Eubios Journal of Asian andInternational Bioethics
EJAIB Vol 17(3) May 2007

ISSN 1173-2571

Copyright ©2007 Eubios Ethics Institute (All rights reserved, for commercial reproductions).
31 Colwyn Street, Christchurch 8005, New Zealand
c/o Darryl Macer, RUSHSAP, UNESCO Bangkok, 920 Sukhumvit Rd, Prakanong, Bangkok 10110, THAILAND

Eubios Ethics Institute World Wide Web: eubios.info/index.htm
Official Journal of the Asian Bioethics Association (ABA)

Abstracts of presented papers at the Eighth

Asian Bioethics Conference (ABC2007)
concurrent with the Second UNESCO
Bangkok Bioethics Roundtable (BBRT2)
19 – 23 March 2007
Century Park Hotel, Bangkok, Thailand

Monday, March 19, 2007
1. Opening Session

Chair: Dr. Soraj Hongladarom
Welcome to the Eighth Asian Bioethics Conference: All Nations … The
Phantom Next Generation (ABA Presidential Address)- Jayapaul Azariah, Ph.D.
President, Asian Bioethics Association; Chennai, India
jazariah@yahoo.com
Distinguished dignitaries on the stage, honored experts in bioethics andtechno sciences, ladies and gentlemen. I am happy to be present in this unique
ABA conference. I would like to bring to your knowledge and concern someselected bioethical issues that are currently discussed in India. I perceive thatthese issues are also faced by all nations. Since all nations are concerned about
the next generation I think that discussing these issues is very important.
Human beings are unique in this biosphere because humans are not only
related to the past but also to the future generations. “Man (Humans) is Man
because he shares a common culture… not only (with) its living members but
also members of past generations and those yet unborn…” (Worsley, 1970).
The problems of the present century and our generation are radically different
from the previous century. It is going to be far, far different from the present!
Are we the conscience keepers of the generation to come?
At the outset we need to consider the three realms (i) Ecology (ii)
Economic and (iii) Ecuminics – anthropocentric development. All threespheres sprout from the same common Greek work “oikos” which means houseor a dwelling place. The word ‘nomics’ stands for ‘management’. We need to
manage the principles of ecology and infuse it with the management of thecommercial world with an aim to achieve a balanced, healthy and just society.
In this current era of neo-liberal globalization we are witnessing a
proliferation of different types of ethical, legal and social Issues. The next
generation is in increasing danger of facing extinction. Therefore, we need toconsider the challenges confronting us. In identifying these global problems for
global solution, let us consider the remedy in a reflective mood. Let me list
some of the problem areas.
The Nathari Killings Loss of sacredness of human life
Nithari is a small village in the District of Noida in Uttar Pradesh, India.
Reported to the police but unattended is the incidence of shocking and brutal
and traumatic incidence of disappearance of young women and children (JanFeb 2007). The whole episode came into public light when human skeletal
remains were unearthed in a near by gutter, close to the suspected murder(s).
The motive of gruesome killing is not very well established. Killing for theorgan trade has not been ruled out. In any case, these incidences raise a batteryof bioethical questions. The vulnerability of the poor in a village to
exploitation, the human rights and human dignity of the innocent and poor
victims, non-existence of accountability in law and legal systems. All thesequestions only endorse that human values have been eroded, plunging thecommon citizen into insecurity. The poor had brought to the notice of the
Police about the disappearance of their children over a period of two years. But
the First Information Report (FIR) was not filed by the Police. Under the
carpet are the issues like transparency of law enforcement system, theconstitutional binding of the judiciary, political patronage and corruption inhigh places. The sanctity of human life has been lost in its fullest sense. Such
disappearance of human beings does happen in All Nations for various
reasons. The answer to uplift human rights and human dignity is to develop asystem of bioethical machinery to upload human moral values in all humans
across cultures and geographical barriers.
Female Feticide and sanctity of life
Another closely connected issue with regard to the question of scantregard of the sanctity of life is the practice of female infanticide. With theadvancement of science and technology, human civilization has advanced a
step forward. Why wait for the infant to be born and then eliminate? If we cando it much earlier then let us do it! The stage has sifted from ‘infanticide” to‘feticide’. According to Ms Renuka Chowdhury, Minister for Women andChild Development, the current estimate of ‘murder of unborn children’ isaround 10 million in the last 20 years! These unfortunate girl children are
eliminated merely due to economic reasons connected with the practice ofdowry and other collateral expenses in bringing up a girl child. Two ELS
issues arise: (1) In the continuum of human development, from conception tobirth, when does a human being is a human being and when does human life
start? Does it start right from conception or at birth? (2). The second ill effectrelated to the undesirable tilt in the male-female sex ration of a nation. The sex
ratio for the world stands at for every 1000 males there are 1050 females.
Whereas the Indian rex ratio is 1000: 933, and 927 under the age of six. The
pattern changes from one State in India from another. The safest state is Kerala
where the ratio is 1000: 1058 while for others for 1000 males the number offemales in Delhi = 821; Haryana = 861 and Punjab = 876. Some states like
Daman and Diu = 710, and Chandigarh is 777. The social consequence will be
the unavailability of a bride to an eligible bachelor. Three out of ten boys in
Chandigarh may face the notice saying “all sold out – Out of Stock – Trylater”. The next generation will be affected. Moreover, humanity stands in direneed of giving a clear guideline to the question ‘When does human life start, atconception or later?’ If it is later, then there is no need for anybody to beconcerned about the social, ethical and legal issues due to foeticide. Killing an
animal is NOT murder. But killing a human being is murder. If a foetus is not ahuman, then humans can have a jolly good time – sex is for pleasure and foetus
is for elimination.
Some bio-political issuesoInstitutionalized injusticeo
The question of corruption in Government ministers down to the
Policeo
The misuse of power vested on officials by the Constitution ofIndia.
oAbuse of power by officials in PoweroStress on transparency and accountabilityoProvision of protection to law enforcing authorities and preventionof political interferenceo
To train young people right from the start through Bioethics
education.
Viral out breaks and Health
Viral fever is deadly in many respects. We had common flu, influenza,
dengue fever, bird flu and Chiengunya. We are familiar with words like,
incidence, prevalence, and epidemic but not to the word pandemic. It is

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Eubios Journal of Asian and International Bioethics 17 (May 2007)

commonly believed in scientific circles that we are only two mutations awayfrom the pandemic situation. Britain is the recent victim of bird’s flu. Millionsof birds were culled and destroyed due to the fear of assuring in a pandemic
situation. In one view is a phenomenal wastage of human food resources andon the other hand the birds faced an ‘untimely’ death. This story is not new inother nations like China, Indonesia, Vietnam, Hong Kong, Malaysia, Thailand,Laos, Nigeria and Russia - both in European and South East Countries. Such a
global outbreak affects all nations.
The virus - H5N1 - though a resident in avian population, it has the canine
ability to befriend humans though its passage through other infect a wide
variety of mammals (cats). If it acquires the distasteful ability to infect humanbeings and if it acquires the ability of human-to-human transmission then weare at a loss. It may be impossible to prevent a pandemic situation. A recent
WHO statistics reveal that out of the 271 humans infected with this deadly
virus, about 165 humans have died since 2003. The poor in Indian villages
keep poultry along with their kitchen garden! It is time that bioethicalstandards are enforced in the mass production –battery – of poultry as well as
to develop preventive measures in terms of developing vaccines both for thebirds and for the humans. People of All Nations and avian population of All
Nations need to adhere to bioethical precautionary measures.
Gay Rights
There has been much discussion in India to recognize the rights ofhomosexuals. Many well informed Indians do think the ‘gayism’ is not an“abnormal” disposition in human sexuality since incidence of homosexuality
has been reported in animals and hence their rights as homosexuals are to berecognized on the grounds of justice and human rights. It is a matter between
two consenting adults. So no conflict is involved! Some others think that if it isan abnormal feature in human beings then regulatory measures are to be
introduced.
Many aspects are to be looked into such as sociological and medical
reasons besides biological and spiritual aspects. Biologically the phenomenonof sex and sexuality is very complex and un-comprehensible. Sex is thegateway for reproduction. But today’s science and technology has eliminatedthe need for sex in procreation. Science and technology advocates that sex isfor pleasure and IVF technology is for procreation. In any case, it is impossible
to produce an offspring without the womb of a female. It is our only limitation.
But it is possible get a progeny without a ‘sperm’ as in the case of ‘somatic
nuclear transfer’, technique used in cloning can eliminate the necessity of asexual intercourse and the sperm but not the womb. In the future, it may bepossible to bypass the involvement of a woman’s womb in procreation. We
have to wait and see! Or medical technology has successfully transplanted awomb. Will technology of womb transplantation in a male’s body save andsolve the problem?
From a biological perspective the natural outcome of human sexual unionis the resultant birth of a child. This process is considered ‘natural’. In thecontext of human male-female relationship, leading to the birth of a child, isalso considered as “normal”. Any other process, which does not fall in linewith the above formula, i.e. not leading to the birth of a child, is considered“unnatural” and not ‘abnormal’ When human technology is involved in IVF,
the question naturally that is raised is this, whether it is natural or not?
In the context of homosexuality, St. Paul took the position of “unnatural’
with regard to same sex sexual relationship (Book of Romans chapter 1 verses
24-27). A thing is unnatural when it does not lead to the expected end.
Biologically, homosexuality is unproductive. Therefore, St. Paul consideredthat homosexuality is “against nature”. He continued “men with men
committing what is shameful and receiving in themselves the penalty of theirerror which was due” (v. 27). That is why there is presently a big rift in theChristian Church since a precise opinion is divided. Ecologically, anyanthropocentric (human centered) act that is not ‘in tune with nature’ (i.e.
against nature) has a ‘price tag’ attached with it. It is unproductive.
The trade off is the extinction of a community. A guide, while narrating
the glory of Ajanta & Ellora caves in India (2nd Century BC to 10th CenturyAD) commented that a community of Buddhist monks did not survive throughgenerations because it was a community of uni-sex (male only) monks. For ageneration to continue, the natural pairing between male and female is vitaland necessary! In the future, The Supreme Authority of The New Sociological
World Order may promulgate to ban heterosexual community and all must be
homosexuals. Then there will be no ‘next generation’. The World without thenext generation of humans will be a peaceful and happy place indeed!
Two options and Precautionary Principle
There are, therefore, two options. One option is to term the practice ofhomosexuality as ‘unnatural’ and non-productive. Based on this premise thesociety can impose a total ban. In the second option, the human rights principleof homosexuals can be recognized and the practice can be legalized as has
been done in many European countries. In both cases, the pros and cons need
to be considered critically.
If the homosexuals desire to have a child then they have to look to theheterosexual for the procurement of a baby to be adopted! Current technosciences have now separated the domain of sex from ‘reproduction’. Only thelesbians but not the gay couple can obtain a progeny with Assisted
Reproductive Technology (ART). ! I Therefore, bioethically, the‘precautionary principle’ has to be applied so as to mitigate future unforeseensocial and cultural risks, if any, when the rights of homosexuals are legally
recognized as a ‘natural’ behavior like any other homosexual humans. As
science and technology progresses human beings will be endowed with thedisadvantage to distinguish between ‘natural’ and ‘unnatural’.
Bioethical maturity is to balance the benefits of benefits and risk ofextending equal rights to homosexual. One area that is needs to be addressed isthe ‘adoption laws’ relating to the adoption of biologically unrelated children
from different lineage. Secondly, the words such as ‘parent, mother, andfather’ may be confusing to many. Hence, the word ‘family’ needs to be
redefined which would exclude the family component of ‘grand parent, grandmother and grand father’ since there will be no such entity as grandfather.
Hence, the new definition of family may have to be acceptable both legally andculturally to all the different strata of the society! This homework has to bedone before hand i.e. before granting the homosexuals equal rights with theheterosexuals.
Climate change - mirage or a reality? Issues cheaper by the dozen
Any consideration on matters relating to climate change may include thefollowing:
1. Increase in surface temperature of the total Biosphere
2. Linked with global industrial development since 1970s
3. Significant rise seen from 1996 to 2006:* Warmest decade and 1998 warmest year since 1861
* Second warmest year 2005
4. 2007 PREDICTED to be the warmest year, more than 1998
5 During 20th Century the temperature has increased by 0.7 to 0.8 degrees
6. Prediction – by the end of this century it could rise by 1.4 to5.8 degrees
7. Global warming is linked with sea level rise
8. Sea level rise is linked with melting of polar ice caps and glaciers
9. Polar ice caps are reduced and glaciers have shrunk
10. Effect on Land - Monsoon in India has been retreated /decreased
11. Extreme weather changes – Either floods or droughts
12. Rise in atmospheric temperature may or may not result in heavy andexcessive rain
13. 2005 was not only the hottest but the rainfall was also excessive thannormal. What is the relationship between the two? We do not yet know.
14. Intergovernmental Panel on Climate Change formulates necessary
precautions and has now blamed humans for all anthropocentric development.
Climate change can topple a nation
Wu Chong enumerated a detailed account on the consequences of climatechange to Emperor Gaozu, founder of the Tang Dynasty. But his empire
collapsed. It is suggested that weak winter monsoon rains may havecontributed to the decline of both China's Tang Dynasty and the Mayan
civilization in Mexico. The authors speculate that global climate change,
causing a tropical rain belt to migrate, may have been a factor — with the same
system affecting monsoon rains in Southeast Asia today. It also emphasizes
that any shifts in an area of low pressure that follows the equator, known as aninter-tropical convergence zone, with weakened monsoon rains in winters
during the eighth and ninth centuries. Dynastic changes often involved popular
uprisings during phases of crop failure and famine, and these are consistent
with periods of reduced rainfall. The same inter-tropical convergence zone
shifts in response to periodic El Nino events, which weaken monsoon rains inSoutheast Asia in the modern era. The final conclusion is that "But I believe
the weather did play an important role in Tang's decline,"
Two human measures
Two significant human endeavors to save the environment and reducecarbon dioxide emission are: (1) The United Nations Conference on
Environment and Development at Rio de Janeiro in 1992 and (2) the Kyoto
Protocol in Green House Gases (GHGs) emission in 1997. GHGs are carbon
dioxide (CO2) - emissions from coal fired industry, automobiles and airplanes,
Methane, Chlorofluorocarbon (CFC) Methyl bromide (Used in agriculture) andtrifluoromethane (HFC -23; a byproduct in incinerators) Any reduction in
GHGs to about 20% by developed countries (North) may have an adverse
impact on their industrial development which may adversely change Gross
Domestic Product (GDP). As results, the luxurious lifestyle of people in the
countries of the North has to change, which nobody wants to reduce.
The Earth Summit in AGENDA 21 concluded “The responsibility topreserve our natural resources for future generations must become one of ourhighest priorities. Reversing the damage we have wrought will be difficult,expensive and achievable only over a long period of time, but with a concerted
worldwide effort, it can be done. The Earth’s future requires it”. So the battle
to save the environment goes on without reducing the GHG. The Kyoto
Protocol has a built in component for the inclusion of a ‘Clean Development
Mechanism (CDM)” to reduce GHGs reduction.
Carbon Market
Carbon trading includes a component called “Certified Emission
Reduction (CER)”. One CER is equated with one tonne of CO2 reduction.
CMD has a component called ‘Carbon Bank’ which is a measure of EcoSecurity against the negative impact of GHGs. Again the three major players
are involved: (1) Ecology (2) Economics and (3) Ecuminic. The World Bank
prototype Carbon Fund may pay a sum of 3-4 $ per a tonne of CO2. If it can becertified that a single tree can reduce up to a tonne of carbon then a sum ofmoney (about 6 Euros) can be paid and the Eco bank can sell the CER to apolluting industry and charge them a higher rate say 20 euros. Attempts havebeen made to reduce the usage of CFC gas the ‘rich’ in the world – both in the
North and in the South – are air conditioning their premises with sophisticatedtechnology and with plasma and liquid crystal display (LCD) televisions whichis energy intensive civilization icons. Should we not, in the near future, turn torenewable energy sources like solar and wind energy? Or in spite of setback inincineration of solid waste materials humanity can turn its attention to suchalternate energy producing mechanisms.
Market Economics of carbon
Globally about 459 polluting industries have registered with CDM; ofwhich Indian component amounts to about 29%. A Gjarathi Company dealing
with fluorochemicals and refrigerant plant has entered in to a deal for Rs. 10
billion. In this eco-economical deal a polluting industry in the North may notEubios Journal of Asian and International Bioethics 17 (May 2007)
take efforts to reduce the GHGs but instead it can buy large amounts of CERs
from the South, which has green cover, which is thought to play a major role in
the reduction of atmospheric GHGs like CO2 has registered with CDM.
Further, there is also inequity in the allotment of quota of pollution offsets
between the North and the South. In the interest of the sustainability of theenvironmental health with regard to the loading of GHGs, it may be necessary
to enforce ‘Carbon Auditing’ to ensure whether or not there is any effective
reduction in CO2 loading due to industrial development.
What is the difference between weather and climate? The former is a
short-term environmental physical features and climate is a long-term event
and a condition, which is hard to predict as to exactly what would happen.
However, we can have a futuristic concern by giving heed to the present trends
in industrial development. Climate change is coupled with changes in theatmospheric temperature as well with the sea surface temperature. The
previous year 2006 has been the sixth hottest year since 1864. By 2100, it ispredicted that the temperature rise may be in the range of 5.8 o C. There will bea wide spread migration of monsoons leading to shortage in vital resources likefood and water. Moreover, climate change can initiate the melting of the polar
ice caps and also the glaciers of high mountains such as the Himalayas. Two
major rivers originate from the Himalayas namely The Ganges and The
Brahapurtra can submerge low lying areas in Bengal delta, Similarly, the two
Chinese rivers, The Mekong and The Yangtse rivers can cause similar havoc,
leading to the loss of property and human life. It has been reported that Peru
could lose almost all of its high altitude glaciers by 2015 due to global
warming.
Change of Lifestyle and Carbon Auditing
Climate change has become a political issue since the economic growth ofa country will be adversely affected, if industries are to reduce their CO2
emission rate by 20%. Neither, do we change our lifestyle to reduce our wants
but satisfy only our needs. Currently, Indonesia experienced unprecedented
rain leading to human and material loss. We seem to tread the path of nonintergenerational equity in that the current generation is putting the next
generation into unprecedented problems of shortage of their vital resources.
Changing contexts demand changing lifestyle and judicial use of industrial
development. In any case as a precautionary measure it is better the concept ofcarbon auditing may be introduced to safeguard the health of the environment.
GM Food and health
The Eleventh Five Year Plan of India has just announced that maximum
financial support will be given to Agriculture. India produced about 50 million
metric tons of food during the post independence time (1947), to feed its 300
million people; the world population at that time was around 1 billion. Today
India is producing about 212 million metric tones to feed its ever-growing
population of 1.20 billion people – a tremendous achievement indeed. But thedifficult days are around the corner. In a few decades, when its population isabout 1.5 billion, its food security will be less by 45 million metric tonnes.
Hence the possibility exists that we may have to go the way of GM food. Twoissues are to be considered. 1). GM crops have the possibility of producing
phyto-hormones like phyto estrogens, an environmental mimic of the humanhormone, estrogen. When a male person eats food along with theenvironmental mimic estrogen then it upsets, in male, the balance between
male hormone, testosterone and the incoming female estrogen. With anincrease in estrogen, sperm production is reduced and the males are feminized.
Such a feminization of males has sociological and psychologicalconsequences. The bioethical dilemma is that do we quench human hunger forfood with GM food or do we pay attention to a hypothetical disability thatcomes after a few decades?
Recently, the United States Food and Drug Administration (US FDA) has
released its draft statement on risk assessment of eating of cloned animals.
Though cloning is not genetic modification and it does not involved transfer ofgenes across the unrelated phyla it is unlikely that the problems faced in GM
plant food may not arise in a cloned mammal since it is only a genetic copy ofanother individual. Although the FDS draft risk assessment states that there is‘no additional risk’ of eating the meat of cloned animals and drinking milk
from cloned cattle, sheep and goats, the fact is that any risk based change inhuman physiology will be so slow and unnoticed that we will know of the ill
effects, if any, only when it/they appear(s). In any case it is the Next
Generation that will be affected! We need to be concerned about thedevelopment of regulatory safety measures like labeling and education thecommon man about the risks and benefits of consuming food prepared fromcloned animals.
Information, communication and health
Neo liberal globalization has assured into India a boom in economic
growth, which is now around 9%. Such an economic growth is possible due tosizable population of intellectual workforce in the age group between 25 and40 years and scientific personals. Young professionals in IT business are
earning money in a few months, which their fathers earned in their entire
lifetime. It is commendable that they lead a populous lifestyle. But the gap
between the rich and the poor has widened due to spiraling of essential
commodities. Moreover, the generation gap has brought in additionalsociological problems. It has become a common saying “what can you get for10
millionRupees?”During 1980s, my relative living in Singapore’s high rise building used to sayththat she is leading a ‘flat life’, meaning the flat in the 16 floor of the building.
To day it is not only a flat life but also it is a ‘mobile life’. Life is conditionedby the mobile telephone so handy in one’s hand with a far reaching potential tocarry out life’s business while on the move. One of my bioethics friends
cautioned me ‘please do not keep the mobile phone next/near to an organ of
your body which you love’. The reason being that wavelength of the
microwave oven and the cell phone are almost same. The former cooks food in(ABC8/BBRT2 abstracts)

67

10 minutes while the later cooks the body tissue, especially the brain, in 10
years. What the next generation can do with a ‘cooked brain’?
The other day, while traveling in a bus a youth had an IPOD playing. His
both the years were plugged with earphones. He asked another passenger,‘What is the time, please?’ Five thirty, replied the co passenger Again heasked. What is the time?! For he could not hear. The co passenger looked at
him angrily. And then he removed the earphones! When the next generationneeds the brain for a decision-making, they may not have it in a functional
condition. Moreover, they cannot hear what the law says since the ear drum
has already been damaged due to high decibels.
We have a big task ahead of us. The way forward is to unite our heart andsoul to find amicable solutions to most of the future problems. One way toachieve this aim is to build the Asian bioethics Association (ABA) and otherregional associations like the All India Bioethics Association (AIBA) to reachthe unreached in the world of bioethics. There is need to augment memberships
in local and international association of bioethics.
Secondly, bioethics is an agent of change. Since we are going to or facing
insurmountable bioethical problems in the near future, we need to strengthen
the bioethics education program of all bioethics associations as an intervention
effort to infuse bioethical maturity in the next generation of all nations. In thisregard, I would like to make an earnest plea to lend a supporting hand to theefforts of Prof. Darryl Macer in implementing the Cross Cultural Bioethics
Text Book as a standard textbook in all school and college curriculum. Thismeans that we need to sideline some subjects that may not infuse moral andspiritual values in the minds of the coming generations and bring about abioethical revolution in terms of change of lifestyle. Is it possible? Well, I am a
pessimist as for the present is concerned but an optimist when thinking of the
future. I wish you all an enlightening conference.

Source: The Hindu 05.02.07 p.12 Cartoonscape.
Thank you one and all for your patient listening.
But do not pay any heed to all of my thought on various issues, especiallyclimate change since they are only a mirage.
Opening Remarks- Prof. Suchada Kiranandana, Ph.D.
President, Chulalongkorn University, Thailand
Minister Yongyuth, Prof. Jayapaul Azariah, Prof. Hyakudai Sakamoto,Prof. Darryl Macer, Prof. Leonardo de Castro, Ladies and Gentlemen,
It is indeed my great honour and pleasure to come here to the Eighth Asian
Bioethics Conference, which is mainly organized by Chulalongkorn University
and UNESCO Bangkok for the Asian Bioethics Association. I would like tothank the Asian Bioethics Association for giving Chulalongkorn University theopportunity to organize such an important event, and I am quite certain that theconference will inaugurate further interest in bioethics, a field that, as you all
know, is of growing importance in the world where the rapid advancements inscience and technology are making serious impacts on the social, cultural andethical
lives
of
the
peopleallaroundtheworld.
The conference has been made possible through many layers of crossorganizational collaborations. First of all, within Chulalongkorn University
itself, the conference is organized both by the Center for Ethics of Science andTechnology, Faculty of Arts, and the College of Public Health. The Center for
Ethics of Science and Technology is a research unit belonging to the Faculty ofArts, and the College of Public Health is an organization that is focused on
graduate programs and research on public health and related issues. Let me tell
you that it is not quite common for different organizations within the university
to work together as closely as this, and I especially welcome this collaboration
because today's complex problems require more collaboration among different
areas of expertise and different organizations, something that is quite difficult
to achieve. So for Faculty of Arts and the College of Public Health tocollaborate in such a large undertaking as this international conference is avery
welcomeprospectfortheuniversity
asawhole.
Moreover, the spirit of cross-organizational collaborations certainly does not
end within the confine of the university. Both the CEST and the CPH havebeen working closely with UNESCO Bangkok, as well as other organizations
namely APEC Foresight of the National Science and Technology Development
Agency, and the Thai National Health Foundation. I would like thank all theagencies that have been collaborating to organize this conference and have
made
it
a
big
success
that
it
is
right
now.
The year 2007 marks a very auspicious occasion for Chulalongkorn

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Eubios Journal of Asian and International Bioethics 17 (May 2007)

University because it is the university's ninetieth anniversary. In fact, just aweek from now, on March 26, we will have a big birthday celebration for theuniversity. As the oldest and some might say most prestigious university in the
country, we will reflect on our past achievements and our unfinished tasks
during the past ninety years, and on what we will have to do for the future,
which includes both the future of Thailand and the world. And I am sure thatbioethics and the study of the relations between science, technology and theirsocial and cultural environs will figure prominently in that vision. The
successful collaboration between the Center for Ethics of Science andTechnology and the College of Public Health is just a start for bioethicalactivities within the university which I am quite sure will have lasting impacts
bothwithinThailandandinternationally.
Finally, the Eighth Asian Bioethics Conference would not have been possible
without its sponsors. I would like to thank the Wellcome Trust and the World
Health Organization, whose grants have enabled many participants here totravel to Bangkok for the conference. Further grants also come from UNESCO
Bangkok, the Center for Ethics of Science and Technology itself, and manyother organizations whose support all contribute to the success of thisconference. Again I would like to thank the Asian Bioethics Association forgiving the opportunity for our university to host their Eighth Asian Bioethics
Conference here in Bangkok. I wish you all the best and success in youracademic endeavors, and please do not focus your attention entirely on theacademic side, but do take some time during your stay here to enjoy our cityand its numerous offerings.
Ethical Issues Facing Science and Technology- Prof. Yongyuth Yuthavong,
Minister of Science and Technology,
Royal Government of Thailand
This paper (presented by powerpoint) will review some of the ethical issues
facing science and technology. We can see new paradigms of science andtechnology, from knowledge for knowledge sake with applications assumed toapplication-oriented science and technology. We also consider from “Science,the Endless Frontier” to “Society, the Endless Frontier”.
Science and Technology change rapidly. Twenty years ago the computer
was expensive and inefficient, and gene engineering was mostly fiction. Ten
years ago mobile phones and the Web were only starting. The word
“nanotechnology” was almost unknown. Science and technology are moving
faster than understanding of the implications to society.
I will also discuss issues on accessibility - the “Digital Divide”, and the“Biotech Divide”. There are safety concerns over new products: Biosafety andNanosafety. New products must take safety issues into account. Discussion of
selected issues for Ethical, Social and Legal Considerations in Biotechnology
including cloning, and genomics will be made. There are also important issues
for Ethical, Social and Legal Considerations in Energy Technology.
Risk management, Intellectual Property Management, and Future Directions
towards Good Governance in Science and Technology will be discussed.
Voluntary Codes (Guidelines) of Conduct on issues involving risks or ethics byscientists, industries, professional societies, may be needed (cf. 1973 voluntary
moratorium on genetic engineering). I will reflect on the role of government,
civil societies (NGOs)/scientists, education/research institutes. We need togenerate healthy debates among various stakeholders and the public.
Opening Greetings from Founding President, Asian Bioethics Association- Hyakudai Sakamoto, Ph.D.
Emeritus Professor, Aoyama Gakuen University, Tokyo;
1-21-16-202 Higashiyama, Meguro-ku, Tokyo 153, Japan
sakamoto@chs.nihon-u.ac.jp
I am very pleased and honored to give you some greetings on thisoccasion of the Eighth Congress of our Asian Bioethics Association at
Bangkok.
This Association was first organized in Beijing, China in 1995 (twelve
years ago), in the name of the East Asian Association of Bioethics (EAAB),
because, I, as the founder, hold a close cultural affinity only to the China
Continent, the Chosen (Korean) Peninsula, and Islands of Japan, and I did not
notice any bioethical movement in other parts of Asia at that time. Directly
after the inauguration of the Association, however, we received strong interest
and widespread advice to expand this bioethics initiative to, first, South andSoutheast Asia and then even to the West and the Middle and Near East Asia,
namely to the whole Asia. Following to these keen demands at the second
Congress, the UNESCO Asia Bioethics Conference in Kobe in 1997, wechanged the name to simply the “Asian Bioethics Association (ABA) ”.
Accordingly, we are now enjoying enthusiastic participation from every
district of the whole Asia. I stepped down as President in 2003, at the time
Professor Song Sang-yong, one of the co-founders, hosted the Fourth Asian
Bioethics Conference. In 2005 we held a great and successful international
Congress in Sanliurfa, Turkey, with our colleague Professor Sahin Aksoy who
is here.
Now we are going to open the Eighth Congress of our Association in
Bangkok, Thailand, the first time in the Southeast Asia. We, together with you,wish to celebrate the great success of the Congress and also hope the further
prosperity of future Asian Bioethics in Southeast Asia.
But what is Asian Bioethics other than, and different from the standard
Euro-American Bioethics? I myself have some ideas about this, and publisheda couple of papers on this. Very fortunately, some of them have been evenbeen studied in this country, Thailand. I quite appreciate Professor Soraj of theChulalongkorn University here, who scrutinized my ideas on the Internet
media, from which I myself learned very much. Professor Soraj was somewhat
critical about my view, saying that Sakamoto’s Asian Bioethics was after all
limited to the Japanese Bioethics. Prof. Soraj may be right. Really I do notknow much about Southeast Asia. I heartily wish, in this precious chance, tolearn much about Southeast Asia, especially about Thailand, and thus todeepen the bioethical philosophy globally.
Welcome to the Second UNESCO Bangkok Bioethics Roundtable- Prof. Darryl Macer, Ph.D.
Regional Adviser in Social and Human Sciences in Asia and the Pacific,
UNESCO Bangkok
www.unescobkk.org/rushsap
d.macer@unesco.org
On behalf of UNESCO I welcome you to this important regional gathering ofexperts from around the world. The Eighth Asian Bioethics Conference isconcurrent with the Second UNESCO Bangkok Bioethics Roundtable. Thisregional conference follows on from a decade of regular Bioethics conferencesthat have been conducted around Asia and the Pacific. As secretary of the
Asian Bioethics Association it is a sincere pleasure to see the development ofso many scholars conducting original research in the context of their own
cultures, which is the foundational goal we had for the Asian Bioethics
Association, and the mandate of UNESCO’s programmes in ethics of scienceand technology.
Networking partners in the development of ethics in the region passed a
critical phase with the 2006 establishment of UNESCO Asia-Pacific School of
Ethics to bring together many active institutions and individuals who arecollaborating with the Regional Unit in Social and Human Sciences for Asiaand the Pacific (RUSHSAP) of UNESCO Bangkok, in coordination with theDivision of Ethics of Science and Technology, to meet needs and priorities of
the region for bioethics research. Currently the school includes around 20
partner institutions and 70 individuals who are involved in collaborative
researchandactivities(website:
http://www.unescobkk.org/index.php?id=apse).
The criteria for membership is output based, to recognize those actively
involved with our UNESCO regional ethics programmes. The goal is that all
members will become self-sustaining in funding through multiple partnerships
and networking, to build sustainable outputs that can influence policy. Half ofthe members are actively involved in bioethics education, including in areas ofenvironmental ethics and medical ethics, which is one of the major priorities
for the region. In July 2006 the UNESCO Asia-Pacific Conference on
Bioethics Education was held jointly with the National Commission of
UNESCO in Korea, at Ewha Women’s University in Seoul, Korea. A regional
action plan defining goals and targets for bioethics education was developed,
and the assembly and maintenance of on-line free access teaching resources,
adaptations and translations into different languages, are ongoing.
The details of this and other regional bioethics meetings can be obtained fromthe Internet (http://www.unescobkk.org/index.php?id=past_events). At thismeeting I also seek partners in new projects such as a broad project on the
ethics of energy technologies, the use of museums to teach ethics of scienceand technology, and strategies to examine community engagement for
implementation of international bioethics guidelines.
The development of the regional school of ethics is the result of recent focus
in the region on ethics, to build upon earlier origins in the development of
dialogue across the region, since the 1997 UNESCO Asian Bioethics
Conference, which we organized in Kobe, Japan. It was at this 1997 meetingthat UNESCO efforts and the Asian Bioethics Association were launched and
it is fitting that a decade later in 2007 we have this joint meeting.
The meetings conducted in Asia since the late 1980s on bioethics havetaken a variety of formats, including panel debates, roundtables conducted inJapan, and other countries. In the past two and half years UNESCO Bangkok
has coordinated the regional efforts in social and human sciences, UNESCO
has also conducted Workshops on Ethics Partnerships for the Asia and thePacific, Consultation Meetings on Codes of Conduct for Scientists andEngineers (Tokyo, New Delhi, Bangkok, Seoul), Rotating Conferences usuallywith National Commissions in the region (Dunedin, Seoul, Beijing, Shanghai,
Iran, Jakarta), Regional Bioethics Workshops with Network Partners (Karachi,
Pakistan; Bangalore, Vellore, Chennai, Delhi, Mumbai, Madurai, Trivandrum,
India; Colombo, Sri Lanka; Manila, Philippines; Yokohama, Japan). Many of
the collaborators are present today.
These intense meetings are important in follow-up to the 2005 meetings ofthe Fourth Session of the World Commission on Ethics in Science andTechnology (COMEST) in Bangkok and the Twelfth Session of theInternational Bioethics Committee (IBC) in Tokyo. The COMEST meeting
was hosted by the Government of Thailand through the Ministry of Scienceand technology, in cooperation with UNESCO, and we are honoured today tohave the Minister of Science and Technology of Thailand, who also happened
to deliver the keynote opening at the COMEST session, together with us again.
We also will have lectures by the Vice-Chairs of UNESCO’s International
Bioethics Committee (Prof. Leonardo de Castro), and the COMEST (Prof.
Sang-yong Song); and the Thai member of the COMEST, Dr. Somsak
Chunharas.
The First UNESCO Bangkok Bioethics Roundtable (BBRT1) from 11-16
September, 2005, saw 100 papers presented in plenary with the majority oftime in discussion. This allows the debates over the methods and results ofresearch, and how to link this to policy needs in a variety of cultures.
UNESCO provides a forum to the neutral but practical elaboration of how we
can implement global bioethics standards into the cultural realities of each
community, and help each society re-discover their long-standing ethicaltraditions in a way that they can apply them to the merging ethical dilemmas ofmodern science and technology.
In the forthcoming few weeks UNESCO bioethics roundtables are beingorganized in Indonesia, Fiji and Samoa. These fora for consultation on specificprojects will set the stage for what is planned to be an even more intense yearof activities across the region. One of the principles of these meetings is thatthey are in principle open to all, encouraging high standards of peer review andcritical reflection while at the same time building a holistic andEubios Journal of Asian and International Bioethics 17 (May 2007)
multidisciplinary community that is working with UNESCO across the region
to build a more ethical future for reflection and progress.
In closing I thank all of you for coming. A handful of us have been at all eightABCs, since the first one in 1995 in Beijing where we established the East
Asian Association of Bioethics. Some others are attending their first ABC. We
welcome you all to this occasion, and trust you can enjoy the intense meetingand chance to make friendships with persons from the wide range of countries
from across the region.
Asian Bioethics: Challenges and Prospects in the Coming Decade- Prof. Leonardo D. de Castro, Ph.D.
Dept .of Philosophy, University of the Philippines; Vice-Chair, UNESCO
International Bioethics Committee
decastro@kssp.upd.edu.phAsian bioethics faces a number of important challenges that appear to becompelling in that our responses to them could indicate how we, Asians,
envision ourselves as a force in global bioethics. These challenges are notnecessarily threatening, but they are of such importance that if we ignore them,
the identity of Asian bioethics could be eroded.
Among the many challenges that we can identify, I can name four that
could encompass several others, and constitute a core of those that we need to
face in the coming decade. These four are the challenge of identity, thechallenge of growing together, the challenge of the unknown, and thechallenge of democratization.
In order to be able to respond properly to these challenges, there arequestions that require our chorus of answers. In order to face the challenge ofidentity, we want to know: What is Asian about Asian bioethics? The
challenge of growing together – or of remaining unique while being integrated– gives rise to this question: How do we balance the importance of maintaining
national integrity with the importance of promoting regional harmony? To beable to meet the challenge of the unknown, we have to ask ourselves: How do
we prepare for the unforeseeable? To deal with the challenge of
democratization, it will be useful to find out: How do we use bioethics as an
instrument for equal opportunities?
This paper explains the challenges that lie before us in terms of concrete
bioethical issues and developments, and explores answers to the corresponding
questions.

