Eubios Journal of Asian andInternational Bioethics
EJAIB Vol. 26 (6) November 2016www.eubios.info
ISSN 1173-2571 (Print) ISSN 2350-3106 (Online)
Official Journal of the Asian Bioethics Association (ABA)

Copyright ©2016 Eubios Ethics Institute(All rights reserved, for commercial reproductions).

Contents

page
Editorial: Innovation & Dialogue
209- Darryl Macer
Ethical issues in medical and health care innovation- Miyako Takagi
210Happiness in Bioethics214- Takao Takahashi
Effects of Electrosmog on Birds: An Overview 216
1- J. Thresa Jeniffer , J. Joannes Sam Mertens
and A. Joseph Thatheyus
Identifying reasons for delays in ethics approval:
Experience of an institutional ethics review committee
219- Chandanie Amila Wanigatunge, Shamini
Prathapan, Gizelle Malinka Warnacula, Rochelle
Shanika TannerWhitehead’s concept of the past as objective
immortality with special reference to Tanabe’s idea ofworld religion
223- Makoto Ozaki
A comparison of socio-cultural values in Japan and
Iran based on social media communications
226- Nader Ghotbi“Is dialogue possible with Islam?”
233- Osama Rajkhan
Would we leave our ageing parent or grandparent in
the care of a robot? – A perspective from Islam 237- Sibtain Panjwani
ABA Renewal and EJAIB Subscription
239

Editorial address, and all correspondence to:Prof. Darryl Macer, Ph.D., Hon.D.
Provost, American University of Sovereign Nations(AUSN), Arizona, USA
Email: darryl@eubios.info
http://www.eubios.info
Registered address of EJAIB: P.O. Box 16 329,
Hornby, Christchurch 8441, New Zealand

Editorial: Innovation & Dialogue
One of the critical issues for societies that seek tobecome ethical is the provision of the innovations ofscience and technology to citizens. This may bethrough accessibility to advanced medicines. Miyako
Takagi, the President of the Asian Bioethics
Association, explores this in the first paper of theNovember 2016 issue of EJAIB with two examples –gene editing and Nivolumab. There is a need for fairdrug pricing that will not over-extend a health budget
as an expensive drug becomes indicated for diseases
that affect a growing proportion of the population.
Takao Takahashi examines whether such innovations
will make people happy – and what is the meaning of
happiness?
Aristotle had said eudemonia, or
happiness, was the ultimate goal of ethics. Is thistrue?
The functioning of an IRB is often measured by thetime that it takes to review, and ask for revisions, in
protocols. A study by Chandanie Wanigatunge andcolleagues explores the practice of an IRB in Sri
Lanka, and the reasons why IRB proposals take time.
The following four papers explore concepts ofreligion and bioethics. There is an analysis of Hajime
Tanabe’s concept of world religion by Makoto Ozaki, apaper that was presented at the Tenth Kumamoto
International Bioethics Roundtable held this month.
Another paper from the conference is a comparison ofJapanese and Iranian values by Nader Ghotbi.
Osama Rajkhan presents a discourse based on ath
dialogue that relates to a joint panel held at the 27
Annual Meeting of the Japan Association of Bioethics
with the Asian Bioethics Association, on this theme.
There is of course a principle of dialogue expressed inIslam that provides a place for philosophicalstimulation and insights that can be useful for dialogue
inside all religions. In the age of extremism, andnationalism, we must remind ourselves of the critical
approach of dialogue for the future of humankind. The
last paper explores the question of being looked after
by a robot in old age. This is the use of technologythat is being increasingly applied in some technology
able countries such as Japan. As AI systems become
more interactive, these will increasingly be used.
- Darryl Macer

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Eubios Journal of Asian and International Bioethics 26 (November 2016)

Ethical issues in medical
and health care innovation- Miyako Takagi, PhD
University Research Center, Nihon University
4-8-24 Kudan Minami, Chiyoda-ku, Tokyo, 102-8275, Japan
Email: takagi.miyako@nihon-u.ac.jp

Introduction
The expectation of innovation has increased within
the field of medicine and health care. With technicaldevelopments in this field, it is necessary to consider
various ethical problems.
First, gene editing can be considered a form of
medical innovation. Tools used to precisely edit thegenes inside living cells, including the affordable andeasy-to-use CRISPR-Cas9, are transforming the fieldof biology. By using such tools, the targeted genes canbe altered, which can result in germ-line changes
intended to be bequeathed to the next generation;
thus, disease-causing genes can be completely
eradicated. Some ethicists warn that such experiments
are a step toward “designer babies,” created by theirparents to be smarter, stronger, or better-looking.
Some critics also caution that genetic tinkering could
have unfortunate consequences for future generations.
In the U.S., gene editing of embryos is not banned;
however, the use of federal funds for such research is
not permitted. On the other hand, a group of British
scientists have been given the license to conduct gene
editing experiments on human embryos. In April 2016,a life ethics panel of the Japanese government broadly
compiled a report tolerating the genomic editing of
human fertilized eggs for basic research purposes
only. The report stated that a study on the functions ofgenes in fertilized eggs could help obtain informationthat may contribute to the treatment of genetic
disorders and infertility. Therefore, basic research on
gene editing could be tolerated under some conditions.
Another important ethical issue in medical careinnovation is the development of novel drugs that canincrease the chances of helping patients overcome
hard-to-cure illnesses, such as cancer. This uniqueform of treatment has transformed immunotherapy inJapan by novel drugs i.e., immune checkpoint
inhibitors that can activate the patients’ immune
response for individual-based therapy.
Although pharmacological breakthroughs arewelcome, new drugs tend to be extremely expensive,
and their wide use can place a substantial strain on thenation's medical expenses. When approving the use ofsuch drugs, the government needs to take utmost careto ensure that it does not bankrupt the nation's publichealth insurance system.
The immune checkpoint inhibitor, Nivolumab (tradename Opdivo), was approved in September 2014 forskin cancer (melanoma) in Japan. Subsequently, it
was also approved for treating lung cancer in
December 2015. In Japan, drugs are covered by
medical insurance after confirmation of theireffectiveness and safety. The cost of Opdivo per lungcancer patient is USD350,000 per year.
It is well known that chemotherapy is associatedwith adverse effects, such as hair loss, nausea, andvomiting. “Financial toxicity” is now considered to beanother adverse effect associated with such treatment.
Under the Japanese health system, a patient pays
between USD350 ~ USD2,500/month according totheir income and the remaining cost is covered by
National Health Insurance. Therefore, the majority of
the cost is paid by tax funds. Should an average,
healthy person bear the burden of such medical
expenses while lives can be saved using cutting-edge
medicine?

What is gene editing and CRISPR-Cas9?
In the process of genome editing, the targeted DNA
in a cell is cut out at a specific location to inactivate aproblematic gene or to insert a replacement DNA
sequence to produce a desired result. While DNA is a
substance that contains genes, a genome refers to theentire hereditary information contained in the genes
and chromosomes of cells. In humans, a copy of theentire genome entailing more than 3 billion DNA basepairs is contained in all nucleated cells. At present,
since the accuracy of genome editing is not adequate
and inaccurate editing can occur, genome editing is
not considered an established technique.
The current mainstream method in genome editing is
CRISPR-Cas9, a rapid, affordable, and simple tool forbiologists to use. CRISPR-Cas9 is a technology thatallows medical scientists to alter DNA with greater
precision than has previously been possible. In 2012,
molecular biologists Jennifer Doudna at the Universityof California, Berkeley and Emmanuelle Charpentier ofthe Max Planck Institute in Berlin created a novel
gene-editing technology termed CRISPR-Cas9.
CRISPR-Cas9 enables scientists to remove or add
genetic material at will. CRISPR is a collection of DNA
sequences that directs Cas9 where to cut and paste in
the genome. Moreover, CRISPR-Cas9 was chosen as
the 2015 breakthrough of the year by the US scientificjournal Science.
Chinese scientists edited the DNA of humanembryos
In April 2015, Chinese scientists edited the DNA ofhuman embryos for the first time. The team had nointention of creating a baby, but the experiment set off
shockwaves nonetheless.
A team of researchers at Sun Yat-sen University inGuangzhou injected 86 nonviable embryos withCRISPR-Cas9 to modify the gene responsible for betathalassemia, a fatal blood disorder. Of the treatedembryos, 71 survived and 54 were genetically tested.
It was found that only 28 embryos were successfully
spliced, of which only 4 contained the replacement
genetic material. The researchers also detected anumber of ''off-target'' mutations apparently caused by
the injection of the CRISPR-Cas9 complex.

Eubios Journal of Asian and International Bioethics 26 (November 2016)
While this research paper triggered a major uproar
regarding the safety of the procedure, the UK Human
Fertilization and Embryology Authority approved an
application from Kathy Niakan of the Francis Crick
Institute to renew her laboratory's research license toinclude gene editing of embryos in February 2016.
International Summit on Human Gene Editing by
the U.S., Britain, and China
Questions regarding the safety and efficacy ofaltering human embryos gained urgency after Chinese
researchers first attempted such gene editing. The
scientific academies of the U.S, Britain, and China
were urged to create an international forum to help
“establish norms concerning acceptable uses ofhuman germ-line editing.”
In December 2015, the International Summit on
Human Gene Editing was held. After meeting for threedays, the committee concluded that it would beirresponsible to proceed with any clinical use of germline editing until: 1) the relevant safety and efficacy
issues have been resolved, based on appropriate
understanding and balancing of the risks, potential
benefits, and alternatives; and 2) there is a broadsocietal consensus regarding the appropriateness ofthe proposed application. However, a tool used to edit
human genes is not currently ready for use inembryos, and altering early embryos as part of carefullaboratory research should be permitted as scientists
and society continue to contend with the ethicalquestions surrounding this revolutionary technology.
As scientific knowledge advances and societal views
continue to evolve, the clinical use of germ-line editing
should be revisited on a regular basis.
A Japanese government study group initiateddiscussions
Apparently prompted by the procedures performedby the Chinese team, the Japanese Cabinet Office's
life ethics study group, composed of 15 experts on life
sciences, law and ethics, issued an interim report in
April 2016 stating that basic research is acceptable forsuch purposes as identifing the roles of certain genes
during the early stages of embryonic development withthe help of genome editing to develop methods to treat
congenital hard-to-cure diseases and improve assisted
reproductive technologies. The report also stated that
returning an embryo with a problematic gene that has
been modified through genome editing to a womb is
not permitted.
The group denied the clinical use of human genome
editing during this stage, citing the risks of inaccurate
or incomplete editing (e.g., off-target mutations andmosaicism)
interminglementofmodified
andunmodified genes, as well as the difficulty of predicting
what effects genetic alteration will have on othergenes. Moreover, there is a need to examine the risks
that future generations may face as a result of genetic
alterations in embryos that will be passed
generationally.
Since the group's report has no binding power, thepossibility cannot be ruled out that ethics committees

211

of research institutes could permit human genome
editing research beyond the scope stated in the report.
The government and academic societies should begin
working to develop binding guidelines or legal
regulations that control human genome editing
research by fully considering both the ethical andsocial problems this technique can cause.
Therapy using gene editing
The first step involved in testing an initial gene
editing therapy using older tools has begun in humans.
Sangamo Biosciences is currently developing an HIV
treatment by isolating immune cells from patient blood,
editing a gene that boosts resistance to the virus, andreturning the cells. To date, 80 HIV patients havereceived the therapy in first-stage testing, withfavorable results. This technique could also help cureother genetic diseases, including sickle cell anemia
and muscular dystrophy, by correcting the sequence of
DNA responsible for such diseases.
If treatment-related gene editing eventually
succeeds, it is unknown how developing countries will
afford it. Even if gene editing becomes a usefulstrategy for the cure of HIV, the cost may make accessto such treatment impossible for people living in lowresource countries.
Discussion
Interest is rising regarding genome editing as thenext generation of technology begins to make aserious impact. However, the latest techniques are far
more accurate, efficient, and affordable than theprevious technology. Human genome editing could
have serious consequences depending on its reliability
and the way in which it is used. Gene therapy is easier
to some extent because the human genome is not
permanently altered; however, gene editing canirreversibly alter heredity on an individual level. Critics
say that human inheritance could have consequences
unforeseeable for several generations and would passsuch genetic alterations to future generations without
their consent. Thus, a single error could havedevastating consequences. There is also concern
regarding babies designed by their parents to achieve
superior intellect, athleticism, or appearance rather
than to prevent disease.
Since thepotential benefits and risks of thistechnology are both of great consequence, there is astrong need for the public, including ordinary citizens,lawmakers, bureaucrats, scientists, as well as legal
and ethics experts, to perform informed and detailed
discussions to ensure that human genome editing cantruly contribute to enhancing the well-being of people
throughout the world.

Effect of Nivolumab
Prof. T. Honjo, a Japanese scientist at Kyoto
University discovered Programmed cell death protein-1(PD-1) in 1992. PD-1 is a cell surface receptor
expressed on T cells which specifically target
cancerous cells. However, cancer cells express theEubios Journal of Asian and International Bioethics 26 (November 2016)212

PD-1 ligand, PD-L1. When PD-L1 binds to PD-1, asuppressive signal is sent to the T cell, thereby
preventing the killing of the cancer cells.
Nivolumab binds to the PD-1 on the surface of T
cells, preventing the interaction between PD-L1 andPD-1, and allow these T cells to kill the cancer celltargets. Nivolumab was jointly developed by Japan's
Ono
Pharmaceutical
Co.
and
the
U.S.
biopharmaceutical firm Medarex Inc. which waspurchased in 2009 by Bristol-Myers Squibb Company.
It is renowned worldwide as the first immune
checkpoint inhibitor that has overcome the problems of
immunotherapy. Moreover, it is used in the treatmentof advanced cancer that is inoperable by injecting it
into the patient through intravenous drips once every
two or three weeks, depending on the patient's
conditions.
Therefore, Nivolumab offers hope to cancer patientswith no other treatment options. Despite the wide
range of available anticancer drugs, many lung cancer
patients often find themselves out of options, as
cancer cells often become resistant to treatment after
a short period.
Many doctors are increasingly supportive of using
Nivolumab due to its effect on drug-resistant cancer
cells. In many clinical trials around the world, theeffectiveness is so great that comparative studies
between Nivolumab and existing anti-cancer drugs
have been abandoned. The drug is now therecommended choice in certain places.
Time
Jul. 2014

Dec. 2014

Mar. 2015

Jun. 2015

Oct. 2015

Public matter
Japan approves Nivolumab for treating
advanced melanoma, making it thefirst PD-1 inhibitor to receive
regulatory approval
Nivolumab is approved in the US for
melanoma after it was shown to shrink
tumors in one-third of patients
Nivolumab is approved by the FDA totreat advanced non-small cell lungcancer, after trials showing that 42%of people survived for at least a year,
twice the survival rate of those taking
thestandard
treatment
drug,
Docetaxel
EuropeanCommission
approves
Nivolumab for lung cancer
Nivolumab approved by the FDA for
kidney cancer after a trial showed thaton average, people on the drug
survived for more than five months to
two years longer than those on therival treatment, Everolimus

The reason the price of Nivolumab is so expensive
Nivolumab was originally approved based on thepremise that it would be used only for a small numberof patients with malignant melanoma, a form of skincancer. In advance of other countries, the Japanese
government approved the product in 2014; it wasestimated that some 470 patients with advanced

melanoma would use it. Therefore, a price of about$7,100 per 100 mg was set for this product. Typically,
when a new drug is introduced in Japan, thegovernment sets the price based on the average pricefor the same or similar drugs in the U.S., the U.K.,
Germany, and France, to keep the domestic pricewithin a reasonable range. However, Nivolumab
cannot be priced using this method.
When the government approved the drug fortreatment of non-small cell lung cancer in December
2015, the potential number of users jumped to the tensof thousands. Lung cancer is the leading cause ofcancer-related deaths worldwide, with 36% of patientsin Japan surviving for at least five years after the
diagnosis, a statistic that has shown little improvement
over the past 40 years. However, Nivolumab isdemonstrating great promise in some lung cancer
patients and offers new hope. Despite this fact, if alung cancer patient weighing 60 kg used the drug for ayear, it would cost $350,000.
In August 2016, the government authorized the useof Nivolumab against renal cell carcinoma, a type ofkidney cancer, adding an estimated 4,500 patients topotential users of the drug.
Medical expenses and the Japanese healthinsurance system
In Japan, there is a “high cost illness insurance
system” that sets limits on patients' out-of-pocket
medical costs according to their income. Therefore, for
Nivolumab, a patient below the age of 70 is required to
pay $350 to $2,500 per month according to theirincome, with the remainder covered by public healthinsurance and taxpayer money.
If Nivolumab's popularity continues to grow, thenation's health care costs will increase infinitely. For
example, if the drug were prescribed to 50,000 of the
77,000 patients in Japan who succumb every year tonon-small cell lung cancer and accounts for 80% oflung cancer cases in the nation, the annual cost of
Nivolumab alone would total $17 billion.
Medical expenses paid to hospitals and clinics
across the nation are estimated to have reached arecord $ 415 billion in 2015, a 3.8% increase from theprevious year. Of the total, prescription drugs costs
accounted for $79 billion, a 9.4% increase from theprevious year. Thus, two other drugs similar to
Nivolumab, would be enough to force the Japanese
health insurance system to the brink of total collapse.
The government is required to solve its drug priceplanning
There were more than 1.8 million newly diagnosed
cases of lung cancer in 2012 globally, accounting for
13% of the total number of cancer cases. Over half of
the individuals with this cancer are diagnosed over theage of 65. As the population of older individuals is
projected to increase, the prevalence of lung cancer isalso anticipated to rise.
Some medical experts have suggested that an age
limit should be set to prohibit patients 75 years old or
more from using Nivolumab to protect the JapaneseEubios Journal of Asian and International Bioethics 26 (November 2016)
health insurance system. While Japan must introduce
a cost-benefit analysis in medical care, it should be
performed prudently, so as not to deny care to a
specific segment of the population.
The current system of reviewing the prices of drugs
once every two years (with the next review scheduled
in 2018) is too rigid to flexibly lower drug prices.
Therefore, the government should introduce a system
under which it can lower drug prices halfway throughthe regular review period if the number of users of aparticular drug sharply increases following approval of
its use in a broader range of illnesses, and placing afinancial strain on the health insurance system. The
government should also fully utilize the system
introduced in April 2016 to lower the price of a drug by
as much as 25% if its annual sales are between $1
billion to $1.5 billion, and by up to 50% if its sales arehigher. The government should also consider the costeffectiveness of drugs when deciding on their prices,
as well as ensure that the process of setting drug
prices is more transparent.
Medical problems associated with Nivolumab
There are medical problems associated with
Nivolumab. Nivolumab is only effective for certain
types of cancer remains unclear. To date,approximately 30% of patients on the drug have shown
remarkable progress. An efficacy of only 30% for
Nivolumab pales in comparison with Sovaldi andHarvoni, hepatitis C drugs sold by Gilead Sciences in
the U.S. These drugs cost between $600 - $800 per
pill and are effective in over 90% of patients.
Therefore, approximately 70% of patients do notrespond to Nivolumab, and it will be important to
identify markers of both responders and nonresponders.
Side effects are also a significant problem. As an
immunotherapy drug, Nivolumab has relatively few
known side effects compared with existing anti-cancer
treatments; however, they do exist, albeit at an
unknown frequency. Researchers are only recently
beginning to understand that some of such side effects
can be life-threatening. Cases of side effects that werepreviously unimaginable in conventional cancer
treatment are emerging, such as fulminant diabetes
and myasthenia gravis.
Another existing question is why the drugs do notappear to be as effective for some of the major cancer
types, including prostate, colon, and breast cancers.
One possibility is that an increased number ofmutations in cancer cells is favorable, because it
provides the immune system with more abnormal
molecular targets. This could explain why melanoma,
lung, and kidney cancers are associated with the mostcompelling results.
Discussion
In Japan, the prices of newly approved cancer drugs
have been increasing rapidly since the 2000s, due tothe development and introduction of “moleculartargeted drugs” that are designed to attack specificcancer cells. A team at the Memorial Sloan-Kettering

