Eubios Journal of Asian andInternational Bioethics
EJAIB Vol. 24 (1) January 2014www.eubios.info

ISSN 1173-2571

Official Journal of the Asian Bioethics Association (ABA)
Copyright ©2014 Eubios Ethics Institute(All rights reserved, for commercial reproductions).

Contents

page

Editorial: Ethics, Religion and Making a Better Society
1- Darryl Macer
Religion and Ethics in the Japanese Society
2- Nader Ghotbi
Spirituality & the concept of amae or the desire to be loved 5- Kenjiro Uemura
Theological and Philosophical Partners for Human Rights 7- Ann Boyd
Tanabe’s Philosophy in the Comparative Contexts
10- Makoto Ozaki
The Current State of Surrogate Conception in Japan andthe Ethical Assessment of Dr. Yahiro Netsu – An
Ethical Investigation of Japanese Reproductive
Medicine (Surrogacy)
12- Masayuki Kodama
Dignity and Freedom through Human Security
18- V. Balambal
Emerging community ethics and student education: A
rural community experience21- Sivapalan Selvadurai*, Ong Puay Liu, Marsitah Mohd
Radzi, Ong Puay Hoon and Nor Adlyizan
Engineered pathogenesis related protein crops andconsumer behavioral patterns
26- Bengyella Louis
Teaching Bioethics to Undergraduate Physiotherapy
students: Students’ Attitudes and Perceptions
30- Zoheb Rafique, Saira Baloch
Ethics Education Addressing Issues Related to Communitybased Healthcare Services: Comparison of Case
Study Methodologies Using Drama Cases
33- Akio Kanayama

Editorial address:
Prof. Darryl Macer,
Provost of AUSN and Director, Institute of Indigenous
Peoples and Global Studies,
American University of Sovereign Nations (AUSN),
8800 East Chaparral Road, Suite 250, Scottsdale,
Arizona, 85250 USA
Email: dmacer@au-sn.com darryl@eubios.info
http://au-sn.com http://www.eubios.info

Registered address of EJAIB: P.O. Box 16 329,
Hornby, Christchurch 8441, New Zealand

Editorial: Ethics, Religion and
Making a Better Society
The first issue for 2014 includes five papers exploring
bioethics in Japan, and another five more general
papers including three on education. One of thecommon themes is the relationships between
descriptive ethics and social structures and norms thateach society, and our world, has constructed.
Ann explores the linkages between religion andphilosophy in the emergence of human rights, andshows that there was global input into the drafting of
the Universal Declaration of Human Rights. Naderlooks at how some of the traditional ethics in Japan
seem to lead to decisions that limit the recognition offull moral agency to certain groups of people. Kenjiro
examines the concept of “amae” or the desire to be
loved, a particular type of love that some Japanesewriters claim to be unique. The application of love ofothers in Japan by the doctor who provides surrogacy
services in Japan, counter to professional opinion, isthe subject of a detailed case study by Masayuki of Dr.
Yahiro Netsu.
Akio presents empirical results of two methods foruse of case studies and drama in teaching bioethics tonursing students in Japan. Zoheb and Saira present
student perceptions of learning bioethics in Pakistan.
Siva and colleagues present a case study of thecommunity involvement in general educational
empowerment in a rural Malaysia school. Bala
presents a review of human security in India. Makoto
explores the philosophy Hajime Tanabe, who
endeavored to unify Christianity and Buddhism fromthe standpoint of Absolute Nothingness. Bengyellalooks at the future of human consensus and choicewith GM crops.
EJAIB wishes you a Happy New Year, counts on you
to renew your membership of Eubios Ethics Instituteand Asian Bioethics Association, and appreciates anyother support. Hope to see you at ABC15 from 1-9
November 2014 in Japan, if not at an earlier
conference! More updates on the web!
– Darryl Macer

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

Religion and Ethics in theJapanese Society- Nader Ghotbi, MD, PhD
Professor, Ritsumeikan Asia Pacific University (APU),
1-1 Jumonjibaru, Beppu City, Oita 874-8577, Japan
Email: nader@apu.ac.jp
Abstract
Religion has individual as well as societal functions.
At the individual level, religion forms the foundation of
spiritual health as an important dimension of humanhealth. At the societal level, having a religion may alsofunction as a ‘proof of righteousness’. Followers of acertain religion can use ‘religious affiliation’ as a guidein making choices on complex issues, because religion
for them provides a ‘reliable’ source for the ‘right’answers. They can also identify and be identified asthe ‘righteous members’ of the society or community
they live in. Religion and religious affiliation thus may
be regarded as a ‘compass’ for making the rightdecisions in complex situations. This is where theJapanese society stands out differently, and therefore
Japanese people may mistakenly be assumed not tobe religious. The Japanese society commonly uses
other ‘social’ mechanisms, not religion, to make thosedecisions, and therefore acts as a ‘secular’ society.
The ‘ethics’ of the Japanese society is closely linked toits collective culture with peculiar virtues and values
that are discussed here.
Introduction
Health is not simply an absence of disease but
requires the existence of positive dynamics in various
health dimensions that include the physical, mental,social, emotional, intellectual, environmental and last
but not the least, spiritual health. Spiritual health refers
to the human sense of having found a meaning andpurpose in life, of inner peace, and a feeling of interconnectedness and mindfulness, with a capacity tounderstand higher values outside the self (Hawks,
1995). Most people rely on religious beliefs to attainspiritual health and this is perhaps the most significant
contribution of religion to human health, especially at
the individual level.
However, religions do not remain confined toindividual believers but are propagated in communities
in a characteristic form, commonly referred to as an‘organized’ religion. As such, religions serve a wider
function at the societal level by bringing their members
together and helping them to recognize and berecognized, accepted and trusted as a member
affiliated with the ‘righteous’ group. Consequently, faithin ‘religion’ can be extended to faith in ‘leaders’ and‘trust’ in members of the religion, particularly for thosemembers who practice the religion in a convincing
manner. Having similar religious beliefs in a group may
motivate the individuals in that group to ‘cooperate’with other members (Wood, 2011).
The alternative hypothesis that religion serves todecrease ‘societal dysfunction’ with an overall
beneficial impact ‘on society’ has not been supported

in an evidence-based study by social researchers(Paul, 2005). In an examination of data related tolevels of religiosity and social health from over 18
developed countries in the 1990s and early 2000s, hefound a negative correlation between the two. This
study therefore refutes the hypothesis that the societal
role of religion is to provide social health benefits andreduce social dysfunction. We can ask why religions ingeneral show such a strong tendency in becoming‘organized’ and turn into a ‘societal movement’?
It has already been shown that people who
participate in religious ceremonies, are more likely tothink of their choices as righteous or ‘sacred’ (Sheikh,2012). I argue for a broader and more significant
aspect of a ‘societal function’ for religion based on
implicit information carried among its affiliatedmembers. Let me offer a practical example; the US
home politics is complex and many people may find it
difficult to know which candidate can be trusted andwho they should vote for. The US Republican
candidates thus commonly use their religious affiliation
as a promotional strategy, because a large number of
US citizens who define themselves as “religious”
choose their desired candidate based on ‘faith’. For
instance, Washington Post published a piece in which
Rick Santorum, the hopeful Republican candidate at
the time, had called the US President Obama’s
Christian faith into question (18 February 2012).
The Japanese society, however, is different in aninteresting way. The Japanese society has been
described as the most secular and the least religious
nation in surveys (Paul, 2005). Still there is some
controversy among researchers whether Japanesepeople are religious or not (Mullins, 1993). Someexperts refer to the culturally strong and widespread
religious practices by the majority of Japanese people
that not only classifies them as being religious but
sometimes to an extreme point of being superstitious;
they commonly offer money to shrines and temples toprotect themselves from bad luck and to help themaccomplish their dreams. However, others believe thatthe majority of Japanese people are not religious
because they do not show a particular choice inreligious activities, visiting Shinto Shrines, Buddhist
temples, and Christian churches for various activities
that have a religious element. Also the Japanese
appear to make purely ‘secular’ choices in sociopolitical affairs and in science, firmly believing in theevolution theory. So which is it? Are Japanese people
religious or not?
Findings
The discussion over the relative significance of‘culture’ versus ‘religion’ in Japan has received someattention. Japanese people as individuals may be as
religious as any people from other nationalities. They
have spiritual needs like any human being and use
various religions to attain these needs. However, there
is a major difference in that the socio-cultural rules,
norms and regulations in a Japanese society are moresignificant in defining the ‘morals’ or ‘ethics’ of thesociety than any religion; these socio-cultural rules

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

dominate and govern the relations among Japanesepeople.
An individual living in a Japanese community
cannot use his/her affiliation with religion to imply
righteousness; righteousness depends on following acomprehensive set of social rules, regulations, virtues
and values, some explicit and some implicit. These
rules and norms are so comprehensive and quite wellestablished that some individuals may feel aconsiderable burden over keeping their individuality incheck. Many studies have shown that the Japanesefeel a large gap between their individual attributes andsense of self, and what they enact as their social role(tachiba) at work, school, and other public arenas (deRivera, 1994, and Bar-Tal, 2007).
There is no doubt that ancient religious traditions inJapan, particularly Shinto, Buddhism and Confucianism
have influenced the culture and social norms and rules.
However, a major point of distinction regarding such an
influence is the dominance of ‘human relations’ over‘relations with god(s)’. Whenever the societal impact ofan action differs from the religious aspect of that action,
the Japanese society finds the human impact to be
more significant. This feature has been interpreted asthe ‘human’ orientation of ethical obligations in a
Japanese society versus the ‘godly’ nature of
obligations in most other societies (Suzuki, 2012). In
other words, in Japan it is more important to satisfy theneeds of the society than the gods. Such ‘secular’traditions could have helped reduce human conflict andimprove cooperation in the Japanese society (Atran,2012).
There are other reasons why no particular religion
plays as a strong role in the ethics of the Japanesesociety as ‘secular’ social rules. After Buddhism andConfucianism spread into the Shinto ruled society inthth
the 6 and 7 centuries, they found a way to merge
elements from the various belief systems into areconciled system of beliefs and thereby helped avoid
opposition and religious conflict among them. So they
selected and took ‘pieces’ from each that would suit a‘combined theory of beliefs’. The success of thiscompound adoption of various belief systems provided
a basis for further borrowings of ideas, concepts andbeliefs from various other sources and adopting theminto the ‘proper’ position in the Japanese society(Davies, 2002). In this way, the social system learned
to transform and dominate almost any new value
system into its own structure.
Moreover, the ethics of the Japanese society isdominated by sociocultural rules and norms rather thanreligious instructions. While some philosophers discuss
the issue whether morality is social or based onreligion, the Japanese demonstrate in practice that thesense of morality may be based on the values ofsociety rather than any particular religion. A good
example is the issue of abortion in Japan (Norgrem,2001). Although abortion has caused a lot ofcontroversy in the West between prolife and prochoicegroups, it is done quite commonly and with few ‘ethical’repercussions simply because Japan has ‘legalized’ it;
the legality of abortion dominates its controversial

ethical status. In other words, in Japan ‘law’ in generalis dominant over ‘ethics’.
Law is the strongest representation of social limits
on individual freedom; as long as a Japanese individual
may act within the limits of the law, he/she cannot bequestioned over the ‘ethics’ of his/her conduct.
However, social rules may still require him/her tobehave in certain ways even with no explicit ‘legal act’behind it. One such example is giri (義理) which refers
to moral behavior a Japanese feels obliged to act on,
based on social relationships, even if it is against
his/her own will. The obligations that one feels obliged
to follow serve to maintain cohesion and harmony in
the Japanese community and the broader society.
Modesty (謙虚) is another basic ethical virtue inJapanese culture which requires playing down of one’s
personal level of wealth, knowledge, and talents; theconcept is not to stand out from members of the group.
It is especially important to be humble towards one’s
seniors or superiors (Davies, 2002). Japanese people
are also widely known to value honesty (Bennett, 1999)
and to aspire to be earnest and decent (majime);dishonesty in a societal situation is a particularly
undesirable characteristic. The opposite term tomajime is furyou which means ‘immoral’ and‘delinquent’. This suggests that being decent andearnest (majime) is considered as the highest moral
status in the Japanese society. In fact, contrary to theWest where a person may be qualified as good or bad,the Japanese emphasize on this social distinction ofwhether a person is earnest (majime) or not.
A question that may be asked is how the secular
Japanese society values virtues such as modesty andhonesty without having a religious source for theconcept? Although many researchers have shown thatbeing ethical, in an individual, does not necessarily
require religion, the Japanese ‘society’ is a uniqueexample where a certain group of virtues, such asmodesty and honesty are so common as to beconsidered the ‘social norm’. I argue how ‘ethicalvirtues’ developed from socially coherent needs in thecollective Japanese culture.
The concept of universal imperatives as atheoretical methodology by Immanuel Kant arepractically demonstrated in the maxims developed by
the Japanese society and culture to allow this collective
society maintain harmonious relationships among
members. Therefore, even without religious principles
requiring modesty and honesty, the Japanese culture
pushes for maxims that can keep it bonded together ina harmonious collective society. I believe that many
ethical virtues that exist in Japanese culture are mainly‘secular’ and related to the needs of this collective
society to ‘moral’ principles, or maxims, holding it inharmony and balance.
This phenomenon is related to another Japaneseconcept known as ‘group consciousness’ (集団意識)
which also supports my argument. It means that manyof the virtues and ethical values common in theJapanese society serve the whole group andcommunity, and are mainly group-oriented. Anotherinteresting consequence of this situation is the

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

observation of ‘conventionalism’ in the ethicalstandpoint of the Japanese society where it contradicts
Western ethics. For example, the Japanese society
has a difficult time why others cannot respect theirstance regarding ‘whaling’ which is supposedly aculturally accepted activity for the Japanese. In fact,
the Japanese society is upset about the intolerance ofthe non-Japanese towards their culturally approved
attitudes. This situation demonstrates the significant
role played by Japanese society in setting the ‘moral’
principles that should or could govern the relationships
based on group consciousness, though limited by an
scale that encompasses individuals formidable to
Japanese cultural values.
There are also instances where ‘social cohesion’requires an attitude which is different from truehonesty; a common example is when questions are
asked about the injustice committed by Imperial Japan
during its colonial rule over Korean and Chinese
territories. Another example is in a court of law inJapan, where telling a lie may sometimes provide‘legal’ protection for an individual, as opposed to asituation where it may harm the society; telling a lie istolerated in the former but severely punished in thelatter. Thus in legal cases between two individuals,
telling a lie may be considered a strategy to win and assuch is rather acceptable; however, similar lies that
may hurt a group of people or can endanger thecommunity or society are not tolerated.
Discussion
The strong socio-cultural obligations to be earnest
and decent (majime) in the Japanese society helpedwith the rapid growth and development of their nation,and thus strengthened the self-image of Japanesecitizens as devoted workers and their sense of‘national pride’. All Japanese citizens irrespective ofreligion can benefit from this ‘secular’ social stature.
The only backdrop is the weakening of the sense of‘moral’ responsibility towards a non-Japanese citizen
or society.
Ironically, under certain circumstances, a Japaneseindividual may be set free from the obligation ofhonesty (Burns, 1998 and Reader, 2003). Burns
explains the lower rates of academic dishonesty
among Japanese high school students, as comparedto the US and South African students, but how they
increase significantly and take over the two othergroups over the college years; the erosion of ‘social
control’ and a weakening of their social commitment
were deemed responsible for this deviation. Reader
refers to Japanese self-images and national identitythat assert moral superiority in the form of a ‘civil
religion’.
Another example is the case of a Nepalese man
who was wrongly accused of murdering a Japanese
woman in 1997, served 15 years in jail, and was simply
deported from Japan with no apology after he wasfound innocent in 2012 (Japan Today, October 30,
2012; Retrial of Nepali convicted in 1997 murder caseclears way for acquittal). Because he did not have avalid visa when he was arrested, there is no ‘legal’obligation for accepting ‘moral/ethical’ responsibility forthe injustice that resulted from some ‘mistakes’.
Consequently, there is a special risk of
discrimination towards non-Japanese people living in a
Japanese society because the social obligation on theJapanese to be decent towards the non-Japanese is
not much strong. Fortunately, the Japanese policymakers can use law and legal remedies to change thissituation because as pointed out before, the law’s
position in Japan is strong, dominant to and setting the‘ethics’. Therefore, the right laws could play animportant role in reducing discrimination because
Japanese law is to be respected and obeyed by
Japanese citizens.
Finally, of special concern, is the still growing
preoccupation of the Japanese society with its‘uniqueness’ and “appetite for self-reflection” with aparadoxical sense of insecurity and “self-doubt” (Pyle).
In Japan, such discussions are presented asnihonjinron (日本人論) and most Japanese consider it
to be true (Dale, 1986). The concept of nihonjinron has
been followed as the Japanese moral code with explicit
as well as implicit rules about community roles andindividual manners (Kanedo, 2010). However, there isa backdrop in their regional affairs.
Although they are Asians with strong historical andcultural bonds to the Chinese, Koreans andMongolians, the Japanese prefer to compare and rank‘outsiders’ on the basis of which country they comefrom; by not focusing on their ‘Asian race’, common totheir regional rivals, they emphasize on ‘Japanese’
nationality as a unique identity. Thus they may see
themselves as similar to the punctual, serious andhard-working Germans, for instance, and build ahypothetical hierarchy of nations similar to thehierarchical structure of the Japanese society. Having
a perspective as such makes it difficult to establish acommon value of human equality irrespective of raceand nationality, which can be a particular challenge inthe development of regional integration in East Asia.
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Bar-Tal Daniel, Halperin Eran, de Rivera Joseph. Collective
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Bennett, Frank G. Jr. Civil Execution in Japan: the legal
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Bulbulia Joseph & Sosis Richard. Signalling theory and theevolution of religious cooperation. Religion 41(3): 363388, 2011.
Burns, Susan Reneé. Academic dishonesty: a cross-cultural
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Contemporary Japanese Culture. Tuttle Publishing,Tokyo. 2002.
De Rivera Joseph, Gerstmann Elena A, Maisels Lisa. The
emotional motivation of righteous behavior. Social Justice
Research 7 (1): 91-106, 1994.

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Hawks Steven R, Hull Melisa L, Thalman Rebecca L &Richins Paul M. Review of spiritual health: definition, role,and intervention strategies in health promotion. American
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Norenzayan Ara & Gervais Will M.. Chapter 13: The cultural
evolution of religion (pages 243-265). From the Book:
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Humanities. Oxford University Press, USA, 2011.
Norgren Tiana. Abortion before Birth Control: The Politics ofReproduction in Postwar Japan. Princeton University
Press, 2001.
Paul Gregory S. Cross-national correlations of quantifiable
societal health with popular religiosity and secularism inthe prosperous democracies, a first look. Journal of
Religion & Society 7:1-17, 2005.
Pyle Kenneth B. The Future of Japanese Nationality: An
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Reader Ian. Identity, Nihonjinron, and academic(dis)honesty. Monumenta Nipponica (Sophia University)
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Sheikh Hammad, Ginges Jeremy, Coman Alin & Atran
Scott. Religion, group threat and sacred values. Judgment
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Suzuki Yasushi. Japan's standing-point and preparedness
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This paper was presented at KBRT7.

Spirituality and the concept ofamae or the desire to be loved- Kenjiro Uemura, PhD Student,
Certified Social Worker; Graduate School of Social andCultural Sciences, Kumamoto University, Japan
Email: kenjirouemura@aioros.ocn.ne.jp

The purpose of my presentation is, first if all, tointroduce the meaning of the Japanese word, amae or
the desire to be loved. There may be no direct
equivalence of “amae” in English. Takeo Doi, thefounder of amae theory, expresses amae in English as
1
follows: “the wish to be loved or to be taken care of,the wish to cling to the love object, the desire to be
loved (p. 267), dependency wishes” (p. 271). Amae is
a noun. Amaeru is its intransitive verb form whose
meaning is, according to Doi’s interpretation, “todepend and presume upon one’s love” or “to indulge in
1

L.Takeo Doi “Some Thoughts on Helplessness and theDesire To Be Loved,” in Psychiatry, 26, 266.1963.

another’s kindness (p. 266).” As a non-Japanese’s
interpretation of amae, let me show you Gregory
Boyle’s, an American Catholic Father, description ofamae. He tells of amae: “The Japanese speak of aconcept called amae, living in a deep sense of being
2
cherished, of raising kids lovingly.” It is quite
interesting that in almost all cases, the Japanesemention amae negatively, while the American Catholic
Father refers to the concept positively. John Bester,
who is the translator of The Anatomy of Dependence
which is Doi’s most influential work, explains amae for
non-Japanese: “The Japanese term amae refers,
initially, to the feeling that all normal infants at thebreast harbor toward the mother―dependence, thedesire to be passively loved, the unwillingness to be
separated from the warm mother-child circle and castinto a world of objective 'reality’.”
The fact that there is no equivalence of amae inEnglish does not signify that English speaking people
don’t feel amae or amae-related emotions. Let meshow you some examples which explicate amae orsimilar-to-amae phrases, clauses or sentences inEnglish:1 the degree to which one feels related to and loved3
by others and experiences safety and intimacy.
4
2 purely seeking attention (This is similar to amae’s
intransitive verb amaeru.)
3 Connections with others enable individuals to feel5
alive, loved, cared for, and listened to. .
4 The consultant responds by understanding andtactfully and appropriately communicating his
understanding of the patient’s predicament through thepsychodynamic life narrative. In so doing, he gratifies
the patient in a way reminiscent of the early motherchild relationship, and a sense of oneness with a6
nurturing figure is reinforced. (The underlining is mine
and in my opinion, it highlights the amae-related
emotion.)Amae is an ambivalent concept. While its negative
connotation is “dependency” in English, its positive
aspects can be found in the four examples mentionedabove. They are, in my interpretation, amae's positive
features.
All human beings experience amae as an infant but
also in adulthood. I suppose amae works almost
positively in Japan without the Japanese being awareof its positive function. As I said earlier, its negative
sense is that of “dependency” or “childishness” in2

Gregory Boyle, Tattoos on the Heart. The Power ofBoundless Compassion (New York: Free Press, 2010),91
3
Laurel Arthur Burton, “The Spiritual Dimension of Palliative
Care”, Seminars in Oncology Nursing (Volume 14 Issue 2,
May 1998), 126
4Phil Cotterell, Helen Findlay, Ann Macfarlane MBE, “Patientand Carer Narratives and Stories,” in Narrative and Stories in
Health Care (Oxford New York: Oxford University Press,
2009 ), 138.
5
Barbara Haight “Sharing Life Stories: Acts of Intimacy” inGenerations: the Journal of the American Society of Aging
25(2),2001:90.
6
Milton Viederman, “The Psychodynamic Life Narrative: A
Psychotherapeutic Intervention Useful in Crisis Situations,”
Psychiatry, Vol. 46, August (1983), 243.

