Eubios Journal of Asian andInternational Bioethics
EJAIB Vol. 29 (1) January 2019www.eubios.info
ISSN 1173-2571 (Print) ISSN 2350-3106 (Online)
Official Journal of the Asian Bioethics Association (ABA)

Copyright ©2019 Eubios Ethics Institute(All rights reserved, for commercial reproductions).

Contentspage

Bangkok Statement on Human Gene Editing and Human
Genetic Engineering
1
International Approaches to Regulation of Human Genetic
Modification
4-Darryl Macer
Developing an indigenous ethics: On Recognition and Social
Justice8- Rogelio P. Bayod
Practical Ethics and the Principle of Merit: Implications to
Disability Rights
14- Christopher Ryan Maboloc
Water Keepers, Fluoridation and the Rule of Experts: Bioethicalimplications of Disciplinary Science18- Daniel Mishori
Ethical Information Foresights: A Journey Across Uncharted
Conflictology
26- Manuel Lozano Rodríguez
Buddhist Perspectives upon Disease & Human Gene Editing 29- Chutatip Umavijani
The Power of Life: Ethics and the Seven Universal Truths 31- Ananya Tritipthumrongchok
Legal & Ethical Issues in Modern Medical Research andProcedures: Cultural, Religious & Political Considerations.
Israeli Society as an Example
32- Tamar Gidron
Preventing the Catastrophian Age: mechanisms to negate theneed of lifeboats
36- Alex Waller
Further Abstracts from the Seventh AUSN-Chulalongkorn
Bioethic Workshop
41- John Weckert, Nilza Maria Diniz, Deborah Kala Perkins, Keith
Aiken M. Pajarillo, Aldrin M. Ulep, Angelo D. Fajardo, Christian
Gilbert S. Esteban, Junel Kristian M. Semaña

Bangkok Statement on
Human Gene Editing andHuman Genetic Engineering
This Statement stems from the Intercontinental
Summit on Human Gene Editing and Human Genetic
Engineering held in Chulalongkorn University, Bangkok,
Thailand from 30 January-2 February 2019.1
The Summit was organised under the auspices ofAmerican University of Sovereign Nations; the Center for
Ethics of Science and Technology, Chulalongkorn
University; Eubios Ethics Institute; Accredited

Universities of Sovereign Nations; and United Nations
Academic Impact. The participants included persons
from Australia, Bangladesh, Belgium, Brazil, Canada,
China, Democratic Republic of Congo, Ethiopia, India,
Indonesia, Iraq, Iran, Israel, Japan, Micronesia,
Mozambique, New Zealand, Nigeria, Pakistan, thePhilippines, Spain, Tanzania, Thailand, United Kingdom,
United States of America, Vietnam, who came together as
individuals to contribute their reflections.
Context
We came together as geneticists, scientists, medical
doctors, lawyers, bioethicists, philosophers, policy
makers, youth, and civil society leaders to consider what
both our future children and our future society shouldlook like, to contribute to global reflection on thequestion of when and how ethical human germ-line gene
editing should occur and how it should be regulated.
In concordance with the Statements of the Organizing
Committee of the First (2015) and Second (2018)
International Summit on Human Genome Editing,2 weconsider that “continued international discussion ofpotential benefits, risks, and oversight of this rapidly
advancing technology” needs to involve persons from allaround the world, including those at the margins,
beyond the more formal limits of National Academies of
Sciences and Governments, and should not be confinedto academic elites. The participants at theIntercontinental Summit share the commitment of theInternational Summits, to fostering in-depth andinternational discussion about human genome editing.
Widen the Debate: Multiple Ongoing Forums andDiscussion is Needed
Reflecting on the statement of the Second
International Summit on Human Genome Editing, withfocus on the organizing committee’s call for “an ongoinginternational forum”, we strongly recommend expanding
the scope of the call to include international, national
and private forums all around the globe to also take partin the discourse and combine efforts to cope with themultiple aspects of the subject of human gene editing.
These fora should happen in as many sovereign nations,communities and societies comprised of persons of all
occupations and different point of views, positions andcalling, from those who air on the side of caution against
http://www.nationalacademies.org/geneediting/2nd_summit/index.htm
2

1 http://www.ausn.info/human_gene_summit_2019

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Eubios Journal of Asian and International Bioethics 29 (January 2019)

possible harm from unforeseen changes to DNA, and those
who consider the potential benefits outweigh the risks.
These fora should include those with eugenic goals of
positive enhancement of human beings, and those who
consider editing DNA counter to nature or “playing God”.
We solemnly believe that the magnitude of the impact
of human gene editing on the world’s population justifies
inclusion of all relevant voices in the process ofenhancing peoples’ health and wellbeing. Any humanbeing, including those who are born after germ-line gene
editing, like their parents, possess all inalienable humanrights, regardless of any parental desire or technologicalintervention, and regardless the social and genetic
lottery of life that each one of us finds ourselves. This
includes freedom to travel the world, and reproduce
freely in countries that may have bans on the birth ofchildren who have germ-line gene editing at some pointin their development.
Regarding the Second International Summit’s
proposed theme of the dialogue: “to foster broad publicdialogue, develop strategies for increasing equitable
access to meet the needs of underserved populations,
speed the development of regulatory science, provide aclearinghouse for information about governance options,contribute to the development of common regulatory
standards, and enhance coordination of research andclinical applications through an international registry ofplanned and ongoing experiments.”, we strongly support
these ideas. We also solicit the need for all publications
on the ethical, social and legal aspects of gene editing
and human genetic engineering, to be freely accessible toall individuals, associations and lawmakers throughout
the world, so that knowledge, values, ethics andmanagements options will be broadly shared.3
Not only should scientific and technologicalknowledge, information and publications be freely
accessed and used, it should also be independent ofgovernment and other interest groups’ interventions.
Hence, free and wide dialogue must be encouraged.
History shows4 that problems can and will occur whensuch independence is not safeguarded.
Thedemocratizing of scientific knowledge and technology isvery important, because it will enhance theunderstanding of such issues reasonably and allow all
Peoples to prepare adequate contributions to broader
policy related to science and technological development,with a balanced approach to the benefits and risks ofresearch and practice. These kinds of factors should not
be treated as political issues in the representative
democracy forum whereby the parliament members
discuss and decide the issues on behalf of the people
belonging to their political party or state. The sensitive
decisions related to human life need to be made in an
inclusive manner, emphasizing the need for holistic
contributions and integrated points of views.

Freedom of Research
Given the narrowing distinctions between clinicalresearch and therapy, we do not share the view adopted
by the 2018 Summit statement, that: “it would beirresponsible to proceed with any clinical use ofheritable "germline" editing at that time.” This statement
is too rigid and too broad, even though we may rejectsome cases. Rather case-by-case review by scientific andethical review bodies should be conducted in order toachieve and further implement the international
consensus expressed in the 1997 Universal Declarationon the Human Genome and Human Rights, and inparticular article 16: “States should recognize the value of
promoting, at various levels as appropriate, theestablishment of independent, multidisciplinary andpluralist ethics committees to assess the ethical, legal andsocial issues raised by research on the human genome andits applications.”
A case-by-case approach is better than painting all thecases with the same rejection for five main reasons:

1. We will never assess properly the value of not to edit if wecannot compare the actual clinical value of doing so;
2. The casuistry and its results might help to create aconstructive discourse in the global bioethics community to
go beyond the moratorium approaches of the past several
decades;
3. 'Not to edit' doesn't imply that techs like CRISPR couldn't be
use in opaque ways or finding an alternative just aroundthe corner; further than this;
4. it implies that we will be less ready to detect its misuse due
to our practical inexperience with the new generation ofgene editing tools (in addition to technological delays intranslation of cutting-edge ones to clinical use);
5. The human right to share in the progress of science andreproductive liberty.

The reported clinical use of germline gene editing
leading to the birth of two babies in 2018 has received,
both applause and fierce ethical criticism. As we are,thus far, unfamiliar with the exact details of the case, we
are unable to usefully comment on the decision to use
germ-line gene therapy as an AIDS vaccine.5 The vague
details of the case do not allow for a responsible
scientific reaction, but we conclude the issue by stressing
the need to safeguard a positive, supportive, andcollaborative atmosphere between scientific researchers,
ethicists, regulators and law makers so that clinicalinterventions are always carried out in the most humanemanner and only for enhancement of the wellbeing of
the individuals involved. It may not be possible to gather
a consensus among all persons on what is morally rightin each case.
Promoting Research into Gene-Editing and Gene
Therapy
The Summit heard some interesting and convincing
evidence-based examples of the use of gene editing and
5 In

3 All articles should be accessible through the Internet or othermedia without publication fees.
4 For example, both positive and negative eugenic policies, andcompulsory birth control.

order to further understand the newest technologies
applied in gene editing, Dr. He, the scientist who has justrecently claimed to have completed germ-line gene editing on
two Chinese babies, was invited, to the 2019 Intercontinental
Summit on Human Gene Editing and Human Genetic
Engineering, Bangkok. Unfortunately he was unable to attend.
The intention of the invitation was to help us in understanding
the complexity of the issue considering the diversity of reaction
to Dr. He’s claims.