213

Cancer Center in New York City compared the pricesof newly approved cancer drugs every five years since1975. The team found that the monthly prices of suchdrugs stood at approximately $130 per person
between 1975-1979, but subsequently rose to $1,770
between 1995-1999 when 30 new drugs became
available. The prices of such drugs continued toincrease thereafter to $4,716 per person from 2000 to
2004. The prices of such drugs then rose rapidly to$9,905 per person from 2010 to 2014.
Physicians currently have no method of knowing
which types of lung cancer Nivolumab works best for,and are thus motivated to use the drug. To restrict theuse of drugs in the category of immune checkpoint
inhibitors to patients for whom they will work, thegovernment should establish a system to accurately
determine which drugs are effective for specificpatients, and when to discontinue their use.
Conclusions regarding medical and health careinnovation
In medical and health care innovation, ethicaldilemmas are both immediate to the patient and ofdeep concern to society. Altering the genes of a
fertilized egg results in changing the genetic code forboth the individual resulting from that embryo, as wellas their descendants, all of which occurs without
consent. Thus, it may be possible that we will alter thehuman genome sometime in the future.
Practical research into genetic editing for crops andfarm animals is ongoing but from a safety perspective,is there any difference between the plants and animals
altered with new techniques versus those already inuse? Genetic editing is, in a sense, the ultimate form ofgene modification. Japanese consumers are often
averse to genetically modified food out of concern forsafety. The creation of regulations is necessary todispel such concerns.
To promote breakthrough products like Nivolumab,
the Health, Labor, and Welfare Ministry Council sets
the prices of drugs to achieve a higher profit. A key
factor behind the high price of Nivolumab is its
associated expensive total manufacturing cost,
including the development expenses that the council
took into account. The price of a drug also tends to be
set higher when the number of estimated users issmall; however the largest problem is that the cost of a
drug's development has not been made public.
Disclosure of more details related to the grounds forsetting drug prices will be of vital importance given the
anticipated development of more innovative and costly
drugs in the future.
References
1) Science’s Breakthrough of the year, Science, vol.350, no.
6267, 12/18/2015
2) P. Liang, Y. Xu, X. Zhang et al., “CRISPR/Cas9-mediatedgene editing in human tripronuclear zygotes,” Protein &Cell, vol.6, no.5, pp363-372, 20153) UK scientists gain license to edit genes in humanembryos, E. Callaway, Nature/ News, 2/01/2016
4) Medication Guide for OPDIVO (Nivolumab) , Bristol-Myers
SquibbCompany

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Eubios Journal of Asian and International Bioethics 26 (November 2016)

http://www.opdivo.bmscustomerconnect.com/gateway5) Databases AZ/ Memorial Sloan-Kettering Cancer Center
Library
https://www.google.co.jp/webhp?sourceid=navclient&hl=ja&ie=UTF8&gws_rd=ssl#hl=ja&q=Databases+AZ%2F+Memorial+Sl
oan-Kettering+Cancer+Center+Library

Happiness in Bioethics- Takao Takahashi, PhD.
Professor Emeritus, Kumamoto
Japan
Email: ttaka@kumamoto-u.ac.jp

University,

Kumamoto,

Abstract
Both in clinical settings and in bioethical arguments,“happiness” is not a commonly cited concept. The
reason seems to be, first, its meaning is too wide andambiguous, and the second is that the concept ofhappiness in medicine or bioethics can be substituted
by QOL which was introduced into medical practices
as an objective and measurable concept and is very
useful for medical staff to judge how to treat a patient.
There are two kinds of health-related QOL:
comprehensive QOL and disease-specific QOL.
However, recently, researchers have tried to devise ascale of happiness in several ways. Roughly speaking,the subjective happiness scale can be built into
comprehensive health-related QOL, but it is difficult tofind the counterpart of disease-specific QOL in the fieldof happiness. Virtue based happiness is quite difficult
to be translated or built into QOL. Virtue basedhappiness is long-term happiness and realized by aman of virtue. Modern medical care, following
individualistic liberalism, has the principle of respect forautonomy of a patient, the basis of which is the right tothe pursuit of happiness which is dependent onpatient’s feelings. Regarding subjective happiness,most of its role is now covered by QOL. Then what, if
any, is the role peculiar to the concept of happiness inmedicine or bioethics? There seems to be at least twoplaces where the concept of happiness can play animportant role. The first is regarding the “enhancement
problem”, and the other is happiness of the medical
staff instead of the patient.
1. Happiness is not a common word in bioethics.
Both in clinical settings and in bioethical arguments,“happiness” is not a commonly cited concept. For
example, there is no separate article of “happiness” inrdEncyclopedia of Bioethics 3 ed (1). According to its
index, the term appears on page 185 only, though we
may find it on other pages. Moreover, there is no
separate article of “well-being”, and its term appears
on pages 758, 2047, 2380-2381, and 2484. On theother hand, there is a separate and comparatively longspace for the concept of QOL (Quality of Life), i.e.,
pp,1388-1402, and we can see or hear about it very
often in clinical settings and bioethics.
The reason for the less emphasis on the concept ofhappiness seems to be, first, its meaning is too wide to

be applied to medical practices and bioethicalarguments. The second is that the concept ofhappiness in medicine or bioethics can be substituted
by QOL which was introduced into medical practices
as an objective and measurable concept and is very
useful for medical staff to judge how to treat a patient.
Historically speaking, QOL is said to have first
appeared in ‘Great Society Speech’ (2) by President
Lyndon Johnson in 1964 as “quality of our American
citizen” i.e. as quality of the nation. But in this speechalso appears the sentence “it is a place where men are
more concerned with the quality of their goals than thequantity of their goods”, where QOL of each people isreferred to. As this speech shows, roughly speaking,
QOL has two mutually related usages, i.e., QOL of anation or a society and QOL of an individual.
In clinical settings and in bioethics arguments, QOL
of an individual patient, i.e., health-related QOL, isdominant. There are two kinds of health-related
QOL: comprehensive QOL and disease-specific QOL.
An example of a comprehensive QOL scale is SF36
(Medical Outcomes Study 36-item Short Form Health
Survey) which assesses the following general healthconcepts: physical functioning, role limitations due tophysical health problems, bodily pain, general healthperceptions, vitality, social functioning, role limitations
due to emotional problems and mental health (3). This
scale was made in the U.S. and translated and used inabout one hundred and twenty countries. Anotherexample is EQ-5D (Euro QOL), which is simpler than
SF36 and assesses mobility, self-care, usual activities,
pain/discomfort and anxiety/depression (4).
In addition to a comprehensive scale, there are a lotof disease-specific QOL scales such as QOL scale ofcancer, Alzheimer's disease and neurologic diseases.
As for happiness or well-being, now we havevarious scales. Researchers have tried to describe
happiness in several ways, e.g., consisting of positive
emotions and positive activities, or distinguishing threekinds of happiness: pleasure (positive sensory
experience), engagement (involvement with one’s
family, work, romance and hobbies), and meaning(using personal strengths to serve some larger end).
Also researchers have identified attributes correlatingwith happiness: relationships and social interaction,
extraversion, marital status, employment, health,democratic freedom, optimism, endorphins released
through physical exercise and eating chocolate,religious involvement, income and proxy to otherhappy people (5).
With regard to the methodology of measurement,
including QOL, happiness and well-being, there are
two basic kinds: subjective and objective. Subjective
methodology focuses on self-reported levels ofhappiness, pleasure, fulfillment and the like. Objective
measurements focus upon quantifiable indices ofsocial, economic, and health indicators. Some try to
combine the two basic measurements (6). We can saythat the distinction between subjective and objective
methodology approximately corresponds to the
distinction
betweensubjective
andobjective
happiness, well-being and QOL.

Eubios Journal of Asian and International Bioethics 26 (November 2016)
In the field of subjective well-being (happiness), so
called set-point theory has been dominant over the
past several decades, the central proposition of whichis that adult individuals have differing but stable levelsof subjective well-being, i.e., adult set-point do notchange except temporarily in the face of major life
events. However, recently it has been criticized andresearchers have begun to pay attention to the
dynamics of happiness (7).
2. Happiness and Health-related QOL
The title of this paper is ‘Happiness in Bioethics’,
therefore, when I refer to QOL, I will focus on healthrelated QOL. Now I will try to show the outline of therelationships between happiness and QOL. To begin
with, it is useful to compare a subjective happinessscale with a comprehensive health-related QOL scale.
To make the consideration simpler, I give two
examples of a scale with four or five items: one isSubjective Happiness Scale (SHS) by S. Lyubomirsky(8) and the other is EQ-5D (Euro QOL) stated above.
SHS’s 4 items were derived from original 13 selfreport items through several tests (Lyubomirsky, S. et.
al. p.140). SHS uses 7-point Likert scales. 4 items are
as follows:
1. In general, I consider myself: from “not a very
happy person” to “ a very happy person”.
2. Compared to most of my peers, I consider myself:from “less happy” to “more happy”.
3. Some people are generally very happy. They
enjoy life regardless of what is going on, getting themost out of everything. To what extent does thischaracterization describe you? From “not at all” to “agreat deal”.
4. Some people are generally not very happy.
Although they are not depressed, they never seem as
happy as they might be. To what extent does thischaracterization describe you? From “not at all” to “agreat deal”.
The EQ-5D health questionnaire requires you toplace a tick in one box in each group.
・Mobility
I have no problems in walking about.
I have some problems in walking about.
I am confined to bed.
・Self-Care
I have no problems with self-care.
I have some problems washing or dressing myself.
I am unable to wash or dress myself.
・Usual Activities (e.g. work, study, housework, familyor leisure activities)
I have no problems with performing my usual
activities.
I have some problems with performing my usual
activities.
I am unable to perform my usual activities.
・Pain/Discomfort
I have no pain or discomfort.
I have moderate pain or discomfort.
I have extreme pain or discomfort.
・Anxiety/Depression

215

I am not anxious or depressed.
I am moderately anxious or depressed.
I am extremely anxious or depressed.
Unlike SHS, EQ-5D contains objective factors, but,roughly speaking, subjective happiness can betranslated or, more exactly, built into comprehensive
health-related QOL.
In the terminal stage of life the concept ofhappiness becomes important, because here
especially, the meaning of a patient’s life is crucial.
However, we can build the concept of happiness into
QOL of end-of-life care, so, generally, subjective
happiness can be built into QOL.
As for disease-specific QOL, in general, it focuseson not only objective but also specific health-related
factors; therefore, it is difficult to find its counterpart in
the field of happiness, i.e., disease-specific QOL isindependent of happiness.
There is an important aspect of happiness that isquite difficult to be translated or built into QOL, i.e.
virtue based happiness. Virtue based happiness islong-term happiness and realized by a man of virtue.
Virtue can be trained and, in principle, objectively
identifiable by other persons. It is difficult to grasp
virtue based happiness by means of a subjective
method, because even if a subject feels very happy,
he/she may feel only short-term happiness or may feelhappiness in the situation where a virtuous person
never feel so.
Now we can show the rough relationships between
happiness and QOL as shown in the Figure.

3. The role of happiness in bioethics
In clinical settings and bioethics arguments, theconcept of happiness can be translated or built into theconcept of QOL, though the difficulty of making a scaleof QOL reflects the ambiguity and subjectivity ofhappiness.
Modern medical care, following individualistic
liberalism, has the principle of respect for autonomy ofa patient, the basis of which is the right to the pursuitof happiness. The happiness in this context isdependent on a patient’s feeling. If a patient feels
happy, he/she is happy, i.e. here subjective happinessis in question. Regarding subjective happiness, mostof its role can be covered by QOL. Here weunderstand the reason why in medicine “happiness” is216

Eubios Journal of Asian and International Bioethics 26 (November 2016)

not a key concept. Then what, if any, is the role
peculiar to the concept of happiness in medicine orbioethics?
There seems to be at least two places where theconcept of happiness can play a unique role.
The first is regarding the “enhancement problem”.
Here not only subjective but also long-term and,probably, virtue based happiness is in question. This isa passage from Beyond Therapy: Biotechnology and
the Pursuit of Happiness: “By directly inducingchanges in our subjective experience, the new
psychotropic drugs create the possibility of severing
the link between feelings of happiness and our actions
and experiences in the world. Who would need betterchildren, superior performance, or more youthfulbodies if medication could provide the pleasure andsense of well-being that is the goal of so many of ouraspirations? Indeed, why would one need to discipline
one’s passions, refine one’s sentiments, and cultivate
one’s virtues, in short, to organize one’s soulfor action in the world, when one’s aspiration tohappiness could be satisfied by drugs in a quick,consistent, and cost-effective manner?” (9).
At the base of an enhancement problem, there is aserious question as to the concept of treatment or
medicine, which is closely related to the concept ofhappiness, freedom and person. This question is
deeply concerned with the problem of modern medicalcare in general which adopts individualistic liberalism.
Thus individualistic liberalism in medicine is challenged
by the concept of virtue based happiness the origin of
which is ancient Greece.
The other place where virtue based happiness is
especially effective can be found when we think about
medical staff instead of the patient. Throughout history,
patients are not required to be virtuous, but medical
staff are required to be knowledgeable, sympathetic,
patient, diligent, just and decisive. By means of thosevirtues, medical staff can achieve self-realization
through their work and stay in a long-term happiness.
However, excessive overtime duty will reduce the levelof their QOL and hinder the self-realization. In thissituation the problem of supererogation of medical staff
has arisen and the concept of QOML (Quality of My
Life/Medical Staff’s Life) has appeared.
References8)

http://www.ppc.sas.upenn.edu/subjectivehappinessscale.pdf(access, 20113/5)
9) Beyond Therapy: Biotechnology and the Pursuit ofHappiness, A Report by the President’s Council on
Bioethics, HarperCollins Publishers Inc., 2003, pp.207-208

Effects of Electrosmog on
Birds: An Overview
1

2- J. Thresa Jeniffer , J. Joannes Sam Mertens and *A.
3
Joseph Thatheyus
1
Department of Information Technology, St. Joseph’s
College of Engineering, Jeppiar nagar, OMR Road, Chennai600 119, Tamil Nadu, India.
2
Department
ofElectronics
andCommunication
Engineering, SSN College of Engineering, Kalavakkam,
OMR Road, Chennai-603 110, Tamil Nadu, India.
3
PG & Research Department of Zoology, The American
College, Madurai-625 002, Tamil Nadu, India.
*Corresponding author Email:jthatheyus@yahoo.co.in

Abstract
Microwave radiation from mobile phone towers
popularly termed as ‘Electrosmog’ is considered tosome evidence to cause damaging effects on humans,
birds and other animals. In this work an overview has
been done on the importance of birds, and the effects
of electrosmog on birds.
Key words: Electrosmog, Microwaves, Birds, Mobile
phone towers.
Introduction
The number of mobile phone users in India is everincreasing and to support this growth mobile phone
towers are on the increase. Due to lack of specificpolicies on infrastructure development regarding thelocation of mobile phone towers, they are installed inboth urban and rural areas in a haphazard manner. As
these towers are based on electromagnetic waves
they pose danger to humans and other animals on
prolonged exposure. Though the adverse effects ofelectromagnetic radiations from mobile phones andcommunication towers on humans are well
documented, their effects on other animals are yet tobe established.

rd1) Post, S.G.(ed.), Encyclopedia of Bioethics 3
ed.
Macmillan Reference, USA. 2004
2)
http://www.h-net.org/~hst306/documents/great.html(access, 2011/3/3)
3) http://www.mhsip.org/reportcard/sf36.pdf#search='Medical
Outcomes Study 36 item Short Form Health
Survey'(access, 2011/3/3)
4)http://www.euroqol.org/fileadmin/user_upload/Documenten/PDF/Languages/Sample_UK__English__EQ-5D-3L.pdf(access, 2011/3/3)
5) http://en.wikipedia.org/wiki/Happiness. last modified on 3
March 2011 (access, 2011/3/4)
6) Constanza,R. et. al. “An Integrative Approach to Qualityof Life Measurement, Research, and Policy”, Surveys andPerspectives Integrating Environment and Society, 2008,
vol.1, no 1.
7) H. Brockmann, J. Delhey (eds.), The Dynamics ofHappiness, Social Indicators Research, Vol.97 no.1, 2010)

Electrosmog
It is reported that the population of sparrows
declined due to electromagnetic radiation in London
1,2
and certain European cities.
The electromagnetic
fields causing ‘electrosmog’ cannot be perceived byhuman sense organs and are not easily detectable.
Their effects appear to be chronic and result in long–term impacts. Several researchers reported negative
consequences on immunity, health, reproduction,
behaviour, communication, coordination and niche
3,4,5,6,7
breadth of species.
Electromagnetic field
inducesaversive
behavioural
responses,
developmental anomalies and mortality in many
8,9animals including birds.