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

English, the Japanese use the word negatively inalmost all cases. I have shown you some examples ofamae expressed in English, and will now tell you howeasily we can find amae within transference both inpsychoanalytic and psychotherapeutic situations. The
four examples of amae, mentioned-above, are parts ofthe therapist-client relationship.
Let me explain the concept of transference in
psychoanalysis. Takeo Doi, one of the most trained
psychoanalysts as well as a psychiatrist says, “Simply
put, the concept of transference refers to something in
the personal feelings of the one being analysed toward
the analyst that is transferred from feelings that once
7
were directed toward people close to the patient.
But I think that to show too much amae, except for
infants and young children, brings shame, which
8
Aristotle defines as a fear of dishonor. On the other
hand, if Aristotle had known the concept, I suppose, hewould have regarded it as something contributing to
the matured personalities. Because, essentially, fromthe rational point of view, “amae” could be consideredas part of his Organicist notion. In all cases, it points tothe idea of Organic wholeness. Indeed, “amae” could
directly refer to and correlate with Aristotle’s Organicist
philosophy and contemporary Biocosmology (neoAristotelism).
In a broader sense and figurative expression,“amae” (reflecting natural healthy conditions for theindividual’s development) is equally essential as inearly childhood (for healthy physiological and social
growth), as in a mature period.
Secondly， consider the definitions of spirituality
where we see an important role for the term “meaning”
in defining “spirituality”. Judging from the context inwhich the word “meaning” is employed, we find theword is almost identical with “meaning in life”.
Let me show you two examples of the definitions ofspirituality: “The essence of spirituality is・・・one’s
concern in the meaning and purpose in life and theafterlife inherent in human beings・・・.Spirituality isa function which searches for the transcendence or the
Ultimate within when one meets life’s crises in which
one loses ‘a frame of reference of being’ or ‘self-[This paper was presented at KBRT7.]

7

Takao Doi, trans. by Mark A. Harbison, The Anatomy of Self
The Individual Versus Society (Tokyo・New York・London,1986),137. Sigmund Freud tells of transference: “In every
psychoanalytic treatment of a neurotic patient the strange
phenomenon that is known as ‘transference’ makes its
appearance. The patient, that is to say, directs toward thephysician a degree of affectionate feeling(mingled, often
enough, with hostility) which is based on no real relation
between them”. In Sigmund Freud, trans. and ed. by James
Strachey Five Lectures on Psycho-analysis (New York
London: Norton & Company, 1977), 51.
8
Citation at second remove from Aristotle. Nichomachean
Ethics(Harvard, Cambridge Mass.)

9

identity’ necessary to be human and to be oneself.”“・・・spirituality is defined as a relationship withGod (or whatever is held to be the Ultimate orTranscendent, e.g. a set of sacred text for Buddhists)that fosters a sense of meaning, purpose and mission
in life. In turn, this relationship produces fruit, such as
altruism, love, forgiveness, etc. which has a discernible
effect upon one’s relationship to self, nature, others,
10
and the Ultimate.”
Takao Takahashi asserts that all human beings are,11
in nature, longing for “being cared for”. I interpret his
statement as a proof of amae’s universality. Since,“longing for being cared for” is nothing other thanamae. He says, “Self-care connotes human nature.
Those who are trying to find meaning in life should takegood care of themselves. Self-preservation and finding
meaning in life are at the basis of caring.” Considering
his opinions, I’ve come to the conclusion that we haveto give ourselves appropriate amae or self-love when it
comes to caring for one another. In other words,
maintaining good interdependence, － especially interms of the spiritual points of view or spiritualities－isparamount not only in therapeutic situations but in all
human relationships. This is because, spiritualities
indicate or imply connections, relationships, love,
meaning, amae and others, which are of vital
importanceregarding
good
or
true
human
relationships. The reason I include amae as acomponent of spirituality is that though very few people
engaging in spiritual care mention transference inJapan, Elisabeth Young-Bruehl, an American
psychoanalyst regards amae as the kernel of the
12transference. I believe psychoanalysts and spiritualcaregivers have something in common. One of whichis that both have to analyze the transference of theirpatients or clients.
In conclusion, let me state my working hypothesis: I
want to claim that both spirituality and amae havesomething in common; that is, there meaning. David
W. Kissane et al says: “Spirituality will be a powerful
13source of meaning for many; ・・・ ”. Before eachindividual finds “meaning in life”, does she/he needwell-met amae experiences, in particular during
infancy? I think they do.

9Toshiyuki Kubotera, A New Introduction to Spiritual Care.
(Tokyo: Miwashoten, 2007), 8-9. Available only in Japanese.
Translation is mine.
10
David R. Hodge, Spiritual Assessment Handbook for
Helping Professionals. (Botsford, CT: North American
Association of Christians in Social Work, 2003), 14.
11
Takao Takahashi, “The Concept of Care in JapaneseThoughts: Focusing on the Idea of Gods.” in The Range ofTheories of Caring, Takao Takahashi, Susumu Nakayama
eds., (Fukuoka; Kyushu University Press, 2001), 69,
available only in Japanese. Translation is mine.
12
Elisabeth Young-Bruehl and Faith Bethelard, Cherishment: A Psychology of the Heart (New York: The Free Press), 30.
13David W. Kissane et al, “Dignity, Meaning, andDemoralization: Emerging Paradigms in End-of-Life Care”,
Hand Book of Psychiatry in Palliative Care , ed. Harvey Max
Chichinov and William Breitbart (Oxford University Press,2009), 326.

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

Theological and PhilosophicalPartners for Human Rights- Ann Boyd, Ph.D
Professor of Biology, Hood College, 401 Rosemont Ave,
Frederick, MD 21701, U.S.A.
Email: boyd@hood.edu

Abstract
Grounding human rights in philosophy or theology
may or may not satisfy the demands of universality
ascribed by the “Universal Declaration of Human
Rights.” This paper seeks to explore how philosophicaland theological partners may contribute or detract fromthe universal applicability of human rights. Major world
religions share universal values such as the Golden
Rule, a conception of compassion and the recognitionof the basic interests necessary for human flourishing.
While the indignities and inhumanity experienced in
World War II prompted the Universal Declaration of
Human Rights, the document affirms human dignitythat relies heavily on a variety of civic, political, culturaland economic rights. Human rights as with global
bioethics share a concern for the human condition,
addressing issues at every stage of life. Human
capacity equates with rational and relational ability. It is
the universal embrace of human dignity for all persons
with various capacities for cognition and relating thatinspires advocates of human rights. The newborn child,the mentally compromised, the dementia sufferers
share species-membership. Empathy and compassion
for the suffering of others is embraced by philosophers
and theologians of diverse stripes, each recognizing
the common humanity articulated at least in theory as
universal human rights. The concept of human rights
depends on a vision of what might be rather than thecurrent status quo. Such a vision challenges power
structures, tradition, and provokes resistance because
claiming human rights as universal suggests we lookcarefully at who we count as persons-humans.
Diverse Contributions to Universal Declaration
On 10 December 1948, the United Nations adopted
the Universal Declaration of Human Rights (UNDR)
without a dissenting vote, declared every human being,
without distinction, possesses a set of morally
authoritative rights and fundamental freedoms that
ought to be socially guaranteed. The document holds
states responsible for the way their citizens are treatedas well as how they treat other states and theircitizens. Recognizing the ideal vision of the UDHR
does not mean every nation will ratify it or covenants
derivative of it.
While Eleanor Roosevelt chaired the commission onhuman rights from which the UDHR emerged, she wasone of several notable contributors to the thoughts
contained in it. A Canadian professor of law, John
Humphrey, based the draft on various European and
Latin American documents on rights. A French secular
Jew and later Nobel Peace Prize Laureate, Rene
Cassin, revised the drafts. Carlos Romulo from thePhilippines campaigned for rights of peoples undercolonial rule and for antiracial discrimination leading toarticle 2: prohibiting discrimination generally (Kao,2011). India’s Hansa Mehta lobbied for inclusive
language e.g. in article 1 “all human beings (rather than‘all men’) are born free and equal in dignity and rights.”
China’s Peng-chun Chang pushed for social and not
rational grounding for how we understand our moral
obligations to others in the human tribe based on the
Confucian concept of ren (two man mindedness) whichbecame “conscience” in the second part of Article 1(“they are endowed with reason and conscience andshould act towards one another in a spirit ofbrotherhood.”) (Twiss, 1998). Confucian emphasis onrole specific duties rather than on abstract individual
rights is significant (Chan, 1999). The Confucianemphasis on role-specific duties does not negate
inclusion of human rights in the ideal of ren (humanity,
humaneness) (Chan 2000). Other Confucian scholars,e.g. Roger Ames (1988), consider Confucianism to beat odds with current formulations of human rights, andadmonish rights advocates to learn the harmony tenetsof East Asian culture in place of possessive
individualism (Dallmayr, 2002).
Human rights are sometimes criticized as “western”
in origin, or based in a particular religious/philosophicalmaxim such as Natural Law. Natural Law thinking has
a diverse history depending on where one starts.
Natural Law thinking can be found in Sophocles (496406 BCE), Aristotle (384-322 BCE), Aquinas (12251274 CE). All of these share the idea of a common
humanity, nature as a source of moral knowledge, anduniversal epistemic access to basic truths. Natural law
thinking took a secular turn in the hands of Hugo
Grotius who wanted a legal system composed of rights
rather than laws: what conforms to our nature as
rational and social beings was considered right. A
century later John Locke argued that the Law of Natureis the basis upon which we claim inalienable rights oflife, liberty, and property, a clearly antimonarchy
political viewpoint and in keeping with the U.S.
Declaration of Independence and the French
Declaration des Crotis de l’Homme et du Citoyen.
Nevertheless, protests arose from such persons as
Jeremy Bentham who dismissed the idea of naturalimprescriptible rights as “rhetorical nonsense”(Waldron, 1988). Universal endorsement of humanrights does not rest on one ubiquitous philosophicalperspective. For this reason, perhaps, the International
Bill of Human Rights refer to neither God nor nature toprovide a foundational underpinning.
Thomas Paine suffered for his advocacy of the“rights of man” as did Nelson Mandela. Sometimes
religious belief inspires advocacy for rights, such as
abolition of the slave trade or ending apartheid in South
Africa. Twenty seven years in a prison designed tostrip a person of dignity did not prevent Mandela fromseeing the dignity in all humanity, including his captors.
Emerging from prison Mandela was devoted to South
Africa as a “rainbow nation” with eleven languages,
three national capitals, a quadrilinqual national anthem
and room for “truth and reconciliation.”

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

Sadly, it is often in horrific cases of abuse of humanrights that we recognize a need for them. For example,
during the trial of Slobodan Milosevic in The Hague,
witnesses reported horrific events in Kosovo andBosnia. As witness after witness recounted the horrorsof “ethnic cleansing”, Milosevic sat with a placid
expression on his face, seemingly untouched by theaccounts of human suffering. In man’s inhumanity
towards others, recounted in too many places and too
many times in history, we are reminded of what ought
to be but is not yet. Each repetition of the inhumanity offellow humans invites us to reclaim the vision that allmen (and women) are created equal. The rights weclaim humans need to flourish need not be insidiousseeds of individualism but a way to recognize ourcommon humanity.
Crisis of universalism
The world community faces a crisis of legitimacy
with respect to human rights for a variety of reasons,most of which pertain to how we answer two questions:
who within the Homo sapiens species has rights andwhose duty-responsibility is it to provide the conditions
that make rights claims practical? Further it has beensuggested that human rights are thinly disguised or
updated ways of imposing “Western” ideas on otherpeoples who have their own values and traditions.
Samuel Huntington crafted the thesis: “clash of
civilizations” between the “west and the rest.”
In it,
Huntington says values of “individualism, liberalism,
constitutionalism, human rights, equality, liberty, rule oflaw, democracy, free markets and separation of churchand state have little resonance in Islamic, Confucian,Japanese, Hindu, Buddhist, or Orthodox cultures”(Huntington, 1998). It is understandable that if humanrights are perceived to be “western” and “individualistic”
many theorists may wish to separate their support forhuman rights from enlightenment liberal values ormonotheistic beliefs.
Contra Huntington, the drafting of the UDHR was
the product of western and nonwestern writers as
mentioned above. Perhaps more importantly, theUnited States, the United Kingdom, and the Soviet
Union did not intend the newly organized United
Nations to prioritize or promote human rights, because
they perceived the purpose of the organization to beprevention of war. At the time of the UDHR writing theworld was recovering from World War II, andcolonization was still in place in much of the world.
Certainly colonization has seeded distrust andresentment, for which apology may be insufficient toachieve reconciliation among peoples.
Encouraging affirmation can also be found in “nonwestern” communities, such as the Organization ofIslamic Conference’s Cairo Declaration on Human
Rights in Islam (1990) and Parliament of the World’s
Religions’ Declaration toward a Global Ethic (1993). In
the Cairo Declaration on Human Rights in Islam(CDHRI) endorsed by the Organization of the Islamic
Conference (OIC) in 1990 was presented for adoption
at the 1993 World Conference on Human Rights in
Vienna, Austria. The origins for human rights in the

document were attributed to divine revelation inseventh-century Arabia to the Prophet Muhammad
when he received the “Revealed Books of God.” The
Cairo Declaration names the Islamic Shariah as theultimate foundation of and reference for all the rights
named within the document. In addition, the document
describes human moral worth and common humanity
and situates human rights within a holistic view of life
(Kao, 2011)
More encompassing and reflective of the ancient
wisdom inherent in many world religions, theDeclaration Towards a Global Ethic issues by the 1993
Parliament of the World’s Religions cited universal
values such as the Golden Rule to reach consensus onhuman rights and responsibilities. This Declaration
calls for respect for life and prohibits killing, torture andgenocide.
Callingformutualrespect
andcompassionate consideration of others, the Parliamentof World Religions did not offer a theological or
philosophical grounding for the Declaration (Kao,2011).
Human Rights are claims every person has simply
because they are human, independent of anything elsethat might follow, i.e. nation-citizenship, religious
affiliation, cultural context, gender, age, social status,
etc. Human rights are a class or moral rights that aim
to recognize and promote the dignity of every humanbeing. That being said, it is clear that rights claims canand do conflict with one another, leaving open theprioritization of rights reflecting the plurality of most, if
not all cultures. Communitarians do exist in culturesthat are predominately characterized as individualistic.
Martha Nussbaum has aptly observed people are“resourceful borrowers of ideas” and wisdom would
counsel that we should think twice before dismissing
an idea simply because it is not indigenous(Nussbaum, 2000).
Who has responsibility for those who suffer?
Slavery and serfdom have a long history. Ancientphilosophers such as Aristotle argued that this was a“natural order”. Slavery existed in the Americas (North
and Latin), in the Pacific Islands, in the Far East. At theth
beginning of the 19 century, over three-quarters of thehuman population were trapped in forced labor byslavery or serfdom, by caste, class, or race, such
persons were not considered fully human and therefore
denied equal rights. Intolerance toward those withdifferent religious, cultural, political, or philosophicalbeliefs has at times contributed to lack of support forhuman rights. If a culture posits a natural order that
includes a hierarchical arrangement, equality isinherently antithetical. Hereditary rulers e.g. the divineright of kings in Europe and the dynasty system in
China illustrate the hierarchical polity and the power ofthe state. National sovereignty allowed rulers to treat
their subjects as they deemed right without being
accountable for abuses of human rights. How a state
treated its citizens was immune from international
scrutiny, and thus any person within said state who
suffered rights abuses had no recourse to help or
assistance.

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

Representatives from western societies, e.g. Britain,
Canada, the United States, spoke strongly andfavorably for universal human rights in the crafting of
the Universal Declaration, with colleagues from manyother cultures, religions and nations. Representatives
were not solo voices of a univocal state. The civil war
did not end racial discrimination in the U.S.A. nor did
the civil rights act of 1964 create a society of harmony
and good will toward all fellow citizens. Indeed eventhough the U.S. A. has signed the civil rights covenantof the UDHR it has not ratified the economic covenant.
This history points to a progressive element in thehuman rights landscape: one which we have seen
recounted in the enumeration of covenants descendent
from the UDHR specifying the rights of women, therights of the prisoner, the rights of the child, etc.
Rather than continue an unproductive dichotomy
between “East and West, North and South” or slide into
infinite relativism, there is merit in a cross-culturaldialogue. It is clear that most cultures are notmonolithic, philosophically or theologically and conflictwithin cultures exists about human rights. One may
reject human rights as ethnocentric. It is also possiblethat in so doing abandon particular culturally relative
and useful human rights claims.
Dignity as grounding:
The Kantian framework of human worth is dignity
arising from capacity for rational action: to act
autonomously according to moral imperatives we giveourselves and others. Nicholas Wolterstorff argues thata functioning, reasoning, approach fails to encompass
all human beings with dignity due respect, using theargument from “marginal cases” that illustrate where
the least able person is still different from the nearest
animal relative (Wolterstorff, 2008). Human Rights per
se does not require the belief that humans are superior
to other species. It requires universal recognition of aset of rights for all persons without saying anything
explicitly or otherwise about other species’ moral worth.
Therefore, a distinction can be made between naturalrights and human rights.
Human rights require some vision of what humans
hold in common. John Rawls used the “original positionand veil of ignorance” to determine content for humanrights applicable to all peoples (not individual persons).
Rawls suggests eight areas that assist humans tofunction well, which he called the Law of Peoples(people to Rawls means essentially a nation-state, acommunity with a system of governance) (Rawls
1999). Rawl’s Law of Peoples lists elements andconditions that he labels decent but not liberal. The
eight norms list conditions required for political stability
thereby allowing rights to exist. The norms include
freedom, equality, treaties, duty of non-intervention,
self-defense, restrictions on conduct of war, assistancefor other peoples living under unfavorable conditions,and honoring human rights (Rawls, 1999). In the eightareas, he affirms articles 3-18 of UDHR as genuine
and posits a minimalist vision of what is necessary forhuman flourishing. Rawls Law of Peoples contains
political support for human rights even if all peoples do

not support them locally. It affirms human rights basedon mutually desirable outcomes but evades questionsof why all persons should be entitled to protection.
Plurality:
Unity is not uniformity. Community or nation-statebased grounding of human rights in their own terms
and perspectives affirms human rights with pluralfoundations. Charles Taylor, the Canadian philosopher,suggests that unforced international consensus onhuman rights will reflect diverse fundamental values,
consensus on norms of human behavior, withoutagreement on why they are the right norms (Taylor,1999).
The capability approach taken by Nussbaum andothers is a broad conceptual framework that offers achance to compare quality of life across nations,evaluate public policy and justice of social institutions.
Sidestepping religion and metaphysics, Nussbaum
offers a set of ten human capabilities every person
needs to be able to function in ways essential to living
life of dignity as a human beings. The list includes life,
bodily health, bodily integrity, sense cognition,
emotions, practical reason, affiliation (in families,
communities,groups),play,awarenessandrelationship with world of nature, and control or
influence over one’s environment (including but notlimited to political choices, property, employment, andmeaningful relationships). (Nussbaum,1999)
There is considerable overlap if not consensus
between the UDHR, the Law of Peoples and thecapacities approach. There is also room for pluralistic
priority setting and interpretation. One country may
secure primary education whereas another will provide
public access to the internet as best serve the interestsof its people.
Rawls and Nussbaum offer us visions of what
human beings need to flourish, but why or how tojustify human rights to sovereign states is not specified.
They remind us that human rights are not the only path
to totally satisfying meaningful and wonderful lives.
Capacity approach is a consensus offering that
supports what it means to have concern for human,
animal and environmental wellbeing. Nussbaum does
not insist on a religious locus of values or on purereason as the source of truth. Respecting the socialand political and moral norms of another suggests
tolerance for a plurality of norms because they hold incommon the object of interest: human beings.
Consensus approaches such as Rawls and Nussbaum
offer provide an olive branch to those who assert
human rights are a western concept (Rawls 1999;
Nussbaum, 2002).
Why might people agree that slavery or humantrafficking is bad? Christians may say social justice orlove of neighbor precludes treating human beings asproperty. Buddhist might use the normative value ofcompassion to sentient beings to oppose the trade.
Kantians would claim the imperative that all persons
should be treated as ends and never as mere means.
Utilitarians would calculate a diminishment in the total
welfare of humans. Other examples can be added, but10

Eubios Journal of Asian and International Bioethics 24 (January 2014)

the point is that a world community could generate alist of universally human rights that are diversely
justified.
Existential Realism:
We should not conflate the normative with the
motivational. The existential failure to will x and do y is
not limited to philosophers or theologians, to do what
we ought is a universal challenge for all humanpersons. There is the possibility that the moral and therational will coincide when the our eyes are opened tosee the poor begging for food, the sick pleading for
health care, and the refugees seeking a home to knowthat these neighbors are no more and no less humanthan we are and therein lies the reason to search forcommon ground. When we experience others coming
into our presence bearing legitimate claims on us andhow we treat them: as when we come into thepresence of others with hopes about how they should
treat us, we begin to see the common wisdom of theGolden Rule, not as a religious edict, or a philosophicalmaxim, but as a practical acknowledgement of ourcommon humanity.
Positing the real and equal value of human beings
gives moral weight to human rights. Why humans haveworth can be grounded in theological or philosophicalconstructs. The International Bill of Human Rights
makes it clear by its silence regarding a particular
philosophical grounding, citation of any sacred text, or
quotation of an individual. We may come to realize
what ought to be through the experiential lens of what
happens when we fail to treat humans humanly.
Political - state sovereignty, aggressive acts of national
defense, incarceration and detention without trial, point
to failure to recognize our common humanity. Humanity
ought to have a “hermeneutic of suspicion” to any claimthat torture extracts useful information when all
empirical data argue the opposite. Human rights
advocates call attention to acts that degrade humanbeings, whether such actions occur within one’s own
country or in that of another. Most, if not all nations arevulnerable to some neglect or infraction of one or moreof the rights articulated in the UDHR. Progress is the
key: linking humanity with social progress. Existential
realism offers a grounding that may transcend
philosophical and theological categories. Human rights
offers a vision of what it means to treat a person as ahuman being, and offers the vision of a human(e)community.
References
Ames, Roger. 1988. “Rites as Rights: The Confucian
Alternative.” In Human Rights and the World’s Religions,edited by Leroy Rouner, 199-216. Notre Dame, IN:
University of Notre Dame Press.
Chan, Joseph. 1999. “A Confucian Perspective on Human
Rights for Contemporary China.” In The East Asian
Challenge for Human rights, edited by Joanne Bauerand Daniel Bell, 212-237. Cambridge: Cambridge
University Press.
Chan, Joseph. 2000. “Human Rights and Confucian
Virtues.” Harvard Asia Quarterly 4, no 3: 51-54.
Dallmayr, Fred. 2002. “Asian Values and Global Human
Rights.” Philosophy East & West 52 (no 2): 173-189.

