Eubios Journal of Asian andInternational Bioethics
EJAIB Vol. 27 (4) July 2017www.eubios.info
ISSN 1173-2571 (Print) ISSN 2350-3106 (Online)
Official Journal of the Asian Bioethics Association (ABA)

Copyright ©2017 Eubios Ethics Institute(All rights reserved, for commercial reproductions).

Contents

page
Editorial: Ethical decisions
105- Darryl Macer
Factors influencing the decision-making of elderly acuteleukemia patients in Japan regarding their treatment 106- Miki Fukuyama, Atsushi Asai, Taeko Hanada
Kenji Sakai, Yasuhiro Kadooka
Eradicating Mosquitoes? The Promise and Peril of Gene
Drive Technologies
113- Bang-Ook Jun
Better Humans and evolutionary nudge
116- Ann Boyd
The lack of environmental ethics in dealing withparticulate matter in Korea
121- Manjae Kim
Contrasting views of the public vs. teenage students
regarding renewable energy
126- Alexander Waller
A Chinese perspective on the concept of common
morality by Beauchamp and Childress
132-Yanguang Wang
The Retraction Watch retraction: how bad advice
became worse advice for scientists and academics 135- Jaime A. Teixeira da Silva
ABA Renewal and EJAIB Subscription

141

Editorial address, and all correspondence to:Prof. Darryl Macer, Ph.D., Hon.D.
President, American University of Sovereign
Nations (AUSN), Arizona, USA
Email: darryl@eubios.info
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Publication Ethics (COPE) Publication ethics andmalpractice policy. All potential authors shouldhave read these guidelines and by submission of anarticle for publication you acknowledge that you
have complied with this policy. Violations will behandled in proportion to the intention andseriousness of the violation.
Registered address of EJAIB: P.O. Box 16 329,
Hornby, Christchurch 8441, New Zealand

Editorial: Ethical Decisions
This is the 160th issue of EJAIB, and it features arange of papers in bioethics. Miki Fukuyama andcolleagues report on a descriptive bioethics studyof the factors that are important for Japaneseelderly acute patients regarding their long termcare. We can compare the conclusions with thepaper of Yangunag Wang that compares theconcept of common morality proposed by
Beauchamp and Childress with the ethos andpractice of medical ethics in China. The principles
model is useful for making decisions, as has been
the conclusion of many earlier explorations of theinternational nature of ethical decision-making. The
theme of Asian bioethics will be explored further in
October at the 18th Asian Bioethics Conference.
New genetic technology is discussed in thepapers from Bang-Ook Jun on the use of gene drive
technologies in vector borne diseases, in particular
wth mosquitoes. Ann Boyd discusses the use of
CRISPR in human beings. Recent papers in Nature
have shown its use in human embryos, raisingquestions to discuss the limits we have placed on
the growth of human embryoes in Culture (See also
the 2017 Nuffield Council report on the topic).
These topics look at the limits of ethics, a topic also
explored in terms of authorship and journal
retraction policies by Jaime A. Teixeira da Silva.
Alex Waller reports a difference in attitudes to theuse of renewable energy between the public andteenagers in Thailand. This is interesting to repeat inother countries. Manjae Kim describes the newspaper
images of the causes of particulate matter in Korea, andasks whether ethics is lacking in the portrayal of data, as
well as in practices. Governments have responsibilities
in developing policy for a sustainable and healthy
environment. Some decisions are clearly the mandate ofindividuals,
whileothersbeg
government
responsibilities in setting standards and guidelines. If
we cannot see many ethical decisions today we can haveserious concerns about opening up the choices of genetic
engineering of embryos, and using gene drive to modify
the biosphere. We need to continue to develop bettermodels for how the cumulative impact of individual
decisions shapes our glocal societies. - Darryl Macer

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Eubios Journal of Asian and International Bioethics 27 (July 2017)

Factors influencing the decisionmaking of elderly acute leukemia
patients in Japan regarding theirtreatment- Miki Fukuyama
Nursing Department, Faculty of Life Sciences,
Kumamoto University; 4-24-1, Kuhonji, Chuo-ku,
Kumamoto City, Kumamoto 862-0976 Japan
E-mail: fukumk29@kumamoto-u.ac.jp- Atsushi Asai
Department of Medical Ethics, Tohoku University
Graduate School of Medicine- Taeko Hanada
Department of Nursing, International University of
Health and Welfare- Kenji Sakai
Division of Medical Oncology, National Hospital
Organization, Kumamoto Medical Center- Yasuhiro Kadooka
Department of Bioethics, Faculty of Life Sciences,
Kumamoto University

Abstract

Objective: This study examined the process throughwhich elderly patients with new-onset acuteleukemia make treatment decisions from the timeof diagnosis, in order to identify factors influencing
this decision-making process in Japan.
Methods:
Semi-structured
interviews
wereconducted with twenty-two elderly patients withleukemia. The data were analyzed using themodified grounded theory approach.
Results: The process of decision-making in elderly
patients with leukemia includes three stages: Initial
reactions at diagnosis, change in attitudes, andentrusting the physician with the treatment plan.
Initial reactions at diagnosis were affected byinteractions with others that brought peace of mind
to the patients. Change in attitudes was affected byencouragement from others to undergo treatment
and their own motivation to face treatment.
Patients came to entrust their treatment plancompletely to their physician, because they wanted
to feel relief and did not want to have to grapple
with difficult medical information that was relevant
to decision-making about their disease andtreatment options.
Conclusions: The process of decision-making inelderly patients with leukemia is affected by several
factors and included three stages. Our present
study findings can provide suggestions on how
medical professionals might better support theprocess of decision-making in elderly patients withleukemia.

Introduction

In 2009, 6.3 persons (7.8 males and 4.9 females)
per 100,000 population developed acute leukemia(hereafter, leukemia) in Japan, with a total of 7,900
deaths (Japan Adult Leukemia Study Group 2011).
Similarly, in the United States and Sweden, acute
myeloid leukemia is much more common in elderly
people (Juliusson et al. 2012). The number of
elderly Japanese patients undergoing treatment forleukemia is expected to increase in the future, due
to progress in treatment methods for elderly
patients with leukemia as well as an increase in thesize of the aging population.
Against this backdrop, it is important to identify
how elderly patients with leukemia make decisions
to undergo treatment and what factors affect thisdecision-making process. Sekeres et al. (2004)
reported that elderly patients with leukemia makedecisions without fully understanding thetreatment involved, and recommended that elderly
patients acquire solid knowledge about treatment
and participate in the decision-making. However,few studies have investigated this process from theperspectives of the elderly patients with leukemia
when they make the decision to undergo treatment.
The present study clarified the process throughwhich elderly patients with leukemia makedecisions about treatment from the time ofdiagnosis, and identified factors that affect thisdecision-making process in Japan.
The results of this study may provide usefulsuggestions for medical professionals as they
consider how to offer support for decision-making
to elderly patients with leukemia.

Materials and Methods

Ethical considerations in recruitment of subjects:
The present study was reviewed and approved by
the Ethics Committees at each medical institution
involved in the study as well as that of Kumamoto
University (Registration Number 239, Approved
December 27, 2007). We received consent from allparticipants before including them in this study.
Recruitment procedure:First, the investigator asked physicians atcooperating institutions to provide an explanationof the study to elderly patients (aged ≥65 years).
Physicians were instructed to contact theinvestigator if any patient indicated a desire tocooperate. The investigator then met with thepatient to provide a detailed explanation about the
purpose of the study, as well as ethicalconsiderations. After obtaining a written consent,
an interview was performed.
The study period was from May 2008 to March2012 (interrupted from July 2009 to August 2010
while the investigator was on maternity leave).

Eubios Journal of Asian and International Bioethics 27 (July 2017)

107

Table 1: Participants’ information

Data Collection
The investigator conducted all interviews withpatients face-to-face. During the interviews,
patients were asked about their awareness,
attitudes, and thoughts regarding leukemia andtheir life with medical treatment. This report
includes patient narratives regarding the period
from diagnosis to treatment decision. Interview
contents were recorded using an IC recorder.
Method of analysis
Data were analyzed using the modified groundedtheory approach (Kinoshita 1999 & 2003). In thisstudy, the analysis theme was as follows: “From thetime of diagnosis to treatment initiation, how doelderly patients make decisions? What factors affectthe process of decision-making?” To analyze data, ananalysis worksheet comprising the columns forconcept name, concept definition, examples, andtheoretical memo was used. Verbatim records were
carefully reviewed, while paying attention to data
related to the analysis theme. Data were recordedin the example column. Next, the data wereinterpreted from the viewpoint of elderly patients,
and ideas that emerged during the analysis wererecorded in the theoretical memo column. The
concept definition and the concept name werecreated, followed by comparative analysis based on
the concept definition to seek out othersimilar/contrasting examples from the data. Other
concepts were created in the same way as
described above. An analysis worksheet was
created for each concept. The relationship between
each concept was examined and categories werecreated from the relationships between multiple
concepts. Finally, the mutual relationships between
categories were examined, yielding a map of
categories.

Results

Participants
Twenty-two elderly patients agreed to beinterviewed. Nine of the participants were in their60s, ten in their 70s, and three in their 80s.
Fourteen were male and eight were female. Two
had been diagnosed with acute lymphocytic
leukemia and twenty with acute myeloid leukemia.
The interview duration ranged from 29 to 79 min,with a mean of 55 min. Patient information isshown in Table 1.
Overall results
The process of decision-making in elderly patientswith leukemia comprised three stages: Initial
reactions at diagnosis, change in attitudes, andentrusting the physician with the treatment plan.

ca
se

Sex

Age

Diseas
e

A

M

70s

ALL

B

M

80s

AML

C

M

70s

AML

D
E

M
M

70s
70s

AML
AML

F

M

60s

AML

G

M

60s

AML

H

M

70s

AML

I

M

60s

AML

J
K
L
M

F
F
M
F

70s
60s
80s
70s

AML
AML
AML
AML

N

F

60s

AML

O

F

60s

ALL

P

M

70s

APL

Q

F

70s

AML

R

M

60s

AML

S

M

60s

AML

T

F

70s

AML

U

F

60s

AML

V

M

80s

AML

Treatment

Remission induction
therapy→4 courses
consolidation therapy
3 courses CAG (quiloside,aclacinon, G-CFS) therapy
Remission induction
therapy→3 courses
consolidation therapy
2 courses CAG
5 courses CAG
Remission induction
therapy→consolidation
therapy→1 course
intensification therapy
RIT IDA AraC (rituxan,
idamycin,quiloside)→CAG→VP(vepesid)＋3 courses CAG
Remission induction
therapy→3 courses
consolidation therapy
Remission induction therapy, 1
course CAG
4 courses CAG
2 courses CAG
2 courses CAG
3 courses CAG
Remission induction
therapy→consolidation
therapy
Remission induction
therapy→consolidation
therapy
Remission induction
therapy→consolidation
therapy
2 courses CAG
CAG twice, MIT-Arac(novantron, quiloside)
2nd course of vidaza
Remission induction therapy, 1
course CAG
Remission induction therapy,
CAG, MIT-AraC, DNR-AraC(daunomycin, quiloside), CAG
Remission induction therapy, 3
courses CAG
4 courses CAG※60s；65 years and older※ALL；Acute lymphocytic leukaemia; AML: acute myelogenous
leukaemia
APL；Acute promyelocytic leukaemia※M: male; F: femaleFigure 1: The decision-making process and associated factors in elderly patients with acute leukemia in Japan
Patients’ initial reactions at diagnosis comprised
negative feelings, but interactions with othersbrought them peace of mind. Patients changed theirattitudes
towardthediseasethroughencouragement from others and their own
motivation to undergo treatment. Patients came toentrust their treatment plans completely to their
physicians, because they wanted to feel relief anddid not want to have to grapple with difficult
medical information pertaining to decision-making
about their disease and treatment. Overall results
are shown in Figure 1.
Stage 1: Initial reactions at diagnosis
In this study, elderly patients described six
feelings including psychological distress that theyexperienced immediately after diagnosis. First,
patients were overwhelmed by the name of thedisease and its treatment methods. This occurred
immediately after diagnosis, as many elderly
patients had stereotypes associated with leukemia
due to the influence of the media, e.g., that leukemia
is an incurable disease. Some elderly patients
formed an image of leukemia based on theexperience of a close friend or acquaintance withleukemia from several decades ago.

“About 40 years ago, my wife’s mother died ofleukemia. Her doctor at the time said thatleukemia was an incurable disease. This
experience has been stuck in my head.”
Second, elderly patients had difficulty accepting
the reality, and some were unaware of leukemia,
particularly among those with few subjective
symptoms. Moreover, some patients were notconvinced that they had developed leukemia, as
they could not think of any cause.
“When I was told directly by my physician that [Ihad] myeloid leukemia, I said: Why? Really? ThenI said: I’m in such good health. I really washealthy. No dizziness. So, I kept saying: No way, noway…”
Third, at initial diagnosis, patients were worried
about the nature of disease progression andtreatment to undergo in the future because they
could not understand the relevant information.
“What treatment will be conducted? Will thetreatment be painful?”
Fourth, in preparing for death, some elderly
patients became strongly conscious of death, felt
depressed, or became very reflective as they lookedback on their lives.

Eubios Journal of Asian and International Bioethics 27 (July 2017)“I have lived for 80 years already, and it’s notlike I have a family, or kids, so I’d say that if I
were to die, it would be OK.”
Fifth, some elderly patients felt that their disease
was unlikely to be cured at their age.
“I felt pessimistic, thinking that, at my age, if I getsick with a disease like that, I would probably not
get better again.”
Finally, they were in no physical or mental state tolisten to physicians’ explanations or make any
judgment concerning treatment decisions.
“When I was told that [I had] acute myeloid
leukemia, I plainly asked: What is it, doctor? He
said: It’s a cancer of the blood. Then my mind justwent completely blank, and while my doctor
explained various things, I asked (my family):
Please listen (to the doctor’s explanations) on mybehalf.”
Interactions that brought peace of mind

109

“As I had already resigned myself to the fact that
I might not get better, I was in a position where I
felt like taking a chance with treatment, even if it
cost me my life.”
Encouragement to undergo treatment

Encouragement from others to undergo
treatment influenced elderly patients to change
their attitudes. Many patients mentioned thephysician’s words; the only thing that elderly
patients remembered clearly was physicians sayingthat they will try their best to cure them. This quote
was noted in the context of ‘Interactions that bringpeace of mind.’Moreover, the physician emphasizing the need for
immediate hospitalization and/or treatment also
greatly motivated elderly patients to move towards
treatment.
“You only have one month to live. We can’t justleave you in a state where the airplane is goingstraight down, [my doctor] said.”

Immediately after diagnosis, the distress thatelderly patients experienced was alleviated to someextent through interactions that brought peace ofmind. In particular, the physician’s words calmed
the distressed patients.

The family’s encouragement and wishes, including
the gathering of the family to make decisions, thecollection of active information, and asking thephysician instead of other patients, also pushedpatients to undergo treatment.

“My doctor said: It’s a big deal to undergo anticancer therapy, but if you do, you will get better.
We will cure you.”“Two of my daughters and my son-in-law, who isa doctor, said: Nowadays, even with a leukemia
diagnosis you can get better if you undergo
proper treatment, so you should do it.”Furthermore, well-timed interactions with nurses
also helped the anguished patients.
“When I said: I wonder if I will get through thisNew Year. I wonder if I will get through...; a nurse
cheerfully said to me: Oh, everyone gets betterand goes home. I remember how happy that mademe.”
Family members accompanying the patient also
helped reduce the distress.
“My husband was always by my side.”Stage 2: Change in attitude
Elderly patients managed to change theirattitudes while going through a number ofhardships. They accepted their leukemia
development as their fate, with the mindset that
nothing can be done about it because they alreadyhave the disease, and tried to focus on treatment.
There’s nothing that can be done about the factthat I got leukemia. I just need to do my absolute
best to be a faithful patient and follow all thatthe doctor is recommending for treatment.
Some elderly patients prepared to take on this fateby hedging their bets on treatment, even though
they were uncertain of the efficacy.

Furthermore, having seen or heard of patients
who had overcome the same disease prior to
diagnosis also served as motivation for elderly
patients to summon their courage.
“My friend had acute lymphatic leukemia. He,
though it’s been 4 years already, has gotten
considerably better. Seeing the way he is now
makes me want to push myself, and hang in there
a little more.”
Motivation within the patient to undergo
treatment

Some elderly patients were able to change theirattitudes with motivation they found withinthemselves to undergo treatment. These elderly
patients first felt the desire to survive, and this ledthem to switch their attitudes toward receiving
treatment.
“I was filled with the idea that I must breakmyself away from this illness.”
With regard to the sense of responsibility for
their roles, there were patients who stepped into
treatment with a strong sense of relationshipbetween themselves and family or society.