2. Medical Ethics Across Cultures
Chair: Prof. Darryl Macer

Bioethics and the Pan Asia Single Nucleotide Polymorphism Initiative- Maude E. Phipps, Ph.D.
Department of Molecular Medicine, Faculty of Medicine, University of
Malaya, 50603 Kuala Lumpur, MALAYSIA
phipps@um.edu.my
The Pan-Asia SNP Initiative is a landmark population study that willassess genetic diversity within Asia. The Initiative will, for the first time,
document the precise level of genetic diversity among Asian peoples andethnicities. The Initiative’s premise is that a very high level of genetic diversity
exists in Asia. Unfortunately, current databases document mainly Caucasian orvery regional Asian populations. Knowledge of Asia’s genetic composition
will create major benefits. First, the resulting data will allow researchers todetermine, with high resolution, the genetic relatedness of Asian populations
and the patterns of human migration across Asia. Second, the Initiative’s
creation of a freely accessible Asian SNP database will assist future studies,particularly association studies and the genetic stratification of case-control
subjects. By developing collaborative networks and by training scientists fromless developed countries, the initiative will improve scientific expertise across
Asia.
Participants are from China (Hong Kong and Taiwan), Japan, India,
Indonesia and Papua New Guinea, Japan, Malaysia, Mongolia, Philippines,
Singapore, South Korea and Thailand. In recognition of ELSI, the initiative hasformed a Policy Review Board. The vision statement is “What we’re doing
must be scientifically sound, in line with technological advances, involve
international collaborative effort and ethically acceptable in our quest for
greater knowledge and wisdom of the human genome, evolution and health”.
The recruitment of all subjects and the handling of samples will follow
international ethical standards, local IRB standards, and local informed consent
standards. Researchers will engage and converse with ethic groups in their own
language. To participate, each country must submit copies of IRB approval to
the Initiative’s Policy Review Board (PRB).
The goal of the Initiative is diversity rather than the analysis of large
sample numbers. The Initiative anticipates the involvement of over 2000
subjects during the first two years. Samples will be anonymized and tracked ona global scale through an international labeling system designed by theInitiative.
Status of Cadaveric Liver Donation in Saudi Arabia – a Single Center
Experience- Abdaal Khan, Bilal Sabra, Ibrahim Sarraj, Abdul Majeed Abdul Kareem &Sameer Issa
Saudi Arabia
Saudi Arabia has the largest cadaveric program for liver and kidneytransplantation in the Arab world. Cadaveric liver transplantation started in
1994 at the King Fahad National Guard Hospital. Since this time, 207
cadaveric liver transplants were performed. The institution has also provided
follow-up care to 190 patients transplanted outside the country. As in the restof the world, there continues to be a severe shortage of organs fortransplantation. Liver is particularly sensitive to hemodynamic instability andelectrolyte imbalances and many potential livers are also declined due to poor

(ABC8/BBRT2 abstracts)

69

quality. Hence, efforts are needed to improve both the quantity as well as
quality of the donor livers offered for harvest.
Data of cadaver donor liver offers from Saudi Center for Organ
Transplantation (SCOT) were retrospectively analyzed from Jan 2003 to 15
Nov 2006. Reasons for declining the offers at the outset were assessed as well
as not using the livers after harvest operation. During this time, 168 livers were
offered to us for procurement. There were 147 males and 21 females. The
breakdown of donors by year was 29 for 2003, 38 for 2004, 47 for 2005 and 54
until mid Nov. 2006. Of the 168 offers, 90 livers (54%) were declined outrightwithout harvest. The main reasons were high LFT’s, hypernatremia,
hemodynamic instability and sepsis. Liver was harvested in 78 donors, and afurther 19 were declined for transplantation. Of these, 17 were declined after
gross examination or biopsy. The main reason was excessive fatty infiltrationin 15 donors. A total of 59 livers were used for transplantation in 57 patients.
30 day mortality was 8.7%.
A healthy trend towards increasing donor offers over time has been noted.
Efforts are underway for timely referral of potential donors from the ICU’s in
the kingdom. However, continuing education for better management of thepotential donors at all the Intensive Care Units throughout the Kingdom are thekey to improving quality of donors.
Functions of the Centre for Biomedical Ethics, Singapore- Alastair V Campbell, Ph.D.
Professor, Director for Centre for Biomedical Ethics, Yong Loo Lin School of
Medicine, National University of Singapore (NUS), Singapore
medavc@nus.edu.sg
The Centre for Biomedical Ethics, located in the Yong Loo Lin School of
Medicine, National University of Singapore, was launched in October 2006,
with the following aims: Initiating multi-disciplinary research projects inbiomedical ethics in collaboration with colleagues in the biomedical sciences
and in clinical medicine; planning and implementation of an integrated
teaching programme in medical ethics for undergraduate medical students;
international collaborative research, linking with centres in the USA,
Australasia and Europe; collaboration with ethics governance and advisory
bodies in Singapore, especially the Bioethics Advisory Committee;
enhancement of public understanding of the ethical issues in biomedicine;promotion of conferences and seminars in biomedical ethics at national,
regional and international level. This paper describes the current developmentsin the Centre and future plans to become a regional resource, and to provide
postgraduate training.
A Survey of the Assessment of the General Practitioners’ View Points
about the Physician Charter- Hashemi Fatemeh, Amini Mitra, and Saberfirousi Mehdi
Education Development Center, Shiraz University of Medical Sciences, Iranhashemifa@hotmail.com
The practice of medicine in the modern era is beset with unprecedented
challenges in virtually all cultures and societies. So, physicians today areexperiencing frustration as changes in the health care delivery systems invirtually all industrialized countries threaten the very nature and values of
medical professionalism. To maintain the fidelity of medicine’s social contract
during this turbulent time, we believe that physicians must reaffirm their active
dedication to the principles of professionalism, which entails not only theirpersonal commitment to the welfare of their patients but also collective efforts
to improve the health care system for the welfare of society. The charter on
medical professionalism is intended to encourage such dedication and topromote an action agenda for the profession of medicine that is universal inscope and purpose. This study was done to assess the viewpoints of the generalpractitioners (GPs) about the physician charter.
Based on the 10 commitments in the physician charter, a two-partquestionnaire was prepared. In the first part we asked the subjects about theirawareness of the charter. In the second part, we clarified 10 commitments ofthe physicians that are discussed in the physician charter, and we asked thesubjects to rank each commitment based on its importance and applicability in
our culture and political system based on their view point (0 for the lower and
10 for the highest rank). Validity and reliability of the questionnaire wasconfirmed in a pilot study. Then, after gathering the data from 30 GPs, they
were analyzed and interpreted, upon the study objectives.
The findings of this study revealed that none of the subjects had any
information about the physician charter. The results of the subjects’ viewpoints
and ranking of the 10 commitments of the physicians based on theirimportance and applicability in our culture and political system will bepresented.
Ethics in Infertility Treatment – A Study of Practices in Allopathic andSiddha Medicine- Jamuna Krishnan, M.D. and V. Murali Krishnan, M.D.
Chennai, India
According to many cultures the inability to bear a child is considered to bea special stigma for woman. There is a failure to understand that infertility iscaused by both man and woman, so the responsibility for this is thrust mostly
on women. It is widely believed that bearing and nurturing a child is a naturaland valuable part of woman’s life. Biological motherhood is the central axis ofgender identity for women in traditional societies. Little attention is given to
ways in which family is structured in traditional societies, organization ofhealth care delivery, gender relations and other social and cultural realities thatshape experience of infertility.
It is to be borne in mind that the new reproductive technologies also got
adopted and changed in the context of local values and customs of a society.
Sometimes the simplest of medicines, leave alone reproductive technologies
are out of reach for huge majority of population. Sometime treatments are usedin such a way that they even have iatrogenic effects. Again infertility need not70 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)

be a stable trait but a process with an uncertain trajectory. Infertility today isthe breadbasket of today’s gynecology. All the technologies from ART to
MESA and TESE, IUE, ZIFT, GIFT and ICCSI apart from IVF are available
and practiced in India popularly. This scenario accounts and justifies a
combination of traditional and allopathic methods for treating infertility.
Siddha medicine is a continuation of the Pre-Aryan Medical System,
Siddha is one of the Ancient System of Indian Medicine, equal to the
Ayurveda in its history, was developed by the “Siddhars” based on theirtreatises after careful observation and study. It to some extent is more
improved in its application than Ayurveda, although the origin is synonymous.
It includes many new Combinations of Herbal Drugs not available in othersystems of Herbal therapy. Basically it aims at not just curing diseases but
provides a longer life of good health. A person who intends to consume Siddha
medicine should have a good moral behaviour and follow a strict code of
conduct. This system is based on the “Thiridosha” humoral theory, akin tomodern endocrinology. Several concrete examples from personal medical
experience will be discussed where unethical practices have been practiced.
Is the Use of Animal Organs for Transplants Morally Acceptable? -Debates over the Use of Animals in Xenotransplantation- Rui-Peng Lei, Ph.D.
Center for Bioethics, Huazhong University of Science & Technology, 1037
Luoyu Road, Wuhan, Hubei 430074, China
lxp73615@163.com; rlei@hsph.harvard.edu
As a first step, the arguments for and against the use of animals for
medical purposes in general are reviewed. Secondly, even if people accept inprinciple the use of animals in medicine and medical research, their use inxenotransplantation may raise particular difficulties. There are three key issues
in the debate over the use of animals in xenotransplantation. The first iswhether as a matter of principle, it is considered to be morally acceptable touse animals as organ or tissue sources; the second is the ethical acceptability of
the use of primates to supply transplant material; the third is the ethical issues
raised by the use of genetically modified animals to provide organs forxenotransplantation. If it is agreed to be acceptable in principle, there are thenquestions to address regarding the welfare of animals within any
xenotransplantation programme. Finally, the author discusses these ethicalissues in Chinese cultural context.
Communicating Bad News to Patients in Circumstances in which there is
No Protocol- Matthew MacLeod, Ph.D.
Faculty of Humanities, Thepsatri Rajabhat University, Lopburi, 15000,
ThailandIn the eyes of the medical field communicating bad news to a patient is
strategically formulated as a plan of action that must be learned to enable aphysician to be properly trained and emotionally equipped to support his or her
patient through a difficult situation. In the eyes of a patient it is much more
simplified. They want an honest and empathetic evaluation of their condition
from their doctor. Physicians should give information on which patients canbuild their hope. They should be adaptable, recognizing the fact that every
patient is different and realize that they can never be 100% right all the time incommunicating something as imponderable as death. Physicians must be
honest to themselves and deliver the message as if they were the recipients.
The results of this study are ongoing.

3. Bioethical Issues in Genetics and Stem Cell
Research
Chair: Dr. Nares Damrongchai and Prof. Aamir Jafarey

Bioethics Concerns in Regulating Large DNA Collections: The Israeli
Experience- David Gurwitz, PhD
Director, the National Laboratory for the Genetics of Israeli Populations;
Department of Human Genetics and Molecular Medicine, Sackler Faculty of
Medicine , Tel-Aviv University , Tel-Aviv 69978, Israel.
gurwitz@post.tau.ac.il
The National Laboratory for the Genetics of Israeli Populations (NLGIP)
at Tel-Aviv University is the national research repository of Israel for
immortalized human cell lines and DNA samples, established by The Israeli
Academy for Sciences and Humanities. The NLGIP resources allow
researchers in Israel and abroad an access to a collection of immortalized
human cell lines and human DNA samples from healthy, unrelated adultindividuals. The donors self-define their ethnicity, and thus their donatedsamples represent the uniquely large and well-defined ethnic variability of theJewish and Arab communities of Israel. Following the Diaspora, Jewish
communities, who immigrated to Israel mostly following its establishment in
1948, have arrived from countries as diverse as (in alphabetical order): Alger,
Bulgaria, Ethiopia, Germany, Georgia, Hungary, India, Iraq, Iran, Libya,
Morocco, Poland, Romania, Russia, Tunis, Turkey, Ukraine, and Yemen. The
NLGIP collection also includes samples from the three main Arab ethnic
groups in Israel: Palestinians, Druze, and Bedouin. Members of the same Arab
populations represented at the NLGIP collection also reside in neighboring
Middle-East countries, such as The Palestinian Authority, Lebanon, Syria,
Jordan, Saudi-Arabia and the Emirates. The NLIGP collection can thus serve
for building a "Bridge for Peace" of biomedical research collaborations
between Israel and its neighboring Arab nations.
Since its establishment in 1995, the NLGIP has received blood samples
and prepared immortalized cell lines from over 2000 donors, representing thevarious ethnic groups in Israel (at least 100 donors from the major ethnic
groups, and at least 50 from minor ethnic groups). All donors are adult Israeli

citizens who have agreed to donate a blood sample (~5 ml) for the preparationof immortalized cell line and signed an “informed consent” form (in Hebrew or
Arabic, according to their mother tongue) approved by the Tel-Aviv University
IRB. Members of the numerous ethnic groups in Israel have different sharedcultural values and traditions; it was thus a key concern to devise a clearly
legible informed consent form, acceptable and appealing for members of all
Jewish and Arab ethnicities. The development of the informed consent form
willbereviewed
andits
utilization
discussed.
The results of interviews about the reasons given by those refusing to donate
their blood sample for the NLGIP repository will be discussed. Among theoptions shown on the questionnaire, the most common answer was, “concern
over withdrawing too much blood” (60% of refusing individuals – although it
is clearly explained that only about 5 ml will be needed for the donation). Only
24% of refusing individuals have expressed concerns about the “exposure of
the donors' identities”. 8% of those refusing “did not wish for their genetics to
be studied” and another 8% cited other reasons.
Women were much more willing to donate blood for the NLGIP
repository compared with men (72% and 57% consent rates, respectively). In
addition, willingness to donate was strikingly higher among individuals who
were over 50 years old compared with younger ones (78% and 39%
consenting, respectively). These data are imperative for addressing publicconcerns over genetic repositories and clinical genetics screening studies. Such
concerns are likely to become more evident, once national campaigns forcataloguing genetic data for the purpose of “personalized medicine” areinitiated. Recent studies on the polymorphism of genes coding for key drug
metabolizing enzymes have already been conducted on the NLGIP collection,and the clinical significance of some preliminary findings will be discussed.
Stem Cell Research: Science, Ethics and the Popular Media- Karori Mbũgua, Ph.D.,
Department of Philosophy, University of Nairobi, P.O. Box 30197-00100
Nairobi, Kenya
Karorim@yahoo.co.uk
Few advances in the history of science and technology have generated asmuch ethical controversy and captured as much public attention as research on
human stem cells. I begin this paper by distinguishing two parallel research
programs involving stems cells: embryonic and adult stem cell research
programs. I then survey the ethical arguments advanced for and against
embryonic stem cell research. I note that whereas the popular media has tended
to exaggerate the therapeutic potential of embryonic stem cells, there has beenan almost complete media blackout on the ethically unproblematic but
therapeutically progressive adult stem research program. I further argue that if
the citizenry is to develop informed opinions about stem cell research, without
imposing the unrealistic expectation that they be trained as scientists, accurate
and unbiased media reporting is necessary. Adult stem cell therapies are
already available for different kinds of cancer and a host of autoimmune
diseases such us lupus, multiple sclerosis, Crohn’s disease and rheumatoid
arthritis. Furthermore, recent research has shown that human adult stem cells
have more plasticity than previously thought. Taking this into consideration,and using the principle of subsidiarity which states that if the same results canbe obtained by two types of research, one should carry out the research that isleast offensive or problematic, I argue that a moratorium should be declared on
the harvesting of stem cells from human embryos until a consensus regarding
its ethical acceptability is reached. In the meantime, I suggest that research on
human adult stem cells and both animal embryonic and adult stem cells should
continue.
Cloning and Stem Cell Research Issues: Religious Viewpoints on Value ofLife- Bagher Larijani, MD1, Farzaneh Zahedi, MD2
1. Medical Ethics and History of Medicine Research Centre, Endocrinology
and Metabolism Research Centre, Tehran University of Medical Sciences
2. Endocrinology and Metabolism Research Centre, Tehran University of
Medical Sciences
Medical Ethics and History of Medicine Research Centre, Endocrinology andMetabolism Research Center, 5th floor, Shariati Hospital, North Kargar
Avenue, Tehran 14114, Iranemrc@sina.tums.ac.ir
Embryonic stem cells have the unrivalled ability to differentiate into any
specialized cell type. The discovery of stem cells early in the 1980s had
suggested therapeutic approaches to chronic, debilitating, and incurable diseasesuch as Parkinson’s disease, diabetes mellitus, congenital heart diseases,
Alzheimer's disease, cardiomyopathies, osteoporosis, etc. Research using
embryonic stem cells (ESCs) is a very important area of current biomedical
investigation. But stem cell research has raised a series of ethical, religious andpublic-policy questions that are being confronted by multiple internationalorganizations, nations, cultures, and religious traditions.
In this paper, the issue of value of life in the field of human ESC researchand cloning will be discussed from different religion’s point of view. The
status of the pre-implantation embryo is the most sensitive and disputed pointin the debate on isolation of human ESCs for research. Considerable
differences of opinion exist with regard to the ontological and moral status of
the pre-implantation embryo. On one side of the spectrum is the‘conceptionalist’ view. According to this view the embryo is a ‘person’ andbecause of the potential of the embryo to develop into a person, it ought to beconsidered as a person. On the other side of the spectrum we find the view thatthe embryo (and even the fetus) as a ‘non-person’ ought not to be attributed
any moral status at all.
There are two different areas of the use of cloning in which the ethical andsocial issues that are raised differ. These areas are: cloning to produce humanbeings (reproductive cloning), and cloning to produce human cell lines ortissues (therapeutic cloning). We will review the various positions that

Eubios Journal of Asian and International Bioethics 17 (May 2007)
different religions such as Christian, Jewish, Buddhism and Islam haveadopted regarding this novel type of research. Most theological perspectives
consider the human fetus as an individualized human entity but there issubstantial debate regarding at which stage of development human dignity isconferred. In Islam the embryo, even in the first day of its existence, has theright to life and we have no right to kill it. However, there is a distinction
between different stages of human development in the uterus. The ensoulment,
based on opinions of the majority of the Muslim scholars, takes place about theend of the fourth month; therefore, the use of embryo for therapeutic or
research purposes may be acceptable under necessity if that is takes place
before the point at which the embryo is ensouled.
Iran is one of the first countries, which have produced human embryonicstem cells. This paper aims to state current achievements of Iranian scientists
and discuss Islamic scholars' decrees in this field. New guideline for thegamete and embryo research (2005) in Iran will be reviewed.
Ethics of Human Therapeutic Cloning Research in Japan: Current Debate
of Drafting the Ethical Guidelines- Ryuichi Ida
Professor, School of Government, Kyoto University, Japan
ida@law.kyoto-u.ac.jp
Since 2000, in Japan, human reproductive cloning is prohibited by law asa crime with imprisonment for ten years. However, the law does not forbid
therapeutic cloning, the regulation of which is mandated to the Ministry of
Education. However, the permissibility of human therapeutic cloning was
encountered by a hot debate for three years in the Bioethics Panel of the CSTP
(Council of Science and Technology Policy), which decided in 2004 to
authorize therapeutic cloning research only for regenerative medical care. A set
of guidelines should be established following the law. The core concept ofJapanese ethical debate on cloning research is human dignity. Human
reproductive cloning is banned under this conception, which is paraphrased inthree elements, namely, instrumentalization of human being, non-respect for
the individuality of each human person and cause of social and family disorder.
The Working Group established for the drafting of the ethical guidelines
on human therapeutic cloning, i.e. cloned embryo research, started its
examination since December 2004 and delivered its Interim Report on thisissue in June 2006. The Report clarifies in extenso the conceptual andnormative framework for the guidelines. The core questions the WG discussed
are: donation of ovum, donation of somatic cells, qualification of research
institution and researchers for cloned embryo research, voluntary donation ofovum and somatic cells. Scientists involved in cloning research and human ES
cell research criticized the Report because of its alleged excessively restrictive
conditions imposed. The discussion in the WG and the outline of this Reportwill be presented, together with the main elements of ethical consideration in
Japan’s context.
Is it morally acceptable to use a cancerous kidney for transplantation?"- Tsuyoshi Awaya, B.Sc., LL.M., Ph.D.
Professor and Chairman, Department of Bioethics, Graduate School of
Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1
Shikata-cho, Okayama, 700-8558 Japant-awaya@nifty.ne.jp http://homepage1.nifty.com/awaya
In 2006 several cases of "transplants from cancerous kidneys" came to light inJapan. The mass media and the Japan Society for Transplantation strongly
opposed them. However, if there is informed consent on both sides, the donor
and the recipient, basically transplantation from cancerous kidneys is notconsidered illegal or ethically wrong. I think that the concept of transplantationfrom unhealthy kidneys including cancerous kidneys is not wrong. It seems
that it is well worth developing transplantation from unhealthy kidneys
including cancerous kidneys by making a governmental guideline andestablishing a transparent organ donation and transplantation system.

4. Histories of Bioethics

Chair: Dr. Nares Damrongchai
The Sorcerer and His Apprentice: Racial Eugenicist Otmar vonVerschuer and his student Josef Mengele. Lessons for Dealing with
Medical Atrocities in different Regional Contexts to be Learned from theAftermath- Peter Degen Ph.D.
Institute for the History of Science, Robert-Mayer Str. 1, 60054 Johann
Wolfgang Goethe University, Frankfurt/Main, Germany
dr.degen@linhard.com
In the area of research and medical crimes during the Third Reich, therelationship between the famed racial eugenicist Otmar von Verschuer and his
student Josef Mengele is still one of the most challenging collaborations
known from this period. While Verschuer became one of the directors of the
Kaiser-Wilhelm Institute of Anthropology, Racial Hygiene and Eugenics inBerlin, Mengele rose to be the SS chief physician in Auschwitz. His notorious
experiments with twins in Auschwitz where actually thought up by Verschuer.
After the war Verschuer could not return to the Kaiser-Wilhelm Society, but
found a new chair at the University of Muenster there becoming the seminal
figure reestablishing human genetics in the early Federal Republic of
Germany. What saved him from prosecution was, as he said over and overagain, the fact that during the Third Reich he was an active member of theresistant Confessing Church thus establishing his ethical integrity. Mengele
who could not produce such a privileged affiliation had to disappear and spent
the rest of his life hiding in Latin America. Not until recently has the career of
Verschuer been exposed to critical examination. In the light of debates about
the Japanese Unit 731 it is of great interest to examine the case of Verschuer as
an example for the ethically problematic impact of ignorance about historicfacts. Recently an international study has published new insight on the(ABC8/BBRT2 abstracts)

71

problematic heritage of the Kaiser-Wilhelm Gesellschaft (see Politics andScience during Wartime, Osiris 20, 2005). The spiritual, symbolic andinstitutional milieu relevant for Verschuer’s career and his collaboration stilllacks critical scrutiny. The sorcerer and his apprentice still need to be
demystified. I shall discuss, what has been gained and what might have been
lost due to the silence about this significant case, and what this could imply forthe maxims of the ethical analyses of the unit 731 situation and our current
bioethicalreflection
in
Asia
as
well
as
the
West.
Consideration of the First Case of Kidney Trade in Japan- Miyako Okada-Takagi Ph.D.
University Research Center, Nihon University, Tokyo, JAPANtakagi_miyako@nihon-u.ac.jp
This paper will describe a case where Mr. A and his common-law wife,
Ms. B were arrested for violating the 1997 Organ Transplant Law by brokering
the trade of a kidney. Mr. A, who suffered severe diabetes, received an
acquaintance (Ms C)'s left kidney in a transplant at a hospital in Ehime
Prefecture on 28 September, 2005. After the operation, Mr. A and Ms B gave
300,000 yen in cash and a car worth 1.5 million yen to Ms C.
The recipient had been undergoing artificial dialysis for his diabetes, andhad told people around him one month before the operation that he would notsurvive without receiving a kidney transplant. They initially asked Mr. A's son
to donate his kidney to him for transplantation, but he refused. Ms B alsooffered to donate her own kidney, but she was unable to do so due to differing
blood types. Ms. B asked Ms. C to be the donor for Mr. A several times sinceAugust 2005, allegedly promising she would repay the debt and an additional 3
million yen if Ms. C donated her kidney. Ms. B told the hospital she was Mr.
A's wife and the donor, Ms. C was his sister-in-law. Subsequently Ms. C told
the police Ms. B did not pay the money she owed her, even though she had
accepted Ms. B's request to be a donor. Then the police began theirinvestigation.
The doctor who had a good rapport with patients and their families, andhad never taken any measures other than checking health insurance certificates
to confirm the identities of donors undertook the transplant. There was no
ethics committee at the hospital to deal with any issues arising overtransplantation issues. The doctor who transplanted this illegally purchased
kidney has never been a member of the Japan Society for Transplantation,
which sets ethical guidelines for transplants. However, he is a renowned figure
who has conducted 627 kidney transplants from living donors from 1977 tillnow.
The police were at first suspicious (The Daily Yomiuri, 2-3 October,2006), however they discovered Ms. C was not in any financial difficulties.
Finally, it was concluded that Ms. C was helping Ms. B, who was having a
hard time finding an organ donor for Mr. A, a diabetes sufferer, out offriendship rather than being motivated by money.
This paper will discuss a number of problems in this case, then the
background over the shortage of organ donations from cardiac-arrest patientsand kidney transplants from living donors. The Organ Transplant Law and thenecessity for reform will be discussed. A study group in the health ministry has
found that at least 151 Japanese underwent kidney transplant operations abroadby the beginning of 2006. Payment of money for kidneys abroad cannot be
ruled out, and the appropriateness of would-be recipients traveling tounderdeveloped countries for an organ transplant will be discussed.

5. Nanoethics

Chair: Prof. John Weckert
Nanotechnology’s Ethics, Safety and Society Implication – In Which Role
Does NANOTEC Play?
- Sirasak Teparkum
Thailandsirasak@nanotec.or.th
Nanotechnology has brought excitement to many fronts. Leading edge
research and development in the field of nanoscience and nanotechnology haveemerged with applications in areas of health, sports, electronics, and manyothers. Some are in the discovery stage, some are in production phase andsome are already on the market. Products with *nano* label continue to maketheir appearances among consumers. Exuberance could be one
dimension felt while the nanoscience and nanotechnology's impact on society,both benefits and risks, must also be addressed. "What's So Special about
Nanotechnology and Nanoethics?" Their benefits, risks, regulations, guidelines
and the role NANOTEC plays will be discussed.
The Impact of Nanotechnologies on Developing Countries- Joachim Schummer, Ph.D.
Center for Applied Philosophy and Public Ethics, Australian National
University, Australia; Department of Philosophy, University of Darmstadt,
Germany
js@hyle.org
This paper provides a brief analysis of how emerging nanotechnologies
could, for the better or worse, have an impact on developing countries. I startwith clarifications of what developing countries and nanotechnologies are andprovide a framework of possible impacts by considering the full life cycle andsocio-economic contexts of technologies. Then I use the framework for the
analysis of a few selected issues: whether nanotechnologies meet specificneeds of the poor; how they can impact the economies by changing material
demands; and how their impact is affected by changing intellectual property
rights.

72 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)

Technological Determinism, Values and the Precautionary Principle in
Nanotechnology- John Weckert, Ph.D.
Centre for Applied Philosophy and Public Ethics, Charles Sturt University,
Australia
jweckert@csu.edu.au
Many are worried about developments in technology in general anddevelopments in nanotechnology in particular. Jürgen Habermas for example,
although talking about nanotechnology, has expressed concern about the futureof human nature itself. Greenpeace and the ETC Group have suggested a
moratorium on developments in nanotechnology until more in known about therisks of certain nanoparticles. Bill Joy has expressed concern at possible
developments in the convergence of nanotechnology, genetics and robotics.
Additionally, various reports, for example that of the Royal Society and Royal
Academy of Engineers in the United Kingdom raises various issues that needaddressing.
Given these concerns, should the precautionary principle be applied to atleast certain aspects of nanotechnology? Assuming that these concerns are real,
the proposed application of the precautionary principle raises a number ofissues. First, the call for the application assumes that technologicaldevelopment can be halted, and this in turn assumes the falsity of technologicaldeterminism, the view that technological development is inevitable. Second, it
assumes that the precautionary principle itself makes sense, something
vigorously debated, and that if it does, it is possible to know when, that is, atwhat stage in the research and development of new technology, it should beapplied.
In defending the application of the precautionary principle, this paper willassess technological determinism and the precautionary principle, consider thedangers of both applying and not applying it and relate this to the Collingridge
dilemma (that before the development of the technology we do not know
enough to assess the risks and after its development it is too expensive to do
anything), and consider the role played by values in the development oftechnology, in particular Habermas’ worry that too often only the values of
efficiency and productivity.

6. Bioethics in Underrepresented Areas

Chair: Prof. Darryl Macer and Dr. Niyada Kiatying-angsulee
Bioethical Challenges in the Pacific Islands- Sue Vize, Ph.D.
Social and Human Sciences Adviser, UNESCO Apia, Samoa
susan@unesco.org.ws
Pacific Island countries are undergoing rapid transformations of theireconomies, societies and environments due to the impacts of globalization.
With relatively small administrative capacities and resources, much of which is
focused on key areas such as primary education and provision of basic healthcare, the bioethical issues of immediate concern in the Pacific relate to theapplication of science and technology in achieving economic growth andproviding for social services and human rights. Melding sustainable
development with Pacific epistemologies, which are now beginning to emerge
from the work of Pacific academics, as well as the context of community,
cultural and Christian values, is the challenge faced in the region.
Preliminary work indicates that there are a number of key issues requiring
dialogue to tease out the intersections and contentions between Pacific values,
western principles and religious morals, particularly the role of Christianity.
This includes further analysis and development of pathways for the applicationof the Universal Declaration on Bioethics and Human Rights, which iscontradictory to some Pacific values such as collective rights.
This paper will introduce the region and globalization, application ofscience and technology in sustainable development, Pacific cultures,
Christianity and the role of the community, Pacific epistemologies, andstrategies for fostering bioethics dialogue in the Pacific region.
Ethics of Corporate Social Responsibility (CSR)- Glen Kurokawa, J.D.
Regional Unit for Social and Human Sciences in Asia and the Pacific(RUSHSAP), UNESCO Bangkok, 920 Sukhumvit Road, Prakanong, Bangkok
10110 THAILAND
g.kurokawa@unescobkk.org
Corporate social responsibility (CSR) is a growing trend, and this appears
to be true for Asia. CSR encompasses a wide spectrum of activities: humanrights, labor standards, environmental management, consumer protection, anticorruption, corporate philanthropy, and more. There are both conservative andliberal views on CSR. We find that taking a fundamental approach to theconservative view using shareholder-focused utilitarianism can create
opportunities for greater CSR than other prominent conservative views. The
utilitarian approach used is, besides shareholder-focused, incorporates
preference utilitarianism, equates rule and act utilitarianism, and nonexclusively incorporate negative utilitarianism. It is found to be a justifiable
perspective for approaching CSR ethics.
When applied to CSR ethics, we find that while profitable and ethical CSR
still remains relatively uncontroversial, various forms of altruistic CSR are also
ethically permissible in contrast to other conservative views. The ethicalanalysis reveals that contrary to traditional market control views, takeover bidsof firms with increased CSR may not occur, if in accordance with shareholderfocused utilitarian prescriptions. Further, utilitarianism may prescribe
increased CSR norm-building to enhance shareholder preferences; this is apossible game-theoretic result. Finally, CSR departments are a possible sourceof ethical “openness”, where there is no utilitarian prescription if shareholder
preferences desire a completely independent CSR department.