Huntington, Samuel. 1998. The Clash of Civilizations andthe Remaking of the World Order. New York: Simon &Schuster.
Kao, Grace Y. 2011. Grounding Human Rights in a
Pluralistic World. Washington, D.C.: Georgetown
University Press
Nussbaum, Martha, 1999. “Capabilities, Human Rights,
and the Universal Declaration.” In The Future ofInternational Human Rights, edited by Burns H. Weston
and Stephen P. Marks, 25-64. Ardsley, NY:
Transnational Publishers.
Nussbaum, Martha, 2002. “Women and the Law ofPeoples.” Politics, Philosophy, and Economics 1 (no 3):
283-306.
Parliament of the World’s Religions. 1993. “Declaration
toward a Global Ethics.” Global Ethic Foundation,
December
27,
www.weltethos.org/pdf_decl/Decl_english.pdf.
Rawls, John. 1999. The Law of Peoples. Cambridge, MA:
Harvard University Press.
Taylor, Charles. 1999. “Conditions for an Unforced
Consensus on Human Rights.” In The East Asian
Challenge for Human Rights, edited by Joanne Bauerand Daniel Bell, 124-144. Cambridge: Cambridge
University Press.
Twiss, Sumner B. 1998. “A Constructive Framework for
Discussing Confucianism and Human Rights”. In
Confucianism and Human Rights, edited by Wm.
Theodore De Bary and Tu Weiming, 27-53. New York:
Columbia University Press.
Twiss, Sumner B. 2004. “History, Human Rights, andGlobalization.” Journal of Religious Ethics 32, no. 1: 3970.
Waldron, Jeremy, ed. 1988. Nonsense upon Stilts:
Bentham, Burke and Marx on the Rights of Man. New
York: Routledge.
Wolterstorff, Nicholas. 2008. Justice: Rights and Wrongs.
Princeton, NJ: Princeton University Press.
This paper was presented at ABC14.

Tanabe’s Philosophy in the
Comparative Contexts- Makoto Ozaki
Emeritus Prof. Dr. at Sanyo Gakuen University, Japan
Email: sp346hv9@chime.ocn.ne.jp

Abstract
As Hegel suggests, there is no philosophy apart fromthe history of philosophy. Each philosophy represents
the spirit peculiar to its own period. Heidegger, too,holds that every philosophy is the sound of Being, andthe history of philosophy is the history of Being. This istrue for the Kyoto School philosophy of modern Japan
represented by Kitaro Nishida, Hajime Tanabe, andTetsuro Watsuji, who made to endeavor to construct a
new synthesis of Western and Eastern philosophy inthe critical, confrontational, and creative ways in thegiven historical contexts. In particular, Tanabe (18851962) attempts at the dialectical unification of
Christianity and Buddhism in the last resort from thestandpoint of Absolute Nothingness. As, inWhitehead’s conception of process, actuality iscomposed of the past objective being as the given data

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

and the present subjective act of becoming, so it might
be highly significant to analyze the constitutive
elements of Tanabe’s system of thought from thehistorical and comparative contexts.
Confucian Influence
Tanabe does not presuppose any pre-existent entity
such as God or the Eternal Ideas prior to the actual
world. The origin of the world is mysteriously
incomprehensible and unrecognizable for humanbeings, according to him. Human beings can start only
from the end as the given facts of the world. His
standpoint is not from above but from below, being
restricted to the historical perspective without thetranscendental realm. This echoes to natural sciences
and Confucian standpoint. Confucianism is secular incharacter and not transcendental in its basic structure
accorded with the given society. The backgrounds of
Tanabe’s thinking lie in Confucian culture and Buddhist
tradition as well.
The historical origin of Confucian culture is found in
the oldest Chinese literature, the Book of Change, inwhich dual elements of the positive and the negative in
opposition are alternately convertible and changeable.
The basic structure of nature represented by the
movement of the sun and the moon is applicable to all
aspects of human society, including the way of life. The
alternation of the positive and negative element
generates all phenomena in the universe, and this isthe basic principle of the Change. On the one hand, thehistorical background of Tanabe’s thought lies in
Confucian culture, and on the other hand, it is alsomuch influenced by the Buddhist notion of Emptiness,
which rejects any pre-existence of the original sourceof the world but whose reverse side constitutes thedependent origination of all phenomena in the nexus.
This means that there is no original source ofphenomena in the world, but rather that phenomena
have no their own substantiality or own being eternally.
All phenomena in the universe arise and perish
alternately, and are constituted by the inner
relationship between the cause and the effect. This
causality is called pratityasamutpada in Sanskrit, whichmight correspond to A.N. Whitehead’s conception of
concrescence. The Confucian idea of Change and theIndian Buddhist notion of the dependent origination
might be in some way parallel to each other from thestandpoint of the occurrence of phenomena. That
Change has no substance but only operation or activity
may suggest the latent correspondence of Confucian
and Buddhist conceptions.
Even so, however, there is another stream within thewider sense of Confucian culture, i.e., Laozi’s andZhangzi’s idea of Nothingness. Their ideas ofNothingness are different from the Indian Buddhist
notion of Emptiness in that the former is characterized
by the original source of all phenomena in the world,
whereas in the latter there is no original reality prior tophenomena. In other words, Laozi’s and Zhangzi’s
ideas of Nothingness are emanational in character,while the Buddhist notion of Emptiness neverpresupposes such pre-existent reality from which

phenomena come about and into which they return.
This difference between them is significant, andcontributes to the preparation for the settling of the
Buddhist notion of Emptiness in Confucian culture.
They are not the same or identical, but merely similaron the surface.
The difference between Laozi’s and Zhangzi’s ideaof Nothingness and the Buddhist notion of Emptinessmight be reflected in another way within the ambit of
the Kyoto School of Philosophy, namely between
Nishida’s and Tanabe’s concept of Absolute
Nothingness. Whereas Nishida leans towards Laozi’sidea of Nothingness, though there is some mixture withthe latter, Tanabe authentically points to the Buddhist
notion of Emptiness. Nishida’s thought may reflect thevery traditional heritage of the Eastern intellectual
history in general without explication of the literalreferences. This is due to the fact that the intellectual
tradition in Japan comprises many different elements
and streams of various ideas which originally camefrom the diverse cultural backgrounds and regions but
are actually mixed with each other in content in thelong historical formation of the intellectual cultural
heritage.
Hegel’s Dialectic in Comparison
For Tanabe, Hegel’s dialectic seems to be still
confined to continuous identity and not yet fully
developed into the existential dialectic which ischaracterized by negative mediation in the proper
sense.
Human beings should act in reformation in front ofdeath to make eternity temporal as the interruption of
its endurance, and resurrect and renew it in the depthof moving origin of being, i.e., Absolute Nothingness,entailing the end of being enduring since the past
countless eons and simultaneously opening up a new
era in reformative action for the future. Humanexistence as a creating element participates in eternity
in the way that return is identical with renewal in theform of the existential cooperation as the spacious
extension as well as the repetitive progress in timethrough the conversion in negation from death toresurrection.
On the relationship between the state existence andthe individual, Tanabe criticizes Hegel’s dialectical logic
for still clinging to the self-identity of being. For Tanabe,
if the subjectivity of the state existence, which is to be
mediated by the individual freedom, were directly
unified with the subjectivity of God, and there were no
conversion in negation of the individual and hence inno need of the mediation of the Other power but only
the self-effort of the individual, then the state existence
could be merely a finite God on earth as a selflimitation of God and never signify the negative
mediation to the revelation of God. Bu on the contrary,
the negation of its finitude, together with the negationof the finitude of the individual spirit, would be
converted into the preservation and retention of thecontent of the world from the eternal God. It would turnout to be optimistic status quo.

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

On the part of Hegel, according to Tanabe, theopposition in negation and reciprocal conversion
between the state existence and the individual cannot
become self-conscious in action, and the concretizationof the individual and its simple subsumption under thestate existence are interpreted in a way of the selfidentical logic. Religion then turns out to be theimmediate revelation of God without the mediation of
the state existence to which the individuals areopposed in action, and the political practice of the state
existence as the species-like substratum whichmediates between God and the individuals in negation
is not required any more. This is a kind of the theory of
emanation and immanence entailing the divinization of
the given actuality. This is the reason that what isreasonable is actual, and what is actual is reasonable.
Thereby the linear progression prevails over the cyclic
mediation.
According to Tanabe, the construction of the state
existence is negative in character as the expedient,and only in so far as it is constantly renewed in thereformative practice, it can be made to exist in action
through the mediation of the individual. The individual
existence is based upon the principle of Absolute
Nothingness, whereas the state existence is the
dynamic balance between the negation resulting in aconstant renewal in reformation and the affirmation
retained by the past tradition. The former is therevelation of the subjectivity of God, while the latter isthe mediating manifestation of the substratum of God.
God as Absolute Nothingness becomes manifest andpresent through conversion in negation of the both of
the state existence and the individual.
The state existence on the level of species-likesociety is such a substratum as the expedient on thebasis of which the individual is to be negated. This may
be analogous to Christ as the archetype of humanbeings in communicating the truth that the relative isidentical with the absolute to us. Therefore the state
existence is such an expedient as mediating between
the individual and the substratum on which the mutual
love among the individuals is communicated, and ismade to exist as far as it is to be renewed in conformity
with its historical mission by the constant practicalaction of the individual; it is so as a moment ofnegation within Absolute Nothingness as the
expedient. It is not such a specific being as is
subsumed under the universal God according to theself-identical logic as in the case of Hegel.
For Hegel, from Tanabe’s viewpoint, there is no
mediation of the state existence which is mediatedbetween the individual and the universal genus, butrather the individuals are subsumed under both of thespecies and the genus. In other words, the individuals
should be negated by the state existence which is
negative in mediating the individual to the genus andwhich is ascribed to Nothingness owing to its selfnegation and by standing in opposition to the universal
divine goodness which is the ground of its existence. In
the later Plato, in particular in his Nomoi, according to
Tanabe’s interpretation, Absolute Goodness arises
from the practical mediation of Absolute actuality qua

ideality as the second order, and in doing so, thespecies comes to the terms to the absolute unity withthe genus solely through the negative mediation of thestate existence.
In Conclusion
In as much as for Hegel the Absolute is apprehended
not only as the substance but also as the subject, forTanabe Absolute Nothingness is not only transcendentand beyond the relativity of the phenomenal world, butalso is immanent in space and time as the selfrealization in and through the mediation of selfnegation. In this sense, Tanabe’s thought might be
Aristotelian in character as a result of his criticalconfrontation with Hegel.
Although for both Hegel and Tanabe the truth ofhuman beings lies in action, Tanabe places more theemphasis on the individual in terms of the perpetually
self-negating activity of Absolute Nothingness, rather
than in terms of the self-identical Being presupposed in
the beginning as in the case of Western thinking.
This paper was presented at KBRT7.

The Current State of Surrogate
Conception in Japan and the
Ethical Assessment of Dr.
Yahiro Netsu – An EthicalInvestigation of Japanese
Reproductive Medicine(Surrogacy)- Masayuki Kodama, Ph.D.
Professor, National Institute of Fitness and Sports in
Kanoya(NIFS), Japan
Correspondence: 1 Shiromizu-cho, Kanoya City, Kagoshima
Pref., Japan, 891-2393
Email: kodama@nifs-k.ac.jp

Abstract
In this paper I will introduce the current state ofsurrogate conception in Japan (layer 1), identify Dr.
Yahiro Netsu’s ethical assessment of the surrogacy
treatment in which he is involved (layer 2) and thefundamental medical viewpoint that supports his ethicalassessment (layer 3).
Layer 1: As of October 2013, from a total numberof 21 cases of surrogate conception, 10 pairs achieved
pregnancy and 10 fetuses developed in 11
mother/daughter cases, and 4 pairs achieved
pregnancy and 6 fetuses developed in 10 blood related
sisters & sisters-in-law cases.
Layer 2: Dr. Netsu’s position, based on his solemn
medical creed that ‘as long as there are people who
suffer, they are not to be left to their fate’, is toimplement
surrogacy‘supporting
reproductive
technology’.
Layer 3: Dr. Netsu is anything but a promoter ofsurrogate conception. When confronted with a patient

13

Eubios Journal of Asian and International Bioethics 24 (January 2014)

who is only able to have a child of her own by thesurrogate conception, and with no other option toanswer that patient’s pleas for help, as a physician Dr.
Netsu just cannot ignore her.
Dr. Netsu does not possess an indomitablereligious mind that would support his ethicalassessment. If asked, I would say the foundation
supporting Dr. Netsu’s ethical assessment is thepatrimonial precepts that shape Japanese culture.
Putting it simply, these are the traditional values (theimportance of justice, and the reverence of heaven andthe love of people) ‘to live in a way that is not shamefulto god or to ones ancestors’ and ‘the gratefulness forlife’ that were common among the Japanese people
before World War Ⅱ.
Dr. Netsu’s basic medical ideology can be 1
summarized in the following 3 points.
1.
A physician is there for his patients
2.
Care for patients through their eyes
3.
The patient is a physician’s best teacher
Keywords: Surrogacy, Art, Yahiro Netsu M.D., Ethics,
Reproductive Medicine
Foreword
The only obstetrician and gynecologist in Japan
who has continued to implement surrogate conception,even before the TV personality Aki Mukai brought
attention to the surrogate conception issue in Japan,
lives in Nagano prefecture. This man is Dr. Yahiro
Netsu, the director of the Suwa Maternity Clinic (SMC).
Since 1996 Dr. Yahiro Netsu has been practicing
procedures in advanced reproductive technology suchas non-spousal IVF and surrogate conception in Suwa
city, Nagano prefecture, based on his medical
conviction that ‘as long as there are suffering patients,
they are not to be left to their fate’ and ‘one must focus
14
on the needs of patients, no matter what happens ’. At
the SMC, based on the clinic’s guidelines, the creed
15
has always been ‘treatment before regulatory report ’,while the Japanese government has not made any
progress in the creation of legislation regarding
surrogate conception, and although the Japan Society
for Obstetrics and Gynecology (JSOG) and theScience Council of Japan Committee for Deliberating
the State of Assisted Reproductive Technology haveextolled a general prohibition of surrogacy in place of
the Japanese government, releasing reports like
Opinion regarding Surrogate Conception (April 2003)
14

Cf. Dr. Yahiro Netsu: Do Not Take Away Our Lullabies.
Karamatsu Shobo 6: 177-243, 2004. Dr. Netsu’s fundamental
attitude towards medical treatment overflows from all hiswords and deeds. See Dr. Takeshi Kaido: Japanese
Medicine. Look at This Person! PHP : 196, 2012.
‘In case that I am asked by a patient, why don’t you help mewith your advanced assisted reproductive technology, I
cannot prohibit using it without being able to give its reason?
Japanese people should be ashamed that the JSOG makes
Japanese suffering patients’ diseases cured in othercountries than in Japan, though there are Japanese doctors
who are well versed in advanced assisted reproductive
technology’.
15
Dr. Yahiro Netsu: Really (“Hokai’”). Karamatsu Shobo : 1921, 2012.

and Issues in Assisted Reproductive Technology
centering on Surrogate Conception – towards a Social
Consensus (8 April 2008).
The purpose of this paper is to investigate
advanced
reproductive
medicine(surrogate
conception) ethics in Japan based on a three-layered
structural analysis. In this paper I will introduce thecurrent state of surrogate conception in Japan (layer1), investigate Dr. Yahiro Netsu’s ethical assessmentof surrogate conception based on his experience (layer2) and Dr. Netsu’s unique standpoint towards medical
science in support of his ethical assessment (layer 3).
In conclusion, I will provide an overview of a topic for
future research.
The current state of surrogate conception in Japan(layer 1)(a) Surrogate conception regulations of the
Science Council of Japan Deliberative Committee
on the State of Assisted Reproductive Technology
While the director of the SMC Dr. Yahiro Netsu
was raising one issue after another to society, on 30
November 2006, the Japanese government (both the
Ministry of Justice and Ministry of Health, Labour andWelfare) requested the Science Council of Japan(president Ichiro Kanazawa), in a communication
cosigned by the Minister of Justice and the Minister of
Health, Labour and Welfare, to hold deliberations on
the state of assisted reproductive technology (infertility
treatment)
focusingonsurrogateconception(‘surrogate mother’ in artificial insemination typesurrogate conception/‘host mother’ in IVF typesurrogate conception). The Science Council of Japan
immediately established (21 December 2006) a
deliberative committee on the state of assisted
reproductive
technology
andrequestedan16
investigation . The fruitful products of this investigation
resulted in the external report Issues in Assisted
Reproductive Technology centering on Surrogate
Conception – towards a Social Consensus (8 April2008).
The main points of the external report concerning
the state of assisted reproductive technology centeringon surrogate conception (‘surrogate mother’ in artificial
insemination type surrogate conception/‘host mother’ in
IVF type surrogate conception) are as follows.
(1)
As for surrogate conception, legal regulation(e.g., a Bill on Assisted Reproductive Technology(tentatively named)) is required and, based on thislaw, as a rule the prohibition of surrogate conception
would be advisable.
(2)
Surrogate conception done for honor and profit
shall be dealt with by punishment. The performing
physician, intermediary and requestor will be subject
to punishment.
(3)
In light of the necessity to provide for the safetyof the mother and the rights and welfare of the childthat is born and to comprehend medical, ethical,

16

The 8th Science Council of Japan (24 August 2007) calleda hearing to learn the opinions of Dr. Yahiro Netsu and Aki
Mukai.