Eubios Journal of Asian and International Bioethics 26 (November 2016)
Among the various groups of animals, birds are
exposed to a greater risk of direct irradiation due totheir flight behaviour. Mainly non-ionizing radiations
10
result in radiation–induced temperature increases.
They can also affect the bird’s capacity to recover fromphysiological stresses, and physiological andbehavioural repercussions. These radiations also
increased calcium–ion efflux in chick forebrain tissue.
The onset of radiation also affects the stabilizing
period of the egg production in birds. The capacity ofbirds to detect magnetic fields is affected due toincreased levels of electromagnetic waves which clash
11with the earth’s electromagnetic field.
Chickenembryos exposed to sinusoidal bipolar oscillating
2
magnetic field exhibited malformations. Interference of
microwaves from base stations with the reproductionof white stork, Ciconia ciconia was also reported.
Telecommunication towers produce 900 MHz foranalog and 1800 MHz for digital transmission pulsatedwaves which interfere with the nervous system of livingorganisms.
Birds
Arising in the Jurassic period of the Mesozoic era
from Orinthschian dinosaurs, birds are bipedal, featherclad, warm-blooded, air-breathing, oviparous and flying
craniates. They mainly live by moving in the air, whichis the most difficult medium of all and the mostrewarding for freedom of movement. It is estimatedthat the total number of bird species that have existed12
is 154,000 of which 9,600 are alive today. Birds havebodies which are highly specialized for an aerial modeof life. Almost every part of their body has been
modified for aerial life. For flight adaptations, they havespecializations in their morphology, anatomy andphysiology including wings, lightness, extra energy
production, speed, and balancing and control.
Feathers are special integumentary derivatives andcover the body. The smooth, closely placed andbackwardly directed nature of feathers result in
streamlined body which enable the bird to passthrough the air with minimum friction. The feather
covering makes the body light and insulates perfectly
by avoiding loss of heat. Some birds undertake
regular, periodic, to and fro movements between theirsummer and winter homes or from a breeding andnesting place to a feeding and resting place. Some of
the migratory birds travel thousands of miles in theirperiodic seasonal journeys. During migration birds likecranes, carrions, crows and finches fly with the speedof 30 miles per hour. Birds like the Arctic tern migrate
11,000 miles during winter and return during summer
12
travelling the same distance. Table 1 shows somethe benefit of birds and the damages caused by them.
The house sparrow, Passer domesticus is always
found associated with human habitats and it is the bestindicator species of urban ecosystem quality. London
has experienced a 75 percent fall in house sparrow
population coinciding with the emergence of mobile
phones. Electrosmog along with other factors may be
responsible for the decline of sparrows in European
1,2
cities. Increase in the level of microwaves in Spain

217

also resulted in a decline in the abundance and15
behaviour of house sparrows. Effects of electrosmog
on birds are listed in Table 2. Balamori (2005)
reported problems in reproduction and coordination
16
and aggressive behaviour in sparrows.
House
sparrows are fast disappearing due to electromagnetic
waves from cell phones and communication towers in
Bhopal,Nagpur,Jabalpur,Ujjain,Gwalior,17
Chhindwara, Indore and Betul in India.
Eggs ofhouse sparrows exposed to electromagnetic radiationin the laboratory also exhibited damage. Table 3
divulges the alterations in behaviour of birds due to18
microwave radiation.
13

Table 1: Importance of Birds
Benefits
Disadvantages
Food
Menace to agriculture
Medicine
Destroyer of game birds
Decorative value
Damage to fisheries
Commercial value
Carriers of diseases
Pollinator
Pests of honey bees
Fertilizer
Biological control of pests
Scavengers
Predators
Messengers
Signals
Entertainment value
Birds have thin skulls and their feathers can act as
dielectric
receptorsofmicrowave
radiation.
Audiofrequency pulse modulated high frequency fields
19, 20can induce piezoelectric effects in the feathers.
Since birds use magnetic navigation, they get
21,22
disoriented due to high frequency magnetic fields.
Nonthermal changes in the amount of neural activity by
the brain cells of the zebra finch, Taenopgyia guttata
23
were noticed. Some of the bird species affected by
microwave radiation are listed in Table. 4.
16

Table 2. Reported effects of Electrosmog on birds
Sl. No.
Effects
1
Egg mortality
2
Embryolethality
3
Teratogenicity
4
Modified growth patterns
5
Altered membrane permeability
6
Coordination problems
7
Navigation problems
8
Affected chryptochrome pigments
9Aggressive behaviour
10
Collisions on telecommunication masts
11
Altered behaviour
12
Developmental anomalies
13
Oxidative stress
14
Reduced abundance
15
Impaired health
16
Piezoelectric effects on feathers17
Lack of prey18
Reduced stress recovery
19
Fall in population strengthEubios Journal of Asian and International Bioethics 26 (November 2016)

218

Table. 3: Behaviour alterations found in birds due to18
microwave radiation
Name
Altered Behaviour
ChickenStanding suddenly, wing flapping andcollapsing
Parakeet
Gasping, beak opening and rapid
swallowing
PigeonThroat quivering, turning and bodyrocking
Quail
Neck extension, and throat quivering
TurkeyFeather erection and rapid swallowing
Table 4. Bird species affected by microwave radiation
Zoological Name
Common Name
1
2
3
4
5

Sturnus vulgaris`
Metacilla alba
Falco tinnunculus
Ciconia ciconia
Columba livia

6
7
8
9
10
11
12
13
14
15

Pica pica
Streptopelia decaocto
Turdus merula
Parus major
Serinus serinus
Carduelis chloris
Parus ater
Troglodytes troglodytes
Picus viridis
Certhia brachydactyla

16Phylloscopus bonelli

Starling
White wagtail
KestrelWhite storkRock(domestic)
dove
MagpieCollared doveBlack bird
Great tit
Serin
Green finch
Coal tit
Wren
Green Wood pecker
Short
toed
tree
creeper
Bonelli’s warbler

Conservation measures
Electromagnetic fields have to be recognized as apollutant and regular monitoring must be carried out in
urban areas as well as vulnerable locations likeeducational, hospital, industrial, residential andrecreational premises and ecosensitive regions. Bird
hits have to be avoided by minimizing security lighting
on ground facilities. Mobile phone towers can be
avoided in national parks, wildlife protection sites, bird
sanctuaries, Ramsar sites and conservational
important locations.
Conclusion
Electromagnetic radiations are interfering with thebiological systems and affect several groups ofanimals including birds, bees, ants, amphibians,
fishes, crabs, bats and humans. There is an urgent
need to carry out well designed studies to quantify theeffects of electromagnetic radiations on birds, otheranimals and humans.
Acknowledgments
The authors thank the authorities of their institutions
for encouragements.

References
1. Balmori A, (2009) Electromagnetic pollution from phonemasts. Effects on wildlife,
Pathophysiology. [Epub].
2. Balmori, A. & Hallberg, Ö. (2007) The urban decline of thehouse sparrow ( Passer domesticus): a possible link withelectromagnetic radiation. Electromagnetic biology andmedicine, 26, 141–151.
3. Preece, A.W. (2007) Health response of two communities
to military antennae in Cyprus, Occup. Environ. Med.
64:402-8.
4. Levitt, B.B. & Lai, H. (2010) Biological effects fromexposure to electromagnetic radiation emitted by cell towerbase stations and other antenna arrays. Environmental
Reviews, 18, 369–395.
5. Hardell. L. (2007) Long-term use of cellular phones andbrain tumours - increased risk associated with use for >10 years, Occup Environ Med. 64:626-32.
6. Hardell, L. & Sage .C. (2008) Biological effects fromelectromagnetic field exposure and public exposure
standards, Biomed Pharmacother.62:104-9.
7. Fernie, K.J. & Bird, D.M. (2001) Evidence of oxidative
stress in American kestrels exposed toelectromagnetic
fields. Environmental research, 86, 198–207.
8. Fernie, K. & Reynolds, S. (2005). The effects ofelectromagnetic fields from power lines on avian
reproductive biology and physiology: a review. Journal of
Toxicology and Environmental Health-Part B-Critical
Reviews, 8, 127.
9. MOEF 2010. Report on Possible Impact of Communication
Towers on Wildlife Including Birds and Bees. Report of the
Executive committee, Ministry of Environment and Forests,
New Delhi, India.
10. Batellier, F. Couty, I. Picard, D. & Brillard, J.P. (2008)
Effects of exposing chicken eggs to a cell phone in “call”
position over the entire incubation period. Theriogenology,
69, 737–745.
11. Hyland, G.J. (2000). Physics and biology of mobile
telephony. The Lancet, 356: 1-8.
12. Jordan, E.L. & P.S. Verma. (2015). Chordate Zoology.
S. Chand & Company Pvt. Ltd., New Delhi. pp 504-552
13. Ali (1996). The Book of Indian Birds. BNHS, Oxford
Univ. Press. Madras. 354p.
14. Ali, S. & L. Futehally (2013) Common Birds. National
Book Trust New Delhi, India. 126p.
15. Everaert, J. & Bauwens D, (2007) A possible effect ofelectromagnetic radiation from mobile phone base stations
on the number of breeding house sparrows (Passer
domesticus), Electromagn Biol Med..26:63-72.
16. Balmori A, (2005) Possible Effects of Electromagnetic
Fields from Phone Masts on a Population of White Stork(Ciconia ciconia), Electromagn Biol Med 24: 109-119.
17. Dongre, S.D. and R.G.Verma, (2009), Department of
Zoology, Jayvanti Haksar Government Post Graduate
College, Betul. ISSN-0974-2832, Vol. II, 52
18. Chou, C. & A.W. Guy. (1985). Absorption of Microwave
Energy by Muscle Models and by Birds of Differing Massand Geometry. J. Microwave Power. pp 75-84.
19. Bigu-del-Blanco, J. & Romero-Sierra, C. (1975a). The
properties of bird feathers as converse piezoelectrictransducers and as receptors of microwave radiation. I.
Bird feathers as converse piezoelectric transducers.
Biotelemetry 2:341-353.
20. Bigu-del-Blanco, J. & Romero-Sierra, C. (1975b). The
properties of bird feathers as converse piezoelectrictransducers and as receptors of microwave radiation. II.
Bird feathers as dielectric receptors of microwave
radiation. Biotelemetry 2:354-364.

Eubios Journal of Asian and International Bioethics 26 (November 2016)
21. Ritz, T., Thalau, P., Phillips, J.B., Wiltschko, R. &W.Wiltschko, (2004). Resonance effects indicate radical
pair mechanism for avian magnetic compass. Nature
429:177-180.
22. Thalau, P., Ritz, T., Stapput, K., Wiltschko, R. & W.
Wiltschko, (2005). Magnetic compass orientation of
migratory birds in the presence of a 1.315 MHz oscillating
field. Naturwissenschaften 92:86-90.
23. Beasond, R.C. & Semm, P. (2002). Responses ofneurons to an amplitude modulated microwave stimulus.
Neurosci. Lett. 333:175-178.

Identifying reasons for delaysin ethics approval: Experienceof an institutional ethics review
committee- Chandanie Amila Wanigatunge, Faculty of Medical
Sciences, University of Sri Jayewardenepura, Sri Lanka
Email: caw@sjp.ac.lk, (Corresponding author)- Shamini Prathapan, Faculty of Medical Sciences, Universityof Sri Jayewardenepura, Sri Lanka- Gizelle Malinka Warnacula:, Faculty of Medical Sciences,
University of Sri Jayewardenepura, Sri Lanka- Rochelle Shanika Tanner, Faculty of Medical Sciences,
University of Sri Jayewardenepura, Sri Lanka

Abstract
Ethics review is a mandatory process in research
involving humans and animals. Incorrect applications
results in resubmissions leading to delays in obtaining
ethics approval. This study was conducted to ascertain
reasons for resubmission of protocols to an ethics
review committee. A randomly selected sample ofproposals submitted during a 3 year period for an
institutional ethics review committee were analyzed tofind the reasons for resubmission. The qualitative
variables were analyzed through the calculation ofabsolute and relative frequencies
Two hundred and sixty nine protocols were
submitted during the study period of 3 years. Protocols
for observational studies accounted for 89% whileclinical trials and animal studies accounted for 7.8%
and 3.3% respectively. The majority (86%) of principal
investigators were those with a medical degree.
Average stop clock time was 23.4 days. Majority(67.3%) were reviewed over 2 meetings to reach a
final decision. Of the 95 reasons for returning theprotocols to researchers, protocol related issues(66.3%) and informed consent form issues (29.5%)
were the major reasons. The main protocol related
issues were those in methodology (41%), statisticalissues (54%) and inadequate risk benefit analysis(14%). Clinical trial related protocols needed morereviews before approval was granted.
Delays in reviewing due to ERC were minimal. Mostof the protocols that required resubmission had issues
pertaining to methodology and informed consent forms
or processes. These are easily corrected and can be
avoided with careful attention to ethical issues by
researchers when preparing the protocols.

219

Key words: Ethics review, research, delays, reasons,resubmissions
BackgroundResearch is essential for advancement of knowledge
and science. Medical research that involves humans,
including those that involve identifiable human data ormaterial must be conducted in accordance with the
ethical principles laid down in the declaration of
Helsinki [1]. Adherence to these principles helps toprotect the rights and wellbeing and ensures respect ofstudy participants.
Research proposals involving human subjects must
be reviewed and approved by an Ethics Review
Committee (ERC) prior to commencement of research.
The assessment by an ERC is needed in order toensure respect and autonomy of the research
participants and to ensure beneficence, nonmaleficence and justice [1]. Owing to the biologicalsimilarities seen between man and animals, animal
research has been an integral aspect of research.
Prior data from animal studies are almost always
needed before a new product can be tried out inhumans. Animal research should also be conducted ina manner that minimizes the impact on animals
involved [2,3] .Thus, the ERCs’ main functions include
evaluating research projects based on their scientific
relevance, technical and operational feasibility andreviewing ethics of the proposed research.
Over the last few years there has been an increasein bio-medical research projects being conducted in Sri
Lanka. This is largely due to the government initiative
to promote research. Most of these are investigatorinitiated while a few are industry sponsored multicentre phase 2 or 3 clinical trials. Phase 1 industry
sponsored clinical trials for new chemical entities are
not allowed in Sri Lanka at present.
In the absence of national guidelines on ethics
review and the ERCs in Sri Lanka rely on internationalguidelines such as the Declaration of Helsinki [1] andCIOMS [4] when reviewing protocols. While providing asound basis for ethical review, these lack guidance onsocial and cultural issues specific to the country andthe ERCs have to rely on the collective expertise andjudgment of its members to reach a consensus onsuch issues.
Although there is a national framework for the
conduct of clinical trials, Sri Lanka lacks laws to govern
the conduct of research and ethics review committees(ERCs). There is no local mechanism to evaluate or
accredit ERCs resulting in inequalities in the quality of
ethics review provided by different ERCs where somecommittees are perceived as being “more rigorous”
and “strict” than others. In the absence of a national
mechanism for accredit ERCs, many are now seeking
recognition by the Forum for Ethics Review
Committees in the Asia and the Western Pacific(FERCAP) under its Strategic Initiative for theDevelopment of Capacity in Ethical research (SIDCER)[5]. In the absence of a legal framework, ERC remains
a major form of research oversight.