7. Moral Status of Embryos, Animals and Abortion
Chair: Prof. Lee Shui Chuen
Is It Moral to Euthanize Animals?
- Wang Hsuan-Ju
Graduate Institute of Philosophy
National Central University, Chungli, Taiwan
nyny-ny@msa.hinet.net
Stray dogs have been a social and ethical problem for Taiwan since there
are so many of them dumped by their masters or mistresses every day.
University students have been offering great help to protect and promote
humanistic treatment to these animals though there are still thousands of them
who ended up in euthanasia in custody. One of the usual instances among
students concerns stray dogs that under their care whether to let certain
unfortunate dogs, which have been heavily crippled but living on, beeuthanized so that more hands could go to helping more straying dogs around.
It is argued that such crippled dogs have their right to life and should not besacrificed for other dogs, while the other side looks to their quality of life andthe demand of service to help them live on. In this paper, I shall elaborate thelines of argument about the morality of euthanising animals in general anddogs in particular. Comparison with the arguments pros and cons of euthanasia
concerning human being and babies are put forward to guide our thinking on
this issue.
Do Pregnant Women need a Cooling Period for Abortion? Some
Reflections from the Caring Point of View
- Ms Hsiao-Chyi Lin
Graduate Institute of Philosophy, National Central University, Chungli,
Taiwan, Chinahsio.chyi@msa.hinet.net
Recently the Taiwanese government is drafting a revision of the bill forabortion and a new condition is introduced that the requesting pregnant women
who want abortion need to have a three-day cooling period before it is to beconsidered. It is controversial whether such a requirement is a limit on theautonomy of women or a proper protection for the fetus. In this paper I shall
examine this from the point of view of care ethics - the care that we shouldhave towards pregnant women, towards the fetus and the caring relationshipbetween mother and fetus. It is argued that there are gives and takes if we faceproperly the caring relations involved in this issue and there is no simple
solution. A comparison with the traditional Chinese ethos and ethicalrelationships is fruitful and brings out the complex not-one-and not-two
relation of the mother and fetus. The implication of such caring relationship on
the cooling period condition is addressed.
The Moral Status of Embryo- Hannah Chen Wen Sen
Graduate Institute of Philosophy, National Central University, Chungli City,
Taiwan, China
wenshanchentw@yahoo.com.tw“Are Embryos Persons?” is a crucial part of the debates around issues ofabortion and assisted reproductive technology. Essentialism insists thatembryos should be viewed as persons on the ground of the potentiality to
become human beings. Functionalism, on the contrary, believes that embryos
are not persons, since the definition of person consists of two vital constituents,
namely, reason and biological individuality.
Recently, due to the rapid growth of development of embryonic stem cellresearch, such as somatic nuclear transplantation technology as well as DNA
transplantation, the dichotomy of somatic cell and fertilized egg has been
turned upside down. More and more our understanding of embryo changes
from substance-oriented to function-oriented, from view of potential individual
human being to view of material of life. This article is to explore thechallenges posed by biotechnology against the old ethical theory of the moral
status of embryo, and tries to argue about the impact of this paradigm shift
upon bioethics.
A Historical Approach to the Hippocratic Oath
- Li-Chuan Kuo
Department of History, National Cheng Kung University, Tainan, Taiwan,
China
kore2022@yahoo.com.tw
Probably because of his famous Oath, Hippocrates has been praised as aparagon of physicians. The traditional interpretation is to regard the Oath as anancient precursor of modern medical ethics and therefore praises it for its
timeless humanitarian spirit. Yet, this may be a reading out of context. In thisarticle, I will try to adopt a historical approach that takes into account all the
specific conditions, which produces this document; and with this I hope we
may find something as valuable as the present prevailing interpretations.
In ancient Greek poleis (city-states), there was no medical school, noformal regulation for training and qualification, and everyone could practicehealing if he wished. Physicians as craftsman that provided service for healing
had to compete with many other practitioners of similar nature in the medical“market.” His medical position and knowledge was not unchallenged. Even
though the Hippocratic Corpus has been eulogized as the beginning of westernrational medicine, for ancient Greek philosophers, the Corpus did not have asecure foundation of knowledge and its opinions the suggestions for healing
found there were not unlike what one could gain through experiences andhandbooks.
These physicians, furthermore, constituted an organization called
Asclepiades, the children of Asclepius (the healing god.) According to Plato’Ion, the cults (cult-festival) of Asclepius was held regularly in the city-statessuch as Epidaurus. It is the traditional practice of Greek trade unions to form

Eubios Journal of Asian and International Bioethics 17 (May 2007)
an association under the patronage of a certain god, called thiasos. A similar
example is that those who recited and performed Homeric poems wereorganized as Homeridai, though the Greek thoasoi might not be as regulated
and as formal as their counterparts in the Medieval Ages, the guilds. It is mysuggestion that the Oath might be the charter of their association. However,when their professional status are queried and challenged, the identifications
and communications created by the cult of healing god, Asclepius, would be
able to maintain their confidences for arguing and competing with otherhealers and philosophers. This charter-like Oath details various points relevantto the Asclepiadai.
It is under this light that the various ethical requirements have toreevaluate ethical principles in the Hippocratic Oath, such as bans on giving
fatal drugs, abortion, unsuitable sexual relationships, eavesdropping and so on,
are possibly stemmed form a citizen’s civic obligations and moral expectationsin poleis. Other elements, such as religious taboo, are involved too, such as theshedding of blood for this is regarded as pollution. These ethical principles are
not created for simplicity. On the contrary, physicians with his medical
knowledge and drugs were easily suspected or mocked by ancient Greeks.
Civic obligation, popular morality and social prejudice have combined together
to make the Hippocratic physicians reassert these articles of faith in the Oath.
Under these circumstances, the Hippocratic Oath should be interpreted as acharter of the Asclepiadae, which maintained a code of practice as well as
prevention from unwanted criticisms. Thus it also fair to recognize that the
Oath under this interpretation is a product of a given socio-cultural situation,
not a timeless assertion of medical ethics.

Tuesday, March 20, 2007
8. Buddhist Bioethics
Chair: Dr. Somparn Promta

Buddhist Theories of No Self as a Foundation for New Bioethics- Susantha Goonatilake
Sri Lanka Association for the Advancement of Sciencesusanthag@hotmail.com
The new biotechnologies are foundationally transforming (or promising in
the near future to transform), life and the living including those of humans at
the level of the gross body, cell, gene and protein. They adjust, re-form and reformulate what it is to be a human. This raises profound issues in ethics.
Ethical domains are either derived from philosophical or religious realms. The
religions are of two sorts - those that recognize a creator God (Judaism,
Christianity and Islam) who sends instructions on how to behave (ethics); andthose like in most Asian religions that do not have a personal creator God. The
philosophical realm in Europe is the development of Greek thought where
ethics is considered part of a foundational tripod of enquiry that includes also
logic and metaphysics. In later centuries, the Western religions brought in afusion of the Western philosophical traditions to its revelations. Asian religionsat their very foundational level have philosophical underpinnings built in, andhence are qualitatively different from those of the revealed Abrahamaic
religions. Ethics in Buddhism also performs a different function from ethics ineither the Abrahamaic religions or the Greek philosophical tradition. Ethics in
Buddhism are also situational, not absolute like the Abrahamaic ones. At thecentral core of Buddhist philosophy is the observation that the world of bothmind and matter is in a state of flux - the goal of Buddhism being to realize
this. In short, both mind and matter are continually reformulated and rebuilt by
the environment as well as by the individual human. Buddhist texts andBuddhist practices are replete with examples deconstructing the body andmind. In not positing a foundational human essence or sacred soul, thisBuddhist approach alone among the major belief systems of the world has,
therefore, much in common with the coming era of continuous transformationof the human body and mind through willful interventions. The paper explores
various dimensions of this foundational Buddhist perspective on the bioethicaldomain brought in by new technological interventions.
What to be Known and What to be Unknown in Biomedical Research: A
View from Buddhism- Somparn Promta
Chulalongkorn University, Thailand
somparn.p@chula.ac.th
Knowledge in Buddhist perspective includes knowing what should beknown and what should be unknown. This paper is an attempt to present theview of Buddhism on the meaning of knowledge to be applied to biomedical
research. The assumption of the paper is that: before we start any knowledge
activity, the first thing to be explored is ‘what should be known and whatshould be kept unknown.’ In the view of Buddhism, it could be possible thatsome problems resulting from the advancements of modern biomedical
research are given to us because the scientists never raise the first question
stated above. However, the author of the paper is fully aware that the Buddhist
principle of knowledge as said is not easy to use. How we can know that thiskind of knowledge is included in ‘what to be known’ and this kind ofknowledge is included in ‘what to be unknown.’ The paper will give thepractical criteria to answer this question as much as possible.
Buddhist Model for Public Health- Mettanando Bhikkhu
Member of the Thai Sangha, Thailand
mettanando@hotmail.com
Although medical services are now available in every province inThailand, there is an ongoing debate of how public healthcare should be best

(ABC8/BBRT2 abstracts)

73

organized. Whether it should be run by private organizations in libertariansocieties like that of the United States or whether the government should be
responsible for the welfare of all of its citizens equally, like that of theegalitarian system of socialist countries or welfare states. This article is aimed
to answer the question: What is the most suitable model of healthcare system
for Thailand? References are drawn from the Pali canon of the Theravada
Buddhist tradition, articles, comments and recommendations of contemporary
thinkers in Thailand, in order to arrive at the most appropriate solution for theThai society.
Improve “Consumer Protection” with Buddhist Ethics: Necessity,
Possibility and Challenge- Suntaree T. Chaisumritchoke
Thammasat University, Bangkok, Thailand
tsunthar@chula.ac.th
This article primarily aims to draw attention on the concept of consumer
protection in health care and drug regulatory systems. Consumer protection isoriginated in western tradition, adopted later as a mainly consumer protection
model in the world; however, this concept is challenged when encounteredunethical mind manipulating strategies of pharmaceutical industries incapitalist societies. Modern advertising and drug marketing contribute tostimulate feelings mixed with greed, fear and delusion so that consumers,
physicians and regulators are weak and vulnerable; drug regulatory systems areundermined; drug disasters recently occurred in the US and European country
were witness. It is therefore needed to search for a new means of protection tostrengthen mind and lessen limitation of the existing model. Consequently, thearticle offers two theoretical investigations of principles for protection basedon moral philosophy or ethics; one based on western traditions, the other from
Buddhist ethics. This analysis is thus designed to understand strengths andlimitations of each moral foundation in order to propose a possible
improvement.
Fetal (an unborn child) Checkup- for Whom?
- Park So Young
Catholic University of Korea, Republic of Korea
bamby4u@naver.com
When pregnant women come to the hospital in Korea, they receive an
investigation according to pregnancy period by a well-organized plan. There
are some differences in the price for investigation between hospitals, but theinvestigation is almost the same everywhere. However, various investigations
or recent medical equipments used in the prenatal checkup do not actually help
pregnant women to give birth to a healthy child, but urge them to undergo an
induced abortion in some cases. Pregnant women chose to have an abortion
voluntarily or by other person's will through the prenatal diagnosis for acquired
hereditary diseases or deformed fetuses. The reason for having less number of
deformed children compared to the past is because of the selective childbirththrough prenatal checkup.
For whom are the investigations performed in the hospital meaningful? Is
it for the pregnant women or the fetus? This study examined the actual
examples of abortions done through fetal checkup without a sense of sin andprovided an opportunity to discuss its problems and their feasible measures.
This paper will review the problems of prenatal diagnosis checkups in Korea.

9. Cultural Perspectives on Principles of Ethics andLove of Life
Chair: Prof. Darryl Macer

Sciences, ethics and the Thai Society- Somsak Chunharas, Ph.D., M.D.,
Secretary General, National Health Foundation, 1168 Soi Phaholyithin 22,
Phaholyothin Rd, Ladyao, Chatuchak Bangkok 10900, Thailand
thainhf@thainhf.org
Future of Bioethics – Rational BioCosmology?
- Konstantin S. Khroutski, Ph.D.
Institute of Medical Education, Novgorod State University after Yaroslav-theWise, Novgorod Velikiy, Russia; A/B 123, PO-25, Novgorod Velikiy, 173025
Russiahrucki@mail.ru hks@novsu.ac.ru
The Earth and the evolutionary process of life (Greek. ‘Bios’) on Earth arenaturally the integrated part of Cosmos, subordinated to the common Cosmic
laws. All the processes of life on Earth (biological, personalist, social) – are thesubjects of BioCosmology (this orthography serves to distinct the explorationof the phenomenon of cosmic life on Earth from (1) the current astrophysicalcosmology and from (2) the biocosmology that explores the forms of life’s
origin in cosmos).
Inasmuch as Life – the cosmic evolutionary process of life on Earth(Evolutionary Process or EvoProcess, briefly) – is objectively (proved bynatural sciences) universal phenomenon, we might speak about the evident
BioCosmological principle of f u n d a m e n t a l u n i v e r s a l i s m . The latter
is apparent in three spheres, firstly in structural-functional realm: Everysubject of life (from a molecule to cell and biological organism, and further, –to a person and the constituted societies, civilizations, humankind, etc.) iscomposed from the same (universal) structures (as nucleotides, the derived
proteins and other molecules, cells, etc.) and in the same order of theirfunctional interrelations. In the second aspect, Life on Earth (EvoProcess) isbased on the evident (natural) principle of f u n d a m e n t a l s e l f ( m a c r o ) e v o l u t i o n i s m – every subject’s (living organism’s, including
social organization’s) ontogenesis is a self-dependent emergent evolution – theautonomous rise of a living system on the successive ontogenetic macro-stages

74 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)

that cannot be predicted or explained from antecedent conditions (for example,
the emergent ascending essence of the biological evolution is quite
demonstrable). The third universal natural BioCosmological sphere is theevident f u n d a m e n t a l m a c r o - c y c l i c r e a p p e a r a n c e (reiteration)of polar evolutionary processes, when the diametrically opposed, but
successive cycles-stages (like Day and Night, or Systole and Diastole)
substantively realize the ascending Evolutionary Process on the whole and theontogenesis of every living subject (biological, personalist, social), overrulingeach other by turns.
This paper will explore world social evolution. Modern bioethics has
important roles in the protection and maintenance of the rights of a person andsociety by neutralizing (minimizing) the possible harmful influences ofpresent-day technologies within contemporary civilizational practice.
However, modern bioethics has fundamentally a secondary role (in relation toscience) – of “technology assessment”, correcting dangerous (to individual orcommunity health) errors (the effects of unreasonable application oftechnological innovations), while the basic role of bioethics (of disclosing andtreatment of the primary reason(s) of unreasonable activity of a man andsociety) is missed.
Considering the future of Asian and global bioethics, in Kiev (2001) and at
the ABC5 (Tsukuba, 2004), Prof. Hyakudai Sakamoto substantiated the need
to follow “Asian holistic way of thinking instead of the European
individualistic way”. He claimed that the gist nowadays is not Western “toconquer nature”, but Eastern “to protect Nature for its own sake” (to turndefinitely from Western human-centrism to Eastern nature-centrism, which is,in my context, – ‘cosmos-centrism’). I will discuss the claim of Prof.
Sakamoto, in substantiating his “a new humanism without human-centrism”. I
also reject (for the future of bioethics) the Western civilizational humancentrism and categorically replace it on personalist cosmos-centrism. I will put
forward and pay attention to the following global alarming paradoxes of-today:
1. The loss of a “motivational basis” to procreation and the directivity on afamily with one child in favor of hedonistic models in realizing her and his
vital energy; 2. The ‘social hypersexuality’ as a feature (norm) of social life; 3.
The increase of depressions; 4. The super-popularity of sporting competitions;5. The current leading role of the philosophy of postmodernism that affirms
basic pluralism (in objectively universal world) – randomness of creativity; 6.
The so-called ‘a n t h r o p o l o g i c a l e v o l u t i o n a r y p a r a d o x ’; 7. The
global b i o m e d i c a l paradox: The inability, in the hi-tech age, to obtain the
etiological – curing, healing – approaches, as regards chronic non-infectious
and non-traumatic diseases; 8. The global b i o e t h i c a l paradox: up-to-datebioethics tackles the problems that are the effects of unreasonableness ofcurrent science and technologies, while, on the contrary, the up-to-datebioethics has no intentions (the aim itself!) to unravel the reason of the existing
civilizational unreasonableness! 9. The Western e p i s t e m a t i c paradox; 10.
Western c i v i l i z a t i o n a l paradox.
Therefore the evident and urgent challenge is to create and advance newrational civilizational foundations – for the new (Third, of Real Cosmism,‘NewDay’) episteme and the derived universal civilization. I will present theconcept of BioCosmology by introducing the cosmological concept ofsubjective functionalist evolutionary universalism (cosmism) and the derived
theoretical and methodological laws, principles and notions, like the objective
laws of EvoProcess, or the basic principles of Universal Functionalist
Reductionism, Basic Cosmist Functionality, CosmoBiotypology, etc., as wellas the supporting basic notions. BioCosmology rejects Western epistematic(civilizational) principles that have the a priori (“Night”) essence and puts inthe forefront the idea to base a new (‘NewDay’) episteme and civilization on
the a posteriori principles – already scientifically discovered natural empirical
truths, like natural universalism (cosmism) and (macro)cyclic evolutionary
essence of our living world, etc. This is precisely a way to ethical disclosing“the reason of existing unreasonableness in everyday life”.
Open Science and the Future of Biomedicine- Yann Joly, LL.B, LL.M, PhD Candidate1,2, Bartha M. Knoppers, PhD,
Canada Research Chair in Law and Medicine1
1. Centre de recherche en droit public, Faculté de droit, Université deMontréal, C.P. 6128, succ. Centre-ville, Montréal (Québec) H3C 3J7, Canada
2. Centre for Intellectual Property Policy, Faculty of Law, McGill University,
3661 Peel St., Montreal, (Quebec) H3A 1W1 Canada
yann.joly@umonttreal.ca
A climate of open science is said to have prevailed in the field ofbiomedicine before the 1980s. It has been described as a climate wherescientific findings were seen as a product of social collaboration that should beshared with members of the community. Thus, claiming property rights ininventions or keeping discoveries secret, was perceived as immoral. However,the past existence of this idyllic open science community is now contested by a
growing number of authors. According to them, scientists are not particularly
unbiased, altruistic or cooperative, and their dealings with one another can attimes result in fierce controversy, ruthless competition, personal animosity,
greed and dishonesty. Although claims of the past existence of an open science
culture in biology remains controversial, it would seem that open science,viewed as a cooperative scientific ideal, has never been more popular than it iscurrently. A substantial number of new projects in the field of biomedicine(e.g. Cambia BIOs Project, International HapMap Project, Tropical Disease
Initiative, P3G Observatory) can already be associated with the open science
ideal and this number seems to be growing quickly.
This presentation will demonstrate via a comparative case study analysis
of five selected large scale biomedical projects associated with open science,that although the commercialization of biomedicine seems to be on the rise,paradoxically, the biomedical community is more interested now than ever in
the ideal of open science. The motivations behind this renewed interest in open
science were investigated by way of a qualitative literature analysis (literaturesearch was done on four major electronic databases using selective keywords)

and will be presented here. The presentation will conclude with a discussion of
the importance of adopting an open science approach to successfully meet theimportant challenges raised by large population projects in field of genomics
and pharmacogenomics.
Bioethics: Love of Life through the Knowledge of Chanting for Health andPeace- Chutatip Umavijani, Ph.D.
Philosophy Department, Liberal Arts, Thammasat University, Thailand
chujid@gmail.com
After reading Darryl R.J. Macer's Bioethics is Love of Life: An Alternative
Textbook I was inspired to relate my article on Chanting for Health and Peace.
If one only knows what is good for oneself, he or she will certainly do
accordingly. Which means having the knowledge is the most important thing,
like that Socrates mentioned, "Virtue is knowledge". If we know that is goodfor us, we will practice it, as all of us have the love of life that Macer wrote.
This article will elaborate upon the benefit of chanting to humankind, that ourancestors practiced for a long time. Chanting in all religions is a part of sacredrituals, the rituals that have become the traditions and are interwoven thereligious culture in each region. At the beginning of civilization, oral traditionin the important means of communication among men. Sound waves have beenused in all parts of the world for healing since ancient times. In Buddhism, Paliand Sanskrit have been used since the Buddha's time until now. Pali is used in
the main texts of Buddhism, and also in chanting.
The West now tries to discover the secret of it through researches andscientific methods. This vibration medicine is in fact, related to the method ofEinstein's theory of substance and energy, that humans generate complex
energy in dynamic equilibrium for the growth of their soul. The result showedthat sound vibrations really affect people in physical, mental, emotions andeven spiritual levels. It shows that we have the ability of love to heal ourselves
if we know how to stimulate the infected organ and enable to maintain good
health by vibration from chanting.
This paper tries to present the following points: First, through human's
love of life, people can use the effectiveness of sound vibration from chantingthat could heal us. Second, is to study the attributes of each chant that hassound and its power, and why they are effective. And finally to find thescientific reasons why we can maintain love and peace through chanting. Lovecan be the beginning and ending of all our actions only if we realize the powerof if.
Justice as Shown in Tamil Literature- P. Senthil Kumaran,
Research Scholar, School of Tamil, Pondicherry University, Pondicherry 14,
Tamil Nadu, India
Senthill732@Yahoo.Com- Dr. Arockiam Thaddeus,
Reader in Zoology, Jayaraj Annapackiam College for Women, Periyakulam,Tamil Nadu, India- Prof. M.A. Jothi Rajan,
Dept of Physics, Arul Anandar College, Karumathur, 625 514, Tamil Nadu,
India
anjellojothi@yahoo.com- Prof. T.J. Mathavan,
H.O.D., Dept of Physics, S.V.N. College, Nagamalai, Madurai, 625 019, India
Tamil language is one of the classical and oldest languages in the world.
The literature in Tamil has the tradition of 3,000 years. There are a lot of
ethical principles like “love everyone, justice, doing no harm, protect the
animals etc.,” that are discussed in Tamil literature. This article tries to pointout how the ethical principle “Justice” has been upheld in some of thedynasties referred to in Tamil Literature.
Chibi, one of the Chola Kings has cut and gave his own flesh (equal weightto the dove which had fallen down on his thighs with wounds) to the hunter inorder to save the life of the dove. Another Chola king called Manuneethi
Cholan has killed his own son for the conviction of a cow’s murder.
Pandiyan Neducheliyan, one of the Pandiya’s emperors, has wrongly
punished (killed) a man namely Kovalan for the theft of Princess’s anklet.
After the death of Kovalan, his wife Kannagi came to the court of the king. She
argued and proved her husband was innocent. As soon as King Pandiyan
Neducheliyan felt his wrong judgment, he suddenly fell down from the king’s
throne and died.
Whenever the warriors go for war, they made an announcement to thepeople before the commencement of the war. The announcement reads like
this, “cows, priests, animals, couples who have no child, ladies, patients, aged
peoples are asked to go to safe places, because the war will be commencing onsuch and such day”. We try to highlight the ethical principle “Justice” from thebackground of Tamil literature and Tamil culture that will help the students ofTamil Nadu to develop their own “Codes of Justice” on the basis of theirculture and tradition.
Autonomy, Dignity, and Compassion: Dying with Dignity in the Context
of Japanese Culture- Michio Miyasaka, M.D., Ph.D.
Associate Professor at School of Health Sciences, Faculty of Medicine, Niigata
University, Japan
Asahimachi-dori 2-746, Niigata City 951-8518, Japan
http://www.clg.niigata-u.ac.jp/~miyasaka/e/eindex.html
miyasaka@clg.niigata-u.ac.jp
In this paper, I examine the ethical questions of withholding andwithdrawing life-sustaining treatments in current Japanese health care.
Comparing clinical cases in different settings of: (1) patients with terminal
cancer; (2) patients with severe motor neuron diseases like Amyotrophic
Lateral Sclerosis; (3) children with severe disabilities, I argue prevailingEubios Journal of Asian and International Bioethics 17 (May 2007)
principles in Japanese context, and the possibility (or impossibility) of "global"or "Asian" principles to address ethical dilemmas in death and dying issues.

10. Privacy: East and West

Chair: Dr. Brigitte Jansen and Prof. Jayapaul Azariah
Privacy: An Old Fashioned Western Driven Paradigm?
- Dr. phil. Dr. rer. publ. Brigitte Jansen,
Berlin, Germany; Visiting Professor, University of Madras; Director
BioethicsLaw e.V.,
http://www.jansen-bioethics.com
jansen@bioethicslaw.net, jansen@jansen-bioethics.com
If we observe the discussion about the participation of patients and donors
in large collections of human biological samples and genetic data, clinical
trials and pandemics the paradigm of “privacy” is gaining an increasingly
prominent position in the western civil society, especially in the relation of theterms law/bioethics, biomedical law/medical ethics. The right of “privacy” canbe seen as a result of the differentiation of the society in the 19th century, thetime in which in Europe the civil society was established. This trend wasestablished in the industrialized society as a result and instrument ofdifferentiation.
Now we are living in a postmodern societies and the connotation and thevalue of the term “right of privacy” has changed. We can observe that we areloosing or giving up the “right of privacy” without any control to third parties
or observers. Does “privacy” become an old fashioned paradigm, or is there aneed to focus again on its importance and value for the civil society. The fearin the discussion of protecting the human genome or the patient’s data showsthat there must be something behind the right of privacy and data protection,
which shows its function for the societies.
Why is this so important for western societies? Is it only a vehicle forlawmakers to increase the numbers of law professionals or ethicists? The valueof the right of privacy and data protection has another status and function in
Asian society and it seems different from the European position.
Privacy as a Human Territory: A German Perspective- Dr. jur. habil. Jürgen Simon,
University of Lüneburg, Lüneburg, Germany; BioEthicslaw e.V, Berlin,
Germanysimon@bioethicslaw.net"Privacy" is a key word in Europe at a time when just this privacy isthreatened by the state or government and by industry in such a manner, as has
not been the case before. Millions of video cameras capture each movement ofa citizen; biometric information is used for the purpose of fighting terrorism;
national and transnational biobanks cooperate with industry by using healthdata of millions of citizens; the see-through user of the internet and thetransparent consumer on any market, just to name a few of the examples whichshow significant elements of the threat.
What is the basis of "privacy"? First, it concerns the creating andmaintaining of the material and immaterial life space of a citizen, which theyneed like, animals need their territory: Living beings and communities have an
instinct for "flight distance" or the "critical distance" (Edward Hall, The hidden
Dimension). In this sense, privacy is determined in Germany in more detail by
the Federal Constitutional Court by means of the theory of spheres (intimate,private and public sphere). Herein, the citizen may defend a sphere in part bymeans of his personality right; in part this is taken care of by the government
by way of institutional protection (for example, data protection). The question
arises whether this double track protection is sufficient considering this very
obvious threat.
This paper describes these correlations and attempts to mark a paththrough the thicket of "privacy" by showing some of the strains ofdevelopment of this "phenomenon", particularly with regard to Germany.
Biomedical Ethics and the Right of Privacy in the Indian Law- N. Manohar
Professor of Constitutional Law and Human Rights, Dean, P.G. Departmentsof Law and Research Development, The TN Dr Ambedkar Law University, 5.
Greenways Road, Chennai 600028, India
profmanohar@yahoo.com
In India, though largely a country with strong flavor of indigenous culture
premised on its civilizational pride, maintaining privacy and secrecy andconfidentiality are part of its civilizational pride, maintaining privacy andsecrecy and confidentiality are part of its ethos. The words indigenously used
are acham, naanam, matam, payirpu, imply a women's inherent gender
qualities. Women never share gender specific complications, issues orotherwise delicate things even with her husband. Some are shared with mother,a few with friends, and very less with her husband. The confidentiality on any
person, especially, a woman about her, her person, anything done to her
sentiments and of physical impact offends or infringes her right to privacy. In
correlation, this phenomenon pervades to many such issues like, testing awomen’s fertility, chastity and such other aspects regarded sometimes good on
health grounds often times regarded as gross invasion of her privacy and much
more sensitive on other counts.
However this tradition, which has been rationalized by medical
advancement and research development, has not focused on individual identity
but on a population for the futuristic benefit of all, as the excuse would claim.
Societies, which are individualistic in character and right conscious in theircommon attitude, are more prone to commoditization of these finer aspects inquality of life. They either accept 'consent' as a license to invade individuallypreserved privacy even in scientific and clinical research of testing, researchingand diagnostic of the illness, aberration, defects, malfunctions and more so
now in biotechnological context biogenetics experimentations, mapping of(ABC8/BBRT2 abstracts)75

genes for creating data bases on the assurance and guarantee of anonymity.
Law lends support to such a trade with a price. Violations are regarded as
injurious act repressible with unliquidated damages. That is the reason theword commoditization of finer aspects in quality of life has been used above.
On the other hand, the socially conscious group rights, which have a collective
sense of ethos never, compromised on it and grow on legal foundations. It has
both the political and legal support with guarantees enshrined in theconstitution. Any genetic testing and research imploring the group identity tostigmatize people with a kind of trait attributed to them is very offensive.
Any individual violation of the personal data with or without consent, isvery seriously regarded as a redressible act, since it is against ones right toprivacy. In India, codes of ethics for medical research culminated from the
ICMR as an institutionalized professional ethics and subsequent efforts tobring in a law has in every sense the European tenets ingrained in it withflavours of the US laws. The peculiarities of the Indian situation are that it has
effectively understood the danger of social stigmatization in an alreadypluralistic society, which would not tolerate any type of stigmatization ofpeople. Disharmony would be viewed as a danger to security issue.
Data preservation in the digital world with emergence of bioinformatics
development, cloning and gene mapping, data chip etc will go along way
endangering right to privacy. The Right to Information Act has to be honed
suitably to the needs of the time. Both the Right to Information Act and theInformation Technology Act in India may result in erosion of dignity of theindividuals guaranteed under the Indian Constitution. Though the expanded
interpretation on Article 21 covers fully with its protection the philosophy of
dignity is addressed in the preamble of the Indian Constitution and the judicial
articulation of Indian jurisprudence. Issues and articulation of legal
components of the law on the right to privacy in Biomedical research andethics will be focused in my elaborate well-researched paper.
European Standards on Confidentiality and Privacy in Healthcare- Colin M Harper, Ph.D.
Visiting Research Fellow in Ethics, Human Rights and Mental Health,Division of Psychiatry and Neuroscience, Queen's University, Belfast,
Northern Irelandc.harper@qub.ac.uk
The European Standards on Confidentiality and Privacy in Healthcare
were developed through the work of the EuroSOCAP Project. EuroSOCAP
was a European Commission funded project (2003-2006) established toconfront and address the challenges and tensions created within the healthcare
sector between the information or knowledge-based society and thefundamental legal and ethical requirements of privacy and confidentiality ofhealthcare information.
Diverse cultures and legal/ethical traditions with a large number of states
and regional international organizations made it difficult to agree on shared
ethical principles and practice in the context of international regulation throughdata protection law (EU) and human rights standards (Council of Europe). The
European Standards are an attempt to place the ethical obligations of respect
for confidentiality and protection of patient privacy firmly in the context ofsuch legal obligations.
The European Standards are designed to apply to all healthcare
professionals and to healthcare provider institutions and address the areas ofhealthcare confidentiality and informational privacy. They provide backgroundon the ethical and legal foundations of confidentiality and privacy in Europe,
guidance on best ethical practice for healthcare professionals andrecommendations to healthcare provider institutions.
The Standards are primarily ethical standards, but they also consider
European legal obligations upon healthcare professionals and the general legal
context within which professional decisions about the protection, use anddisclosure of confidential information take place. Laws do not exhaust the
obligations on healthcare professionals to respect and protect patient
confidentiality and privacy and healthcare professionals may also need toexercise professional judgment with respect to both the ethics of certain
decisions. These European Standards provide ethical guidance for all
healthcare professionals in the making of such judgments. They are unusual inthat they are a regional ethical instrument, which in many ways parallels thestrong regional human rights framework in Europe.
The European Standards were written following detailed consideration of
the needs of vulnerable patients—particularly children and young people, older
people, migrants and mobile populations, prisoners, homeless people, people
with mental health problems, people with an intellectual disability, and people
who lack decision-making capacity. The explicit focus on the specific risks to
the healthcare privacy and confidentiality of vulnerable patients has greatly
informed the development of generic Standards to guide healthcare
professionals, including practice involving vulnerable patients.
The Project team had 20 members—clinicians (with various specialities),
therapists, legal experts, and ethicists from 11 European states. Draft Standards
were developed over a two-year period by this team (with contributions fromsix invited experts). The draft Standards were then circulated widely for
consultation during 2005 and were the subject of a Workshop attended by 80
experts from 26 European and neighbouring states. A broad range of responses
were received through this consultation process, including perspectives fromPatient Organizations, National Medical Associations, National Ministries of
Health, National Data Protection Authorities, the European Commission,industry, universities, and relevant international organizations. Based on thisconsultation process, revised draft Standards were prepared and circulated fora further round of consultation.
This paper will explore theoretical and practical issues, including:
1. The process by which the Standards were produced, including the context
of funding and the powers of the European Commission as the funding body.
2. The content of the Standards as representing a European consensus on theconfidentiality and privacy obligations of European healthcare professionals.