14

Eubios Journal of Asian and International Bioethics 24 (January 2014)

legal and social issues, trial implementations ofsurrogate conception (clinical tests) under strict
control limited to women who congenitally lack auterus or whose uterus has been removed as amethod of treatment can be considered.
(4)
For the performance of surrogate conception
trials, an official committee of operations including
medical, welfare, legal and counseling specialists
must be established. This committee will, in duetime, evaluate the medical safety and thesocial/ethical validity, and if there are no concerns, itwill amend the law and give its approval within astandard set of guidelines. If there are any harmful
effects, trials will be discontinued.
(5)
Concerning the parent-child relationship of thechild born out of surrogate conception, the person
who undergoes surrogate conception will be
regarded as the mother.
(6)
Concerning the requesting couple and the childthat is born, a parent-child relationship will beestablished by adoption or special adoption.
(7)
Concerning the right of the surrogate child toknow his or her family background, the welfare of thechild must be given maximum consideration.
However, this will be a major topic hereafter as thecase of surrogate conception has to be assessed
upon ample preliminary consideration of this right incase of long-term practices such as artificial
insemination with sperm from a third party (AID).
(8)
Since the problem remains that the debate on
conception through egg cell donation or with frozen
sperm of a husband after his death remains
unfinished, and because there is also the possibility
that new problems may still arise, the continued
deliberation of assisted reproductive technology isrequired.
(9)
Concerning issues of a bioethical nature, given
their importance, it would be advisable that theseissues are dealt with, including policy development,by the establishment of a new official permanentcommittee and public research facilities.
(10) In the event of any debate surrounding
assisted reproductive technology, beginning withsurrogate conception, the welfare of the child that isborn must be given top priority.
On 16 April 2008, the Japanese government (theMinistry of Justice and the Ministry of Health, Labourand Welfare) received the external report from the
Science Council of Japan Deliberative Committee on
the State of Assisted Reproductive Technology. After
this time, it appeared as if there would be some
progress in the preparations for an Assisted
Reproductive Technology Bill (provisional name), but
to date the Japanese government has not taken any
action towards the establishment of such a law. Under
such circumstances, on 9 May 2008, Diet memberswith a direct interest in surrogate conception launcheda ‘suprapartisan study group to further preparations for17
a surrogate conception bill ’ (Yoko Komiyama,president; Seiko Noda, secretary), and when on 30
November 2010, following the change of cabinet, the‘study group on preparations for a bill concerningassisted reproductive technology’ (lead by the office of
Masako Obuchi) was launched, this group formulated
in June 2012 the draft for a Diet member billconditionallyapproving
assisted
reproductive
technology such as egg cell donation and surrogate
conception involving a third party.

17

was inaugurated in August 2006 (president Kayoko Shimizu,
secretary-general Seiko Noda).

Its predecessor was the ‘suprapartisan study group for the
deliberation of bioethics and reproductive technology’ that(b) The current state of surrogate conception fromthe experience of Dr. Yahiro Netsu
The SMC director Dr. Yahiro Netsu opened an IVF
facility inside the SMC in 1996 as the result of an
encounter with a woman with Mayer-RokitanskyKüster-Hauser syndrome, and in 1997 he opened acounter for patients without a uterus with his own
guidelines at the foundation. Dr. Netsu’s publication of
the first performance of surrogate conception(surrogate conception with a blood related younger
sister) in Japan occurred on 19 May 2001. Thereafter,
Dr. Netsu’s publications on the realities of surrogate
conception have piled up one after the other, adding to
the list whenever finding the chance.
Though, at the time of the SMC’s opening, Dr.
Netsu was performing surrogate conception with bothblood related sisters and sisters-in-law, he began
surrogate conception with blood related mothers in
2003, and has worked to unify his treatment policies
since 2006 in favor of surrogate conception with blood
related mothers with whom certain kinds of problems
are difficult to occur.
The Japanese government (the Ministry of Justiceand the Ministry of Health, Labour and Welfare)interpreted the issues that Dr. Netsu consecutively
raised to society with grave concern and on 30
November 2006, requested a deliberation regarding
the state of surrogate conception by the Science
Council of Japan. The Council that accepted therequest, established a deliberative committee
regarding the state of assisted reproductive technology
and reached the conclusion of general prohibition.
Dr. Netsu, upon hearing of Committee chair
Shigehiko Kamoshita’s statement that the deliberative
process in reaching this conclusion did not containpublic data on surrogate conception in Japan, on 3
April 2008, published data from 15 cases of surrogate
conception on the homepage of the SMC in the paper
Deliberation from Surrogate Conception Practice atThis Clinic – Report on Surrogate Conception at This
Clinic.
The breakdown of the causal disorders in these 15
cases was: 6 congenital cases (1 case of severe
uterine hypoplasia where only traces of the uterus
existed, 5 cases of Mayer-Rokitansky-Küster-Hauser
syndrome), 9 acquired cases (4 cases with a myoma of
the uterus, 2 cases of premature detachment of theplacenta and DIC (disseminated intravascular
coagulation), and 2 cases of uterine body cancer and 1

15

Eubios Journal of Asian and International Bioethics 24 (January 2014)case of uterine rupture). Embryo transfer was
performed 37 times in these 15 cases, with surrogate
mothers, in 11 cases becoming pregnant, in 8 cases
the surrogate mother gave birth, in 3 cases thesurrogate mother had a miscarriage. In 4 cases thesurrogate mother did not become pregnant.
The surrogate mothers in these cases were madeup of sisters-in-law (7 cases), blood related mothers (5cases), and blood related sisters (3 cases) with the age
range of over 35 years of age (10 cases), and over 55
18years of age (4 cases) . Of the 4 surrogate mothers
aged over 55 years, the oldest one was a 61 year old
blood related mother who gave birth to her
19
grandchild.
Thereafter, Dr. Netsu released the actual surrogate
20
conception results as of 1 February 2011. Among thetotal 21 surrogate conception cases, 11 cases were
between mother and daughter, and for the 10 couples
with whom implantation and pregnancy were achieved,
10 children were born. 10 surrogate conception cases
involved blood related sisters and sisters-in-law, andfor the 4 couples that achieved implantation andpregnancy, 6 children were born. The results showed
that, as compared to surrogate conception with blood
related sisters and sisters-in-law, the pregnancy rate ofsurrogate conception with blood related mothers washigher.
Dr. Yahiro Netsu’s ethical assessment regarding
surrogate conception (layer 2)
For the main part of this paper, we will look for the
ethical assessment of Dr. Yahiro Netsu who is the only
physician to bravely continue to perform surrogate
conception based on his personal medical beliefs inJapan where assisted reproductive technology
legislation is non-existent and immersed in
18

The results of 15 surrogate conception trial cases (Tokyo
morning edition Yomiuri Shimbun, 5 April 2008).
Relation to
Numberofrequesting
Pregnancy Miscarriage BirthpeoplespouseBloodmotherrelatedBloodsisterrelated

5

4

0

4

3

2

1

1

Sister-in-law

7

5

2

3

Total

15

11

3

8

19

Tokyo morning edition Yomiuri Shimbun, 21 August 2008.
By the end of March 2013, the number of surrogate
conception cases Dr. Netsu had managed remained at 21.
Relation to
Numberofrequesting
Pregnancy Miscarriage Birthpeoplespouse20

BloodmotherrelatedBloodsisterrelated

11

10

0

10

3

2

1

1

Sister-in-law

7

5

2

3

Total

21

17

3

14

declarations for the prohibition of surrogate conception
from the Science Council of Japan Deliberative
Committee on the State of Assisted Reproductive
Technology to the JSOG. While we can gain anunderstanding of Dr. Netsu’s medical ethical point ofview through his numerous writings and his ordinary
words and deeds, it is concisely summarized in his
documented lecture It Is Thus That I Perform Surrogate
Conception in Japan Based on An Ideology that wasthdelivered when he was invited as a panelist at the 5
Symposium on Religion and Bioethics, Considering theIssue of ‘Surrogate Conception’ (Kokugakuin
University, 25 February 2011). With this lecture as our
foundation, we will next search for Dr. Netsu’s medical
ethical point of view.
We can divide Dr. Netsu’s ethical view into an
absolute ethical view and a relative ethical view. The
absolute ethical view that Dr. Netsu holds can besummed up in the following 4 articles.
1. It is not allowed to kill or wound human beings.
2. It is not allowed to steal the property of people.
3. It is not allowed to trade human beings.
4. It is not allowed to deceive people.
The absolute ethical view that is composed of theabove 4 articles is a legal structure, i.e. natural law as
a universal law grounded on the rational faculty inhuman beings that must be universally protected,
whereas the relative ethical view is an ethical norm thatchanges together with periods in time, ethnicity andplace of residence. The tools by which humans are
made to obey are positive laws that are effective in acertain period and society. The JSOG’s regulatory
report concerning the practice of assisted reproductive
technology (surrogate conception, non-spousal IVF-ET,
preimplantation genetic diagnosis, and others) is no
more than a regulation based on the relative ethicalview of one elective vocational body; it is not a positive
law in the capacity of norms that bear thecontemporary and social restrictions the Japanesepeople must adhere to. In short, the JSOG regulatory
report does not hold legal power. Moreover, in cases
where the JSOG regulatory report is not able toadequately reflect contemporary and social changes,
Dr. Netsu’s stance is that even though he is a JSOG
member, it is not a requirement that he is restricted
100%, and that he should be able to practice ‘relief
offering reproductive treatment’ under the medical
belief that ‘as long as there are suffering people, theycannot be left to their fate’. Dr. Netsu continues tobattle with the JSOG that at times makes erroneous
judgments in its regulations for assisted reproductive
technology. The term ‘relief offering reproductive
treatment’ that was coined by Dr. Netsu, implies‘reproductive treatment that is effected by the spirit ofmutual support’. Specifically, the treatment consists ofthe following 3 types of reproductive treatment.
1. Non-spousal artificial insemination called AID thathas been performed for about 60 years.
2. Non-spousal IVF (sperm donation, egg cell
donation).
3. Surrogate conception―author’s note: even though
Dr. Netsu approves of the IVF type surrogate

16

Eubios Journal of Asian and International Bioethics 24 (January 2014)

conception ‘host mother’, he is opposed to the artificial
insemination type surrogate conception ‘surrogate
mother’.
However, Dr. Netsu takes a definite stance against
surrogate conception (a ‘host mother’ in artificial
insemination type surrogate conception/a ’surrogate
mother’ in IVF type surrogate conception) for21
commercial purposes . On this one point, Dr. Netsu’s
opinion is in agreement with fundamental policy of the
Science Council of Japan Deliberative Committee on
the State of Assisted Reproductive Technology (2), thatclearly states that ‘it should be dealt with bypunishment.
The
performing
physician,theintermediary, and the requestor should equally betreated as subject of punishment.’
Accordingly, in order to prevent abuses ofsurrogate conception that are contrary to the basics ofmutual support, Dr. Netsu emphasizes ‘the necessity ofdeveloping a constructive positive law for surrogate
conception’, stating that it is ‘indispensable to provide a
positive law that will, among other things, prohibit
surrogate conception for profit, commercialism, andeven more, by coercion’. Dr. Netsu, being aware ofcontemporary and social restrictions, also insists on
the necessity of regular revisions to such a positive
law. It is ‘also the right and the responsibility of each of
us individually to check if the laws are appropriate to
our changing society, and to modify the law whenrequired’.
Finally, regarding the critical opinion whether it isnecessary for women with the Mayer-RokitanskyKüster-Hauser syndrome who congenitally lack auterus, and women whose uterus has been totally
removed as the result of affections like a myoma of theuterus and uterine cancer, to go as far as to be given‘reproductive relief treatment’ in order to have their own
child, Dr. Netsu believes as follows.
The irresponsible assertion that ‘people who do nothave a uterus must give up and accept reality without
hoping for a child’ is an old-fashioned interference, notin any way different from others demanding that‘women with a uterus must always make children’.
‘People must not interfere in another life with regard towhether they have children or not’. As long as one
does not violate public order and standards of decency,
it would be a socially sensible attitude for others not to
meddle in other families’ reproductive liberties. In thefirst place, the right to pursue happiness with regard to21‘Supporting reproductive technology is not something thatshould be implemented forcibly or commercially, it isvoluntary mutual assistance, i.e. an interdependence that isrealized through a volunteering spirit, goodwill and humanthlove’ (the February 25 , 2011 recorded lecture of Dr. Yahiro
Netsu: It Is Thus That I Perform Surrogate Conception in
Japan Based on an Ideology). Below opinion of the samethpurport is also expressed in the July 24 , 2011 recorded
lecture of Dr. Yahiro Netsu: The Art of Medicine – To All Who
Aim at Becoming a Physician (Medical Department, Shinshu
University). A point that is of vital importance in conducting‘supporting reproductive technology’ is a volunteering spiritthat regards everything except necessary expenditures as
free of charge (the prohibition of trade in things related tolife), ‘it may not be done as business.’

reproduction within the family as the basic unit
constituting society, as long as it does not violate social
standards, is guaranteed in article 13 of the JapaneseConstitution.
The fundamental medical view supporting Dr.
Yahiro Netsu’s ethical assessment (layer 3)th
At the outset of his lecture at the 5 Symposium on
Religion and Bioethics named Considering the22
Problem of ‘Surrogate Conception’
Dr. Netsu
expressed the following medical view that supports andformulates the foundation of his ethical assessment.
I am not in any sense a member of the school that
promotes surrogate conception. There was a patient infront of me who could not have her own child in any
other way but by the method of surrogate conception,
and when I was solicited for relief by this desperatepatient, as a physician I could not ignore her.
The Japanese saying which states that ‘we help
those who appeal to us in a time of distress’ is anexpression of the medical ethics in the art of healing.
Dr. Netsu, who practices the ‘benevolent art of
medicine’, does not have an indomitable religious
backbone in support of the foundation for his medical
ethic. If I were asked, I would say that the foundation
for his ethical assessment lies in the patrimonial
teachings that make up Japanese culture. To put it
plainly, these are the traditional values (a strong moral
sense and, the reverence of heaven and the love ofpeople) that were common to the Japanese people
prior to World War Ⅱ like those of, ‘living in a way thatwill shame neither god nor ancestors’ and ‘being
allowed to live; being grateful’.
Dr. Netsu’s fundamental medical belief can besummarized in the following 3 points.
1. A physician is there for his patients.
2. Care for patients through their eyes.
3. The patient is a physician’s best teacher.
The above medical convictions are the product of
the exhortation of a dozen or so American teaching
staff at the time Dr. Netsu was a resident intern at
Ryukyu Governmental Central Hospital (present day
Okinawa Prefectural Central Hospital), and afterwards
became his precept in his daily diagnosis andtreatment as general practitioner; Dr. Netsu’s threecommandments of self-reproach as it were.
Obstetricians and gynecologists involved inassisted reproductive technology, actually realize anew
daily the dignity of life by witnessing in their medicalroutine the birth of life and, in unfortunate times, theunexpected death of a mother or a child. Obstetricians
and gynecologists, who in the implementation ofassisted reproductive technology use IVF-ET as theiressential technology, will inevitably in the process ofchoosing a gamete (sperm, egg cell, fertilized embryo)confront the selection of life issue. With respect to thispoint, obstetricians and gynecologists are required tohave a highly ethical outlook that restrains them at all22

The 25 February 2013 lecture of Dr. Yahiro Netsu: It Is
Thus That I Perform Surrogate Conception in Japan Basedon an Ideology (Kokugakuin University).

17

Eubios Journal of Asian and International Bioethics 24 (January 2014)

times. Dr. Netsu, who is more than any average
physician aware of the need for a highly ethical view in
his official capacity, performed the first selective
reduction operation in Japan in 1986. At that time, thearrows of criticism were shot at Dr. Netsu by the Japan
Association of Obstetricians and Gynecologists(JAOG), and his fellow physicians and the generalpublic condemned him by calling it ‘an act against theprovidence of nature’ and ‘an act infringing on thedomain of god’.
To criticisms such as these, Dr. Netsu offers thefollowing unsophisticated sentiment. Medical treatment
is a persistent activity endeavoring to both eliminate
matters obstructing life and to prolong life. If people
reassessed this hard reality again, speaking from a
broad perspective, the very medical activities that
resist the death of living organisms would already be‘acts against the providence of nature’ by which thesouls of all things in nature transmigrate.
Nevertheless, whether medical activities that resist
the death of living organisms are ‘acts against theprovidence of nature’ or not, progress and clinicalapplication of medical technology are favorably
received by human society as instruments that amplify
human life and public welfare, and transcended raceand time. A perfect understanding of the paradoxicalworld of such people is an important prerequisite for adebate. Still furthermore, would they persist in calling a
medical act that ultimately, after having exposed themother to physical danger by not doing selective
reduction, artificially terminates all pregnancies inexchange for the safety of the mother’s body ‘an act inaccordance with the providence of nature’, while at thesame time condemning a medical act that in a multiple
pregnancy saves mother and child by reducing thenumber of pregnancies an unethical ‘act that goesagainst the providence of nature’? If the humancapability of performing selective reduction is to becondemned as ‘an act that goes against theprovidence of nature’, then should not the ultimately
total pregnancy termination as measure to save
women with a multiple pregnancy be denounced evenmore as ‘an act going against the providence of
nature’?
Since 1986, Dr. Netsu has continued to perform
selective reduction on the conviction that ‘it is wrong toregard rescuing some as outrageous, while artificial
termination of all fetuses in a multiple pregnancy is23allowed ’, and by July 2011, the number of his cases
exceeded 920 with more than 1500 children born.
Today, selective reduction has been implemented inmany Japanese obstetric and gynecological clinics.
As stated above, Dr. Netsu also expresses a senseof discomfort with the discussion that denounces
selective reduction as ‘an act trespassing on thedomain of god’. Humankind’s strenuous work through23

The 24 July 2011 recorded lecture of Dr. Yahiro Netsu: The
Art of Medicine – To All Who Aim at Becoming a Physician(Medical Department, Shinshu University). On the commotion
surrounding the first implementation of selective reduction in
Japan, see The Practice of Selective Reduction – The
Questions That It Raises (Kindai Bungeisha, 1998).

intelligence and the technology of the life sciences thathas served in explaining causes of disease and theeradication of obstructions to life in the fight against
unknown diseases that made humans of the precivilized world shudder with fear as divine punishment
is a chronicle of progress replete with tough andsuccessful struggles in medical science. The course of
medical science, that has stepped into an unknown
realm while respecting the entity unifying all things innature, struggling with strange diseases, is the fruit ofhuman intelligence and unmistakably has been thedriving force behind the advancement of humankind.
Nevertheless, the ‘domain of god’ exists on an elevatedplain and greatly surpasses human intelligence thatremains as only a little wiser than a monkey, ‘fromwhere god is quietly watching how we humans use theintelligence that we have received, and whether we live
interdependently.’
In concluding this investigation into Dr. Netsu’s
basic medical view, I quote 2 fragments from My
commandments of self-reproach in the daily practice ofdiagnosis and treatment as general practitioner(“Kotonoha Tuzuri”） that subtly illustrate Dr. Netsu’s
mindset:Be grateful for everything in the service of people(tanka, March 1989)
My own emotional pain and sorrow and myth
responsibility and my growth (tanka, March 16 , 1995)
These tanka are characteristic of a unique
Japanese obstetrician and gynecologist who, based on
the above-mentioned fundamental medical ideology, isstruggling to open up the untouched field of assisted
reproductive technology (selective reduction, nonspousal IVF, surrogate conception, preimplantation
genetic diagnosis).
Conclusion
The present paper is a preliminary investigation of
reproductive technology ethics in Japan using amethodology called the three-layered structural
analysis. Previously, facts concerning the current stateof surrogate conception in India and Thailand and theethical assessments of physicians in charge have been
revealed by way of this analysis. In our continued
research on reproductive medicine (surrogate
conception) ethics in each Asian country where
surrogacy is practiced (India, Thailand, Malaysia, theUkraine, etc.), the gathering of diversified information
helpful to the preparations for an assisted reproductive
technology bill in Japan is a future topic of research.
This paper was presented at KBRT7.

18

Eubios Journal of Asian and International Bioethics 24 (January 2014)

Dignity and Freedom through
Human Security- V. Balambal, M.A.B.T. Ph.D. FRAS (London)
Professor (Retd) of History, University of Madras, India
Email: drbala50@hotmail.com drbala50@gmail.comthth159, 94 Street, 15 Sector, KK Nagar, Chennai, 600078,
India

Introduction
Human Security (HS) may mean “the right of all
people to live in freedom and dignity, free from poverty
and despair and all individuals, in particular vulnerable
people, are entitled to freedom from fear and freedom
from want, with an equal opportunity to enjoy all theirrights and fully develop their human potential” (article
143 of the 2005 World Summit Outcome(A/RES/60/1)). HS is at great risk in modern times. It
may look outwardly that external wars and cause
insecurity to the people; but a deeper study on thesocio-economic and environmental conditions of thepeople prove that they cause more danger andinsecurity not only to the people but to the nation itself.
. Human security brings together the ‘human elements’of security, rights and development. It is mainly people
centred. Millions of people are threatened by poverty,
climate-related disasters, organised crime, humantrafficking, health hazards and sudden economic
depression and financial downturns.
There are different types of HS and the threats andsolutions.
Need for Human Security
National security is important for peace and stabilityof the nation. But various other challenges which thepeople and nation face cause more insecurity.
Sometimes, it has its own impact on our friendly or
unfriendly nations. HS is needed not only to safeguard
oneself from external and internal conflicts but to givesome freedom, relief, safeguards to protect oneself
from poverty, illiteracy, unemployment, under
employment, gender bias, domestic violence,
inequality, health hazards, terrorism, fundamentalism,
climate change and economic depression.
More so, with HS, one can have access to various
opportunities to tackle various such challenges andthreats through human rights, approach to Internationalorganizations and friendly ties with other bodies.
HS aims at safeguarding the dignity of people,
providing them good livelihood and ability to facechallenges and threats. It is not mere physical needs
but emotional and intellectual too. Human security
acknowledges the interlinkages between security,
development and human rights and considers these to
be the building blocks of human and, therefore,
national security.
Main Features of Human Security
HS is inter-disciplinary as it deals with security, rights
and development. It is people-centred, comprehensive,
prevention oriented, multi-sectoral with specific context.
There should be advancement of political, social,economic, environmental, cultural and even militarysystems which helps people to develop and progressachieving peace.
As a people-centered concept, HS places theindividual at the ‘centre of analysis.’ Consequently, itconsiders a broad range of conditions which threaten
survival, livelihood and dignity, and identifies thethreshold below which human life is intolerably
threatened. Human security is also based on a multisectorial understanding of insecurities. Therefore,
human security entails a broadened understanding of
threats and includes causes of insecurity relating for
instance to economic, food, health, environmental,
personal, community and political security.
Only by comprehending the causes of insecurities,
planning and execution of solutions are possible for the
wellbeing of the people. Human security identifies the
structural as well as the behavioral changes that areneeded to help mitigate the impact, and, where everpossible, prevent the occurrence of current and future
threats. By protecting and empowering people in facing
threats, development could be made possible.
Focus of Human Security
Though there is a general focus of HS in all thecountries, it differs from nation to nation and people topeople based on various factors. People under stressand threat are to be identified and their problems are to
be analysed and solution is to be planned andexecuted. The role of the government, NGOs andpeople in solving the problems is necessary andimportant.
Protection of people from threats is important. But
what is more important is the empowerment of people
to face the threats bravely and successfully.
Application of Human Security
Reducing poverty: HS will be of great use in
reducing poverty if the government officials do justiceto their duties. Rich becoming richer, and poor
becoming poorer should not be the case in any country
where development of the community is the goal of thegovernment. .It should be ready to face natural
disasters and climate change affecting the economy of
the nation and individuals.
Protection and empowerment: HS safeguards therights of all especially the women, Dalits, marginalized
people and victims of trafficking. It also protects themand helps them in their empowerment.
Ending of conflicts: In a diversified country like
India various factors such as different castes,
languages and religions and classes cause conflicts
among people, leave alone the external factors. Whenthe unity of the country and people is affected by thesefactors, HS helps to end such conflicts in the form ofConstitution and Human Rights
Healthy and hygienic environment: People are to
be safeguarded from health hazards and poor people
are to be provided not only with awarenessprogrammes concerning health but also with necessary
treatment for diseases. It will be easily possible
through HS.