220

Eubios Journal of Asian and International Bioethics 26 (November 2016)

The ERC of Faculty of Medical Sciences (FMS),
University of Sri Jayewardenepura (USJ) is an
institutional ERC established in 1995 to facilitate
research of its academic community. ERC FMS USJ
was granted recognition by the FERCAP under its
SIDCER recognition programme and is one of the 8
ERCs recognised by the Ministry of Health of Sri Lanka
to approve phase 2 and 3 clinical trial protocols.
ERC FMS USJ performs full board reviews of about
70-90 protocols a year and entertains applications
from any researcher who wish to conduct research
involving human participants in Sri Lanka and those
involving animals. In addition to the duly completed
appropriate application form, a detailed study protocol,
a letter of approval issued by the relevant higher
degrees board for protocols submitted for higher
degrees, data collection tools, information sheets,
consent forms and translations of all relevant
documents are required at the time of submission.
Review by ERCs is considered by many researchers
as an obstacle for research [6]. Review time andhence time for approval if prolonged may result a studysite being taken off a multi-centre study and ERC
reviews are therefore considered as undue delays bysome researchers [7].
Sometimes proposals are reviewed over several
meetings and this delays the final decision. The delays
in review could be due to increasing workloads of
ERCs over time, complexity of research protocols thatmight need external expert evaluations or even poorly
prepared submissions submitted by Principal
Investigators (PIs) which would lead to multiple
resubmissions. Lack of knowledge about research
participant protection among researchers is anotherfactor. Understanding the issues that lead to an ERC
delay due to resubmissions would help applicants to
prepare their application better. In audits of ERCs in
Brazil and Spain the main reasons for resubmission of
protocols were issues in the informed consent form
and methodological and statistical issues [8.9].
Identifying the reasons for resubmissions would help
to identify what corrective measures need to be taken
to minimize delays in decision making of ERC. This
would in turn, will help researchers to better prepare
their applications. We therefore performed an audit ona sample of applications submitted to ERC FMS,USJ
from 2012 – 2014 to ascertain causes of leading toresubmission of protocols.

worksheet. Statistical analyses were performed using
Statistical Package for Social Sciences (SPSS, version
15). The qualitative variables were analyzed throughthe calculation of absolute and relative frequencies.
This project was approved by the ERC FMS USJ(ERC55/14).
Stop-clock time – i.e. time taken for principal
investigator (PI) to respond to ERCs queries – wascalculated separately to help determine its contribution
to the time needed for final ERC approval.

MethodThe study was conducted between April – August
2015. Using a skip interval of three, every third
protocol in the database was selected to achieve therequired sample size of 88 to be analysed to find thereasons for resubmission.
All documents pertaining to individual protocols are
kept is separate protocol folders in the ERC office andthese were used for data extraction. Investigator profile
was determined from the application forms and theother data pertaining to each protocol were extracted
from the relevant minutes and the correspondences in
the protocol folders. Data was entered into an Excel

Reasons

Results
A total of 269 protocols had been submitted forreview for the period January 2012 – December 2014.
The majority (n=239, 89%) were for observational
studies while applications for clinical trials and animalstudies accounted for only 21 (7.8%) and 9 (3.3%)
respectively. The majority (n=203, 76%) were selffunded. Eighty eight (32.7%) protocols were approved
without requiring further clarifications. The averagetime taken by the ERC to reach a final decision(inclusive of stop clock time of 23.4 days) was 58 days.
The mean number of meetings needed by ERC for the
final decision to be reached was 1.8 meetings with amode of 2.
Eighty-eight protocols were selected at random forfurther analysis. Of these, 93% (n=82) were humanstudies while animal studies and audits accounted for
5.7% and 1.1% respectively.
Of the human studies observational studies were thecommonest study type (n=78, 89%) while 8% (n=7)
were interventional studies / clinical trials. Studies
related to herbs and other traditional medicinal
products accounted for 3.4% (n=3). Sixty five (74%) of
the protocols were submitted by Principal Investigators(PIs) with a basic medical degree. Of the 88 selected
protocols 47 (53.4%) had required resubmission. All
clinical trial protocols required resubmission and wereapproved after an average of 2.4 meetings. When thestop clock time was excluded the average time taken
for approval was 55.3 days which is nearly equal to 1.8
meetings
The main reasons for returning the protocols to PIs
for resubmission are given in table 1.

Table 1: Reasons for returning the protocols to PI
for resubmission
Total (n=95)
N%
Issues in protocol
63
66.3
ICFs
28
29.5
Administrative issues
4
4.2* Total is > 47 as some protocols had more than 1
reason that needed to be addressed.
There were a total of 95 reasons for returning theprotocols to PIs for resubmission. The reasons werecategorized under 3 main domains – protocol,
informed consent and administrative. Of the protocols
requiring resubmission, the majority (57%) were due toEubios Journal of Asian and International Bioethics 26 (November 2016)
issues pertaining to a single domain (e.g. protocol orinformed consent process) while 43% had issues
related to multiple domains. Every clinical trial protocol
had issues related to multiple domains that needed tobe corrected or clarified. The main reasons for
returning protocols were those related to themethodology of the study (46%) and issues in theinformed consent forms (27%). The issues related toprotocol and informed consent forms/process are
given in tables 2 and 3 respectively.
Table 2: Issues related to protocol leading toresubmission (n=47)
Issues in protocol
N%
Clarifications in the study instruments
and its translations
Lack of or inadequate risk benefit
analysis
Lack of detail in the methodology

12

25.5

11

23.4

9

19.1

Failure to mention or doubts regarding
issues related to sample size
Clarifications in recognition andprovision of treatment for adverse
effects and side effects
Inadequate definition of Inclusion
criteria
Inadequate definition of exclusion
criteria
Clarifications in title

6

12.8

5

10.6

4

8.5

Fate of samples

3

6.4

Inadequate justification/literature
review
Inadequate definition of the generaland specific objectives
Poor definition of terms used in the
protocolFailure to mention or doubts regarding
study setting
Total no of methodological issues

2

4.3

1

2.1

1

2.1

1

2.1

4
4

8.5
8.5

63

In nearly one fourth of protocols returned to PIs, theinformation sheets contained inadequate information.
Administrative issues were very few in numbers,
accounting to only 8.5% of the total issues.
Issues in the protocols in clinical trials and in nonclinical trials were compared. On average, clinical trials
took longer to receive approval and most (n=5/7) had
needed 2.4 meetings for approval to be granted.
Issues pertaining to study methodology, informed
consent forms and translations and inadequate risk:
benefit analysis were the leading causes requiringresubmission for clinical trial related protocols. These
were similar to those seen with non clinical trial
applications. The issues pertaining to risk: benefit
analysis in clinical trial applications are given in table
4.

221

Table 3: Issues related to Informed Consent
leading to resubmission of protocols (n=47)
N%
Inadequate information provided in 11
23.4
information sheets
Language too technical6
12.8
Translations
notprovidedorinconsistency in translations
Contact details of PI not mentioned

6

12.8

5

10.6

Total no of issues
informed consent

28

relatedtoTable 4: Issues related to Risk Benefit Analysis inclinical trial protocols (n=7)

N
Inadequate information on treatment ofadverse effects
Failure to provide Biological Material
Transfer Agreement
Failure to provide or inadequate risk
benefit analysis
Lack of information on likely adverse
effects
No justification for use of the drug on avulnerable population
Lack of appropriate medical personnel
on the teamRole of sponsor with regard toownership of data collected not clarified
Insufficient details on risk to participants
Failure to mention fate of the samples
once study is completed
Total number of issues related torisk: benefit analysis in clinical trial
protocols

%
57.1

4
28.6
2
28.6
2
14.3
1
14.3
1
14.3
1
14.3
1
1

14.3
14.3

1
14

The non-clinical trial protocols had more reasons forresubmissions. These were related to methodology,
inadequate literature reviews, definition of theobjectives and justification of the study setting.
Discussion
Delays in obtaining ethics approval can be due todelays in processing by the ERC and/or due toincomplete submissions by the investigators to the
ERC. The reasons need to be identified to enable
corrective measures to be taken and thereby minimize
delays in approval process. To the best of ourknowledge this is the first study to analyse experiencesof an institutional ethics review committee in Sri Lanka.
The results of our study indicate that approximately
two thirds of the applications to the ERC during thestudy period contained scientific, ethical oradministrative
defectswhich
necessitatedresubmission. This is comparable with that of a similar
study done in Spain [9] but nearly twice that of a study
in Brazil [8] where 68% had been reviewed in a single
meeting. Methodological issues were the main reasonsfor protocols needing resubmission in our study.
Among the ethical issues, inadequacies in the

222

Eubios Journal of Asian and International Bioethics 26 (November 2016)

informed consent process was the commonest causethat required resubmissions.
Informed consent is the cornerstone of research
ethics. Adequate information presented in a manner
easily understandable would help the participants tomake an educated decision on taking part in the
research.
It is also important for researchers,
especially those who are also in clinical practice, torecognise that there are differences between informed
consent for participation in research and informed
consent in patient care [10].
The main issues
associated with informed consent forms (ICFs) in thisstudy were inadequate information provided, language
too technical to understand the contents andinaccuracies of translations in to Sinhala or Tamil. The
main problem noted in the translations was the use of
written language which is in most instances not incommon use, a problem encountered when profession
translators are involved. The issues seen with ICFs inthis study were similar to those in other similar studies[11]. Researchers must be aware that the ICF is meant
for the potential participants [10] and the language andcontents should therefore be appropriate for their levelof education and understanding. It is the responsibilityof the researcher to ensure that the ICF is appropriate
in both contents and the language used. In addition to
the procedures that will be carried out during the study,
the ICFs must contain information regarding
background, justification and objectives of the study.
The responsibility of the ERC is to ensure that the ICF
is written in a manner that the research participant
understands the research, especially the potential risks
and benefits thus enabling him to make an informed
decision [11].
In the absence of a separate and independentscientific review, it falls on the ERC to review thescientific aspects of the protocol as scientifically invalid
research is unethical in that it exposes researchsubjects to risks without possible benefit [4]. Scientificreview must consider the study design, including theprovisions for avoiding or minimizing risk and formonitoring safety [4]. In our study, the protocol related
issues (53.8%) that necessitated resubmission weremainly those related to study instruments and its
translations (25.5%), methodology (19.1%), sample
size calculations (12.8%) and risk benefit analysis(14.1%). These were seen in both clinical trial andother research protocols submitted to our ERC.
However, information on management of adverse
effects/events (57.1%) were seen more with clinical
trial protocols while issues related to study instruments
and their translations were more in other types ofprotocols.
An awareness of what may lead to delays in ERC
approval would help researchers to plan theirsubmission better. This includes paying attention to theprotocol especially the methodology, to the informed
consent process and preparing the information sheets
and consent forms appropriately and other necessary
documentation. Investigators should be aware thatscientific and operational aspects of the study must be
understood not only by review experts in that field of

research, but also by reviewers from other research
fields, and even reviewers who are not linked to theresearch but are members of the community [11]. Mostof these can be easily corrected if attention is paid
while preparing the protocol and necessary
documentation[11].
Familiarityofethicalconsiderations by researchers is helpful when
discussing the issues raised by the ERC andnegotiating these with it [12].
The delays can also occur with the review processitself by the ERC. This could be due to the workload of
ERC members who in nearly all instances would be
providing an honorary service in addition to their usual
work. Non-availability of the required expertisenecessitating the project being sent to external
reviewers is another potential cause for delay. ERCs
should have mechanisms to minimize delays whileproviding a good quality and timely review. ERC FMS,
USJ has a policy of resending the documents to theoriginal primary reviewers if they are resubmitted for
major modifications and a process of Chairperson’s
approval for minor modifications to reduce delays
associated with the administrative process.
The average time taken by ERC, FMS USJ to grant
approval for a project from the time of its submission
was 2 meetings (57.9 days) inclusive of the averagestop clock time of 23.4 days which is the time taken by
the investigators to respond to ERC comments. In
most instances a single resubmission addressing theissues of ERC was all that was needed for approval.
The approval time was longer for clinical trial protocols
which took an average of 3 meetings to reach adecision. Investigators of such trials would also takelonger (average of 34.6 days) to respond to ERC’squeries. This would necessitate the protocol to remainin the agenda for extra meetings without it being taken
up for discussion. The ERC approval time can befurther shortened if the investigators take note of thescientific and ethical issues when preparing their
protocols.
Conclusions
Ethical analysis of a research project must be
viewed as a fundamental and essential step by all
those involved in conducting research involving bothhumans and animals. Researchers need to havegreater awareness of the rights of individuals who
participate in biomedical research, especially withregard to protecting the autonomy of participants andensuring their safety and wellbeing. Greater
understanding of research ethics by those conducting
research would help to minimize delays associatedwith the ethics review process. The interactions
between the researchers and ERC should be viewed
positively by all involved to ensure that the research is
conducted in a scientific and ethical manner.
Competing interests - CAW was Chairperson, SP
was Secretary and RT and GW were administrative
assistants of ERC, FMS USJ during the study period.
Authors' contributions – CAW proposed the initialconceptual framework for the research and wereEubios Journal of Asian and International Bioethics 26 (November 2016)
responsible for overall conduct of the project. CAW, SP
and RT and GW were involved in the protocol design,
writing and editing the manuscript. CAW, SP and GW
contributed to collection and analysis of data including
the statistical analysis. CAW prepared the first draft
and SP wrote the second draft. All authors wereinvolved in subsequent editing and agreed on the final
version.
References
1. World Medical Association. Declaration of Helsinki:
Ethical Principles for Medical Research Involving
Human Subjects. Helsinki, Finland: World Medical
Association, 1964. Latest revised and updated
version, 2013
2. Russell
WMS, Burch RL. (1959). The
Principles of Humane Experimental Technique,
Methuen, London. ISBN 0900767782
3. Baumans V. Use of Animals in Experimental
Research: An Ethical Dilemma? Gene Therapy.
2004 Oct; 11 Suppl 1:S64-6.
4. Council for International Organizations of Medical
Sciences (CIOMS). International ethical guidelines
for biomedical research involving human subjects.
Geneva: CIOMS; 2002
5. SIDCER recognition programme. http://www.fercapsidcer.org/recog.php. [Accessed 15 June 2016]
6. Burris S, Moss K. US health researchers review
their ethics review boards: a qualitative study. J
Empir Res Hum Res Ethics. 2006; 1(2): 39–58
7. Silberman G, Kahn KL. Burdens on Research
Imposed by Institutional Review Boards: The Stateof the Evidence and Its Implications for Regulatory
Reform. The Milbank Quarterly.2011; 89(4): 599–
627
8. Bueno M, Brevidelli MM, Cocarelli T et al. Reasons
for resubmission of research projects to theresearch ethics committee of a university hospital inSão Paulo, Brazil. Clinics. 2009; 64(9):831-6
9. Martı´n-Arribas MC, Rodrı´guez-Lozano I, AriasDı´az J. Ethical Review of Research Protocols:
Experience of a Research Ethics Committee. Rev
Esp
Cardiol.
2012;65(6):525–529
doi:10.1016/j.rec.2011.12.018
10.
Levine R.J. Informed consent in research andclinical practice: Similarities and differences.
Archives of Internal Medicine, 143, 1229–1231.
11.
Colt HG, Mulnard RA. Writing an application
for a human subjects institutional review board.
Chest. 2006;130:1605-7.
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Burke GS. Looking into the Institutional
Review Board: observations from both sides of thetable. J Nutr. 2005; 135:921-4.

223

Whitehead’s concept of thepast as objective
immortality with specialreference to Tanabe’s ideaof world religion- Makoto Ozaki, Ph.D.
Emeritus Professor, Sanyo Gakuen University, Japan
Email: orig57eter@orion.ocn.ne.jp
The Kyoto School philosopher Hajime Tanabe
proposes a new idea of world religion in which
Christianity, Japanese Buddhism and Marxism are to
be unified in a dialectical way as the selfdevelopmental synthesis in history in anticipation of
the second religious reformation. It would probably betenable in comparison to Hegel’s idea of history inwhich abstract and implicit potentiality gradually comesto actuality, superseding each specific stage, until theunity of the whole is completely realized. Whereas for
Hegel the Divine Spirit is the immanent agency
operative throughout the progressive history, it is thetask of human endeavor for Tanabe to construct sucha project as unprecedented. How is this feasible? Itmight be highly productive of the actualization ofpotentiality to employ the Whiteheadian process whichis composed of the subjective becoming for the futureideal and the objective being as the real potential
inherited from the past with the view of the advance ofhuman ideas. This piece may be tempted in adventure
to open a novel phase of the hidden potential truth up
to the actual reality as the Aristotelian entelecheia,
suggesting the Hegelian Absolute as the effect or end
qua the actualized beginning, in the event.
The past as Objective Immortality
With regard to Aristotle’s distinction of actuality andpotentiality, A.N. Whitehead makes a further distinction
between pure potentiality and real potentiality inrelation to actuality. While pure potentiality refers to the
Platonic eternal ideas or universal forms, realpotentiality is on the status of the past being which is
no longer subjectively active but still remains the
stubborn fact or given datum functioning as theefficient causation for the succeeding subjective
actuality of becoming. For Whitehead, the past isnever ascribed to nothingness but is rather immanentin the present as the objective immortality. For him, theworld is composed of actual entities or occasions insuccession of time which have the double structure of
subject and object or superject in such a way thatwhen the subjective act of becoming in the present
completes and terminates its activity, it is negatively
converted and turned out into the object as being
without its own subjective immediacy. In other words,
the past lives in the present with the vectorialtransference to the future, and hence is still actual andactive in the form of memory and causality for224