110

Eubios Journal of Asian and International Bioethics 27 (July 2017)“If I can live, I must live [for my family] as long as
I can. After all, that’s what caring for my family is
about, I think.”
Other elderly patients decided to undergo
treatment by becoming conscious of their own
psyche and pride.
“I want to be able to live my own life. Nothingbothers me. I’ve always kept a spirit of ‘que sera,
sera.’”
Stage 3: Entrusting the physician with thetreatment plan
After changing their attitudes, elderly patientsembarked on the first round of treatment byleaving treatment plans entirely up to their
physicians. Patients placed complete trust in their
physicians. In particular, the degree of reliance on
the expertise of physicians at a hospital treating
leukemia and doing chemotherapy tended to behigh from the very beginning.
“I was still worried but I felt peace of mind
because I was hospitalized and trusted myphysician. This entrustment made me feel good.”
The elderly patients did not need detailed
information about their disease and treatment.
Some of them even tried to limit their intake of suchinformation, which may have increased theiranxiety.
“I don’t really want to know about the efficacy ofdrugs and what is involved in this disease. “(Regarding supply of books about leukemia): “I
couldn’t look at them at all. I was afraid that if I
read those books, the knowledge about thedisease entering my mind would make me moreanxious.”

Discussion

Initial reactions at diagnosis

The elderly patients of this study experienced
several kinds of distress, as described in previous
reports (Friis et al. 2003; Koenigsmann et al. 2006;
Meenaghan & Dowling 2010; Rodin et al. 2013).
Also, the elderly patients’ reaction to their onset ofleukemia took into account their age. For example,
they felt that their disease was unlikely to be cured
at their age, or they began to prepare for death. In
addition, we found that they were unable to listen
to the physicians’ explanations or make any
judgments about their treatment. Their Initial
reactions at diagnosis were based on stereotypes
that had developed based on information from themedia as well as their own experiences fromseveral decades ago.
In Japan, TV dramas, documentaries, and films
often feature patients who battle leukemia. Manyelderly patients were exposed to instances in which

effective treatment for leukemia was notestablished. Interactions with others broughtelderly leukemia patients peace of mind. In
particular, physicians’ words alleviated their
psychological distress. LeBlanc et al. reported thatmany patients with leukemia described blunt
communication between medical professionals thatlacked emotional support, resulting in feelings ofdisappointment, fear, and even abandonment(LeBlanc et al. 2016). Therefore, we would proposethat healthcare professionals can improve patients’initial reactions by exploring and correcting their
outdated assumptions about leukemia, as well as
through verbal communication that provides
emotional support.
Change in attitude

A change in attitude came about when elderly
patients managed to change how they perceived thefact that they developed leukemia. This change inperception likely resembles one of the coping
strategies described by Lazarus et al., emotionfocused coping, in which one seeks to find adifferent meaning in an incident that he or she
encountered and deemed stressful, by changing
how the cause of this stress is interpreted (Chaen
2006). In this study, patients’ change in attitude
was influenced by encouragement from their
physicians, family members and other leukemia
patients. Some elderly patients found withinthemselves the motivation to undergo treatment,
which led to a change in attitude. This motivation
was driven by their desire to survive, patient’s
psyche, pride, and a sense of responsibility toward
fulfilling their roles.
Physicians’ words in particular appeared to have amajor impact on patients as they considered
undergoing treatment. In this study, the wish to livewas expressed by many elderly patients. For elderly
patients with such thoughts, a physician’s
encouragement evoked a feeling of great hope thatthey could undergo treatment, which led to achange in attitude. Puts et al. reported thatchemotherapy, as the last resort to prolong life, was
one of the most important reasons to facetreatment (Puts et al. 2017). We surmise that thephysician’s explanation significantly influenced thischange in attitude of patients.
The present study also revealed that the familiesof the elderly patients were active participants inthe decision-making process. In Japan, patients andtheir families often desire to make decisions
following a consultation with both the physician
and the family present (Ito et al. 2010). In fact,some elderly patients in the present study decided
to undergo treatment after obtaining informationfrom their family members. Thus, involvement ofEubios Journal of Asian and International Bioethics 27 (July 2017)
the patients’ family members as mentors greatly
impacts the changes in patient attitudes.
The present study revealed that experiences ofothers overcoming the same disease served as
encouragement to elderly patients. Yogaparan et al.
reported that family, friends, other patients, and theInternet were uncommon sources of information(2009). Peer support is a flexible concept used inhealthcare across diverse areas to describe theactivities of individuals acting in a non-professional
capacity offering support to others with whom they
have some experience in common (McLeish &Redshaw 2015); in recent years, peer support has
become widespread in clinical practice for cancer(Kawakami et al. 2014). A report on peer support
for patients with breast cancer found that patientswere relieved to see others with the same disease
doing well and that their true inner feelings were
heard by others (Osaka et al. 2011). In this study,some patients experienced a desire to overcome thedisease after listening to the experiences of other
patients. Interactions with other patients who had
overcome the same disease seem to contribute
greatly toward the changes in attitude in patients.
The elderly patients’ sense of responsibility
toward fulfilling their roles also influenced changes
in attitude. With regard to their responsibility
toward their family members, some patientsthought that receiving no treatment would maketheir family feel regret. This thought may be
influenced by Confucianism, which values blood
relationships, and collectivism, which not only
considers individuals to be consistently part of alarger group, but also expects them to downplay
their own personal goals relative to those of thegroup (Kaji 2015; Ishikawa & Yamazaki 2005). In
fact, elderly patients of this study reported thatthey thought about how their decision affected
their family, and chose to undergo treatment not
only for themselves, but for their family as well.
The present study also revealed that patients’
psyche and pride contribute greatly to changes in
attitude among patients. One patient expressed that
she had an unwavering mindset of “que sera, sera”.
Other patients took pride in themselves due to theirpast discipline (mental and physical), as well as
their experience in overcoming many difficulties.
For elderly patients, these types of psychologicalpredisposition and pride can serve as sources ofpower that enables them to overcome difficulties
and encouragement that can lead to a change inattitude. With regard to decision-making about
treatment for elderly patients, some researchers
have emphasized the need for sufficientconsideration of treatment risks (Klepin 2015),
while others have clarified that some elderly
patients turn the decisions over to their family
members (Miyama 2016). However, we would

111

suggest that a patient’s psyche, pride, and sense of
responsibility in fulfilling their various roles should
also be taken into consideration when making
decisions about treatment.
Entrusting the physician with the treatment
plan

The present study revealed that elderly patients
suffering from leukemia often opted to entrust thephysician completely with their treatment plan.
Underlying such a posture may be complete trust in
the physician for their peace of mind, the lack ofdesire to obtain medical information, and the
difficulty to understand such information.
With regard to complete trust in the physician,Nissim et al. reported similar patient attitudes as
their psychological response (2013). Specifically,
they found that patients with leukemia expressed astrong sense of trust in their health care providers,which provided a sense of “safety” in the midst of
the chaotic and traumatic experience of the illness.
In this study, after elderly patients changed theirattitude and decided to receive treatment, they
were still worried about their disease. Somepatients stated that they entrusted their physician
completely with their treatment plans so that theymight eliminate the anxiety and feel relieved.
Previous studies on leukemia patients’ need for
information have reported that patients did notwant to know detailed medical information, such as
numerical data or potential side effects (LeBlanc et
al. 2016; Puts et al. 2017). The elderly in particular
expressed no desire to receive further medical
details about their disease (Friis et al. 2003).
Elderly patients of this study also exhibited little
desire to obtain medical information. Some patients
limited their intake of medical information in order
to avoid anxiety. Friis et al. reported that avoiding
information in this manner could be explained as a
strategy to maintain hope, and that most patients
more readily sought after information on problems
affecting their everyday life and how other patients
had coped with their disease (Friis et al. 2003).
Similarly, some elderly patients of this study foundthemselves asking, “What will happen from now
on?” Medical professionals who are interested inwhy patients are not eager to obtain medical
information, or what kinds of information theelderly patients desire, may benefit from providing
information consistent with patient preference.
With regard to the difficulty of understanding
medical information, LeBlanc et al. argued thatpatients with leukemia face a particularly daunting
task in trying to understand and contextualize
incredibly complex information (LeBlanc et al.
2016). In addition, because the subjects of thisstudy were elderly patients, declined cognitive

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Eubios Journal of Asian and International Bioethics 27 (July 2017)

function was likely to increase this difficulty (Uldry
et al. 2013).
In addition to a low desire to obtain medical
information, participants of this survey exhibitedcomplete trust in their physicians. In Japan, such an
attitude is known as omakase, a traditional
Japanese approach to medical decision-making(Specker Sullivan 2017). The term means to entrust
decisions to another person, and is often heard inrestaurants in Japan, where asking for the omakase
set is to have the chef determine the contents of
one’s meal (Specker Sullivan 2017). In medical
settings, it implies that a patient wishes to leave thedecisions up to the physician (Specker Sullivan2017). One reason why Japanese patients preferomakase, Specker Sullivan argues, goes back to theimportance of trusting relationships in the Japanesesociety, which may explain why they do not preferto make decisions alone and take responsibility forthese (2017). In this study, elderly patients placed ahigh value on their relationship with their
physicians. To this end, they chose to entrust their
physicians with their treatment plans.
LimitationsFirst, the sample size was small, and it wasdifficult to describe the process of decision-making
for all Japanese elderly patients with leukemia.
There may be other contributing factors in addition
to those identified in this study.
Second, given the background of the study
participants, recruitment was limited. Many of theparticipants had a decent support system. It will benecessary to study decision-making in elderly
patients with various backgrounds.
Finally, the present study did not adequately
compare decision-making in elderly patients withleukemia from a cultural perspective. In the future,similar studies in other cultures might help clarify
the extent of involvement of certain Japanesecultural factors.

Conclusions
This study examined the thought processes ofJapanese elderly patients with newly-onset acuteleukemia from the time of diagnosis to decisionmaking on treatment, and identified factors that
affected decision-making. Based on our findings,
medical professionals should acknowledge thesignificance of their role in influencing patients andtheir decision-making; in particular, words fromthe physicians were reported to calm patient
distress and encourage them to change theirattitude. Second, medical professionals should pay
attention to patient characteristics such as theirsense of responsibility toward fulfilling their roles,
their psyche, and pride, as these characteristics canbring about positive changes in a patient’s attitude

toward treatment. Third, families of patients play amajor role in the decision-making process, so
medical professionals should offer support to thefamilies as stakeholders. Finally, medical
professionals should proceed with their decisionmaking regarding treatment for elderly leukemia
patients knowing that the patients may seek relief
in the form of entrusting their treatment plans to
the physician and not obtaining detailed medical
information.
Acknowledgements
We would like to express our sincere gratitude to
the patients who participated in the survey. We
would also like to thank the physicians at the four
medical institutions for providing the sites for thesurvey and for introducing us to their patients. This
study was supported by a Grant-in-Aid from theJapan Society for the Promotion of Science (Grant
Number 20791771).
Conflict of interest: The author declares there areno conflicts of interest.

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Eradicating
Mosquitoes?
The
Promise and Peril of Gene Drive
Technologies- Bang-Ook Jun, Ph.D.
Professor, Department of Biology,
Gangneung-Wonju National University,
Gangneung, Republic of Korea
Email: bojun@gwnu.ac.kr

Abstract
This paper discusses the ethical issues associatedwith genetic modification of mosquito species thatare human disease vectors. The Oxitec geneticallychanged mosquito—a variant of a species
called Aedes aegypti, OX513A, is taken as an
example. The benefits and risks are discussed, andquestions need to be discussed in public prior torelease of this gene drive system.

Introduction
Mosquitoes are high-impact disease vectors withthe capacity to transmit pathogen agents that cause
diseases such as malaria, yellow fever,chikungunya, dengue, and most recently Zika
(Overcash 2015). Mosquitoes kill an average of
725,000 people every year. Since scientists firstmade the connection between malaria andmosquito bites, the mosquito has been the subjectof important research, and also the vector of atleast a dozen fatal diseases (Dawson 2016).
There are as many as 3,500 different mosquito
species, of which 30 spread malaria, which kills
more than 400,000 people, mostly children, every
year. Zika virus, closely associated with birthdefects and severe neurological symptoms, has

114

Eubios Journal of Asian and International Bioethics 27 (July 2017)spread to dozens of countries. If species suchas Anopheles gambiae, a major malaria vectorand Aedes aegypti , a Zika virus vector could be
eradicated, the world would surely be relieved fromthe deadly diseases (Economist 2016). The mostcommon manners in which to target the mosquito
are familiar. Nets, spray repellant, and insecticides
are used worldwide to keep mosquitoes away andto reduce population density. But more recently,
genetically-modified mosquitoes have beendeveloped, which could potentially be used toreduce mosquito populations. A British company
named Oxitec has developed a genetically changed
mosquito—a variant of a species called Aedes
aegypti. This mosquito, called OX513A, is a sterilemale, modified so that when a male OX513A mateswith a wild female, the resultant eggs will not be
viable. They will never hatch. These male A. aegypti
mosquitoes have been released in Brazil, andsought approval to release the male OX513A
mosquitoes in Florida, as a way to combat the
spread of the Zika virus (Wolf 2016).
While there is no vaccine for Zika virus, many
people are so excited at using genetic engineering
to kill off mosquitoes. However, no one yet knows if
this method is an effective solution (Plumer 2016).

Gene drive

A tool called gene drive may be even more
effective than Oxitec’s GM mosquito. Unlike anordinary gene, which is passed on to just half of alloffspring, a gene drive construct could be passed on
to virtually all offspring (Adelman 2016). By
combining a revolutionary new technology called
CRISPR-Cas9 with gene drive, eradicating themosquito has become reality. CRISPR (an acronym
for “clustered regularly interspaced shortpalindromic repeats”) refers to bits of viral DNA
that bacteria have incorporated into their own
genomes. With assistance from the splitting enzyme
known as Cas9, CRISPRs help bacteria defend
themselves against viruses. In 2012, researchers
modified the CRISPR system into a gene-editing
tool to cut and paste any gene in any organism(Saey 2015). Guide RNA helps the Cas9 enzyme tofind and cut the pre-selected location in double
DNA. As the cell moves to repair the cut strand ofDNA, it replaces it with DNA that matches theselected DNA. It inserts a pre-selected genesequence precisely where researchers want to put
it.
Because the CRISPR-Cas9 tool can be made ofDNA (that code single guide RNA and Cas9 protein),
it is possible to use CRISPR to insert it into thetarget organism. Whenever the cells divide, the
CRISPR-Cas9 tool is spliced into each genome, andbrings with it whatever genetic sequence

researchers select. In this way, a genetic sequencecan be inserted into every wild-type DNA sequencewith which it is paired. This mechanism is called a“gene drive,” because it can be used to drive aselected genetic sequence into a population so that,eventually, if the genes function as expected, every
descendent organism will possess the phenotypic
trait associated with the selected sequence (Wolf
2016).
Gene-drive technology essentially creates
genetically modified organisms to stimulate theinheritance of certain genes combating malaria
throughout entire populations. Last year, a researchteam at Imperial College successfully modified
Anopheles gambiae mosquitoes to have 95% maleoffspring (Hammond et al. 2015); this sex ratio bias
was further inherited by the modified offspring.
The long-term effect of this modification would be
the eradication of this mosquito species.
The research team of the University of California,
San Diego and Irvine campuses reported that theysuccessfully modified the mosquitoes to carrygenes for antibodies that target the Plasmodium
parasite (Gantz et al. 2015). The anti-malarial gene
was inherited by 99.5% of the modified offspring.
These mosquitoes would then mate with nonmodified mosquitoes in the wild and pass the antimalarial genes on to their offspring, ideally leading
to all future generations being resistant to themalaria parasite.
As noted above, a trait is a genetically determinedcharacteristic of an organism. In normal sexual
reproduction, a trait generally has only a 50%
chance of being expressed. With a gene drive,
however, that trait is “driven” into the organism’s
reproductive cycle so that every single offspringalways carries and expresses the specified trait(SynBio Watch 2016).