Eubios Journal of Asian and International Bioethics 29 (January 2019)gene therapy. The Summit noted that there is anestablished international consensus, supported by
ethical discourse since the 1970s, that research andclinical trials on the use of gene editing and gene therapy
on individuals should be encouraged subject to case bycase ethical review as clinical trials. Basic and preclinicalresearch in base editing has produced significant
increases in efficiency and precision while greatly
reducing off-target events. At the Summit we heard ofpromising gene therapy trials of persons with betathalassemia, in Thailand and other countries, that havebenefited individuals and even offer more cost-effective
solutions than alternative therapies. This will help
achieve the goals for greater health equity andalleviation of the burden of genetic disease and meet oneof the earlier objections against gene therapy that it will
only be available to the rich in a manner different toother therapies.
Five percent of the world population are carriers ofglobin gene mutations, and every human carries some
genetic mutation that causes disease. Editing the DNA ofembryos or gametes may allow parents who carrydisease-causing mutations to have healthy, geneticallyrelated children. There is public support for germ-line
therapeutic intervention, with several scholars also
supporting this once it is reasonably safe. However,current European legal guidance prohibits trials of germline gene therapy. The Summit calls for a greaterinternational discussion of such issues to avoid an
unreasonable reality in which some regions of the world
will embrace and conduct inheritable genetic therapy forthe benefit of the babies, the community and the nation
while others do not. Although we firmly support thenotion that every nation has a sovereign right to regulatetechnology according to its own public choices, we still
believe that the personal legitimate basic human right ofall human beings is to have an unlimited therapeutic andreproductive choices so an international declarationthat will confer such right to all needing individuals is indire need.
Ethically we concluded that the primary reason to
reject the choice of parents to apply germ-line genetherapy to a serious disease is significant risk of harm to
the future baby. Regarding the “Proposed Translational
Pathway” of the Second Gene-editing Summit, we agree
that there should be dialogue for “establishing standards
for preclinical evidence and accuracy of genemodification,assessmentofcompetencyforpractitioners of clinical trials, enforceable standards ofprofessional behavior, and strong partnerships withpatients and patient advocacy groups.”
Pursuit of Progress and Medical Technology
One of the underlying philosophical ideas of society is
to pursue progress, the principle of beneficence.
Research shows there is high support for use of genetherapy to cure disease, both as somatic cell therapy (forfatal, and late onset diseases) or inheritable therapy (forfatal, and non-fatal diseases); and high support for genetherapy approaches to an AIDS vaccine.6
6 Macer, DRJ., Akiyama, S., Alora, A.T., Asada, Y., Azariah, J.,
Azariah, H., Boost, M.V., Chatwachirawong, P., Kato, Y., Kaushik,V., Leavitt, F.J., Macer, N.Y., Ong, C.C., Srinives, P. & Tsuzuki, M.

3Currently around the world there is ubiquitous use ofcosmetic surgery. Already some physical enhancement is
accepted, whether it be vaccination, vitamins, cosmetics,
or cosmetic surgery. We also accept enhancement ofother species to make better foods, and even to adapt
our diet to our personal genetic traits (nutrigenomics).
The ethics of hard work and reward for studying hard is
widespread. One can expect enhancement tourism toexpand in countries that are marketing to persons wholive in countries with more restrictive or expensive
options.
While improving human capacity such as health andintelligence through any means including gene therapy
may be desirable, the danger of social injustice anddiscrimination looms in the background. The creation of
unnecessary gaps between the genetic “haves” andgenetic “have nots” would affect employment
preferences and retention, academic placing, social
benefits, political influence and power concentration,social division and alienation, unreasonable and unjust
entitlements, and so on. We also need to ensure actively
the involvement in discussion, and access to therapies, ofvulnerable persons including indigenous persons andpeople of different abilities. On the otherhand, the “onlypurpose for which power can be rightfully exercisedover any member of a civilized community, against his
will, is to prevent harm to others.”7 Although we canargue that there is a precedent in internationalcustomary law against reproductive cloning of humanbeings, there is not such a precedent against humangermline gene therapy.
The attitudes towards use of gene therapy to improve
intelligence, or even make a person more ethical, arepositive. It is difficult to argue that improved intelligenceis a harm against anyone. If genetic enhancement isfeasible, it is likely that there will be demand for it
because parents compete to produce able children andnations compete to accumulate human capital in skilledworkers. If some parents or nations begin using genetic
enhancement, this will change these competitions inways that increase the incentives for others to use it.
People in many indigenous communities have a range ofvalue systems which are often neglected in global ethicaldiscourse, but self-determination is a central humanright.
Maybe we can only become complete moral beings
when we also love our own life, pursuing our capabilities,
gifts and desires to achieve more of the potential that wehave. To be responsive to the needs of persons withdisability, society should possess the fundamental senseof justice that is meant to value the dignity of each
person. We do not believe that an international law thatprohibits development of technology is ethical, nor will it
protect society and individuals from making choices toenhance themselves. History has shown that people
reject stringent laws or legalistic religions. Education of
mature and tolerant citizens is a more effective andlonger-term solution.
(1995), "International perceptions and approval of genetherapy", Human Gene Therapy 6, 791-803; Macer, DRJ. (2012)“Ethical consequences of the positive views of enhancement inAsia”, Health Care Analysis. 20 (4), 385-397.
7 John Stuart Mill, On Liberty.

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Eubios Journal of Asian and International Bioethics 29 (January 2019)

In our deliberations during the Summit we conducteda broad discussion on balancing the pursuit of
improvement, transhumanism, questions of causation,
alleviation of suffering, and broader ideas of the pursuitof human desire. Our new biotechnological capabilities
have brought us to the frontier of the meaning andintegrity of birth and personhood. To be accused ofplaying God is to be accused of doing something morally
wrong. The wrongness might not derive from harms
caused but might rather come from the fact thatsomething is being done that has no business to be doneby humans. Playing God is expanding the sphere overwhich we have control, to the extent that we no longer
have the knowledge or capacity to competently makedecisions in that expanded sphere. All of life isindependent and intertwined.
Humanity must decide how best to use theastonishing power we are gaining through majoradvances in such fields as genetic engineering, cloning,
medicine, robotics, neuroscience and ICTs. We're today
potentially able to re-engineer our very existence andhow we share it with the others. In many ways we arebeing called to rethink what it is to be human. Just how
far should we go in modifying ourselves, and ourchildren, in the quest for intelligence, health, beauty,
strength and entrepreneurial ability? Is there a risk of
future conflicts between those persons born withenhancements and those who are not? Previous
generations have opened the door to widespread use ofgenetic selection in the control of which babies will beborn, which have enhanced the choices of parents andallowed some reduction in the frequency of children
born with genetic disease. Should this or the next
generation open the door to germ-line genetic
modification in the process of human reproduction, adoor that may not be closed?
These issues need to also be considered in the context
of broader issues of the age of the Anthropocene, when
we may consider the ethics of control of humanpopulation growth, and the associated environmental
pollution that affects not only the health of human beings.
We also note that there are so many enhancements
without risk, such as a basic healthy diet for all persons,and especially pregnant women and children, that weare still far from realizing. Promoting public health,bioethical literacy, and bioethically mature choices is a
responsibility of all of us.
There are various ways that governments can infringeon human rights through coercive restrictions on
reproductive liberty, yet the cumulated individual
choices of the current generation also affect ourcollective destiny. Let us develop a bioethically maturesociety where all people have a say and develop
responsibility.
Address all correspondence on this Statement to: Prof.
Darryl Macer, Ph.D., Hon.D. Email: darryl@eubios.info

International Approaches toRegulation of Human Genetic
Modification- Darryl Macer, PhD., Hon.D., MPH
President, AUSN, USA/New Zealand; Founding Member,
UNESCO International Bioethics Committee; Former
UNESCO Regional Adviser; Former, Human Genome
Organization Ethics Committee
Email: darryl@eubios.info
www.eubios.info