76 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)

3. Ongoing current work on the dissemination of the Standards. The
processes of engagement with stakeholders and attempting to get the Standards
taken up and used in healthcare practice.
Collection and Protection of Genetic Data in the European Union- Cosimo Mazzoni and Valeria Carfi
University of Siena, Italy
Genetic data are considered by the European law as “personal data”, inparticular as “sensitive data”. In fact, genetic data constitute data that are “ableto reveal the health condition or the sexual orientation of an individual” (art. 8,
Council Directive 95/46/EC of 24 October 1995 on the protection ofindividuals with regard to the processing of personal data and on the freemovement of such data).
Some scholars have argued that everyone has a kind of intellectual
property right over her personal data: following this way of reasoning, every
person might claim an intellectual property right (sui generis) over her genetic
data. We will question this.
Art. 12 of Directive 95/46/EC describes the data subject’s right ofaccess to personal data. But, can a third party access the data banks?
And, if so, in which cases? EC Member States must provide that thecontroller must implement appropriate technical and organizational
measures to protect personal data, among the other, against
unauthorized disclosure or access (art. 17, par. 1, Directive 95/46/EC).
Therefore, the general rule is that the communication and the diffusion
are possible only with the previous consent of the data subject. The
consent is not necessary if the disclosure is imposed by a statutory
duty, if it is necessary for the protection of life or health of the data
subject (and if he or she is incompetent) or of a third party, if it is madefor forensic, scientific or statistical purposes.
The communication of genetic data is not submitted to specific rules,
others than those provided for the sensitive data. The Italian Data Protection
Authority has decided for the first time in Europe a case concerning the accessby a third party to the genetic data of an individual. A woman suffering fromglaucoma has been authorized to access the genetic data of her father, without
his consent, in order to proceed to a pre-natal diagnosis (decision 22-5-1999, inBollettino, n. 8, 1999, p. 13).
As a general principle (art. 18, Directive 95/46/EC), anyone who starts atreatment of personal data has to notify the National Data Protection Authority,
before the collection takes place, a signed declaration containing several
elements (name and address; purposes and modalities of the treatment; kind ofdata, place of conservation and categories of people whom the information isrelated to; to what extent the data will be communicated to a third party).
Secondly, the data subject has to be informed, orally or in writing, about: a) the
purposes and the modalities of the treatment; b) the existence of a duty tocommunicate the data; c) the possible consequences of a refusal to answer; d)the subjects whom the data can be communicated to; e) the right of access toand the right to rectify the data concerning him; f) the name and the address ofthe person responsible for the treatment (art. 10, Directive 95/46/EC). Thirdly,
as a general principle, the consent of the data subject must be obtained (art. 7,
Directive 95/46/EC).
If the data are able to reveal the health situation of the individual thetreatment (“sensitive data”) is subject to some additional requirements. In
particular, it is necessary to get the permission of the national Data Protection
Authority (excepted the treatments conducted for indispensable therapeutical
purposes). In the Italian system, particularly meaningful are art. 16 of thedecree n. 281/1999 and art. 17 par. 5 of the decree n. 135/1999, where it isprovided that the treatment of the genetic data is submitted to the specificauthorization of the Data Protection Authority (notwithstanding who - public
body or private subject - is the responsible for the treatment) with theaccompanying advice of the Ministry of Health (but it’s not clear whether thisadvice should be deemed binding or not).
However, the authorization must not be in any case specific. The
Authority can release by decree some general authorizations. In the year 2000,
for instance, in Italy the Authority has issued seven different authorizations
and, among them, an authorization to the people that practice a medical
profession to process the medical data and, for some purposes (medical
treatment with the data subject’s consent), the genetic data (see art. 2 provv.
20-9-2000, Autorizzazione al trattamento dei dati idonei a rivelare lo stato disalute e la vita sessuale).
Confidentiality and Genetic Data: Ethical and Legal Rights and Duties. A
European Perspective- Sergio Romeo Malanda, Ph.D.
Centre for Law and Genetics, Law Faculty, University of Tasmania, Hobart,
Australia
sergio.romeo@utas.edu.au
This paper is based in three ideas, namely:1.
All the questions in the field of “privacy” and “confidentiality”
derived from genetic tests only must be taken into account if we deal with“personal data”.
2.
When we are dealing with personal genetic data, two aspects mustbe specially guaranteed: a) the freedom and autonomy of the individual; and b)
the duty of secrecy in order to protect the privacy of the person.
3.
Some conflicts can appear between these two aspects and we haveto deal with them
I will discuss Directive 95/46/EC of the European Parliament andCouncil, of 24 October 1995, on the protection of individuals with regard
to the processing of personal data and on the free movement of suchdata. The Directive states that personal data “shall mean any
information relating to an identified or identifiable natural person”. The
scope of “genetic data” will be discussed, and who it can be sharedwith.

In principle, genetic data must also be protected from other persons evenin case of a biological relative who seeks information concerning the possible
presence in him or her of a pathological gene similar to the discovered in thedata subject and also inherited from the parents, even when the doctor
considers it necessary for family members to know the information because
they too might be affected by the results of the genetic test.
Genetic medicine can give rise to a variety of conflicts of interests.
These conflicts may be classified in the following categories, according
to the person or institution seeking access to the data:a) Biological relatives might unknowingly be healthy carriers of thesame genetic anomaly as the subject and consequently have a directinterest in the informationb) Legal entities or individuals have entered or plan to enter into acontractual relationship with the subject, especially an employment,
service-related or insurance contractc) The use of genetic data may be required by society as a whole(collective interest), for example as a vital clue in identifying theperpetrator of a crimed) The advancement of medical research may be dependent on thegreatest possible knowledge of data relating to subjects belonging tofamilies within certain hereditary [hi’reditri] diseases occur.
Only exceptional circumstances, whereby disclosure could prevent
serious harm to the health of a Third party, and provided there are noother less-intrusive alternatives with respect to the privacy of thepatient, may justify a breach of confidentiality in the doctor-patient
relationship, and disclosure of the information by the health professional
against the wishes of a patient.
In this way, having established that a person has rights over his or her own
genetic information, and that said rights must prevail over the interests ofothers, it is nevertheless possible to consider the rights of those other people
when their health or lives are seriously affected. Specific regulation is not
required for this. Rather, it can be achieved on grounds of the conflict of duties
or, as the case may be, the state of necessity, techniques which exist in the
majority of national legislations.
Privacy of Biometric Information in a Networked Environment: aPhilosophical Approach- Eamon Daly
Bioethics Council of New Zealand, Wellington, New Zealandeamon@xtra.co.nz
In this paper I discuss privacy issues arising from the increasing use ofbiometric information technologies in a networked environment. My analysisof these issues is informed by a brief account of the relatively recent history of
the western concept of privacy, particularly in terms of the thinking ofphilosopher John Stuart Mill. I then differentiate personal privacy frominformation privacy, where the latter is more relevant to effects brought about
by biometric information systems. I argue that the effects on information
privacy by networked biometric information systems are more appropriately
framed in terms of personal autonomy, and I apply the ideas of philosopher
Immanuel Kant to illuminate these effects. I note here that biometrictechnologies are a major component of the security infrastructure inherent inpresent-day international travel, and my discussion should therefore be read inthat context.
Globalization and the Dynamic Role of Human Rights in Relation to a
Common Perspective for Human Biotechnology- Carlos M. Romeo-Casabona
Professor, Faculty of Law, University of Deusto and University of The BasqueCountry, Bilbao, Spaincromeo@genomelaw.deusto.es
International law has promoted a global perspective in relation to life
science technologies. This global perspective has been favoured because statelaws lacked ethical and cultural reference points for a clear and undisputed
application to the new challenges created by the biomedical technology. The
UNESCO’s Universal Declarations on the Human Genome and Human Rights
and on Bioethics and Human Rights, as well as the European Convention on
Human Rights and Biomedicine are significant contributions for thedevelopment of biolaw at the international level.
Globalization doesn’t mean automatically to share cultural values andtraditions; the diversity of these in a society has a specific cultural andhistorical foundation. Nowadays we need go further to reach a truetranscultural ethics and law in the field of human genetics and biotechnology,
this is to say, to share worldwide a minimum common of those.
This means that there are some values (human rights, juridical goods) thatare related to human life sciences that have achieved a universal recognition
with great ease, but at the same time these have not always found an adequate
match with certain cultural and ethical conceptions of some non-westernhuman communities, as they have a holistic view of human social relations.
Human rights continue to be an unavoidable reference point to better
capture the multiple challenges of biomedical technology, in that thedevelopment of these rights is the result of an ethical construction that givethem the conceptual support and the axiological credibility. In the future, it
shall be necessary to look further into the following aspects:
1.
Human rights also present an objective dimension that permits
through them the protection of realities or situations independent of thepossibility of accepting the existence of a subject titleholder of a specific right.
2.
Human rights are not only individual rights, but at the same timethey have a collective dimension that must be implemented, as it serves toguarantee the adequate protection of specific social groups and communities,
without decreasing the individual dimension as a hypothetical side effect; and3.
From this point of view, in the future there should increase therecognition of the greater importance that shall be granted to a collective focus

Eubios Journal of Asian and International Bioethics 17 (May 2007)of human rights or those that guarantee the coexistence. In order to develop
them, we must take into account principles such as responsibility, solidarity,
justice, equity, tolerance, non-discrimination and responsibility towards future
generations.

11. Confucianism and a New Dimension of Bioethics

Chair: Prof. Lee Shui Chuen
Panel abstract
This panel will present Confucian bioethics in contrast with Western
bioethics as a contrast between familial solidarity versus individualistic
liberalism. We shall highlight from a number of issues the difference between
the East and the West in doing bioethical matters.
Justice and Health Care: A Confucian Program- Shui Chuen Lee, Ph.D.
Professor, Graduate Institute of Philosophy, National Central University,
Chungli, Taiwan, China
shuiclee@cc.ncu.edu.tw
The just allocation of healthcare resources has been a daunting andpressing problem for countries rich and poor. The mainstream theory of justhealthcare of Norman Daniels though gives a broad outline of reasonable
practice but could not be said to be more than satisfactory. Though the freemarket is an important motive for better medical services, the encroachment ofmarket forces in medical matters is not only deemed as inappropriate and very
often charged as promoting inequality of social classes. How to mobilize thesocial resources is a further issue both for the health of the nation and for thefamily and individuals. In critiquing the limiting of justice to fair equality ofopportunity, we resurrect the idea of solidarity of a moral community to treat
the disables and patient as brothers and sisters.
In this paper I shall espouse the Confucian conception of just healthcare asa co-venture of family and society. Except for some necessary major public
provisions for the treatment of diseases and rehabilitation, part of the publicfunding for healthcare will be listed under the personal account of theindividual, which could be shared by the family members. Each person could
use this funding for personal medical needs and preferences so that medical
services could gear to the most of personal choices. It is thus more liberal andfair as each has his or her share and could get the most of what each one wants.
The sharing of family medical accounts provides better incentive to familial
solidarity according to the Confucian conception of family ties. Also, theinsufficient portion of medical expenses will be supplemented by personal orfamilial resources rather than by public funding. It shall realize the Confucian
ideal that everyone, especially the frail elderly will be well taken care of.
A Comparative study of Confucian and Taoist conception of Well-Being
and Their Implications on Health- Wong Hon-Chung
Graduate Institute of Philosophy, National Central University, Chungli,
Taiwanhoncwong@cc.ceu.edu.tw
This paper compares the conception of well being in healthcare by the twomain streams of thoughts in China and how they differ and could provide a
new dimension of bioethical considerations in healthcare other than that of thewest.
A Confucian Appraisal of Justice in Genetic Therapy and Genetic
Enhancement- Chou Wan-Ling
Graduate Institute of Philosophy, National Central University, Chungli,
Taiwan, China
ipss.iks@yahoo.com
The rapid development of genetic technology brings to the front the ethicalproblems of the applications of genetic therapy and genetic enhancement. Oneof the pressing problems is genetic justice. In this paper, I shall approach the
problem from a Confucian point of view. First, Confucianism will support
genetic therapy, as it is a kind of genetic interference for the curing of diseases
or restoring of health. It is regarded as a participation of the nourishing processof Tao, that is, a moral obligation. For Confucians, justice is to let people fully
extend their natural endowment as a human being, the so-called hsing feng.
Hsing feng encloses both the moral mission of human being as well as thetalents one inherited. A just society should provide support for everyone so that
she or he could manifest to the utmost their talents. A crippled person faces
much more difficulties than the normal and his or her chance for selfdevelopment is thus less than usual. Hence, if genetic therapy could raise theirstates back to normal, it is by all means approved by Confucians. As to genetic
enhancement, I venture to argue that Confucianism will not object to it inprinciple, though its execution requires two restrictions. The kind of genetic
enhancement to be deplored could not affect the fair equality of opportunity ofothers on the one hand, and it is supposed to be beneficent to human being as awhole. The first requirement is to avoid furthering social injustice and thesecond to avoid the negative effects of enhancement such as causing moresocial injustice. I shall espouse the grounds for genetic therapy andenhancement, and delimit the scopes of application.
Confucian Conception of Genetic Privacy and Public Interest and Its
Application to Biobank- Yen-Ling Kuo
National Central University, Chungli, Taiwan, China
zweigbear@gmail.com
The conflict of privacy and public interest has been a focal point of
discussion in bioethics and it is fueled recently by the talk of genetic privacy.
New issues emerge as our genetic information bears not only individual(ABC8/BBRT2 abstracts)77

characteristics but also ethnic and familial features. The case becomes
especially sensitive in that when genetic stigmatization may bring todiscriminations of all sorts. On the other hand, the rapid progress of genetic
researches requires more and larger samples of genetic information and leads
to the need for biobanks. The problem of genetic privacy looms large whensuch information will merge with other personal data such as medical records,
working and living environments, health and disease. Does the importance andcontributions of such public interest that could be brought forth by genetic
researches overrides the genetic privacy of the individual and the familial andethnic groups? Should civilians bear such risks? In this paper, I shall probe into
the genetic privacy and related problems of biobanking. In order to bring out
the Confucian point of view, I shall compare it with the individualistic accountof the West. For the latter, I employ the UK model. Finally, I shall present theConfucian idea of familism and privacy and how to solve the kind of privacy
problem with biobanking.

12. Asian Perspectives on Neuroethics: Can
Neuroscience Contribute to the Peace and Health of
Human Beings?

Chair: Dr. Tamami Fukushi and Prof. Osamu Sakura
Panel abstract
Neuroethics is a newly emerging field, which is roughly defined as "ELSIsof neurosciences." Rapid development of neuroscience, with neurotechnology,
allows us to understand human being more deeply, which may contribute tosolve, at some degree, several social issues, such as education, medical andhealth policy. On the other hand, unthoughtful application to social issues
surely will cause several problems. The aims of this session are: First, toreview the current status of neuroethics especially in North America andEurope, with introduction of the cases in Japan. Second, to have a picture of
the present conditions of neuroscience and bioethics in Asian countries in orderto launch the discussion what should be necessary for neuroethics in thisregion? Third, to re-evaluate the cultural and philosophical framework(s)related to mind and soul, which may be unique among Asian areas. Each
presentation roughly corresponds to one purpose of the session, respectively.
Current Status of Neuroethics: International frontier and Japaneseperspective
Tamami Fukushi, Ph.D.1 and Osamu Sakura, Ph.D.1,2
1
Research Institute of Science and Technology for Society (RISTEX), Japan
Science and Technology Agency (JST), Tokyo, 100-0004, Japan.
2Interfaculty Initiative in Information Studies, University of Tokyo, 113-0033
Japan
fks@ristex.ist.go.jp sakura@ili.u-tokyo.ac.jp
We introduce the background and current situation of neuroethics inWestern countries and in Japan. Academically, neuroethics originated at aninternational meeting entitled “Neuroethics: Mapping the Field” held in San
Francisco, California, United States in 2002. Participants from various fields
including neuroscience, bioethics, philosophy, law, genetics, and journalism,
discussed and summarized the topics into the following five categories: “Brain
Science and the Self,” “Brain Science and Social Policy,” “Ethics and thePractice of Brain Sciences,” “Brain Science and Public Discourse,” and“Mapping the Future of Neuroethics.” Since then various ethical issues,
including criminal applications of brain scans, incidental findings during nonclinical brain imaging, cognitive enhancement using both pharmacological andmechanical procedures, have been recognized roughly within the perspective
settled in San Francisco conference. In Europe, on the other hand, more societyoriented movements seem to be dominant such as “Neuroscience Future” and"Meeting of Minds: European Citizens’ Deliberation on Brain Science." InJapan the Neuroethics Research Group, Japan (NeRGJ), was launched in 2004,
under the project of “Brain-Science and Society” of Research Institute of
Science and Technology for Society (RISTEX), the Japan Science andTechnology Agency (JST). This group mainly focuses on the ethical issues ofneuroscience and has organized several domestic and international
symposiums, and has been facilitating communication between neuroscientists
and the public. We will also report several ethical issues caused by the drastic
development of the technology of neuroimaging and of brain machineinterface. These cases may require the establishment of nationwide institution
for bioethics, and of effective guidelines. Finally we will discuss what is andshould be neuroethics in Asian countries. It may be necessary to make someinternational strategic plan because of rapid progress of the neuroscientificresearches. In such a case, the most important is the consideration for varietiesand differences of cultural backgrounds in this area.
Neuroethics: Pathetic Pleasure and Persistent Pain
- Jayapaul Azariah, Ph.D.
All India Bioethics Association, Chennai, 600 020, India
jazariah@yahoo.com
If late 20th Century belongs to bioethics then the beginning of the 21st
century belongs to neuroethics. The emerging discipline of neuroethics has
been recognized as a subdivision of the ubiquitous bioethics. Recognizing the
emerging importance of neurosciences as a new source of obtaining “new tools
for achieving our goals and prompting a new understanding of ourselves associal, moral and spiritual beings” (mission statement of Neuroethics Society)
the Neuroethics Society was “finally established to progress more worldwide
and practical, social activities of related to neuroethics” (Fukushi and Sakura2006). Such an emphasis recognizes the two sides of neuroscience: day-to-day
application of neuroethics in practical life and its philosophical importance.
The present paper deals with the practical scenario relating to addiction ofyoung adults in India. Addiction by definition is a feral habit that has become78 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)

uncontrollable. Traditionally the mention of the word addiction brings theimage of a drug-addict. In today’s youth addiction has a different connotation.
I am serving as a volunteer in a Counseling Center on an All India basis. The
paper describes a few cases where young adults have been addicted tounhealthy websites for pleasure. Frequent visits to these undesirable websites
have left them with lingering psychosomatic pain coupled with fear. In the caseof ‘bipolar disorder’ patients are put on a ‘foreign’ drug without proper
adherence to standard procedure of “informed consent.”
First, the paper discusses the ELSIs connected with emerging problem aswell as with the possibility of ‘out sourcing’ of Indian patients as guinea pigs.
Manipulative neuroscience and neural imaging of treated patients may take thehuman race to an unknown destination through an unknown path. Secondly,
the paper discusses the urgent need of governments to wake up to these newand emerging issues of mind over mind emotional pollution. Thirdly, the paper
points out the newly emerging lifestyle and mindset of younger generation’s
icons of the cell phones and IPODs, which have the potential for damaging
their ability to observe and obey societal laws and decision-making capacity.
Toward A Clearer Understanding of the Multi-Cultural Perspectives
Concerning Pressing Neuroethical Issues- Daofen Chen, Ph.D.
National Institute of Neurological Disorders and Stroke, National Institutes of
Health, Bethesda, MD 20892-9523, USA
ChenD@ninds.nih.gov
Over the past two decades neurotechnology has emerged not only as aneffective tool for exploring cognitive functions of our brain such as analyzing
sensorimotor control, thinking and mental interaction, but also as potential
interventions to reduce the burden associated with many neurological disorders
and disabilities. Advances made in neuroimaging techniques allow us to view
the brain structure in far greater details and clarity, which has brought new
insight into what is perhaps humankind's oldest challenge of all: the interactionof our mind and our body in knowing, perceiving, and learning about the world
and ourselves. Significantly improved efficacy and safety of psychotropic
drugs have also made effective treatment of some psychiatric conditions
possible. To cope with the ethical ramification of these new knowledge andapplications, the society should proactively begin to grapple with ethical issues
raised by advances in neuroscience. We also have to deal with the culturaldimensions of ethical reasoning, keeping the focus of our discussions onneuroethical issues from the perspectives of both western and eastern
philosophies and being sensitive to the distinct cultural and social values heldby different ethnic communities in different Asian societies.

Wednesday, March 21, 2007
13. Ethical Challenges of Aging
Chair: Dr. Soraj Hongladarom

Aging Prevention Paradigm: Against the Idle Brain- Natallia Aniskovich
Interdisciplinary Center BRAIN, Department of Physiology and Pathology,
University of Trieste, Via Fleming 22 -34127 Trieste
natalia.aniskovich@gmail.com- Oleg Artemenko
Department of Japan and Korean Studies, Faculty of Foreign Relations,
Belarusian State University, Akademicheskaya Str. 25-402, Minsk, 220072,
Belarusoleg.artemenko@gmail.com
The modern situation of increased human lifespan leads to thedifferentiation of two main approaches to aging, which can be referred to as
passive longevity and anti-aging. Both in developed and developing counties
we observe aging boom or longevity revolution, which is a particularcharacteristic of Japan. Increased passive longevity and statistically supported
prognoses in the substantial increase of chronically ill bedridden persons withneed of home and institutional care entails large problems. Besides the search
for new policies to deal with elderly we need also to find answer on the generalquestion: how to make longevity effective?
The anti-aging approach has its goal in the slowing of the rate of aging andfinding the ways of effective aging. Effective aging means first of allconservation of both physical and mental capacities for the whole life extended
period. Several alternative ways to reach this goal will be discussed. First,
there is an increasing impact of new convergent technologies, which appear tobe so-called gerontotechnologies. Thus means an involvement of allcomponents of convergence: biotechnologies and nanotechnologies.
When speaking about the legacy of traditional healing techniques in Japan
one should first mention the famous systems of health management, so-called«nourishment of life» (yangsheng in Chinese or yōjō in Japanese). One of themost known text amongst many others is a «Bible of longevity» (Yōjōkun)written by neo-Confucian scientist Kaibara Ekken in 1713, which contains themain principles of longevity admitted in traditional Japanese society. Japan
represents an ideal social system for elderly and a perfect «experimental field»
for the revival of ancient health-oriented systems. According to many acceptedand cultivated longevity techniques such as yōjō, nourishing the spirit was theprimary goal and have been treated to be more important then nourishing thebody. Japanese society also succeeded in the creation of an active environment
for older people and a family-mediated society with intensive social contacts
involving both old and young generations.
However, it seems more promising from our viewpoint to investigate therecovering potential of the original Japanese health techniques remained fromthe epoch of western transformations in Japan, i.e. Meiji and Taisho era (1868-

1926). Such systems, which combine elements of traditional yōjō techniqueswith western approach in science and medicine, gained a huge popularity inmodern Japan where they have returned back under the title of kenkōhō (lit.
«health techniques»). Among others of special interest are the systems ofrespiratory exercises exploiting the so-called «hara»– the concept of human«life-centre» located in the belly region, which according to the traditional
Japanese views is considered as unification centre of a human being,
consolidating it’s spiritual, mental and physical power. These methods under
the general name of «fukuryoku kokyūhō» («methods of breathing by the powerof hara») or «harashiki kokyūhō» («abdominal breathing»), were incorporated
into modern systems of health rehabilitation from ancient Taoist techniques of«life nourishment». Firstly, they have occupied a solid place amongst the folk
health methods (kenkōhō), and then penetrated into their modern variations,having lost however some have there own particularities.
In the group of health techniques based on the «power of hara» the mostpopular at present are the following three systems: «quiet sitting» by Okada
Torajiro (Okada shiki seizahō), system of breathing by Fujita Reisai (Fujita
shiki kokyūhō) and the system of «health improvement» by Hida (Kawai)
Harumichi (Hida (Kawai) shiki kyōkenjutsu). For example, the system by
Fujita Reisai utilizes method of «wave breathing» (harōsoku), in which apatient sitting on the chair makes deep abdominal breathing leaning
simultaneously forward, that enhances diaphragm movement in downward
direction by the incoming air flow. The chest however remains immovable.
Nowadays the method of «wave breathing» is practiced in several Japaneseclinics for rehabilitation purposes.
Modern medical studies will also be discussed. Wide application of newtechnologies makes people too passive in their daily activities and too hopefulon any external efforts. In general, health promoting system for longevity
society should include not only the creation of adaptive environment (withambient technologies), but rather stimulating environment provocation
applications of at least some aspects of traditional longevity techniques andmind-body therapy together with new anti-aging therapies and technological
implementations.
«Against the idle brain» approach means the achievement of brain
controlling the process of aging and effective in continuous information
processing in information society. The ideas of life-long learning rely on thepotential of successfully aging of the brain and supports its effectiveness.
Traditional longevity techniques help to organize such an effective brain tohave influence on the aging of the whole organism. The ideal situation meansthat the brain would determine the effectiveness of the whole body.
Flourishing the spiritual approach should be converted into modern situation
and be applicable as a part of all anti-aging approach including prospective
bio- and nanotechnologies.
Legal and Ethical Protection of Aging Persons- Cordelia Thomas
Senior Legal Adviser, New Zealand Bioethics Council, Ministry for theEnvironment, PO Box 10362, Wellington, New Zealand
Cordelia.thomas@mfe.govt.nz
In New Zealand, the number of people aged 65 years and over has doubled
over the last 50 years and is expected to double again in the next 50 years. By
2051, older people will have exceeded one million and will account for one outof every four New Zealanders. The most rapid growth in older people over the
next 40 to 50 years will occur among those aged 85 and over. This group is
projected to make up 22 percent of older people in 2051, up from 9 percent in2001. 1
Many older people fear becoming a burden on others and losing
independence, but results from the 1992/1993 household health survey showthat most people aged 65 to 84 were quite capable of carrying out everyday
tasks like shopping for food, housework, bathing, and preparing meals. People
over 85 tend to need more help with these activities, but a substantial numberof the very old appear to be managing to look after themselves without help.
Family and friends was the most likely group to be helping older people witheveryday tasks.
The aging of the “baby boom’ generation is expected to drive up a demand
for a broad range of long-term care services. One common suggestion for
counteracting this is to encourage home care in preference to hospitalization
and residential care. An additional driver over the past few years has been
concern from both elderly persons and their families about the effect of theasset testing of persons in rest homes. On 1 July 2005 the Social Security(Long-Term Residential Care) Amendment Act 2004 came into force. It
increased the asset thresholds to enable older people to retain more of theirassets and still qualify for a Government subsidy to help meet the cost of theircare. However, this increase must be considered in light of the rapid increase invalue of houses in recent years so that there may still be a considerable
incentive for families to discourage elderly persons from residential care inorder to protect their inheritance. Alternatively, families may choose topressure those elderly persons with minimal assets into institutional care to
avoid responsibility for their care. In the 2005 budget, the Government
announced that it is investing $3 million over the next four years to improveand expand services for elder abuse and neglect prevention and increase
national and regional co-ordination. This is in line with the commitment madeunder Opportunity for All New Zealanders to prevent family violence andabuse and neglect of older people.
Changing social trends have led to drastic changes in the lives of older
people. In the past they would commonly live in the same residence as theiradult children, who were socially and morally obliged to care for them. Today,
people are more mobile and children may live far away from parents. This
1

Statistics New Zealand Older New Zealanders: 65 and beyond
http://www.stats.govt.nz

Eubios Journal of Asian and International Bioethics 17 (May 2007)
together with the reduction in the numbers of children and the increasing
numbers of people with no children at all results in increasing numbers of older
persons have no close family support or care. A society that equates anindividual’s worth with productivity and an emphasis on youth, which often
links activity and vitality with youth and senility with old age, conditions older
persons to adopt the role allocated to them. Additionally, they are
economically more dependent on government support than any other segmentof society.
It is likely that in the future New Zealand will have a substantial increasein the number of elderly people who may need social and legal support topreserve their ability to take care of themselves, remain independent and avoid
abuse, neglect and economic hardship. Home care will be a clear proving
ground for public policy and social consensus as well as more personal ethicalissues. Medical technology has become ever more adept at extending thelength of life as yet there is little indication of an ability to lift the burdens oflife in old age.
This paper will consider the impact of family dynamics on the personalautonomy of older persons whose mental competence is in question and yet areable to participate meaningfully in making decisions about their financial,
medical, housing and other personal matters. The provisions of the Protectionof Personal and Property Rights Act 1988 (PPRA) and suggestions for changes
to the law to ensure the ethical care of older citizens are explored.
Personhood-as-Process, and the Four Noble Truths of Buddhism: Red
Herring, or Conceptual Bridge?
- Steven Horrobin
United Kingdom
In recent work arising from questions of the nature of personhood and thevalue to persons of their continued existence, or life extension, the author has
proposed a re-evaluation of the liberal conception of personhood arising fromthe Western analytic tradition. I have described this as the “personhood asprocess” account. Certain structures and outcomes of this analysis have been
noted, post hoc, to appear to have some symmetries and resonances withparticular key principles in traditional Buddhist thinking, especially thosereferred to by the title of “The Four Noble Truths”. This paper is a preliminary
exploration of these possible symmetries with a view to stimulating discussion
on a possibly useful conceptual bridge in East-West bioethics.
Ethics of Increasing Human Lifespan- Soraj Hongladarom, Ph.D.
Department of Philosophy, Faculty of Arts, Chulalongkorn University
Bangkok 10330, Thailand
Director,
Centerfor
Ethicsof
ScienceandTechnology
http://www.stc.arts.chula.ac.th/hsoraj@chula.ac.th
In a recent book, Aging, Death and Human Longevity (U of Calif. Press,
2003) Christine Overall argues for a position called 'prolongevitism.' Basicallythis is the idea that, all things considered to be equal, it would be preferable toprolong human life than let it end out of natural course. The idea opposed toprolongevitism, apologism, argues on the contrary that death is a natural partof life and should be accepted as such. In this talk I shall comment on some of
the arguments that have been put forward either defending or attacking
prolongevitism. The whole issue underlining the debate between
prolongevitism and apologism concerns what should be considered as 'one'
human life in such a way that a continuation of bodily and mental functions insome form count as one's own survival. Prolongevitists seem to assume thatwhat is to be prolonged is one's own body and one's own mental continuum,
but it is deeply questionable how such a continuum could be metaphysicallyjustified. Without having to delve into deep metaphysical analyses like theBuddhists have done, common sense often has it that one's childhood, forexample, is so different (in bodily dimensions, in mental capacities, and soforth) that sometimes it merits talking about being a different person eventhough there is bodily and mental continuation in the commonly accepted
sense. Moreover, one also often talks about 'becoming a different person' or'becoming totally transformed'. The point is only that there seems to be a basis
behind these kinds of talks. And it is also a scientific fact that no molecules in
the human body remain the same after a period of time; in other words, after aperiod of time all molecules in the body change and are replaced. Hence itsometimes does make sense that in the commonly accepted sense (i.e., one
goes from birth through childhood, adolescence, maturity, old age and ends
with death) the idea of there being one self is rather untenable and is a
metaphysical construction in any case. I shall argue that the sense of being one
self here is a construction and has no basis in reality. This implies that
Overall's recommendations for social policy that favors increasing human
lifespan and quality of life does not necessarily hinge on the idea that
prolonging one's self is a good thing.