The promise
The implications are huge, with both tremendous
potential and risks. Among the possibilities, gene
drive could be used to spread genes that reduce theability of mosquitoes to transmit parasites or that
produce mostly male mosquitoes to twist the sex
ratio. Such systems could stop mosquito-borne
deadly diseases, including malaria, Zika, anddengue (Otto 2016).
Gene-drive-based
approaches
differfromtraditional vector control methods such as
insecticides and removing breeding sites. With agene-drive system, the population of the target
species could be massively disrupted, without
directly affecting any other species.
The development of gene drive approaches,combined with current mosquito control practices,
holds the promise of reversing this trend andbringing us closer to the goal of eradication of a

Eubios Journal of Asian and International Bioethics 27 (July 2017)mosquito species and the terrible pathogens that
depend on it (Adelman 2016). Some researchers
even contend that the eradication of deadly
mosquito is our moral duty (Meador 2016).

The risks
Many people including some researchers areuncomfortable with the idea of gene drives thathave the potential to eradicate an entire species.
Though we might assume that mosquito lacksignificant moral status, we can distinguish killingof individual organisms from the eradication of awhole species. For example, Holmes Rolston III
argues that to kill a species is the “super killing” of awhole pattern of life, and as such is less acceptable
than the killing of an individual organism. Althoughspecies lack moral agency, self-awareness,sentience or individuality, Rolston’s contention isthat species lines are individual systems, whoseparts are individual organisms. The argument for
species-level respect might be to accept thetraditional deontological view that a duty requires amoral agent, while denying that this agent must bea person or an individual organism (Jebari 2015).
Yet, there has been a degree of moral concern
about eradicating mosquitoes. it seems ridiculous
to claim that humans were overly bold in
eradicating the mosquitoes responsible for malaria
or Zika transmission through the development ofgene drive, and even more problematic to claimthat such boldness was morally wrong; the wrongof the supposed bold attitude here is surely morally
outweighed by the value of the many human lives
that were saved by eradicating mosquitoes (Pugh2016).
On the other hand, the risks of gene drive
following release can be also huge. Driven genes
could spread beyond the intended area. Applying
gene drive to reduce or eliminate the species may
have unintended side effects (Otto 2016). Genedrive might act in unexpected ways and cause avariety of environmental harms, while not deliver
the promised benefits. And, it’s impossible topredict the ecological consequences of such a rapid,
massive, and unprecedented disruption (SynBio
Watch 2016).
Mosquitoes might play key roles in ecosystems,
such as providing food for bats and otherinsectivores, and “scientists have minimal
experience engineering biological systems forevolutionary robustness”. It’s possible that a gene
drive might not distribute the intended trait
throughout a target population, or might find its
work blocked by a naturally occurring mutation, or
might spread the trait to non-targeted species. It’s
also possible that a gene drive could stimulate
other unforeseen evolutionary responses over alonger term in both target and non-target species.

115

And, again, the ability to redress any of theseunintended consequences could be sharply limitedby the lack of reliable reversal mechanisms(Meador 2016).
However, many scientists who research mosquito
biology and ecology are skeptical that theeradication of mosquitoes would have particularly
bad ecological consequences.
“Mosquitoes don’t occupy an assailable niche in
the environment. If we eradicated themtomorrow, the ecosystems where they are active
will hiccup and then get on with life. Something
better or worse would take over (Fang 2010).”
Scientists are unclear whether gene drives could
spread to closely related species. Eight species
known as the Anopheles gambiae complex ofmosquitoes in Africa came from common ancestors
less than 5 million years ago, and they sometimes
still interbreed, producing fertile hybrids. Genedrives might transfer from one species to anotherby this interbreeding. But given that almost all
species can carry malaria, transfer from one species
into another might even be desirable (Saey 2015).
In contrast, the eradication of a mosquito lets
another mosquito occupy the same niche, making
things even worse. Once Aedes aegypti is gone,
Aedes albopictus might move in and serve as a Zika
vector (Adelman 2016).

Conclusion
The ethical, ecological and societal implications ofgene drives are especially complex and challenging.
Activists and even some experts in the field are on
alert against this powerful technology. This raises
the basic question: Who will benefit from thistechnology and who decides how it will be used?
How would anyone be able to assess the risks ofgene drives? Would the public be informed andhave a say in how they would be used? And if an
accident were to occur, given that the damage

would be massive and irreversible, who would beheld accountable (Civil Society Working Group
2016)?
Until recently, such questions are exclusively inthe hands of scientists, who promise to regulatethemselves so as to push their research to the limit(Akbari et al. 2015). As attractive as the promise oferadicating mosquitoes and halting the advance ofmalaria and Zika using CRISPR-Cas9 gene drives
may be, we need a deliberation on the risks of gene
drive technologies. We need to have a genuinely
inclusive debate about the issues raised by this newtechnology, addressing the ethical, legal, and social
implications of gene drive (Dawson 2016).

References

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Eubios Journal of Asian and International Bioethics 27 (July 2017)

Adelman, Zach. 2016. When Extinction is ahumanitarian cause. The mosquito spreading Zika
doesn’t belong in our environment. Soon we may beable to eradicate it with new technology. MIT
Technology Review. Posted February 12, 2016.
https://www.technologyreview.com/s/600793/wh
en-extinction-is-a-humanitarian-cause/.
Dawson, Ashley. 2016. Save the mosquitoes: weshould fight Zika with better public health, notgenetically modified mosquitoes. Posted April 22,
2016.
https://www.jacobinmag.com/2016/04/
zika-mosquitos-crispr-genetic-engineering-puertorico/.
Economist (The). Extinctions to order: Gene-ocide.
The promise and peril of “gene drives”. Posted
September 17, 2016. http://www.economist.com/
news/leaders/21707211-promise-and-peril-genedrives-gene-ocide.
Gantz, Valentino M, Nijole Jasinskiene, Olag
Tatarenkova, Aniko Fazekas, Vanessa M Macias,
Ethan Bier, Anthony Gantz. 2015. Highly efficientCas9-mediated gene drive for population
modification of malaria vector mosquito Anopheles
stephensi. Proceedings of National Academy of
Sciences U.S.A. 112. E6736-E6743.
Hammond, Andrew, R. Galizi, K. Kyrou, A. Simoni, C.
Siniscalchi, D. Katsanos, M. Gribble, D. Baker, E.
Marois, S. Russell, A. Burt, N. Windbichler, A.
Crisanti, T. Nolan. 2015. A CRISPR-Cas9 gene drive
system targeting female reproduction in the malaria
mosquito vector Anopheles gambiae. Nature
Biotechnology. Published December 7, 2015.
http://dx.doi.org/10.1038/nbt.3439.
Jebari, Karim. 2015. Should extinction be forever?
Philosophy & Technology. Published October 17,
2015. DOI: 10.1007/s13347-015-0208-9.
Meador, Ron. 2016. Argument builds around a genetic
tool that can erase an annoying species. MinnPost.
PostedSeptember
06,
2016.
https://www.minnpost.com/earth-journal/2016/
09/argument-builds-around-genetic-tool-can-eraseannoying-species.
Otto, Sally. 2016. Genes in the fast lane: The
implications of new gene drive technology-A
Canadian perspective. http://www.rsc.ca/en/aboutus/our-people/our-priorities/genes-in-fast-laneimplications-new-gene-drive-technology.
Overcash, Justin M., Azadeh Aryan, Kevin M. Myles,
Zach N. Adelman. 2015. Understanding the DNA
damage response in order to achieve desired gene
editing outcomes in mosquitoes. Chromosome
Research 23:31-42.
Plumer, Brad. 2016. The unsexy truth about how tokill off mosquitoes and stop the Zika virus. Posted
February7,
2016.
http://www.vox.com/
2016/2/4/10908754/zikaPugh, Jonathan. 2016. Driven to extinction? The ethics
of eradicating mosquitoes with gene-drive
technologies. Journal of Medical Ethics 42(9): 578581.

Saey, Tina Hesman. 2015. Gene drives spread theirwings: CRISPR brings a powerful genetic tool closer
to reality. Are we ready? ScienceNews 188(12):16.
SynBioWatch.
2016.
Controversial
genetic
engineering technology: “Gene drive” and themodification of entire species. Posted August 1,
2016. http://www.globalresearch.ca/ controversialgenetic-engineering-technology-gene-drive-andthe-modification-of-entire-species/5548316.
Wolf, Clark. 2016. Engineering Extinction: CRISPR,
Gene Drives and Genetically-Modified Mosquitoes.
PostedSeptember,
2016.
http://www.biotech.iastate.edu/bib-crispr/.

Better Humans and evolutionary
nudge- Ann Boyd, Ph.D.
Professor, Biology Department, Hood College, 401
Rosemont Ave, Frederick, MD, 21701 U.S.A.
Email: boyda@hood.edu

Abstract

Gene therapy especially newly developed CRISPR
gene editing spawns complex conversations,ethically, emotionally, politically, and economically,
within and among countries. As new technology
makes its way through the experimental
development,
assessment,
refinement
andapplication, it is not too soon to begin the policy
and ethical dialogues about how and when and forwhat purpose it is used. Certainly experiments
should continue to assess whether CRISPR is thelong sought for means to effective gene therapy. It
will probably be used in somatic cell gene therapy
trials sooner than later. Policy and ethicaldiscussions ought to precede its use at the germline
stage.

Introduction
The recent discovery and application of clusteredirregularly interspaced short palindromic repeats(CRISPR) Cas9 editing of DNA has generated great
optimism for its potential to correct harmful
genetic traits. Eliminating all “genetic diseases”
stretches the imagination and posits an objectivethat may be feasible in theory while doubtful inapplication. New applications, tests, and successes
with CRISPR/Cas9 saturate the scientific literature.
So prevalent are such reports that the faculty in the
Biomedical Sciences Master of Science program at
Hood College offered a special topic graduate
course on “Gene Editing” in summer 2017. The
course had three units: (i) the science of editing,
how the guide RNA matches the target DNA to
specify where to cut and repair the genetic

Eubios Journal of Asian and International Bioethics 27 (July 2017)
sequence, (ii) how the guide RNA and target DNA
sequences are evaluated using bioinformatics toinsure the most correct fit and the least off-target
possible “mistakes” which would create new
mutations even while editing a chosen site, (iii)ethical evaluation of the technology. Students wereasked to write an address they would give to apolicy forum about using CRISPR/Cas9 for genetherapy.
Discovery and Response
Genome editing technology using CRISPRassociated nuclease Cas9 opens the possibility oftherapeutic genome editing in diseased cells andtissues (Hsu, 2014). Applying the technology tohuman embryos, Liang et al. (2015) reported using
CRISPR/Cas9 to edit human beta-globin gene in 86
donated human embryos obtained from in vitro
fertilization (IVF) clinics. The scientists were
careful to report that of the 86 embryos used, 71
survived the manipulation and 54 had corrected
DNA sequence in the beta-globin gene.
Unintentional mutations were also documented
revealing the possibility that the guide RNA wouldbind to sites other than the target globin sequenceand create unintended mutations. Safety andefficacy are the guidelines used to justify moving
new “therapeutic” discoveries into clinical practice.
Finding ways to hit only the target sequence andeliminating off target hits is the current focus ofresearch using CRISPR for gene editing. Delivery of
the CRISPR/Cas9 to the intended cells is equallyimportant if the editing technique is to be used inpatients to reduce symptoms of a genetic disease.
UNESCO, the Council of Europe and the European
Union has stated that modification of the germline
is unethical and an abuse of human rights. The
National Institute of Health (NIH) director, Francis
Collins, released a statement saying no national
research money would be used to edit humanembryos within weeks of a report by Zhang (2015).
Similar protests have been made about
establishment of human stem cell therapeutics but
private enterprises have found ways to continue
applications. Denial of European or US federal
support drives technology into the private sphere.
It is not a given but a recognized risk thatprivatization of technology may result ininequitable access.
If the potential for gene editing is shown to bereliable and therapeutic, what is to prevent using
the technology? Three considerations areimportant in reaching an answer: the history ofeugenics as it affected gene therapy policy, genetic
literacy among the population, and just allocation.
Eugenic laws in the 1920s in the US and othercountries aimed at improving the human species
through selective breeding. Once legalized, it took

117

decades to reverse the perception that involuntarysterilization was for the “greater good” when intruth it is a breach of human rights. Eugenics is adark chapter in human history and before germline
gene editing becomes the new eugenics, care ought
to be taken to ensure applications are understood
regarding risks and benefits and that personalautonomy is protected and respected (Sparrow,2011).
Moving away from negative eugenics
toward a positive application aimed at correction ofgenes with disease and disability phenotypes, genetherapy became the hope of scientists late 20th
century. One of the lessons of the gene therapy
experiments is that results using cell culture in
vitro generates more positive data than when usedin vivo in living organisms, especially in humanclinical applications. The amount of DNA that canbe inserted into a virus vector is limited as well as
the ability to direct the DNA to the right genomic
location to either replace the mutated sequence orto add a functional gene (Misra, 2013).
To date somatic gene therapy protocols havebeen limited to somatic (non-reproductive) cells,
specifically in experimental treatment of cystic
fibrosis, hemophilia B, Fanconi’s anemia,
hypercholesterolemia, adenosine deaminase (ADA)
deficiency and three types of cancer (Misra, 2013).
Each of the clinical trials aimed at reliving
symptoms of a genetic deficiency by supplying afunctioning gene or its product. Delivery has been
problematic as well as consequences of adding athird gene to restore function. In cases where theforeign DNA can integrate into the genome, the site
has not been limited to the target gene causing
unanticipated damage and/or pathology (Check,2002). Enthusiasm for ADA gene therapy turned todisappointment when the patients subsequently
developed leukemia (Misra, 2013). The lesson
learned is that the results of gene therapy
applications are not always immediately obvious.
Policy Debates
Individuals and groups who take a test, evaluate,
move forward deliberately in advancing newtechnology, are often labeled “bioconservatives”. In
contrast, advocates for swift application of newtechnology to benefit suffering patients are called“bioliberals” (Giubilini, 2015). Bioconservatives
tend to bring the gene therapy lack of success into
debates about gene editing whereas bioliberals
tend to move from a failed system to a newopportunity with renewed enthusiasm, such as thepromise of gene editing with CRISPR. Representing
two ends of a continuum, the policy debates haveresurrected an earlier debate about somatic vsgermline gene therapy. It should be clear to all that
empirical data is needed to establish risks andbenefits of embryo manipulation (without

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Eubios Journal of Asian and International Bioethics 27 (July 2017)

implantation for the purpose of giving birth to achild), in animal and plant model systems should
inform the debate.
It matters how the question is framed and which
philosophical foundation is used for the debate. One
foundation is the concept of human nature,
imperfect but functional. There are groups withspecific disabilities that are sensitive to being
regarded as inferior, “in need of fixing.” Of course
there is a significant difference between a genetic
loss of hearing in contrast to a genetic loss ofmuscle strength that steadily progresses. Hearing
loss can be compensated for by learning to use sign
language and live a life of dignity, whereas indiseases such as Parkinson’s the person is reduced
to total dependency and lacks the pleasures ofcommunication, mobility, independence, etc. It is
not that a person with Parkinson is robbed of
dignity as a human being, but that the progressive
nature of the disease deprives him or her ofcapacities that contribute to human dignity,
justifying the bioliberals’ appeal for aggressive
progress towards treatment. Claiming an intent tocorrect genes that rob individuals of the basic
functional abilities we associate with being humanaligns with the duty to help relieve suffering.
Beyond ‘therapy’ at the aggressive end of thespectrum, gene editing enthusiasts dream ofapplications well beyond therapeutic potential,
such as the ability to master engineer evolution infavor of better humans (Powell and Buchanan,2011). Taking the framework of species survival inan evolving ecosystem that is challenging or eventhreatening, DNA editing become more than atherapy – it becomes a survival strategy. Harris andSavulescu suggests that we are morally obligated touse genetic technology to produce the best children
possible for the survival of the human species(Harris, 2007; Savulescu, 2005). Bioliberals clearly
intend to help both relieve suffering from a specificgenetic trait and push evolution forward in waysthat prevent death from environmental hazards.
Modification of a harmful gene to reduce or relieve
suffering from a genetic disease benefits the one
patient and is therapeutic, however, none of thesomatic gene therapy protocols have beensuccessful enough to be standard of care for the
thousands of genetic diseases affecting humanbeings. Therefore, regarding the intervention as atherapeutic tool is good only so far as it has beeneffective and for the relatively few who have access.
There is no evidence that the genes that could
confer species improvement are known or what
specific changes would lead to better humans.
Bioconservatives tend to frame the question interms of concern for just allocation. As new
discoveries become therapeutic options and therisk-benefit potential inherent in such technologies

is quantified, the new technique replaces older orless effective treatments. This is a long process
taking decades of clinical trials and regulatory
approval.
Careful and sequential development,
testing, evaluation, and objective analysis of data
slows progress but in the minds of bioconservatives
is the means to avoiding harm as much as possible.
To counter excitement of a new scientificbreakthrough, the conservative is patient enough to
see that the uncertainties, and moral concerns are
addressed first. Considerations about future impact
on the human gene pool may be overstated in thesense that relatively few individuals may elect touse it. It is a leap without supporting data to project
improving human beings by gene editing. If
approved for enhancement at the germline levelunless many participate the human gene pool will
not be enhanced, but a minority of individuals may
become gene-rich.
Assisted ReproductionMore than five million babies have been born
through assisted reproduction since the birth ofLouise Brown. In some countries, pre-implantation
genetic diagnosis (PGD) is fast becoming part of the
IVF process whereby embryos are selected on thebasis of their genetics. Within hours of fertilization,
the embryo reaches 8 – 16 cells. DNA can beextracted from one of the cells and sequenced
revealing entire genetic blueprint. Against a panelof markers for specific genetic diseases it ispossible to select embryos that do not have genetic
diseases. Families with known risks may request
screening Tay-Sachs, Cystic Fibrosis, Sickle Cell,
Huntington’s Disease, Cooley’s anemia etc. In using
PGD-IVF a negative selection is taking place: sortingout embryos with risk of a genetic disease andimplanting those that do not have risk for the traits
being tested. As the list of reliable genetic tests
increases and as the cost of sequencing the wholegenome of the embryo decreases, the full genetic“score” of the embryo will be within reach. While
PGD-IVF was not designed for positive selection,
there has been success in selecting siblings with atissue match suitable to supply cord blood to treat asibling with leukemia (Kahn and Mastroianni,2004). The Nash family went through several cycles
of IVF and PGD before finding the embryo match fortheir daughter. It is a success story but has not been
replicated often, either because a matching embryo
was not found or because of the expense of theprocedure.
CRISPR and Gene Editing
CRISPR/Cas9 enters the horizon of hope because
it has the potential to repair a genetic abnormality
and prevent the disease not only in the person but
also in future descendants if used in embryos