Eubios Journal of Asian and International Bioethics 26 (November 2016)

producing a new creation. The imperishable orimmortal past as the preservation of the actualized
potentialities may in some way correspond to the IndoBuddhist idea of karma, i.e., action and its potential
power influencing the subsequent lives. For
Whitehead, becoming is more primary than being inthe sense of being as the product of a becoming, and itis the replacement of the traditional metaphysicalconcept of substance by endurance in supersession oftime. Aristotle’s analysis of becoming should bebalanced by Whitehead’s analysis of perishing which is
the weakest point of modern philosophy as well. Thismight contribute to searching for a solution of the
puzzled problems involved in the nascent world.
Whitehead says that actual entities perpetually perish
subjectively, but are immortal objectively (PR). For
him, time is perpetual perishing as well as perpetual
arising of actual entities in supersession, and isirreversible and asymmetric in character orienting
towards the future, without returning to its beginning.
This is the cumulativeness of time, contrary to the
Buddhist notion of cyclic time as symmetric and to
Hegel’s and Heidegger’s ideas of the coincidence ofthe end and the beginning in such a way that at theend time is the beginning fully realized, or the return ofthe end time to its origin as the retrieval and repetition.
The irreversibility of time arises from the objectificationof the past in the present, the conformation of thepresent to the past as the completion.
The past is re-enacted and restored in the present
with richness and depth in the direction of the future byreason of its objective immortality in the modes ofmemory and causation. The power of the past as theimmortal potentiality may give rise to the errant cause
as the irrational element by virtue of which any
unforeseen accident may happen.
This is due to the fact that the potential past is still
active and actual in the arising of the present event as
its efficient causation. Tanabe refers this errant cause
in Plato’s idea of khola, i.e., space or place or thematrix of becoming in the Timaeus to the Buddhist
notion of karma as the past potentiality. According to
the Buddhist principle of non-duality of subject andobject, human existence and its environmental world
are viewed as correlative, or even the environmental
world is effected by the human subjective action, in thedepth of karma causality of action and its potential.
This means that one should not be confined within
one’s own past causality but rather beyond it takeaction to reform the given actual world in conformity
with the subjective aim of the ideal towards the future.
Historical Actuality
In the western metaphysical history, on the other,
Aristotle emphasizes actuality vis-à-vis his mentor
Plato’s eternal ideas or universal forms transcending
the actual imperfect world, and seeks for a unity of the
opposed constituting factors of actuality andpotentiality as complete reality, i.e., the so-called
entelecheia. And this tendency towards actuality istaken into Hegel’s philosophy as indicated by the
famous phrase “what is rational is actual, and viceversa”. In this sense, his thought may be regarded as
evolutional pantheism in the way of unfolding of theAbsolute in history as its own self-manifestation inprocess, reaching the goal at the end of history inwhich the presupposed abstract beginning is fully
realized. This thought may be reflective of the Christianidea of the Incarnation of God in history in the humanform of Jesus which is also influenced by the
Aristotelian immanence of form in matter or of
potentiality in actuality.
Another modern German philosopher Heidegger, too,is in pursuit of returning to the historical origin ofwestern type of thinking which is to be resumed as thesecond other beginning of a new era of history,
concealed in the depth of the first beginning, i.e., thepre-Socratic age, at the eschatological present time, in
preparation for the coming of the last and ultimate
God. His expectation of the last God in the otherbeginning implies the second coming of Christ alongwith the realization of the Kingdom of God at the end of
history in view of his earlier study of Christian theology,
as his disciple Karl Löwith and others mention. The
Christian idea of the Incarnation is the immanence ofthe transcendent God in the human world, and Hegeland Heidegger express this idea in terms of
metaphysics as the secularized version of Christiantheology. In fact, Heidegger interprets Aristotle’s
metaphysics, and it might not be denied that histhought is much influenced by the latter as well.
Hereby it might be no surprise to find out some affinity
in structure between Heidegger’s idea of the last God
and the Bodhisattva in anticipation of theeschatological era over 2000years after the historical
Buddha’s passing, which is predicted in the Lotus
Sutra.
Inadequacy of Zen and Pure LandIn this regard, the Kyoto school philosopher Tanabe
proposes a new synthesis of Japanese Buddhism,
Christianity and Marxism from the dialecticalperspective in that Japanese Buddhism, represented
by Zen and Pure Land, which are devoid of thehistorical actuality, should be mediated by thehistorical character of Christianity and the Marxist
socio-historical practice as well, and the mythologicalconnotation of the Christian idea of personal God
should be demythologized in terms of the Buddhist
principle of Emptiness. Although Tanabe is muchinfluenced by Zen and Pure Land Buddhism,
nevertheless, he later on criticizes both of them forbeing devoid of the socio-historical actuality in such a
way that Zen is devoid of social extension of practicedue to its abstractness of sole one’s own action andwith respect to Pure Land the Amida Buddha as theAbsolute Other saves human beings in the one-sided
way without mediating human beings’ own subjectivity
and independency.
By the same token, the Japanese philosopher of law
Tsuneo Hirano also points out the deficiencies of Zen
and Pure Land in that Zen remains abstractness ofsublation or abolishment of the historical actuality of
the causal determinations into absoluteness and Pure

Eubios Journal of Asian and International Bioethics 26 (November 2016)
Land is involved in the direct redemption of this world’s
people by the other world’s authority without historicalactuality of the causal determinations on this side.
Another Marxist Kyoto School philosopher Jun
Tosaka makes a criticism of Tanabe’s philosophy as akind of creative eclecticism or syncretism as well. Even
if so, however, as Hegel also foresees the third religion
which is neither Catholic nor Protestant, and Nietzsche
declares that a new God has never appeared over2000 years, Tanabe’s insight may not be curious but
rather profound in view of the historical development ofreligion on a world-wide scale. For the French thinker
Jacques Attali, too, predicts the future fusion of theChristian view of linear time and the Buddhist view ofcyclic time. Whitehead also says that philosophers
have expressed the same idea differently. The
American process theologian John Cobb also
proposes a mutual transformation of Christianity andBuddhism from the Whiteheadian process perspective
in favor of the Christian superiority of historical realityof Jesus as the Christ to the mythological Amida
Buddha in the other world. If so, it might probably becogent that the existing world religions are to be unified
in the historical development of humankind, though in
the immensely far future.
Dialectic
From the Whiteheadian perspective, since a new
becoming of actuality arises from the existing actual
world as the past potential data, a new form of creativeadvance occurs by mediating a diversity of thehistorical elements accumulated so far to a unity ofconcrescence of them at a higher stage ofdevelopment. Tanabe’s methodology of dialectic as thetriadic logic of the genus or universality, the species on
the particular level, and the individual is muchinfluenced by Hegel’s dialectic of negative mediation
which bears a resemblance to the Buddhist principle of
Emptiness perpetually emptying itself in the temporalprocess. Tanabe’s grand project might implicitly reflect
the second coming of Christ or the Bodhisattva inanticipation of the eschatological future in a
metaphysical manner. So, Tanabe and Heidegger
might be in agreement with each other in the
expectation and preparation for the unseen God or
Being à la Heidegger, or the Bodhisattva as the selftransformation of the eternal original Buddha hidden in
the depth of history.
How is this related to Whitehead’s concept of thepast as objective immortality? A new actuality takes
place in conformity of the past to the present together
with the subjective aim; in other words, when theefficient causation and the final causation are unified
with each other, a new actuality becomes in thepresent as a creative advance into novelty. Thissignifies that the past is mediated in and throughnegation to the present in which the past, in the lostmode of its immediate subjectivity, is turned out intoand preserved as the objective being, i.e., superject(his own new term), in the succeeding higher stage of
becoming of actuality mediated by the subjective aim.
According to this scheme, the existing world religions

225

in the different cultural areas, Buddhism andChristianity, are to be mediated in negation to eachother into a novel creation of actuality whereby bothreligions as the past continuous objective beings (thegiven data) are negated and still preserved as theinner constituent elements of a nascent actualization of
the real potentialities transformed from the subject tothe object. So, Tanabe’s attempt at a dialecticalunification of Buddhism and Christianity may benecessarily directed towards the ideal world religion in
the sublated or lifted up mode in the creatively
advancing process of history. As a result, it is not amere mixing of the different religions but rather a new
synthesis of the past beings in potentiality into a higher
creative becoming of complete actuality as the selfrealization of the real and pure potentialities in theconcrescent novel origination of actuality lured by the
subjective aim. Hereby it is obvious that the subjective
aim plays the important role in the complete
actualization of potentiality, and when the potentiality is
fully realized, it is no other than what is meant by the
Aristotelian concept of entelecheia, i.e. the perfectunity of the opposed elements of potentiality andactuality in the dynamic movement. Tanabe’s ideal
world religion as the postulate aims at a harmony to beattained in the future, though indefinitely remote for thepresent. Hereby might be seen his propensity for
Kantian and Platonic idealism, contrary to Hegelianrealism.
As a whole, it might be tenable that Christian theology
and Heidegger’s metaphysics as the secularizedversion of it are indicative of the messianic expectationfrom the apocalyptic perspective, and this may in someway correspond to the Bodhisattva in anticipation of
the eschatological future of the post-the historical
Buddha, as alluded in the Lotus Sutra.
Identity in Diversity
According to Eugen Fink, for Hegel Being is time as
the process of producing its own moments in the selfmovement of becoming and perishing, retaining itself
in and through its changes as the subject as well as
the substance. Even so, however, Fink points out that
Hegel remains obscure in respect to the possibility of
opening up of a new aeon of history. For Hegel,following the Aristotelian concept of entelecheia, theAbsolute is nothing but actual being as the movementof activity participating in actuality. For Fink, however,
it is almost impossible to tell in advance about thepossibility of a new self-revelation of God or Being on
the final stage of history with Hegel. According toHegel, Being cannot remain as such but goes a stepfurther to negate itself in the other form, differentiates
itself into the multiplicity of forms, and then returns toitself as a unity of the outer appearance and the inneressence.
Process
In particular, for Whitehead the teleology of theuniverse is directed to the production of beauty as truth
which is the conformation of appearance to reality,interweaving absoluteness upon relativity as the226

Eubios Journal of Asian and International Bioethics 26 (November 2016)

realization of harmony, and the harmony of harmonies
is peace as the self-completion of civilization. The pastobjective immortal being is reenacted in the present in
unison with the subjective aim for the future. This may
imply the return and repetition of the most archaic pastor even the eternal original essence hidden in thedepth of history upon the present free subjective actionof realizing the ideal potential for the future purpose.
The messianic expectation of the occurrence of Being
as the last God or the coming Bodhisattva as the
eternal Buddha in the transformed mode of being as aresult of the self-emptied Emptiness in a cyclic way
might be in resonance with the Whiteheadianconception of process.
For Whitehead, the process in which actual entities
perpetually arise and perish with the vector direction of
the future upon the accumulation of the past potentials
does not end but goes on further endlessly; there is noeschatology in his system of thought, as compared toChristian theology, its metaphysical versions of Hegeland Heidegger, and Buddhology. In the Whiteheadian
process there is no culminating point of the current oftime, but ever and always increases the objective
immortality of the past towards the future irreversibly in
its asymmetric structure of time. Hence, the process
theologian Lewis Ford asserts in respect of God’s
future activity in that God is everlastingly becoming
and never in being, always subject, never object,always future, never present, never becoming past.
This is the divergence of Whiteheadian thought fromothers mentioned as above. Even so, however, inorder to avoid the involvement in the schematic logic ofdialectic, it might be necessary for us to adapt theWhiteheadian idea to the Buddhist and Christian
thought with the view of constructing a unification ofthem.
For Hegel, too, the history of philosophy is nothing but
the self-unfolding of itself in historical process, the selfmanifestation of the Absolute Spirit or Reason inhistory. This is because the Infinite can manifest itself
in the finite regions, and the finites are the modes of
the Infinite in space and time; there is no Absoluteapart from the relative, no eternity without history. The
Absolute as the Infinite exists in relation to the relative
finite as the reciprocal relationship between the
opposed. For Tanabe, eternity is to be manifested in
the present in and through the mediation of human freesubjective action as the self-realization of eternity inhistory. Even so, however, in Tanabe’s viewpoint there
is no line and direction to connect each present but
simply a point in isolation without conjunction withother points in the form of continuity of discontinuity
eventually due to his involvement with the Zenstandpoint of one’s own action as the self-power.
For Hegel, Being occurs as event, becomes actual inspace and time of human existence; God as the
subject becomes manifest and present in history, andhistory is the predicate. On the identity of time andbeing, for Picht, too, truth is not the truth ofunchangeable being but the truth of changing time,
and the appearance of the becoming present of thepast. God’s being is in becoming in the event of the

Incarnation in the human form, and this is the logic of
Christology, as expounded by Eberhard Jüngel. This
logical scheme, however, is not only relevant toChristianity but also to Buddhism as well in which theeternal original Buddha assumes a variety of forms
and names in his immensely long journey of salvation
history on a multi-universal scale beyond our planet,
as elucidated in the Lotus Sutra. The eternal Buddha
returns to himself in the primordial origin upon the selfcompletion of saving course and inaugurates his
activity of salvation again ceaselessly. So, at issue is
how to make both religions compatible with one
another. In this regard, the Kyoto School philosophy isin need of further explication of accommodating themin a harmonic unity on account of its limited scope of
the knowledge of Buddhist thought.
[Paper presented at KBRT10, Kumamoto, Japan 2016]

A comparison of sociocultural values in Japan and
Iran based on social media
communications- Nader Ghotbi, MD, PhD
Professor, College and Graduate School of Asia PacificStudies (APS), Ritsumeikan Asia Pacific University (APU),
1-1 Jumonjibaru, Beppu city, Oita 874-8577, Japan
Email: nader@apu.ac.jp

Abstract
The core sociocultural values of a nation may have asignificant influence on the pace of its socioeconomic
development and adaptation to a globalized
community of nations. Max Weber was the firstsociologist to conduct a comparative study of two belief
systems and their impact on socioeconomic
development. This study examines the social values ofcontemporary Iran in comparison with the developed
nation of Japan to investigate whether there aremeaningful differences that could be responsible forthe shortcomings in the socioeconomic development of
Iran. Besides the review of literature regarding coresocial values in both Iran and Japan, data wascollected from Internet-based discussion forums run bya few hundred educated Iranians over a period of 8months. Data was examined through a qualitative
method to refine and update the findings in literatureand through debates over the cultural aspect of socialchange in Iran in the years following the 1979
revolution. The study provides a cluster-based systemfor exploration of the core social values in Japan and
Iran, and compares the typical Japanese and Iraniancharacter prototypes. The discussion includes a
description and an analysis of these values, andconcludes that a number of traditional values in Iraniansociety including individualism and societal divisionparticularly into religious (mazhabi) vs. national/ethnicclasses may have played a role in the slow pace ofEubios Journal of Asian and International Bioethics 26 (November 2016)
development in Iran
Keywords:
Iran,
Japan,
Socialchange,Socioeconomic development, Sociocultural values.
Introduction
The motivation for this paper came from theexchange of messages and other communication
through Internet-based social media shared byhundreds of my university alumni, including a few
friends and relatives, all living in Iran. During a periodof 8 months, I realized a common preoccupation of thislarge group of Iranians, based on their observations ofdaily life in Iran, was that a gradual “cultural decline”
had been in progress over the last 30 years. Because I
grew up and lived in Iran till graduation and followed acareer there for a few years before moving to Japan in
my early 30’s, I was familiar with many of the ‘socialchanges’, but some recent ones were surprising evento me. Therefore I decided to review a few alreadypublished papers on the subject, gather the group’s
observations, and use a sociological analytic method
to describe, analyze and then explain the cultural
aspects of social change in contemporary Iran in a waythat helps with its understanding to anyone interested
in this debate.
However, without a point of comparison, such a
study would suffer from being one-sided, interpreted
wrongly and would probably appear as a subjective
stereotyping of Iranians and an attempt to connect a
false cultural image to the myriad of ‘socioeconomic’problems. Therefore I decided to use my familiarity
with Japanese society and ethical values, related to
my research career in Japan, by conducting acomparative study of core cultural values incontemporary Japanese vs. Iranian society to reveal
their differences, as well as any similarities thatJapanese social values have with Iranian values. A
comparative method would thus help avoid unfetteredstereotyping and non-deserved criticism, while
demonstrating whether there were any significant
differences in sociocultural values that could be
associated with socioeconomic problems in Iran.
Before attempting an analysis, we need to review
some basic concepts in sociology for our discussion
and describe our main assumptions to help simplify thetask. Values of a culture define what is desirable orconsidered good, right and/or worthwhile in that
culture. The ‘norms’ in a society develop out of its
cultural values. We assume that social behavior,including the norms of a society, is significantly
influenced by sociocultural values that are learned
directly and indirectly through living in a society. The‘core’ values of a society are values that are commonly
adhered to, or acknowledged as fundamental by mostmembers of that society. It is assumed that thesevalues influence social behavior and the norms of thesociety. Some of these values are so closely related to
one another that they can be grouped as a ‘cluster
value’, while others may contradict one another tosome degree and appear as ‘value contradictions’.
This is different from another possible situation where
the core values of a large number of people in a227

society clash with the core values of another growing
number of people supporting an opposing value. Sucha situation is common during social change.
Max Weber (1864-1920) was probably the firstsociologist to use cross-cultural material to examinesocial change and to explain how differences in socialgroups could affect their socioeconomic orientation. He
realized that followers of the Catholic belief system
would preserve their traditional way of life, while
followers of the Protestant belief system searched forfinancial success. In a comparison of capitalism in
Catholic and Protestant countries he showed that
capitalism had flourished in the latter (Henslin, 2011).
Here we adopt from Max Weber’s theory in forming the
hypothesis that a comparison of core social values
between Iran and Japan may provide clues as to theradically different directions in socioeconomic
development between the two nations. World Bank
data (2014) show that Japan has the third largest GDP
in the world (4.6 trillion US dollars) compared with Iranth
at 29 (415 billion US dollars).
After the 1979 revolution in Iran substituted the
kingdom rule with an Islamic republic government, asocial change started that has been promoting shia
Islamic values in Iranian society ever since. Here welimit the study to the sociocultural aspect of change
and exclude the political process so that we can havea sharper focus on the role of core ‘cultural’ values. It
is worthwhile to note that ‘ideal culture’ refers to values
and norms that are considered as ideal in a society
while in reality many people may not follow and/or
achieve them, hence ‘real culture’. So perhaps one
question this paper attempts to answer is whether thereal culture in Iran conforms to its ideal culture. This
will be further explained in the discussion part.
Methodology
This research is partly based on a review of theliterature including published academic papers andbooks about Iranian society and cultural values(Beeman 1976; Hillman 1990; Bar 2004) andJapanese society and cultural values (Wierzbicka
1991; Yoshino 1992; Morishima 1982; Hofstede 1988;
Soutar 1999; Davies 2002; Hendry 2012). Moreover,an analytical tool for qualitative research was used to
examine information collected through Internet-basedsocial media, as well as observations of Japanese andIranian societies by the author and the focus groupmembers, respectively. The analytical tool used was
the “three- layer structural analysis” after Takao
Takahashi (Takahashi 2011) who refined this method
for use in ethics research after John Rawls (19212002) in “A Theory of Justice”. The so-called “threelayer structure” in sociological research as used hererdrefers to the fundamental or ‘core values’ as the 3ndlevel, the existing ‘social directives’ as the 2 level,stand the social ‘norms’ of behavior as the 1 level.
Figure 1 shows a scheme of the relationships
between the three levels of analysis and where
deductive, inductive and abductive reasoning is usedin the course of analysis (Figure 1). Takahashi made a
distinction between intrapersonal and interpersonal

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Eubios Journal of Asian and International Bioethics 26 (November 2016)reflective equilibrium; these processes represent theworking out of data and information in the brain of a
researcher (intrapersonal), vs. the analysis of theinformation among a group of researchers(interpersonal). Takahashi made the distinction
following the work cited as “Reflective Equilibrium:
Essays in Honor of Robert Heeger” edited by W. vander Burg, T. van Willigenburg (1998). He useddeductive, inductive and abductive reasoning toposition data in different layers of this structure, as
seen in Figure 1.