14. Medical Ethics and Relationships
Chair: Prof. Alastair Campbell
The Unity of Ethics in the Face of the Diversity of Morals?
- Margit Sutrop
University of Tartu, Losin 3, 50090 Tartu, Estonia
margit.sutrop@ut.ee
Two words “ethics” and “morality”− are often used interchangeably. Several
authors, however, have brought influential arguments to the effect that there
exists a sharp theoretical distinction – which ethics is the broader notion andrefers to the whole domain of morality and to the theoretical reflection upon
morality. Morality is the embodiment of norms and values, which have beencollectively acknowledged as binding. Morality refers to historically emerged
practices of people and cultures and is constantly under change. This, however,(ABC8/BBRT2 abstracts)

79

does not exclude the possibility of universal values, which are embodied in allthese practices.
I will argue in this paper that even if particular moral rules and norms
may vary from one culture to another or transform within one culture, this israther the consequence of a different interpretation of values and not the uptakeof different values. All moral practices appreciate honesty, freedom, humandignity, justice and beneficence. If these values are not esteemed, we cannot
speak about moral practice. Moral values are objective in nature, thus allowing
for criticism of people and groups who do not accept these values. The
problem is that these values can be interpreted very differently. For instancedistinct political ideologies all appreciate justice but understand it differently.
For some it means providing freedom from constraints of others and the state,
for others it means providing for positive freedom through guaranteeing equal
opportunities.
The same concerns apply with the diversity of morals. The interpretationof moral values depends largely on our self-understanding, on our needs anddesires, on our understanding of good life. All this is closely tied up with theconcrete historical, cultural, and economic conditions in which we live or on
our religious and ideological convictions. This emerges very clearly in thedebates on bioethical issues such as abortion, euthanasia, and embryonic stem
cell research or gene therapy. The diversity in morals cannot be explained by
the fact that some cultures do not appreciate human dignity or do not consider
human life to be a value. All moral practices acknowledge these values. The
disagreement can, rather, be explained by different interpretation of thesevalues. Several issues bring along value conflicts and we have to choose which
value we appreciate most. Different hierarchies of values lead to different
moral norms.
There are also a variety of normative ethical theories, which differ as they
focus on the character, motive, consequences of acts or an action itself, ascentral. Can we speak about unity of ethics if moral norms are justified using
so different principles? But the acknowledgement of the complexity of ethics
does not relegate one to a position of ethical relativism. The paper shows thateven if we acknowledge that there is a diversity of morals as well as a diversityof ethics, one can still share universal moral values. As the process of adoptinginternational documents shows, we can basically agree on our values, but it ismuch more difficult to agree on moral norms which guide our action.
Since the disagreement in morals and ethics is caused by a different
interpretation of objective values, there is still hope that we can convinceothers in the advantages or even correctness of our interpretation of values.
This would bring us closer to the unity of morals and ethics.
A Buddhist Model in Promoting Bioethics Education in Cambodia- Chanroeun Pa
Cambodian Mekong University, Cambodia
Email: chanroeunkh@gmail.com
Bioethics can be viewed in three ways 2 : (1) Descriptive bioethics is the way
people view life, their moral interactions and responsibilities with livingorganisms in their life; (2) Prescriptive bioethics is to tell others what is
ethically good or bad, or what principles are most important in making suchdecisions. It may also be to say something or someone has rights, and others
have duties to them; (3) Interactive bioethics is discussion and debate between
people, groups within society, and communities about (1) and (2) above. Basedon these various ways of viewing bioethics, there are also different model inpromoting bioethics education. In this paper the researcher will bring a modelof bioethics education in Cambodia. The main objective of this paper is toshare a personal experience and disseminate examples of good practice of a
Buddhist model in promoting bioethics in Cambodia and the reflection on thelessons learned from Cambodian culture and how bioethics can help to balance
the risks and benefits of science and technology and towards sustainable
development in a developing country from a religious perspective.
Ethical aspects arising from the involvement of psychiatrists intermination of pregnancy- Kirsty Morris. M.D.
Royal Prince Alfred Hospital, Sydney, Australia
kirstymorris@Bigpond.com
Prior to liberalization of abortion laws, some jurisdictions permitted
abortions if the mother’s life was at risk from psychiatric or medical
conditions. As medical treatment improved, psychiatric reasons played a more
prominent role. Psychiatry was even described as “society’s face-saving
answer to providing freely available abortion without outcry”. As earlyterminations became legally and socially accepted, psychiatry involvement
declined. Psychiatry now seems to have acquired a role in late terminations.
Late terminations present a more emotive and ethically challenging situation
for both the patient and staff for a number of reasons: the pregnancy is often
wanted; the fetus becomes more like a baby at later gestations; attachment to
the fetus may be strong, particularly if movements have been felt or the fetus
has been seen on ultrasound; respect for the fetus increases with gestation
regardless of its legal rights; the fetus is starting to be seen as a patient now
that treatment options are becoming available for third trimester fetuses; andlater terminations might require an induction of labour as opposed to dilatationand evacuation.
The ethical dilemmas surrounding late termination will be explored. Whatis the moral status of the fetus? What is the significance of sentience and is thisthe same as personhood? Furthermore, once the fetus reaches viability, there isa sense of conflict between the rights of the mother and those of the fetus. Do
the utilitarian views of Singer on fetal rights help us in this dilemma? There are2

Macer, Darryl .(1998). Bioethics is Love of Life: An Alternative textbook.
Eubios Ethics Institute80 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)

a number of ways in which a psychiatrist might assist in late terminations.
These include assessment of competence, coercion, coping skills, andpsychiatric vulnerability; education about mental illness and pregnancy or theeffects of psychotropic medication on the fetus; provision of psychiatrictreatment in the case of psychiatric complications; and the provision of staff
support.
Is it appropriate for psychiatrists to assist in resolution of clinical ethicaldilemmas, particularly in the assessment of competence? Can a psychiatrist
predict when carrying a pregnancy to term will be more harmful thantermination. Overall, it seems that termination due to fetal abnormality elicits
significant psychological distress, including depression, grief and symptoms of
trauma. Does psychiatry as a profession have a social contract with society touse its specialized body of knowledge and skills for “the common good”. How
do the principles of respect for autonomy and “primum non nocere” fit withinvolvement in late terminations?
Many countries do not have explicit law or policy regarding late terminations
and seek the help of committees. Does this undermine the patient’s autonomy
and the doctor-patient relationship? Upon which criteria should the decision be
based? Is the current biomedical model of discourse ethics flawed as it is notinclusive of all views such as those of nurses? What is the role of psychiatrist
in such committees? Is there a real danger that the psychiatrist is being forced
into social agent role? Is this akin to the euthanasia debate of 10 years ago? Is
psychiatry at risk of being used as a gatekeeper for a procedure that society is
not at ease with?
Viewpoints of Euthanasia between the Public and Nurses- Heo Yang Hee
Catholic University of Korea, Republic of Korea
allisa919@hanmail.net
This study is a descriptive survey dealing with different viewpoints about
euthanasia between the public and nurses to better understand the patients interminal stage who encounter death. The fundamental materials of Lee KeumJa (2001), which are expected to bring social consensus about euthanasia, wereused. For this research, 186 citizens and 196 nurses responded to the questions
from 8-15 July, 2005. The analysis and statistics of this research werecompleted through Frequency Analysis, Cross Analysis, t-test, and ANOVA(Analysis of Variance) in the version of SPSS for Windows 12.0.
The results of this research were that both the public and nurses showed
positive opinions about euthanasia for themselves and for any other family
members. Noticeably, the agreements with euthanasia for themselves
outnumber those with euthanasia for their family members in sickness. As far
as the reasons for euthanasia are concerned “loss of meaning in life”, were
followed after “present pains” according to the responses from the public andnurses.
Regarding the attitudes about euthanasia, both groups have somewhat
positive viewpoints about euthanasia. The citizens supported the governmentand society to strengthen existing welfare policies in favor of the human rightsof patients in terminal stage, in addition, nurses argued for more objective andmorally accepted social standards before any decision be made about
euthanasia. Six remarkable provisions represented the divergent perspectives
about euthanasia between the citizens and nurses. Both the public and nurses
agreed with “living will” in terms of arrangement for it.
In conclusion, human life is to be completed by birth and death in the end.
It's our common desire that, if unavoidable, we maintain human dignity andrestfully put our thoughts and surroundings in good order for greeting the
moment of death peacefully. Irrespective of richness and poorness, the patient
and remaining family members are all eager to spend the rest of life with eachother. So any legal restriction or interference should not prohibit the right ofchoice because of the violation of human rights after all.
It is suggested that more objective, ethical standards, social responsibility,and government's obligation needs to clarified legally so that euthanasia might
be accepted in our society: this is how we can prevent illegal euthanasia
practices from being repeated.
Brain Stem Death, Persistent Vegetative State and Asking to Die in theIndonesian Moslem Society- M. Sajid Darmadipura, Ph.D.
Bioethics Unit, Airlangga University School of Medicine, Surabaya, Indonesia
www.fk.unair.ac.id mail.fk.unair.ac.id Mendunia bersama UPeDDi FK Unair
bioetik@fk.unair.ac.id
Brain Stem Death (BSD) is almost universally accepted as one of thedefinitions of death. In Indonesia, with more than 70% Moslems, BSD is also
accepted by the Indonesian Medical Association (IDI), and is formally
accepted by legislation. The implementation, however, varies considerably. In
only 31% (10 out of 32) of cases I am aware of stated as BSD, the family /relatives agreed on the statement and the following cessation of any life
support, in another 40% (13) of the relatives accepted the diagnosis of BSD but
requested the continuation of life support until the heart stops beating (cardiac
arrest), and in the rest (9), the relatives refused the statement of BSD andinsisted that any possible life support be given. The level of education did not
make a difference in accepting the statement of BSD.
Asking / assisting to die or the practice of euthanasia is prohibited by thesyariat and also by the national legislation. There are sometimes requests foreuthanasia. Two cases are presented, one is a young woman who was earlier
predicted to be in Persistent Vegetative State due to brain ischemia but later
regained her consciousness, and the other was an MD with painful diabetic
neuropathy.

When Personal Interests Come into Conflict with Patient Interests: And
What Could, Should, or Would be done about It- R. Norman Bailey, MA, OD, MBA, MPH, FAAO
Clinical Professor, University of Houston College of Optometry, Texas, USA
nbailey@uh.edu
Health care practitioners at times face personal conflicts where that whichis ‘good’ for themselves may not lead to that which is best for others,
especially for the practitioner’s patients. Conflicting interests are a part ofeveryday life around which health care practitioners must make decisions,
often major decisions that could impact the outcome of a patient’s care. The
practitioner must first be aware that a conflict is present. To be aware, thepractitioner must be sensitive to the professional ethics and ideals that placepatient interests ahead of the practitioner’s personal interests. In confronting
these ‘conflicts of interest,’ the health care practitioner must consider possible
alternative actions and then pass through a critical thinking process whereby adecision is made as to which, under the most ideal of circumstances, should be
done. In reality, circumstances may make it difficult to follow through with theideal action; however, due diligence and sincerity should surround any
alternative choice of action in order to come as close as possible to assuring a
positive outcome for the patient. All chosen actions must be constantly
monitored and modified as indicated to assure the integrity of the health carepractitioner and the welfare of the patient. This paper will address theconditions that lead to conflicts of interest, the ethical ideals and imperatives
facing the health care practitioner in such circumstances, and include a
discussion of the critical thinking process that can assist the health carepractitioner in reaching decisions about appropriate action.
15. Medical Doctors' Moral Dilemmas
Chair: Prof. Yanguang Wang and Dr. Fan Chien-Te
Panel Abstract
The original ideal of medical training is to cultivate physicians who are
devoted to saving lives based on humanistic concerns. As the world becomes
more modernized and medical costs rise, equitable distribution of theincreasingly scarce medical resources is becoming a more difficult issue foradvanced countries. In the industrialized nations, democratic mechanisms areoften used when seeking resolutions concerning public health care policy.
Although the legislative process may take a long time, and the outcome canhardly please everyone, the character of public health care system inindustrialized nations is often in accordance to the country’s political reality.
For instance, in the USA health care services rely heavily on market-driven
HMOs, whereas Scandinavian countries develop their medical insurance policy
based on their socialist inclination. All in all, it is easier for the governments in
Europe and North America to reach reasonable agreements in finding effective
strategies for medical resource distribution because of their solid democratic
tradition; in the newly democratized Asian countries, however, solving thedilemma is usually much harder.
Why is it so? First of all, in Asia’s authoritarian tradition, the governmentis expected to take comprehensive care of its people’s welfare, as opposed to
the west where the government is only obliged to protect people’s basic rights,
the extent of which is defined in the constitution through democratic discussion
and negotiations. Therefore in the West the allocation of medical resources ismore transparent and socially predictable; but in most Asian countries, policy
direction is largely dependent on charismatic leadership, so the decisionmaking process is often obscure and arbitrary to the public. Using Taiwan as
an example, although it is one of the first democracies in Asia, decision
making in public health policy is mostly constrained to the elite. In otherwords, Taiwan’s public health policy is still based on the traditional
paternalistic model as reflected in its top-down allocation of resources andinsufficient information available to the public. In addition, some claim that thecongress of this new democracy is incapable of conducting mature andproductive dialogues at the legislative level, particularly concerning issues that
require professional knowledge such as allocation of medical resources.
Therefore it is difficult for the administrators to implement public policy basedon rational negotiations—the basis for a mature democracy—and often resultin vacillations and fragmentation of bureaucratic process.
Since its implementation in 1995, Taiwan’s National Health Insurance has
become an internationally notable case of public health care. During the recent
years, however, the NHI of Taiwan is facing severe challenges coming fromthe country’s shallow democratic tradition, a disharmonious mixture ofcapitalism and socialism in the nation’s governance structure, the lack oftransparency in policy decision making, lack of communications among
different professions, the popularist tendency of the current administration, theinformation gap between practitioners and legislators, and insufficient channels
for public debates. In the past when information was not fully available to the
public, the injustice beneath the old form of medical services was rarely
challenged or protested, so the inequity remained an obscure policy issue thathas long been neglected by the people. Currently, if without drastic
modification, all of the above challenges will eventually change the NHI froma paternalistic product of the post-authoritarian era to a cross-generationalnightmare with its fast accumulated debt and deteriorated quality care.
The role of doctors is the key to this transformation process. Doctors’
professional ethics is oriented towards healing people and saving lives basedon humanistic concerns. But this kind of professional ethics has been shatteredby the limitation of payment from the Bureau of National Health Insurance. On
the other hand, in the present competitive era, how to upgrade medical
supplies, how to maintain the existing energy in R&D, and how to sustain thefinancial resources to meet these demands have become a national concern.
How to determine a doctor’s pay scale and assess his/her job performance is asignificant problem worthy of scholarly attention.

Eubios Journal of Asian and International Bioethics 17 (May 2007)
This panel, consisted of three papers, will discuss the challenges facing
Taiwan’s current medical care system and the practitioners. In presenting theconflicts between ideal and reality that have occurred during the process ofhealth system reform in Taiwan, we hope to explore the challenges that facedoctors when their morality becomes ambiguous, when their adjustment to thelegal system becomes difficult, and when they are left on their own to deal
with the challenges brought by the government’s inadequate policy decisions.
We hope that Taiwan’s experience will provide insights to other Asian
countries, which are trying to implement similar reform in their health caresystems.
Paper titles and presenters:
Ethics: Dynamic Moral Status among Hospital, Patient and Physician- Chih-Jaan Tai, M.D. & Prof. Duujian Tsai
Graduate Institute of Humanities in Medicine, College of Medicine, Taipei
Medical University, Taipei, Taiwan, China
di-tsai@msa.hinet.net
Law: An Incomplete Legal Response to the Health Care Delivery System- Fan Chien-Te, PhD., Lin Jui Chu, and Lee Chung His
Institute of Law for Science & Technology & Director, Bioethics & Law
Center, NTHU, No.101, Kuang Fu Rd. Sec.2, Hsin Chu, Taiwan, China
fanct@ms31.hinet.net
Sociology: Lacking of Sufficient Institutional Support to Support
Physician in Confrontation with the Challenge Derived from the Public
Health System Reform- Lu Shin Yi

16. Research Ethics
Chair: Prof. Abnik Gupta

Ethics in Clinical Trial for AIDS Vaccine and Antiretroviral Drugs:
Patient Perspectives in Thailand- Niyada Kiatying-Angsulee, M.D.1 and Niphattra Haritavorn2
1 Social Pharmacy Research Unit, Chulalongkorn University, Bangkok,
Thailand2 Ph.D. Student Macquarie University, Sydney, Australia
niphattraha@yahoo.com
Current bioethics analysis of clinical trials focus on strengths or standardsof the project. The character of ethical concerns with clinical trials seems to bevaried, ranging from research methodology, ethics committees and an approval
process. However, less concern is placed on patient aspects such as
experiences in the trial and participation in the approval process. Trials in
AIDS patients are good examples for debate on this aspect. This paper aims todiscuss bioethical issues in AIDS vaccines and antiretroviral drugs clinical
trials by using patient perspective approach in Thailand.
Despite the move for international ethical codes and guidelines(Declaration of Helsinki, CIOMS, Good clinical practices) recent reports stillshow that unethical situations have repeated what have been shown years ago.
The most prevalent seemed to be lack of voluntary, informed participation andadequately informed consent while the most disturbing cases are safety trials
with new drugs where testing in humans has not yet been confirmed.
Because of well-equipped healthcare infrastructure and highly trained andexperienced biomedical researchers, Thailand was inevitably targeted to
manufacture clinical trials in Asia. Given this high prevalence of HIV/AIDS invarious risk groups, international drug companies and researchers are attracted
to carrying out trials in Thailand both with the treatment with ARv and theprevention of transmission through vaccine. AIDS patients are targeted fortreatment trials, and commercial sex workers and injecting drug users for
vaccine trial. All three groups are marginalized groups being discriminated by
the society.
Some concerns include: biased ethical approval, unethical conduct ordeviation of the approved protocol without third party supervision, ineffective
consent process or not telling the whole true story, subjects do not have muchchoice, what to offer to those who cannot enroll or fail the inclusion criteria?,
post-trial medication, and research colonialism. There have also been attempts
to improve the quality and transparency of clinical research by using CAB
model (Community Advisory Board) organized by the Thai Red Cross AIDS
Research Centre.
The civil society movement of AIDS patients in Thailand is recognizedaround the world for their participation in decision making of related positions
and fighting for rights and responsibilities. It is now another move to advocate
for ethical consideration and participation in higher levels for making decisions
about the AIDS trial.
Informed Consent in Malaysia: A Socio-Legal Study- Anisah Che Ngah, Ph.D.
Associate Professor, Law lecturer (medical law), Faculty of law, Phase 2,
Universiti Kebangsaan Malaysia (National University of Malaysia), Bangi ,43000 Selangor, Malaysia
anisah@pkrisc.cc.ukm.my
The right of a person to control their body is a concept that has long
been recognized in Malaysia under the law of torts. The purpose of
requiring informed consent is to preserve that right in medical decisionmaking. Informed consent is a relatively new concept in medical
litigation cases. However in the late 1990's, it has become one of theimportant claims under negligence made against the doctor for failure todisclose relevant information to patients in respect of the proposed
treatment. Whether Malaysia has begun to recognize patient's right todecision-making is yet to be seen. Furthermore the social-cultural
relationship between doctors and patients had to be considered. In this

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81

respect, the writer had conducted interviews with doctors and patientsto gauge their reaction towards a shared process of decision-making,which is the central issue in the doctrine of informed consent. Findings
suggest that in a society where primary health care is the main thrust toachieve health for all, the possibility of recognition of the rights ofpatients to receive information before making decisions about treatment
appears remote. The findings also underscore the importance ofincorporating aspects of informed consent as part of providing quality
service to patients.
Externally-Sponsored Research in Developing Countries: A challenge for
Research Ethics Committees- Alireza Bagheri, M.D., Ph.D.
Joint Centre for Bioethics, University of Toronto, Canada; Iranbagheria@yahoo.com
In developing and developed countries alike, biomedical research is an
essential component of improving healthcare. However, many developing
countries have been targeted as host countries for clinical trials on humansubjects, which might not be conducted in developed countries because ofvarious reasons. Externally sponsored research refers to research conducted inwhole or in part by a foreign sponsor. It also can be part of a collaborative
multinational or bilateral research project to be carried out in a developing
country. The common feature of these projects is that the research protocol has
been designed or funded by a developed country while human subjects arerecruited from a developing country.
This paper elaborates some of the important issues, which an ethics
committee in a developing country should take into account while reviewing
externally sponsored research. Given the structure and functions of ethics
committees in many developing countries, the paper suggests that national
ethics committee (if one exists) or an ethics committee specifically charged
with these tasks should review externally sponsored proposals. This centralized
review would be a great step forward to ensure protection of human subjects
and benefit sharing with the local communities.
Ethical Considerations in International Traumatic Brain Injury Research- Debjani Mukherjee, Ph.D.
Clinical Educator, Donnelley Family Disability Ethics Program, Rehabilitation
Institute of Chicago;
Assistant Professor, Physical Medicine and Rehabilitation & Medical
Humanities and Bioethics, Northwestern University, Feinberg School of
Medicine, Illinois, USA
debjanimukherjee@yahoo.com
Conducting research with potentially “vulnerable human subjects,” such as
persons with traumatic brain injury (TBI), raises a host of ethicalconsiderations ranging from obtaining fully informed consent to addressing
therapeutic misconception. This is further complicated when conducting
international research as the norms and cultural context of the research process
may be unfamiliar for the investigator as well. While ethical guidelines provide
a framework for conducting the research, each step of the research processfrom setting the groundwork to collecting data leaves open many options forthe researcher. In this presentation I will draw on my ongoing experience as a
US Fulbright scholar of Indian origin, conducting research on long-term
adjustment to traumatic brain injury (TBI) in Kolkata, India. I will explore
some unforeseen ethical concerns including methodological issues and cultural
responses to research.
TBI is an international public health problem and there is a dearth ofliterature on long-term outcomes. Not all people who have sustained a TBI are
considered vulnerable. According to the US National Institutes of Health,“individuals with questionable capacity to consent” fall into this category
along with other groups such as children and prisoners. Briefly, TBI is a termthat refers to a heterogeneous group of disorders; the etiology,
symptomatology, prognosis and treatment can vary widely. Frequent causes
include motor vehicle accidents, falls, and assaults with and without firearms.
Common areas of difficulty after TBI include activities of daily living,cognitive functioning, emotional functioning, physical health issues, sense ofself, and social functioning. The diagnosis is not synonymous with a lack of
capacity to consent, but each potential participant must be assessed
systematically and if necessary, research consent proxies can be utilized. Other
ethical issues to consider with this research population include maximizing
self-determination and respect for autonomy, avoiding therapeutic
misconception, and addressing biases and stigma associated with acquired
cognitive disability.
The concerns are complicated further in the context of international
research, in which the researcher may simultaneously be learning the norms
and specific cultural context in which the examination is being carried out. For
example, I have extensive experience working with people with TBI in the
United States and have considered the ethical aspects of conducting qualitativesocial science research with that population. Working in Kolkata, India
however, a new set of research ethics questions has arisen. Methodologicalissues include translation of measures, obtaining institutional research
approval, gaining the trust of collaborators and participants and adjusting todifferences in communication style and expectations. How do we respectpersons and work with families and systems to deeply understand complex
experiences of adjustment? How do Western notions of privacy and use of
written consent forms fit into an understanding of how best to conduct
research? While bicultural knowledge and comprehension of the native
language mitigate some obvious missteps, navigating the ethical dimensions of
the research process is a complicated endeavor.

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Eubios Journal of Asian and International Bioethics 17 (May 2007)

Ethical Issues in Post Disaster Clinical Interventions and Research- Working Group on Disaster Research and Ethics (WGDRE) to be presented
by Athula Sumathipala
Forum for Research and Development, Sri Lanka
Althula.Sumathipala@iop.kcl.ac.uk
Asia has witnessed quite a few large-scale disasters over the last 2 years in
our regions. We have also experienced a large number of foreign organizations
and individuals rushing to provide ‘humanitarian aid’ including therapeuticinterventions but some without adequate understanding of the country or its
culture. There were concerns that research has been carried out without proper
scientific rigor or ethical standards given the vulnerability of the people
affected by these disasters; be it intentional or unintentional. This isconsiderable, particularly given the possibility of ill planned exploitativeinternational collaborations.
Even under normal circumstances informed consent alone is not protective
enough, because of the asymmetry in knowledge and authority between
researchers and participants, particularly in the developing world. When
research is combined with aid, relief and at times clinical care, there is undue
inducement for participation in this vulnerable population. Additionalsafeguards are needed to protect the vulnerable as well as to facilitate highquality research given the nature and the scale of the disaster and thecomplexities of the issues related to healthcare and research. International
research community and ethicists should take this issue seriously as it has notbeen adequately addressed up to now.
The WGDRE met in Colombo on 15-16 January 2007 to draft a consensus
statement agreed among the participants. We have decided to present thisstatement to the international research as well as ethics community for further
discussion.
We believe that post-disaster research is important and should bepromoted, as more and more evidence is needed for appropriate disasterplanning and prevention. However, it has to be performed in an ethical manner,planned preferably well in advance. Specific research proposals should be
carefully scrutinized for the level of risk, and the significance of the proposed
research. Such scrutiny may result in the need for additional procedural
safeguards. Participants should be made clear whether there is therapeutic
intent or whether it is pure research project to reduce the likelihood ofparticipants mistaking research for clinical services. These issues should beequally if not more important to the developing countries as the ethical review
processes are yet to be developed adequately
The draft statement covers areas such as relevance of proposed research todisaster situations, informed consent and voluntariness, community
consultation and participation, exploitation, dignity, privacy andconfidentiality, risk minimization, responsibilities of the sponsors andinstitutional arrangements, professional competence, public interest anddistributive justice, dissemination of results, ethics review, and international
collaborative research. Even though, most of these are applicable to researchunder normal circumstances, we argue the necessity of additional attention tothese components during disaster related research.
WGDRE:- Aamir Jafarey
Centre of Biomedical Ethics and Culture (CBEC), Sindh Institute of Urology
and Transplantation & Consultant Surgeon, Aga Khan University, Karachi,
Pakistan- Aasim Ahmad
Chairperson, Bioethics Group, Hon. Senior Lecturer, Aga Khan University &Chief Nephrologist, The Kidney Centre, Karachi, Pakistan- Athula Sumathipala
Institute of Psychiatry, Kings College, London, UK; & Director Institute of
Research and Development, Sri Lanka- Chandrani Jayasekera
Deputy Director, National Institute of Health, Sri Lanka- Dananjaya Waidyarathne
Consultant Judicial Medical Officer, Ministry of Health, Sri Lanka- Darryl Macer
Regional Adviser in Social and Human Sciences for Asia and the Pacific,
RUSHSAP, UNESCO Bangkok- Leonardo de Castro
Department of Philosophy; University of the Philippines; & Vice Chair of
UNESCO International Bioethics Committee; Secretary, International
Association of Bioethics- Nandini Kumar
Deputy Director General, Indian Council of Medical Research, India- Sandhya Siriniwasan
Executive Editor, Indian Journal of Medical Ethics, Mumbai, India
Sarath Edirisingha
Director of the Health Emergency Disaster Management Training Centre &Consultant Medical Parasitologist, University of Peradeniya, Sri Lanka- Sisira Siribaddana
Consultant Physician & Project Leader Sri Lankan Twin Registry- Sleman Sutaryo
Consultant in Pediatric Hematology – Oncology & Secretary of Indonesian
Network on Bioethics and Health Humanities- Sriyakanthi Beneragama
Epidemiologist, National HIV/STD campaign, Sri Lanka

Statement on Ethical Issues in Disaster-Related Research -- A
Developing World Perspective (draft of 16 January, 2007)- Working Group on Disaster Research & Ethics (WGDRE)
Faced with the aftermath of the Asian tsunami, earthquakes, volcanic
eruptions, recurrent floods, cyclones, droughts, conflicts, and other disasters
that devastate communities in the South and South-East Asian Region, we
have come together as a multidisciplinary working group of persons involved
in research ethics to draft this statement on the ethical management of disasters
and research related to disasters.
Disasters result in damage, displacement, and death of large numbers ofpeople with significant disruption of society. They can happen at any time,
affect anyone any community and any state, be sporadic or regular in nature,and occur as a natural phenomenon or as a result of human design. Disasters
create an imbalance between the capacity and resources of the society and theneeds of the survivors and the affected.
The global divide and disparities that already exists within societies become
even more exaggerated in disaster, especially in developing countries. During
such calamities government policies (or their absence) and those of a wide
variety of governmental and non-governmental organizations impact on
mobilization of response to the disaster and provision of care of those affected.
Disaster response needs to be integrated, appropriate and evidence-based. It
also needs to flow along coordinated and well-managed governance systems.
Prevention of exploitation and physical, sexual and psychological abuse ofvulnerable survivors and their families need to be strictly enforced.
Therefore there is a need to systematically map existing and relevant
evidence pertaining to disasters, their management and their impact on thecommunities. There may be gaps in the existing knowledge. There may also be
gaps in the implementation of research recommendations and the developmentof evidence-based guidelines for proper management during the disasters andits immediate and long-term aftermath. Research is needed in such areas as
disaster response and relief, health care, management and public health issues,and even the ethics of disaster management. Disaster anticipation and early
warning systems, mitigation and preparedness are preferable to disaster
response and needs research. Therefore, further evidence needs to be gathered
through culturally appropriate research for more effective and compressive
responses from all sectors of society in dealing with those affected populations.
This research needs to be contextual, as well as culturally and regionallyappropriate, in order to facilitate shaping of policies by the local management
teams and the governments. It should also examine at what stage of therecovery process are appropriate for conducting research and what type of
research should be done in such stages.
In fact, it may be unethical not to conduct research in such situations since
ethical research that takes into account the needs and priorities of affected
communities must be encouraged and promoted.
Disasters, by their very nature, results in vulnerability in individuals and insocietal groups particularly in disadvantaged communities. Any process of
research involving human participants requires a robust and on-going ethicalreview. Existing guidelines and norms pertaining to research on humanparticipants may not be sufficient to address all situations that arise indisasters. Greater vigilance is necessary in disaster-related research to ensurethat the general ethical principles are adhered to and participants are protected.
Research involving disaster-affected populations must adhere to universal
humanitarian imperatives of alleviating human suffering, preserving humandignity as well as protecting and respecting human rights regardless of race,
culture, creed, nationality or political belief. More specifically, work with such
populations needs to place special emphasis on the unique needs and special
concerns of survivors, thereby ensuring the services and opportunities forrehabilitation are appropriate and acceptable to these individuals.
Guidelines for disaster research
In addition to the accepted national and international ethical guidelines forthe conduct of research, we urge researchers to pay particular attention to thefollowing ethical principles when conducting research in disaster-affected
situations. These guidelines are meant to supplement the relevant existing
national and international documents and not to replace them. The areas, whichthese guidelines address, include the potential for harm resulting from theresearch process and its sociopolitical implications, the potential for the
exploitation of the research participants as well as the affected community.
They also look at conflicts of researchers’ interest with that of the community
being studied, and the process of recruitment of survivors as participants with aparticular emphasis on obtaining a valid informed consent. These guidelines
also emphasize on ensuring gender and cultural sensitivity, and the need forresearch to contribute to the healing and empowerment of the disaster-affected
community.
1.
Relevance to disaster situationsa.
Research planned to be conducted after a disaster should be essential
and is not possible in non-disaster situationsb.
The objectives of all potential research in disasters should be weighedvery carefully for their potential contribution to the survivors, and for theirvalue in future disaster situationsc.
All phases of the research must be culturally sensitive and should involve
those familiar with the community’s situation and their cultural beliefs andpractices.
2.
Informed consent and voluntarinessa.
Any research is only to be carried out with the prior, free and informed
consent of the person concerned based on adequate information.
b.
The research team must identify factors that serve as a barrier to thefreedom of individual members of the participant population to give consent,
and provide effective mechanisms to address them.

Eubios Journal of Asian and International Bioethics 17 (May 2007)c.
Survivors of disaster situations are particularly vulnerable and should
not be subjected to inducement.
d.
Research should not be disguised as treatment, relief or humanitarianaid. Every effort must be made in the informed consent process to makeresearch participants aware of the difference between participating in a study
and receiving humanitarian aid. The different roles of the researchers,
caregivers, and volunteer workers must always be clarified and the potential
conflicts of interest declared.
e.
In cases of collection and storage of human biological materials during adisaster, the purposes of such collection and storage should be explicitly statedin the informed consent process and also that these materials gathered would
not be used for any other purpose.
f.
The requirement for research on children affected by disasters cannot be
ruled out. However, due to their greater vulnerability, the researcher will haveto justify the need to use children as research participants. The informed
consent process will have to incorporate mechanisms of proxy consent by theirparents or guardians and include provision from permission by the childwhenever applicable. The reviewers will look very carefully at the process ofconsent involving children who have lost one or both parents in the disaster3.
Community consultation and participationa.
Community participation before and during the research is essential indisaster-affected communitiesb.
The researchers and review process need to identify the communities that
may be affected by the research and consult with them. The research teammust describe a preliminary community mapping/scoping exercise to ensurefamiliarity with the community as well as identify local resources that will
support ethical execution of the research.
c.
A community representative or advocate must be identified by a process,which is acceptable to the study population.
d.
Community representatives or advocates should be involved inconceptualization, review, research and dissemination of research involving
disaster-affected populations.
e.
In no case should a collective community agreement or the consent of thecommunity leader or other authority or advocate substitute for an individual’s
informed consent.
4.
Non-exploitationa.
The selection of research participants must be made on scientific reasonsand not based on accessibility, cost, gender or malleability.
b.
The research should not impose additional burdens on people who are
already traumatized, and on the local infrastructure.
5.
Dignity, privacy and confidentialitya.
Given the circumstances that survivors of a disaster face, extra care must
be taken to protect the privacy and confidentiality of individuals andcommunities.
b.
In the collection of data and human biological material, human dignity
must be respected for both survivors and the deceased.
c.
Similarly, stringent standards must be maintained for the storage andpossible sharing of human biological material and data.
d.
Utmost attention must be paid to prevent stigmatization, ostracisation,and other harm to individuals and communities at all stages in the research
process.
6.
Risk minimizationa.
Since disaster-affected populations are particularly vulnerable it must be
ensured that the conduct of research imposes the absolutely minimal risk.
b.
Risks that are acceptable under ordinary circumstances may notnecessarily be acceptable in disaster situations.
The research team must demonstrate the ability to anticipate adverse reactions
and facilitate appropriate interventions.
7.
Institutional arrangementsa.
Institutions that sponsor and conduct research should recognize that astronger ethical obligation is required in disaster-related research.
b.
Research in disasters should be coordinated with other disaster relief
activitiesc.
Research should not disrupt or further burden the existing infrastructure
8.
Professional Competencea.
Ensure professional competence of all members of the research team fortheir specific tasksb.
The highest standards of scientific research and peer review should bemaintained through the entire process.
9.
Public interest and distributive justicea.
The research undertaken should provide direct or indirect benefits to theresearched group, the disaster-affected community or future disaster-affected
populations.
b.
Prior agreement should be reached, whenever possible, between thecommunity and the researcher on what benefits could arise from the research,and how they would be shared.
c.
The actual benefits arising from research should be shared with society
as a whole and with the international community with due consideration to thepotential negative effects upon the participants and the communities involved,
in consultation with the community.
10. Dissemination of resultsa.
Transparency in dissemination of results should be a prior condition forthe conduct of research in disasters.

(ABC8/BBRT2 abstracts)83b.
Research published in open access journals will ensure the widest
dissemination of findings.
c.
Efforts should be made to use the results of research to influence theformulation and modification of policy.
d.
The presentation of the results of research to the community whoparticipated in the research, and to the public, should be after a process ofpeer review has validated the conclusion reached.
e.
The relevant results need to be presented in understandable language toresearch participants and the participating community.
11. Ethics reviewa.
Independent, multidisciplinary and pluralist ethics committees should
assess all the relevant ethical, cultural, legal, scientific and social issues
related to research projects. These should include representation or advocatesfrom the disaster-affected community.
b.
All research should be subject to local ethics review that includes regularfeedback from the researchers and community representatives.
c.
In addition, there should be a centralized mechanism (such as a national
ethics review committee) for review and coordination of all research in thedisaster-affected area to ensure a wide perspective on all the research and toprevent unjustified repetitive work.
d.
A central/national "clearing house" on an open web Site would be more
effective in preventing duplication, as well as letting everyone know what
topics have been covered, are currently being researched, and which ones arebeing plannede.
Prior ethics review and approval may be taken before initiating researchin an expected disaster situation of periodic or recurrent nature. However, theresearch may commence only after consultation with the actual disasteraffected community.
f. Expedited review may be necessary in exceptional situations, but should be
conducted with extreme caution. This expeditious review must follow thestandard procedure considering the guidelines mentioned above, with aquorum agreed beforehand.
g.
In the case of research projects that commenced before a disaster, theinvestigators must go back to the ethics review board to consider – in
consultation with the community, wherever or whenever possible – whether the
research may continue or stop.
h. Where applicable, the protocol should include provisions for aftercare,including appropriate mechanisms for continuation of essential services thatwere associated with the research protocol, and a proper referral mechanism
to deal with the needs of participants and members of the research team.
12. International collaborative researcha.
All research in the disaster-affected area needs to be done with a local
partner(s).
b.
Such collaborations should be based on mutual respect and partnership.
Collaboration needs to be undertaken between national researchers, policy
maker and the community, to share responsibility for determining theimportance of the problem, assessing the value of the research, planning,
conducting, and monitoring the research, and integrating that research into
the social system.
c.
Contribute to developing the capacity for researchers, policy makers,
and the community to become full and equal partners in the international
research enterprise.
d.
Permission taken from local authorities does not exclude the requirement
for ethics review at local level and at national level.
e.
Special consideration should be given to transfer of biological material,
ownership of data and intellectual property rights issues. The export of
biological materials from a disaster-affected area should be strictly regulated
through a central mechanism.
f.
Benefits of the research if any financial or non-financial should beshared fairly with the community and decided a priori.
Informed Consent in Sri Lanka: Review of Research Conducted in Sri
Lanka to Understand the Progress of Informed Consent Process- Suwin Hewege, Athula Sumathipala, Sisira Siribaddana, Mnaura
Lekamwattage, Manjula Athukorale, Joanna Murray, Martin Prince
Forum for Research and Development, Battaramulla, Sri Lanka
suwinhewage@yahoo.com
Consent is considered to be ‘informed’, when it is given by a person who
understands the purpose and the nature, what participating in the study requires
the person to do and to risk, and what benefits are intended to result from thestudy.
The issue of informed consent can be studied from two main angles;
genuine efforts made by the researchers to adhere to good ethical practices byobtaining ethical clearance from a review committee, providing the required
information to the participants and the process adopted to ensure ‘freely given
consent’, and the capability of the research participant to comprehend the given
information and to provide or refuse consent.
We present one of the three components of a larger project on informed
consent in which particular attention was drawn to the issue of informed
consent in contemporary Sri Lanka.
The objective was to carry out a compressive review of the documented
evidence of informed consent practices and related ethical procedures, asfeatured in the research projects carried out in Sri Lanka. This was undertaken
to provide a baseline so that any future intervention to improve consent
procedures and ethical standards can be compared. All published researchoriginating from Sri Lanka, between 01.01.1999 to 01.09.2004 that could beobtained from a Medline search carried out with MeSH major and minor
heading; ‘Sri Lanka’, were scrutinized according to pre-agreed checklists toevaluate the ethical practices followed. All MD and MSc. thesis available atthe Postgraduate Institute of Medicine (PGIM) library were also included.