Eubios Journal of Asian and International Bioethics 27 (July 2017)(germline therapy). It has been ethicallypermissible to wipe out diseases caused by viruses
or bacteria using vaccines or antibiotics,
respectively. Why should human ingenuity notproceed with a means to convert disease causing
genes into normal functioning genes? To limit the
research because there is not sufficient evidence ofbenefit and lack of harm is justifiable. To limit the
research because the DNA of an embryo might bechanged in ways that promote health andwholeness should be re-evaluated (Boyd, 2016a).
When leaders like National Institute of HealthDirector, Francis Collins, refer to genome editing as“correcting the typos in the book of life” the average
person may think the procedure is entirely safe andexpect that something so helpful should certainly
be made available. In reproductive freedom,
couples would expect to use a technology that“guaranteed” genetically healthy children. The
laborious research that is required to move an idea
into a therapeutic treatment takes years and great
financial and human investment. Technology is bydesign and intent for the use of people, for theirbenefit (Boyd, 2016b).
If CRISPR can be made safe and specific, effective
and efficient, then like any other biomedical
invention, it will proceed from animal models,
human cells, embryos, somatic corrections, tosomeday, perhaps germline therapy through PGDIVF. The time from theory to practical applicationand general use is often decades. Is there enoughdata to encourage us to move deliberately andresolutely down the path of gene editing as atherapeutic
tool?
Do
we
have
enoughbioinformatics information and analytical acuity toensure the edit happens at the target site andnowhere else? As these questions are answered in
the progressive progress of science and technology,
the ethical deliberators should revisit why germline
therapy has been set aside as unethical. It is difficult
to get eager science majors to pause and thinkcarefully about risks and benefits. As they rightly
point out, almost every therapeutic intervention
has some risks. The most effective way to get
students to seriously look at the potential for harm
was achieved with an assignment directing
students to compare three different searchalgorithms to look for off target sites for aparticular target sequence of DNA. The question toanswer was: would the guide RNA find sites otherthan the intended gene sequence? Each algorithm
generated different answers. Students were initiallyconfused by these results until they realized thatthe search tools are limited in scope such that risk
identification is not specific enough to be used inrisk-benefit assessment. More data is needed using
experimental models before proceeding with119

human gene editing but this is easier said than done
(Boyd, 2016a).
Private enterprise
In vitro fertilization as a reproductive alternative
to natural procreation has existed for decades andmillions of children have been born with assistanceof IVF. In the UK there are national guidelines forthe use of IVF that sit within the National HealthService policies of universal health care for all
citizens. In the US, where no universal health carehas yet been adopted IVF is available within theprivate sector. Some insurance companies
compensate patients for IVF expenses, some do not.
This creates a system in which those who have thewill, knowledge, and means to use IVF can do so.
The US Census Bureau reports the medianhousehold income in 2015 is $55,775 (Bureau,2015). The American Society of Reproductive
Medicine lists the average cost of a single in vitro
fertilization cycle at $12,400. The cost of one cycleof IVF is 22% of the average household income per
year. It is not reasonable or just to expect that asignificant number of citizens will have IVF
assistance with reproduction. Further costs would
be added for genetic screening of embryos andediting genes with CRISPR or some other genetherapy tool. One estimate for current genetherapy offered by Spark Therapeutics is $500,000
per eye to restore loss of vision caused by a genetic
disease (Johnson and Dennis, 2015). While it ispossible for costs to decline as the technology
becomes more refined, it does not allay fears of
injustice based on access.
Social Justice or InjusticeIf gene editing is ever approved in the US for
germline therapy (which it is not currently) it
would most likely be done in the private IVF clinics.
If this happens gene editing to correct or improveembryonic genes would be available to a small
percentage of the population, unless laws mandated
insurance coverage or health care reform in the US
moves into a universal single payer system.
Current regulations in gene therapy in the US limit
clinical trials to somatic cell gene therapy.
Bioconservatives generally caution that even if
CRRISPR’s potential for gene therapy is fantastic,
we should tread slowly, cautiously and deliberately.
Bioliberals in contrast argue that we have an
obligation to provide all the technology and medical
support we have to prevent genetic illness at the
beginning of life. Even if successful beyond current
empirical evidence, who benefits, at what cost, andwith what impact on future generations remain
uncertain. If any parent has an obligation to
improve the genetic constitution of their child inorder to provide a better life, then every parent

120

Eubios Journal of Asian and International Bioethics 27 (July 2017)

should at least have an equal opportunity,
otherwise gene editing may emerge as the latest
expensive acquisition of the economicallyprivileged. How far from the gate of the uber
wealthy are those whose genetic endowment are
deemed inferior or worse ‘in need ofenhancement?”
Current efforts to use gene therapy for monogenic
diseases such as Huntington’s Disease get firstpriority because the majority of cases affect adults
and the one gene responsible for the disease is
known.
Data from an in vitro model of
Huntington’s Disease using CRISPR-Cas9 to silence
the mutant gene and allow the normal gene torestore function is promising (Kolli et al., 2017).
Therefore, the idea that cells expressing the mutant
Huntington protein could be corrected in living
patients, reversing the symptoms of the disease isvery attractive.
Huntington’s disease is an
autosomal dominant genetic disease that shows nodiscrimination on the basis of gender or ethnicity.
The disease is neurodegenerative typicallybeginning in mid-life and progressively impairs aperson’s ability to walk, talk, remember, reason,and finally causes death. There is no cure.
Simultaneously with somatic gene therapy,
research should continue on gene editing in humanembryos, without implantation to determine
specificity and efficiency. The research published
to date is promising. Scientists have targeted thebeta globin gene (HBB) and found that within apopulation of embryonic cells generated after“editing” that some cells contained corrected genes.
This resulted in a mosaic due to inefficient repair of
the targeted sequence. Furthermore genes related
to the HBB such as endogenous delta-globin, (HBD)
caused an error rate of 25% (Liang, et al., 2015;
Tang, 2017; Wang et al., 2016; Cox et al., 2015).
These data support both conservative caution andliberal hope for gene editing.
Social concerns
Advances in medicine have increased theaverage human life expectancy. In 1900, theaverage life span was approximately 50 years, but
in 2011, it exceeds 80 years in many countries(HHS 2012). If the current rate of population
growth continues the population is predicted toreach 9.5 billion by 2050. Scientists worry whether
natural resources can supply human demand.
Population needs and natural carrying capacity ofplanet earth create the beginnings of a new geologic
epoch called the Anthropocene (Powell, 2015).
While a small subpopulation of people could
become genetically rich through gene editing, it isinconsistent with the intent to help that access may
be limited to financial affordability rather than on
the basis of need. Genetic injustice challenges us tofind pathways to greater equality. Justice corrects
injustice.
Ethical Awareness of Technology
Theodore John Rivers recently described themetaphysical significance of human beings andtechnology (Rivers, 2015). In his analysis hedifferentiates the process of human maturation andchange as a process of will, dependent upon
freedom. The appearance of technology changing
to meet a purpose may appear to be a process
independent of the human agent but will the
distinction hold when small computer chips are
implanted to trigger a moral response to a
repugnant thought? Will there evolve a time when
the technology is perceived as having ontologicalbeing – a nature of becoming – equivalent to that of
the human being?
Human becoming is a way in which humans
express their creativity, but it is not true thattechnology has its own becoming innate to itself.
Humans become but technology does not.
Technology changes as a consequence of humanaction. A technique may be improved or replaced or
discarded as the need for it changes. Humans are
the agents of change.
Technology is a demonstration of our relationshipwith the world. It reflects our desire, what we will
to be. Our desires for what technology does reflects
our values and choices, our ideas of the type ofworld we want or expect. It is quickly becoming the
primary means by which we create, manipulate andchange the world.
Technology, especially robotics, nanobots,
CRISPR-gene editing, gene therapy, enhancement
and what we may not yet imagine that hold greathopes for the bioliberal who advocates unimpeded
progress using all technology to improve the lengthand quality of human lives, and maybe the lives ofplants and animals too. It is likewise true thattechnology is becoming a means to the will to
power, with an open ended question about whether
it will be used for good or ill effect. If or when gene
editing is developed and deployed the growingedge of this genetic technology holds the potential
to change the world as we currently know it andthat may be good or bad.

References

Boyd, A. (2016a). “Deliberative Democracy for a Gene
Editing Policy,” Eubios Journal of Asian andInternational Bioethics 26: 185-190.
Boyd, A. (2016b). “Science and Ethics in Dialogue:
Ethical Research Conduct and Genetic Information
Application” IN Colloquium Series on the Genetic
Basis of Human Diseases #7, Morgan & Claypool Life
Sciences(ed)
MichaelDean
DOI
10.4199/COO138ED1V1Y201509GBD007.

Eubios Journal of Asian and International Bioethics 27 (July 2017)
Bureau, US Census. (2015). “Library.” Map: MedianHousehold Income in the United States: N.p., 15
Sept. 2016.
Check, E. (2002). “Gene therapy: A tragic setback.”
Nature 420: 116-118.
Cox, D.B.T, R.J. Platt and F. Zhang.
(2015)“Therapeutic genome editing: prospects andchallenges, Nature Medicine 21 (2) 121-131.
Hsu, P.D. Lander, E.S. and Zhang, F. (2014).
“Development and applications of CRISPR-Cas9 forgenome engineering.” Cell 157: 1262-1278.
Liang, P., Y. Xu, X. Zhang, C. Ding, R. Huang, Z. Zhang, J.
Lv, X. Xie, Y. Chen, Y Li, Y. Sun, Y. Bai, Z. Songyang, W.
Ma, C. Zhou, J. Huang (2015). “CRISPR/Cas9mediated gene editing in human tripronuclear
zygotes” Protein & Cell 6 (5): 363-372.
Giubilini, A. (2015). “Don’t Mind the Gap: Intuitions,
Emotions, and Reasons in the Enhancement
Debate,” Hastings Center Report 45 (5): 39-47.
Harris, J. (2007). “Enhancing Evolution: The ethicalcase for making better people” Princeton NJ:
Princeton University Press.
Johnson, C. Y., and B. Dennis (2015). “Gene therapies
offer dramatic promise but shocking costs.” The
Washington Post. WP Company, 11 Nov.
Kahn, J.P. A.C. Mastroianni, (2004). “Creating a Stem
Cell Donor: A Case Study in Reproductive Genetics,
Kennedy Institute of Ethics Journal 14 (1): 81-96.
Carrying capacity, World Population, N.p.n.d.web 31
May 2017
Kolli, N. M. Lu, P. Malti, J. Rossignoi, G. Dunbar, (2017)“CRISPR_Cas9 mediated gene-silencing of themutant Huntingtin gene in an in vitro model of
Huntington’s Disease,” Int. J. Mol. Science 18:754768.
Living longer, (2012). National Institute on Aging, U.S.
Department of Health and Human Services, 26 Mar
2012, web. 01 June 2017.
Misra, S. (2013). “Human Gene Therapy: A Brief
Overview of the Genetic Revolution.” JAPI 61: 127133.
Powell, R. and A. Buchanan. (2011) “Breaking
Evolution’s Chains: The prospect of deliberate
genetic modification in humans, Journal of Medicine
and Philosophy 36: 6-27.
Rivers, T.J. (2015) “Technology and Being: A
discussion of their metaphysical significance.”
Advances in Historical Studies 4:43-50.
Savulescu, J. (2005). “New Breeds of Humans: The
Moral Obligation to Enhance,” Ethics, Law, andMoral Philosophy of Reproductive Biomedicine 1(1): 36-39.
Sparrow, R. (2011). “A Not-So-New Eugenics: Harrisand Savulescu on Human Enhancement, Hastings
Center Report 41 (1): 32-42.
Tang, L., Y. Zeng, H. Du, M. Gong, J. Peng, B. Zhang, M.
Lei, F. Zhao, W. Wang, X. Li, J. Liu (2017)“CRISPR/Cas9-mediated gene editing in humanzygotes using Cas9 protein.” Molecular Genetics andgenomics 292: 525-533.

121

Wang, H., M.L. Russa, L.S. Qi (2016). “CRISPR/Cas9 ingenome editing and beyond.” Annual Review ofBiochemistry 85: 227-264.
Zhang, F. (2015). “CRISPR/Cas9: Prospects andchallenges.” Human Gene Therapy 26 (7): 409-410.

The lack of environmental ethics
in dealing with particulate matterin Korea- Manjae Kim, Ph.D.
Professor, Gangneung-Wonju National University,
Gangneung, Republic of Korea
Email: mjkim@gwnu.ac.kr

Abstract

This paper discusses some of the data and theethical issues associated with problems ofparticulate matter in Korea. The major sources ofhousehold particulate matter are grilling mackerel
and pollution from China. Diesel is a further source.
Semantic network analysis that focuses on
associations between words was used to examine
the words used in the media. The issues raised in
the media are discussed in light of ethical theory.

Introduction

Problems of particulate matter have recently
become a sensational issue in Korea. According to
the news search service, Kinds, almost a third ofrelated news articles have been produced in 2016(as of July 19), since “particulate matter” appeared
for the first time in 1993 as an article
title(http://www.bigkinds.or.kr).
Particulate matter is known to cause serious
illness such as lung cancer, stroke, and heart andrespiratory diseases. In spite of its toxic effects,
however, it is still confusing to identify what is
causing it and what we ought to do for policy
decisions. Is China responsible for the harmful dust
in Korea? Is grilling mackerel without proper
ventilation causing air pollution? Do we have toimpose stricter regulations of diesel cars? Media
have provided contradictory disputes, and the
Korean government has failed to answer thesequestions.
Therefore, this paper aims to present how
Korean government and media have played an
ambiguous role in dealing with particulate matterby using a semantic network analysis largely basedon news articles. It finally claims that the lack ofenvironmental ethics can be a crucial cause of allthese disputes. There are three possible causes forparticulate matter:122

Eubios Journal of Asian and International Bioethics 27 (July 2017)

MackerelAccusing mackerel as a main cause of particulatematter began with the Ministry of Environment’s
May 23 report referring “frying mackerel in one’s
kitchen with the windows closed releases 25 times
more fine particulate matter than one would
experience with a PM2.5 level of 90 micrograms per
cubic meter” (Chung & Sung 2016), the highest
among foods cooked and tested by the ministry.
The Ministry of Environment also added that “theamount of fine dust created from pan-friedmackerel is several times that of air pollution levels
rated by meteorologists as ‘very bad’” (Choi 2016).
Although the survey of 32 households carried out
between May and November in 2015(K. Lee 2016)
was not at fault, the news immediately affected themarket, resulting in “at Garak Market insoutheastern Seoul, a 10-kilogram box of small
mackerel was auctioned off at 12,000 won, downfrom 40,000 won a week earlier” (S. Kim 2016a).
As mackerel fishermen’s protests grew fiercely(Choi 2016), the ministry attempted to resolve themackerel scandal by insisting that “it was not theministry’s intention to single out mackerel as thecause of air pollution,” and explaining that “thestudy had only referenced indoor pollution levels
and not pollution in general” (Chung & Sung 2016).
China
China’s influence on yellow dust in Korea’s air
quality goes back to the 13th century (S. Kim 2016b).
As environmental problems are more serious in
China than Korea, with South Korea ranked 80th of
180 countries while China was 109th in the 2016
Environmental Performance Index (Yale Center for
Environmental Law & Policy), China has been easily
blamed for recent problems of particulate matter.
The Korea Environment Corporation affiliated with
the Ministry of Environment also pointed to Chinaas the primary origin of the hazardous air pollution(Kang 2016).
There seems to be no doubt that the dirty air in
Korea is “the combination of what is being
generated within Seoul and within the broader,very industrial environment of Korea, added ontotransport of pollution from China” (Hu 2016).
Shapiro, however, insists that it is the Korean media
that “largely frame transboundary air pollution in
the region as a problem emanating from China”(Shapiro 2016: 1).