Pursuit of Progress and Medical Technology
Humanity must decide how best to use the astonishingpower we are gaining – through major advances in suchfields as genetic engineering, cloning, medicine, robotics
and neuroscience – potentially to re-engineer our very
existence. In many ways we are being called to rethink
what it is to be human. Just how far should we go inmodifying ourselves, and our children, in the quest for
intelligence, health, beauty, strength and entrepreneurial
ability? Many people reach the conclusion that if weallow cosmetic surgery than some types of genetic
enhancement without medical reason may also be
ethical.
There are a great variety of views about the prospectsof changing humanity, and the associated attitudes to theuse of science and technology to enable this (Parens,1998). Although there has been a generally negative
attitude towards genetic enhancement expressed inacademic literature in Europe, there are academics who
assume varying perspectives. However, the practices
that shape medical advancement and cosmetic fads are
determined more by the views of consumers as shapedby industrial marketing. Positive attitudes to use ofscience and technology and enhancement in Asia maylead to different outcomes in the future (Macer, HCA).
The public in Asia has a relatively high level of interestin science, and a high level of awareness of specificdevelopments of science and technology (Macer, 1994a;
Macer & Chen Ng, 2000). The International Bioethics
Survey conducted in 1993 in ten countries in Asia andthe Pacific (Macer, 1994) found positive views towards
genetic enhancement in China, India and Thailand, withless approval in the Philippines, Singapore, and amajority rejection of this in Japan, Australia and New
Zealand.
Less than 10% in all countries in theInternational Bioethics Survey saw science andtechnology as doing more harm than good. Overall, mostpeople in industrialised countries around the worldperceive more benefit than harm from science. Most
people also believe that improved quality of life depends
on scientific knowledge.
Eugenic ideas found both positive support in somecountries, for example for improving genes by genetic
screening, with less negative reaction, for example a few
people cited social eugenics programs, or many being
against gene therapy for enhancement. The questions
regarding genetic screening and gene therapy suggest
positive support for eugenics among a significant portionof the population, especially in China (Lo et al., 1994), as
well as India and Thailand (Macer, 1994a). Subsequent
research has also supported this conclusion that there isEubios Journal of Asian and International Bioethics 29 (January 2019)significant support for enhancement in the mostpopulous countries in the world, China and India.
Germ-line enhancement is also supported by many
persons in these surveys. The acceptance of eugenic
arguments linked to use of genetic screening is
widespread in interviews conducted in China (Su andMacer, 2003). The Chinese concept of "Yousheng"(healthy birth) is more appropriate than eugenics as an
expression of Chinese social policy and public attitudes.
The Chinese word "Yousheng" is similar to the Greek
work eugenes meaning "good in birth." It is consistent
with Galton's eugenics core doctrine of improving thestock of humankind by application of the science ofhuman heredity. In this sense, the Chinese word
"Yousheng" can be translated to eugenics.
The actual practices of use of sex selection of children
supports this conclusion, with higher frequencies in
China and India, and growing tendencies in Vietnam(Macer, 2009). Despite laws to prohibit female feticide
the practices continue in these countries, which raises
questions on how laws can be implemented. It suggeststhat in the future there may also be difficulty to haveeffective laws.
Whitening creams are widely used in East and South
East Asia, and it is difficult to find cosmetics that do notcontain whitening agents. Even the dowry prices forladies to marry is lower for fairer skins in India, andconversely fairer skin tones in Thailand can raise ahigher price for the ladies (where men pay the dowry).
There have been studies of attitudes to dental
orthodontics which suggest Asian patients are more
willing to tolerate discomfort and pain from realignmentof teeth than Caucasian patients (Law, 1993).
Improvement in dento-facial aesthetics following
orthodontic treatment enhances the self-confidence andself-esteem of a majority of patients. The same could besaid for hair styling and fashion accessories.
Macer et al. (1995) found that about three quarters of
all samples in the International Bioethics Survey
supported personal use of gene therapy, with higher
support for children's use of gene therapy. Lo et al.
(1994) found similar results in China with the samequestions. Indians and Chinese were the most supportive,
and Thais the least for personal use, but when asked
about use on children, Thai respondents were among themost willing (Macer, 1994a; Macer et al., 1995). When
compared to US results, we find a general tendency for
Asians to be more accepting of gene therapy. The
surveys did not find any significant differences
dependent upon sex, age, education or religiosity. The
major reasons given in open comments were to save life
and increase the quality of life. Some respondents gave areason like "improving genes", which will be discussed
below under "enhancement". About 5-7% rejected genetherapy considering it to be playing God, or unnatural.
There was very little concern about eugenics (0.5-2%).
The most significant reason for disapproving of genetherapy was health risk, except in Thailand where more
people gave a response that it was unnatural. About 10%of Thai respondents gave "improving gene" reasons forusing gene therapy.
There was extremely high support for use of genetherapy to cure disease, both as somatic cell therapy (forfatal, and late onset diseases) or inheritable therapy (for5fatal, and non-fatal diseases); and high support for genetherapy approaches to an AIDS vaccine. There was lower
support for enhancement uses (improving physicalcharacters, intelligence, making people more ethical)
than for treating disease, suggesting some discretion inwhat people judge to be ethically good. In India andThailand more than 50% of the 900+ total respondents
in each country supported enhancement of physicalcharacters, intelligence, or “making people more ethical”.
There was no qualification of what to make people more
ethical meant, and a few persons indicated they were
aware of the complexity of setting standards for whatmight be psychologically considered to be a “good”
person socially. It could suggest several things: that poor
living standards and infectious disease make people
more pragmatic about "improvement". It is interesting if
this is still a general trend in developing countries, as it
could have significant implications for international
policy.
Positive attributes to be enhanced?
One of the underlying philosophical ideas of society is
to pursue progress. The most common justification forthis is the pursuit of improved medicines and health,which is doing good. A failure to attempt to do good, is aform of doing harm, the sin of omission. This is theprinciple of beneficence. This is a powerful impetus forfurther research into ways of improving health andagriculture and living standards.
The principle of beneficence asserts an obligation to
help others further their important and legitimate
interests. It means that if you see someone drowning,providing you can swim, you have to try to help them by
jumping in the water with them. If you cannot swim, youhave to try to find another way to save them. If you could
give everyone the ability to swim, just in case they fell
into the water, or had to struggle to survive in the wakeof a tsunami, it would seem to be basically ethical. When
we consider the thousands of persons who lost theirlives in the 2004 Indian ocean tsunami simply because
they could swim (not counting those who were killed by
the force of the waves), it would have saved lives tosimply give everyone the innate ability to be good
swimmers and survive in water, rather than relying
upon being taught.
BeautyBeauty should be judged in the eyes of the beholder,
and there are diverse views of who is beautiful. However,there are social pressures in many countries to conformto certain stereotypes of beauty (Bordo, 1993). People
die due to the excesses of eating disorders, and these
diseases are transmitted by stereotypes introduced in
the Western media. In Fiji before Western television was
portrayed there were reportedly no incidences ofanorexia nervosa, but after the television these disorders
arose.
Kung (2010) described reasons for increased cosmetic
surgery in East Asia, especially in Republic of Korea,
Taiwan, Thailand and Japan, saying “double eyelid(blepharoplasty) and nose (rhinoplasty) surgeries has
become akin to getting braces.” There is less social
stigma attached to the cosmetic surgery in those Asian
countries, so that many Asian-American girls undergo

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Eubios Journal of Asian and International Bioethics 29 (January 2019)the surgery during their vacations in Asia. We can also
see medical tourism linked to the lower prices forundergoing these treatments in some Asian countries,
compared to Europe. One can expect enhancement
tourism to expand in countries in South East Asia, suchas Thailand, that are marketing to Arab and Westerncountries.
Physical body strength
Enhancement, for example of the immune system orfor avoiding memory loss, could also be accepted in thespirit of current medicine. Already some enhancement is
accepted, whether it be vaccination, vitamins, cosmetics,
or cosmetic surgery. We also accept enhancement ofother species to make better foods, and even to adapt
our diet to our personal genetic traits (nutrigenomics).
We will also expect improvement of digestive systems bygene therapy, for example, overcoming lactose
intolerance.
Making smaller bodies with decreased environmental
impact would be an example of enhancement for benefitsof nature. It could also be reinforcing in cultures where
body size is smaller. However, globally increased size isapplauded and associated with increased chance of
employment and income.
Intellect
The ethic of hard work and reward for studying hard is
widespread in Asia. Many parents will send children tocram schools and force them to study very hard, andthey are focused on the results of the examination
systems. They will also spend a lot of money on
education in private schools. However, cheating in exam
systems is also found, as elsewhere in the world,
although discouraged in public.
People teach their children that they must take care ofthemselves and strive to do the best in what they are
doing. We are taught from an early age to work andstudy hard, because it will be better for us. Education at
school and competition for places in higher education,and better employment, reinforces the idea that weshould love ourselves. Respect for people's love ofthemselves or of their family, and giving people freedomof self-determination, can be derived from the ethicalprinciple of autonomy. The surveys towards use of genetherapy to improve intelligence (Macer et al., 1995)
suggest that it will be supported. It is difficult to argue
that improved intelligence is a harm again anyone.
Goodness
There is a strong belief that love and compassion
constitute ideal ethical behaviour and a reflection of ourtrue humanity. We need to be able to love to be fully
human, and to enhance this would seem to be ethical(Macer, 1998). It is another universal belief that it isbetter for one's soul to be nice than nasty, to be loving
rather than unkind. As the Dalai Lama (1995) wrote,“There are various positive side-effects of enhancing one’s
feeling of compassion. One of them is that the greater theforce of your compassion, the greater your resilience in
confronting hardships and your ability to transform theminto more positive conditions”. Hare (1981) wrote, “Those
who do not love their fellow men are less successful inliving happily among them.” There is a popular sayingthat it is better to give than to receive, reflecting thepositive affect on ourselves of giving. Few, however,would call the art of giving selfishness, if the motive islove of others
There is broad religious and moral support to haveconcern about our own flourishing and development,
and in this view the moral evil may be inactivity or slothrather than pride (Outka, 1992). Laziness means thatwhatever potential we have is lost, and the potential tolove the life we have been given, and to love others or
God has been lost.
Welfare and freedom of expression
There are some inherent contradictions in theassumption that ethical values can be universal,
illustrated here by two political principles, namely
welfare and freedom of expression. As for the former,
socialism holds that as the state takes over the metaorganisation of human beings, it is incumbent upon thestate to ensure that the vulnerable are cared for withbasic provisions, such as shelter, food and decent life
opportunities. The capitalist model is, however, criticalof this and believes that the welfare state leads to people
becoming dependent upon state handouts, which in turnleads to lack of incentives to work, weakening the
economy as a result. The capitalist system believes thatprivate philanthropy and minimal state support, if any,
should form the basis of any welfare system protecting
the vulnerable (Rai et al., 2010).
These two positions on the role of the welfare statebring Articles 9 and 11 of the International Covenant on
Economic, Social and Cultural Rights16 into conflict withregard to interpretations and compliance. Article 9 statesthat “The states parties to the present covenant
recognize the right of everyone to social security,
including social insurance.” Additionally, Article 11
asserts that, “The States Parties to the present Covenant
recognize the right of everyone to an adequate standardof living for himself and his family, including adequate
food, clothing and housing, and to the continuous
improvement of living conditions. The States Parties willtake appropriate steps to ensure the realization of thisright, recognizing to this effect the essential importanceof international cooperation based on free consent.”
While the socialist traditions consider a strong welfare
state to be consistent with fulfilling these articles, thecapitalist system sees such a position to be dangerous toa strong and vibrant economy. It would appear thatwhile the articles are idealistic and communitarian, their
universality is immediately brought into contest bycompliance and interpretation – two different levels ofcommitment to the ideological systems. Socialism might
limit enhancement but capitalism would embrace it
within a market system.
The second political principle concerns the freedom of
expression, which is reaffirmed in Article 19.2 of theInternational Covenant on Civil and Political Rights (The
United Nations International Covenant on Civil andPolitical Rights, entered into force 23 March 1976,
http:// www.hrweb.org’/legal/cpr.html) The article
asserts that “Everyone shall have the right to freedom of
expression; this right shall include freedom to seek,
receive and impart information and ideas of all kinds,
regardless of frontiers, either orally, in writing or inEubios Journal of Asian and International Bioethics 29 (January 2019)print, in the form of art, or through any other media of
his choice.” Freedom of action is considered afundamental right in many secular political systems.
Would a ban be possible?
Even if therefore a ban on enhancement, including
genetic intervention would not be supported by mostAsian value systems in general. As has been discussed for
decades, attempts to ban human germ-line genetic
change would need to be made international if theywould be effective (Macer 1994b). We can see examples
with reproductive surrogacy that medical tourism iswidespread to evade laws that prohibit it. Even if one
country prohibited it (as some do) throughintermarriages genetic changes would eventually be
spread among every ethnic group and nation.
If genetic enhancement is feasible, it is likely that there
will be demand for it because parents compete toproduce able children and nations compete toaccumulate human capital in skilled workers. If someparents or nations begin using genetic enhancement, thiswill change these competitions in ways that increase the
incentives for others to use it. Therefore, a ban on
genetic enhancement would be unstable, because oncethe ban was breached by defectors the motivation ofothers to uphold it would weaken, making the ban liable
to collapse (Gardner, 1995).
One of the basic applications of the principle ofautonomy to bioethics is the idea of informed consent.
There is debate over the definition of informed consent
and its origin. Faden and Beauchamp (1986) define
three conditions necessary for informed consent:
1) a patient or subject must agree to an intervention
based on an understanding of (usually disclosed)
relevant information.
2) consent must not be controlled by influences thatwould engineer the outcome3) the consent must involve the intentional giving of
permission for an intervention.
The same conditions apply to enhancement, andshould be applied for cosmetic surgery along with
important questions such as the necessity of theintervention, and the broader accumulated social impactof the growing practices. Is this the community we aim tobecome? Consideration of the accumulated social
consequences of individual actions is an ethical principlethat Asian communities easily relate to.
Conclusions
Maybe we can only become complete moral beings
when we also love our own life, pursuing our capabilities,
gifts and desires to achieve more of the potential that wehave. Asians will also pursue their capabilities withassistance, be that wearing coloured contact lens,
whitening creams, cosmetic surgery. I do not believethat international law to prohibit development oftechnology will protect society and individuals frommaking choices to enhance themselves. History has
shown that people reject stringent laws or legalistic
religions. Education of mature and tolerant citizens is amore effective and longer term solution.