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Eubios Journal of Asian and International Bioethics 17 (May 2007)

From the 367 identified Medline articles originating from Sri Lanka, 250(68%) were human subject research, and of them only 87 (35%) were freely
available as complete papers. Of those only 37 (42%) had mentioned obtaining
ethical clearance for the study. Papers published in the Ceylon Medical Journal(CMJ) showed that the percentage reporting about obtaining ethical clearance
has increased from 17% in 1999 to 71% in 2005. The articles that had
specifically mentioned about ‘informed consent’ had increased from 17% in1999 to 57% in 2005.Of 305 MD and MSc thesis available at the Postgraduate
Institute of Medicine library from the year 1985, 66% had not mentioned aboutobtaining ethical clearance. However, the percentage of those that mentioned
about obtaining ethical clearance and also provided evidence for it andreporting specifically about taking or not taking consent from participants,
showed a trend towards a gradual increase with time.
It is encouraging to see that there is an upward trend in obtaining ethicalclearance for research projects carried out particularly by local investigators forpostgraduate qualifications. Reporting about obtaining ethical clearance inlocal PGIM theses has increased steadily from 1989 to 2005. Attention to
ethical issues also appears to be higher in the local journal CMJ compared tothe overseas journals.
Similar to reporting on sample size and method of analysis in themethodology, ethical clearance and informed consent should be mentioned as
essential components of the research and publications.

17. Ethical and Social Implications of Biotechnology
Chair: Prof. Sang-yong Song

Analyzing Stakeholder Attitudes, Perceiving Ethical Issues and Risk
Assessment, in Linking Trust, Bias, and Fairness of Information Sources
for Biotechnology Issues: A Bioethical Resonance to Reconcile- Dipankar Saha1 and Abhik Gupta2
1. Senior Scientist, Agriculture Research Service (ICAR-ARS), IndianCouncil of Agricultural Research, Department of Agriculture Research and
Education, Ministry of Agriculture, Government of India.
dipu_1962@yahoo.co.in
2. Professor and Dean, School of Environmental Sciences, Assam University,
Silchar, Assam, India.
agecol@rediffmail.com
An individual's perceptions of the risks and benefits of a new technology are
determined by personally selected sources of information, values, interests, andindividual experiences. However, where agricultural biotechnology isconcerned, most people cannot rely on their own experience. Instead, they
depend on information received from other sources such as rumours, theexperiences of people working in the field, and statements issued by industry,
government, public interest groups, academia and the media. An individual's
personal worldview strongly determines how information is assessed forreliability. In each of the case studies of this paper, a stakeholder-based
approach was used to investigate public perception. Sampling method was
simple random systematic samples as per social research methods.
The results of a study on 100 respondents found 35% of the public said thatthey would agree with government statements, 21% would not and 44% not
sure. For corporate sectors, 17% said they would believe, 36% not and 46%
not sure. Response categorization found that genetically engineered foods orbiotechnology in the Indian food supply received a mean rating of 2.84 on afour point scale from “not at all concerned” to “very concerned”, compared to
the USA (3.61). Regarding open categories questions people failed
categorically to express their views in India, which shows their limitations ofpresent day understanding about biotechnology and its related issues.
In this paper I could come out with an analysis, which identifies six key
factors influencing people’s opinions about the subject, which account for
about 63% (19.20; 18.47; 14; 3.97; 3.90 and 3.33) of the total variance. The
results of cluster analysis of consumers’ responses to various questions aboutbiotechnology suggest that the respondents can also be classified into fivegroups (clusters) [Benefit Seekers, Self Protectors, Biotechnology Opponents,
Open Minded Biotechnology Learners and Biotechnology Optimists]. Results
also emphasized that although there is broad public agreement over the use of
biotechnology in plants in the interest of health and well being, people are lesscomfortable with its use in animals or for purely economic reasons. However,the public seems to be interested in learning more about the issues involved
before they arrive at definitive conclusions about the wisdom and desirabilityof biotechnology in the best interest of the society.
In spite of the detailed and comparative analysis of the public perception
issues of biotechnology, there exists a rich public debate about how thepotential risks associated with biotechnology methods and bio-industry
products should be assessed and about whether and how bioethics should
influence public policy. A general structure for guiding public policy discourse
is generally emerging but is not fully developed. There are inherent conflicts
involved in how biotechnology develops as an industry and the way ethicalquestions and public policy positions are discussed and adopted. This paper
will also look at issues relating to biotechnology communication. Journalists
surveyed generally believed that university scientists/researchers andnewspapers were trustworthy, unbiased, and fair, while activist groups are
untrustworthy, completely biased, and unfair in communicating agricultural
biotechnology issues. They are most opposed to public opinion outweighingscientists' opinions when making decisions about scientific research.
From this study a substantial positive correlation came out between sciencejournalists' attitudes toward democratic processes in science and trust in
newspapers; there exist moderate correlations between attitudes and trust in
television (positive) and biotechnology industry representatives (negative). In
other words, as science journalists' attitudes toward democratic processes inscience increased, so too did their trust in newspapers and television.
Conversely, as their attitudes increased, their trust in biotechnology industry

representatives decreased, or vice versa. It is also important to note that these
are not cause-and-effect relationships, but the correlations do show asignificant connection between trust in some information sources andjournalists' attitudes toward democratic processes in science, which is a pivotal
reconciliatory issues to derive out a holistic bioethical resonance.
Community Consultation for Statement of Ethical Principles for
Biotechnology- M. Gorton and Ellen Kittson, Ph.D.
Charles Sturt University, Australia
ellen.kittson@daff.gov.au
In January 2006 the Victorian Government (Australia) endorsed aStatement of Ethical Principles for Biotechnology in Victoria (Statement)
following an extensive consultation of its citizens. The Victorian
Biotechnology Ethics Advisory Committee (VBEAC) had the task, on behalfof the Victorian Government, to develop an ethical framework to guidebiotechnology activities undertaken in Victoria. The Victorian Government
made this commitment in its public statement “Biotechnology Strategic
Development Plan for Victoria”.
Work commenced in early 2004 to develop a key statement for ethicalprinciples and an ethical framework under which biotechnology could beassessed. In December 2003 VBEAC had already issued a position paper on
ethical issues concerning community engagement in relation to biotechnology,
noting that, as an ethical position, community engagement was an importantpart in the development of any public policy in relation to biotechnology.
VBEAC stated:“VBEAC believes that effective public education, coupled with a timely,
responsive, ethical and coordinated approach to communication aboutbiotechnology, is needed to ensure the bi–directional flow of information.”In the development of its Statement, VBEAC undertook a substantial
community consultation, including:• Public notices seeking submissions in relation to the form andsubstance of a proposed ethical framework for biotechnology.
• Synthesis and consideration of submissions received.
• Development and issue of a draft statement, distributed widely tocommunity groups and community sectors for further consideration andconsultation. Particular groups included industry, community organizations,scientific and research bodies, schools and educational institutions, and the
public generally.
• VBEAC undertook a substantial consideration of all submissions
received and a transparent consideration of changes and variations to the draft
Statement and accompanying materials.
• The final Statement was delivered to Government for consideration
through a “whole of Government approach”. The Victorian Government
endorsed the Statement and authorized its release in January 2006.
In the development of the Statement of Ethical Principles for
Biotechnology in Victoria, it was recognized that the biotechnology sector was
already substantially regulated by law, codes and guidelines. The scientific andmedical research community in particular noted substantive regulatory
requirements already in place, particularly for human research and in relation
to animal welfare. Accordingly, the Statement needed to balance therecognition that large parts of the biotechnology sector were already regulated
substantially, compared with the community’s expectation that nonetheless allof the biotechnology sector would have due consideration and appropriate
processes for considering ethical issues.
The Statement, endorsed by the Victorian Government, was issued as avoluntary statement. It anticipated that those involved in biotechnology,
particularly scientific and medical research institutions, would measure theirown systems and processes against the Statement, to determine whether any
gaps existed, which required reconsideration. At the same time as the issue ofthe Statement, VBEAC issued:• Map of Ethical Controls and Guidance.
• Decision Making Tree for Recognizing and Managing Ethical Issues.
This kit of materials would enable any participant in the biotechnology
sector to determine whether its existing processes and systems sufficiently
dealt with ethical principles, both explicitly and substantively.
Major issues in the development of the Statement included considerationof:• Inter–generational issues.
• Cultural requirements (consideration of issues raised in New Zealandwith Maori recognition were considered).
• Long-term environmental concerns.
• The requirement for transparency of process and action.
Accompanying the principles developed for the Statement were a series ofinterrogatory type questions, to guide the reader through the issues raised by
the Ethical Principles, so as to properly understand all of the issues involved in
the consideration of each Ethical Principle. The interrogatories act as a“checklist” in the consideration of a participant’s own processes andprocedures.
Subsequently, the Statement of Ethical Principles has been released to theVictorian community, with some substantive promotion, with particulartargeting of scientific and medical research institutions. Further consultation
has taken place, and VBEAC is committed to ongoing review and monitoring,to establish whether take–up of the Statement has been substantive, andwhether outcomes have been positive.

Eubios Journal of Asian and International Bioethics 17 (May 2007)
Biotechnology, Genomics and Global Health: A Challenge for Traditional
Bioethics- Patricia C. Kuszler, MD, JD
University of Washington School of Law, William H. Gates Hall, Box 353020,
Seattle, Washington U.S.A
kuszler@u.washington.edu
Biotechnology, whether in the context of new drugs derived from DNA
and genetic technology, genetically modified food, or biologics making use ofliving cells, raises ethics concerns at a variety of different levels. There is
growing concern that the very nature of research is being subverted, rather thanenhanced by entrepreneurship. This area of ethical concern has intensified in
the United States as a result of the conflicts of interests resulting from thegrowing alliance between University academia and private industry in the
research enterprise. As we travel down the research path into development of adrug or technology, ethical questions arise with respect to protecting humansubjects and society from danger and exploitation by researchers. As
development gives way to marketing and dissemination of a new product,
government regulators, such as the United States FDA, are pressed to get drugs
and biologics through the regulatory pipeline into the market faster and areforced to walk an ethical tightrope between speed and safety. As new
biotechnology products enter the market place, doctors and patients traverse
yet another tightrope, that between unknown risk and the promise of benefit.
And finally, we have growing attention paid to patent protection as a culprit in
keeping prices high and depriving the global poor from lifesaving drugs andbiologics.
Modern bioethics grew out of the post WWII Nuremberg Trials. The
Nuremberg trials involved testimony that referred frequently to the “laws ofhumanity” and the “ethical principles” that are necessary to ensure humanrights of the individual. The Nuremberg Code ushered in a code of ethics withrespect to research that provides a construct for the protection of subjects
involved in medical research. This rights-based approach focuses on the dutyof the researcher to provide full disclosure of risk and benefits of research andto obtain consent from the patient/subjects who will be used in the research.
This approach gave rise to the principles-based approach to biomedical ethics,
as initially enunciated in the 1979 Belmont Report, which detailed guidelines
for the protection of human subjects in medical research.
However, as several scholars have noted, this is wholly inadequate torespond to the cascade of ethical issues that flow from a vibrant biotechnology
industry. Moreover, it may not be particularly apt from a perspective ofmultiple cultures. And if biotechnology is in its infancy as most believe, it is
crucial that scientists, entrepreneurs and governments – to name only a subsetof the players – engage in dialogue about the ethical and societal questions
raised on the road of scientific progress. This brief paper will consider some ofthe ethical challenges resulting from the brave new world of biotechnology andconsider some ways of recasting ethical inquiry to better meet thesechallenges.
Discussion in this paper will show how Western “principles-based”
bioethics is inadequate to fully address the issues arising in biotechnology andgenetic research and innovation. The future will demand an ethical constructthat is less focused on the individual and more on populations. It will need tobe more global and capable of addressing cultural diversity and pluralism. The
new ethical paradigm will need to more firmly embrace social justice andconsider the skewing of justice by politics and economics. It will need toaddress not only the rights of individuals and populations, but also ecologies.
With respect to genetic modification, ethics and social justice requires risk
evaluation with an orientation to the generations of the future.

18. An Empirical Study on the Observation of UN
Bioethics Related Declarations in Mainland China& Taiwan
Chair: Prof. Darryl Macer, Prof. Ji-Ming Yi and Prof. Chien-Te Fan

Panel Abstract
Envisioning the rapid progress in genetic research would make possible
far-reaching medical research and biomedical applications, the International
Declaration on Human Genetic Data was adopted unanimously and by
acclamation at UNESCO's 32nd General Conference on 16 October 2003. This
Declaration and the Universal Declaration on the Human Genome and Human
Rights turn out to be most important international points of reference in thefield of bioethics.
The International Declaration on Human Genetic Data was articulated in
response to the needs for fair guidance from governments, non-governmentalorganizations, the intellectual community and society in general at theinternational level, when facing the ethical challenges derived from the rapidly
developing fields of genetic databases and the fear that such databases might
be used for purposes contrary to human rights and freedom.
On the other hand, the Universal Declaration on the Human Genome andHuman Rights of 1997 calls us to take into account concerns about the social,
cultural, legal and ethical implications of the progress in the life sciences,which provide human beings with a new power to improve their health andcontrol over the development processes of all living species. Recently, some ofthose predicted concerns turned real, especially in the fields of stem cellresearch, cloning and gene testing.
Now, both declarations indicate to us the good faith of human being’s
willingness to handle the revolutionary biotech development with due care.
However, how can these ethical guidance/norms be implemented? How can theideological vision of humanity be accomplished? What kind of institutional
mechanism is needed to support related practices? The main focus of thissession is trying to explore the experiences relating to the Declaration(ABC8/BBRT2 abstracts)

85

compliance in mainland China and Taiwan, through conducting some
empirical studies in certain biotech application fields.
On both sides of the Taiwan Strait, people have faced similar challenges
and gone through the similar and necessary bioethical realignment. In thissession, some empirical experiences in human genetic data protection and/or
bioethical issues will be taken to reflect the trends of the Chinese community
in keeping up with the development of international ethical norms promoted by
UNESCO. In particular, the ethical guidance of stem cell research aiming forcosmetic surgery, the biobank development in Taiwan, the ethical governancefor gene therapy study, the benefit sharing issues and the entitlement of
stakeholders to exploration of gene testing techniques, ethical codes to govern
research related to the aboriginal people, will be included extensively. Theseempirical studies may, to some extent, express to us how the Asian community
responds practically to the daring move of international bioethical norms. In
the meanwhile, these explorations shall be valuable to those researchers whoare interested in the bioethical development in China, especially from theperspective of culture anthropology.
Papers:Substantial Points in Medical Ethical Formal Procedures: A Medical
Professional View
- Jiao Hong-Tao
jiaohongtao@126.com
Associate Professor of Law, College of Law, Huazhong University of Scienceand Technology, 1037, Luoyu Road, Hongshan District, Wuhan, China
zhchqang@yahoo.com.cn- Triumph Wang, M.D.
Fellow, Bioethics & Law Center, Tsing-hua University; Chief, Plastic Surgery,
Ton-Yen General Hospital, No.101, Kuang Fu Rd. Sec.2, Hsin Chu, Taiwan,
China
dr.wang@doctor.com
The Establishment of Taiwan Biobank in Compliance with the EthicalNorms Provided under UN Declarations- Chien-Te Fan, Ph.D.
Professor of Law, Institute of Law for Science & Technology & Director,
Bioethics & Law Center, Tsing-hua University (NTHU), No.101, Kuang Fu
Rd.
Sec.2,
Hsin
Chu,
Taiwanfanct@ms31.hinet.net
Rights Designation and System Arrangement of Genetic Testing Technique- Hongtao Jiao
Associate Professor of Law, College of Law, Huazhong University of Scienceand Technology, 1037, Luoyu Road, Hongshan District, Wuhan, China
jiaohongtao@126.com- Min Luo
Graduate Law Student, College of Law, Huazhong University of Science andTechnology, 1037, Luoyu Road, Hongshan District, Wuhan, China
The ELSI Implication of Gene Therapy Development- Jui-Chu Lin
Associate Professor of Law, Taiwan University of Science and Technology,
No.43,
Sec.4,
Keelung
Rd.,Taipei,106,Taiwan,
China
reju@ms31.hinet.net- Ji-Ming Yi
Professor of Law, College of Law, Huazhong University of Science andTechnology, 1037, Luoyu Road, Hongshan District, Wuhan, China
yijiming@263.net
From Principles to Guidelines--The Bioethics and Cultural Pluralism in
Taiwan- Chung-His Lee
Assistant Professor of Law, National Tung Hua University, Hualien, Taiwan,
China
iplaw.lee@msa.hinet.net
The Benefit-sharing of Biomedicine Research Production Based on the
Genetic Resources
Chunyan
Wu
Lecturer, College of Law, Huazhong University of Science and Technology,
1037, Luoyu Road, Hongshan District, Wuhan, China
yanhust@163.com

19. Ethical and Social Analysis of Stem Cell
Research: Empirical Reports from Taiwan
Chair: Prof. Lee Shui Chuen

Panel abstract
In 2006 we conducted research on the public opinion in Taiwan and madea policy report to the government on the regulation of stem cell research. We
used a stratified sampling method and obtained some interesting results of the
public opinions of stem cell research in Taiwan. Some of the major points arethat their trust in scientists and ethical committees are fairly high and thenotification and consent of family members are highly respected. Anomalous
results are also noted. Upon the result of a multi-factorial analysis of theempirical data, we proposed a draft of stem cell research regulation
incorporating the Chinese ethos and ethical beliefs as well as keeping in linewith the global declarations on related researches. We shall present some of thesalient ethical elements of the proposed regulation with comparisons to theWest in mind. Finally, we shall also explore the social and policy implications

86 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)of the regulation of stem cell research in Taiwan. The two panelists and thechair will present the three major parts of this research for discussion.
The Public Opinions of Stem Cell Research in Taiwan: A Factor Analysis- S. C. Liao
China Medical University, Taiwan, China
liao@mail.cmu.edu.tw
Shaping Social Opinions for Stem Cell Research in Taiwan- D. J. Tsai
Graduate Institute of Humanities in Medicine, College of Medicine, Taipei
Medical University, Taipei, Taiwan, China
di-tsai@msa.hinet.net

Poster Presentations
Bioethics Clubs in Schools and Colleges: Challenges, Prospects andBenefits
Arockiam Thaddeus1, M.A. Jothi Rajan 2 , T.Mathavan3, P. Senthil Kumaran4
1
Jayaraj Annapackiam College for Women, Periyakulam- 625601, India.
2
Arul Anandar College, Karumathur-625514, India.
3
NMS S Vellaichamy Nadar College, Nagamalai-625019, India
4
School of Tamil, Pondicherry University, Pondicherry-605014, India.
arockiamt@yahoo.co.in
There are as many Clubs, Associations, and Forums in schools andcolleges. Science clubs and environment clubs are doing exceptionallywonderful services in schools. Each club is unique, and has its own goals,
objectives, rules and regulations. In addition these clubs have their own
activities based on their goals and objectives. The Unity in Diversity brought
forth by clubs and associations need not be overemphasized. Clubs createawareness, promote healthy discussions, and pave the way for joyful andmeaningful living of human beings in harmony with the environment on themother earth. In India Bioethics Clubs are of recent origin, and developed outof cooperation with Eubios Ethics Institute and UNESCO Bangkok. In thispaper the origin and the functioning of the bioethics clubs in two colleges
situated in rural settings of south India will be presented at length. The
challenges, prospects and benefits acquired to date, and envisaged in the years
to come will be highlighted in this paper. The time is ripe for all the bioethics
educationists to come forward and start clubs in their schools and colleges andassist the functioning of the clubs by their expertise. The future world is in thehands of the children and youth of this period of time. It is said “Better latethan never”.
Nursing professionals’ awareness of ethical problems in Japan- Hisako Nakao, Akiko Chisaki, and Masayuki Obayashi
Nursing Course, Department of Health Science, School of Medicine, Kyushu
University, Fukuoka, Japan
nakao@shs.kyushu-u.ac.jp obayashi@kit.ac.jp
Recently, many ethical problems have been posed to medical practicebecause we have attained dramatic development of medical technologies anddiversity in moral value has become an important issue as well. In thesesituations, most nurses have faced ethical dilemmas in the practice of nursing
due to their positions close to patients.
We performed a questionnaire study to elucidate the problems related to
medical ethics, which nurses confronted in their daily practice. We studied thenursing professionals’ awareness of ethical problems and their ways ofconfronting the problems in a district hospital in Japan.
As a result 30-35% of the nurses answered that they actually faced ethicalproblems or that they were worried about facing them at their work places.
About 15% of the nurses thought that they were currently involved in someethical problems in their practice, despite the low levels of their awarenessabout the existence of ethical problems.
In terms of their answers to such questions, they usually consulted withinvolved parties, such as patients or the third party who are disinterested, andabout 36% of the nurses had neither opportunity to talk about ethical problems
nor official discussions on such problems.
Our results suggested that “subjectivity of nurses” and “worries anddilemmas of nurses’ roles” had impacts on their nurses’ awareness of ethicalproblems. We have a future plan of our inquiry into nurses’ roles of hospital
ethics committees.
The Effectiveness of Medical Ethics Workshop on Different Level of
Cognitive Domain in Dental Students- L. Bazrafkan, M.D. and S. Z. Tabei
Education Development Center, Shiraz University of Medical Sciences(SUMS), Iranbazrafcanm@yahoo.com
Revision of medical education was began by the Cultural Revolution
Council in 1981 when the medical group of the council revised the aims andcurriculum of medical education. Five years later they added a course of
medical ethics to the curriculum of general medical schools. So far we offer aseparate program of medical ethics offered within physiopathology course.
However, there is some evidence that the program is not effective enough andthe students are not satisfied in this course.
Medical ethics has increasingly become a common component of theundergraduate curriculum at many medical and dental schools around theworld. The Liaison Committee on Medical Education in the USA identified theteaching of medical ethics as a core curriculum component of modern medical
school education. This has resulted in a trend towards revision and inclusion of
medical ethics in the early years of the medical school curriculum in Iran. In
Shiraz University of Medical Sciences, we tried to revise the current
curriculum and direct it to the enhancement of student's attitudes towards

ethical decision making. The new curriculum based curricular requirements on
the demands of well-chosen clinical problems due to the needs of the patients,society and students' training. This paper presents a new model for teaching
medical ethics in the dentistry school in Shiraz University of Medical Sciences.
The results of medical ethics workshops suggest that ethics education plays animportant role in the attainment of the cognitive domain. Ethics education does
not function as a single factor. Instead, it is very often accompanied byentrenched moral beliefs such as religious observance that also accounts forsome of the differences observed among respondents. This study showed apositive effect of workshops and attendance of stakeholder in ethics teaching
and learning. These findings support the idea that active learning andworkshop discussion is the best way to improve the student learning.

Thursday, March 22, 2007
20. Ethics in Public Health
Chair: Dr. Valaikanya Plasai

Ethical Issues in International Public Health and Health Research- Richard Cash, Ph.D.
Professor, School of Public Health, Harvard University, Cambridge, Mass.,USA
racash@hsph.harvard.edu
Public health concerns and research goes beyond the individual and takes into
consideration the interests of the group or society, even when this may conflictwith the best interests of some individuals. Public health interventions clearly
benefit some and not others. In the case of global public health the potential
reach across national, cultural, and economic boundaries adds more moral
complexity. This is particularly true when dealing with international healthresearch where there are significant differences in how societies view ethicalbehavior especially involving issues of substance. What is the purpose of
informed consent? Is it to fulfill a legal agenda or is it meant to insure
understanding of the participant? And if it is the latter how does limited
literacy or scientific understanding affect the process? Do issues ofconfidentiality extend to groups of people, especially those in vulnerable
situations? Should there be a single international standard of care? Whatshould it be? In a resource poor environment, what is owed to a community ora nation that is involved in a study? These and other issues will be discussed.
They will need to be developed with the concerned countries, and not simply
follow the practice some would call the ‘golden rule of development’: He who
has the gold makes the rules.
Contemporary Issues of Debate in Social Philosophy- Daniel Nesy, Ph.D.
Professor and Head, Department of Philosophy, University of Kerala,
Kariavattom, Thiruvananthapuram, Kerala, India
dnesynet@eth.net
Philosophy in the new millennium must be social philosophy. Reflecting
upon the agonies and sufferings of the existing society affected by intermittent
crises and chaos and suggesting a way out of them, stressing the ideal ofindividual and social happiness, striving for new and ennobling ideals form thevery basis of social philosophy. Our urgent need is to debate upon the basis fora healthy, happy and satisfactory life; a full and abundant life. The cleavages
that separate art from science, morals from economics, political affairs andreligion from education are to be sorted out and attended to.
Social philosophy is different from Sociology. Sociology being anempirical study deals with ‘the origins of human communities, the study of
their various forms, laws customs, institutions, languages, and ways ofthinking, feeing and acting’. Unlike such an enterprise, thinking brains are
upset with questions regarding the destiny of humans and society, particularly
in times of crisis. There were occasions in the history of thought, when
thinkers became discontented and dissatisfied with the prevailing order ofthings in society and goaded in to action. Plato’s The Republic and Hobbes’
Leviathan are shining instances of social philosophies attempting vigorousstudies and analyses of the existing social conditions and are prompted to lookbeyond time for evolving a new set of values and ideals in order to makehuman life fuller and happier. And as such, social philosophy is concernedwith narrowing the gap between the factual and the normative, between the ‘is’and the ‘ought’.
Social philosophy that is discussed herein is a human-centered philosophy
rather than a God-centered one. Some of the important issues for the social
philosopher to attend in the contemporary society are the following:Multiculturalism; Science and Technology; the Environment; Equality andJustice; Development, and the changing role of religion.
In conclusion human beings want to lead wholesome lives. Abundant power
is at our disposal. At the same time issues of peace and war, poverty andabundance and racial, political and industrial conflicts face us on every side.
Religious divisions and clash between the aged and the youth are prominent.
The conflict between the material and spiritual values, between self-interest
and world-service lie at the root of all problems. In a world of unending andfrightful problems, the role of the social philosopher is very significant. A
scientific and critical attitude to problems creates a new thinking pattern and a
new social philosophy conducive to a meaningful life.
Human Rights and Gender Equality- V. Balambal, M.A.B.T., Ph.D., FRAS (London)
Professor (Retd) of History, University of Madras, Chennai, India
drbala50@hotmail.com
In the modern world, every country is concerned about Human Rights andthe Constitution of each country specifies what are the rights given to its

Eubios Journal of Asian and International Bioethics 17 (May 2007)
people. Always focus has been on men and women of the country. The Indian
constitution specifies that there is no caste, creed, sex, sect, religious andlinguistic differences in dealing with the people of India and all can enjoy theirrights. But in actual practices there is lot of violation of Human Rights basedon the above classifications. One more category is economic differences. A
deeper study reveals that citizens are deprived of their basic rights andprivileges. The present study focuses on the rights of women and transgenderpersons in India as a whole and Tamil nadu in particular.
Women are in the secondary position despite the constitutionalsafeguards. Gandhiji’s dream of “Ramarajya”, where a woman with all jewelry
could travel alone even at night, remains a utopia. Society could be broadly
divided into three categories-upper, middle and lower classes. Their life style,wants, means, treatment, etc. are not the same. Ethical codes are not followed,
and are violated especially in the case of poorer and depressed class of people.
Their sufferings cannot be described in words. They lack awareness, care andconcern. Women suffer till lost and face ill treatment. They do not even know
the meaning of human rights.
When we talk about gender equality, it is painful to note the condition of
women. But not only the government but the common people too do not botherabout the condition of the transgender persons. To what category, will they fit
in? Does the society care for them? They are treated as the ‘laughing stock’ ofthe society. It is heartening to note that in modern times, there is an awarenessamong the transgender people and associations to fight for their rights. They
should be empathized not sympathized. The physical aspects of the transgenderneed not be a block to their progress. The bioethical aspects of this category of
the society are to be well understood by the people and the government. Casestudies have been made after collecting data.

(ABC8/BBRT2 abstracts)87rising industrial nature of local economies presents new challenges to the
public health network. In meeting these challenges capacity building in publichealth is increasingly being recognized as an important priority on the local
andinternational
level.
Some time ago Thailand conducted a study using WHO’s WPRO frameworkon the essential public health function carried out in Thailand. This study
made us aware that Thailand wasn’t doing enough and needed to improve theareas of health promotion, disease control; prevention and monitoring. In
response THAIPHEIN was created as a vehicle of communication and capacity
building among the nations public health institutes. The subsequent knowledge
sharing, skill building workshops and technical building activities proved so
successful that in December 2003 at a WHO Regional Consultation held in
New Delhi, delegates proposed the establishment of SEAPHEIN.
One of the first steps in the long term process of improving the publichealth standards within any country is to improve the educational standards
within the public health institutes. To address this need, minimum educational
standards, accreditation and guidelines for SEAPHEIN MPH programs weresuccessfully adapted. To help all member institutes meet these guidelines
workshops attended by MPH program educators are conducted on a regularbasis at the Mahidol Faculty of Public Health. Through this sharing of skills
and expertise among member institutes, the goal of insuring a high standard ofeducation in Public Health regardless of location within the SEAPHEIN
network is being realized.
One successful recent example of a Public Health capacity building
workshop at Mahidol University addressed the many areas of HospitalManagement. This was not only attended by area member institutes from
Bangladesh and Maldives but also by hospital administrators and educatorsfrom North Korea. The workshop included discussion of the lessons learned
through the experience of SARS and the Avian-Flu and the management ofemerging and re-merging diseases
These are only two examples but we see SEAPHEIN and capacity building
activities such as these as being invaluable vehicles in the continuing andexpanding advancement of SE Asian public health, today and into the future.

From Farm to Pharma: public health and challenges of nutrigenomics- Minakshi Bhardwaj, Ph.D.
ESRC Centre for Economic and Social Aspects of Genomics, Cardiff
University, UKbhardwajm@cardiff.ac.uk
Developments in genomics have led to the prospects of tailored medicine
The Role of Public and Private Sectors in Health Care: Emerging Ethicalwith focus on pharmacogenetics and the recent trends towards “eat right for
Dilemmas in India
your genotype” has shifted nutrition and health research towards nutrigenetics- Aruna Sivakami, Ph.D.
and nutrigenomics. Nutrition is an input to and foundation for health andaDepartment of Politics and Public Administration, University of Madras,
development. Food and nutrition becomes even more interesting it is Professor,
Chepauk, Chennai 600005, India
personal choice practiced daily and a global issue influencing internationalcpolicy discourse on food security and undernourishment, including publirunashiva_246@yahoo.com
All over the world, family has always been the primary context of healthhealth and trade. Nutrigenetics and nutrigenomics capitalise on the notion ofcare for its weaker and sick members. Today this role of family is further
smart diets uniquely tailored for each genotype, and based on the genotype
reinforced by policies of community care, cutbacks in social welfare
people and populations can be screened for susceptibility genes; for example
expenditure and increasing chronic sickness. Who the patient is in the family
susceptibility of PKU and complex disorders such as hypertension and obesity
structure and their life cycle determines not only positive or negative responses
where it is assumed that diet plays a significant role in determining “health”.
but also the income, class or social status of the family. Accommodating the
Genetic predisposition to particular type of food raises concerns choice andphysical, psychological behaviour, social, economic vocational incapacitations
practice, cultural and traditional values and where can we draw the boundaries
and their secondary development forces (due to illness of the earning member
between what we want to eat and what we should eat daily. This presentationof the family) that has so far regulated structural and functional changes in thewill introduce a new project starting at CESAGen and highlight some of thefamily becomes complicated.
challenges and opportunities of nutrigenomics and public health.
Two factors, which are very important in public health, are urbanization
Ethics in public health for Thailand
and the health hazards, which are due to over crowding, and another is due to
Valaikanya
Plasai,Dr.P.H.
environmental quality of the surroundings. Health is thus ascribed to be aCollegeof
PublicHealth,Chulalongkorn
University,
anddynamic equilibrium, out come of which is determined by a wide variety of
Department of Communicable Disease Control, Ministry of Public Healthbiological, socio cultural, economic, political, physical, psychological andvalaikanya@yahoo.com
environmental factors. The Ninth Indian Five Year Plan (1997 –2000) enlisted
This paper posts a question if a separate set of ethical guidelines isa number of factors responsible for inefficient functioning of Public Healthnecessary for the practice of public health in Thailand. It argues that public
Care System.
1.
Persistent gaps in manpower and infrastructure especially at the primary
health is a distinct entity, which complements but differs from ethics inhealth care level.
biomedicine. The goals of public health are fundamentally different from those2.
Sub-optimal functioning of the infrastructure; poor referral, services.
of medicine. While public health focuses on the population or the community,
3.
Plethora of hospitals not having appropriate manpower, diagnostic andand attempts to measure and improve the health status of the population,therapeutic services and drugs, in Government, but not in Voluntary andmedicine focuses on the individual patient and his or her welfare. A code ofprivate sector.
biomedical ethics therefore is, at best, insufficient to guide the practice of
4.
Massive inter-state / inter-district differences in performance as assessed
public health. Some scholars have gone so far as to argue that biomedicine isby health and demography indices; availability and utilization of services areirrelevant in public health, and yet, there are no guidelines to assist publicpoorest in the most needy states/ districts.
health workers in practice and research in public health. A relevant code of5.
Sub – Optimal inter – sect oral coordination.
public health ethics is badly needed.
The paper proposes that a key element in the development and practice of6.
Increasing dual diseases, burden of communicable and nonethics in public health is the development of a cadre of public health workers
communicable diseases because of ongoing demographic lifestyle andand investigators who have been trained in the concepts and practice of ethics
environmental transitions.
7.
Technological advance which widen the spectrum of possible
in public health. Strategies need to be developed not only for creation of suchinterventions.
expertise, but also to develop a framework so that these scientists and8.
Increasing awareness and expectations of the population regarding healthinvestigators at different institutes could form a network, which would
care services.
strengthen each institute, and also the entire network. Career prospects for such
9.
Escalating cost of health care, ever widening gaps between what istrained personnel, either within their specialty or in a special unit for ethics,
possible and what the individual or the country can afford.
could also be discussed. The paper therefore calls for collaborations among
10. Improper integration of all institutional machineries and services
public health workers and scientists, at the national and international levels, formentioned above.
such development.
This paper will also discuss National Health Programmers including:
Disease Control Programmers; Care of the Instruments
21. Capacity building and networking in ethics in Non-communicableand Linen; Bio-Medical and Diagnostic Equipment; Nursing Services;
Computers in the Hospital Administration and Management of Information
public health
Systems in a Hospital.
Chair: Prof. Leonardo de Castro and Dr. Valaikanya Plasai
Health Partnerships are essential. As we move into an advanced
technological era, the challenges for health promotion go beyond the wider
Capacity Building and Networking in Ethics in Public Healtharticulation of the concept of health promotion, from building infrastructure to
Pittaya Jarupoonpol
achieving adequate levels of resources, both technical and supportive demands
Thailandfor health promotion as well as love and care for patients. With Voluntary
The phenomenon of globalization is having a dramatic impact on public
sector and NGOs in Partnerships, with State and Central Governments, should
health around the world. The increasing movement of people and productsbeable to effectively respond to the health needs of vulnerable population
across borders as well as the urbanization of populations in response to thegroups, such as workers, women, children and elders in the society this needs88 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)

to be more vigorously pursued. Healthy public policies need to be developed toensure supportive environments for individual and community health action,and to protect people from lifestyle-related problems such as those due totobacco drugs and alcohol. Documentation and dissemination of healthpromotion outcomes are also critical to the legitimization of the cause of healthpromotion in the region. New health challenges mean that new diverse
networks need to be created to achieve intersect oral collaboration. Such
networks needs should provide mutual assistance within and among countries,
and facilitate the exchange of information about which strategies have proved
effective. This paper looks into the picture that unfolds and analyses thereasons and prospects.