DieselDiesel cars are so popular in Korea that morethan half of the newly registered automobiles in2015 (960,000 of 1.83 million) were diesel(Editorial 2016a). Largely due to the clean diesel
policy which was introduced by the Lee Myung-bak
government to “promote low CO2 emissions bygranting tax benefits to diesel cars that met theEuropean Union's Euro 5 emission standards” (Y.
Kang 2016); diesel fuel is less expensive thangasoline.
As concerns about increasing pollution get more
attention than before, the Korean government hasplanned to apply new measures. However, probably
the most effective way such as raising the diesel
prices has faced strong opposition by the Ministryof Strategy and Finance. Furthermore, the Ministryof Trade, Industry and Energy plans to build ninemore coal-burning power stations by 2022 due tothe increasing difficulty in constructing nuclear
power plants (Korea Herald Editorial 2016).

Research Methods

Semantic network analysis is a research paradigm
that uses “network analytic techniques on paired
associations based on shared meaning” (Doerfel
1998: 16) and focuses on associations between
words. Using the KrKwic (Korean Key Word In
Context) which is a computer-based content
analysis software, frequency analysis and cooccurrence matrix were retrieved (Park &Leydesdorff 2004), and UCINET 6.0 was applied to
calculatecentrality
valuesandnetworkvisualization (Borgatti et al. 2002).
Google news was used to collect the data
between January 1 and September 30 in 2016.
Among 58 news articles in total, those combining“particulate matter” with mackerel were 17, while
China or diesel related particulate matter news
were 13 and 28 respectively.

Results
1) Particulate Matter and Mackerel
Table 1 shows that particulate matter and mackerelrank top two, while according to the Ministry ofEnvironment, cooking and grill follow next. Because
the mackerel scandal was initiated by the Ministryof Environment, almost all top 20 keywords areclosely related with cooking mackerel inside the
kitchen except for diesel car. Results of degree
centrality are very similar to those of keyword
frequency. Fig. 1 shows that particulate matter,mackerel, and ministry of environment occupy thecentral position.

Figure 1: Visualizing mackerel related particulate matter news

Figure 2: Visualizing China related particulate matter news

Eubios Journal of Asian and International Bioethics 27 (July 2017)

124

Figure 3: Visualizing diesel related particulate matter news
Table 1: Top 20 keywords for mackerel relatedparticulate matter news

Table 2: Top 20 keywords for China relatedparticulate matter news

keyword
Particulate_Matterf
233

keywordDiesel_Carf31

Mackerel
Ministry_of_Environment
Cooking

154

Pollution

30

91

Announcement

29

86

Ventilation

28

Grill

76

Dust

26

Occurrence

57

Substance

25

Concentration

48

Cause

25

Air

39

PM2.5

Fine_Particulate_Matter
Kitchen33
32

ResultInsidekeywordf

Particulate_Matter

114

Exhaust

20

China

74

Problem

19

Korea
Fine_Particulate_Ma
tter
Pollution

58

Korean Peninsula

1951

Concentration

18

43

Diesel_Car

15

Cause

30

NASA

15

22

Air

28

13

22
21

NIER(National_Ins
titute_of_Environm
ental_Research)

Substance

25

Analysis12

Government

25

Level

12

Occurrence

22

12

Research

21

Solution
Ministry_of_Enviro
nment2) Particulate Matter and China
Using two primary words of particulate matterand China, the top 20 results present threecontents. First, blaming China as a primary cause of
air pollution in Korea appeared in news withkeywords such as Korea, Korean Peninsula, fineparticulate matter, pollution, cause and air. Second,
stressing internal problems instead of China gets
results expressed through keywords including
diesel car and exhaust. Finally, keywords such as
NASA, NIER, and analysis indicate NASA’s efforts totry to answer questions of how much pollution
drifts over and how much is home-grown (Zastrow2016).
The analysis of degree centrality shows a similarorder to be seen in Table 2. China as a main reasonof pollution problem is also indicated in Figure 2.

keywordf

123) Particulate Matter and Diesel
As seen in Table 3, most words are related withhow diesel cars affect air pollution and how
government including Ministry of Environment,
and Seoul Metropolitan Government respond tothese problems.

Eubios Journal of Asian and International Bioethics 27 (July 2017)
Table 3: Top 20 keywords for diesel relatedparticulate matter news
Keywordf

keywordf

Particulate_Matter

325

Exhaust54

Diesel_Car

242

Increase

51

Diesel

155

47

Bus

101

Government

80

Occurrence
Seoul_
Government
Cause

Measures
Ministry_of_
Environment
Air

72

Nitrogen Oxide

43

63

PM2.5

42

62

Emissions

42

Old

60

Policy

41

Korea

60

Augmentation

41

Pollution

57

Conclusion

46
44

Policy debates regarding three factors causing
particulate matter in Korea clearly show the lack ofenvironmental ethics. Mackerel issues turned out tobe a scandal carelessly initiated by the Ministry ofEnvironment. Concerning China impacts, blaming
others is easy but fails to suggest any constructive
solution. Even the fact itself is not clear at thismoment. One study commissioned by Seoul
Government concluded that “the problem comesroughly equally from local sources and countries
upwind of South Korea,” while Greenpeace claimed
that as much as 70 % of some types of pollution
originated locally (Zastrow, 2016).
Diesel debates provide more serious problems
than others. The nation’s Green Growth Policy of2009 has pictured diesel as eco-friendly, resulting a
sharp increase in the percentage of diesel cars from
18.5 percent in 2010 to 44.7 percent in 2015 (J. Lee,2016). Despite growing concern over particulatematter, the government plans to construct new
coal-fired plants (J. Kim, 2016).
The analysis of this paper also indicates that
diesel and government are at the center of debates.
Keywords such as air, cause, diesel car, Ministry ofEnvironment, occurrence, particulate matter andpollution are listed in all three network analyses.
Among seven key words, it is only natural that“particulate matter” occupies the top. Whatever themain cause of particulate matter, Ministry ofEnvironment and diesel car appear in all cases,
which implies that they are two keywords ofparticulate matter. Therefore, the government
policy on diesel vehicles needs to be reestablishedbased on environmental ethics.
However, conflicts within the central government
make things worse. For example, the Ministry ofEnvironment and the Ministry of Strategy and

125

Finance take different positions on whether toincrease the price of diesel fuels or not (Chung &Sung 2016). Setting a long term environmental
ethics based on facts and sharing them seem to beneeded more than else.

References
Borgatti, S.P., Everett, M.G. and Freeman, L.C. 2002.
Ucinet for Windows: Software for Social Network
Analysis. Harvard, MA: Analytic Technologies.
Choi, Dung-jin. “Mackerel fishermen anger withenvironmental report” Korea Times 2016, May 28.
Chung, Esther and Sung Si-Yoon, “Mackerel let off thehook as major fine particle pollutant” JongAng Daily
2016, June 8.
Doerfel, M. L. 1998. What constitutes semantic
network analysis? A comparison of research andmethodologies. Connections, 21(2): 16-26.
Hankyoreh Editorial. “Need to find diesel cars’ role inSouth Korea’s terrible air quality” The. 2016a, May
19.
Hu, Elise. “Korea's air is dirty, but it's not all closeneighbor China's fault” NPR, 2016, June 3.
Kang, Ki-heon. “Gov’t criticized for not accurately
forecasting air pollution” JongAng Daily 2016,
April10.
Kang, Yewon. “South Korea shuns diesel following
emissions scandal” Nikkei Asian Review. 2016, June
29.
Kim, Jeong-su. “South Korea must choose energy
future: dirty coal or renewable?” The Hankyoreh.
2016, July 16.
Kim, Se-jeong. “Mackerel shunned as cause of finedust” Korea Times 2016a, May 30.
Kim, Se-jeong. “Korea at loss over fine dust from
China” Korea Times 2016b, May 31.
Korea Herald Editorial. “Quarrel over dust” The.
2016b. June. 1.
Lee, Jae-min. “A more breathable Seoul” The Korea
Herald 2016, May 17.
Lee, Kyung-min. “Indoor cooking creates fine dust”
Korea Times 2016, May 23.
Park, H. W. and L. Leydesdorff. 2004. Understanding
the KrKwic: A computer program for the analysis of
Korean text. Journal of the Korean Data Analysis
Society. 6, 5: 1377-1388
Shapiro, Mattew. 2016. Transboundary air pollution in
Northeast Asia: the political economy of yellow dust,
particulate matter, and PM2.5. Korea Economic
Institute of America.
Yale Center for Environmental Law & Policy et als.
2016. Global Metrics for the Environment(www.epi.yale.edu)
Zastrow, Mark. “NASA jet gets a sniff of pollution overSouth Korea” Nature: International Weekly Journalof Science. 2016, May 9.

126

Eubios Journal of Asian and International Bioethics 27 (July 2017)

Contrasting views of the public vs.
teenage students regarding
renewable energy- Alexander Waller
St Stephen’s International School, Thanarat Road,
Pak Chong, Nakhon Ratchasima, Thailand
Email: alexander_ky@sis.edu

Abstract

This paper reports on the compared views of andsome attitudes towards the use of renewableenergy technologies and some feedstocks forbiofuels in a sample of the general public in the
North Eastern region of Thailand with a similar
number of local secondary school students .The
data collected provides a small snapshot into public
opinion of socioeconomic, scientific and politicalfactors that are relevant to the transition towards
more renewable energy provision within Thailand.
In addition to this, participants indicated which
subjects they considered would be of value forschool students to study in more detail to equipthem with knowledge to make informed choices of
their own .The results reveal some holes in thegeneral public knowledge of government policy, as
well as a few issues in their thoughts, which
demonstrated that generally people are aware of
the complexity of energy transition. Environmental
ethical issues also ranked high in peoples’ opinions
of topics for secondary school educational
improvement. An adjunct to the results of thesurvey was carried out in 2013, with a partial
analysis of a small repeat survey completed in July
2017. This gives a small insight into opinion trends
over a four year period. The findings of the pilot
study provide some useful baseline data for arefined and larger survey of a wider section of thegeneral public to help inform educational
curriculum planners and RE community education
programmes of some attitudinal barriers tolearning.

Introduction

There are daily reports in the media of issues
relating to climate change and the increased
provision of RE technology to meet governmental
targets and international agreements. Manysocioeconomic,
political,
scientificandtechnological factors contribute towards thetransition towards renewable energy and reachingthese targets (1). A growing body of evidence also
draws a link between deterioration in psychologicaland spiritual or mental health with human
disconnectedness from the natural environment(2). Several religious organisations of different
faiths endorse the need for environmental

protection (15,18). The motivation for alternative
energy can be focused on energy security such as
UK nuclear policy or the Sufficiency Economy
Philosophy of the late king Bhumibol Adulyadej ofThailand (3), on economic reasons such as
investment in new technology (4,6) and incentives(6) or ethical concern over the sustainable use ofenvironment (7, 8).
This survey was carried out following a pilot
study of the opinions of students studying a master
degree in public administration, which reveal animportance placed on religious values, a lack ofknowledge relevant to science and a very high levelof concern over the issue of climate change. The
aims of the survey were firstly to gauge public
opinion, the level of scientific awareness andattitudes towards environmental issues that have
ethical implications. Secondly, this survey could be
used for formative assessments of secondary
students’ prior levels of knowledge andunderstanding during the development of arenewable energy and environmental ethics course.
The results and partial analysis of data may also beof use for further societal and educational research
as reference, comparative or baseline data whenreporting on societal opinions of and possible
barriers to renewable energy transition.

Pilot Study
The pilot study was completed in 2012 using asimilar questionnaire on the opinions of 53
voluntary respondents who were students studying
part-time on the master in Public Administration
course at the Sikiew Campus of National Institute ofDevelopment Administration (NIDA). The results
revealed some fundamental gaps in scientificknowledge (94% thought carbon dioxide waspoisonous and 89% could not state electricity
consumption is measured in units or kilowatt
hours) and others revealed partial understanding
such as suggesting volts or amps for the units ofelectricity consumption or suggesting fire, fossils,
air, pressure, dynamos and the environment assources of energy. This lack of scientific knowledge
and understanding may explain in part why there
was a very high level of concern over climatechange. 74% were very concerned, 11% had someconcern, 13% admitted they wanted more
information first and 2% did not believe inanthropogenic causes of climate change.
When asked about questions relating todevelopment, less than half (43%) thought thatelectricity should be a basic human right but overhalf (53%) thought it should be funded by the state.
Yet only just over a quarter (26%) of respondents
considered that electricity was one of the mostimportant requirements for their work. This was
rated slightly more important than democracy

Eubios Journal of Asian and International Bioethics 27 (July 2017)(25%), yet combating corruption, the legal systemand the economy were seen as significantly more
relevant (45%, 49% and 51% respectively).
In response to questions on ethical frameworks
that they felt most relevant in their lives 83% said
that each individual was responsible to develop
their own virtues, 38% applied utilitarianprinciples of seeking the greatest benefit for the
majority and 21% felt that rules and laws should
govern social behavior. 0ver three quarters of the
respondents considered that society as a whole was
responsible for moral education rather than isbeing mainly the duty of parents (55%), teachers(32%), religious leaders (30%). In contrast to thisalthough 72% believed that moral education should
include religious content only 15% consideredhealth issues relevant in moral development.
However,50%
considered
that
work
responsibilities, environmental issues and humanrights should also be included in moral education.
At work 79% said that safety was of paramountimportance, although they survey did not reveal
whether they were referring to personal or third
party safety concerns. Full results of this pilot test
and copies of the questionnaire in Thai and English
are available from the author upon request.

Methodology of the Current Study

A survey was conducted of 103 randomly
selected adult members of the pubic in Nakhon
Ratchasima province of Thailand in July 2013.
These general public (GP) participants were
customers at a liquefied gas, diesel and petrol
station, at a rural section of the main route 2
highway. The results were compared with datafrom the same questionnaire completed by 62
secondary school students at the local Pak ChongWorldclass School (PCS) and 45 secondary students
at St Stephen’s International School, (Khao Yai)SISKY. The school student numbers were combined
to make a total of 107 for analysis in this paper,
called the teenage sample. The nine partquestionnaire was available in both Thai andEnglish, and respondents could select which
language they preferred to make their responses.
The customers at the service station volunteered
their time to respond to the questionnairequestions, and the students at the schools were
given it as an optional task to complete in their own
time. The same survey was distributed at theschools and service station again in July 2017; thissurvey has been analysed in less detail but somecomparisons in results have been made. There
were fewer respondents in the repeat trial: 79 in
the 2017 group and 67 in the 2017 sample.
Some of the questions were designed to test if
some findings of the pilot study were illustrative of
the perceptions of ethics education and level of127knowledge of the general public many of whomwould have had limited scientific or philosophicaleducation. Other questions were designed to give
greater insight on what the wider public saw aspush and pull factors in addition to barriers against
combating climate change or making the transition
towards more renewable energy. There was someattempt in the questions to ask respondents toconfirm their opinions, for example if respondents
showed concern for spiritual wellbeing in one
question did they later indicate that religious
instruction was an important component of ethics
education.
The first two questions were to gain an insight
into knowledge of governmental energy policy
targets. The third and fourth were to determine if
people knew of various biofuel feedstocks. The
fifth question asked directly about people’s views of
a human right of access to energy. The sixth andseventh questions were based on selection fromtwelve multiple choice statements, including one
invalid statement about fossil fuels and ozone
depletion. The seventh question requesting them toidentify a statement relating to carbon dioxide wasaimed to gain an insight into the level of knowledgeof atmospheric pollution issues. The eighthquestion made reference to the late King Bhumibol
Adulyadej’s Sufficiency Economy Philosophy andthe need for moderation. Respondents were asked
to state what they personally could do to reduce
fuel consumption. The final question was regarding
what schools should teach more about to help
students make responsible energy choices in the
future.