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

Violence: Violence is of different types. Women
suffer from domestic violence; children suffer becauseof child abuse; and violence breaks out due to various
other causes. Caste, religion, language and regional
differences result in violence. Its impacts are very
harmful to the progress of a nation. If HS is at work,
violence could be prevented or even stopped. HS helps
to reduce violence and crime rates, by protecting thepeople.
Types of Human Security
The government should provide different kinds of
securities to people for their good living. Security isthreatened in economic, social, political, environmental,
personal and health aspects of the life of the people.
Various threats to HS results in insecurities. It isnecessary to find out the nature of threats and causes
of insecurity and execute possible and plausible
solutions as the context is very specific. What it needs
is good governance and recognition of Human Rights.
Economic security
A good government has its base in healthy economic
conditions which it could offer to its people. Common
people should be able to enjoy the basic needs of life---food, clothing and shelter. Persistent poverty andunemployment of majority of the people will doom theeconomy of a country. People should be free fromhunger and unemployment. Many people in villages
and urban slums live without basic amenities especiallyfood. Natural calamities like famine, floods, tsunami,
etc. cause damage to personal as well as national
economy. A nation should be able to protect its people
from insecurities arise due to these negative factors.
Many people in developing and under developed
countries live in below poverty line. It is important thatthe government is well prepared to face thesecalamities causing economic insecurity. Human
security improves local capacities, strengthens social
networks, and ensures coherence in the allocation of
resources and policies.
Threats: Some of the threats to economic security
are increased poverty and unemployment, prevalenceof war economies, illegal networks, collapse of
economy, destruction of property and infrastructure,lack of economic opportunities, discrepancies in aid,internal and external economic shock.
Food security, an off shoot of economic security isthreatened by hunger, destruction of food systems as aresult of war, famine, flood, disruptions of food supply
or allocation, malnutrition and unsafe food.
Solutions: Better economic policy and execution by
the government could solve the food threats.
Poverty reduction strategies will benefit fromcomprehensive and coherent policies and actions..
These will minimize duplication and accelerate theimpact of actions taken by those at the international,
national and the local level.
The impact of poverty on the vulnerable people must
be well understood and better policies are to be
executed for the actual needs of them.

People should be able to have access to food, by
growing it themselves, having the ability to purchase itor through a public food distribution system, diversified
agriculture and economy, local and national distribution
system. They are to be protected from natural andhuman-made calamities. Proper distribution of foodmaterials is essential.
Infrastructure recovery and restoring access to basic
services like transport, communications, water, andelectricity are essential.
Poverty
alleviation,
agricultural
rehabilitation,
dismantling of war economy and ending illegal
economic networks are to be given utmost priority.
Provision of micro-finance opportunities will help thepoorer section to start their own small scale industries
and better their economic condition. Macroeconomic
development will be helpful to get job creation for
many.
Everyone should remember the words of India’s
National poet Subramania Bharathiyar that if one
person is without food, we should destroy the world.
Nutritious food is important for healthy life. Awarenessis to be created on these issues and the way HS will beof great use to achieve economic and food security.
Though natural calamities cannot be avoided,
government and other organizations could protect
people and environment through long term planningand execution.
India is a country where there is plenty of natural andhuman resources which should be properly utilized forthe economic development of the nation having in mind
the significance of HS.
Health security:
The World Health Organisation (WHO) is very clear
in stressing the importance of health and hygiene forall, especially to the poorer section of the society.
According to WHO, it is the basic right of every
individual to get health security from the State.
Health is wealth. A state should see to the health of
its people. Basic facilities are to be provided to thepeople. Important ones are good drinking water,
sanitation and hygienic and healthy environment. As
the rural population has been migrating to the cities,
there is rise in population in cities which resulted inslums which lack basic facilities. Most of the slums do
not have proper water and toilet facilities. Though theNGOs like Rotary and Lions clubs build toilets for theslum and rural people, they are not sufficient and notneatly maintained. Floods and famines cause
epidemics and sickness. The illiterate people are notaware of free medical facilities available to them. It is
the duty of the government to educate the illiterate andpoor people to know about clean and healthy
environment. HS will help them to realize it.
Threats: Ignorance, poverty, unsafe food, stress,
unhealthy and unhygienic environment, spread of
diseases, non access to medical aid, lack ofawareness about diseases, unsafe drinking water,
drinking, domestic violence are some of the major
threats to health of the people especially the poorer
section.

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

Solutions: People should have access to basic
health care and health services. Community based
Health Insurance Schemes are to be promoted for thewelfare of the people. Interconnected surveillancesystems should be set to identify disease outbreaks at
all levels. Universal basic education and knowledge
should be made available on health related matters .
The Government should encourage indigenous andtraditional and modern health practices. Free medical
camps for periodical health check up could beorganized by the State and NGOs. Availability of free
medicines, operations facilities and treatment for the
economically poorer section of the people is of prime
importance… All these will be possible through HS.
Environmental Security:
India is a vast country with plenty of natural
resources. There was lot of greenery in many parts of
the nation. But over the course of time, it lost its charmdue to deforestation and environmental degradation.
Natural resources are illegally exploited. Cultivablelands are being sold for industrial and residential
purposes. Due to exploitation, there is unequal accessto resources. Deforestation has caused climate change
and water scarcity. The environment is spoilt due to theirresponsibility and lack of awareness of people.
Natural calamities like flood, famine, tsunami harm theenvironment. Lack of sanitation and water make theenvironment unhealthy.
Solutions: Natural resources are to be protected andproperly used. Forests are to be protected. Treeplantation is to be encouraged. Early warning andresponse mechanisms for natural hazards and/or manmade disasters at all levels. Indigenous or traditional
practices that respect the environment are to behighlighted. Apart from these public interests, it isnecessary for every individual to keep the environment
neat and clean. HS looks in to these angles to andsees that insecurities in environmental protection do
not exist.
Personal Security:
Every individual is expected to be protected by
his/her country’s constitution and other organizations.
The Rule of Law should safeguard individual’s rights
and liberty.
But in real practice, personal safety and security isvery much absent in a democratic country like India.
Violence in different forms (i.e.) domestic violence,
gender based violence, child abuse, dowry killing, elder
abuse, human trafficking etc., make the people feelvery insecure. Increased criminality, murder, theft,terrorism, and fundamentalism affect personal freedom
and safety. In larger scale, state violence, police
atrocities cause insecurity to individuals. It not only
affects the physical health but mental health too.
Solutions: Human rights and civil liberties are to be
enforced to protect the individuals from insecurities.
People should be aware of their Fundamental Rights
and Rule of Law. This could be made possible help in
promoting Personal Security.

Social Security:
All are the same before law and every one isprotected with human rights. But differences in castes,
creeds, languages, and religions damage the unity ofIndia. Society should be free from all differences andwork for the development of the community. Genderbias, domestic violence, inter-ethnic violence,
inequalities in the society, exploitation of themarginalized people are great threats to social security.
Solutions: Proper protection is to be given to minority
ethnic groups and weaker sections of the society.
Protection from oppressive and unwanted traditional
practices is necessary. Women’s education andemployment should be given priority to empower them.
Various social evils against women, are to be put an
end to. Free education for poor and girls, nutritional
midday meals for poor students, severe punishment for
rape and child abuse, protection of elders from abuse,
employment opportunities for women and men aresome aspects of social security. Apart fromgovernmental measures, the NGOs resources are to
be tapped for safeguarding the interests of the needy
people.
Political Security:
In all democratic countries, human rights are given
utmost importance. India is no exception. Politicalsecurity ensures every individual is entitled to enjoy
human rights. All securities could be practicable andpossible through enforcement of Human Rights.
People should be protected from abuse and military
dictatorship. Protection from political or state
repression, torture, ill treatment, unlawful detention andimprisonment are essential. Some threats to politicalsecurity are political repression, Impunity, Human
Rights violations by conflicting parties, corruption,
political violence, etc.
Solutions: Political security will be possible if good
governance prevails. Otherwise, people will suffer
because of corruption, violence, degradation of
economic standards etc. Moral values are to be given
importance, especially in administration. If there isgood administration, people will progress smoothly.
Good governance is possible, if only there are good
leaders. If they do not value ethics as representativesof the people, they live for their own progress, but notfor the progress of the people. With a clean
conscience, they must realize their accountability to thepeople who put them in power.
Conclusion
Human security is to be understood as a concept of
freedom from fear (personal, political, and social
security, etc.), freedom from want (economic, food,health, environmental security, etc.) and life with dignity(education, access to freedoms, equality, human rights,
community security, political security, etc.). It is theduty of the government to protect people from thesefears and empower them with education andemployment to lead a dignified life. It is necessary toempower the people to act on their own behalf and re-21

Eubios Journal of Asian and International Bioethics 24 (January 2014)

establish their livelihoods in a culture of peace. For thatthe human security needs of the communities in theareas of public safety, economy, environment,
coexistence and reconciliation, health, education,
training, employment and institutional support are to begiven priority. National security remains foremost in
maintaining peace and stability. But insecurities canspread rapidly and cause more intractable crises
challenging individuals and causing security threats.
With the availability of resources and advanced
technologies, insecurities could be removed easily.
Mahbub ul Haq rightly puts, “We need to fashion a newconcept of HS that is reflected in the lives of thepeople, not in the weapons of our country.“ Without
Human Security and Human Rights, it is impossible tolead a dignified life, for which HR could be seen not
only in paper but also in practice.
References
143 of the 2005 World Summit Outcome (A/RES/60/1)).
Ajai Sahni and C. Raja Mohan India's Security Challenges at
Home and Abroad, 2012.
Alagappa, Muthiah. 1998. “Asian Practice of Security: Key
Features and Explanations.”
Alagappa Muthiah, ed., Asian Security Practice: Material and
Ideational Influences. Stanford: Stanford University Press.
Amitav Acharya, Subrat Kumar Singhdeo, M. Rajaretnam
Human Security: From Concept to Practice : Case Studies
from Northeast India and Orissa, New Delhi
Amitav Acharya, Series Editor, World Scientific Series on
Human Security, Washington, DC
Ash Narian Roy, Policy: issues & actors Vol 20 no 1 Human
Security in India
Discussions & Interviews.
Gary King & Christopher JL Murray, Rethinking Human
Security.
Human Development Report for South Asia, 1999: The Crisis
of Governance, Human Development Centre (Karachi:
Oxford University Press, 2000).
Human Security in Theory and Practice, UN Trust Fund for
Human Security.
Human Security Handbook
Kanti Bajpai, Human Security: Concept and Measurement,
Kroc Institute Occasional Paper #19:OP:1, August 2000
Mahbub ul Haq, New Imperatives of Human Security, RGICS
Paper No. 17, Rajiv Gandhi Institute for Contemporary
Studies (RGICS), Rajiv Gandhi Foundation, New Delhi,
1994
Mahendra P Lama, Human Security in India: Discourse,
Practices, and Policy Implications, Bangladesh Institute ofInternational
andStrategic
Studies,
2010, ISBN
9848815287, 9789848815281.
Mallika Joseph and P.G. Dhar Chakrabarti, Nontraditional
Security Challenges in India: Human Security and Disaster
Management, NBR Report, Nov 2011.
Mallika Joseph, Human Security Challenges in India
Nicholas Thomas, William T.Tow,The Utility of Human
Security: Sovereignty and Humanitarian Intervention, In
Security Dialogue.
Step-By-Step Guide to Applying the Human Security
Approach
United Nations Development Program (UNDP). 1994.
“Redefining Security: The Human Dimension.” Current
History, vol. 94
United Nations Development Program (UNDP). 1994. Human
Development Report1994. New York: Oxford University
Press.
Paper presented at ABC14.

Emerging community ethics
and student education: A ruralcommunity experience- Sivapalan Selvadurai*, Ong Puay Liu, Marsitah Mohd
Radzi, Ong Puay Hoon, Badariah Saibeh and Nor Adlyizan
Theis*Corresponding author: Faculty of Social Science andHumanities, Universiti Kebangsaan Malaysia, Bangi,
Selangor Malaysia.
Email: sivap02@gmail.com

Abstract
Ethics of society have been found to influencecollaborative efforts of stakeholders which thenenhance student’s performance and experience. The
aim of this study is to examine the ethical precepts of
an isolated mountainous community and its success in
uplifting the students’ education. The study was
undertaken in Ba’ Kelalan village which is located in
the northeast region of Sarawak, East Malaysia. A
focus-group discussion with village heads andinterviews with teachers, ex-students and current
students were carried out. The transcribed materials
were analyzed via constant comparison method. The
findings revealed that there were several ethicalprecepts that forged the community spirit, namely theMusang tradition of collective effort, local leadership,
and teacher’s duty-bound and commitment attitude,
and preservation of local identity. Other schools candraw lessons and adapt features suited to their local
environment and shared value.
Introduction
There is a conventional view that educators havebeen viewed as change agents, but the going getstough when students do not perform well or low
achievement is the norm. This has been the case inpoor performing schools in both rural and urban
schools. Many teachers believe that it is difficult tomotivate students from rural areas as their social
environment and under-developed nature constraint
positive reinforcements and intervention measures.
Before the year 2000, absenteeism, truancy andlow performance was the norm amongst the primaryschool children in Ba’ Kelalan, a remote school in themountainous area in Sarawak, East Malaysia. Although
primary education is free the school children were notwilling to go to school because they were not interested
or passionate about education. This is attributed toparental attitude that did not prioritize education but
more on working the land and expect their children to
do the same. In fact some students were unable tocope with the learning process in school whilst someother students who were capable had poor parents
who were unable to support them. As a consequence,the school witnessed low achievement by the students
and was one of the bottom-runged schools in the
Lawas district of Sarawak.
Under the leadership of a new principal in 2001, theschool transformed from one of the lowest performing
schools in Sarawak to one of the top schools and even

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

managed to receive the prestigious Commonwealth
Education Good Practice Award in 2009. Considering
the remote location of this school in the highlands ofBorneo and the limited resources available, theschool’s success has caught the attention of theeducation community. This paper examines the ethicalprecepts of this isolated mountainous community andits success in uplifting its students’ education.
Literature Review
Community is a complex, multi-layered concept. A
community can be thought of as something that isinternal to local community (MacFarlane 2009). In
simple terms, it can be viewed as a perspective thatseeks to lessen the focus on individual agency andstructural determinism and attempts to focus oncommunal responsibilities of the local community. The
idea of community ethics came about after reading
works on community technology by Pinkett (2002) andan
attempt
atreformulating
the
idea
of
communitarianism. Community ethics can be seen asa process of utilizing local ethics and values to service
the local community by identifying their needs/goals
and providing appropriate solutions. The ethicalelements comprised of shared communal values,social norms and traditions, and considerations of thelocal community. Thus the emphasis is the influence of
local community on individuals and asserts that values
are embedded in common history and tradition(Beauchamp and Childress 2001).
Tam (1998) suggests that community value (orcommunitarianism as asserted) is based on threeprinciples: i) communities of co-operative inquiry, ii)
common values that underpins mutual responsibilitiesof all community members, and iii) citizens’ equal
access and participation in the power structure ofsociety.
The process of educational transformation has also
been viewed from a participatory perspective
attempting to provide localized education inestablishing anti-colonial education (Freire and Macedo
1987 in Sefa Dei 2008). Few studies have examined
how local subjects such as teachers, parents andcommunity utilize their local community ethics tounderstand and engage educational change in
improving student achievement and how educators
respond (in classroom instructional and discursive
practices) to the diverse needs and local knowledge ofstudents under difficult conditions (Sefa Dei,
2008:188).
The process of inculcating community ethics
requires community engagement and collaborative
efforts. According to Pinkett (2002), community
collaboration in schools can be viewed from an insider
or outsider perspective. An insider perspective involves
the internal actors, comprised of neighborhood
residents and governing boards who manage theresources and expertise of researchers, funders andtechnical assistance providers to achieve the school’s
goals (Pinkett, 2002: 222). Meanwhile an outsider
perspective includes non-residents attempting tosupport and learn from the community members andorganization in fostering ownership and empowerment
amongst them, thus reducing their reliance anddependence on others. The ideal situation forcommunities to collaborate is where the schools arepart of the community and they have to truly work
together as partners where the needs of both parties
are met and the community’s capacities arestrengthened as a result of this partnership.
Past studies have shown that when schools
develop programs for family and community
partnership, the likelihood of increasing parental
involvement and its impact on children witnessed
improved achievement or performance as well as
better discipline especially in reducing absenteeism(Sheldon, 2003 in Sheldon and Epstein, 2004).
However, a study by Zellman and Waterman (2001)
appears to suggest that formal programs of parental
involvement do not appear to improve child outcomes.
But they suggest that it depends on the individual
parental enthusiasm and positive parenting style.
Meanwhile, Philipsen (1996) asserts that parental
involvement is shaped by parent-school relations and adecisive factor in parental involvement is the extent towhich they felt a sense of ownership over the school.
Both these studies suggest that local social relations(i.e. informal ties) and extent of local shared norms
matters in shaping educational outcomes.
In a broader sense, Sefa Dei (2008) in dealing withthe disadvantaged African Canadian students in
Ontario, Canada, suggests the need for education tocultivate a sense of identity within local culture andcommunity. Thus he proposes several measures in
educational reform in public schools: (a) effective
method of teaching diverse student needs, (b) create
opportunities for the needs of the disadvantaged
groups, (c) encourage schools to establish close ties tothe community, and (d) help students build theiridentities in terms of self, collective, and cultural
identities within their social environment. Here the ideaof community ethics is enhanced where the interactionof the school with local community, not only in terms of
its teaching and learning process should reflect local
diverse needs, but it promotes ties and connects withthe local community’s identity and resources.
Previous studies in Malaysia have examinedcommunity partnership with university-initiated action
research for remote rural community from the use of
ICTs (Harris, 2002) but few studies have examinedcommunity ethics as a vehicle for student’s educational
enhancement.
Study Area and Method
Ba’ Kelalan is a rural mountainous community
located in the district of Lawas in the northeastern partof the state of Sarawak, Malaysia. The closest town
and city includes Lawas and Miri. The name Ba'
Kelalan originates from the word "Ba" meaning paddy
while Kelalan is the name of a river and thus refers to
the wetlands suited for paddy planting. Ba' Kelalan
comprises of nine villages, all located in the highlands
about 3,000 feet (910 m) above sea level. The villages
are Buduk Nur, Long Langai, Long Lemumut, Long

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

Ritan, Long Rusu, Pa Tawing, Buduk Bui, Buduk Aru
and Long Rangat (see Figure 1). Ba’ Kelalan has avery small population comprising about 1500 people
who are Christians of the Sidang Injil Borneo
denomination. The majority of the people living in Ba’
Kelalan belong to the Lun Bawang tribe, formerly
known as the Murut people found in central Northern
Borneo. Besides Ba’ Kelalan, the Lun Bawang people
are also scattered in Lawas (Sarawak), Limbang(Sarawak), along the borders in Long Bawan(Indonesia) and are also known as Long Dayeh people
in Sipitang-Beaufort area (Sabah). In Sarawak, the Lun
Bawang people belong to a sub-group of a minority
ethnic group known as Orang Ulu who comes under
Dayak native people category. The other major Dayakgroups in Sarawak comprised of Iban, Bidayuh andMelanau.