General Meeting of the
Association (Open to all)Asian

Bioethics

22. Ethics in the Practice of Public Health
Chair: Prof. Darryl Macer and Dr. Alireza BagheriFeminist and Virtue Perspectives on the Ethics of Public Health Research- Wendy A Rogers, Ph.D.
Associate Professor in Medical Ethics and Health Law, Flinders University;
the Ethics Centre of South Australia
wendy.rogers@flinders.edu.au
The central tension in public health research ethics is between actions
taken for the common good, and the rights of individuals affected by thoseactions. Public health research uses a wide variety of methods, including
epidemiology, randomized controlled trials for disease prevention and healthpromotion, and social and behavioural techniques. All of these methods raise
ethical issues, ranging from informed consent, community involvement, andprivacy issues through to coercion and manipulation, and conflicts of interest.
Given the wide range of research methods and potential interventions, it ischallenging to build a theory of public health research ethics.
In this paper, I discuss the potential contributions of feminist and virtue
perspectives on public health research ethics. Feminist public health ethics
urges us to address inequities, attend to specific details and context, provide forfair shares of resources and just rewards, and to embrace diversity in researchmethods. Feminist approaches also highlight the need for procedural justicethat considers the ways in which individuals and communities can exercise
their capacities and determine their own actions. Virtues in public healthresearch include honesty, courage and justice, all of which are necessary tocounter inequities and conflicts of interest, and to promote community
partnerships and trust. Using feminist and virtue approaches, it is possible todevelop practical guidelines for supporting ethical practice in public healthresearch.
Social Discrimination and Health Disparity Across Generations: Are We
Sufficiently Informed?
- Irina Pollard, Ph.D.
Dept of Biological Sciences, Macquarie University, Sydney, NSW 2109,
Australia
ipollard@rna.bio.mq.edu.au
Genetic susceptibility in combination with chronic physical andpsychological distress is recognized as an important etiological factor in many
lifestyle diseases of the cardiovascular, immune, nervous and reproductive
systems. A range of adverse environmental and behavioural factors; including
inadequate nutrition, lack of exercise, poverty, depression and drug
dependencies, contribute to ill health and poor fertility. Therefore, poor fertility
in some circumstances maybe a good indicator of an individual’s overall healthstatus. Given that the capability to bear healthy children depends on our genes,
the conditions under which we live and the ways in which we behave,inappropriate lifestyle choices may generate profound health consequences
across the next and subsequent generations. Regardless of cultural sensitivity,
it has to be recognized that poverty and their socio-behavioural consequences
are particularly significance for many Aboriginal Australians; thus,
highlighting the scandalous reality that in one of the most economically
successful nations on earth the benefits are not shared fairly among all
Australians. There is little doubt that many of the current poor health outcomesof Indigenous Australians result from past impoverishment which, as a result,
imposes on all Australians a collective and inherited ethical responsibility tomake amends by way of reconciliation – a process that aims to empower
through management of cultural and biological diversity, education,
employment opportunities and economic development. These initiatives
increase wellbeing by means of increased collective autonomy, self-esteem andsocial adhesion. The presentation’s intention is to provide an in depth
understanding of biological systems from which adaptive socio-ethicalcommitments may evolve1.
Reference
The Bioscience-Bioethics Portal at http://www.bioscience-bioethics.org/
provides free admittance to educational material for those interested in Bios
HIV/AIDS Prevention: A New Bioethical Framework for China- Yanguang Wang, M.D., Ph.D.
Professor, The Center for Applied Ethics, Chinese Academy of Social
Sciences, Beijing, China
ameliawyg@sohu.com ameliaw2002@hotmail.com
The first case of HIV infection was reported in China in June 1985. At theend of 2006, there were 183,733 reported cases of HIV-positive and AIDS
patients all over the country. Even though the numbers of HIV infection seemto be quite low considering China's population of 1.3 billion, we have reason toassume that it is very probable that China will become a country with a highHIV infection rate. Which bioethical framework ought to govern China's HIV
prevention policy? The basic bioethical framework we use to evaluate actions
in bioethics consists of Principles such as nonmaleficence, beneficence, respect
for autonomy, and justice. It seems that these principles are not fully suitablefor HIV/AIDS Prevention. I suggest an improved bioethical framework thatconsists of the principles of tolerance, beneficence, autonomy and care. In mysuggested bioethical framework the principles of tolerance and care shouldplay a central role.
Foreign Dental Health Research and the Philippine Dental Act- Evangeline Joy U. Ramos,DMD,DipBE
Philippines
Evangeline_joy.ramos@up.edu.ph
The image of security, order and labor are the key factors for a better
society. This can only be achieved by educating the people on ethics that will
enable them to respect and embrace their culture. This paper was made inrealization of commoditization of health at the expense of the vulnerable
groups. The market oriented motivation of health research that drives theresearcher to work on studies with better monetary returns rather than thoseresearches that will help the people to have better lives. This study aims toanalyze the Philippine situation in research and as well as to analyze thegovernment concern in dental health. The market driven researches as well as
non - access to dental health care in the Philippines.
As of the moment, oral health care is not covered by Philippine Health. In
the Philippines, the limited financial public resources are mostly spent on
urgent medical and social problems. As caries and periodontal diseases are notregarded as life threatening, prevention and treatment of dental diseases have a
low priority. 94% of 5-year-old Filipino children had caries and in 12-year-old
children the mean DMFT was 4.6. Ninety percent of the decay was untreated. I
will compare this with Malaysia, which during the Eight Malaysian Plan
(2001-2005), stated the focus of health sector development will be further
improve the health status of the population particularly the low income and thedisadvantaged groups and optimize utilization of resources in the delivery ofhealthcare. In relation to this, the recent amendment to the Dental Act 1971,
the Malaysian Ministry of Health has made it compulsory for all dental
graduates registered with the Malaysia Dental Council to serve as dental
officers in public service for three years. In Thailand, most of the dentists arefrom public academes that oblige them to work in public sectors. Increasing
the number of health practitioner to serve the underprivileged to relieve theinequity in health care. Thai Ministry of Public Health (MoPH) also produces
many cadres of health personnel, mainly for staffing its own health services
infrastructure.
Ethical Issues including poverty and Vulnerability, research ethics, thelegality of the Ethics Review Committees will be discussed. I analyze an
externally funded research project for the researchers to place amalgam
restoration on a cavity prepared supposedly for atraumatic restoration. The
issues relating to the continued use of amalgam will be discussed, noting that
Sweden, Denmark, and Germany have restrictions on dental amalgam use.
This restriction made it clear to that this research is linked to the reason of
possible market of Amalgam. A market driven intention is a clear unethicalmotivation. I cite this case as poor governance. The legality of a medical ethics
committee to allow dental research to occur in the country is questionable.
Their incompetence to the methodology made them vulnerable as well to judge
it and had placed these children participants at risk.
Ethical Dilemmas in Public Health Research- Godofreda V. Dalmacion, MD
College of Medicine, University of the Philippines
Lymphatic filariasis is endemic throughout most of the southern half of thePhilippine archipelago afflicting 45 of the 77 provinces. Within the country
areas endemic for the parasite are in regions with highest incidence of poverty
and eliminating the disease in these areas provides significant opportunities toalleviate poverty and reduce inequalities in health. Mass treatment with single
dose of DEC given yearly has shown to effectively kill the parasite but adding
albendazole has increased to 99% the killing effect on the microfilaria.
Nevertheless, the ideal treatment regimen still needs to be defined despite
growing medical literatures attesting to the safety of the combination.
A couple of years back, mass treatment with DEC and albendazole wasadministered in many areas endemic for the condition without passing
Institutional Board Review (IBR). Unfortunately this resulted to quite anumber of unexpected deaths including that of an apparently healthy young
boy and a couple of health officers escaping the outrage of the town’s folk .
This brings to mind when public health activities are or are not research.
Ethical guidelines for conducting clinical trials have been based on therapeutic
obligation to treat individual patients. In contrast, public health is concernedwith the health of the entire population and thus public health ethics is foundedon societal responsibility to protect the health of the population. The
distinction between research and activities of public health interventions is
critical to the timely and effective practice of public health because routine
public health practice activities cannot be effectively carried out in a timely
manner if they are subjected to the considerable administrative burdens
associated with an IRB. In this case, will society’s benefit take precedence overindividual patient risk no matter how fatal it may be for some? Will the ethicalissues be resolved based on quantity rather than quality of benefit over risk? In
addition, the issue of accountability also arose because albendazole was a drug
donation, which commonly occurs in public health activities.
Public Health and its Ethical Aspects in Ottoman State (1299-1923): Some
Good Examples for Modern Age- Sahin Aksoy M.D., Ph.D.

Eubios Journal of Asian and International Bioethics 17 (May 2007)
Harran University Faculty of Medicine Department of Medical Ethics andHistory of Medicine, Sanliurfa, Turkey
saksoy@harran.edu.tr
Since health is the most valuable asset of an individual, the health level ofthe citizens is the most prominent indicator of the welfare in a society. Everynation develops policies and establishes infrastructures to provide a better
environment, which prevents the public to be ill. Public health policies and theservices provided may vary according to the wealth of the state as well as its
ideology. The equity and accessibility of public health services is as importantas its provision.
Modern public health concepts have emerged in early 20th Century.
However, there were some societies and civilizations in history where publichealth policies and services were very well organized and provided. In thispaper, I will firstly present the meaning of health and its prevention in Ottoman
State (1299-1923). Secondly, I will examine the duties and obligations ofindividuals and the State to keep society in healthy state. And finally, I will
give some historical examples from Ottoman documents, which set very good
examples even for the modern developed countries.
The reason to choose the Ottoman State is that, it has been the leader ofMuslim Nations for centuries; therefore, its application can be considered as
the prototype of Islamic understanding on public health care. As it will beobvious in the presentation, the Muslims’ holy book, Qur’an and the traditionof the Prophet Muhammad are full of orders and recommendations concerning
public health and its ethical provision. Another reason to choose Ottoman Stateis that, its people and institutions had evolved to Turkish Republic, and its
public health policies and institutions had constituted the pioneering principlesof Modern Turkish Public Health Policies.

23. Ethics and Research
Mediterranean Region

in

the

Eastern

Chair: Dr. Aamir Jafarey and Dr. Sahin Aksoy

This panel seeks to highlight the importance of the consideration ofcontextual aspects that is required in research ethics in the Eastern
Mediterranean (EM) countries both in terms of basic research on bioethics
issues and in the development of guidelines and ethics framework. The panel
consists of five speakers from two countries of the EM region, Egypt andPakistan. The panelists will present their original work based on the research
they have conducted or are planning to conduct or in one case, the ethics
guidelines that have been developed, with relevance to the local needs andcircumstances.
The Good/Ethical Doctor: The Eye of the Beholder- Aamir Jafarey MBBS, FCPS, FRCS
Assistant Professor, Centre of Biomedical Ethics and Culture, SIUT Karachi
Pakistanaamirjafarey@gmail.com
This paper is based on an ethnographic study conducted on patients andfamily members at two different hospitals in Karachi, Pakistan, exploring theirperceptions on what they consider to be the qualities of a “good physician”.
One set of study participants, interviewed at a free public sector hospital,
consisted of patients with little formal education and came predominantly fromthe underprivileged class. In contrast, the other set of participants, interviewed
at a premier private hospital, represented the educated and affluent class of
Karachiites. At both sites in-depth interviews were conducted in privacy by
two co-principal investigators simultaneously talking notes. Perceptions abouta “good/ethical doctor” by both sets of study participants were strikingly
similar and did not seem to be influenced by their educational level or
economic status. For most, a “good doctor” was one who “spoke to the patient
nicely” and “considered the patient like a next of kin”. They mentioned traits
like “kindness” and “soft spoken” and “forgiving” repeatedly as being essential
for a “good doctor.” All of these traits related to the character of the individual.
Clinical competence, experience in the field, and a good track record were notstressed by our participants. This study highlights the importance of tailoring
bioethics education for medical students and young physicians on aspects ofvirtue ethics.
Adequacy of Ethical Review and Informed Consent Documents Submitted
For Funding To The Eastern Mediterranean Region of WHO- AbouZeid Alaa1, MD, MPH, Afzal Mohammad1, Silverman Henry2
1
WHO, Eastern Mediterranean Regional Office, Research Policy andCooperation Unit, Cairo, Egypt; Lecturer Public Health, Cairo University,
Faculty of Medicine, Cairo, Egypt
2
University of Maryland School of Medicine, Baltimore, Maryland, USA
Supported in part by Health Research Ethics Training Initiative in Egypt(www.hretie.com)
alaabouzeid@yahoo.com
This paper will discus the adequacy of the ethical review process fromresults in 12 countries in the EM region. This study is based on the study
proposals that the Eastern Mediterranean Regional Office (EMRO) received
from member states in answer to a call for proposals. The submitted research
proposals involved the participation of human participants in 85% of cases.
However only 44% of the proposals involving human participants had obtained
an ethical review from a relevant committee prior to submission. In this study,
the investigators also found several deficiencies in the submitted informed
consent documents. The conclusion is that there is lack if awareness regarding
the need for ethical review and obtaining informed consent among researchers
in the region and therefore, there is a need for more emphasis on research
ethics education in this area.

(ABC8/BBRT2 abstracts)

89

Stem Cell Research and Therapy: Voluntary Guidelines for a Public
Sector Organization- Tashmeem Razzaki, PhD
Professor of Molecular Biology, Sindh Institute of Urology andTransplantation, Pakistan.
trazzaki@yahoo.com
This will discuss the process of the development of guidelines for Stem
Cell Research and Therapy, a project that I voluntarily assumed for my public
sector organization, because of a lack of such guidelines at the national level.
In her paper she says that stem cell research and its applications pose serious
ethical concerns, particularly when it comes to human embryonic stem cells
derived from embryos. The issue is highly charged, emotive and evokes
intense religious and political debates. As the field grows, there are
simultaneous efforts underway to regulate research by various national andinternational codes and guidelines. However Pakistan has not as yet made suchan initiative. The Sindh Institute of Urology and Transplantation (SIUT) is a
publicly funded organization where a stem cell lab is being developed and suchresearch will shortly be undertaken. This initiative at developing guidelines
was motivated by the need to provide guidance for researchers at SIUT and toserve as a framework for a national level policy document. Razzaki will
describe the salient features of these guidelines and highlight its relevance tothe work being done at her institution.
Evaluation of Ethics Review Procedures for Research in Egypt- Hany Mohamed Safwat Sleem, M.D., Henry Silverman
Supported in part by Health Research Ethics Training Initiative in Egypt(www.hretie.com)
Deputy-Head, Dermatology and Andrology Department, National Hepatology
and Tropical Medicine Research Institution, Cairo, Egypt
hanysleem@hotmail.com
This paper discusses proposed research on evaluation of ethical review
procedures for research in Egypt. Ethical regulatory processes are being
developed in Egypt to meet the increased research agenda being developed inthis country. However, there are little data regarding the structure and functionof Research Ethics Committees (RECs) in Egypt as well as the resource needs
for these RECs. Also unknown is the extent of awareness of research ethic
principles among researchers who conduct investigations in Egypt. It is
intended to study the existing RECs in Egypt, their composition, their training
needs, the challenges that they face and the nature of their workload. Such data
will establish a baseline so that proper training can be initiated based on theaccurate needs of these RECs. Those RECs that have been functioning for atleast one year and have been registered with the OHRP office will be included.
Quantitative as well as qualitative data will be collected and analyzed.
Survey of Attitudes of Egyptian Population Living in Remote Area
Towards Research Participation and Storage of Human BiologicalSpecimens- Magdi Shehata, Ph.D., Mohamed Shams, Alaa Abou-Zeid, Henry Silverman
Sponsor: Health Research Ethics Training Initiative in Egypt(www.hretie.com)
Professor of Medical Entomology, Research and Training Center on Vectors of
Diseases, Faculty of Science, Ain Shams University, Cairo, Egypt
mgdshehata@yahoo.com
This paper presents a research proposal investigating the attitudes ofindividuals living in remote areas of Egypt towards their participation in
research. Areas to be explored in this survey will include: the research
participants’ understanding of the meaning of medical research, theircomprehension of risk levels in different types of research, their understandingof the process of randomization and blinding, their understanding andinvolvement in the informed consent process, their concept of consent forunspecified future research on stored human biological samples, their comfort
regarding collection of samples for genetic analysis, and their general
understanding of genetic research. The data obtained will help devisingstrategies for education for members of Research Ethics Committees as well as
for researchers conducting human subject research in remote areas where thepopulation’s general level of awareness of advanced technological processes
may be rudimentary.
18.00 – 20.00 Farewell Dinner
Friday, March 23, 2007
24. Bioethics Education
Chair: Prof. Darryl Macer
Perception of Modern Medical Ethical Issues by Non-Medical Science
Graduates- M.A. Jothi Rajan1, Arockiam Thaddeus2, T.Mathavan3, P. Senthil Kumaran4
1
Arul Anandar College, Karumathur-625514, India.
2
Jayaraj Annapackiam College for Women, Periyakulam- 625601, India.
3
NMS S Vellaichamy Nadar College, Nagamalai-625019, India
4
School of Tamil, Pondicherry University, Pondicherry-605014, India.
anjellojothi@yahoo.co.in
A mini debate was conducted on “Medical Ethics” for the final year
undergraduate students of Physics course. A batch of 36 students (5 girls and
31 boys) in the age group of 18+ was divided into 15 groups. The topics for thedebate were given two months prior to the conduct date, and relevant study
materials were provided from different books on ethics, newspaper cuttings,
internet web sites of Eubios Ethics Institute, internet web site of UNESCO
Bangkok, and other relevant web sites. All the students were given to read the
textbook “A Cross Cultural Introduction to Bioethics” (2005) edited by Darryl90 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)

Macer. The following topics were identified for the debate (number ofparticipants who were given the respective topics for debate): Doctor- Patient
relationship (2); Surrogacy (2); Euthanasia (3); Human Cloning (4); Animals
are also moral beings(2); Nursing- A noble Job (3); AIDS in India (3); Brain
death (2); Health for all by 2000AD (1); Private hospitals (3); Organ donation(2); Medical care for pregnant women (3); Government hospitals (2); Altruism(1). Each participant was given a maximum time of 5 minutes to express
her/his views related to the ethical issues associated with the problem. Thiswas followed by a debate for a maximum of 5 minutes where participants ofother topics will express their views and also get clarifications from the
speaker. The majority of the participants expressed their views in English and aminority in Tamil (Mother Language). The authors have translated the Tamilanswers into English as the whole debate was recorded in audiotapes. Threeexperts were present to conduct and facilitate the smooth progress of the debate
and two staff members were taking down the notes of the whole proceedings ofthe debate. The participants were arranged to sit on a circle in chairs without
tables.
The main objective of the debate was to find out the level of awarenessamong the non-medical student community on the ethical issues related to
medicine with more emphasis towards the human community. In the view of
the authors and the experts present in the debate, it was noted that there wassignificant level of awareness on the present issues related to medical ethics.
The responses of all the participants will be presented elaborately in the full
text. The good news for bioethics in our region is that it will be implemented
as an elective course for all the undergraduate arts and science students fromthe year 2007. The overt response to this debate was a voluntary visit to amentally challenged home by the debaters by spending a few hours with theinmates of the home. No doubt increased respect for human life is overflowing
by conducting debates of problems related to ethics, which will strengthen the
moral character of the younger generation.

Young People, Ethics and Culture: Some Observations on a Comparisonof Responses to Contemporary Biomedical Dilemmas in Sri Lanka andGreat Britain, and their Implications for Medical Education- P. V. R. Kumarasiri1, S.N. Arseculeratne2, P. D. Premasiri3 & R. Simpson4
1
Departments of Community Medicine, 2 Microbiology, Faculty of Medicine, 3Pali & Buddhist Studies, Faculty of Arts - University of Peradeniya, and4
Department of Anthropology, University of Durham, England, UK.
Most instruction in normative medical ethics to medical undergraduates in
Sri Lanka is based on Western ideas and documents, from the Hippocratic
corpus to more recent documents such as the Helsinki declaration, the Geneva
Code, the Nuremberg Code and many others. A notable omission in theteaching of ethics to Sri Lankan medical students is traditional indigenous
ethics that have been explicitly stated, mainly in the literature of Buddhism, thecountry’s predominant religion. We will provide arguments why the curricular
content should include Asian ethics in addition to ideas from the Westernsources. This will include discussion of cultural relativism in medical ethics,
and provide results of quantitative evaluation.
The responses (‘agree’) of rural Sri Lankan students to 6/15 culturally
dependent questions differed significantly from those of the urban Sri Lankan
students,
probably
indicatingacultural
drift
due
to
modernization/westernization of the latter. The responses of the rural Sri
Lankan population to 10/15 questions that were taken to be culturallydependent, differed significantly from those of urban England, while urban Sri
Lankan responses to 11/15 such questions also differed significantly fromthose of urban UK suggesting that despite the cultural drift among the urban
Sri Lankan students, both groups retained their indigenous ethos that differedfrom that of the urban group in England, supporting the idea of cultural
relativism in ethical decision making. The implications in medical education
will be discussed, with discussions also of ‘Situation ethics’ versus ‘rule
ethics’.

Teaching Ethics and Humanities to Medical Students in Sri Lanka: A
Multi-Cultural Approach
Anoja
Fernando,
BA,
MBBS,
FRCP
Faculty of Medicine, University of Ruhuna, Sri Lanka
anojaf@yahoo.com
Medical ethics is now included in the curricula of most western medical
schools, but it is still not common in Asian medical schools. Teaching medical
ethics is now fairly well established in most Sri Lankan medical schools. The
Faculty of Medicine, University of Ruhuna was established twenty five years
ago as the third medical school in Sri Lanka. While professional ethics andlegal medicine were taught in forensic medicine from the very inception of theschool, medical ethics was dealt with briefly by one or two lectures. After aseries of workshops for faculty staff on reorienting medical education in theearly 1990s, a formal programme on medical ethics, based predominantly on
Western models was introduced in 1995. In the University of Ruhuna, themedical curriculum is a traditional one, and medical ethics is taught throughout
the five-year course. This paper will describe the medical ethics courses from1995-2006.
An introductory lecture is given at entry to medical school. After fiveterms of preclinical studies, at entry to the clinical course in the 3rd year, thestudents have a two-week introductory course of lectures and demonstrations
during which the main input of medical ethics teaching occurs. This consists ofa series of 7 lectures and one seminar discussing ethical scenarios, given over a
period of one week. The lectures include an introduction, history, ethicalcodes, doctor – patient relationship, confidentiality, patient autonomy andinformed consent and introduction to research ethics. Student assessments are
not done at this stage.
From the 3rd to the final year, professional and legal ethics are covered by
the Department of Forensic Medicine, research ethics by the Department ofPharmacology. Summative assessments of students are done as part of theexaminations of both subjects. It was originally planned to cover otherspecialized topics such as HIV/AIDS, abortion etc by the relevant departments,
however this aspect was not done consistently. During the final year clinicalethics discussions are held in the wards. A few years ago a Medical Students’
Oath was introduced at entry to the medical school.
An evaluation of the ten-year programme on medical ethics carried out in2005 will be presented. In 2005 an attempt was made recently to include
Asian medical ethics drawn from the indigenous systems of medicine, whichhave existed for many years in India and Sri Lanka. The other innovation was
the introduction of Medical Humanities in October 2005. Student enjoyment oflectures ranged from 80%-97% and agreement on the relevance to objectives
ranged from (80%-88%). The preferred method of teaching was half-hour(69%) lectures (71%). Except for 4 neutral comments, all other comments (38)were positive, appreciative and indicated that lectures were effective. 96%
wanted continuation of the course. Art and medicine was the most favoured
topic. It is difficult to prove that teaching medical humanities in any form to
medical students will result in more humane physicians or better-cared forpatients. However, I conclude that short, didactic lectures are feasible,
acceptable and effective as a preliminary method of introducing medical
humanities to undergraduates in a developing Asian country with limited
resources. The paper provides quantitative data with respect to feasibility andacceptability and discusses the implications and methods to assess course
effectiveness.

Knowledge of Bioethics amongst Postgraduate Trainees of a Medical
University in Southern Pakistan- Inayat U. Memon, M.D.
Senior Pathologist, Liaquat University Hospital, 21/8 – Soldier Bazar, Saddar,
Hyderabad, Sindh, PAKISTAN
inayatm@yahoo.com
There is increasing knowledge among general public about medical ethics
and awareness about patients’ rights vs. health professionals’ responsibilities.
In Pakistan, most of the medical colleges / universities do not offer the subjectof bioethics in the curricula intended for undergraduate or (post) graduate
medical studies. The objective of this study is to ascertain the baselineknowledge of bioethics amongst physicians (postgraduate-PG trainees), so as
to help to develop curriculum for PG studies in Liaquat University of Medicaland Health Sciences (LUMHS) Jamshoro, Pakistan.
A one-page, 15 item questionnaire was prepared and administered on 74
PGs working in various departments (Obstetrics and Gynaecology, Internal
Medicine, Pediatric Medicine, General Surgery, Radiology andAnaesthesiology) of LUMHS. It contained questions about frequency of
encountering ethical problems in clinical practice, knowledge of existence ofany ethics committee in the institution and its performance, need of informed
consent from the patient during clinical practice & surgical procedures,
adherence of patients’ wishes, patients’ confidentiality / disclosure, need of
informing patients about the errors/wrong-doings carried out during their
management, respect of the patients’ religious beliefs and recognition of
ethical dilemmas. Questions were also asked to assess knowledge of PGs about
current ethical issues and history of bioethics/research ethics. In the end of thequestionnaire their opinion was sought about alleged increasing reports of
misconduct by the physicians and their responsible causes.
About half of the number of PGs (49%) encounter ethical problems morethan once a month, 23% once a month, 3% less frequently, 11% claim that they
never encountered while remaining 14 declined to reply to this question. Only
8% of the respondents knew about the existence of ethics committee, while
43% could not decide to reply to this question. 53% of the participants showed
their dissatisfaction regarding the performance of the committee. Almost all
PGs (95%) considered it essential to take consent from patients (during clinicalpractice), while all (100%) considered it as necessary pre-requisite while
undertaking surgical procedures. 54% of the PGs chose not to administer
necessary medical treatment against patients’ wishes, while 32% wanted toover-ride their wishes in this situation, 11% of them could not decide while 3%
declined to reply. But when religious beliefs were involved, 43% of them
respected patients’ wishes when treatment is against their religious observance.
31% wanted to over-rule patients’ wishes in these situations, while 24% wereunable to decide and 1% decline to reply to this question. Majority (54%) of
respondents thought that patients’ record is confidential and should not be
disclosed to their relatives without their permission, while a quarter of them(24%) were unable to decide about this issue. Borderline majority (52%) of the
PGs were ready to disclose to the patients any errors (if these were committed)
during their management. Of the remaining respondents 24% wanted to hide
this fact from patients, while 24% could not decide this problem if it
encountered. 43% of PG trainees were able to recognize ethical dilemma(withdrawal of mechanical ventilators). A big majority of them (92%)
considered inclusion of the subject of bioethics in medical curriculum as anecessary step. 35% were aware of current bioethical issues (euthanasia), while
54% were unaware. Regarding the knowledge of evolution of research ethics,
67% of them correctly knew about Helsinki declaration, while only 36%
correctly knew about Nuremberg code. Regarding allegedly escalating reportsof misconduct by physicians, 63% considered lack of bioethics training as the
responsible cause, while only 11% considered the public as the responsible
party, while 7% thought physicians themselves were are responsible for thisproblem.