Results and analysis

Question 1 revealed that students generally had
high expectations of government targets with anaverage target of 49.5% of renewable energy use in
Thailand within a decade. The GP average target
was lower at 39.9%. However, 51% of the public
respondents and 22% of the teenage group madeno response. In question 2 both the public andteenage respondents correctly thought that more
electricity is planned to be generated throughhydro and solar than by wind turbines or biomass
combustion. Although more of the teenage
incorrectly believed that solar would generate
more than hydropower.
In the third question the majority of public groupranked palm nuts (40%) and cassava (34%) as themain biofuel feedstocks, whereas the cassava(23%) was replaced by sugarcane (30%) in theranked order of teenage responses. Both adults andstudents thought that rice husks would be the least
likely feedstocks for a biofuel. The average
percentage of ranked values are given in Table 1
below.

Eubios Journal of Asian and International Bioethics 27 (July 2017)128

Table 1: Average ranked scores for the suggested
order of use of different vehicle biofuel feedstocks.
Group
Cassava Sugarcane
Rice
Palm
husks
nuts
GP
34
19
7
40
SS
23
30
9
38

Table 2: Average ranked scores of preferences forvarious biogas feedstocks for home cooking use.
Group LPG Animal Plant M & H
GMO
dung
waste waste ferment
GP
36
30
13
13
8
SS
28
19
25
12
16

The collective data from question four indicatedthat both students and adults were most in favourof fossil fuel liquefied petroleum gas overrenewable alternatives. Yet for the adults animal
dung was a more favourable alternative to plant
waste and much more so than fermentation by
genetically modified organisms (GMO) or the use ofmunicipal and household (M&H) waste. The
teenage group were generally less in favour of fossil
fuel and comparatively more in favour of plant
waste and GMO fermentation than the adult group.
The average ranked scores are given in Table 2.

In the response to the question of whether accessto energy should be considered as a human rightcomparable to the right of access to water, more
students were undecided about this than the adults.
In the pilot study 43% of university respondents
considered that there should be basic human rightof access to energy. However, unlike the pilot trial,
the majority within both groups in this study
considered that it should be a human right. The
percentage of responses in this study are in Table 3.

Table 3: The percentages of respondents who considered access to energy should be a human rightGP, ) .
(N=103; SS, N=107
Group
In favour
AgainstUndecided
No answer
GP
55
8
3
34
SS
62
3
16
19
Table 4: Reasons selected for the replacement of fossil fuels with renewable energy technologies
Group

1st

2nd

3rd

4th

Least relevant

GP (n=103)

Rising fossil
fuel cost

Toxic carbon
monoxide

SISKY (n=45)

Finite natureof fossil fuels

Toxic carbon
monoxide

PCS )n=62(

Thai energy
security

Sharingplanet withanimals
Sharingplanet withanimals
Finite natureof fossil fuels

Climatechange floods

Climatechange floods

Spiritualvalue ofnatureSafety factors

Protection ofozone )false(

Spiritualvalue ofnatureRising fossil
fuel cost

Table 5: The percentages of respondents in favour of different school subjects to support renewable energy
education (GP, N=103; SS, N=107)
Group
Buddhism Economics
EthicsPhilosophy
Politics
Science
Society
GP
42
42
35
17
24
48
33
SS
19
47
44
37
21
63
40
Table 6: The 2017 percentages of respondents who thought access to energy should be a human rightGroup
In favour
AgainstUndecided
No answer
GP (n=67)
65
23
1
11
SS (n=79)60
36
22Table 7: The percentages of respondents in favour of different school subjects to support renewable energy
educationGroup
Buddhism Economics
EthicsPhilosophy
Politics
Science
Society
GP n=67
23
15
26
16
18
31
13
SS n=78
21
26
19
14
21
28
23

The statements selected for reasons why
renewable energy (RE) should be used to replacefossil fuels showed variation between the public
and teenager groups and within the SISKY and PCS
schools there was also variation. The adults haveprimarily cited an economic reason. However, alongwith SISKY students, they also selected two reasonsthat indicate an appreciation some slightly more
intrinsic and less instrumental values orenvironmental ethical reasons that show value wasplaced on the environment. The PCS students
generally chose more scientific and economic
political reasons .Generally, few respondents fromboth groups selected reasons of conflict (16%), acidrain (17%) future generations (13%). There waseven less concern for future generations amongst
the SS group (7%) than the adult GP (22%). The
primary four reasons selected by the groups are
given in Table 4.
The following question was only answered
correctly by three out of the total 210 respondents,
45 respondents (33 from GP and 12 from SS)
actually cited ozone depletion as a valid reason for
not using fossil fuels. This indicates a lack ofknowledge and understanding, or at least a
misconception, of the scientific basis of
atmospheric pollution. The lower rate of this error
in the responses from SISKY students could be areflection that the damage of CFCs to the ozone
layer is specifically included within the lower
secondary Science curriculum. This leads to thefinal question asking them to state what subjects
they considered important for students to learn tobecome competent at making energy choices. The
percentages of the responses to question nine are
given in Table 5. There is a consistency of opinion
between both adults and students, although adults
predominantly thought Buddhist values would beof more use than learning philosophy yet theconverse is true in the teenagers’ opinions. In bothgroups politics was seen as the less importantsocial science but science as the most relevant or
beneficial, with students being particularly infavour of science. Ethics and socioeconomic
education was also rated as important by over one
third of the respondents .
The answers given to question 8 about how
respondents could personally use less energy are
not analysed in this paper. The question was
included to promote reflective thought and for
raising awareness. Answers included sharing or
using public transport, walking and cycling, turning
off lights and other appliances when not in use.
There were very few responses that suggested
converting to or buying energy efficient appliances
or using insulation to reduce air conditioning costs.

Initial results from survey in July 2017

In response to the first question the respondents
were much more ready to offer a suggested value
with only 13 of the total 146 not submitting a
numerical value. The average values of these public(2017) and teenage (2017) groups this time werealso very close to each other with the public (n=63)
average of 45.1% and the teenage (n=70) averageof 44.7%. This average however does notdetermine the range and standard deviation ofthese data and although closer to actual
governmental targets does not demonstrate how
many respondents actually knew the real target
value .
The results for question 5 regarding the right ofaccess to energy are given in Table 6. This shows
relatively consistent student opinions in favour of aright to energy, compared to the data from 2013 intable 3, but there has been a shift in confidence toexpress a negative response to the question. The
responses are generally much more clearly
expressed with few undecided or unanswered
responses in the student cohort. This may indicate
a greater confidence in making responses
regardless of giving the perceived correct answer1.
There has been a 10% rise in the number of adultresponses in favour of this potential right since2013, which was also higher than the 43% reported
the year before during the pilot.
The results of the final question regarding
educational subject choice to assist students tomake informed energy choices, is given in Table 7.
For many subjects there is a degree of consistency
between the adult and teenage opinions for thisquestion, although the students are slightly more infavour of the social sciences compared to theadults’ opinions. This latter point of students seeingsocial sciences as more relevant than adults do, andthe ranked importance of science compared toother subjects mirrors the results of the 2013
survey. The recent results show that althoughscience is still believed to be the most relevant
subject for making choices of energy it was rated as
relatively less important than in the 2013 survey.
There were generally much fewer subjects selectedby each respondent in the 2017 survey comparedto the data from the 2013 survey, which explains inpart why the averages for each subject weregenerally lower. An exception to this trend was that
Politics maintained a level of importance by
1 Thai students are reluctant to volunteer answers toforeign teachers on a cultural phenomenon unless they
are sure that they know the correct answer; anecdotal
evidence from teacher conversations with the author
suggest that this trend may be changing and that there isa growing confidence within classrooms. The validity ofthis proposition and possible reasons for it relating tochanging teaching practices and educational philosophy
merits further research.

130

Eubios Journal of Asian and International Bioethics 27 (July 2017)

approximately one fifth of respondents. Buddhist
Studies was also slightly more important in thisyear’s student responses, although an increase of 2
percentage points in a sample of the size may not
be statistically significant (n=78) for this question.
It remains far below the 72% of university students
sampled in the pilot study who professed a desire
to include Buddhist studies in a curriculum for
moral development within schools.

Discussion
From these results there is some evidence that
there are gaps in fundamental scientific knowledgeof climate change issues relating to environmental
ethics that may hinder future learning until
addressed. The general public and school students
are aware of RE being a topic of media interest, yetthey have little accurate knowledge of thesocioeconomic issues and political factors involvedin the governance of energy transition. The lack of
GP responses and the overestimation of
governmental targets, just prior to the time of thissurvey had been set at 20% by 2020 but wereincreased to 30% by 2025. The media had beenreporting this as a success of Thai policy inproviding subsidies for electricity generation
through RE technologies in the form of economic
adders to electricity sold to the national grid. There
was awareness in the media of the issue of
overdependence on fossil fuels, the transition
towards gasohol blends for petrol driven cars, newexhaust gas emission limits and differentially risingfuel costs. The wider international media wereraisingsocioeconomic
andecologicalenvironmental issues including the loss of
biodiversity associated with palm oil plantations inSouth East Asia, flooding due to climate change2 aswell as ongoing conflict in the Middle East being
attributed, to various degrees, to the fight for accessto oil. There is some evidence supporting that theseissues were perceived as relevant to RE transitionin the responses to question 6, yet generally thecosts of fuel was reported as higher significancethan fuel security, conflict and other socioeconomic
factors. The factors that had a direct impact onparticipants were of more consequence than the
remoteness of war in far away countries.

2 In October 2010 there had been extensive flooding inurban parts of Korat and Pak Chong in Nakhon
Ratchasima province .The following year throughout
October flood waters moved south through central
Thailand with serious socioeconomic impact on the
agricultural, industrial and retail industries and housing .
The management of this extensive flooding had politicalramifications as the prime minister was accused ofmismanagement .

The final response from participants regarding
what school students should be able to learn is
encouraging for educationalists who are seeking topromote environmental ethics within thesecondary school curriculum (11,12). The response
rate of the GP group in question 6 of the importanceof nature to spiritual and mental health was highalong with their relatively high rating of religious
instruction to be included in school curricula inquestion 9. The benefits of religious debate and theinclusion of religious institutions promoting
sustainable practices has been stressed by many
authors regarding the environmental initiatives indifferent faith and interfaith organisations(15,16,17,18). The importance of understanding thescientific aspects when applying bioethicalprinciples is referred to by many researchers(7,8,9,10). Teachers play a vital role in thistransmission of knowledge (11) but often theteachers themselves have limited understanding ofcurrent RE issues (13). The aim within Thailand has
been associated with further promoting the SEP
which is already included in the secondary school
curriculum, yet the further challenge is to makesufficiency and sustainability part of the mindset(14).

Discussion of some initial results of2017 survey
The increased number of responses to thequestion of governmental RE policy targets and thesimilarity between adult and student responses is
intriguing and merits further exploration; a firststep will be a statistical analysis of the data in
addition to extend the sampling of both the generalpublic and student groups. The consistency of
responses in favour of the right to energy is a usefulreference for researchers seeking to data to
support this case. The results indicate that there
may be a trend where although Science is perceived
as the most relevant subject for making RE choicesthat other subjects including religious studies,
ethics, social, political and economic studies areranked relatively more important in relation to
Science than they were in the study conducted four
years ago. This snapshot flags up that, within thesesmall samples, there is a growing preference for amore balanced curriculum to include relatively
more socioeconomic, political and ethical religious
studies than curricula with technical scientific biasthat were deemed as preferential four years ago.
This needs greater exploration through collectionof data from a wider population.

Limitations

The length of this questionnaire was quite longand some respondents complained of feeling weary

Eubios Journal of Asian and International Bioethics 27 (July 2017)and others remarked that it felt like an
examination .This fatigue may have caused certain
respondents to skim and or skip answers. The
questionnaire could be simplified yet still provide
insightful results, for example by using Likert
scales. The small sample size and limited regional
sample pool make this an interesting snapshot as apilot study, but for more reliable results a survey
should be conducted over a wider area and usinglarger numbers.
The data from both surveys indicates that there
are gaps in teenage and the wider general publicknowledge of the scientific and technologicalfactors and socioeconomic issues relevant in the RE
debate. There is a recognition by both adults andschool students that modifications to school
curricula would help to empower students to makemore informed choices of their own. There is anindication that this means a shift away fromcurricula with technical scientific emphasis to one
with a greater balance between social sciences,
ethical or religious studies and science. This pilot
study provides a useful baseline reference to launch
further investigation from a wider population base,which could subsequently be used to inform
education policy and curriculum developers. It isalso a useful reference study for community
educators who are seeking to promote acceptanceof RE technology within the general public, some ofwhom had not had the benefit of complete or recent
secondary school education.

Acknowledgements
The author is grateful to Thanakorn
Boonchareonkitja for permission to conduct
surveys at the Pakchong PTT Partnership service
stations, to Visut Chareonsiriwatana, Jane
Deotrakul and David Aitchison for permission to
conduct research at St Stephen’s International
School and to Ramida Onnom, Nicolas Kamfin
Noumsi, Ryan Alconcel and Nji Tsi for permission at
Pak Chong Worldclass School. This research would
not have been possible without Suriyaporn
Sonpeng’s translation of the questionnaire fromEnglish into Thai. Thank you also to Tankay
Bunruean for assistance collecting the survey
responses and to Pattaraporn Singharatch andSutharat Suksangthong for their interpretation
skills. Full copies of the questionnaires in both Thaiand English are available from the author uponrequest.

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Eubios Journal of Asian and International Bioethics 27 (July 2017)

A Chinese perspective on theconcept of common morality by
Beauchamp and Childress- Yanguang Wang, Ph.D.
Professor, Institute of Philosophy, Chinese Academyof Social Sciences, Beijing, China
Email: ameliaw2002@hotmail.com

Abstract
T.L. Beauchamp and J.F. Childress are American
bioethicists. They formulated four clusters ofprinciples of biomedical ethics in their book, “ThePrinciples of Biomedical Ethics.” They are thePrinciple of Respect for Autonomy, the Principle of
Non-Maleficence, the Principle of Beneficence, and
the Principle of Justice. Beauchamp and Childress
also developed their theory of common morality as
the source of considered judgments for the
principles and the method of bioethics. These
principles and common morality are usedinternationally and successfully. This book has beenrevised to the seventh edition to allow for
improvements. The principles are being used in
China, but the understanding of common morality
is not enough. This paper studies the implicationsof common morality. This work is useful for thedevelopment of Chinese bioethics.

Introduction

Professors Thomas L. Beauchamp and James F.
Childress are American bioethicists who formulated
four clusters as principles of biomedical ethics intheir book “The Principles of Biomedical
Ethics”. Professor Beauchamp received graduate
degrees from Yale University and Johns Hopkins
University, where he received a Ph.D. in 1970. He
then joined the Philosophy Department at
Georgetown University, and in mid-70s accepted ajoint appointment at the Kennedy Institute of Ethics
where he later served as Professor of Philosophy
and Senior Research Scholar. His research interests
include the ethics of human-subjects research, theposition of universal principles and rights inbiomedical ethics, and methods of bioethics. In
1975, he joined the staff of the National
Commission for the Protection of Human Subjectsof Biomedical and Behavioral Research, where helater wrote the bulk of The Belmont Report (1978).
Professor Beauchamp thinks that a method basedon principles can work well for medical ethics. In
1998, he published the paper “An Inquiry
concerning the Principles of Morals” (Oxford:
Clarendon Press, 1998). In 2010, he published thebook “Standing on Principles: Collected Essays”(Oxford University Press, 2010). The Collected
Essays include his philosophical theory, principles,133and methods. After finishing the Belmont Report, in
1979, he co-authored a book entitled “Principles ofBiomedical Ethics”. This book has been revised toseven editions to allow for improvements from theyears 1979 to 2013. This book was translated toJapanese, Polish, Spanish, Portuguese, French,
Korean, and German. In 2014, the Chinesetranslation book was published. These books havebuilt a philosophical and doctrinal function for
American bioethics. Also “The Principles ofBiomedical Ethics” has played an important role inthe development of bioethics worldwide.