References

7

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Su, BQ. and Macer, DRJ. (2003) Chinese people's attitudes
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(2012) “Ethical consequences of the positive views ofenhancement in Asia”, Health Care Analysis. 20 (4), 385-397.

Developing an indigenous ethics:
On Recognition and Social Justice- Rogelio P. Bayod
Director of Student Services, Cor Jesu College, Digos City,
Philippines
Email: roger.bayod@gmail.com; rogerbayod@cjc.edu.phAbstract
An indigenous ethics is usually seen as opposed toWestern viewpoints. However, in the same manner as
Buddhist thought has found resonance in the tradition ofmodernity, an indigenous way of life can actually find a
symbiotic relationship with concepts of recognition andsocial justice similar to those developed by Axel Honneth.
Using actual cases in the hinterlands of Mindanao andthe traditional practices of some IP groups, this paper
will investigate how such an indigenous ethics may be
applied to particular social issues, including land ethics,
disaster resilience, access to modern medical and genetic
therapy and others.
Introduction
Ethics is a discipline that studies about what is rightand what is wrong and how human being lives his/herlife in pursuit of what he/she thinks is good or is right.
Since human beings, by the very fact of their rationality,
possess the capacity to differentiate right from wrong,good from bad, there should never be moral problems as
regards to the conception of the good or ethical life. Yet,
why is it that moral problems continue to arise andthreaten the stability of society especially in the poor
countries, such as the Philippines?
One reason why the poor society is disgustingly
affected by various moral problems is the imbalance of
its social structures. It is evident that in many poorsocieties, social structures favor the rich and powerfuland put the poor and the weak at a disadvantage status.8
In the case of the Philippines, “Philippine society has
been at the receiving end of a global hegemonic order”.9
The diverse and dangerous problems of the Philippines
have its roots in the country’s long history of subjugationand colonization by dominant countries coming from theWest.
One of the many negative impacts of colonization of
the Philippine society is the disenfranchisement andmarginalization of the country’s diverse indigenous

8 Christopher Ryan Maboloc. Applied Ethics: Moral Possibilities
for the Contemporary World. Revised Edition. (SMKC
PrintShoppe, Davao City, Philippines, 2018)
9 Ibid. p. vii

peoples and communities.10 Modern cultural practices
and influences which mainly originated from Westerncountries continue to wreak havoc in many indigenous
peoples’ territories. 11 The encroachment of thecolonizers from the Western countries in partnershipwith their cohorts in the Philippine mainstream
government has destroyed not only their traditional
worldviews and systems but also their lands which are
the very source of their lives. They considered theirlands as inseparably linked to their lives and it is in theirlands that they performed their sacred rituals and otherindigenous knowledge and practices.
My Growing Interest with the Indigenous Peoples’
Struggles for Recognition
My interest towards the plight of the indigenous
peoples (IPs) in the Philippines, particularly in Mindanao
grew as a result of my different engagements with theIPs during my seminary formation as well as my work as
an educator. I usually find time to visit and immerse
myself into different indigenous communities even when
I was a college student up to the present. I have lived,
slept and ate with them and participated in their daily
routines in the farm while listening to their stories,
struggles and experiences. I even brought my students totheir communities to allow them to experience the richcultural practices of the IPs. I also pursued studies
related to the IPs. In this paper I will highlight threeimportant aspects of my fieldworks to the IPcommunities that ushered me to work on the project ofdeveloping an indigenous ethics.
The first impetus for this research project was myengagement with the Manobos12 in my fieldwork in oneof the hinterlands in Mindanao. In one of myconversations with the Manobos in the area, one tribal
leader said to me, “Ang tumatabang, adesir sila mutabang,mutiglum una sila sa tinuod nga kahimtang namong mga
lumad”13 (Those who would help us must first immerse
into our real situation as indigenous peoples before they
will help). That statement of the tribal chieftain has
lingered into my heart and mind until this very moment.
It is like a sword that pierced into the interior core of mybeing. It reminds me that the longing of indigenous
peoples to be heard and recognized, to be involved andconsulted in any programs, projects and issues affecting
their lives and communities are like a tide that ebbs andflows throughout their long history of marginalizationand subjugation. Since then, I was very involved with
their struggles especially in relation to selfdetermination in ancestral domains, visiting theircommunities as often as possible and providing needbased projects and assistance to them and especially totheir children.

10 Karl

M. Gaspar. The Lumad’s Struggle in the Face of
Globalization. (Alternate Forum for Research in Mindanao
Incorporated, 2000).
11 Ibid. p. 5.
12 The Manobos are one of the IPs in Mindanao and they aremostly located in Agusan del Sur, Davao Occidenta, Sarangani
Province, North Cotabato and Bukidnon.
13 Excerpt from my interview during my fieldwork last October
2015.

Eubios Journal of Asian and International Bioethics 29 (January 2019)
The second movement that urges me to pursue thisproject is during my other fieldwork with the Banwaon14
last summer of 2016. During my interview with thetribal chieftain he said to me:“Sa una nagpuyo man mi nga malinawom tungod kay ang
among mga katigulangan ug mga Datu makasulbad man
dayon sa among mga away gamit ang among traditional
nga pamaagi sa paghusay ug dunay mga ritwal aron
maresulba ang mga away sama sa pagbayad ug mga
danyos pinaagi sa paghatag ug baboy, kabayo, manok
depende sa kadaku sa sala nga nabuhat. Ang among mga
Datu mitabang pud sa pagpangita ug pamaagi aron ang
nakasala makabyad gyud sa mga danyos nga dapat niya
bayaran sa pamilya sa iyang nabuhatan ug sala. Perokaron naa namay korte unya kinahanglan naka magkuha
ug abogado unya hastang mahala nila mao nang ang
uban sa amoa mosangko na lang sa pangayaw”(We were living peacefully before because our elders
were able to easily resolve our conflict using our
traditional way of doing it like our traditional “Husay”
and some rituals to resolve conflicts like paying damages
through pigs, horses or chickens depending on thegravity of the offenses. Our Datu also helped in looking
for means so that the offending party could really pay
the damages to the persons or families being offended.
But this time there is this court already and you have tohire lawyers and they are so expensive. That’s why someof us would just resort to “pangayaw15”)
Normally when there is “Pangayaw” in the community,
there is disruption in their daily activities. Women
cannot go to their farms, children cannot go to school
and fear and tension overwhelmed the entire community.
During this time, “pangayaw” is usually waged against
the abusive colonizers and outsiders who have forcefully
grabbed the lands of the IPs.16
Pangayaw is waged by the IPs as their last recourse toassert their right to self-determination especially in theirancestral lands. When the colonizers grabbed their lands
either through the use of force or other deceitful means,the IPs were pushed further at the margins and wereforbidden anymore to till their land and do hunting intheir forests. Their once revered forests were converted
to huge agricultural and livestock production and otherpurposes which resulted to the loss of their endemic
plants and animals which are very much needed for theirsurvival. Seeing the negative impacts of all these modern
developments, they sought help from the government tointervene to the development aggression that happenedin their sacred territories. Since they were not heard by
those in authorities, they pursued other peaceful means
such as submitting petition letters, participating ingatherings and seeking help from NGOs. When all thesemeans were exhausted and yet their pleadings were notheard, they resorted to wage pangayaw. 1

14 The Banwaons are another IP groups but have their roots
from the Manobos. Usually they live in the hinterlands ofAgusan, Bukidnon and Surigao.
15 Pangayaw is their traditional way of avenging for justice andthis is done as the last recourse after all other peaceful means
to resolve the conflict had been exhausted.
16 Karl M. Gaspar. Manobo Dreams in Arakan: A People’s
Struggle to Keep their Homeland. (Ateneo de Manila University
Press), 2011.