Eubios Journal of Asian and International Bioethics 17 (May 2007)
The results of this study reveal that there is significantly high frequency of
encountering ethical problems by PGs but only 43% could correctly recognize
ethical dilemmas. This fact highlights the need for training in bioethics. Veryfew of them (8%) knew about the existence of ethics committee and they were
not happy with its performance. Relative unawareness of current bioethicalissues (euthanasia) and older research ethics milestones i.e. Nuremberg code
(while familiarization with more recent Helsinki declaration) stress upon theneed of teaching this subject at both levels of medical education, as they
themselves suggested to a question. Existence of a positive insight (7%considering themselves as responsible for medical misconduct) and desire tolearn provide a fertile atmosphere where teaching of bioethics could be
successfully started.
In the current atmosphere of medical management (with advanced
biotechnology), frequent occurrence of ethical problems in medical practice,
relative unawareness of knowledge of current bioethical issues and lack ofskills to resolve ethical problems stress upon the need to develop curricula andteach bioethics at both undergraduate and (post) graduate levels in medical
institutions.
Ethics Curriculum for Postgraduates in OB-GYN- Yasmin Wajahat, M.D.
Centre of Biomedical Ethics & Culture, Sindh Institute of Urology andTransplantation, Karachi, Pakistan
ywahat@gmail.com
It has been realized by the medical community of Islamic Republic ofPakistan that there is an urgent need of laying structured curriculum inbioethics, both at undergraduate and postgraduate levels. Only in one private
university, bioethics is included in the curriculum for undergraduate level. Dueto the lack of formal knowledge our junior colleagues find it difficult to
identify ethical issues and to deal with them.
This presentation describes the innovative program of designing thecurriculum for the postgraduates related to the busy specialty of OB-GYN. The
curriculum is designed for the duration of six months to give exposure ofbioethics education to the junior doctors. The topics chosen for the curriculum
include confidentiality, privacy, informed consent and issues related to
miscarriage. The postgraduates will not be required to input any extra time into
attending these teaching sessions as they will be conducted during theirtraining hours.
Due to the lack of trained staff in this faculty, like-minded postgraduatesand colleagues will be selected and trained so that they can be of help in theteaching program in future. Hence, the aim to establish and implement
bioethics as a discipline and assisting doctors to practice ethically may be
fulfilled in the OB-GYN field.
Drama and Bioethics- Nadege Nechadi and Valaikanya Plasai
RUSHSAP, UNESCO Bangkok; Chulalongkorn University, Bangkok,
Thailandrushsap@unescobkk.org
This paper will review the links between drama and ethics. It offers abackground on drama as an instrument for communication and explores theway drama can facilitate to teach ethics and values of cultural understanding.
For centuries, drama has been used to deal with important ethical issues,
especially about religious topics. Nowadays drama is applied mainly in the
education field through the Drama in Education method (DIE) or as tool for
prevention. Indeed, drama can be efficient to illustrate the different aspects ofcontemporary issues such as disease, old age, responsibility, education andfamily interactions. Thus it stimulates thoughts and discussion.
This paper analyzes the way drama has been used through history andcultures, compares some different forms of drama, and how it can be used toteach ethics and finally examine what the concept of “ethico-drama” brought tothis field. Through two short plays written by NN (to be performed in thecultural evening) on different bioethical dilemmas viewed from different
cultural viewpoints, this paper will stimulate debate.
One play is “My career, my life, my choices…”. The plays take place inAsia in a near future. Tada, a career woman spends her life devoted to her job.
She has been working all her life to get respect and recognition in her field.
Single and with no children she is attached to her mother. After long years ofhard work, she finally gets the reward she deserves and gets promoted. This
new position is the chance of a time life to show what she is able to do even if
it is more challenging in terms of responsibilities and involvement. However a
few months later, her mum is diagnosed with Huntington’s disease.
Huntington's disease (HD) results from genetically programmed
degeneration of brain cells, called neurons, in certain areas of the brain. This
degeneration causes uncontrolled movements, loss of intellectual faculties, andemotional disturbance. HD is a familial disease passed from parent to childthrough a mutation in a normal gene. Each child of an HD parent has a 50-50
chance of inheriting the HD gene. If a child does not inherit the HD gene, he or
she will not develop the disease and cannot pass it to subsequent generations.
A person who inherits the HD gene will sooner or later develop the disease. At
this time, there is no way to stop or reverse the course of HD. For the moment,
Tada doesn’t want to know and is wondering if she should get the test if she
has the mutated gene and maybe find out the fatal answer.
The other play is “The responsibility of saving lives”. The play takes place
nowadays somewhere in Asia. A school principal is aware that his pupils tend
to gain in weight. He wants to collect money to organize sessions andworkshops to teach the kids how to eat well with nutritionists andpsychologists and coaches. Unfortunately, despite his extensive research, henever managed to get any funds for it. One day, a big fast food company offers
to sponsor him with actions like gym sessions, nutritionists and weight
management. No Fast food will be promoted verbally but the different(ABC8/BBRT2 abstracts)

91

professionals will wear Fast food uniforms and distribute them to the children.
Who will be responsible if the kids eat Siam Burger?
The application of PBL (problem-base Learning) in Bioethics education –my experience in General education of Medical University- Dena Hsin-Chen Hsin, Ph.D.
Associate Professor of Bioethics, China Medical University, Taichung,Taiwan, China
hchsin@hotmail.com
This presentation is aimed to share the experience of applying
problem-base learning (PBL) in bioethics teaching, which was designed as anelective course of General education curriculum in medical university of
Taiwan.
Bioethics education was featured in its multidisciplinary learningwhich is intended to enable the skills to identify existing ideas and beliefs, beaware of multiple perspectives, and to find out relevant information andcommunicate the findings to others. However, the traditional educational
method, which is characterized by large class didactic lectures, is not only
limiting in cultivating the attitude of self-directed learning but also deficient in
integrating knowing and practicing those skills to everyday living.
PBL, a relatively new approach to teaching, has been introduced in
medical schools all over the world, which has proved to provide a platform toenable students to integrate acquired knowledge and to enhance learning inreal-life professional context. The philosophy behind the implementation of
PBL in Bioethics teaching is to ensure every participant (students who take thecourse), who is a self-directed and life-long learner in bioethical issues as is
expected of all health science professionals. In PBL, the use of practicalproblems as triggers enable student in small group to discuss and debate on thelearning issues. The essential parts are that there is a practical problem
presented to students in a small group and a teacher-tutor for each group who
facilitates the discussion and guide students based on learning objectives of thecase problem. Thus, the course materials included a general introduction of
Bioethics concepts and five PBL cases, those are issues of GM food, Organ
donation, animal right, genetic privacy, stems cell experiment and truth telling
about terminal cancer. To make it attractive and interesting, each of them werecomprised 3-4 well written scenarios and named as following titles; "Does the
supposedly cheaper and better GM food make you uneasy? ", "I will dowhatever it takes to keep my daughter alive.... ", "what are those animals foranyways? ", "I do have the right to refuse to know, don't I? ", "Will theparalyzed superman rise again?” and "To tell her, or not to tell her, that is thequestion...”.
The course has ended with satisfaction from both faculty and student
aspect. The monitoring and evaluation adopted for quality assurance has so far
been found to be effective. We are therefore pleased to present the outcome ofthis trial to accompany with the project of Bioethics education.
Perceptions of Management Issues in Biotechnology in Thailand- Siriyupa Roongrerngsuke, Ph.D. and Sarote Phornprapha, Ph.D.
Chulalongkorn University, Bangkok 10330, Thailand
siriyupa.roongremesuke@sasin.edu
Over the past century, biotechnology has created great promise and newopportunities for the human community as a whole. However, biotechnology iscomplex, fast-moving, science-driven, expensive and ethically charged. The
dangers of unqualified growth of biotech businesses and the growing interest in
this business call for professional approaches to management of this particularbusiness. Thus effort has been made by the researchers to develop a curriculumof a Biotechnology Management course, the first curriculum to be offered in
Thailand at the graduate level. This research investigates the perceptions ofexperts, executives, and managers in leading biotech companies in Thailand
regarding the topics and issues to be covered in the curriculum.
Results from the questionnaire and the interviews show that most
respondents agree that there is a need for the development of biotechnology
management course to prepare managers to be fluent in all areas of the
management of the biotech business – fundamentals of management, strategic
management, and entrepreneur ship in biotech industry, management for
invention and innovation, marketing of biotech invention, financial
management and grant management, creating and managing human resource inbiotech business, intellectual property of biotech products, corporate
governance for biotech business, and managing conflicts of interests and safetyissues in biotech companies. Among these eight areas, the marketing of biotech
invention appears to be the area that respondents deem the most important area
to be offered in the curriculum.
In addition to the above results, an interesting, perhaps, frightening,
finding learned from managers in the non-biotech companies and from thepublic is that about 90% of them are not familiar with the term
“biotechnology” and are not sure about what the term really means. These
people are not certain if they know the biotech products and/or inventions asexisting and/or available in the daily life. This lack of awareness andunderstanding of biotechnology and its impacts might serve as an obstacle tothe development of professional and ethical management and practices ofbiotech business.

25. Initiatives in Bioethics Education in Countries of
the Eastern Mediterranean Region

Chair: Prof. Farhat Moazam
Panel abstract
The panel consists of three speakers from EMRO countries who will
present three different initiatives in enhancing bioethics education. One
program, introduced by the Centre of Biomedical Ethics and Culture, SIUT in
Karachi, Pakistan consists of a one year long, and broad based Postgraduate92 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)

Diploma Course in Biomedical Ethics catering to health professionals of thatcountry. The second, a Middle East focused program (based in Cairo),provides training focusing specifically on research ethics in the region.
Another, initiated by the UNESCO Bangkok office, consists of efforts to
involve a much broader audience in educational strategies to introduce
bioethics at different levels including high schools, medical schools, andwithin postgraduate training. The UNESCO programs also incorporate
discussions on ways of implementing the Universal Declaration of Bioethics
and Human Rights, which forms an integral part of the organization’s overall
ethics strategy.
Disseminating Biomedical Ethics to Healthcare Professionals: CBEC
Programs in Pakistan- Farhat Moazam MD, PhD and Aamir Jafarey, MD, PhD
Centre of Biomedical Ethics and Culture, SIUT, 5th Floor, Dewan Farooq
Medical Complex, SIUT new premises, Karachi Pakistan,famoz@mindspring.com
This paper will describe the strategy adopted by the Centre of Biomedical
Ethics and Culture (CBEC) in Karachi, in enhancing national bioethics
capacity. CBEC primarily targets healthcare related professionals utilizing a
multipronged approach. This includes short courses, workshops, internationalseminars and symposia and, most importantly, a year long, part time
Postgraduate Diploma (PGD) Program in Biomedical Ethics that was initiatedin 2006. The PGD, run through the Karachi University, is for 23 credit hours,
and is the first step towards an MA in Bioethics to be offered by CBEC in the
future. Moazam will discuss the need for such a program, its modular naturethat combines contact periods and long distance learning - a format that allows
mid-career level healthcare professionals to enroll and complete course
requirements without undue disruption of their professional responsibilities
She will also present examples to show that the PGD is beginning to achieve
its intended objective of introducing ethics into the educational systems in the
country.
Middle East Research Ethics Training Initiative: A Program to Enhance
Research Ethics Capacity in the Middle East
- Ibrahim Rahmahi1, Maged El-Setouhy2, Henry Silverman3
1
Consultant of Forensic Pathology and Clinical Forensic Medicine,National Institute of Forensic Medicine; Amman, Jordan, 2Ain Shams
University, Cairo, Egypt 3University of Maryland School of Medicine,
Baltimore, Maryland, USA
iramahi@hotmail.com
This paper describes the Middle East Research Ethics Training Initiative(MERETI) which offers an eight month long Certificate Program in research
ethics. The program consists of a two-month academic study period (June/July)at the University of Maryland, Baltimore, U.S.A. Trainees undertake academic
courses equivalent to 8 credit hours, observe research ethics committees inaction, gain practical experience in the review of research, and attend a "trainerof the trainers" program to enable them to provide education to their colleagues
in their home countries. MERITI also offers a two year program leading to a
Master of Science Degree in Research Ethics. Rahmahi will discuss theactivities of the graduates of the MERETI program as a measure of some of thesuccesses of the program.
UNESCO led initiatives in Bioethics Education in the Region- Darryl Macer, PhD
Regional Advisor in Social and Human Sciences for Asia and the Pacific,
UNESCO Bangkok
d.macer@unescobkk.org
This paper discusses some of the strategies employed by UNESCO to
implement the Universal Declaration on Bioethics and Human Rights adopted
on 19 October 2005 by UNESCO's General Conference in its 33rd session. The
text, adopted by acclamation, addresses ethical issues related to medicine, life
sciences and associated technologies as applied to human beings, taking into
account their social, legal and environmental dimensions. In the debates during
the preceding three years in its formulation and the time since, the Declaration
has generated intense discussion in not only the bioethics community, but also
in wider circles. One such debate on the Declaration took place at Karachi in
January 2006, which generated intense discussion. In the same conference,
UNESCO and CBEC organized a bioethics curriculum development workshop
for schools, a first for the country and possibly the region. I will describe these
initiatives and future plans to implement the bioethics declaration and foster
bioethics education in the region, including those linked to the UNESCO AsiaPacific School of Ethics, the development of open access bioethics materials,
numerous bioethics meetings and training courses across the region, and themapping of teaching curriculum through the Global Ethics Observatory (geo).

26. Environment Ethics and Code of Conducts
Chair: Prof. Jayapaul Azariah

Concerns for practicing environmental health issues among doctors andpatients in Bangladesh- Sanchoy Kumar Chanda M.D.1, Krishna Rani Bhowmik1, Mirza NizamUddin
1
Institute of Social Sciences and Public Health (ISSPH), 1/16 Tajmahal Road
(3rd Floor), Block-C, Mohammadpur, Dhaka 1000, Bangladesh
2Society for Promotion of Health, Education and Environment (SPHEE),
Dhaka
sanchoychanda@yahoo.com
Biodiversity has a strong impact on human health, on emerging and reemerging disease pattern and on medication as well and very much linked tochanged natural environment, living conditions and life style. In last decades,
Bangladesh is facing a huge degradation of environment, witnessed massive

deforestation in the name of urbanization, increased number of factories andother means that polluted environment enormously, many water resources andreservoirs have been dumped for constructing multistoried buildings. In major
cities, 25-30% population is now living in slums, in a very congested andunhygienic situation. There is rapid change of environment in the country,
which is a big threat to human health. Practicing environmental health isimportant for doctors in particular, who are in the prime focus on dealingdiseases. Environmental health issues have been taught in medical curriculum;
however patient attitudes toward these issues have been largely ignored.
The objectives of this study were to explore doctor’s attitude towards
patient regarding environmental education and to examine the awareness levelof patients about environmental issues, its impact on health, sources of
information including doctors. Patient desire for more environmental education
was also assessed. Cross-sectional data has been obtained from face-to-faceinterviews with a structured questionnaire with patients (n=514) and doctors(n=34) in five hospitals and ten clinics and ten garment factories in Dhaka
City. Environmental issues, sources of information, and the amount ofeducation received from their doctors were answered by patients and doctors
were questioned about conveying message of environmental impacts to thepatients.
Almost all patients expressed high level of concern for environmental
issues, 21% of patients mentioned doctors as source of environmental
information while 24% of doctors said that they really talk about
environmental pollution and its impact. 63% patient said that they should know
more about air and water pollution and genetically modified food relateddiseases etc. Patients also expressed concern about inadequate environmental
education from their doctors. Another reality is revealed that doctors aremainly practicing what they have learnt from their medical curriculum, lack ofinvolvement or training on environmental degradation and associated problems
has resulted that most doctors have very little knowledge on this issues.
Though there was a chapter on environment and its relation to public health in
the medical curriculum, it was more general compared other topics in the
curricula. 68% of doctors even can’t remember what the topics were in thisregard. The main source of information and education about environment hascome from media, efforts from government and NGOs working on
environment issues, this is true for both doctors and patients. Though some ofthe doctors are very much up-to-date about medical and scientific literatures onenvironmental issue, still they very seldom discuss this with patients.
There is huge information gap between doctors and patients regarding
health impact of environmental pollution and changes where doctors have
major responsibility for minimizing the gap. By discussing about
environmental issues would really mean to health and lives of people, people
would be able to understand need for behavioral in order to protect them frommany ailments. More attention should be paid on environmental andoccupational medicine in medical curricula. Doctors would be able to help
people to overcome their avoidance, denial and confusion and to motivatethem for good practice about environmental issues in everyday life. It isessential to inform patients on implication of environmental changes on healthand therefore many tend to take the issue terribly seriously and doctors shouldtake time and have patience to pass this message, which is a part of theirethical practice as well. It is only people will be willing to change theirpersonal behaviours and be motivated to support policies necessary to protect
the environment. At the same time it very urgent to train doctors about
environmental issues and its influence on health in an attempt to talk about thiscritically important task.
Environmental Ethics and Sustainable Development- S. Panneerselvam, Ph.D.
Professor, Department of Philosophy, University of Madras, Chennai 600 005,
India.
sps@md4.vsnl.net.in
The relationship between sustainability and development is always
complex. It should be studied in relation to ethics. What we need is the ethicalcomprehensive sustainability. The very status of sustainability sometimes
remains unclear. Is 'sustainability' a 'good thing' by definition or by
implication? Munasinghe defines the social dimension of sustainability as
follows: "The socio-cultural concept of sustainability seeks to maintain thestability of social and cultural systems, including the reduction of destructive
conflicts. Both intragenerational equity (especially elimination of poverty), andintergenerational equity (involving the rights of future generations) are
important aspects of this approach" (p.3 Environmental Economics andSustainable Development, World Bank Environment Paper No.3, World Bank,
Washington DC).
The distinction between the "Environmental sustainability" and the"development" components of sustainable development has the advantage of
avoiding the ambiguities inherent in such terms as "economic sustainability""social sustainability" and "cultural sustainability" where it is not certain what
is to be sustained and how sustainability would affect environmental capital.
For instance, the concept of social sustainability might be taken to mean thesustaining of current societies and their social structures when the meeting of
human needs without developing environmental capital implies major changes
to existing social structures. Social sustainability can be taken to mean thesocial measure needed to prevent social disruption or conflict, and the
reduction of poverty justified by this.
The ethical assessment of economics deals with three important areas,
namely social, cultural and environmental. It has been agreed that globalization
always causes transformation of the economics from common economy tomarket economy. As for polity, it is believed that globalization would strength
democracy and federalization process, promote decentralization andparticipatory governance, ensure transparency in administration andaccountability of political leaders and bureaucrats to people, and cause
downsizing of government and weakening of the State so that civil society willEubios Journal of Asian and International Bioethics 17 (May 2007)
come to play a larger role in the delivery of public goods. These changes in thepolicy are considered to be the logical correlated of the economic reform
process. Thus, the reforms, on the final analysis, are meant to promote
efficiency in production and distribution, and to integrate the national
economics into the world economy. These changes in the profile of theeconomy would be accompanied by similar changes in the polity too. Thechanges that are likely to occur in the polity are efficiency in governance andintegration of the governing units.
The civil society has emerged and was growing even while the state wastending to occupy new spaces. What is notable is that during the post-reformperiod the civil society is not only occupying the space vacated by the State but
it is also moving into areas where the state and private sectors are operating.
The opening up of the economy to foreign goods, capital and political ideas ona larger scale than before soon after the globalization has led to the realizationon the part of well meaning individuals and social activists to take up the causeof the weaker sections in particular and the community in general. When the
citizens became dissatisfied with the services provided by the state they
organize themselves to reject state help and to provide such services more
efficiently. The solid waste management in the urban areas is a case in point.
In many towns and cities, citizens have with or without the help of NGO's
organized door to door garbage collection and its disposal. Talking about the
NGO's which is yet another important constituent of the civil society they havegone into a series of areas starting from organizing the poor and looking after
the welfare of the old, disabled, widows, and street children to provide healthand education facilities, drinking water, better sanitation and such other basic
needs in the rural and urban areas.
Technology and Human Progress: Importance of Negative Feedbacks- Abhik Gupta, Ph.D.
Professor, Dept. of Ecology & Environmental Science, Assam University,
Silchar, India
agecol@rediffmail.com
Technology is a complex tool with many faces. It is perhaps unfair toascribe ‘goodness’ or ‘badness’ to technology on absolute terms. As Heidegger
stated, when technology is manifested as “revealing” in the sense that it“brings forth” what is yet unrevealed, then it can be perceived as benign anduseful for all. However, more often than not technology is an agent of“enframing” and even enslaving. It challenges Nature instead of trying to learn
Nature’s secrets or ways of functioning by moving in harmony with it. Insteadof recognizing intrinsic values in Nature, it treats Nature as a “standing
reserve”, excluding all other possibilities that Nature may have. An oft-cited
example is that of the use of atomic energy or the use of water’s energy inlarge dams. Biotechnology and bio-nanotechnology would also perhaps head
the same way if they are used to challenge Nature and in turn to enframe themind and enslave the weak, the poor and the underprivileged. This negativeside of biotechnology is illustrated in several case studies of the introduction ofgenetically modified organisms, including crops. If human societies intend toexist as self-regulated, cybernetic systems that do not exhibit violent
oscillations and live in peaceful co-existence with Nature, they need to pay
equal, if not more, attention to negative feedbacks, just as is done by stable andoptimized natural systems. Even the latter have various forms of ‘overshoots’,
but capitalizing on negative feedbacks to achieve cybernetic control eventuallysmoothes these out. It is perhaps time we learn to accept that “Nature knowsbest”, as Barry Commoner once said, and rely increasingly on negative
feedbacks to guide our advancements in biotechnology, more so because weare tinkering with life that is the culmination of several billion years of
evolutionary experiments.
Scientific and Technological Advancements for the Holistic Developmentof Humankind- M. Selvanayagam, Ph.D. and Francis P Xavier SJ, Ph.D.
Loyola Institute of Frontier Energy (LIFE), Loyola College, Chennai-600 034,
India
drmssel@yahoo.com
As an after effect of the information-explosion and Himalayan
advancements in technological world the question comes up: What are theseadvancements for? Any improvement in the existing system and any scientificand technological advancement should have a philosophical and ethical base –otherwise humankind might become a victim to its own discoveries. Hence any
scientific and technological advancement should be for the purpose of
improving the quality of life – quantitatively and qualitatively. Quantitatively
all levels of humankind, especially the economically marginalized, should havebetter livelihood. Qualitatively all should enjoy the equal status withmeaningful human rights for self-actualization. Any discovery or improvementof existing scientific and technical development and advancement should havethe humankind as the focus. Mere scientific or technological advancement forthe sake of inanimate improvement would not be of any use for the meaningful
life of humankind. Hence human rights, livelihood and equity for all should be
the philosophical basis of any advancement. Further the human being is thesteward of the environment – Quality of human life depends on the quality ofenvironment and hence eco-friendly atmosphere also should be kept in mind
for any meaningful development.
Towards a Code of Conduct for Scientists and Engineers: COMEST and
Korea- Song Sang-Yong, Ph.D.
College of Humanities, Hanyang University, 17 Haengdang-dong, Songdonggu, Seoul 133-791, Republic of Korea ; Vice-Chair, COMEST
songsy63@hotmail.com
COMEST has sought for making a code of conduct for scientists andengineers for some years. Faced with unfavourable reactions in some Western
member states, it decided to utilize the UNESCO Recommendation on the(ABC8/BBRT2 abstracts)

93

Code of Conduct for Researchers of 1974 as a starting point. However, theefforts of COMEST are making little progress.
In Korea, the Korean Academy of Science and Technology carried out astudy on the Charter for Scientists and Engineers supported by the Ministry of
Science and Technology. The Korea Federation of Science and Technology
Societies succeeded in making a short version of the Charter for Scientists andEngineers in 2004. After two years, a big scandal in stem cell research wasdisclosed in Korea. A detailed code of conduct for scientists and engineers isbadly needed. But neither the government nor the scientific community areseriously interested in it.

27. Closing Forum and Debates on Future of Asian
Bioethics Research

Chairs: Prof. Jayapaul Azariah, Dr. Soraj Hongladarom, Prof.
Darryl Macer
Open Discussion and Recommendations for the Future-------------Acknowledgments
The financial contributions of the Wellcome Trust, World HealthOrganization, Chulalongkorn University, UNESCO, National HealthFoundation, Thailand, and APEC Foresight, Thailand, as well as
numerous other bodies and individuals have made this event possible.
ABC2007 is the Eighth Asian Bioethics Conference organized by the
Asian Bioethics Association. ABC2007 is concurrent with the Second
UNESCO Bangkok Bioethics Roundtable (BBRT2). It is co-organizedby the Center for Ethics of Science and Technology, Chulalongkorn
University; College of Public Health, Chulalongkorn University;
Regional Unit for Science and Human Science in Asia and the Pacific(RUSHSAP), UNESCO Bangkok; National Health Foundation,
Thailand; and APEC Foresight, Thailand.
Call for papers for publication
Papers should be submitted in electronic form to d.macer@unesco.org
for publication in the Asia and Pacific Perspectives series that is being
published by UNESCO Bangkok. From BBRT1 there are five
volumes forthcoming, including Asia-Pacific Perspectives on Ethics
of Science and Technology, Asia-Pacific Perspectives on Bioethics
Education, Asia-Pacific Perspectives on Environmental Ethics, AsiaPacific Perspectives on Biotechnology and Bioethics, and Asia-Pacific
Perspectives on Medical Ethics. Possibly some papers from BBRT2
can be included in these volumes if received by 10 April. The
reference style is the Harvard style (authors name, year), withalphabetical system. Footnotes should be minimized. English spellingis UN standard.
Send papers to the editor in electronic form if possible. Please use
reference style used in News section, do not use automatic footnotesor endnotes. Papers are peer reviewed. The papers do not represent theviews of Eubios Ethics Institute, or the editor or editorial board, which
upholds the principles of freedom of expression.
Editorial address for papers and for EJAIB:
Prof. Darryl Macer, RUSHSAP, UNESCO Bangkok,
920 Sukhumvit Rd, Prakanong, Bangkok 10110, THAILAND
Fax: Int+66-2-664-3772
Email: d.macer@unescobkk.org
Deadline for the July 2007 issue of EJAIB is 31 May, 2007.

Next Asian Bioethics Conference
The website for ABA is <eubios.info/ABA.htm>
There were meetings of the Board and a general meeting in the
ABC8 conference, held 19-23 March in Bangkok, Thailand:
Ninth Asian Bioethics Conference (ABC9): Healthy andProductive Life in Harmony with Nature, 3-7 November,
2008, Jogyakarta, Indonesia. Hosts: Indonesian National
Bioethics Commission.
More details to be posted soon.

94 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)

Asian Bioethics Association
Website: eubios.info/ABA.htm
ABA Membership is open to all who share the goals of developing
cross-cultural and international bioethics in their region of theworld.
Asian Bioethics Association (ABA) Board of Directors 2006-2008
President: Jayapaul Azariah
Vice President for China: Yanguang Wang
Vice President for India: Abnik Gupta
Vice President for Japan: Atsushi Asai
Vice President for West Asia: Aamir Jafarey
Vice-President for South Asia (East of India, excluding other named
regions): Soraj Hongladarom
Vice President for Asian Ethnic and Religious Minorities: Alireza
BagheriVice President for Korea: Un Jong Pak
Secretary: Darryl Macer (Thailand/New Zealand)
Immediate Past President: Song Sang-yong (Republic of Korea)
Persons who want to confirm their membership of the ABA must
send their completed membership form (pdf version can be
downloaded) to the secretary, Darryl Macer, (by Email, fax orairmail).
Membership fees are payable at any time in the year, including at thetime of renewal to EJAIB, the official journal of ABA. Why not pay
your fees atABC2007.
A three tier system exists for annual fees:a) Regular price (US$50 Euro 50 Yen 5000).
This includes the EJAIB journal subscription and free associate membership ofEubios Ethics Institute.
b) Reduced contribution (the amount is up to the member, and is alsosuggested for students)
This includes the EJAIB journal subscription.
c) No fee, because the person is not in a position to pay the fee.
This does not include a hard copy of the EJAIB journal, but anyone can apply
to Eubios Ethics Institute separately for a hard copy of the Journal, to beconsidered case by case.

The Asian Bioethics Association Constitution(adopted on 25 November,2002 at ABC4)Article 1 (Name)
The name of this academic organization shall be the: Asian Bioethics
Association (ABA). Hereafter referred to as the Association.
Article 2 (Definitions)
In interpreting this Constitution the following definitions shall be used:
Bioethics is the interdisciplinary study of philosophical, ethical, social, legal,
economic, medical, therapeutic, ethnological, religious, environmental, andother related issues arising from biological sciences and technologies, and theirapplications in human society and the biosphere. Asia is the regions, peoples,and cultures which constitute the geographically largest continent of the world.
Article 3 (Objectives)
The basic objective of the Association is to promote scientific research inbioethics in Asia through open and international exchanges of ideas among
those working in bioethics in various fields of study and different regions of
the world. In order to achieve this end the Association will encourage thefollowing work and projects: (1) to organize and support international
conferences in bioethics in Asia; (2) to assist the development and linkage ofregional organizations for bioethics; (3) to encourage other academic andeducational work or projects to accomplish their goals consistent with theobjectives of the Association.

Article 4 (Membership)
4.1 Membership of the Association shall be open to any individuals andinstitutions sharing the objectives of the Association.
4.2 A member of the Association shall be in good standing. There will be a
voluntary payment of annual dues. The Board of Directors may tentatively set
the suggested annual dues at a different rate for members with different
income.
4.3 Membership shall be valid unless and until they are rejected by the Boardof Directors and/or by the majority vote of members.
Article 5 (the Board of Directors)
5.1 The Board of Directors shall be nominated from among the members of the
Association.
5.2 Institutional or regional members may nominate delegate(s) for the Board,but the nominee, if elected, shall hold office in his or her own right, and not asa representative of the institution or the region.
5.3 The Board of Directors shall consist of no more than 15 members and no
more than 3 members from any one nation state. The nation state of eachmember should be defined by the member on the basis of residence or
nationality at the time of nomination for election.
5.4 The Board of Directors may appoint, or authorize the President to appoint,
additional officers, sub-committees, executive staffs to carry out specific tasksof the Association. In particular a list of regional representatives will bemaintained for promotion of the ABA.
Article 6 (the Officers)
6.1 Officers of the Association shall be the President, seven vice-presidents(one from each of China, India, Japan, Korea, South Asia (East of India), West
Asia (West of India), and Asian Ethnic and Religious Minorities, and a
General Secretary. They are nominated and/or elected by members of the
Association. The President can serve a maximum of two years in office. The
Other Officers should stand re-election every two years.
6.2 The Officers shall be responsible for the general management and the
direction of business works of the Association.The President and/or Secretaryshall have authority to execute, in the name of the Association, all authorized
deeds, contracts, or other instruments.
6.3 The Vice-presidents shall provide secondary leadership for the Association,
substituting for the President when needed.
6.4 A vice-president can be elected for a maximum of two successive terms asa vice president.
6.5 The General Secretary shall keep, or arrange to have kept, a true record of
the minutes of all meetings.
6.6 The General Secretary shall have custody of the Association's funds, keep
full and accurate accounts of the receipts and disbursements, and deposit all
money in the name and to the credit of the Association in the depositories
designated by the Board of Directors. The accounts shall be shared with all
members of the Association every year.
Article 7 (Amendment of the Constitution)
This Constitution may not be amended, replaced, or annulled except by anaffirmative vote of two-thirds of the members in secret ballot.
Supplemetary Note 1
The principles of this Constitution were initially adopted at the Inaugural
Meeting of the East Asian Association for Bioethics held in Beijing on the 5thof November, 1995, when the Officers of this Association were also
nominated.At the UNESCO Asian Bioethics Conference, 4 Nov, 1997, theAssociation was broadened to become the Asian Bioethics Association, andseveral further members were nominated.This initial Board of Directors was
replaced by a new Board in November, 2002, at the Fourth Asian Bioethics
Conference in Seoul, and when the Constitution was formally adopted. The
2004 election was held on 10 November 2004.
Supplementary Provision 2
The business office of the Association was placed in the University ResearchCenter, Nihon University, Tokyo, Japan, from 1998 to February, 2002. From
February, 2002 to February 2005 the secretariat and office was: Prof. Darryl
Macer, Institute of Biological Sciences, University of Tsukuba, Tsukuba
Science City 305-8572, JAPAN. From February 2005 the secretary and office
moved to Prof. Darryl Macer, RUSHSAP, UNESCO Bangkok, 920 Sukhumvit
Rd, Prakanong, Bangkok 10110, Thailand [asianbioethics@yahoo.co.nz]. The
website from 2005 is eubios.info/ABA.htm. (E-mail:asianbioethics@yahoo.co.nz ).

Eubios Journal of Asian and International Bioethics 17 (March 2007)
How to order books or journal or the CD!
Cheques in local currency are accepted from accounts withmajor banks in Australia, Canada, New Zealand, USA, U.K.
(The currency has to be the same as the address of the bank,and the cheque made out to "Eubios Ethics Institute").

95

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Eubios Ethics Institute Publications (Books sent by SAL post, Journal by Airmail - Price included)
Eubios Journal of Asian and International Bioethics
Other countries/credit card
Price:

US$35 Euro 35 UK£20 NZ$40 A$40 C$40 ¥3000

NZ$60

Shaping Genes: Ethics, Law and Science of Using Genetic Technology in Medicine and Agriculture
by Darryl Macer, Oct. 1990, 421pp.
Cost: US$20 UK£10 NZ$30 A$25 C$22 ¥2500 Others or credit card NZ$30
Equitable Patent Protection in the Developing World
by William Lesser, May 1991, 150pp.
Cost: US$15 UK£8 NZ$20 A$20 C$17 ¥1500
NZ$25
Attitudes to Genetic Engineering: Japanese and International Comparisons (Bilingual)by Darryl Macer, May 1992 330pp.
Cost: US$30 UK£15 NZ$35 A$30 C$30 ¥3000
NZ$40
Human Genome Research & Society
Eds: Norio Fujiki & Darryl R.J. Macer July 1992 ISBN 0-908897-03-0 (English),
230pp. ISBN 0-908897-04-9 (Japanese), 240pp. Cost: US$20 UK£10 NZ$30 A$25 C$22 ¥2000

NZ$30

Intractable Neurological Disorders, Human Genome Research and Society Eds: N. Fujiki & D. Macer
Feb. 1994 ISBN 0-908897-06-5 (English), 320pp. ISBN 0-908897-07-3 (Japanese), 340pp.
Cost: US$25 UK£12 NZ$30 A$30 C$27 ¥3000

NZ$40

Bioethics for the People by the People
by Darryl Macer,... May 1994 ISBN 0-908897-05-7, 460pp. Cost: US$30 UK£15 NZ$35 A$35 C$32 ¥3000 NZ$50
Bioethics in High Schools in Australia, Japan and New Zealand,
by D. Macer, Y. Asada, M. Tsuzuki, S. Akiyama, & N.Y. Macer
March 1996, ISBN 0-908897-08-1, 200pp.(A4)
Cost: US$25 UK£15 NZ$30 A$30 C$30 ¥2000

NZ$40

Protection of the Human Genome and Scientific Responsibility (Bilingual)
Editors: Michio Okamoto, Norio Fujiki & D.R.J. Macer,
April 1996, ISBN 0-908897-09-X, 210pp.
Cost: US$25 UK£15 NZ$30 A$30 C$30 ¥2500

NZ$35

Bioethics in India (includes 115 papers from Jan.1997 conference)
Eds: Jayapaul Azariah, Hilda Azariah & Darryl R.J. Macer
June 1998 ISBN 0-908897-10-3, 403 pp.
(Printed in India)
Cost: US$30 UK£18 NZ$34 A$36 C$36 ¥3000
NZ$45
Bioethics is Love of Life: An alternative textbook
by Darryl Macer, July 1998 ISBN 0-908897-13-8, 152pp. Cost: US$26 UK£14 NZ$34 A$34 C$32 ¥3000
NZ$40
Bioethics in Asia (includes 118 papers from Nov.1997 conferences, ABC’97 Kobe and Fukui Satellite)
Eds: Norio Fujiki & Darryl R.J. Macer
Cost: US$36 UK£20 NZ$40 A$38 C$40 ¥3000
NZ$50
June 1998 ISBN 0-908897-12-X, 478 pp. October 1999 ISBN 0-908897-14-6 (Japanese), 320pp.
Ethical Challenges as we approach the end of the Human Genome Project
Editor: Darryl Macer, April 2000 ISBN 0-908897-15-4, 124pp. Cost: US$20 UK£12 NZ$30 A$30 C$30 ¥2500 NZ$35
Bioethics Education in Japanese High Schools (in Japanese only)
Editor: Darryl MacerApril 2000 ISBN 0-908897-16-2, 112pp. Cost: US$20 UK£12 NZ$30 A$30 C$30 ¥1000 NZ$35
Bioethics and the Impact of Human Genome Research in the 21st Century
Eds: Norio Fujiki, Masakatsu Sudo, & Darryl R.J. Macer March 2001 (English and Japanese bilingual, 350pp).
Cost: US$30 UK£20 NZ$40 A$38 C$40 ¥3000

Bioethics in Asia in the 21st Century
Eds: Song Sang-yong, Koo Young-Mo & Darryl R.J. Macer
August 2003 ISBN 0-908897-19-7, 450pp. Cost: US$35 Euro35 UK£20 NZ$40 A$38 C$40 ¥3000
Challenges for Bioethics from Asia
Ed: Darryl R.J. Macer
November 2004 ISBN 0-908897-22-7 656 pp. Cost: US$35 Euro35 UK£20 NZ$40 A$38 C$40 ¥3000
A Cross Cultural Introduction to Bioethics 2006, 300pp. (A4)
Editor: Darryl Macer

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96 (ABC8/BBRT2 abstracts)

Eubios Journal of Asian and International Bioethics 17 (May 2007)

Fax to: Asian Bioethics Association, Fax Int+66-2-664-3772 (or send by Email or post)
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