Figure 1: A scheme of “three-level structural
analysis,” after Takao Takahashi, showing the steps
where deduction, induction and abduction are used, as
well as the associated feedbacks. There are twostndpathways to identify the components at the 1 , 2 , andrd
3 level. One uses abduction (with feedback used as astrdcheck) between the 1 and 3 levels, and the otherstnduses induction and deduction between 1 and 2 , andndrdbetween 2 and 3 levels, respectively.
The data for the qualitative study was collected fromsocial media during a period of 8 months from January
to August 2015, with the participation of the author inInternet-based discussion forums where a few hundred
Iranians participated in sociocultural discussions. A
wide range of social issues were put forward for
discussion; tentative hypotheses to help explain themwere sought and formed step by step, using the threelayer structural analysis as the framework of research.
st
Observations from the society (1 level) were used inabduction to reach a potential core value, and eachvalue found in literature was traced to see if membersrdof the society were observed or known to act (3 level)
according to it. These findings were double checked by
the other path which uses induction to arrive fromstndsocial norms (1 level) to social directives (the 2rdlevel) and uses deduction to trace core values (3level) to social directives (the 2nd level).
For example, the observation of “increased violencestin Iranian society” at 1 level was correlated to thevalues of strength and bravery (shoja-at), zeal andrdhonor (gheyrat) and emotionalism at the 3 level. The
ndsocial directive at the 2 level would be: “vigorously
fight a man who insults you and your family”; this wascorroborated with the participants in social media.

Also, the observation of “cleanliness of public spaces
despite a lack of garbage cans in Japanese cities” atst
1 level was correlated with the value of “concern forrd
the environment” at the 3 level. The social directive atndthe 2 level would be: “do not throw away garbage inpublic space”; this was also corroborated withJapanese subjects. Such a process was conducted for
all the values listed in the two forthcoming tables.
To avoid biased criticism, negative attributes were
not presumed to be sociocultural values. This aspectmakes our study different from many critical writings
which associate socioeconomic problems withnegative cultural characteristics. Our approach has
been different as we assume no society would promotea negative value; thus if a problem seems to be
associated with a sociocultural attitude, it may be
because of the ‘lack’ of a positive value, as comparedwith the other society where it exists, rather thanexistence of a ‘negative’ one. The comparative natureof our study between Iran and Japan facilitated thisapproach.
Findings
Although Iran and Japan are both located in Asia,
they are culturally very different and it may be wrong toassume that they share an Eastern (as opposed toWestern) characteristic. For the most part, Japanesesociety is quite secular, as opposed to the strong roleof religion in Iranian society. Japanese people are alsomuch more homogenous, as compared with themultiethnic society in Iran with a multitude of ethnic
groups who share many values but also have theirown different tunes. It is thus naïve to consider ‘one’average Iranian prototype for comparison with theaverage Japanese prototype; for the purposes of thispaper, we simplified the differences among Iranianpeople to the level of ‘two’ typical Iranian characters inorder to examine their shared values and differenceswith those of a typical Japanese character. Also, forsimplicity, we did not consider “gendered” charactersin this study while we should acknowledge theexistence of differences between values common tomen and women, particularly in Iranian society. It is
hoped that other studies look into the important genderissues especially in Iran.
Let’s start by listing the core values of Japanesesociety. Table 1 shows a list of these values as well asclusters (A to F) that group some of them together. It
should be noted that this table is not an attempt tostereotype the Japanese society but rather torecognize a series of (positive) sociocultural values
that can then be compared with the core values of the
Iranian society.
The typical Japanese character described in Table 1
usually behaves as a responsible member of thecommunity and the society at large, tries not to standout among others, controls his emotions to avoid directconfrontation, consults group members to reach aconsensus decision, believes in fairness, and showsdeep respect to the law and regulations in public andat work (cluster A). Values in cluster B imply that theJapanese prototype behaves politely towards
everyone
especially
his/herseniors,showsEubios Journal of Asian and International Bioethics 26 (November 2016)
consideration to others by trying not to cause them any
trouble, has friendly manners, says thank you whenanybody does him a little favor, is apologetic whenever
he feels others might be constrained because of him,
does not show off and is humble especially to his
seniors, and takes good care not to embarrass himself
by wrong actions; many researchers (Befu 1990;
Hendry 2012) have emphasized on the significance offeeling ‘shame’ which is more of an outward emotion
compared with the feeling of ‘guilt’ which is more
inward. It is also worth noting that some of thementioned values involve a consideration of thehierarchical system of Japanese society.
Table 1- Values in Japanese society arranged inclusters (produced by author as explained inmethodology)
A-1
Respect to social obligations & social
conformity (collectivism)A-2
Self-control (avoid confrontation)
A-3
Group conformity (seek consensus)
A-4
Concern for Fairness
A-5
Deep respect for law & regulations
B-1
Politeness and social manners (such as
consideration for others, friendliness)
B-2
Gratitude
B-3
Ability to apologize
B-4
ModestyB-5
Avoid shame & embarrassment
C-1
Honesty & seriousness (majime)
C-2
Effort (gambari) & hard work
C-3
Endurance (gaman)
C-4
Stay safe
D-1
Reliance on science & technology forbetterment of life
D-2
Reliance on evidence & professional advice forD-3 decision-making
Concern for the (natural) environment
E-1
Individuality (have/keep/value one’s uniquefeatures)E-2
Respect to one’s ancestors
F-1
Strive for health & physical fitness
F-2
Youthfulness
The next cluster (C) may be considered the ‘work
ethic’ of the Japanese character. He is typicallyhonest, follows his job seriously, shows a lot of effort at
hard work, and endures difficult work conditions for along time while paying particular attention to the safetyof everyone including himself (“safety is first” as aJapanese motto).
Cluster D includes values that imply the roadmap to
the development and betterment of society by relying
on science and technology, relying on evidence fordecision-making, and respecting the value of natureand its protection. Thus our Japanese prototype
believes that using science and technology can help
solve most problems, understands that decisions
should be supported by (scientific) evidence and seeks
the advice of professionals in each area, while trying
not to disturb the nature and to keep the environment
clean.

229

The individuality value in Cluster E may be seen as
relatively contradictory to collectivism in Cluster A but
in fact it helps reduce the pressure of collectivism inJapanese society by allowing people to enjoy a series
of individual characteristics that can make one feel
unique (Hoffmann 2000). Thus our Japanese characterhas a strong sense of his own individuality andbelieves such unique features can help differentiate
him from others, features he has received from his lineof ancestors and are in his blood. In other words, hecommonly values being a unique individual at thepersonal level.
Finally cluster F is about the value of preserving
one’s health and fitness. The average Japaneseemphasizes a healthy lifestyle with healthy food andexercise, appreciates youth and tries to preserve his
stamina and appearance as he ages. The youth areseen as enjoying their best years of life, and areadmired for their youth; people want to preserve youth
by leading a healthier lifestyle. These cultural values
have probably influenced the choice of universal
healthcare through social-community coverage inJapan. On the other hand, this may underlie thecommon fear of getting old and losing social
significance after retirement.
The common values of Iranian society are presented
in Table 2; however, we propose two Iranian character“variants” that represent average prototypes thatbelong to two opposite sides of a spectrum with a wide
range of characteristics in between. We thus describe
two typical Iranian characters to grasp the wider
heterogeneity of Iranian sociocultural styles of
behavior; let’s call them N for national (melli) and R for
religious (mazhabi). We assume that social change
after the 1979 revolution resulted in the demarcation of
two typical Iranian characters that probably alreadyexisted but instead of moving closer over time
gradually moved more apart. However, there arestrong cultural similarities between the two which stillbind them together. The main difference may appear
as having a more religious/conservative character, butthere are other differences including pursuing leisurevs. wealth, and using humor vs. a more serious
appearance. Still, the two prototypes share many corevalues though they may apply them differently when
adopting social norms that are influenced by thesevalues. One observer said: “the religious character
colors the social and public activities of those who aredefined as such.”
It is not simple to define what religious (mazhabi)means in the Iranian context; the most common
feature of this group is that they want to be identified
as such! For this reason, physical appearance plays
an important role such as by wearing a beard amongmen, the dress code (quite well defined for men andwomen), and manners of speech. Next in relative
frequency, is the observance of shia Islam rituals,
mourning customs, and following Islamic celebrations
as well as visiting mosques for group prayers. Only
next would be adherence to Islamic requirement ofdaily prayers and fasting in Ramadan, paying zakat
and etc. Under the current political system, being

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Eubios Journal of Asian and International Bioethics 26 (November 2016)

identified as mazhabi would be advantageous inrespect with power connections and may also provide
some extra protection and a higher chance of getting
public and governmental employment.
The other group (N) would be identified by observing
a relatively free dress code within limits of public,
faithful observance of Iranian ancient celebrations
such as Nowruz (the Iranian New Year), Yalda,
Mehregan, and Chahar-Shanbe Suri, paying respect tonational heroes, poets, novelists, etc., and enjoying
Iranian music, singing and dance. This group simply
identifies itself as non-religious (not mazhabi) even if
they observe Islamic daily prayers and fast in
Ramadan! Iranians with a strong ethnic affiliation (suchas the Kurdish, etc.) are also included here. Table 2
summarizes the core values of the two typicalcharacters in today’s Iranian society.
Table 2- Values in Iranian society and the associatedclusters (produced by author as explained inmethodology)
N(national)
R(religious) Prototype
Prototype
A-1
Individualism, with some emphasis on relations
with the extended family & close friends
A-2
Stronger
National
Stronger
Religious(melli)or
ethnic (mazhabi) identity
identity
A-3
Loyalty to one’s family and group, skepticism of‘others’
B-1
Cleverness(zerangi)
forsuccess&achievement (outwitting others)
B-2
Pragmatism (practical rationalism)
B-3
Sophistication (through formal or selfeducation)
B-4
Iranian etiquette in speech called taarof(pleasantry)
C-1
Bravery & strength (shoja-at)
C-2
Zeal & honor (gheyrat)
C-3
Emotionalism (rage, sadness, sensitivity toinsult, …)
C-4
Frequent use ofConservative (morehumor (playful & fun- serious, less humor)
loving)
D-1
Concern with material comfort:
More inclined toMoreinclinedtopursue leisureincrease wealthD-2
Aestheticism (beauty, art, poetry, ...)
E-1
Valuing friendship and its code (marefat,
maram)
E-2
Hospitality to guests (mehman-navazi)
E-3
Altruism and assistance to the poor and needy(kar-e kheyr)
The two typical Iranian characters, N and R
prototypes, both firmly prioritize their individual wants
and needs, and consider themselves, their immediate
and extended family and a few close groups they
associate with as having priority over the rest. They
highly value family relations and demonstrate a lot of
respect to their closest relatives. The two prototypes of
N and R both value loyalty to the groups they are close

to, and may be skeptic of other groups. However,prototype N is less religious and considers his
nationality or ethnicity to be a more significant factor in
defining who he is, while R has a relatively stronger
religious (mazhabi) identity in which certain religious
characteristics are as significant as, or even more
important than, national/ethnic characteristics. Thus bybeing identified differently, they may already feel
somehow skeptic towards one another and may havereservations on whether they can get along in a sharedproject. Indeed, some groups have tried to bridge thegap by calling themselves melli-mazhabi, but they risk
coming under the suspicion of both main groups! In
summary, Cluster A shows the strong role ofindividualism in Iranian society plus familial (as well as
small group) bonds that grow around it. However, aconsiderable amount of skepticism and suspicion ofothers exists that may complicate cooperation andsolidarity. The stronger the loyalty to one’s bonded
group is, the more skepticism towards others may be
expected. In a sense, people may ‘envy’ to see close
relations of one of their members to another group.
Cluster B defines a series of values common to most
Iranians; they believe in using various strategies tooutwit others (called zerangi) in order to succeed inlife, and are quite pragmatic about it (Bar 2004). Thisimplies that the purpose of behavior can be more
important than the actions composing the behavior.
Therefore they may rationalize unfair actions to othergroups as necessary and justified; these may include a
certain amount of trickery and deception, such as“white lies”. However, people must demonstrate a sortof ‘sophistication’ in how they commit themselves totheir purpose and avoid acting in a lame manner(Hillman 1990). When dealing with others in social
situations, this requires following a unique Iranianetiquette called taarof (pleasantry); it is an
exaggerated form of nicety in manners that would betaken with a grain of salt by a wise listener who may
respond only with more of the same etiquette!
Cluster C includes a number of values that are in
relative contradiction to the previous cluster (B). The
two Iranian prototypes both value strength and bravery(shoja-at) to the point that safety, reason and manners
may all be sacrificed. They also value a unique code ofzeal and honor (gheyrat) though it may mean different
things to different people. Prototype N, for example,
may find it honorable to do sacrifice for the sake of
one’s family or nation while prototype R may put
considerable value on religious symbols especially
protecting the chastity and innocence of women in
their family or group. People in both groups may act
quite stubbornly (ta-assob) and show strict
adhesion/resilience in changing their position. Doingso, Iranians commonly express strong emotions thatthey barely try to control, such as rage, anger andsensitivity to insult. The N prototype however may
have a happier mood compared with R. The N
prototype shows more desire to fun activities andcommonly uses humor (shukh, shukhi) in his vision oflife and in speech, while the R prototype is more
serious-looking and conservative; in extreme

Eubios Journal of Asian and International Bioethics 26 (November 2016)
situations, one may describe N as acting like a maniac
while R appears as suffering from depression.
Cluster D describes the interest of both of our Iraniancharacters in “material comfort” with this difference that
the N prototype is especially on a pursuit of leisurewhile the R prototype is more conservative and may
seek more comfort in accumulating wealth/property.
They both appreciate beauty such as in art, poetry andmusic; however, the R prototype may limit the vision of
beauty to more conservative forms such as mystic
poetry and traditional music without female singers.
However, the N character enjoys working on thebeauty of appearance including fashion, and shows anappreciation for art including traditional and modernmusic and dance.
Cluster E describes the very warm and sympathetic
values common to most Iranians. They value
friendship and have close friends who observe astrong code of support and assistance (marefat,
maram), warmly welcome even strangers as guest to
their home (mehman-navazi) and commonly engage inaltruistic donations, financial aid and assistance with
the needs of those who seek help (kar-e kheyr).
In spite of all the differences existing between the N
and R prototypes (and the two spectrums of Iraniancharacters they represent), there is no constant clash
between them. It appears as they are well familiar with
one another and have accepted the reality of life under
one banner. Although they may sometimes try tocompete by pushing their community in one directionor the other, there are also many instances that theyshow an appreciation for the opposing norm as long as
it helps avoid a direct confrontation. Still many find theexisting differences in values too big for truereconciliation and usually stay away in separate
groups.
Discussion
A comparison of the listed core values between
Japanese and Iranian society in Tables 1 and 2
demonstrates the lack of certain key values in each of
the two compared with the other, as well as a few
opposing values, most importantly collectivism inJapanese society vs. individualism in Iranian society.
In the context of our paper, we especially differentiate
whether a typical individual demonstrates in his/herbehavior a priority for group goals over his/herindividual goals, or vice versa. Let’s analyze some ofthe observed differences between the two and thepotential impact and implication for the whole society.
The first observation is the dominance of collectivism
in Japan versus individualism in Iran. Iranians havetraditionally been known as especially loyal to theirfamily (as a social group); however, this has beenchanging with the changing form and size of thefamilies in recent times and their breakup into smaller
units because of millions of people who migrated tolarger cities or to abroad. The Japanese, however,commonly emphasize on the goals of the larger groups
they are a member of, whether at work, in thecommunity they live in, and in the wider society andnation that they strongly associate themselves with.