Figure 1: Sketch Map of Bekalan
Source: Anonymous 2010. A trip to Ba'kelalan, Sarawak,
My story, July 15, 2010 http://mypleasantstory.blogspot.com/
2010/07/trip-to-bakelalan-sarawak.html

With water supply from the Kelalan river, thecommunity has created well-irrigated paddy fields in
Buduk Bui and Long Langai, and cultivated smallgrained “Highland Adan Rice” which has fine andsweet grains. Besides rice, mountain salt is obtained
from the salt water wells in the nearby hills and this has
been an important source of revenue for someresidents. Tourism has increased in recent years withthe promotion of apple farming though its activities areseasonal. The first Apple Fiesta in Malaysia was heldin Ba' Kelalan in 2007. It has become an annual eventand tourist attraction, based around the Apple Lodge in
Buduk Nur. Ba' Kelalan also has a 9-hole natural golfcourse, and the settlement is also accessible forvisitors to neighbouring Kayan Mentarang National
Park in Krayan, Kalimantan in Indonesia.
Prior to 2009, road access to Ba’ Kelalan from the
nearby town of Lawas was via a 125 km former
logging trail using four-wheel drive vehicles. Depending
on weather where road conditions can be particularly
bad in the rainy season, the journey can take fromeight hours to two days. In September 2009, thefederal government of Malaysia approved RM50 million
for the first construction phase of a road from Lawas to

Ba’ Kelalan to facilitate access and cutting short thejourney within three to four hours. Another key mode oftransport prior to the highway construction was air
travel. Ba’ Kelalan Airport has flights to and from Miriand Lawas using 19-seater DHT aircraft that serve thelocals and tourists alike. The half-hour flight by
MASWings from Lawas to Ba’kelalan is available threetimes a week. There is also a 55-minute MASWings
flight from Miri to Ba’ Kelalan every Wednesday.
The method used to collect information entails a
focus-group discussion with village heads andinterviews with teachers and students.The transcribedmaterials were analyzed via constant comparison
method to elicit appropriate themes.
Findings
There are several community ethical values thatwere introduced into the school environment toencourage the participation of the community thateventually led to the enhancement of the school
children’s learning and performance. These ethicalvalues include: firstly, Musang is a collective effort
external to the classroom, secondly, the Community in
the Classroom (COMIC) program is a collective effort
inside the classroom, thirdly the local leadership of theschool administrator, fourthly the commitment andduty-bound nature of teachers and finally, thepreservation of local identity.
Musang as the tradition of collective effort
The Lun Bawang people in Ba’ Kelalan live a lifethat is closely associated with nature. Its fertile valley isvery suitable for paddy cultivation. As Ba’ Kelalan is
located in a remote mountainous region, it is isolated
and detached physically and communication-wise fromthe outside world, resulting in the Lun Bawang
community living in a close knit manner. Out of thisphysical setting/context arose the tradition of Musang.
Musang means “working together to accomplish acomplex task” (SK Ba’ Kelalan 2009). As things weredone manually, such Musang collaborative practices
are very crucial as complex tasks can be accomplishedwith ease with the participation of many people (SK Ba’
Kelalan 2009). Musang refers to the tradition ofcollective effort and culture in working their paddy fields
and has become an innate character of the Ba' Kelalanpeople (Amrizan Madian 2013). This is a Lun Bawang
teamwork tradition where an “individual or a family
appeals to the surrounding community for assistance incompleting a complex task” (Blair 2010). This tradition
has been extended to collective activities in otherspheres of life such as clearing land or in organising
events (Amrizan Madian 2013).
Realizing the potential asset of this tradition, Mr
Pudun, the principal of the primary school from 2001 topresent, mobilized the local community’s voluntary
service or Musang in uplifting the school’s predicamentin terms of lack of human and physical resources. The
school undertakes special projects that require many
volunteers (physical strength) and specific skills suchas carpentry. The assumption is that the community
posseses certain skills and these skills can be utilized24

Eubios Journal of Asian and International Bioethics 24 (January 2014)

to accomplish varying tasks as well as difficult tasks.
As such the school collaborates with the Parents
Teachers Association (TPA) to obtain the consent for
their participation in the Musang Program. The Musang
program entails the school administration to identify
projects to develop and beautify the school compound.
It then seeks the community’s voluntary service to
execute the projects and subsequently persuade themto undertake their own activities to allow them to evolve
their own creative strength. The respective village
volunteers are assigned to a particular area of theschool compound and are expected to improve thearea. Some examples of such tasks include cleaning
up their areas, plant flowers and trees, and in someoccasions, erect huts.
The Community in the Classroom ( COMIC) project
There is sense of the urgency in narrowing the gap
in educational attainment between the urban and ruralschools and one of the mechanisms introduced was
the partnership between the school and the local
community. The Ba’ Kelalan Primary School being asmall school realized the need to activate the role ofthe community in developing the school toward asustainable excellence level. The school is constrainedmaterially in terms of funds and human resources.
Limited funding added constraints in providing
adequate infrastructure and facilities that can provide a
comfortable and lively environment for the children.
Meanwhile the limited number of staff and students
constrained the school in undertaking projects that
require longer duration and adequate human resourcesto accomplish these projects. Thus the school
administrators realize the need to involve thecommunity directly in developing institutions and norms
that can create a feeling of sense of belonging.
The COMIC (Community in the Classroom) project
entails the participation of community volunteers
comprising of students’ parents, community leaders
and residents of Ba’ Kelalan irrespective of whether
they are young or old. In the COMIC project, thevolunteers from the respective villages work inside theclassrooms rather than on the school compound as in
the Musang program. The classroom refers to not only
the year 1 to year 6 classes but also the rehabilitationand pre-school classes. Each village is assigned to aclassroom and is expected to beautify it in a way
appropriate for the respective age cohort of students
who occupy the classroom. The volunteers havecreated mini ‘huts’ at the back of each classroom andequipped them with relevant pictures, posters, andreading materials. The huts’ designs reflect the uniquearchitectural craftsmanship of members from thevarious villages and provide a unique physicalenhancement to each of the classrooms. The
representatives of each village are expected to comeperiodically for maintenance and improvement of theirassigned areas. An interesting feature of this programis the participation of residents who might not haveschool going children. The inclusiveness of themembers of the local community participation suggests
a commitment towards community building through the
projects.

Local Leadership and Vision
The local leadership led by the school principal Mr.
Pudun and group of committed staff and teachersbegan to believe that academic excellence wasattainable, no matter what the circumstances were. Ina short time, this belief spread to the students and thento their parents as they witnessed improved exam
results and growing enthusiasm for learning in theirchildren. As the parents came on board through thetwo signature programs, Musang and COMIC, they
began to volunteer their time and talents to improve theschool under the direction of the school administrators.
As the local community actively participates, thecreativity of the local community was set free and theschool’s appearance, inside and outside theclassroom, was transformed.
Teacher’s Duty-Bound and Commitment
According to a senior teacher, many children in the
primary school prior to 2001 were not interested in theirstudies or learning process due to: i) lack of motivationfrom parents who themselves lack adequate level of
education, ii) the social environment in the rurallandscape does not encourage and expose thestudents to learning new things, and iii) students
encounter boring teaching and learning methods.
As such the school administrators sought toimprove the situation by encouraging the teachers tobring the learning process outside the classroom tostimulate the students’ interest. For example, one of
the senior teachers provides some examples such as
bringing students to the paddy field to see how the
buffalos were utilized to plough the field, as well as
identifying types of woods available in the neighbouring
forest. This engagement and familiarization processwith the local village environment encourages thestudents to appreciate the knowledge obtained. Thislearning method has also managed to reduce thestudents’ feelings of boredom in school as well assustained their interest in the subject matter. In fact
one of the village heads (Mr M) asserts that, “thechildren like to go to primary school in Ba’ Kelalanbecause of the teaching method [outside theclassroom] which attracts their interest and attention inlearning and when they go to secondary school (inLawas) they appear to be disinterested in learning
because of the conventional teaching method.”
The teachers are also committed to uplift theperformance of students by undertaking the following
activities (Blair 2010):
a. special instruction in the afternoons and evenings
so as to give weaker Year 6 students an opportunity tosucceed on par with their peers on the UPSR (Year Six
examination) .
b. Undertaking test-taking strategies and providing
adequate sample exam questions for practice bycoaching Year 6 students so as to improve the school’s
overall UPSR (Year 6 exam) results.
c. Provide incentives for students to read books ontheir own outside the classroom so as to develop goodreading habits.
d. Daily repetition of memorization exercises for
multiplication table so as to ensure students’ mastery.

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

e. Create more opportunities for English interaction byencouraging university graduates from Englishspeaking countries to come to BKPS for several month
stints as volunteer teachers. This approach wasundertaken to motivate the students to speak English
more in school.
f. Recognizing the student’s sporting talents early andcoaching them effectively so as to groom excellent
athletes.
g. Providing remedial instruction outside of classroom
so as to help weak students master the basic
necessary skills of reading and writing.
h. Students given daily chores and responsibilities so
as to develop their independence, responsibilities tocare for themselves
i. Motivational presentations by teachers and outside
visitors so as to keep the students continuously
motivated to do their best.
j. Leadership training for potential selected prefects
so as to build leadership capabilities and inculcating
adequate responsibilities.
Each program is routinely monitored and adjusted
under the direction of a different staff member. Also
almost all students reside in the hostel and it is easierfor the teachers to monitor them. Unlike parents ofchildren in conventional urban schools commonly
utilize private tuition to give their children extra
instruction outside of class, the programs in Ba’
Kelalan primary school takes place inside the school
compound and the students receive school assistance,
without any charge.
The Ba’ Kelalan Primary School has certain
features which give it an advantage over other schools.
There are few enough students in each class that thedesks can be arranged in a U-shape, leaving an open
space in the center. This facilitates better interaction
between the teachers and students and among thestudents themselves. Teachers often invite the pupils
to sit with them on the floor and approach learning
more informally. Recognizing that these young
students are away from their parents in the boarding
school and the children go home every weekend, theteachers try to relate to students more like parents sothat the children feel comfortable. This is all part of theadministration’s goal of the school being a home awayfrom their homes. This policy has been successful toensure that all students stay in school without using
coercion approach. In general, the teaching staff arecommitted and take full advantage of their 24-houraccess to the students by planning various extra
activities for them to learn beyond the daily classschedule.
Preservation of local identity
According to one of the village heads (Mr M), there
is a change in the mindset of the parents in sending
their children to schools. Previously parents tended not
to send their children to school because both of themwere working and there was no one to care for their
younger children. They also feared that if their children
were to study in school and then progress tosecondary schools or colleges, they would migrate andleave their parents alone. In fact one village headsuggested that they had this perceived idea that it
would be better for their children to settle down and get
married early. However, such mindset has changed inrecent years as the parents have greater awarenessand are more open in sending their children to school
because these children can secure better jobs andpay. In fact the parents are willing to sacrificeeconomically by not only paddy planting but also
rearing buffaloes to support their children’s education
up to the secondary level.
Because of the remoteness and relative
backwardness of Ba’ Kelalan, the children are notexposed to those harmful elements of urban society.
Television, movies, and video games which can betime-wasters are not available, so the students read orplay inside and outside their homes or school forentertainment. With unspoiled tropical rainforest in thevicinity, the students tend to take an interest in theirlocal environment. The Parent Teacher Association of
the Ba’ Kelalan primary school constantly seek out forbooks and financial assistance. Together with thesignature programs of Musang and COMIC, the local
community is able to preserve its local values andtraditions and inculcates the spirit of local identity.
Conclusion
The case of Ba’ Kelalan Primary School illustrates
how a remote school in a mountainous area cantransform with the partnership of educators andcommunity and innovative local leadership. This caseillustrates how the quality of education can be madeavailable even in a remote and disadvantaged school
when the school undertakes community ethics
involving not only the schoolgoing children’s parents
but also the wider community to inculcate local values
that inspire and motivate the students to perform
academically and finding their self-worth. As aconsequence of these efforts the school achieved
academic excellence and depth in co-curricularexperience. With active and innovative leadership ofeducators and a culture of excellence the school has
managed to transform. Though some of the reasons forthe school’s success are unique to Ba’ Kelalan and are
not transferable, the key attributes of community ethics
played an important role. What this case study reflects
is that educators not only execute their daily teaching
duties but also have an added responsibility to help
families and communities or be part of community sothat they become involved in reducing absenteeism aswell in improving performance of students especially inacademic achievements.
From the findings it can be seen that the informal
nature and the idea of incorporating the local culture
played a role in activating the students enthusiasm inlearning. Zellman and Waterman’s (2001) finding
suggests that formal nature of programs does not havepositive impact on parental involvement. This parallels
our finding where the programs though they appear
formal, have an informal nature of participation.
Drawing on local culture triggers active local
participation as the people feel and draw on their

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

tradition and a sense of attachment is cultivated. As
such integrating the local cultural values enables these
programs to be successful.
The moment the participation of the students’parents is viewed as following the local cultural value,
the enthusiasm of the parents’ involvement is activatedresulting in a sense of ownership over the school. In
fact the relevance of school curriculum was further
enhanced when the teachers relate the curriculum tooutside classroom and the students’ interest were
rejuvenated resulting in the students’ attachment tolocal knowledge and locality. In short, both parental
involvement in school and student engagement inoutside classroom activities enable a sense of local
attachment to evolve.
This case illustrates that schools which want toemulate the success of this primary school can draw
lessons from the activities and programs carried out,
as well as utilize local values to solicit involvement of
their communities. There must be shared vision andpassion to strive for excellence under transformational
leadership. The students, parents, and staff of any
school must believe in their potential and insist that no
obstacles can be an excuse for poor performance.
Acknowledgements
The writers wish to thank the Ministry of Education Malaysia forproviding support to the research group on “Social Cohesion throughthe 1R Concept in Education of Malaysia’ (LRGS/BU/UKM/CMN/01)
under
the
research
programfor
SocialCohesion((LRGS/BU/UKM/CMN).

References
Amrizan Madian 2013 Ba'kelalan The "Wind Peak" With
UntoldSecrets.
Bernama.
June
1,
2013
http://www.bernama.com/finance/news.php?id=415020
Ba’kelalan Primary School (SK Ba’kelalan) 2009. Cluster
school of excellence:Musang Program. Be’kelalan,
Sarawak : Parents Teachers Asociation.
Beauchamp, T.L. and Childress J.F. 2001. Principles ofBiomedical Ethics . New York: Oxford University Press.
Blair, 2010. Outstanding Education in Marginalized
Communities: The Ba Kelalan Story. Blair’s Travel Blog.
Sunday,
March
28,
2010
http://blairdaly.blogspot.com/2010_03_28_archive.html
Harris, R. 2002. Research partnerships to support ruralcommunities in Malaysia with Information andcommunication technologies. In Lazar, J. (ed) Managing
st
IT/community partnerships in the 21 century. Hershey,
Pennsylvania: IGI Global. doi:10.4018/978-1-93070-833-4
Macfarlane , B. 2009. Community as an academic ethic, In
Strain, J., Barnett, R. and Jarvis, P.(eds.) Universities
ethicsand professions: debate and scrutiny, : NewYork:
Routledge.
pp.
69-80.
http://web.edu.hku.hk/staff/bmac/docs/Community_
as_an_ Academic_Ethic.pdf
Philipsen, M.I.D. 1996. Parental Involvement in Schools:
Case Studies of Three High Three High Schools in aSoutheastern
Metropolitan Area. Richmond, Virginia: Metropolitan
Educational
Research
Consortium(MERC).
http://books.google.com.my/books?id=cWDySAAACAAJ
Pinkett, R. D. 2002. Creating Community Connections:
Sociocultural Constructionism and an Asset-BasedApproach to Community Technology and Community
Building in a Low-Income Community. Unpublished PhD

thesis. Massachusetts: Massachusetts Institute ofTechnology.
http://crcp.mit.edu/documents/pinkett_thesis.pdf
Sefa Dei, G.F. 2008. Schooling as Community: Race,
Schooling, and the Education of African Youth. Journal ofBlack Studies, 38, 3: 346-366.
Sheldon, S.B. and Epstein, J.L. 2004. Getting students toschool: using family and community involvement to
reduce chronic absenteeism. The School Community
Journal, 4,2: 39-56.
Zellman, G.L. & Waterman, J.M. 1998. Understanding the
Impact of Parent School Involvement on Children's
Educational Outcomes. The Journal of Educational
Research,
91, 6:
370-380.
DOI:10.1080/00220679809597566
thPaper presented at 14 Asian Bioethics Conference inrdChennai (India) 19-23 November 2013

Engineered pathogenesis
related protein crops andconsumer behavioral patterns- Bengyella Louis
Department of Biotechnology, The University of Burdwan,
Golapbag More-713104, Burdwan, West Bengal, India.
Email: bengyellalouis@yahoo.fr

Abstract
The transmutation of classical genetics into in vitro
recombinant DNA (rDNA) technology didn’t only
provoke wariness, but divided the consumer society as
some past economic crops were modified into
engineered pathogenesis related protein crops(EPRC). However some pathogenesis related proteins(PR) are life-threatening allergens for those vulnerable,
and thus food toxins. The consumer society as a whole
since the inception of rDNA technology in agriculture ispolarized by the emergence of a new breed of
consumers referred herein as the ‘contransgenimers’
and ‘transgenimers’.
Profiling ethical issues and concerns over EPRCconsumer behavioral pattern is based on the potential
evils of PR vis-à-vis human health. Are EPRC ‘redgoods,’ ‘red-flag’ or a debacle to human disintegration?
Can consumers rollback from EPRC or transgenic
crops (TC) as a whole? Results show thedetermination of our EPRC-body compatibility prior to
the recombinant DNA technology green revolution
culmination by 2015 maybe the way forward. This may
probably confer virtue to our entelechy and subsequent
reclassification within the dominant consumer
mainstream of ‘contransgenimer’ and ‘transgenimers’.
Oversight to this before the expected zenith of thisrevolution in 2050, as anti-labeling of food-stuff, world
population, food demand and inaccessibility for food on
the raise will cost lives.
Key words: Pathogenesis related proteins, allergens,food toxin, ‘contransgenimers’, ‘transgenimers’.
Introduction
Humans lived before the inception of rDNA crops as asocial group thriving omnivorously on conventional

27

Eubios Journal of Asian and International Bioethics 24 (January 2014)

crops and animals solely. Crop improvement using PR
led to the creation of engineered PR crops which
ignited a polarization among consumers.
In a broader sense, a consumer is an ecologicalcommunity or food chain with organisms that feeds onother organisms or on material derived from them.
Equally, the most acceptable definition for PR is that ofpolypeptides with relatively low molecular weights(10,000-40,000 kilo Daltons) that if not broken down
might accumulate extracellularly in infected tissue,
exhibit high resistance to proteolytic degradation, andsome possess extreme iso-electric points (Van Loon,
2006). A red-flag for EPRC consumption for people
with allergies came with the Brazilian nut soya beanssaga incident (Nordee et al., 1996), USA food corn
contamination by Starlink corn (Marvier, 2007), Filipinoallergic crisis marked by victims producing antibodies
to Bt-toxin (Aglionby, 2004) and India allergy cases
handling Bt-cotton and cotton oil (Gutpa et al., 2005).
Enhancing plant resistance or protein enriching
conventional crops involve the intricate use of‘plantibodies’ or better still, PR and other antimicrobial
proteins and their chimera ‘transgenes-construct’ in astate-of-the-art in vitro RDT by biotechnologist(Bengyella and Pranab, 2010). This method of crop
improvement ultimately leads to EPRC in particular andtransgenic crops in general. Complications andallergenicity related to PR were profiled by HoffmanSommergruber (2002) and updated by Bengyella(2011) as depicted in Table 1.
As a prologue, it’s important stating that PRs interact
with allergens from different sources and represents
the molecular core for allergic syndromes as depictedon the table. Furthermore, allergic patient abnormally
produces specific Immunoglobulin E (IgE) after inhalingor eating foodstuff with nutritive allergens. Divergedpolarization over EPRC had resulted to different
behavioral patterns viz: 1) Those feeding on non-GMO
food only, (2) Those feeding on transgenic crops as
well. This paper ethically peruses the social structure of
consumers; their organic behavioral pattern to EPRC
and predicts stakes by 2050. Finally, and perhaps
interestingly; this work probes into the genomic andproteomics level, unveiling the possible reasons for
introgressed PR involvement in allergenicity.
Profiling EPRC - consumer’s behavior pattern
Although, early consumers behavioral pattern was
aimed at avoiding EPRC and transgenic crops,
receding production of conventional crops haveprompted them into open circumstantial circle of either
feeding on EPRC or both EPRC and conventional.
Some freethinkers (referred herein as group-A)
fundamentally consent to the consumer behavioral
pattern related to EPRC, based on the dangers
associated with the high rate of world population
growth, the need for food fortification and decreasing
farmland due to biotic and abiotic factors. Meanwhile,other freethinkers (referred herein as group-B) question
the future human viability or decadence upon
consumption of EPRC’s and the non respect of the“natural” order or intrusion into the genomic dogma.

