioethics.

Q) I think it is difficult to explain Asian elements conceptually. So my idea is that it is useful to accumulate concrete cases which express Asian elements, and categorize the cases.

A) I agree with you. In the future, we would like to assemble such cases and find a concept to express Asian elements in cases.

3. China, Japan, and Korea as the first priority

Q) Asia is too large and diverse to deal with as one area. So, I think the area of China, Japan, and Korea is the proper area to discuss at first, since they have Confucianism culture and are one economic region. What do you think?

A) China, Japan, and Korea are easiest to understand for us Japanese. However, my original interest was in the difference between European and Asian including Japanese Ethics. So I used the concept of Asia as a non-European area. I thought that there is diversity in Asia and divided it into 3 sub-regions. Among the 3 areas, we understood East Asia best at the Seoul workshop. China, Japan, and Korea share the influence of Chinese civilization. Southeast Asia is an area of Buddhism also, but differs from China, Japan, and Korea. Central and West Asia is a Muslim area, it has the most differences from us. Through, sub-regional workshops of the 3 areas during the 2nd year of the project, and the international conference in the 3rd year where people from the 3 areas discussed together, we came to understand differences and common elements.

4. Sharing mission among Asian countries about this Project

Q)Did the people from Asian countries other than Japan share the interest of the mission to clarify Asian Values?

A)They shared the idea that Asia has differences from Europe; however Asia is too diverse to extract Asian Bioethics.

5. Legal system

Q) In the future is there a possibility that Asian elements of Bioethics will completely change the international legal system and legal system about biotechnology?

A) I do not think so. They use general and neutral terms in universal bioethics declarations such as the UNESCO declaration. I do not think legal systems will change suddenly and dramatically even if we avidly introduce Asian elements. It is likely more correct that what has heretofore only been a European-U.S. form will be modified by Asian elements.

6. China, Japan, Korea relationship

Q) The subject of China, Japan and Korea came up. Since the Meiji Restoration Japan has focused on Europe and the U.S. and almost ignored China and Korea, and perhaps do not understand them well.

A) In our project, we approached "Asia" as non-European/U.S., so in a sense we looked at China, Japan and Korea from outside of the area. However your comment is from inside of the area. I think both viewpoints are important.