231

The implications of this difference for economic
development are not too hard to elaborate.
Moreover, Iranians are not as homogenous as theJapanese; we limited the wide variety of typical Iraniancharacters into two common prototypes to simplify ourcomparison. The size of a truly secular population
inside Iran is still limited but a large population of nonreligious Iranians commonly identify themselves as
nationalist (melli or mihan-parast) or ethnic centered(especially common among Kurdish and Azeri people).
However, those identifying themselves as religious(mazhabi) have the wider support of the government
as compared with nationalists or the ethnic-centered.
This situation may especially intensify the rivalry
between the two sides and/or obstruct theircooperation; people from both sides sometimes try to
reduce friction by softening their stance “in public” andinclining towards the middle. Although this tactic helps
avoid a direct clash, it may also aggravate the existing
skepticism to others because in the start of anegotiation, people are sure of the true affiliation of aperson they do not know, and thus it takes a long timeto acquire somebody’ trust. Some people may tend to
only trust and work well with those who they alreadyknow well, such as their relatives. This situation leads
to nepotism which is a very common observation in
Iran. On the other hand, Japanese society can benefit
from values in its B cluster to increase cooperation
between all members of the society, though the
hierarchical system in Japan puts some pressure on
less senior members to conform and give in to thedemands of more senior members. Iranians, however,depend on their unique etiquette in manners (taarof)
which although nice is mostly skin-deep and cannot
prevent from rivalry, infighting and enmity when aconflict exists.
Another significant difference is the lack of a strong
work ethic in Iranian society as compared withJapanese society (cluster C). In fact, values in cluster
B of Iranian society include cleverness and outwitting(zerangi) which may imply the value of success withless effort. A person who tries very hard to earn aliving may be considered as “less clever” and a person
who can outwit others and succeed with the least
amount of physical effort may be considered as“cleverer”.
The Iranian values in cluster C as well as
individualism itself may provide a source of pride andmotivation for individual growth. However, theexcessive use of these values in the context of analready existing skepticism, heterogeneity, andpragmatic competition centered on outwitting rivals
cannot be helpful for the growth of the society as awhole. There are also certain disadvantages such as
the higher rates of social violence in Iranian society
associated with emotionalism and a strong sense of
personal or family honor. In comparison, Japanesesociety shows a significant value for controlling one’s
emotions to reduce confrontation. Thus Japanesesociety values encourage cooperation.
Likewise, the “lack” of strong values in Iraniansociety similar to those in Japanese clusters D, E and232

Eubios Journal of Asian and International Bioethics 26 (November 2016)

F may explain the weak pace of economic
development in Iran despite having rich natural
resources; the assignment of related but unqualified
people in sensitive positions in policy-making, etc.
which has led to mismanagement at the industry; asignificantly higher incidence/prevalence of death,illness and injuries among Iranians because of
unhealthy lifestyles such as risky driving; and higher
levels of environmental degradation and overuse ofnatural resources to the point that the naturalenvironment and water resources in Iran are currently
at critical levels.
Values in Iranian Cluster E are probably the nicest
qualities that foreigners travelling to Iran recognize
among Iranians. Also, Iranians in general show
significant solidarity to the poor, the needy, and people
who they feel are oppressed. They also develop warm
friendships that may last a long time. There are a lot of
observations to support the strength of these values
among Iranians; from common low interest loansystems and charity donations to the poor, to tourism
hospitality and personal sacrifice there exists so muchamong Iranian people, which is not observed
commonly within the Japanese society, in comparison.
Iranians, however, do not demonstrate the strong
sense of individuality that can be observed among theJapanese. An observation was the huge interest incosmetic surgery among Iranians to acquire the ‘same’
beauty that others have; however, the stronger senseof individuality existing among the Japanese
discourages them from losing their unique qualities.
Many Iranians do not attempt to preserve their own
unique form and instead, they “envy” the beauty ofothers and want to become like them.
Reviewing the turbulent history of Iran and its
conquest over the centuries by many armies including
the Greek, Arabs, Turks and Mongolians, one may
suggest that many of the existing social values could
have evolved as a response to invasion or an attempt
to adapt to life under the ruling armies. However, it canbe debated that this traditional system of values(Beeman 1976) is no longer helpful in the modern era
when Iranians need to cooperate with one another andbe less skeptic about relations with other nations.
One of the strong influences remaining after theIslamic conquest of Iran is the religious affiliation which
has been further reinforced under the more recent
Islamic republic government. While the governmenthas been busy promoting Shia Islam to its people, thepromotion of other values such as a strong work ethic,
observance of law, reliance on science and evidencebased decision-making, respect to environment andetc. has not received due attention and support. The
currently increasing rates of social problems in Irancan be ascribed to many factors including the pressureof economic sanctions, mismanagement by the ruling
government, lack of agreement between traditionalsocioeconomic practices and modern economics,
increasing urbanization, and overcrowding of the cities.
However, we believe that the comparative lack of
certain sociocultural values among Iranians plays asignificant role in slowing the pace of socioeconomic

development. This relative lack of positive values, ascompared with Japanese society, may act primarily
through channeling the human resources away fromconstructive social development and rather onindividual goals. Following individual (or limited group)
goals does not help overcome the existing barriers insocietal cooperation based on fairness, rule of the law,and improved management of national resources by
the experts.
Fortunately, the increasing usage of Internet-basedsocial media in Iran by a growing number of people
and the younger generation may provide a means for
Iranians to engage in discussions over social issues
whereby they may get to know each other better, findtrust, and organize shared activities that may improvesolidarity and cooperation in the nation and thus to astronger socioeconomic development in the future.
Acknowledgements
I am very grateful for the constructive comments andinformation provided by Dr. Ramin Yazdani (Ottawa,
Canada), and Dr. Pantea Farjad (Tehran, Iran) who
read the initial draft and helped with its revision.
[Paper presented at KBRT10, Kumamoto, Japan 2016]
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Western Technology and the Japanese Ethos. New York:
Cambridge University Press.
Soutar, Geoffrey N., Richard Grainger and Pamela Hedges.
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Takahashi, Takao. 2011. “Three Levels Structure Analysis
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Yoshino,Kosaku.
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CulturalNationalism
inContemporary Japan: A Sociological Enquiry. New York,
Routledge.

“Is dialogue
Islam?”

possiblewith1- Osama Rajkhan
Saudi Arabia
Email: osamarajkhan@gmail.com
It depends on who is talking to them. I would like toinvite you to read this anecdotal experience to explainwhy.
I celebrated the Millennial New Year with an
American friend from work in Phuket. He had justfinished a two year stint on board of a nuclear
submarine in the service of the US Navy and joined the
UN System in Bangkok. I, a citizen of Saudi Arabia,
had been recently transferred on promotion from the
UN High Commissioner for Human Rights in Geneva
to assume the functions of the ProgrammeManagement Officer at the UN Economic and Social
Commission for Asia and the Pacific in the same city.
We both left friends and loved ones behind to move to
Bangkok and the pain of distance was made that more
intense with the approaching holiday season, so wefelt maybe we should try something different to distractourselves from missing girlfriends back home andheart breaks. The healthy adult response in such asituation is to reach for support from others, and so we
decided to spend the holiday together.
The ensuing adventure beat the pain of loneliness.
When we arrived in Phuket the sky was clear and it
was almost sunset, befitting the resort we chose as it
was also called Sunset Resort. The transfer from theairport was smooth and I was listening to my favorite
song by Heart “let me go crazy on you” on theheadphone set when I was the hotel’s counter, and atthat instant, the artist sang, “whatchya gonna do,” andmy heart lept forward and started beating faster; myimagination soared as I thought of what we were goingto do now that we are here, and the sight of the sea
and smell of the breaze wafting across the lobby sentheart-warming shivers through me. “I love this place.”“Whatchya gonna do?” There was nothing left to do
now other than the obvious. We checked in, changed
and went out and hired an electric golf-cart to take us
to dinner at a cliff-side fancy restaurant overlooking thebeach. The view, the company, and the conversation
over dinner made our ordinary concerns disappear in
the midst of the moment. Life just couldn’t get better
than that, the things off the view of the naked eye –1This is an opinion piece contributed to the Conference
Dialogue on Bioethics and Religion, Japan Association of
Bioethics and Aisan Bioethics Association Joint Session, 4
December 2016, Osaka, Japan.

233

loved ones, family issues, work, even identities –seemed to burn.
We were just a couple of young men looking for fun
and building new friendships, maybe even laying someroots if the circumstances were right, in a new country
that would be our home for some years to come. At
the restaurant the waiter asked us if we had
reservations and at once both of us looked to the sea.
He looks at us in anguish and escorts us to a whiteclothed table with a red candle glass in the centre.
“We are doing alright,” I said to myself as we sat down.
It might as well be summer in the northernhemisphere. Doo-wap, we went with heart bruises andnow the view from the table felt like the soothing balm
the doctor ordered. With eyes pinned on the waves inthe distance, our dinner conversation began and intime covered many areas of the living – from girls togeography and from successes to disappointments inlife to movies and novels – and when we arrived to the
topic of beach reading material , like the latest
publications and novels, which most travelers carry totheir destinations, much to our surprise and delight, welearned that we both brought books that essentiallydealt with politics, in his case it was
SamuelHuntington’s “Clash of Civilization” and “War andPeace” by the Russian author, Leo Tolstoy, in mine.
What followed was a 3-hour stimulating conversationthat took us unnoticeably to midnight. We were botheducated and skilled so this was more than aconversation: it was more like a chain of reactions to
the arguments that humanity handled during difficulttransitions in time and how it stayed connected under
the strain and stress of fear and boredom while
seeking redemption. Our discussion stayed away fromthe familiar “official” angles of “republican” vs.
“democrat” positions and instead teased out thephilosophical assumptions people make in everyday
life and what they saw as true or fiction.
We both grew up in the liberal and democratic West
where the individual was considered supreme, andpretty much trusted in the West’s righteousness not
only in terms of its virtues but also culture of freedomof choice. American pop-culture was the foundationand spring board that shaped our outlook on life. Our
work at the United Nations was essentially about
spreading this outlook on human freedom, to include
all people though (not just the smug), from theconstraints of nature and society.
This wasunderstood as a necessary condition to ensure
everyone had their own space on the map and could
pursue their own aspirations in due time. Choice iswhat mattered in the end. That’s what we thought. But
freedom can take a long time to build.
Brendon (not his real name), understood this andgave his attitude a certain tincture epitomized by what
he told me: he lives by the credo of “highdiscrimination, high survival chance.” He shared thispoint about half way through the evening,
unexpectedly. Having spent close to six years working
as a Human Rights Officer in Geneva, that reply struck
me as a bit odd.
Understanding difference andsimilarities fascinated me ever since high school234

Eubios Journal of Asian and International Bioethics 26 (November 2016)

biology so I asked him with an open mind why he felt
discrimination was a “good” thing to live by as he put it.
Decisions are made every moment in an instant, he
explained, and like in a football match, you have toquickly run with the ball, pass it, tackle, or you will go
down. He saw life as football game; a struggle
between two teams for survival and glory. And here iswhere we differed. I also saw life as a struggle forsuccess too but for me the losers in the confrontationneeded consolation to pave the way for their reintegration (not isolation) in recognition of their humanright to exist in dignity and diversity and let a marketlike model decide what is best for achieving their wellbeing. In other words, the looser was not the enemy;
in fact there is no enemy – that is just an abstract ofthe mind people like to imagine to simplify thecomplexity of real life. I felt strongly about this also
because I wanted to be consistent with the idea ofindividual supremacy. In the Kantian tradition, whichpermeated my work as a human rights Officer, the ideathat individualism was sacred meant seeking theconsent of the person in all aspects of life before
making any implicit or explicit judgments about what isbest for them and that’s how the system can guarantee
everyone’s free will. Kant believed in free will, but not
Nietzsche; he saw humans as prisoners of genetic andenvironmental determinism.
My friend was more Nietzschean, believing that weare all hard wired by our respective cultures and that
free will was an illusion, a nice idea but not real, a view
he explained so poignantly that prompted me to decideto read Nietzsche’s philosophy when I got back to
Bangkok. Then I asked him what he thought about
Hiesenburg’s quantum observation, upon which many
liberals rested their arguments for free will. “That wasa tiny effect,“ he replied and, it was a rare thing, as therarefied habitats of the jet set. The rest of us are
enslaved to our backgrounds and only withextraordinary effort and high-energy can a man or
woman escape the warp of determinism. So do wegive up on development I said? Do we give up on
making people come first? No, we just need tounderstand that if someone wants to fly, then there arewalls to be climbed over, mountains to be scaled, anda lot of heartbreaks along the way. Look at America’s
history: it wasn’t built in a day. So is there room for
Kant’s ideas today. I mean, where does liberalism
stand in the world today? The State is the dominant
player on the field, he said, which was also myunderstanding, and added that the liberal tradition wasantithetical to the notion of the State, which is political.
Liberalism tries to constraint the actions of the State,even aiming to abolish it; politics is founded on theidea of conflict, the constant duality of friends and foes,
allies and enemies. When war breaks out, he said,
you cannot be a liberal, watching from the side anddoing nothing: you quickly get to know yourself andtake sides, the side of the State. It’s like being in astorm, debris can hit you in the head and the wind canlift you and throw you on a deadly pile of unknowns,
and you will go down to the ground, like a football on
the football field if you lost it when you hit thatbreakdown wall. In a storm, you need to decide what
is safe and what is not, and that required a highcapacity for discrimination.
And this is why hebelieved the human capacity of discrimination wasgood and must be cherished as it had survival value indifficult times.
For him, different cultures are like different footballteams, their game is essentially about a struggle forsurvival, and when it came to Islam, a culture currently
devoid of the liberal tradition that prevailed in the Westafter enlightenment, and disappeared from its domaintharound the same time (circa 15 century), one could
only assume that they are essentially dealing with apeople hard determined to pursue a way of life that isdifferent than that in the West, and with affinity
dissolving into phonetic claims of peace and tolerance,
obscurity and darkness can only lead to a clash of
civilizations, and indeed a clash reared its ugly head
like a medusa in the form of oil wars in the 1970s.
“Sure,” I said, it maybe that 20 years ago
commitment to development at the United Nations to
reduce the wretchedness of the people of the third
world helped push developed countries to transfer
more of their wealth over but the three main players of
the world system appear to be playing for each other,
not against one another as in the football match. “Howso,” he asked?
His question jotted my memory back to the dreaded
gas lines on Sunset Boulevard in Hollywood during thesecond oil shock on 1979. The inconvenience wasdramatic -- that’s actually when the thought ofcommuting to college by bicycle first entered myyouth’s mind as I spent up to two hours in line every
morning before going to class. That’s also when I
started taking novels to read in the car to kill the agonyof the wait. But, in retrospect, it seemed that was anaberration – a freak accident in the history ofinternational relations because in reality things were
not so disjointed and distressed; our leaders worked
hard to make our world, our cities, our families andourselves safer and better. Besides, no government
wants to govern over consenting poor people because
stately governments who live with a lot of poor people
must dread and hate poverty.
Fast forward and I explained that during my post
graduate studies at Arizona State University (1990), I
found the Wallersteinean school of thought ininternational
economics
best
explained
myunderstanding of the world back then.
Immanuel
Wallerstein viewed the world as a triangular system of
a division of labor and power consisting of core, semiperipheral and peripheral countries with a high degreeof cooperation and coordination between them, in spiteof their ideological differences.
At the time, threetheoretical approaches prevailed in the study ofinternational politics and economics at my university:
conservative, liberal, and revolutionary.
The
conservative school was premised on the status-quo
argument that saw life as comprising harmonious
cycles of repetition that preserved (not changed) theorder of things. By contrast, the liberal view wascentered on the idea of evolutionary change that wasEubios Journal of Asian and International Bioethics 26 (November 2016)
driven by human innovation and eventually leading tototal freedom from the deterministic shackles of life.
The revolutionary school believed the internal
contradictions of any system will eventually produce acrisis and lead to its transformation - or worse,
overthrow and replacement.
It is perhaps that religions best capture the essenceof the conservative school and feel enraged whenchallenged believing that things ought to stayunchanged. Conversely, the market philosophy ismore or less grounded in the liberal school of thought
and thus, is predisposed to pursue freedom of choice
and individualism. And as for the revolutionary school,at the heart of it’s framework of reference of the view ofthe world system is the myriad of human issues related
to poverty and environmental degradation brought
about by globalization and hence, for this view society
takes precedent over the individual because in the end
it’s all about a class-struggle between the haves andhaves not. This was just a rough comparison between
the three world views and notwithstanding theirdifferences, it might be worth noting that both theconservative and liberal views agree that the State is
the most important actor in world politics, not theindividual nor society, and thus, coordination,
cooperation, and communication between the organsof the States were vital for continuity and selfperpetuation.
In his counter reply, he said indeed coordination iswhat separates the few from the majority. However,
because information communication was still
problematic in the world, with quality information about
the intentions of other countries extremely difficult toacquire, there is a limit to loyalty and besides, people
can move from one country to another but rarely shift
their world views of how things work. So even when
wealth was transferred from the West to thedeveloping countries, these countries quickly realizedthat to keep things smooth with their people, they knew
things had to live up to the standards set by theirculture and religion – in the case of Islam, it meant
their leaders had to demonstrate their Islamic
credentials at every turn and that meant using andcreating only convincing images that in most cases
have nothing to do with the underlying reality of theirsocial situation or the world at large. As the realist hewas, he added that in politics, it is easier for leaders togive the appearance that the development problems of
their countries had been solved by focusing on thoseimages that create comfort in the minds and hearts ofthe public rather than actually solving them. This
maybe a very effective way to create consensus
internally but not between countries in internationalsettings because while these much desired transfers ofwealth and technology can bring about certain
comforts, as he said, there are limits. And thus, aclash is only inevitable and peace unlikely, he thought.
In retrospection, I can definitely see some merit tohis argument. I mean the flow of petrodollars in the
1970s did prompt Islamic scholars of all colors andshades in every Muslim country to quickly remind -and insist -- the rulers about their social duty toward235