Table 1: List of pathogenesis related proteins in crops
involved in allergenicity
FamilyDesignee
Plant source
Allergy
of PR
PR
name
PR-2

βGlucanase

PR-3

Class I
Chitinases

PR-4

Class II
Chitinases
Thaumatinlike proteins

PR-5

PR-8
PR-10

PR-14

Class III
Chitinases
Ribonuclea
se-likeproteins andBet v I
homologues

Lipidtransfer
proteinsHevea
brasiliensis latex,
bananaAvocado,Chestnut, H.
brasiliensis Latex,
bananaH. brasiliensis
latex, turnip
Cherry, apple,
bell pepper,
mountain cedar
H. brasiliensis
latex
Birch, hazel,
alder, hornbeam,
chestnut, apple,
celery, peach,
apricot, pear,
carrot, potato,
parsleyPeach, apple,
soybeans, apricot,
plum, cherry,barley, H.
brasiliensis latex,
chestnut, hazel,
walnut, mugwort,
ragweed,asparagus, grape,
maize, olive

Hev b2

Pers aI, Cas
S5, Hev bII

Hev b 6
Pru av2,
Mal d2, Cap
aI, Jun a3
Hevamine
Bet vI, Cor
aI, Aln gI, Car
bI, Cas SI,
Mal dI, Api gI,
Pru av I, Pru
PI, Pru arI,
Pyr cI, Dau
cI,STH-2,
PcPR-I
Pru p3, Mal
d3, Gly mI,
Pru av3, Art
v3, Amb ab,
Par j I, 2, Cas
s8, Cor 8,
Jug rI, Asp
OI, Vit vI, Hev
b12, Zea
m14, ole e7

EPRC’s and its mass production came as a
psychological blow to the skeptical consumer society
and warier moral freethinkers; and raised excitement
amongst adventurous consumers and optimists in thequest for new flavours, fortified nourishments,
fragrance and feeding stimuli. As for the status quo, it
was quite exciting to hear cotton clothes were bearer of
introgressed Bt Cry-genes. Intrepidly, that transgenic
potato carried osmotin gene, a PR under the control of
35
the Cauliflower mosaic virus
S promoter andconstitutively expressed in edible potato (Liu et al.,
1994; reviewed in Bengyella and Pranab (2010)).
Group-B, strengthened by anti-transgenics angstridden, question the Human physical decay at a corefundamental level as a principal consumer, within an
already disequilibrated ecological system. Can thepolarized consumer society expect any noticeable
decrease in PR’s and other engineered proteins in our
foodstuff in the future?
The answer is seemingly yes, if the whole consumer
society within a given biota stringently rejects
rDNATGR. Unfortunately, this appears impossible inthis era where gigantic world economies are driven bytransgenic technology with policies differing from one
country to the other. Moreover, bioprospection andgene-mining for the obvious creation of new transgenic
crops apt to counteract biotic and abiotic stresses on

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Eubios Journal of Asian and International Bioethics 24 (January 2014)

land where conventional crops have failed to propagate
are on the rise. Probing into proteomics law of ‘onegene-one-protein dictum’ and considering that eachengineered PR salvages only one abiotic factor suchas high salinity, drought, fluctuating high temperatureetc, and mindful of the continuous spread of thesestress factors; neither consumer nor land will escapefrom engineered PR crops by 2050. The amazing 2007
results from the human genome project revealed thatthe human genome could actually code for many more
proteins than the number of available genes (ENCODE
PROJECT CONSORTIUM, 2007). This severelycompromised the ‘one-gene one-protein dictum’ andthe forward create wariness as to the type, quantityand quality of protein each consumer will ingest per
meal. Group-B school of thought believes further
engineering of PR encoders in economically important
plant will be an oversight swap deal for consumer’shealth; instigated by shysters.
Are engineered PR crops evil? What degree of evil
are they; and of what nature? Consider two
circumstantial people, one in a war-torn zone andanother in a peaceful zone; both inflicted by lethal
hunger. If these individuals are rescued with foodsupply, consumption is evident for the different spheresof people for hunger is the bottom-line issue andsurvival is unequivocally the ultimate goal. These
individuals will never raise the question of allergenic
PR, land ethics or the farmland used for cultivation of
the foodstuff. This hypothetical consumer behavior isreproducible in all circumstances provided the subject
is prone to acute hunger. This raises the question howevil is EPRC’s? If EPRC’s are an evil for all, it cannot
be because of its positive virtue, but uniquely becauseof what it deprives us of; and per se health. Evidently,
Human health is the polarizing issue. Although PR
harmful potentials have been limited to allergies,
allergies are recognized as disease affecting
approximately 25% of the total population inindustrialized countries of northern hemisphere(Hoffmann-Sommergruber,
2002).
This
has
strengthened group-B doomster views on the harmful
potency of engineered PR in economical crops and into
the human food chain. Group-B freethinker’s diehard
rejection of EPRC’s and their paradoxical consumptionof animals fed with EPRC’s put their consumer
behavioral pattern into jeopardy. This behavioral
pattern may be equated to refusing the devil andaccepting a legion of demons, if and only if EPRC’s areevils. Interestingly, the body composition and allanthropometric parameters of every being aredetermined primarily by food intake content. Hence,Group-A school of thought had tendentiously qualified
bugaboo’s related to engineered PR crops emitted bymoral philosophers and ethicist as a whole as ‘antitech’, ‘jeremiad’ and ‘pusillanimous changers’.
Scientific angling for EPRC’s shows the goodelements are plentiful and overweigh bad elements.
Should we abandon this technology because of its
risks? Food security related issues loom over the Earthalready. Projections into 2050 show an absolute foodscarcity if nothing is done now to salvage 11 billion

people, excluding domesticated animals. Within thetime frame of 2014 to 2050, survival is eminent indeveloping countries facing chronic food security
problems. Is it morally right to see the over two billion
world population impoverished and malnourished with
rDNATGR in our hands? Are moral freethinkers
advocating for Human misery by refusing rDNATGR
and it products or simply protecting their stances in thedebater’s animato echelon?
Everything being equal, group-A freethinkers argue
that the value of life on earth does not and should notdepend on organic survival of humans solely, but
indispensably the viability of all the other components
which interacts directly or indirectly with humans inharmony or disharmony, but ensuring the equilibrium of
our being and the ecological system. Kick starting fromthis stance, limiting our food to conventional crops will
be tantamount to questing for humankind organic
survival solely by 2050. This excludes the fact all
domestic animals depend on Man agricultural produce.
Hence, the art of improving plants is simply aconcession of rendering Man more Humane to fellow
Man, and other living things in ‘the natural order ofthings’.
‘Removed PR, I’ll eat’; ‘Give me free allergic crops’,‘To hell with shyster biotech crops’ etc, are epitomized
anti-transgenic slogans. Do consumers really shy-awayfrom biotech crops? A hungry man is an angry man
and can not distinguish between biotech andconventional crops especially in troubled zones
characterized with energetic food dumping. Scientists
have demonstrated that food allergies are not unknownwith conventional crops; giving an upper hand togroup-A school of thought. Scientific evidence has
limited EPRC’s evils and potential of their evils tohumankind at the level of allergic reactions; whichsolely depends on an individual sensitivity. The trend ofthings depicted in figure 1 is a favorable variance for
EPRC’s acceptance.
Initially, conventional crops had one luxurious
consumer
population;
whichI
christened‘normoconsumers’. EPRC’s acceptance tenor has
instigated many consumers to also add EPRC’s in theirbiota. I call this consumer behavioral pattern, the‘contransgenimers’. While optimistic consumers
feeding solely on transgenic crops (in the future when
all crops are modified) from the inception of thetechnology
inagriculturearehereincalled‘transgenimers’. Moreover, criticisms of rDNATGR are
scientifically unproven and are merely fears,
unmatched to those associated to nuclear technologies
and health. Group-A freethinkers see abandonment asa far-fetched issue. If the technological overhauled was
possible, what will become EPRC-junkies? Worries are
drifting from ethical issues solely to biosafetymeasures, among which labeling of biotech products
before deployment into the market is a key issue. This
offers the polarized consumer society the choice tochose their food.
It’s important to note PR are plantibodies produced
constitutively
andinducedduringplantphytopathogenic and some plant-abiotic factors

29

Eubios Journal of Asian and International Bioethics 24 (January 2014)

specific interactions both in transgenic and inconventional crops. PR existed before the advent ofrDNA technology in agriculture. Moreover, plantvaccines are now widely appreciated in developing
countries due to the antimicrobial properties of PR andrelated introgress genes in plants (Pribylova et al,2006). Furthermore, bias trade mark by infiltration of
unlabeled engineered PR crops into the market
exposes ‘transgenimers’, diehard ‘normoconsumer’
and pusillanimous ‘contransgenimers’ for consumption.
‘Qui vive’?
Outlook
Post-transcriptional, post-translational modification,
gene interaction and overlapping are probably the root
causes for the failure of the ‘one-gene one-protein
hypothesis’. This implies scientists cannot affirm withcertitude the product of each introgressed PR encoderin crops based on revelation from the human genome
project, creating a tense consumer society. However,
optimistic consumers overlook the failure of the onegene one-protein model; and challenge the verificationof its lapses if they exist at the plant genomic dogma. If
the evil of engineered PR is allergenicity and foodpoisoning, then nascent proteins must undergo somedeformities due to: 1) wrong or antisense introgression
process, since it’s usually probability-randomized
event, (2) Systemic quenching of introgressed PR
genes and activation of pseudogene families probably
by mutation some incorporating methods confer to thehost genome, (3) Absence of appropriate chaperones
molecules to mediate processing and targeting leading
to novel malformed PR. This malformed PR can exhibit
malicious and erroneous metabolic function upon
consumption. All these suggestions shed light why PR
is present in conventional crops but few has high level
allergenicity and food poisoning. Hence, responsible
and purposeful consumption of EPRC is highly
recommended.
Logical evidence shows ‘transgenimers’ and‘contransgenimers’ are the direct polarization scars left
by EPRC’s and transgenic crops on the consumer
society. Has EPRC’s brought evil unto humankind? I
argued it has brought us diversity, freedom, availabilityof quality and quantity crops to both ‘contransgenimers’
and ‘transgenimers’. After all, Man is supremely
indispensible in ‘the natural order of things’ and in thereconstitution of things in ‘the nature order of things’;
and must thrive from the best within or around his foodchain. This supremacy is referred to in Genesis 1: 26,“Then God said, “Let us make mankind in our image, in
our likeness, so that they may rule over the fish in thesea and the birds in the sky, over the livestock and all
the wild animals, and over all the creatures that movealong the ground.” Paradoxically, humans was nevergiven powers to control plants, modify nor create newones; except eating them in their natural form as food(Genesis 1:26; 9:4). Man and his nature are mutable.
Tolerance to biotech crops, availability of biotech crops
and purchasing power of consumers will definitelydetermine the proliferation of the consumer behavioral
pattern by 2050 i.e. incontrovertibly becoming‘contrangenimers’, ‘transgenimers’ or remaining‘normoconsumers’. If we denote contemporaryconsumer population size by a, b, and c representing
the tendentious consumer behavioral patterns i.e.
‘transgenimers’,‘normoconsumers’and‘contransgenimers’ respectively, as depicted in Figure
1.

Then, now characterized by food security related
issues, |b|˃|a| and |c|˃|a| ↔ |b|˃|a|˂|c|; based on the factthat most countries back in time of rDNATGR inception
applied a skeptic transgenic application policy.
Secondly, most of these countries are developing andover-populated. Hence, cheap available crops aretransgenic ones. If we consider ‘transgenimers’ and‘contransgenimers’ are tolerant to engineered
pathogenesis related proteins and conventional crops.
Then, ‘transgenimers’ {a} for now are a subset of‘contransgenimers’ {c} due to its continuous growthrate, and that ‘normoconsumers’ {b} population
decreases as market influx of transgenic crops
increases with widespread application of rDNATGR
and biased trade of biotech crops. Hence, c Í a or a Êc. Therefore, by 2050 projected to be characterized byfood scarcity and population enlargement; the net
population behavioral size feeding on transgenic crops
either partial or entirely will be |a + c| ˃˃|b|. Unarguably,‘contransgenimers’ will dominate the consumer society.
A psychological challenge for detractors of transgenic
technologies to accept; but reduce to the option offollowing the change itself. The deviant behaviors
favouring some ‘normoconsumer’ thriving on both TC
and CC; and becoming ‘contransgenimer’ is thewidespread tendency. This voluntary or involuntarytransformation as the case may be is inevitably thequest to override the lapses of traditional
nourishments. A phenomenon I call ‘sweet
equilibration’. Hence, allergies payback for our divine
defiance of the nature order of things? For the time
being, tolerant ‘contransgenimers’ and ‘transgenimers’
will continuously flow with transgenic crops in generaland EPRC’s in particular. Mindful allergies are notcaused solely by biotech crops, but even by organic
dust particles responsible for allergic alveolitis
diseases:Are
youa‘contransgenimers’,‘transgenimers’ or ‘normoconsumer’?

30

Eubios Journal of Asian and International Bioethics 24 (January 2014)

Conclusion
Today, the use of PR chimera transgenes for crop
improvement is widely applied. This signal‘normoconsumers’,‘transgenimers’and‘contransgenimers’ are poised to prepare their minds tosavour and see EPRC’s flourish on our land whatever
the case. Normative views about what is good or bad,right or wrong related to engineered PR cropsconsumers and TC-land relationships will solely
depend on the benefits and needs at the individuallevel. There will be concerns of allergenicity,irrespective of group-A and B being champions ofvirtue.
Hence,
the‘contransgenimers’
arepusillanimous circumstantial benefactor enjoying‘sweet equilibration’ believed to have hermeneuticallyobserved the wind of change in ‘the nature order ofthings’. Humans may forcibly evolve by 2050 not by
natural selection pressures, but by nutritional
engineered transmutation leading to transmundane
beings.
References
Bengyella, L. and Pranab R. (2010). Engineered
antimicrobial and pathogenesis related proteins against P.
infestans in potato plant. Biotechnology and Molecular
Biology Review Vol. 5(4): 61-66
Dunfield, KM. & Germida, J.J (2004). Impact of geneticallymodified crops on soil and plant mediated microbialcommunities. J Environ. Qual., 33: 539-563.
Hoffmann-Sommergruber, K. (2002). pathogenesis related
Proteins identified as allergens. Biochemical Society
Transactions. 30(6): 930-935.
Liu D, KG. Raghothama, PM. & Bressan, RA. (1994).
Osmotin over expression in potato delays development ofdisease symptoms. Proceedings of the National Academyof Sciences USA 91, 1888-1892.
Pribylova, R. & Pavlik, BM. (2006). Genetically modified
potato plants in nutrition and prevention of disease in
humans and animals. Veterinarni. Medicina. 50: 212-223.
THE GOOD NEWS BIBLE (1994): Genesis. United Bible
Societies Ltd.
Van Loon, LC. Rep, M. & Pieterse, CMJ. (2006). Significanceof inducible defense related proteins in infected plants.
Annual Review of Phytopathology 44, 1-28.
Nordlee, JA. Taylor, SL. Townsend, JA. Thomas, LA. (2006).
Identification of a Brazilian allergen in transgenic
soybeans. New England journal of medicine. 333(11),PP.688-692.
Aglionby, J. (2004). Fillipino islanders blame GM crops for
mysterious sickness. The Guardian, 3 March.
Gutpa, A. Nidhia, A. (2005). Impact of Bt cotton farmers
health. Investigation Report Octo-Dec-2005. [Available
online: www.gmwatch.org, accessed 02/02/2008]
Marvier, M. (2007). Pharmaceutical crops have mixed outlook
in California, California Agriculture, 6(20), PP. 59-99.
ECODE PROJECT CONSORTIUM (2007). Identification andanalysis of functional elements in 1 % of the humangenome by ECODE pilot project, Nature, 44 (7146), P.791816.

Teaching Bioethics toUndergraduate Physiotherapy
students: Students’ Attitudes
and Perceptions
1

2- Zoheb Rafique , Saira Baloch1
Department of Biochemistry, Liaquat University of Medical &Health Sciences (LUMHS), Jamshoro, Pakistan
2Medical Research Center, Liaquat University of Medical &Health Sciences (LUMHS), Jamshoro, Pakistan
Email: dr_zohaib@hotmail.com

Abstract
Objective: To determine the attitudes and perceptionsof undergraduate physiotherapy students on different
components of their bioethics course.
Materials and Methods: The final year physiotherapy
students at IPRS LUMHS were given the pre-designed
self-report questionnaire at the end of their bioethics
lecture and were requested to participate in the study.
Results: All 39 present students participated in the
study and 3 were absent. All the students were of theview that learning bioethics is necessary for good
professional practice. The students were satisfied withthe course and they are now able to identify andresolve ethical dilemmas in their field of physiotherapy.
Conclusion: The students’ evaluation of their bioethics
course is very important as this will help us in further
improving our bioethics curriculum. The student’s
responses will also facilitate us in the betterment of thebioethics teaching.
Introduction
Physiotherapy has evolved dramatically in recent
years, to the extent that it is now a major healthcare
profession. Ethical development is cited as a basic
objective of physiotherapy education and many authors
have identified an ethical dimension in everyday
functions of the physiotherapist. The Behavior guided
by the ethical code has been described as identifying
physiotherapy as a profession rather than technology
and thus contributing to professional stature (1).
Physiotherapy raises some serious bioethical queries
and questions that are neglected and far too little
discussed and debated (2). To understand the ethicalissues and dilemmas and their solutions, bioethics is
introduced in the curriculum of almost all the fields
related to medicine. Significant progress is achieved indeveloping bioethics in undergraduate curricula overlast 20 years (3). Medical ethics has now become acompulsory and standard component of medical
curricula around the world (4). In Pakistan bioethics
teaching started in 1988 at Aga khan University
Karachi and was included in the undergraduate
curriculum (5). In our University Liaquat University of
Medical & Health Sciences (LUMHS), bioethics iscurrently being taught in MBBS and Physiotherapy
undergraduate medical education. The Institute ofPhysiotherapy and Rehabilitation Sciences (IPRS)
introduced bioethics as separate subject in their final
thyear (4 year) of BS of Physiotherapy. We have

31

Eubios Journal of Asian and International Bioethics 24 (January 2014)

included all the major topics of bioethics in the
curriculum.
Along with general ethics, principles,issues and dilemmas, we have also included theethical issues related to physiotherapy, organizational
ethics, administration and the code of conduct ofphysiotherapy to strengthen the curriculum. This paper
reports our experience of evaluating the undergraduate
bioethics course, particularly in relation to the students’
perception of teaching of medical ethics. Our aim is tostimulate debate and discussion on how we can
improve our bioethics curriculum and teaching of
bioethics.

indicates agreement and disagreement with thestatement while the second response (‘Neutral’)indicates unsure with the statement. The responses ofthe physiotherapy students to the questions wereanalyzed as percentage of those surveyed who agree,
neutral or disagree with the statement.

Methods
To assess the attitude and perception ofundergraduate physiotherapy students at institute ofphysiotherapy and rehabilitation sciences (IPRS),LUMHS Jamshoro regarding the components ofbioethics course, a self-report questionnaire wasdesigned. Our study population included final year BS
Physiotherapy students. A total of 39 present students
participated in the study and 3 students were absent
on that day. There were 42 enrolled students in thebatch. The questionnaire was given to the students atththe end of their last bioethics lecture of their 8semester (Final Year), to make sure that their bioethics
course finishes before conducting this study. The
course contents are shown in Table 1. The data wasstcollected on 21 October 2013. The students took 1015 minutes to complete the questionnaire. All students
willingly participated in the study. The questionnaire
consisted of total 11 questions. Completed
questionnaires analysis was done using statisticalmethods.

Table
2:
Attitudes
andperceptionsofphysiotherapy students on different componentsof the bioethics course
Responses: (1) Agree (2) Neutral (3) Disagree
1. Learning Bioethics is important for good
professional practice (1) 39 (2) 0 (3) 0

Table 1: The contents of the Bioethics course:• Fundamental Principles of Bioethics• Theories of Bioethics• Informal consent• Confidentiality• Privacy• Veracity• Euthanasia• Ethical Dilemmas• Abortion• Medical Error• Breaking Bad News• Doctor-Patient Relationship• Doctor-Pharmaceutical Sales Representative
Relationships• Professional Ethics• Organ Donation• Equity and Equality• Human Rights• Nuremberg Code• Code of conduct of Physiotherapy• Organizational Ethics•
Ethics and Administration
Statistics: For each question, we calculated thepercentage of students responding in each category.
Responses to the questions were analyzed such thatfirst response (‘Agree’) and third response (‘Disagree’)Results
A total number of 39 undergraduate physiotherapy
students participated in the study. There were 4 maleand 35 female participants. Table 2 shows the students
responses to the questionnaire.