9

The third impetus that really inspire and compel mework on this research project happened just recently.
Last December 2018, I went into the IP communities in
Davao del Sur to distribute school supplies to the IP
students.17 In that ocassion, I found out that there was aconflict between the Bisaya learners 18 and the IP
learners because the former had been bullying the latterby labeling them as “uncivilized”, “ugly”, “idiots” andmany other degrading names which prompted the IP
learners to consolidate themselves and fight back those
who bullied them. The case was brought up to the
Principal’s office and to the Barangay Captain19 who is a
Bisaya. The supposed peace negotiation andreconciliation in the presence of the Barangay Captain
resulted to further disappointment and discrimination of
the IP learners because they heard demeaning remarks
from the Brangay Captain. One IP learner recounted thewords of the Barangay Captain:“Ayaw mo pangita ug gubot diring dapita kay ang akong
mata naa ni kanunay nag bantay sa inyoha. Unya
gisampal ug gisipa pa ang among mga kauban kay kami
daw hinungdan sa kagubot. Ambot init mana siya ug dugo
sa amoa molaban dyud na siya sa mga bisaya”(Don’t’ look for troubles in this place because my eyes
have been watchful to you. Then he slapped and kicked
our companions because we are the cause of troubles. I
do not know why he has disgust with us then he reallyfavored the bisaya)
The three scenarios that I discussed above are all
expressions of the issue of recognition or misrecognitionof the indigenous peoples. Like issues of distribution,
recognition or misrecognition is not just an ethical issue
but it is a political issue as well.20 A “struggle forrecognition is standardly, both a challenge to aprevailing rule or norm of inter-subjective recognition
and a demand for another rule or norm of recognition bya group (or groups) of citizens against those who oppose
the proposed change and defend the status-quo”.21 The
indigenous peoples have been subjugated, marginalized
and misrecognized for so long because they belong to aminority group. They have been discriminated by thelowlanders especially the Christian settlers because of
their cultural and practices and traditions that are totally
distinct from those in the mainstream society whose
ways of behaving and doing things are basically
influenced by the Western worldview.
Discrimination among the indigenous peoples inwhatever forms happens because of lack of recognition
or misrecognition of their way of life. A “demeaning or
degrading form of misrecognition tends to undermine
the basic self-respect and self-esteem that are necessary
17 I have been doing this regularly since 2015 up to the present.

I distribute school supplies to different IP communities in
Davao del Sur, Davao Occidental, Sarnagi Province and Agusandel Sur.
18 Bisaya refers to the Christian students or students from themainstream community.
19 Local Chief Executive in the village.
20 James Tully. “Struggles Over Distribution and Recognition”.
Constellations,
Volume7,
Number4,
2000.
https://doi.org/10.1111/1467-8675.00203, accessed January
8, 2019.
21 Ibid. p. 470

10

Eubios Journal of Asian and International Bioethics 29 (January 2019)

to empower a person to develop the degree of autonomy
and sense of self-worth that is required to participate
equally in the public and private life of her society”.22
The prominent form of discrimination nowadays
experienced by the IPs especially the IP learners, isbullying. Bullying is regarded as a social problem
experienced by IP learners whose well being needs to berespected by schools and those in authorities23 This kindof scenario usually happens in a democratic society
where individual as well as collective identities are notrecognized and valued. In a society such as thePhilippines where there is a long history of oppression
and colonization, struggles for recognition are stillpresent especially among the disenfranchised andmarginalized sectors such as the Indigenous peoples.
Despite the creation of the Indigenous Rights Acts (IPRA)
law in 1997 which clearly uphold the unique identity of
the IPs, they are still subjected to different forms of
discrimination and bullying. Verbal bullying and teasing
are the most common form of bullying to our IP
learners.24 This is rooted in the hegemonic mindset ofthe colonizers declaring the IPs as uncivilized and uncultured because they are not following their “scientific”
and “standard” way of doing things and evenworshipping God. Thus, labeling and name calling suchas “idiots, being “backward”, “uncivilized”, and “crazy”
are just some of the many labels that have been attachedto the IPs. Since most of the IP children now are
educated, they cannot just be subjugated easily. Whilesome opted to ignore the bully and chose to remain
humble, few asserted their rights and tried to defend
their identity and dignity as distinct people25 thus, chaos
or conflict is always a possibility when these IP students
would experience different forms of bullying anddefamation from the non-IP groups in the school.
Why is it that a lot of people especially the Christiansettlers who are heavily influenced by Western
Christianity misunderstand the IPs? Why is it that theycannot accept the unique identity and culture of the IPs?
Why is that that they cannot accept and recognize theconcept of right and good of the IPs? In my continuingengagement with the IPs, I found out that the lack ofcorrespondence between the Western ethics andindigenous ethics is very much apparent in theirrespective concept of land and land ownership. While
the Western viewpoints, approached land as means to anend, the indigenous peoples communicated to their land
and treated it as a kind of living being. The Western
22 Ibid. p. 470

23 Ken Rigby. “Addressing bullying in schools: Theoreticalperspectives and their implications”. School Psychology
International, 25(3),2004(287-300),
https://doi.org/10.1177/0143034304046902.
Accessed
January 8, 2019.
24 Agnes Reyes. “Bullying Experienced among Indigenous
People Students of Philippine Normal University North Luzon,
Philippines: A Basis for Formulating School Policy.” American
International Journal of Contemporary Research, Vol. 6, No. 1,(February2016),
http://www.aijcrnet.com/journals/Vol_6_No_1_February_2016/7.pdf. Accessed Janaury 8, 2019.
25 Karl M. Gaspar. Manobo Dreams in Arakan: A People’s
Struggle to Keep their Homeland. (Ateneo de Manila University
Press), 2011.

tradition on the one hand, promotes a very
anthropocentric viewpoint such that they espoused landownership and that people, as scientifically trained
beings, should be the owner, hence, the master designerof the land and the entire ecosystem. As master
designers of the land, they have to use their “scientific”
knowledge to design and develop the land. The
indigenous peoples on the other hand, believed that theland is a gift given to them by their deity. As such they do
not own the land. Their deity owns the land. In fact, tosome of them, the land owned them instead of them
being the owner of the land. Thus, for the indigenous
peoples, their survival and destiny are shaped by theirinseparable partnership with their land and the entire
ecosystem and they don’t behave as if they are superior
over their land.
The problems arise during the colonization period
when the colonizers, armed with cross (as in the case of
Spanish Friars) along with the sword (as in the case of
Spanish soldiers) came to the Philippines andestablished a system of land ownership that is very muchcontrary to the belief of the native Filipinos.26 This has
been exacerbated during the American colonization
when the Americans instituted a torrent system which
invites multi-national companies and corporations andthe Christianized Filipinos from other parts of thecountry to come to the indigenous peoples’ territories in
Mindanao and claim ownership of their land through atitle – a kind of piece of paper they obtained from theAmerican government. This system of land ownership isbeing practiced by the Philippine government until thistime. Thus, the disenfranchisement of the IPs continues
to be a gloomy reality in the Philippine society nowadays.
Towards Developing an Indigenous Ethics
The indigenous ethics is heavily influenced by theirconcept of land and in their struggle to keep theirancestral lands intact and sacred. In the previous section
I mentioned that for the IPs their lands are not only thesource of their lives but also their cultural survival as
distinct peoples. It is in their land that they performed
their sacred rituals. In this section I will highlight two
indigenous practices that are closely linked with theirconcept of the good and just. These practices are deeply
rooted in their struggle for self-determination or theirstruggle to be recognized as distinct people capable ofmanaging their own state of affairs. Although theirpractices and beliefs have not been properly
documented, they are still very much alive especially inthe hinterlands of Mindanao. One Manobo even wishedthat they had their own written scriptures like theMuslims with their Qur’an and the Christians who had
their Bible because for him sacred book about theirbeliefs would be very useful for their struggle for
identity and recognition. This Manobo shared his
ultimate dream and wish to have full control of theirdestiny as IPs which could only be attained if they will
not lose ownership of their remaining ancestral domain.
The first indigenous practice that I will highlight inthis paper is their traditional healing. This traditional
26 Ibid. See also Karl M. Gaspar. The Lumad’s Struggle in theFace of Globalization. (Alternate Forum for Research in
Mindanao Incorporated, 2000).

Eubios Journal of Asian and International Bioethics 29 (January 2019)healing is being performed by their baylans.27 Thesebaylans are believed to have abyan28 who will assist
them in their works of healing the sick members of thecommunity. “Belief in a supernatural world is aconstitutive part of the life of the IPs that control ororder their behavior.” 29 While many IPs have beenproselytized and have joined different Christiandenominations operating in their village, most IPs
especially the Manobos retain their indigenous beliefs
and practices, such as the holding of rituals.30 Rituals areimportant component of the life of the IPs. Normally they
performed rituals around the start of the clearing season,of if they invoke the assistance of the deities in curing thesick or in seeking revenge and even sending a war party
during the time of pangayaw. Rituals enhance unity as
they create a feeling among the people that all these aredone for the common good.31 My fieldwork with the
Manobos in the hinterland of Mindanao validated theearlier work of Karl Gaspar about the role of abyans in
the traditional healing practices of the IPs. Some Baylan
claimed to have two abyans who are sent to them by
their deity. Through the assistance of their abyans, thebaylans were able to cure the sick. One baylan evenclaimed that when she does the healing, it is the abyan
who giver here the instructions as well as the materials
to be used. Thus, it is important for the IPs to protect
their forest because it is there that they can get theherbal plants and other materials they need for healing
the sick.32 These baylans are forbidden by their abyans to
ask payment for their service. It is very clear that thesebaylans are performing their duties as healers because
for them this is the right thing that they must do topromote the common good and to keep their tribes alive.
Because of this practice, the IPs were able to live andsurvive as a distinct people for so many years. However,these indigenous ways and practices were under somuch threat of extinction with the dawn of globalizationand modernization.33 Many people nowadays do notrecognize the effectiveness of this practice and they trust
so much on the medically and scientifically trained
doctors. What makes the matter worst is that these IPs(baylans) were discouraged or even forbidden topractice their traditional healing methods by somehealth workers in the government. I witnessed an
occasion during my fieldwork wherein the healthworkers encouraged the communities to have their
medical check-ups at the health center and do not relyon their traditional healing practices. While theintentions of the health workers for doing such works
are noble, they are born out of a kind of bias against thistraditional practice that has helped the IPs since time
immemorial. Forcing these IPs to embrace their
27 Baylan is like a medical Doctor for today’s modern society.
28 Abyan is a spirit guide29 Ibid. p.22
30 Ibid. p.39

31 Ibid. p. 23
32 Ibid. p. 41

33 Victoria
Tauli-Corpuz. The Concept of Indigenous
Peoples‘ Self-determined Development orDevelopment with Identity and Culture: Challenges andTrajectories.
Tebtebba
Foundation.
Indigenous
Peoples‘ International Center for Policy Research and
Education. 2008.