the public, and in so doing, produced very richliterature accounts on what they deemed as necessary
for a just distribution of this newly acquired wealth,even demanding that the rulers share it with the public
and other Muslim countries equally. The strategies
devised by these Islamic scholars slowly but surely led
to an unprecedented “islamization process of Islam”
that swept throughout the Muslim world, contaminatingurban as rural areas, replacing secularism with faith in“Allah” and in the span of 30 years gave birth to an
Islamic middle class that accessed the spoils ofscience and technology but in practice remained
somewhat true to its traditional faith. I remember
mainstream media playing a dramatizing and majorrole in this planned transformation. This I believe
pushed a religious consciousness to become
permanently seated in the realm of the self (nafs orruh, in Arabic or psyche, in English). For example, theMinister of Haj in Indonesia went on public televisionadvising “good” women to wear the hijab in public andread the Kuran at home, and constitutions werechanged by replacing references to secularism withfaith in God. The use of the word “Allah” was as asalutation became the norm. In no time, once thedecision was made, all media outlets participated andhelped governments mobilize public opinion torepresent and mainstream this change in the 1970s.
Their role was tremendous.
Indeed, the skill andspeed by wish this change was made in the span of afew years marked the ability of changing public
attitudes with a convincing new version of “reality,” nomatter how artificial or far removed from the fact.
Brendon said what happened in Islam in the 1970s
was akin to what former Secretary of State Dean
Acheson said once to his staff, the job of public officers
was to make their points “clearer than truth”. Brendon
was very well informed about clear politics, I felt.
Thus, the point was that the middle class in Islam did
not emerge organically or spontaneously from theashes of a couple of centuries of violent struggles
between science and religion, feudalism and themarket, and collective interests against individual
rights that in the end created a middle class in thewest, and led to the emergence of a new set of values
and virtues that were compatible with the demands ofscience and protected by a social contract, the rule oflaw and engagement, and human rights in society. In
the absence of this hard-won social structuraltransformational tradition, a person in other cultures,
like Islam, has clearly arrived in this post-modern worldof globalization with no free will, no freedom of choice,and therefore no choice but to fall back on theirinherited social customs and beliefs to protect his
survival when the storm breaks out, so to speak.
Storms clear the ambiguity. If he or she chose
individualism, like many in the west would in the faceof life challenging decisions, he or she would not makeit much less the group, and thus notions of humanrights and the rule of law will be rendered meaninglessin their society, or obscure at best, if not dangerous,
Brendon explained. That’s discrimination at work.

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Eubios Journal of Asian and International Bioethics 26 (November 2016)

This is not to say that the Western tradition ofliberalism is “bad” for the Islamic people, he added; its
only to say that the Western liberal tradition of freedomof choice and responsibility does not fit all othercultures: it is uniquely and contextually Western andthe others will likely revert back to tribal ways and their
old religions believing they are acting to protect
themselves and their heritage from extinction when
they clash with the west in the end.
Wow, I mused! “So you believe the world is headingst
towards conservatism in the early 21 century,” I said,
if I recall correctly. Does this mean that we will see therejection of mechanistic approaches to fix social
problems, the return of the family and heavy-handed
security measures by the State, and property rights?
Well, he started saying, in a football match no one isentirely innocent. Everyone causes some social injury
to somebody.
If you had to choose between
defending a teammate in a clash with the others, nomatter how justified they are, you’re not going to stayon the sidelines and watch. That’s just what you do.
You don’t follow untested ideas or passions; you don’t
go off the beaten track, that’s what inexperienced
youth travelers do. If you want to look at a tree in thejungle, he smirked, “here, look at this tree,” andpointed out one next to our table, “they’re all thesame.”At that point, a couple of young tourists arrived to therestaurant and were seated next to us by the waiter,and I looked at them wondering if the path they’d taken
to get here was a familiar one or the unbeaten one
Brendon alluded to.
The next thing I heard jazzmusic coming from the corner by the edge of the bar
area overlooking the bay, and we both turned towards
the band. A frail looking African man played a hugecello with a beautiful Philippina who sang standing
next to him. The waiters were going back and fro
between the tables serving clients, and one of themsang along as he brought two plates of salmon andasparagus to the table next to us. The restaurant
became lively at that instant and for a moment I had aflash of clarity – so I took a sip from my glass of a local
fruit mix decorated with an umbrella and a slice of
pineapple, and tried to hurtle through the theories andconcepts I have learned in college for ammunition but
all I saw in my mind was college football matches, one
stood out in particular; it was a hard-fought andexciting game between ASU and the University of
Arizona played at the ASU stadium in Phoenix thatwas followed by a great open-field barbeque and a lotof pitchers of Budweiser beer.
I look back inhappiness on that experience, the cheers of thecrowds and the joyful buzz in the air that wascharacteristic of sports and academia in America.
I felt even better after I took another sip and I look at
Brendon now and say, Ok, “you think a clash between
the West and Islam is in the works and since friction ismost intense along the lines of contact, the Levant willbe the place of the fight. He nods his head inagreement. I continue. Both sides will keep their eyeson the trophy at the end of the fight, because that’s
why two teams clash in a football match as you said.

Agree. So who do you think will get the hardware in
the end? “It depends on how many touchdowns youwin,” he answered. “If everything you do is gold,
victory is guaranteed.” “Does victory means God is on
your side,” I asked. “Yes, many people of a religious
mind will understand that victory in battle is God’ssignature on his message, and thus approval.”
At that stage in this incredible conversation (why I
love hanging out with smart people) my ears heard
what could be interpreted as a common groundbetween both sides, I thought at the time. “Brendon,”I said. Please consider this. Muslims, like Christians[and Jews], believe in angels and miracles, andalthough their understanding of their sacred books
have changed over time as science pretty much posedserious questions about the veracity of such a belief,both still believe angels can appear and miracles canhappen in a moment of need, and especially on abattle field; the English vs. the Spanish Armada,
Saladin vs. the Crusades, to mention a couple ofdesperate situations that seemed miraculous toobservers at the time for their incredible results.
Obviously, “victory” in both cases was perceived
according to the epistemology or ontology of the day.
This means Muslims and Christians today will rely on
their respective experiences and presuppositions when
they assess what victory means. Can both Muslim
and Christian observers look for “inter-universals” toovercome the social and cognitive boundaries thatdefine them to enable better communication with theirrespective followers?
Good question, Brendon said. His response wasbased on the idea that many Christians today
understand that the language of the Bible is merely
symbolic of life’s experiences (not a literalrepresentation of phenomenology). For Muslims, on
the other hand, religion is a living discipline thatenables humans to experience what “good and moral”
means in social and economic interaction with others.
Back then, many people would ask me whether or
not a living tradition was better than a dead one, so I
had just started studying quantum theories andfeelings, and so I told Brendon that most of us believe
and agree that making people feel comfortable in life is
the “good-and-moral” thing to do, that’s what
technology and innovation are all about, to makepeople more comfortable. This means the good-andmoral are two mentally perceived virtues that hover
above knowledge production and thus, can be reduced
to physical phenomena, it is believed today, thoughfrom recent findings in the neurobiology of the brain,some scientists think that the “qualitative characters of2such an experience” are not so reducible. That is
because some aspects of our experience aresubjective. For example, what the color yellow feels
like to you may be different than what it means to me.
We can both agree that what we are seeing is thecolor yellow but, its meaning for us can differ. Why
2

See Jaegwon Kim, “The Mind-Body Problem at Century’sTurn,” in The Future for Philosophy, Brian Leiter, editor,
2006.

Eubios Journal of Asian and International Bioethics 26 (November 2016)
does this difference exist between us even though thesource of the information is the same?
-----------------------------A lot has happened in the 16 years since thatamazing dinner conversation in Phuket with Brendon.
Science has given us many answers to questions
about why humans consciously or even subconsciously discriminate. Answering this question iscurrently the target of very interesting neurobiologicalresearch trying to understand, for instance, how thereceptors on the retina of the eyes processenvironmental information and investigate how the
wiring of the brain interprets the information to produce
survival-enhancing knowledge. Once we understandthe mechanisms, we can be then be in a better
position to tell if the “facts” inform anything new about
the world or merely produced by people to lend
credibility to particular social ends. Until then, thisqualitative difference will probably continue toproblematize communication with the public in both
camps because all processes of evaluating choices
and making decisions are placed in interpretive
frameworks that filter knowledge on the basis ofepistemic presumptions to give them an ironed look(not wrinkled).
Therefore, to counter this conundrum I would argue
for the gradual decolonization of knowledge to remove
the lid of the jar that contains our implicit judgments so
we have a better idea of which “facts” to take seriously
and which to ignore when solving a crisis. For
example, Mr. Donald Trump the President-elect of theUnited States, i.e., of the world, is in favor of
deregulating the US market with likely scornful worldwide implications that can potentially affect everyoneof us where it matters, our wallets, maybe even our
sex lives. I have yet to hear Gloria Steinem’s reaction
but I wonder, like many people here in Bangkok, if thisis wither economics that will make many trading
countries in the Pacific rim feel like a fox with its tailcaught in a thorny bush or good for everyone as it
reflects the spirit of the age? Regardless, this means
it’s high time that we all need to work better to feelbetter and the smart use of knowledge can be crucial
for understanding things like empowerment, agency,
and freedom of choice today.
In a world that is equally dedicated to the pursuit ofreligion and science, a smarter way of using
knowledge also means we recognize that mental
phenomena are not always experiential; i.e. physical;
sometimes it is self-produced on the basis of deduction
but sometimes it’s not: a man of science myunderstand knowledge that is not, that is mysterious,
as paranormal, extra-sensory perception, but areligious person will most likely say it was given by
god. Thus, a man of science would say we live in a
man-made world. A man of faith, on the other hand,
would claim it’s a god-made world.
So, if this is a valid and reliable dichotomy, and if
you agree that all humans are conscious beings, thenperhaps both Muslims and others could consider
human experience as a powerful source of learning,philosophical reflections and debate, and dialogue, not237just in relation to angels and miracles in the battle field
but all aspects of life, material and spiritual. If so, is itthen possible to look for a common and verified
experience that both have interpreted similarly in its
epistemic dimensions that can be used to authenticate
a message from scripture or science that both sides
consider as decisive that coheres with both traditions
to launch a dialogue about common grounds(theoretical and practical)?
Therefore, to get back to the original question, “isdialogue possible with Islam”, for a more nuanced
answer, instead of diving with the sharks, goodmanners would require us to first try to understandwhether or not the experiences of a people, like theones alluded to in the anecdote above, and theircontemporary epistemic meaning, are perceived as
self-deduced or god-induced.
It is important tounderstand the interplay between these two distinct
and overlapping sources of knowledge. This would
probably help more people stay on the right side of theargument. In my opinion, I believe this is an area for
academic verification and critical study that could beundertaken to adequately and critically answer theabove original question.

Would we leave our ageing
parent or grandparent in thecare of a robot? – A
perspective from Islam- Sibtain Panjwani BDS MA PhD
sibtain@blueyonder.co.uk
You may think this question is far-fetched. It is not.
Just look at what the social/economic trends tell us. In
Western Europe and Japan, there is ageing populationand shrinking population size. In the long term, it isestimated that by 2050, all the continents except for
Africa will have increased ageing population andshrinkinggeneralpopulation.
Twoimportantchallenges for the world in 2050 are:
1. Demands of the Ageing population
2. Limited human resources available from thedeclining general population.
In the UK, there are 11 million people aged 65 orover with 3 million people aged 80 or over. By 2050,
estimates predict that the elderly will account for 16%of the global population. Research suggests that about
three in four of elderly people will develop a social careneed such as assistance getting up in the morning to
all day support for physical, emotional and mental
care. With declining population generally throughout
the world, there will be shortage of human resource
willing to take on the responsibility. Families thattraditionally look after the elderly will also come underpressure due to much social and economic pressure.
In the last 500 years, technology has come to therescue of humanity to solve some of our challenges. It

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Eubios Journal of Asian and International Bioethics 26 (November 2016)

is said that, in the last 100 years, more knowledge is
discovered than ever before. It is increasingly likelythat robots and artificial intelligence (AI) assisted
appliances will take on the part of the role of careproviders, including, meeting practical care needs,
providing round–the–clock support and even providing
a form of companionship. Over 22% of Japan’s
population is currently aged 65 or older and many
companies are working on robots that can assist theelderly, ranging from those which offer therapeutic careto those which can help move and carry objects.
Within the next 20 years, it is increasingly likely that
(AI) robots will be used in the care of older adults
throughout the developed world. What are theimplications for human society as a whole of thisintervention in our social relationships? What ought tobe the Muslims perspective on Artificial Intelligence(AI) assisted appliances?
As part of larger global society, Muslim
communities are also undergoing increasing ageing
populations. The community needs to deliberate upon
the key ethical and social implications on the use ofthis technology; implications it will have, on the family
life, social life as well as on individual identity. I am
expressing a reflection from an Islamic perspective on
this topic briefly, hopefully, to encourage deeper
deliberations on this topic among bioethics andreligious scholars:
Metaphysical perspective
Though there is little work, if any, done in the
aforementioned subject, there is one major issue whichruns
throughout
Islamic
metaphysicalandphilosophical literature – the soul (nafs). There is no
indication in the Qur’an or hadith that a being higher
than the human being would possess something likethe complexity of the human soul – both in terms of its
intellect, desires, capacity, emotion and transcendental
yearning. For this reason, a robot would not be able toreplace the human soul but only resemble it. We haveto ask, is this resemblance enough for communication
with an elderly person? It is possible that in cases
where an elderly person has no one at all, a highly
developed robot with some human-type personality
possessing self-awareness could be programmed tocommunicate with the elderly person. It is up to anelderly person to accept such an entity. However, fromthe Islamic viewpoint, this does not replace the soul
which is the basis for human identity, emotional
capacity and spiritual, ethical and transcendental
growth. This complexity allows for deeper intuitions
which the robot may not be aware of. Therefore, one
may argue that the use of robots in absolutely
replacing humans (from a metaphysical point of view)
is not only counter-human but dangerous as it reduces
human beings to nothing more than mechanical beings
who require mechanical communication. There would
no room for deep human communication or flourishing.
However, the use of robots in aiding human beings to
perform certain services like cleaning or the such
would be permissible as the role of human identity is
not threatened in a major way.

Scriptural perspective
There is nothing in the Qur’an and ahadith which
explicitly talks about A.I or robot. Even if so, it has to
be interpreted a great deal. From a purely textualist
angle, one may argue there is no prohibition on using
robots to communicate with the elderly but this is alimited angle requiring a greater ethical andmetaphysical framework which is not present in Islamic
theory.
Legal viewpoint
This depends on the judgment of a jurist with his
own ijtihad. Again, this is subjective as no overall
framework exists with regards to bioethical issues.
Usually ihtiyat or bara’ah (exemption) is used in theface of bioethical issues unless some verses andhadith is found which contain some sort of orderprohibiting or permitting the technology or action inquestion.
The Islamic viewpoint may, at present, utilize a
mixture of principles from metaphysics, philosophy andethics with a broad reference to scripture to argue forthe protection of human identity. This would position
the soul as the basis of human identity requires
cultivation rather than hindrance. If robots hinder thetranscendental and ethical cultivation of the elderly,
even at the time of death, this is against the spirit ofjourneying towards God. It is possible that robots
aiding human beings in their services to the elderly
would be allowed and as a last resort, to allow robots
to replace a human in the case of truly isolated andalone elderly persons (as some movies havesuggested). But the thumb-rule is one of prohibitionand caution as from a metaphysical viewpoint, it
renders human beings like machines which is not their
purpose in accordance with Islamic scripture andmetaphysics.
Dr Sibtain Panjwani has a special interest in bioethics andcurrently operates on a freelance basis in both Muslim
community life and the wider academic environment

EJAIB Editor: Darryl Macer
Associate Editors
Jayapaul Azariah (All India Bioethics Association, India),
Masahiro Morioka (Osaka Prefectural University, Japan).
Editorial Board: Akira Akabayashi (Japan), Sahin Aksoy(Turkey), Martha Marcela Rodriguez-Alanis (Mexico),Angeles Tan Alora (Philippines), Atsushi Asai (Japan),
Alireza Bagheri (Iran), Gerhold Becker (Germany), Rhyddhi
Chakraborty (India/UK), Shamima Lasker (Bangladesh),
Minakshi Bhardwaj (UK), Christian Byk (IALES; France), Ken
Daniels (New Zealand), Ole Doering (Germany),
Amarbayasgalan Dorjderem (Mongolia), Hasan Erbay(Turkey), Soraj Hongladarom (Thailand), Dena Hsin
(Taiwan), Rihito Kimura (Japan), Abby Lippman (Canada),
Umar Jenie (Indonesia), Nobuko Yasuhara Macer (Japan),Anwar Nasim (Pakistan), Jing-Bao Nie (China, New
Zealand), Pinit Ratanakul (Thailand), Qiu Ren Zong (China),
Hyakudai Sakamoto (Japan), Sang-yong Song (Republic ofKorea), Takao Takahashi (Japan), Noritoshi Tanida (Japan),
Ananya Tritipthumrongchok (Thailand), Yanguang Wang
(China), Daniel Wikler (USA), Jeong Ro Yoon (Republic ofKorea).

Eubios Journal of Asian and International Bioethics 26 (November 2016)

239

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