2. I have learned fundamental principles of bioethics(1) 37 (2) 02 (3) 0
3. I found bioethics teaching interesting(1) 25 (2) 12 (3) 02
4. Bioethics is just a common sense so no need forformal teaching(1) 07 (2 ) 0 9 (3) 23
5. Topics in our bioethics course were relevant to thefield of physiotherapy. (1) 33 (2) 0 3 (3) 03
6. I can now identify and resolve ethical dilemmas inphysiotherapy(1) 32 (2) 04 (3) 03
7.
Length of the course was reasonable(1) 32 (2) 06 (3) 01
8.
It was appropriate to learn bioethics for one year
(1) 31 (2) 06 (3) 02
9. Couse contents were relevant to my culture(1) 31 (2) 06 (3) 02
10. The methods used for final assessment wereappropriate(1) 34 (2) 02 (3) 03
11. I have understood the code of conduct in the field ofphysiotherapy(1) 39 (2) 0 (3) 0

Ratings from Likert Scale: Agree (1) Neutral (2) Disagree (3)Discussion
Identification and recognition of the ethical issues
facing a profession is an important activity (6) and isconsidered as a mark of professionalism. In last 20
years, there has been an increased interest in the
ethical issues. With this increase in curiosity andinterest, there has been a concurrent increase inpublications relating to medical ethics. The majority of32

Eubios Journal of Asian and International Bioethics 24 (January 2014)

the literature has been related to nursing and medicine(7). Only in the last few years have other healthprofessions begun to address ethical issues specificand related to their professions.
The need for these other health professions toaddress their distinctive ethical issues has become
more urgent as these professions have expanded theirscope of responsibilities, placing practitioners into
positions in which ethical decisions must be madefrequently. In recent years, the profession ofphysiotherapy has increased its autonomy in decisionmaking and has further expanded its role in patientcare (8-9). Due to the recent publicity of patient safety
and the medical errors, it is necessary to emphasize
the importance of biomedical ethics as integral part ofour undergraduate medical education (10). The resultsof our study showed that the students strongly valued
biomedical ethics.
The questionnaire of our study comprises of 11
different questions and Likert scale was used to assess
the responses of the participants. In the response to
the first question all 39 students agreed that learning
bioethics is important for good professional practice.
When asked about the fundamental principles ofbioethics, 95% of the students agreed that they havelearned fundamental principles of bioethics.
64% of the responders found bioethics teachinginteresting. In one question, the students were asked
that bioethics is just a common sense so there is noneed of formal teaching, in the response 59% of thestudents disagreed with the statement and only 18%
agreed with the statement, while 23% students were
unsure. 82% of the participants were of the view thatthey can now identify and resolve ethical dilemmas in
the field of physiotherapy. About 80% of the students
believed that the course contents were relevant to theirculture and it was appropriate to learn bioethics for one
year.
The students when asked about the length of thecourse, 82% of the students agreed that the length ofthe course was reasonable. When asked about themethods used for final assessment, 34 students (87%)
agreed that the methods were appropriate. This is also
reflected in their semester results, in which only 2
students were declared to have failed and 40 students
passed the exam.
We used (BCQS) and (SEQS) to assess thestudents. In the response to the question related tophysiotherapy, all (100%) students agreed that they
have understood the code of conduct in the field ofphysiotherapy. The results of our study showed thegeneral attitude and perception of undergraduate
physiotherapy students at IPRS LUMHS Jamshoro.
Conclusion
The increasing debate and discussion in theprofessional and academic literature about thenecessity and importance of exploring bioethics inPhysiotherapy profession, and also the contribution ofbioethics training to the ethical decision making of the
future professionals, supports the view that it isnecessary to encourage the academics and educators

to work together to further improve the academic
bioethics curricula (11). The current study shows thatthe undergraduate physiotherapy students tookbioethics as an important subject which is necessary to
be taught, and not barely to be worked out as common
sense. This study will further help us in improving ourbioethics curriculum and also bioethics teaching.
References
1. Andrew A Guccione. Ethical Issues in Physical Therapy
Practice: A Survey of Physical Therapists in New
England. Phys Ther. 1980; 60:1264-1272.
2. Ioannis Poulis. Bioethics and physiotherapy. J Med
Ethics. 2007; 33:435–436.
3. K Mattick and J Bligh. Teaching and assessing medical
ethics: where are we now? J. Med. Ethics. 2006; 32:181185.
4. Julian Savulescu, Roger Crisp, K W M Fulford and Tony
Hope. Teaching medical ethics: Evaluating ethics
competence in medical education. Journal of Medical
Ethics. 1999; 25:367-374.
5. Kulsoom Ghias, Syeda Kauser Ali, Kausar S. Khan,
Robyna Khan, Murad M. Khan, Arshi Farooqui & Parvez
Nayani. How we developed a bioethics theme in anundergraduate medical curriculum. Med Teach. 2011; 33:
974–977.
6. Purtilo RB, Cassel CK. Ethical Dimensions in the HealthProfession. Philadelphia, Pa: WB Saunders Co; 1981.
7. Veatch RM, Sollitto S. Medical ethics teaching: report of anational medical school survey. JAMA. 1976; 235: 10301033.
8. Burch E, Mathews J, eds. Practice Issues in Physical
Therapy. Thorofare. NJ: Slack lnc. 1989:5-28.
9. Herman L Triezenberg. The Identification of Ethical Issues
in Physical Therapy Practice. Phys Ther. 1996; 76:10971107.
10. Ali I. Al-Haqwi, Ali M. Al-Shehri. Medical students’evaluation of their exposure to the teaching of ethics.
Journal of Family and Community Medicine. 2010; 17:4145
11. Anne Hudon, Maude Laliberte´, Matthew Hunt, Vickie
Sonier1, Bryn Williams-Jones, Barbara Mazer, Vale´ rie
Badro, and Debbie Ehrmann Feldman. What place for
ethics? An overview of ethics teaching in occupational
therapy and physiotherapy programs in Canada. Disabil
Rehabil. 2013; Early Online: 1–6.

www.eubios.info/Conferences
A feast of bioethics, culture, mind studies in Japanand Korea from 1– 14 November 2014…let us know
if you wish to join. Email: ananya@eubios.info
Friday 31 October fly into Fukuoka International Airport,
direct airport bus to Ritsmeikan APU at Beppu [domestic
airport is Oita]; 1-3 Nov Asian Bioethics Conference ABC15 (part 1) in Beppu; 4 Nov Beppu sights (hot springs,
including coloured waters, monkeys in hot springs…nature);
5 Nov travel through Mt. Aso, visit to active volcano (evening
stay in Kumamoto); 6 Nov one day trip by ferry and bus toNagasaki; 7-9 Nov ABC15 (part 2) and KBRT8; 10 Nov travel to Fukuoka airport (2 hours by bus) and either home or
to Seoul, Korea; 11-13 Nov Mind Studies andBiocosmology, Seoul; 14 Nov Seoul sightseeing; departeither evening or next day.

33

Eubios Journal of Asian and International Bioethics 24 (January 2014)

Ethics Education Addressing
Issues Related to Communitybased Healthcare Services:
Comparison of Case Study
Methodologies Using Drama
Cases- Akio Kanayama
Kiryu University, 606-7 Azami Kasakakemachi MidoriCity Gumma 379-2392 Japan
Email address: m10702055@gunma-u.ac.jp
Abstract
In bioethics and medical ethics education,
methodologies have been developed from a range ofviewpoints, between the principles-based and opposite
approaches. However, all these methodologies
similarly adopt the case study method as an
educational approach. This study aimed to confirm theusefulness of the case study method commonly
adopted in various methodologies, rather than conflicts
among them, by comparing the effects of two different
methodological approaches: narrative- and dramabased. Considering that the majority of case study
methodologies adopt the former approach at present,
the effect of the latter was focused on in the study.
A study was conducted involving 85 second-year
nursing students, who were divided into 2 groups: A:
43; and B: 42. To examine a case, 2 different study
materials, a narrative text and drama DVD, wereprepared, with the same content. Group A students
were initially read the narrative text, and underwent aquestionnaire. Subsequently, they watched the drama
DVD, and underwent a similar questionnaire. In
contrast, those of Group B as control students initiallywatched the drama DVD, and underwent thequestionnaire to confirm their levels of comprehensionof the case. They subsequently read the narrative text,
and underwent a similar questionnaire.
The results showed no differences in the level ofcomprehension between the narrative text and drama
DVD in Group B, while the level of comprehension was
higher when watching the drama DVD in Group A,
suggesting the usefulness of using drama cases incase studies.
Key words: Medical Ethics Education, Case Study,
Drama Case

while involvement in individual cases is focused on indifferent approaches from opposite viewpoints, it may
be possible to classify the case study method into
these major categories.
1. Principles-based approach: Beauchamp andChildress adopted this approach to apply 4 principles,<respectforautonomy>,<non-maleficence>,<beneficence>, and <justice>, to individual cases. In
actual cases, however, mutually conflicting principles
are mostly applied, without clarifying the appropriate
order of application; in this respect, there may be atendency for the principles-based approach to24
generalize each case with simpler descriptions.
2. Casuistry: As a solution to such a disadvantage ofthe principles-based approach, a movement toreconsider casuistry, which had been forgotten since25
the 16th to 17th centuries, arose.
The term"casuistry" is derived from the Latin casus ("case"),meaning involvement in individual cases. In short, it isa method of case reasoning, unlike the principlesbased approach. While the latter examines issues
based on principles, the former addresses them on a26
case-by-case basis. In the casuistry-based approach,typical cases are initially defined as a basis for
examining issues, focusing on analogy between theseand relevant cases. The principles- and casuistrybased approaches are frequently differentiated,referring to 2 ancient Greek philosophers, Plato andAristotle; while the former considered ethics as one of
the logical sciences, the latter separated theories(theoria) from practice (praxis), and gave more
importance to practical wisdom (phronesis) compared27
to theoretical knowledge (episteme). Based on thisidea, the casuistry-based approach tends to describe
the details of individual cases.
3. Narrative ethics: In narrative ethics (ethical science),
starting discussions by shifting principles to cases is28
not sufficient, unlike in the casuistry-based approach.
As individual cases involve personal stories, whichcannot be generalized as common events, and,
therefore, it is difficult to objectively reduce individual
29
cases, and consider this process as a science. Suchdifficulty, in short, leads to the necessity of considering
ethics as non-academic and differentiating it fromacademic sciences, highlighting its contradictorycharacteristic as a science.
4. Care ethics, which is also closely related to narrative
ethics, is characterized by the following question,raised by feminists during discussions regarding
24

Introduction
Up to the present, the case study method has been
generalized in the field of nursing and medical ethics
education to a certain extent. Its details, however,widely vary under the diverse circumstances ofbioethics. For example, they are frequently based on
the principles-based approach, casuistry, or narrative,care, virtue, or situation ethics, and, therefore, it isdifficult to simply define the case study method.
On the other hand, as cases are reduced tocommon events and described to provide a basis for
ethical judgments in the principles-based approach,.Tom,L.Beauchamp, James F. Childress, Principles ofthBiomedical Ethics, 5 ed., Oxford University Press,2001;p39
25.Jonsen, A.R, Casuistry: An Alternative or Complement toPrinciples?, Kennedy Institute of Ethics Journal Vol.5,1995;
237–251.
26.Richard Brian Mille, Casuistry and Modern Ethicsnd
2 ,1996;p5.
27.Jonsen, A.R, S. Toulmin, The Abuse of Casuistry,
Berkeley: University of California Press,1998; 23-26.
28.Carson, A.M, That’s Another Story: Narrative Methods andEthical Practice, Journal of Medical Ethics Vol.27,2001; 198202.
29. Rita Charon, Narrative Medicine: Honoring the Stories ofIllness, Oxford University Press,2008;pp8-2

34

Eubios Journal of Asian and International Bioethics 24 (January 2014)

modern theories of justice: The principle of justice in30
principlism is right-based reasoning. In this principle,
inequality between equal individuals is considered
unfair; in other words, inequality between unequal
individuals, such as between physicians and patientsor nurses and between males and females, is notconsidered unfair. However, considering that equality
and inequality were originally defined by males, justice
may also be a masculine concept. According to ethics
of justice, led by the question "what is appropriate withrespect to justice", moral problems arise from conflicts
between different types of rights, and, therefore, it ispossible to solve them by prioritizing rights from formal
and abstract viewpoints. In contrast, in care ethics, theimportance is given to the question "how to meetothers' needs", and contextual and narrative
perspectives are needed. Care ethics has been
underestimated to the present, as it has beenmeasured based on justice as an ethical index.
Feminists also pointed out this tendency in principlebased bioethics, consequently leading to the31
development of care ethics perspectives in this field.
5. Virtue and character ethics: Pellegrino andThomasma are representative scholars who developed
virtue and character ethics. Pointing out principlists'
overemphasis upon patients' autonomy, as well as
their rights, they advocated the adoption ofcommunitarianistic virtue ethics in bioethics. From sucha perspective, virtue and character ethics focus on
physicians' human morality, rather than patients' rights,
and aim to restore medical ethics by nurturing theirvirtue indispensable for benefiting patients. Pellegrino
and Thomasma also focused on the ethical studies
promoted by Aristotle in ancient Greece and Thomas
Aquinas in the Middle Ages, suggesting the importanceof physicians' virtue and appropriate personality for32
establishing trust relationships with patients.
6. Situation ethics: examines all the situations whichmust be decided fully in consideration of ethical action
principle which the community where oneself belongs
has. It is the same as a Law of nature at the point
accepted that reason serves as a means of a moral
judgment. But construct the good and it does not makeit into the law-of-nature idea which shall be given apriori.
Although Situation ethics also follows a morality
law, it is not a Categorical Imperative according tohypothetical imperative. Therefore, a morality law canbe broken according to the necessity for love. Situation
ethics can also be called "the principle-ized relativism."
A principle, Maxim, and agreement are enlightening.
These only demand people to follow love andreason as much as possible. On the other hand,situation ethics guides an ethical act and requires it ascertainly observing it at the place where love and30.Peter Allmark, Can there be an ethics of care?. Journal of
medical ethics,1995; 19-21.
31. Nel Noddings, Caring: A Feminine Approach to Ethics andMoral Education, University of California Press 2ndedition,2003; 79-80.
32
Edmund D. Pellegrino, David C. Thomasma, The Virtues in
Medical Practice. Oxford Univ Pr 1993; pp20-26.

reason can be useful. And love cannot be defined
beforehand.
As for the core of Situation ethics, I hear that asituation changes the ethical judgment about a case.
Or you may put it in another way as a situation
33
changing a norm and a rule.
Situation ethics duty isvery relative to a situation. But the duty within asituation is absolute. Situation ethics does not ask forthe good or justice which have universal validity. Itasks for the worthiness in a situation right that andspecific. Joseph Fletcher emphasized the necessity ofshifting from <the sanctity of life> to <the quality of
34life>.
In short, in nursing and medical ethics education, it
may be necessary to conduct unbiased case studies,while considering these different views.
Methods
1. Challenges in nursing and medical education using
the case study method
From any of the above-mentioned viewpoints, casestudies as a methodology to examine cases in clinicalenvironments, including ethical problems, may be
indispensable for making ethical judgments, regardlessof their levels. In line with this, the case study method
may play an important role in providing medical ethics
education.
The author realized a number of challenges anddifficulty when providing ethics education, presumably
due to marked differences between leaners in theability to accurately interpret individual cases, evenwith carefully developed contexts. Consequently, theyneed a long time to achieve a certain level ofcomprehension, including in minimized case studies,and educators' efforts are frequently made to solve thisproblem, in addition to playing their primary role inmanaging discussions and activating classes by raisingquestions to prevent learners from reaching easy
conclusions. In short, the author developed a sense ofcrisis against insufficient discussions due to learners'
necessity of taking a long time to address theirquestion, "I don't know what questions I should ask".
Considering such a situation, this paper discusses
the usefulness of drama cases as a method to nurturelearners' basic comprehension from a different
perspective than those of ethical methodologies, inorder to appropriately conduct case studies, as
previously mentioned.
Subjects
The study was conducted on 12 May 2010,
involving 85 second-year nursing students belonging to
the Department of Nursing, Faculty of Health Care,
Kiryu University. The students were divided into
Groups A (43) and B (42) and instructed to selfevaluate their levels of comprehension of a single case(appended table). Group A students initially read anarrative text describing the case (story case), and33

Joseph Fletcher, Moral Responsibility, SCM,1967; pp141147.
34
Joseph Fletcher, Situation Ethics: The New Morality,
Philadelphia, The West Minster Press,1966; pp26-39.

35

Eubios Journal of Asian and International Bioethics 24 (January 2014)

underwent a questionnaire. Subsequently, they
watched a drama DVD representing the same case(drama case), and underwent a similar questionnaire.
In contrast, those of group B as control students
initially watched the drama DVD, and subsequently
read the narrative text before undergoing thequestionnaire.
Case study: Care for community residents withdementia and intellectual disability
Shizue Arima, an 80-year-old female, lived with her son
with mild intellectual disability, Shinichi (40), in a small townof the Hokuriku area of heavy snowfall. Her husband, who
had been a government worker for a long term, died five
years ago due to gastric cancer. Shinichi was her only child.
The chief nurse of the Health and Welfare Center
supporting elderly residents and those with disabilities in thecommunity, Sayoko Kurokawa, occasionally visited Shizue
with helpers to observe her condition, as her forgetfulness
had recently become marked. Shizue and her son lived in a
30-year-old wooden house.
Up to then, she had maintained a favorable health state,
without suffering from serious diseases. Due to her naturally
introverted character, relationships with her neighbors andcommunication with her sister-in-law living in the same town
had become limited since her husband’s death. Herneighbors stated that she had rapidly aged over the past 2 or
3 years, appearing depressed, and the signs of dementia,
such as not recognizing her acquaintances and forgetting
their names when she met them, were observed.
Last winter, Shizue developed pneumonia after thecommon cold, and was hospitalized for a month. Her
nutritional condition was poor. In hospital, she was diagnosed
with mild cerebral infarction and hypertension, and, after
discharge, home care by visiting helpers and nurses for her
was initiated. Although she was also advised to use day-careservices, she refused this, stating that she was unwilling tovisit places where a large number of people gather. Nurse
Kurokawa visited Shizue twice or three times a month toconfirm her blood pressure and medications. Helper
Mizukami visited her weekly to assist her in housekeeping.
Nurse Kurokawa recently recognized Shizue's poor
medication adherence, in addition to a loss of appetite anddecreased body weight. Helper Mizukami also became
anxious about her status, as cooked dishes were left uneatenin the refrigerator for a week, and rice in the cooker
frequently became moldy. When she visited Shizue the otherday, a new set of futon was laid in the living room --- a costly
product she bought via pernicious door-to-door sales. She
began to go out for shopping less frequently unless thehelper visited and accompanied her. Her closet was full of
unwashed clothes. One of the care-givers' major concerns
was fire management; in the past month, a fire nearlyoccurred twice, as Shizue left a pot on fire for too long. Herpoor fire management might be a serious problem in the
coming winter. In fear of possible fire accidents and solitary
death, her neighbors demanded through the town office that
the Welfare Center should admit her to a care facility.
However, she also refused this, insisting that she should stayat home to continuously take care of her son.

(ABC of Medical Ethics, Second Version: Kenji Hattori
and Takao Ito; supervised by Toshiko Ibe; Medical
Friend Co., Ltd.; p220; 2012; <Case 19> was partially
35
modified to use as a drama case)35

Toshiko.Ibe,Kenji.Hattori,Takao.Ito,Iryo Rinri no ABC (ABCof medical ethics), Medical Friend., 2012; p220.

Results
1. Students' evaluation of the case
The results were as shown below when thestudents initially read the narrative text, underwent aquestionnaire, and subsequently watched the drama
DVD. Their self-evaluated general comprehension
levels were clearly higher with the drama DVD.
Evaluation items included: the probability of selfencountering;
actuality;
medicalprofessionals'
approaches; the patient's problems and sense ofvalues; interpersonal relationships; situation; andchallenging issues in this case.

2. Quantitative test of Students' evaluation with t-test
On the t-test, values were within the range between
0.0079 and 1.1101, supporting the null hypothesis that
there are no differences at a significance level of 5%.
When calculating at a degree of freedom of 40 to 60,
the value was 2.021 at a significance level of 5% and2.704 at that of 1%. T-test values in Group B were:0.0079≤t≥1.1101. *T-test values: 0.0079 to 1.1101,
supporting the null hypothesis that there are nodifferences at a significance level of 5%.
Discussion
This study was based on the idea that it isnecessary to confirm learners' reactions, in order touse drama cases as a new case study methodology. In
this respect, it may be pointed out that the results are
epidemiologically and statistically inaccurate; in fact,
the questionnaire survey was conducted, without
setting the accurate number of the target population orconfirming the accuracy of the questionnaire.

36

Eubios Journal of Asian and International Bioethics 24 (January 2014)*Significance level: 5%: 2.021; and 1%: 2.704 *Calculated at a degree of freedom of 40 to 60 *T-test values in Group B: 0.0079≤t≥1.1101

Naturally, it is possible to determine such accuracy
by repeatedly examining it, such as performing retests;
however, in nursing education, repeating the same testin the class, involving students and consequently
forcing them to repeatedly undergo educationallyinvalid tests, may be inappropriate from an ethicalviewpoint. Similarly, the number of the population
targeted for the questionnaire was not accurately set,as the study was limited to a framework as a university
class.
Further studies were conducted since the study in2010, as a questionnaire for the measurement of the
ethics classes, and I am continuing the investigation of
the same issues with the permission of the nursing
school and several universities. In the analysis, it ispossible to see the same tendency as the present
study. However, it is difficult to get permission toannounce the official data from the ethical review
committees of all the universities.
On the other hand, the results of this study may
provide a basis for future studies to compare data by
performing meta-analysis. The data obtained in the
study were managed on such an assumption.
Although the data may be statistically insufficient,
the questionnaire was significant in observing students'
actual attitudes from a philosophical viewpoint. Someof its results were not predicted in the initial study
scheme; they may be statistically inappropriate anddisregarded as outliers. These data, however, may
play an important role in addressing the challenge ofinterpreting and understanding individual cases as a
subjective action in future studies. Similarly, this study
may also provide a future perspective on thedevelopment of class discussions to nurture students'
inter-subjective comprehension through case studies.
Conclusion
While the results of this study may be statisticallyinsufficient due to limited settings in the field of nursing
education, retests to confirm their accuracy were notconducted, considering that they may be ethicallyinappropriate and educationally invalid. On the other
hand, as the questionnaire was conducted in the
beginning of a class, continuous case studies may
have provided students with an opportunity to enhancetheir comprehension of cases in relation to their own
development through the class. Although thispossibility has not yet been fully examined withevidence, it may be a useful finding for educators. Inline with this, in nursing ethics education, it may beeffective to conduct case studies using visual materials
as drama cases to deepen students' comprehension in
combination with narrative texts as story cases tonurture their accurate and imaginative interpretation.
Acknowledgments
In this study, basic data were collected with theapproval of the Ethics Committee of Kiryu University.
The author would like to express gratitude to all theuniversity staff members who approved and nursing
students who cooperated with the questionnaire.

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