11“scientific” way of doing things means that the IPs haveto go down from the mountains to go to the nearest
Barangays where the health centers are located and haveto wait until the midwife or nurse will have their duty.
Sadly, in these areas midwives and nurses have theirintermittent schedules of duty due to circumstances
which are not difficult for us to understand given thekind of government that our country has. In addition,
aside from the fact that these IPs do not have enoughmeans to come to the cities and towns where thehospitals are located, most of them also experienced
discrimination when they are in the towns and cities andfelt neglected in many of these hospitals.
This kind of mandate or directive from the
Department of Health (DOH) to the IPs is a clear sign thatthe personnel in the department are either ignorant ofthese traditional healing practices or that they are notreally recognizing these as the “proper” way of healing
the sick. Another area of these traditional healing
practices of the IPs wherein many lowlanders who are“scientifically” trained by Western models of education
found objectionable is the concept of the abyan. Many
Christians found this belief weird because they havebeen taught that there is only one God and that is Jesus
Christ. But what about other religions who have different
concepts of God? Why are they not critical about them? I
suspect it’s not about their religious practice of believing
in an abyan that these Christian settlers and otherforeigners found to be intolerable but because of theirstatus as IPs. This is their bias against this group that
because they are IPs they are not entitled to assert theirbeliefs. They are considered as second-class citizens inthe society. This is a clear example of lack of recognition
or misrecognition that Honneth is talking about.
Honneth discusses three spheres of recognition that
individuals must experience in order to achieve selfrealization. The first sphere is in the individual’s intimate
relationship with others where love is formed as a resultof this symbiotic relationship with other people.34 The
second sphere is in the individual’s legal relationship or
individuals’ relationships with the state and how thestate ensures them equality with the law or legal
equality. The third sphere is in the individual’s social
relationship where merit or recognition of their special
contribution to society is experienced thereby,enhancing their self-esteem. There spheres ofrecognition of Honneth, though he applies these to
individual persons and not to a group of persons, can beapplied to the IPs struggle for recognition of theircollective identity.
In the first sphere, the IPs didn’t experience genuine
love from the lowlanders and Christian settlers. Insteadof love which is expressed through genuine respect andacceptance,
theyexperienced
manipulation,
discrimination and bullying.
In the second sphere, though the Philippine
government has crafted the Indigenous Peoples’ Rights
Act (IPRA) Law to ensure legal protection of the rights of
the IPs, this is still basically in papers but not in actual
practice. What makes the matter worst is that some of
34 AxelHonneth. The Struggle for Recogntion: The Moralgrammar of Social Conflicts. The MIT Press Cambridge,
Massachusetts, 1995).

12Eubios Journal of Asian and International Bioethics 29 (January 2019)

their fellow IPs who are appointed as theirrepresentatives in the National Commission for the
Indigenous Peoples (NCIP) have been manipulated by
the government to advance their vested interests on therich lands of the IPs.
The last sphere of recognition which is on merit andattainment of self-esteem through recognizing theimportant contributions of individuals can provide anavenue for the IPs to exercise their indigenous
knowledge, skills and practices such as traditional
healing and even indigenous knowledge and skills inprotecting their environment and adopting to the effectof climate change as their important contributions in the
aspect of alternative or holistic healing which is
gradually adopted by many people including medical
doctors. These practices can also add to the literature
about climate change adaptation and mitigation using
indigenous knowledge, skills and practices. If thesepractices will be recognized by the dominant culture
which is basically influenced by the Western viewpoints,
this will be a very good point of convergence or “fusionof horizons” in Gadamer’s language. Thus, instead of
telling them to abandon these practices that have kept
them intact for so many years, maby the government andthe mainstream healthcare practitioners can engage
these baylans into dialogue so that they can learn fromeach other and thereby, improve the health services of
the country for the IPs and non-IPs alike. Health carepractitioners influenced by the West can learn so muchfrom the traditional healing practices of the IPs
especially on herbal medicine, holistic way of treating
the sick which includes psycho-spiritual aspect not justpurely biological or physical.
The second indigenous practice that I would like tohighlight is the IPs traditional justice system or theirconcept of pangayaw. For the mainstream community,
the practice of pangayaw is morally wrong because of
the killing of people that is involved in the practice. They
immediately judged the consequence of this traditional
practice without looking into the circumstances why theIPs, a generally peace-loving people, resorted topangayaw. If the Western culture and tradition accepts
just war as a justifiable action, maybe they can also try to
study and accept the pangayaw of the IPs. Before
proceeding, it is important first to answer the following
questions: what is the IPs concept of pangayaw? Why theIPs waged pangayaw?
The history of the IPs in Mindanao is not only aboutcolonization, oppression and exploitation but also theirresistance to the many kinds of violence inflicted onthem by the colonizers and the outsiders. 35 My own
interviews with some Manobo and Banwaon tribal
leaders and my observation of how they prepared someof their pangayaw plans through rituals validated thewords of Karl Gaspar that “such actions of the IPs havedefined the manner in which they have dealt with thedisruption of their lifeworld from the early years ofcolonization until this contemporary period.”36 It must
be noted that their concept of pangayaw is deeply rooted
in their struggles for self-determination on theirancestral domains. It is their response to the “disruption
and breakdown of their lifeworld due to the one-sided
rationalization that took place.”37 This happens because
more and more corporations and individuals penetrate
the remaining domains of the IPs resulting in the
introduction of more sophisticated science andtechnology that further subjugated the traditional
practices of the IPs including their traditional customary
law and governance system.38 My interviews with many
Datu’s39 as well as the literature of Gaspar can provide
rich narrative about this reality.
From the words of Manobo Datu in Arakan Cotabato:“Before there were no barangay captains, only datus.
Now that the Bisaya have arrived, they come to the datu
and ask form land. They pay little for it. Now we nolonger have lands. Not only we lost our land but also our
dignity. If a Bisaya kills one of us, no one is put in prison.
But if we kill one of them, we are sure to be put to prison.
We even have to pay a lot of money”40
From the words of Manobo Datu in Arakan Cotabato:“We cannot prove that we are datus, that we have somepower, can represent our people and are capable ofjudging what is wrong and what is right. What can we do,
faced with someone who does not know andrecognize41 our ways, but who is more powerful? We
can get killed and be arrested for things that are notcrime for us. We can get arrested for noting at allbecause there is nothing we can show to prove ourstrength as datus”42
My own fieldwork with the Manobos and Banwaonsalso proved that another cause of the disruption of the
lifeworld of the IPs is the diminishing competence of
their datus to resolve issues related to their ancestral
domains. I have to reiterate that all these indigenous
practices are deeply interwoven with their own land
ethics. The moment lands will be taken away from them,
all these beautiful and rich cultural practices andtraditions will be put to waste.
From a Manobo Datu: “We only borrow the land
from Manama43 who is the real giver of land to us. We
die and leave the land to our children and grandchildren
and they will be the one to borrow the land from
Manama. It was on this basis that I, as a datu, resolved
conflicts related to land. Now, I am helpless since I haveto depend on this law of the Bisaya, all of us have todepend on this law which we find very difficult tounderstand”44
From a Banwaon Datu: “We were living peacefully
before because our elders were able to easily resolve ourconflict especially those that are related to pour lands
using our traditional way of doing it like our traditional“Husay” and some rituals to resolve conflicts like paying
36 Ibid.p.63

37 Ibid. p. 64
38 Ibid. p.66
35 Karl

M. Gaspar. Manobo Dreams in Arakan: A People’s
Struggle to Keep their Homeland. (Ateneo de Manila University
Press), 2011. See also Karl M. Gaspar. The Lumad’s Struggle in
the Face of Globalization. (Alternate Forum for Research in
Mindanao Incorporated, 2000).