The Principles Approach and Common
Morality
In “The Principles of Biomedical Ethics,” Professor
Beauchamp formulated four clusters of principles
for biomedical ethics. They are the Principle of
Respect for Autonomy, the Principle of NonMaleficence, the Principle of Beneficence, and thePrinciple of Justice. Respect for autonomy is rooted
in Western liberal moral traditions. This principle
gives a central role to respect for autonomy of thesubject or patient. This principle proposes anautonomous authorization model for the doctrineof informed consent and the patients’ capacities forautonomous choice, obligating the professionals tofoster it in decision making.
Non-maleficence was the basic requirement oftraditional medical ethics. Contrary to the othertraditional standard distinctions, this principle
gives considerable weight to quality-of-life
judgments as to whether treatments are optional or
obligatory. Beauchamp and Childress endorsed acriterion of acting as an advocate in the bestinterests of patients. The Principle of Beneficence
includes all forms of action intended to benefit
other persons. In developing the principle ofbeneficence, Beauchamp and Childress proposedthat a person had obligations of beneficence whenconditions were satisfied. Concerning the Principleof Justice, they argued that the right to a decent
minimum of health care is one of universal
accessibility, in a two-tiered system of health care.
These principles are used internationally andsuccessfully.
Beauchamp and Childress developed their theoryof common morality as the source of consideredjudgments for the principles and the method ofbioethics. They regard the source of the four
principles as common morality. Common morality
is not merely a morality, in contrast to othermoralities, but is applicable to all places, and werightly judge all human conduct by its standards.
The following are norms that are examples(though not a complete list) of standards of action(rules of obligation) found in common morality: Do134

Eubios Journal of Asian and International Bioethics 27 (July 2017)

not kill; Do not cause pain or suffering to others;
Prevent evil or harm from occurring; Rescue
persons in danger; Tell the truth; Nurture theyoung and dependent; keep your promises; Do notsteal; Do not punish the innocent; and Obey the law.
The set of norms shared by all persons committed
to morality, and the shared features are universal
and pluralistic (Beauchamp 2009).
Common morality includes, in addition, standards
other than rules of obligation. Here are examples(not a complete list) of moral character traits or
virtues, recognized in common morality: nonmalevolence; honesty; integrity; conscientiousness;trustworthiness; fidelity; gratitude; truthfulness;lovingness; and kindness. These virtues areuniversally admired traits of character. We can findthe relationship from the norms and moral
character traits in common morality with the fourclusters of the principles of biomedical ethics.
(Beauchamp 2009)

Interaction with Chinese bioethics
Biomedical ethical principles are being used in
China, but the understanding of the implications is
not enough. From the beginning of the developmentof bioethics in China, for the most part, it depended
heavily upon the scholars who were exposed to its
tenets at foreign universities or conferences. These
pioneers also made persistent efforts at
establishinganddeveloping
bioethics
ateducational, governmental, and health care levels ofChina. After studying bioethics in the USA, in
1987, Professor Renzong Qiu published the first
Chinese book of “bioethics”. With this book,Beauchamp’s and Childress’s “Principles of theMedical Ethics, American Bioethics was introduced
to China.
However, most Chinese bioethical text books only
focused on introducing the four principles. In theearly 1980s, many Chinese scholars misunderstoodbioethics as a subject that specifically only used
these proposed four principles to deal with ethicalissues arising from the application of advanced
technologies in biomedical practice. They did notunderstand the basic theory of common morality.
After 1998, this situation was changed by some
Chinese bioethicists who studied American
bioethics in the USA. They came back to China orother Asian countries, and continued working on
Chinese bioethics. Before that time, most Chinese
bioethicists did not use more ethical theories orapproaches to do philosophical analysis anddiscussion (Baker 2009).
During the development of Chinese bioethics, thebioethical principles were guidelines for protectionof human subjects of research and clinical medical
ethics. Chinese bioethicists paid attention to the
ethical issues of research on human subjects. It ismarked by the establishment of the Medical Ethics
Committee in the Chinese Ministry of Health andFamily Planning and the Committee for theProtection of Human Subjects in Biomedical and
Behavioral Research. These committees haveadvised their administrations on the importance,
meaning and possible implementation or regulationof rapidly developing biomedical technologies at
the national level.
In this way, Chinese bioethics has become
institutionalized
throughhospital
ethicscommittees and IRBs (Institutional Review Boards).
This allows for one to bring ethical questions aboutcases, if the hospital ethics committee is unable toprovide an answer. The four clusters of principles
of biomedical ethics have yet to determine therelevant doctrine to resolve the issues. Therefore,
philosophers and bioethicists are expected to
produce relevant analysis and arguments with thehope that after some debate, an initial consensus
will be reached that can define the appropriate
guidelines for practical use.
During this process, Chinese philosophers andbioethicists regarded Beauchamp and Childress’“The Principles of Biomedical Ethics” as the only
significant source for the theory of thephilosophical nature and doctrinal function. After
2014, the Chinese translation of Beauchamp andChildress’s book “The Principles of Biomedical
Ethics” was a big help to understand the deeper
meanings of bioethical principles and, in particular,
the clarification of the view of common morality
and the related method of reflective equilibrium for
Chinese bioethicists. In recent years, a small groupof scholars in the Chinese Academy of Social
Sciences participated in a project funded by anational foundation researching the theories of
Beauchamp’s “common morality” and the debates.
This team works on conceptual, moral,
methodological, and policy dimensions of the
distinction between research and practice (Wang2016).

Discussion

There are debates about whether there isuniversality in common morality of Beauchamp
and Childress. Some have argued that particularmoralities, including Confucian bioethics, differ
from common morality. They disagree that
common morality and Confucian bioethics could be
developed in a Reflective Equilibrium Method tocreate practical guidelines with varying degrees ofcoherence (Fan 2011). After I researched the viewsof Confucius, I tried to compare the principles ofbioethics with the views of Confucius, doing an
inquiry on common morality within Confucian
bioethics, and whether Confucian bioethics could be
developed to create practical guidelines with

Eubios Journal of Asian and International Bioethics 27 (July 2017)
varying degrees of coherence and whether there isany possibility to harmonize American bioethics
and Chinese bioethics.
I agree with some Chinese bioethicists’ opinion that
there are principles inside Confucianism, and thatthe principles are relevant to American bioethics
principles and common morality. Some Chinese
bioethicists think that although Confucius’ ethics
demonstrates distinctive features of deontologicalethics, his philosophy is both ethical and political in
its concern to promote public welfare. This dualityof approach inevitably incorporates a utilitarianreasoning on certain occasions. This madeConfucius’ ethics resemble that of certain
contemporary ethicists’ mixed deontological ethics.
These ethics are basically rule-centered but in sucha way as to take into account the teleological aspectof utilitarianism (Oiu 2004).
A Taiwan bioethicist thought that there is actuallya resemblance between Confucius’ ethics and theframework of principles approach to bioethics. In
Confucius’ ethics, the basic ethical “principles” of“Ren”, “yi”, “li”, and “he”, provide guidance for more
specific action. This action is similar to “rule” and“recommended action.” Confucius’ “Ren”, “yi”, “li”,“he”, comprise the most fundamental thoughts andprinciples in Confucius’ ethics. “Ren” (humaneness)has been translated as love, benevolence, humanity,
human-heartedness, virtue, perfect virtue, true
manhood, and humaneness. It also signifies theidealrelationshipbetweenpersons.
“Yi”(righteousness)
generallymeans
appropriateness, obligation and justice, and is “theprincipleofsetting
thingsright
andproper.” “Li”
(rules of propriety) indicates
ceremony, rites, decorum, courtesy, etiquette, andat first represents the ceremonial order. “He”
(seeking harmony) could be described as the outerform and standard of morality that is concrete for
man to abide by in the context of human society (Li2008).
Another Chinese bioethicist said, “Ren” means
loving the people. “Yi” means respecting thevirtuous. “Li” means ritual—that is a complex ofembodied pattern of interactions that announceand sustain virtues, obligations, and the communal
ground approach to bioethics issues. The key
concepts in Chinese philosophy are nonmaleficence,compassion,respect,
andrighteousness. (Cheng-Tek Tai 2008) In their book,Beauchamp and Childress also proposed five focal
virtues for health professional: compassion,
discernment, trustworthiness, integrity andconscientiousness. It seems there are somesimilarities.
Most Chinese bioethicists favor the American
bioethicists’ views. The seven traditional virtues
are placed into two categories; they are the135theological virtues of prudence, temperance,
fortitude, and Justice. The seven deadly sins or vices
are pride, gluttony, lust, anger, greed, envy, anddespair. Perhaps the noblest and most practicalpoint of balance between religion and scienceshould be to love justice and humaneness. Thisbalancing test between religion and science is theachievement of a point of equilibrium that
promotes policies, and shapes direct actions thatminimize suffering and improve the social andhuman well-being (Kane 2011).
A Chinese–Western bioethicist has said in Chinathat some aspects of traditional Chinese medicine
ethics are still alive, and are shaping Western
bioethics. Western bioethics has been integrated
into Chinese health care and modern medical
morality. He thinks a number of generalizedcomparisons or dichotomous terms about “China
vs. the West” have been formulated to indicate
these supposed differences in cultural values andsocial morals. There is a serious problem with that
notion. It is oversimplifying and distorts thecomplex reality of both Chinese and Westerncultures (Nie 2011).
“The Guiding Ethical Principles on Stem Cell
Research,” issued by the Ministry of Health of China
in 2003, was met with big objections from
American religious bioethicists. During theadministration of then-President George W. Bush,there was a federal prohibition on the use ofgovernment funds to created new lines of stem
cells. However, certain cell lines already inexistence could still be used in research withfederal funding. The Obama administration liftedthat ban. This administration permitted, withcertain limits, the production of new cell lines withthe use of government funds by using unwanted
embryos. Also, in 2010, the first experiments using
stem cells in humans progressed in USA. Therefore,
American and Chinese policies worked to direct
actions that minimize suffering and improve socialand human well-being (President’s Bioethics
Commission, 2012).
I will continue to research any possibility on thisharmonization of common morality between
American bioethics and Chinese bioethics with thecross-cultural exchange of Chinese–American
bioethics, influencing and comparing of views andpractices.

References
Beauchamp, Tom L. and James F. Childress，Principles
of Biomedical Ethics ， Oxford University Press,
2009, P3.
Baker, Robert B. The Cambridge World History ofMedical Ethics, Oxford University Press,2009, pXXI.
Cheng-Tek Tai, Micheal The way of Asia Bioethics, Asia
Bioethics Review, Dec 2008 inaugural edition, p 22.

136

Eubios Journal of Asian and International Bioethics 27 (July 2017)

Fan, Ruiping Contemporary Confucian Bioethics,
Peking University Press, 2011, p5.
Li, Ruiquan The Confucian Bioethics, National Central
University Press, Taiwan, 2008, p 10.
Kane, Brian M. The Blessing of Life-A introduction to
Catholic Bioethics, Press: Lexington book: Laham,
New York, UK, 2011, p16.
Nie, Jing-Bao Medical Ethics in China-A Transcultural
Interpretation, London, New York, Routledge, 2011,
p 209.
Qiu Renzong, Bioethics: Asian Perspectives, Quest for
Moral Diversity, Philosophy and Medicine 80, Kluwer
Academic Publishers, 2004, p5.
President’s Bioethics Commission, the Final Report on
Stem Cell Research, Sep 2012.
Wang, Yanguang. Research on the Views ofBeauchamp and Childress’ Common Morality ，Medicine and Philosophy 37 (2 A), 2016)

The Retraction Watch retraction:
how bad advice became worse
advice for scientists andacademics- Jaime A. Teixeira da Silva
P. O. Box 7, Miki-cho post office, Ikenobe 3011-2,
Kagawa-ken, 761-0799, Japan
Email: jaimetex@yahoo.com

Abstract

In 2015, the Retraction Watch leadership, Adam
Marcus and Ivan Oransky, retracted an article thatthey had written for The Lab Times in 2013.
According to Marcus and Oransky, in the 2013
piece, they had offered “bad advice” to academics.
In the 2013 piece, Marcus and Oransky suggested
that when an error, actual or potential, wasdetected in a published paper, that they should firstcontact – by name or anonymously – the editor,
then the author, and finally the research institute,following Committee on Publication Ethics (COPE)
guidelines. They also recommended readers to copy
Retraction Watch on their communications – most
likely so that Retraction Watch could gather a scoop– suggesting even that by mentioning or copying
Retraction Watch would twist the arm of the editor,and perhaps speed up – or influence – the journal’s
action, or decision. Offering such bad, flawed andunscholarly advice, claiming boldly, without any
citations “that cronyism can protect obvious fraud”,
the 2013 Lab Times piece was a clear act of antiscience advice. Clearly recognizing their own bad
advice, and flawed and misleading logic, but taking
considerable time to do so, Adam Marcus and Ivan
Oransky retracted their 2013 article in December of2015, but replaced it with a substitute offering evenworse advice, indicating to concerned academics to
scrap their 2013 advice of contacting authors,
editors and academic institutes, and opting instead
for a potentially biased anonymous option, using awhistle-blower website, PubPeer. Marcus andOransky failed to indicate any financial or otherconflicts of interest in their Lab Times piece. This isimportant, because, as we now know, the marriage
between these watchdogs has been in the pipe-line
for years now, reaching public prominence in early2016 during a meeting in UC Berkeley, andculminating in generous financial backing – in thehundreds of thousands of US$ – by the Laura andJohn Arnold Foundation, to both Retraction Watch
and PubPeer. This commentary examines how theretraction of one badly written journalistic piece forlack of professionalism led to the emergence of aneven worse article full of biases. Perspectives on
how this could be interpreted, and what should
happen, are provided.
Bad advice offered to academics, including
scientists, by Retraction Watch
In January of 2013, Adam Marcus and Ivan
Oransky, the co-founders of Retraction Watch3, ascientist-shaming blog, wrote an article for The Lab
Times, an online “news magazine for the European
life sciences”, in 2013 (Marcus and Oransky, 2013).
Very unexpectedly, almost three years later, they
retracted their flawed article claiming that they had
offered bad advice to academics and scientists,
opting to publish a new set of advice to the sameacademics that they had ill-advised about three
years earlier. In their new article, also in The Lab
Times, published in December of 2015, Marcus andOransky stated “we want to retract one of thesuggestions we made” (Marcus and Oransky, 2015).
There are many problems with the original 2013
article, and also the 2015 article, both offering bad
and worse advice, respectively. This commentary
dissects both articles to better understand what
may have gone wrong, to try and assess the hidden
information gaps. It also shows that both pieces
were not only badly and superficially written, they
were unsupported by any evidence, literature orreferences, a sign of very poor academic behavior.
Finally, no conflicts of interest (COIs) were
declared, but were in fact hidden from the public.
Flaws with the 2013 article
The Marcus and Oransky (2013) article has, as
the author sees it, multiple flaws. Firstly, many facts
are stated, but none are substantiated by sources,references, or citations. A fact that is not supported
by a supporting source is an “alternative truth”. In
science publishing, there are severe penalties when
3 http://retractionwatch.com/