39 Datu is a tribal chieftain or head
40 Ibid. p.65

41 Emphasis is mine
42 Ibid.P.65-66

43 Manaman is the name of diety of the Manobos
44 Ibid. p.69

Eubios Journal of Asian and International Bioethics 29 (January 2019)
damages through pigs, horses or chickens depending on
the gravity of the offenses. Our Datu also helped inlooking for means so that the offending party could
really pay the damages to the persons or families being
offended. But this time there is this court already andyou have to hire lawyers and they are so expensive.
That’s why some of us would just resort to “pangayaw”.45
It is very clear that that the coming of the colonizers
have “systematically distorted the rationalization of theIPs because of the sheer pervasiveness of the Western
dominated rationality that promoted a kind of discoursethat growth can only take place through a kind ofmanipulation of the physical and social environment andnot paying attention to the promotion of self-conscious
reflection about values.”46 Because of this estrangement,
the IPs tried to grapple for support from the lowland
authorities especially on the loss and destruction of theirancestral lands but many of these attempts were provenfutile. Thus, they waged pangayaw as their way of
avenging the injustices inflicted on them. As you can see
pangayaw is their last recourse. Had they given
authority to resolve land conflict and had the lowlander
recognized and respected their traditional governancesystem, cultural practices and traditions, there havebeen peace and harmony in their sacred territories.
Although plenty of people especially in thiscontemporary period will despise pangayaw, I will argue
that pangayaw is their traditional customary law on how
IPs assert their rights and promote justice and thus, it
must be recognized and respected.
Conclusion
In today's world, claims for social justice are
increasingly divided into two types. First, and mostfamiliar, are redistributive claims, which seek a morejust distribution resources of and wealth. The second
type of social justice claim is generally called "politics ofrecognition" which has a goal, in its most plausible form,of a difference-friendly world, where assimilation to
majority or dominant cultural norms is no longer the
price of equal respect.47 Honneth proclaims that all social
conflicts are expressions of a struggle for recognitionand struggle for social justice is not only about economic
distribution as Fraser as well as John Rawls advance. For
Honneth the struggle for social justice has its roots in the
struggle for recognition. Honneth “conceives recognition
as the fundamental, overarching moral category anddistribution as its derivative and reinterprets thesocialist ideal of redistribution as a sub-variety of the
struggle for recognition.”48 Justice for the IPs requires
both redistribution and recognition. Neither alone issufficient. The question is how to find a single
comprehensive framework that should integrate thetwo? In this paper I highlighted two indigenous practices
that need to be recognized and respected. These
practices are so much interconnected on their concept of

13

land. Without their land where herbal plants and otherelements are present, traditional healing won’t prosper.
Their concept of pangayaw is also deeply entrenchedwith the issue of protection of their ancestral land whichis the gift of their deity to them. The IPs concept of land
found resonance with Aldo Leopold’s land ethic in theWest. Aldo Leopold’s land ethic affirms the inseparable
relationship between the people and the land and thatthe land is a community of beings.49 The land ethic of
Leopold and the deep ecology movement in the Westand the indigenous peoples’ spirituality and ethics inthe East need to converge to give harmony andrhythm to the SONG that human beings have to singto have healthy and productive lives. This SONG is
about human being’s relationship with Self, Others,
Nature and God.
References

Fraser, Nancy and Honneth, Axel. Redistribution or
Recognition?: A Political-Philosophical Exchange. Verso. New
York
Gaspar, Karl. Manobo Dreams in Arakan: A People’s Struggle to
Keep their Homeland. Ateneo de Manila University Press,
Quezon City, Philippines, 2011.
Gaspar, Karl. The Lumad’s Struggle in the Face of Globalization.
Alternate Forum for Research in Mindanao, Inc., Davao City,
Philippines, 2000.
Honneth, Axel. The Struggle for Recogntion: The Moral grammarof Social Conflicts. The MIT Press Cambridge, Massachusetts,
1995).
Leopold, Aldo. (1949). A Sand County Almanac and Sketches
Here and There. Oxford University Press.
Maboloc, Christopher Ryan. Applied Ethics: Moral Possibilities
for the Contemporary World. (Revised Edition). SMKC
PrintShoppe, 65 Salcedo Bldg., Arellano St., Davao City,
Philippines, 2018.
Reyes, Agnes. “Bullying Experienced among Indigenous People
Students of Philippine Normal University North Luzon,
Philippines: A Basis for Formulating School Policy.” American
International Journal of Contemporary Research, Vol. 6, No. 1,(February2016),
http://www.aijcrnet.com/journals/Vol_6_No_1_February_20
16/7.pdf
Rigby, Ken. “Addressing bullying in schools: Theoretical
Perspectives and Their Implications.” School Psychology
International, 25(3), 2004, 2287-300, accessed January 8,
2019 at https://doi.org/10.1177/0143034304046902
Tauli-Corpuz, Victoria. The Concept of Indigenous Peoples‘ Selfdetermined Development or Development with Identity andCulture: Challenges and Trajectories. Tebtebba Foundation.
Indigenous Peoples‘ International Center for Policy Researchand Education. 2008.
Tully, James. “Struggles Over Distribution and Recognition”.
Constellations,
Volume7,
Number4,
2000,
https://doi.org/10.1111/1467-8675.00203

45 Taken during my interview and fieldwork in Agusan.
46 Ibid. p. 75

47 Nancy
Fraser and Axel Honneth. Redistribution or
Recognition?: A Political-Philosophical Exchange. Verso. NewYork
48 Ibid. p.3

49 Aldo Leopold. A Sand County Almanac and Sketches Here and

There. Oxford University Press, 1949.

14

Eubios Journal of Asian and International Bioethics 29 (January 2019)

Practical Ethics and the Principleof Merit: Implications to Disability
Rights- Christopher Ryan Maboloc, PhD.
Ateneo de Davao University, Philippines
Email: ryanmaboloc75@yahoo.com
Abstract
The merit system is based on a person’s ability toachieve. The concept of merit hence rejects a processthat awards any particular entitlement explicitly basedon disability. Brian Barry says that under the meritprinciple, people can compete for positions or advantage.
This paper argues that the idea of merit, as explained by
Barry, is unjust. Iris Marion Young points out that aperson with cognitive disability faces a different
situation compared to other people. Under normal
circumstances, persons can have skills that enable themto do things with ease, something that is not readily
available to individuals with autism or Asperger’s
syndrome. The problem is also exacerbated by policies
that do not recognize the diverse needs of individuals
with impairment. In this regard, practical ethics
demands that a law or national policy must ensure alevel playing field for everyone.
Introduction
Practical ethics is the discipline that seeks to bridge
theory and practice. 50 Moral reasoning requires anunderstanding not only of principles but also therecognition of practical issues as well. In this way, thetask at hand is to draw relevant information across aspectrum in order to arrive at a reasoned judgment.
Precisely, this is what we intend to achieve in this paper.
By first understanding the principle of merit, we apply
our judgments to a specific moral concern - mental
disability. We then examine the parameters of the issue
at hand, which include, among others, social policy,
rights, and institutional practices. The question that thisstudy finds significant is the apparent conflict in thenotion of merit when the same is applied to the issue of
impairment. In this investigation, we shall emphasize theinstitutional context of the problem.
Ethics in general tends to focus on social structuresand human relations but has neglected institutional
issues.51 Most problems arising from mental disability
come from the inability of governments to address
specific policy concerns. For example, people can look
into health care policy, work policy, and fiscal policy tolocate the gaps that need immediate action. A crucial
aspect in terms of the development in practical ethics isthe political nature of these problems. There is a need tolook into the process of deliberation and the matter bywhich leaders and professionals deal with particularconcerns. In the issue of cognitive disability, there is aneed to consider fairness in the allocation of funds. For
this reason, policies must be just and institutions should
50 “What is Practical Ethics?” Edmond Zafra Center for Ethics.
Harvard University. https://ethics.harvard.edu/what-practicalethics. Accessed January 7, 2019.
51 Ibid.

be held accountable. The reason for this is that inaddressing social injustices, people have to look beyond
personal accountability and consider important
institutional responsibilities.
The legitimacy of any policy depends on its ability
to protect and promote the well-being of those who are
disadvantaged. By this, it is meant, that social
institutions should serve human persons as ends inthemselves. This paper will use such claim as aframework to understand the situation of persons withcognitive disabilities. The first section explains theprinciple of merit. To do this, we will discuss theargument in favor of the merit system from Brian Barry.
The second section, which is based on the debate
between Iris Marion Young and Barry, will present thecounter-argument that explains why competition on thebasis of a merit system is actually disadvantageous topeople with disability. The final section will be an
attempt to relate poverty and disability in order tojustify the preceding position against the merit systemand explicate the social policy implications of theposition of this paper to disability rights and the care of
the person with mental impairment.
Explaining the Principle of Merit
The principle of merit asserts that what is
important is the availability of opportunities foreveryone. For Barry, people must earn their share ofsociety’s wealth by means of competition. Any form ofaffirmative action on the part of the government for
special groups is something that must be discouraged.
Barry thinks that, “uniform rules create identical choicesets.” 52 Since the people have personal preferences orchoices based on their motives and expectations, thenthey must be responsible for the consequences of theiractions. Individuals must act in accordance to existingnorms. Barry says that, “equality of opportunity inrelation to employment means that those who are
equally well qualified to do a job have an equal chance ofgetting the job. But if some people who are as wellqualified as others are denied an equal chance of
employment in some job, they can complain of unfair
discrimination.”53
For Barry, equal opportunity is about what a person
deserves to get. As such, for Barry, all equally talented
people should have uniform opportunities. Barry assertsthat justice is about “equal rights and opportunities, but
not equal outcomes defined over groups.”54 The fortunethat people make in life is something that must come as aresult of their individual pursuits. What matters is thatthe rules in the beginning are fair for everyone. If aperson is productive, then the same individual should be
able to enjoy a proportionate amount of goods. Merit, in
this sense, is about what a person stands to get in any
competition. However, in this instance, Barry seems toassume that no situation, whether natural or man-made,can have an impact on the results of such competition.
But what about the situation of persons with
impairment? Persons with disabilities can refer to any
52 Brian Barry, Culture and Equality. (Cambridge, MA: Harvard

University Press, 2001), 32.
53 Ibid., 55.
54 Ibid., 92.