Eubios Journal of Asian and International Bioethics 27 (July 2017)
scientists report facts in published papers without
supporting sources, and in extreme cases, these
may even result in retractions. So, the example set
by Marcus and Oransky is poor, both academically,and ethically. Starting off their discussion, Marcus
and Oransky, referring to the now-shuttered Paul S.
Brookes4 site (www.science-fraud.org), misled the
public and readers by stating “some saw the sixmonth-old site as a vital way to report allegedscientific misconduct.” In fact, this is not correct.
The site was shut down by a DCMA notice because
Brookes had misled scientists and the public byautomatically associating every paper and scientist
that had been profiled on his site, as fraud, or
fraudulent. So, apparent libel is what caused the
Brookes site to be shut down by legal threats. Even
minusciae such as the precise day of the shut-down
are confusing, with the Marcus and Oransky (2013)
article indicating that “closed down the Science
Fraud website late last year”, referring to the end of
December 2012, whereas a report by Oransky at
Retraction Watch (Oransky, 2013), published on
January 3, 2013, indicates that “the whistleblower
site Science Fraud, which went dark yesterday inresponse to legal threats”, referring to January 2,
2013. Thus, Marcus and Oransky reporting can beinaccurate, undermining accurate, trustworthy andreliable science journalism (Bubela et al., 2009).
This background indicates that the Retraction
Watch leadership enjoys dabbling in “alternative
facts”5, even before this term was informally coinedby President Trump’s Conselor, Kellyanne Conway,
on January 22, 2017, just after the inauguration of
Donald J. Trump as the 45th US President. The use of
inaccurate and misleading journalism poses a risk
to society, and to science (Teixeira da Silva, 2017a).
Alternative facts, which are equivalent to mis- or
disinformation, lies, or false propaganda, which arebasic elements of tabloid journalism (Popović andPopović, 2014), is a dangerous example being set
by these science-trolling journalists to academia.
Oransky (2014) was clearly inspired by a Brookesinterview in Science 6 promoting PubPeer for the
anonymous critique of scientific papers. So much sothat the Brookes experience may have inspired
Marcus and Oransky to dump, via a retraction, their2013 article, to set a PubPeer-supporting stance intheir 2015 Lab Times article.
So, to counter the failed fraud-accusing policy that
had been imposed by Brookes, Marcus and Oransky(2013) stated: “we wanted to offer some thoughts
on how readers can best call attention to potential
https://www.urmc.rochester.edu/people/23781238paul-brookes
5 https://en.wikipedia.org/wiki/Alternative_facts
6
http://www.sciencemag.org/careers/2014/03/paulbrookes-surviving-outed-whistleblower
4137

problems in the literature.” Marcus and Oransky,
acknowledging that anonymous complaints “maybe wielded as vendettas or used to cripplecompetition”, offered a few ways to achieve this in a
non-anonymous manner: a) contact a journal editor
with a suspected problem in a paper; b) contact theauthors; c) contact the authors’ research instituteor an office of research integrity when contact witheditors or authors yielded no response, using the“electronic trail” used to attempt to correct theliterature as the evidence that editors and authors
were uncooperative to correcting the literature.
Marcus and Oransky based their advice heavily on
the advice offered by the Committee on Publication
Ethics (COPE), which they defined inaccurately as
the Committee for [sic] Publication Ethics, further
cementing the sloppy and lax nature of the sciencejournalism by this pair. Claiming that COPE is “nothostile to anonymous complaints,” even embracing
anonymous complaints, the next advice offered by
Marcus and Oransky was “to resist the temptation
to take out your frustrations in personal attacks
against the editors or authors with whom you’recorresponding”, noting that such an approach could
reduce the responsiveness of editors to futurecomplaints. Readers are drawn to the discussion of
the pros and cons of anonymity in the context of the
post-publication peer review process (Teixeira da
Silva and Blatt, 2016). In fact, until this point of
their 2013 article, the suggestions made by Marcus
and Oransky were reasonable, fair, and realistic, toface problematic authors, journals, editors or
publishers head-on, directly, by name, or, where
there may exist a fear of retaliation, anonymously.
However, this is the point in the Marcus andOransky (2013) article that destroys the entire andcore academic basis of their argument, simply
showing that this is an egotistical narcissistic pairof science journalists that are seeking only to draw
attention to their blog rather than dealing with thefundamental ills that plague science. They stated:“Readers should also feel free to copy us oncorrespondence, although we would prefer it if you
somehow made it clear you’re not acting on ourbehalf.” In other words, Marcus and Oransky want
to be associated in some way with the credit for
blowing the whistle, but they don’t want any
responsibility associated with the claim, disguising
their argument as “journalistic independence”. The
nail in this coffin of bad advice comes with thisstatement, “knowing a well-read website is awareof the allegations can prompt quicker action,although we make no promises.” Here, too, Marcus
and Oransky sought recognition for Retraction
Watch, through its “fame factor”, while washing
their hands free of any liability or association withthe anonymous complainant or whistle-blower. A
legally smart defense, no doubt. Finally, Marcus and138

Eubios Journal of Asian and International Bioethics 27 (July 2017)

Oransky claim that “cronyism can protect obvious
fraud,” but offer no examples or citations to support
their claim. For the record, a clear example is the
Serbian Archives of Biological Sciences (Teixeira da
Silva, 2015).
The most glaring problem with that 2013 article
by Marcus and Oransky is the failure to provide any
concrete affiliation, other than their association
with Retraction Watch. It is now known that both
authors held and hold multiple positions.
Flaws with the 2015 article
Marcus and Oransky must surely have felt guilty,
or it is possible that their funders (see hidden COI
later) or partner COPE may have called them out.
Whatever the truth is, the public will never truly
know, because Oransky and his Retraction Watch
are extremely opaque with the public regarding
their own practices, and with scientists who haveseen through their journalistic farce. The new 2015
article starts with an “alternative fact”, by stating“Better not contact the authors first.” This is odd,
because the advice to contact authors in their 2013
article was indicated as the second step of contacts,
after contacting the editors. So, not only do Marcus
and Oransky try to correct a false and misleading
fact, they continue to display poor attention todetail, thereby fortifying the notion that theirscience journalism is of poor quality (see moreevidence later in this commentary). They then state“we want to retract one of the suggestions wemade.” This retraction in itself is very odd. Why
would a simple correction not have sufficed, or an
updated article indicating that their views hadchanged, and evolved, which seem to be reasonable
solutions to their 2013 opinion article. Instead,what drove this science watchdog pair to bow theirhead in apparent shame and retract a fairly hollow
opinion piece? In a liberal and pathetic apologetic
culture, Marcus and Oransky weep, clearly withcrocodile tears, wailing loudly “we’ve realised that
we were wrong” and “we offer apologies to thescientific community”. Apology accepted, but was it
truly necessary? Using the excuse that by alerting
authors ahead of time “only serves to give unethicalscientists time to hide their tracks”, Marcus andOransky fail to understand that their bad advice in2013, and even worse advice in 2015, does not take
into consideration that most likely most scientists
are not guilty of misconduct, but may have simply
made errors that require fixing. In essence, Marcus
and Oransky collectively clump together honest(likely the majority) and dishonest (likely theminority) scientists, as if they are all escaping thetruth commissions set up by libelous and masked
fraud-accusing whistle-blowers like Paul S. Brookes
on anonymous accusation sites like PubPeer. To
their credit, Marcus and Oransky state correctlythat “there are still too many [editors; Jaime] who
rebuff efforts to correct the literature”, but theyshoot down the option to first contact the editors,
indicating that it is best practice to contact research
integrity officers instead. The problem is that mostdeveloping countries most likely do not have officesof research integrity in their research institutes,
making their advice unrealistic, and thus silly.
In the last section of their 2015 article, Marcus
and Oransky propose a silver bullet to correcting
science’s erroneous literature: PubPeer. The mostglaring problem with the 2015 article by Marcus
and Oransky was their failure to indicate a very
important COI, namely that the parent organization
for Retraction Watch, The Center for Science
Integrity Inc. (CSI 7 ), a business-turned-charity
based in New York and in Oransky’s apartment,
receives generous funding by the Laura and John
Arnold Foundation 8, the MacArthur Foundation 9 ,and the Leona M. and Harry B. Helmsley Charitable
Trust10. A second hidden COI, but directly relevantto the 2013 article, maybe explaining their
passionate defense of COPE, was that Elizabeth
Wager, a former COPE Chair from 2009-2012,serves as a director of the CSI11. So, these currently
hidden COIs show that there is a revolving door
between power and ethics, and, thrown into themix, money and funding from philanthropic
organizations.
As we entered 2017, academia learned that the
PubPeer Foundation, PubPeer’s parent charitableorganization, has received over US$ 400,000 fromthe same philanthropic organization as Retraction
Watch’s parent organization, the CSI, namely the
Laura and John Arnold Foundation. This, in itself, isastonishing because it places the relationshipbetween Retraction Watch and PubPeer as the mostprominent financial COI in the science watchdog
and post-publication peer review movements. At
the end of their 2015 article, Marcus and Oransky
state “We’re glad to have the chance to retract someof our previous advice and update it, as new evidence
comes to light. That’s what self-correction is allabout, right?” If these science watchdogs (Teixeirada Silva, 2016) truly believe what they stated at theend of 2015, then they must go back to their 2015
Lab Times article, and retract it for the reasons
listed above, or issue a mega-correction that adds
suitable references to support factual information,and state the highly important and relevant missing
7
http://retractionwatch.com/the-center-for-scientificintegrity/
8 http://www.arnoldfoundation.org/
9 https://www.macfound.org/
10 http://www.helmsleytrust.org/
11 http://retractionwatch.com/the-center-for-scientificintegrity/board-of-directors/

Eubios Journal of Asian and International Bioethics 27 (July 2017)
COIs, which continue to be missing.
Cynthia McKelvey, in a blog article entitled“Science watchdog blog retracts its own article”12,
makes an extremely pertinent statement: “We’renot sure if the retraction will be included in
Retraction Watch’s upcoming database, but it
seems likely.” A search of that database13 indicates,in fact, that the retracted 2013 article by Marcus
and Oransky is still not listed, making Retraction
Watch, its leadership and its directors blatantly
dangerous hypocrites.
Ethical issues
There are multiple ethics-related aspects to thiscase. Adam Marcus and Ivan Oransky are trying tobe legitimized as ethicists, but they are not. They
are science journalists with a medical backgroundthat have smartly surrounded themselves by handpicked allies, such as COPE, that give them a fakeaura of ethical legitimacy. In turn, organizations
that continue to invite Oransky to serve as guest
speaker or moderator at ethics-related events also
contribute to his rise as pseudo-ethicist.
Paul S. Brookes used at least one fake,anonymous or pseudonymous identity to smear
academics’ reputations, and referred widely to theirerrors as fraud. Marcus and Oransky of Retraction
Watch offered support to and defense of Brookes’
actions in their 2013 Lab Times article, which they
then retracted. It can be argued that the Retraction
Watch team sought to promote whistle-blowing notin the interests of academia, but rather as a selfserving interest (Ahmad et al., 2014) as an effective
and strategic way to reap highly profitable funding
from US philanthropic organizations. Whistleblowing does play a corrective role in publishing(Malek, 2010), but its skewed encouragement by
Marcus and Oransky, without respect for the rank
and file present in the publishing process, i.e., thecall to fly over the editor and publisher, claiming
cronyism as their reason to subvert the standard
processing of error, opting instead to encourage
informants to release their discoveries on PubPeer.
This fortifies that the call by the Retraction Watch
leadership to use whistle-blowing carries with it anelement of malice.
The lack of information sources to support a
claim constitutes a violation of journalistic ethics14.
The Marcus and Oransky 2013 and 2015 Lab Times
articles are replete with information that is notsupported by any citation to sources. In publishing,such writing practice is not only unprofessional, it
is unethical, because it is the appropriation of ideas
https://www.dailydot.com/parsec/retraction-watchretracts-own-article/
13 http://retractiondatabase.org/RetractionSearch.aspx
14 https://www.spj.org/ethicscode.asp
12139that are not one’s own but without disclosing therelevant source, i.e., a classical case of plagiarism.
The most striking ethical issue with the 2013
and 2015 Lab Times articles is the distinct absenceof a COI statement. The most glaringly absent COI isthat between Retraction Watch and PubPeer, which
now share a financial COI, namely the receipt offunding from the same philanthropic association,
the Laura and John Arnold Foundation. Even if, at
the time of publication of those articles, funding
had not yet been received, this post-publication fact
remains omitted, even in the retract-and-replaced
article. The omission of important facts and COIs
constitutes serious misconduct (Thornton, 2017).
Finally, the fact that Marcus and Oransky have
not yet archived their own retraction in the
Retraction Watch database can be minimallydescribed as hipocrisy.
Conclusions
Several important conclusions can be drawn.
1)
Bad advice was given by Retraction Watch’s
senior leadership to global academia, via a public
online channel, on at least two occasions. Even
though the Retraction Watch co-founders are
cognizant of their bad academic advice, which could
have caused real damage to scientists that may
have followed that advice in the intermittent three
years, their apology lacks sincerity, is too jovial, anddoes not go far enough to cleaning up the continued
bad advice offered in their follow-up 2015 article.
2)
Science journalism operates with values
and communication morals that are inferior tothose embraced by science. Unsupported claims,
lack of references, and the lack of a COI statement,
Retraction Watch’s Adam Marcus and Ivan Oransky
serve as a bad ethical example, in these articles, foracademics, including scientists.
3)
Marcus and Oransky are frequently invitedand interviewed and what they say, how they say it
and what advice they may be offering the public,
academia and scientists has to be very carefully
analyzed. How frequently is misappropriation of
information (i.e., the use of facts without attributing
the source, or a form of plagiarism) taking place,and is this a standard writing form that Retraction
Watch is trying to impose upon academics? Are
hidden COIs a standard that they wish academics tofollow, while ignoring COPE guidelines?
4)
Post-publication peer review does not exist
simply for the sustained existence of Retraction
Watch, PubPeer and their anti-science supporters,
but is also a tool that exists to scrutinize Retraction
Watch and PubPeer, and what their leadership havestated in public, so that their stances can be closely
scrutinized so that one day in the future, theseorganizations and their leadership may be held
accountable for the damage that they have caused.

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Eubios Journal of Asian and International Bioethics 27 (July 2017)5)
Retraction Watch and its leadership havealready several documented problems: a) poor
editorial and journalistic standards (Teixeira da
Silva, 2016b); b) bias, opacity and lack ofreciprocity (Teixeira da Silva, 2016c); c) anapparent interest in issues unrelated to retractions(Teixeira da Silva, 2016d), as also evidenced byhidden COIs; d) the use of slang and profanity(Teixeira da Silva, 2017b); e) hiding facts about
Oransky’s professional publishing history (Teixeirada Silva, 2017c); f) undisclosed acknowledgment by
PubPeer of Retraction Watch as media/press(Teixeira da Silva, 2017d). These documented
characteristics begin to paint a picture of anorganization that is not truly interested in the
integrity of science, in retractions, or in the bestinterests of science and scientists. Instead, these
documented qualities show that we are dealing
with a very powerful, strongly conflicted, wellfinanced anti-science movement that is losing trust,even as it builds incredible power. While scientists
focus one eye on their science, they would also dowell to focus their other eye on Retraction Watch
and its long-term objectives, and on the modus
operandi in place to achieve its goals, including its
suspect association with PubPeer and COPE.
Disclaimer and conflicts of interest
The author is not associated with any academic
institute, blog or web-site. The author was profiled
by Retraction Watch, often with issues unrelated toretractions. The author has also been profiled by
PubPeer. The author has commented on Retraction
Watch and used PubPeer, as a signed commentator,
and anonymously.

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Eubios Journal of Asian and International Bioethics 27 (July 2017)
For forthcoming conferences see:www.eubios.info or www.ausn.info
Email to Darryl@eubios.info for more information.
18th Asian Bioethics Conference, Seoul, Republic ofKorea, 25-27 October 2017
Joint AUSN-Gangneung-Wonju (GWNU) National
University Bioethics Conference, 28-30 October
2017, Gangneung, Republic of Korea
Joint AUSN-KAIST International Conference on
Ethical Policy, Science and Technology at KAIST,30
October – 2 November 2017, Daejoon, Korea
Eleventh Kumamoto University International
Bioethics Roundtable: Philosophy and practice of
bioethics across and between cultures, 18-19
November 2017, Kumamoto University, Japan
Youth Peace Ambassadors Training Workshop
YPA14, February 2018 in Sri Lanka
Youth Peace Ambassadors Training Workshop
YPA15, June 2018 in Legapzi, the Philippines
Nineteenth Asian Bioethics Conference (ABC19):
Bioethics for Smart Living in Asia and Beyond: Taiwan
as a hub for nurturing international partnerships andsustainable practices, 13-16 November 2018,
Kaohsung and Pingtung, Taiwan.

141

EJAIB Editor: Darryl Macer
Associate Editor
Nader Ghotbi (Ritsumeikan Asia Pacific University(APU), 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),
Masahiro Morioka (Japan), Anwar Nasim (Pakistan), JingBao Nie (China, New Zealand), Pinit Ratanakul (Thailand),Qiu Ren Zong (China), Hyakudai Sakamoto (Japan), Sangyong Song (Republic of Korea), Takao Takahashi (Japan),
Noritoshi Tanida (Japan), Ananya Tritipthumrongchok(Thailand), Yanguang Wang (China), Daniel Wikler (USA),
Jeong Ro Yoon (Republic of Korea).

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Shaping Genes: Ethics, Law and Science of Using Genetic Technology in Medicine and Agriculture
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Equitable Patent Protection in the Developing World
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Ethical Challenges as we approach the end of the Human Genome Project
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Bioethics Education in Japanese High Schools (in Japanese only)
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Bioethics and the Impact of Human Genome Research in the 21st Century
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Challenges for Bioethics from Asia Ed: Darryl R.J. Macer
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