Eubios Journal of Asian and International Bioethics 29 (January 2019)
heterogeneous group. Barry points out that across thisgroup, “its expected members will be less qualified than
the average even if the amount of money spent on theireducation is more than the average.”55 Such an idea
appears to suggest that for Barry, the monetary
resources spent in educating individuals with disabilities
are not commensurable to whatever they are able to giveback to society. The point is that Barry’s point isobjectionable. It is one that reveals people’s prejudice
and bias. It unfairly puts undeserved burdens on people
with autism, as if suggesting that there is no reason goodenough to educate them because their parents or thegovernment will not get anything good in return if they
invest their resources on a child with autism.
The real problem of Barry is his bias. Young writes
that for Barry, “all positions of authority or expertiseshould be occupied by those persons who demonstrate
excellence in particular skills and who best exhibit thedemeanor expected of people in those positions.”56 In
this regard, Barry has failed to consider the imbalance
between the demands of a competitive labor market andthe difficult situation of persons with disabilities. For
instance, if we take our modern schools as an example,
normal children will have the natural advantage thanthose who have disabilities due to the environment
inside the classroom. The achievement of good results on
the part of normal kids will come about quite frequently
as expected. However, while we allow people to achievethings on the basis of their talent or skill, this should not
impede society from helping or caring for children who
might require more attention and love. It should notcome as a surprise that children with autism also
possess special set of skills that can help society in someway.
Barry thinks that any “special treatment formembers of disadvantaged groups is justifiable only for
as long as the inequality persists.”57 This position is a bitnaïve. The proper idea here is that it is not an issue about
special treatment. People with disabilities are in adifficult condition and for this reason, there must be amoral duty on the part of society to prioritize theirsituation because it is the right thing to do. Barry is
telling us that for any society to be just, all that matters is
a “one size fits all” type of rule for every human being.
But this cannot be the case because the problem is that
there appears to be a lack of balance between what aperson with disability can actually do and the structuresthat dominate human society. 58
In fact, Barry has protested against the declarationthat the Rawlsian theory is “designed for disembodied
beings and not for real people.”59 Barry believes thatsuch criticism “rests on a complete misunderstanding.”60
But Barry’s position is understandable. For him, only
procedures matter in the end. It is no longer the
55 Ibid., 94-95.

56 Iris Marion Young, “Structural Injustice and the Politics ofDifference.” In Multiculturalism and Political Theory. Edited by
Anthony Simon Laden and David Owen. (Cambridge, MA:
Harvard University Press, 2007), 66.
57 Barry, Culture and Equality, 13.
58 Young, “Structural Injustice and the Politics of Difference,”
66-67.
59 Barry, Culture and Equality, 69.
60 Ibid.

15

responsibility of the state to look into the outcomes ofpolitical arrangements. Barry thinks that as long as all
the parties in the social contract endorse the principles
of justice as the objective means for any cooperation,then people can adhere to it. The problem, however, isthat society often suffers from system imbalance due tothe distinct attributes of persons.
Iris Marion Young’s Counter Argument
To counter the above, Young says that while meritinvolves equal opportunity, the situations of people are
not actually the same.61 The merit principle is based on
the ability to achieve on the part of individuals but it also
“rejects a system that awards position explicitly
according to class, race, gender, family background, andso on.” Young clarifies that “under a merit principle, all
who wish should have the opportunity to compete forpositions of advantage, and those most qualified should
win the competition.” But Young explains that a personwith disability faces a different hurdle compared tonormal people. Normal people possess skills that enable
them to do things with ease. But impaired people have a
different case. Managers refuse to consider the latter aspart of the regular workforce. Persons with impairment
are seen as a burden. As a result, they are deprived ofgainful employment. However, the point is that persons
with impairments do not wish to take away anythingfrom those who are able-bodied. Like normal people,
they also deserve to have a life that is decent.
One way of improving the situation of persons withdisabilities is by means of promoting their basic rights.
The question is – what sort of entitlements must persons
with disability enjoy? Formally, constitutional essentials
that promote and protect the dignity of persons must be
amplified by civil society and the public in general tochange the biased attitude of people toward those withfunctional impairment. Indeed, as Young explains clearly,“the built environment is biased to support thecapacities of people who can walk, climb, see, hear,
within what is thought of as the normal range offunctionings, and presents significant obstacles forpeople whose capacities are judged outside this range.62
The problem is apparent. People who suffer from
impairment cannot work because regular jobs are notavailable for them. For this reason, their well-being will
have to be dependent on their immediate family
members.
While individuals too have “a right to a distributive
share of material things, resources, or income,” Youngsays that in such cases, “it is the good that is distributed,
not the right.”63 Some rights are entitlements by virtue ofour humanity. These are called human rights. They are
the most basic because without them, a human being is
not human. There are rights, however, that the state may
grant to individuals. These are specific legal rights. Whilelegal rights are meant to protect people from abuses or
exploitation, there are factors that affect the enjoymentof these state rights. Young suggests that, “rights are notfruitfully conceived as possessions. Rights are
61 Young, “Structural Injustice and the Politics of Difference,” 66.
62 Ibid., 67.
63 IrisMarion Young, Justice and the Politics of Difference.
(Princeton, New Jersey: Princeton University Press, 1990), 125.

16

Eubios Journal of Asian and International Bioethics 29 (January 2019)

relationships, not things; they are institutionally definedrules specifying what people can do in relation to one
another. Rights refer to doing more than having, to social
relationships that enable or constrain action.”64
To enjoy a dignified life, certain things must be
improved to make human society truly just. Barrymissed the important point when he rants against giving
extra care and better attention to impaired people.
Justice also involves caring for persons. You will carebecause the person matters. The person matters because
he or she is a source of value. If people are inconsiderate,then they are demeaning the human person. An
affirmative action that favors the disadvantaged is not abad thing. In fact, the Rawlsian theory of justice states
that, “the principle of fair equality of opportunity
requires that everyone [emphasis mine] should have thesame legal rights of access to all advantaged social
positions.”65 This means that persons, as moral beings,
possess equal dignity and should be given due
consideration by the state.
For instance, Young tells us that most “people withdisabilities, to continue the example, too often must
respond to assumptions of others that their lives arejoyless or that they have truncated capabilities toachieve excellence.”66 Such type of bias demeans the lifeof persons or children with special needs. Bad ideas
should just be thrown away. Children with disabilities
are an infinite source of motivation for their families.
The commitment of parents to their welfare isincomparable. In a society such as ours, love andcompassion are humanity’s greatest redeeming quality.
The above only shows that the principle of merit isfundamentally inadequate. In a society where individuals
have the same set of positive attributes, perhaps, merit
might work. However, in the world in which we live,
merit means nothing but the poor excuse of some people
so that their inconsiderate actuations are justified. There
are persons who hide their uncaring ways to from thepublic view. The absence of empathy on the part of many
among us is symptomatic of our thoughtlessness andinability to strive for the ideal of a world that people
with disability are equally entitled to have.
In a similar fashion, Martha Nussbaum believes that
disability raises a very important moral issue. She thinksthat the issue arises because individuals with some formof disability “need atypical social arrangements,
including varieties of care, if they are to live fully
integrated and productive lives.”67 For example, there
are parents who opt to prioritize business over the careof a mentally impaired child. Some parents prioritize
their careers and so, they might opt to send a child with
ASD to a care institution. The problem with such anarrangement is that there is no opportunity to deepen
the bond between the parent and the child because of
the lack of physical and emotional contact between the
two. In addition, it can stigmatize the child and alienate
64 Ibid., 26.

65 John Rawls, A Theory of Justice. (Cambridge, MA: Harvard
University Press, 1999), 62.
66 Iris Marion Young, Inclusion and Democracy. (Oxford: Oxford
University Press, 2000), 74.
67 Martha Nussbaum, Frontiers of Justice. (Cambridge, MA:
Harvard University Press, 2006), 99.

the same from the daily life of the immediate family. In
sum, the scholar and disability rights advocate Eva
Fedder Kittay writes:“With one stroke, dependents—be they small children or
incapacitated adults, be the impairments physical ormental—become an integral part of any socialorganization. To presume that they stand outside ofjustice, that they are not entitled, that—for reasons of
their impairments and dependence—they lack rights,
seems odd indeed if the point and purpose of suchprinciples (if not the sole one) is a social order that
secures the ability to care for dependents.”68
Poverty, Disability Rights, and Social Policy
It is important to determine the correlation
between poverty and disability. A poor child is most
likely undernourished, lacks health care, and has very
limited opportunity to finish higher education. Poor
children with functional impairment, in this regard,
experience a dual difficulty. They lack basic nutrition andat the same time, the money needed for therapy. For thisreason, they are excluded from a truly dignified humanexistence. The ills of human poverty are due to bad
policies, impertinent laws, and wrong decisions. Stephen
Smith explains that social exclusion is built from “thesystematic, possibly unwritten barriers that preventclasses of poor people from having access opportunities
to develop and use their capabilities.”69
Smith tells us further that social exclusion canhappen by means of “active and deliberatemarginalization.”70 Powerful interests in the society canpush the powerless into the peripheries, thereby
subjugating them and stripping them of their freedom topursue the good life. This sense of powerlessness
perpetuates poverty. Young says that this happens
because individuals have no power in terms of voicing
out their concerns on issues that matter to their welfare.
For instance, parents of children with mental disability
lack enough representation in Congress. Young says that,“the old, the poor, the mentally and physically disabled,
are subject to patronizing, punitive, demeaning, andarbitrary treatment by policies…”71
The World Health Organization and the World Bank,in their World Disability Report, say that more than one
billion people around the world have some form of
disability.72 Persons with disability, more often than not,have less in terms of opportunities to realize their wellbeing. For example, this is the reality in our school
system. Most schools are rooted in the merit system.
According to Soya Mori and Tatsufumi Yamagata, theproblem is that “inequality in educational attainment

68 Eva Fedder Kittay, “When Caring is Just and when Justice isCaring,” Public Culture 13 (3): 574.
69 Stephen Smith, Ending Global Poverty. (New York: Palgrave
Macmillan, 2005), 127.
70 Ibid.
71 Iris Marion Young, “The Five Faces of Oppression.” In Social
Ethics: Morality and Social Policy. Edited by Thomas Mappes
and Jane Zembaty. (New York: McGraw-Hill, 2002), 340.
72 World Health Organization. “World Disabilities Report.”
http://www.who.int/disabilities/world_report/2011/report.p
df. (Accessed December 28, 2018).

Eubios Journal of Asian and International Bioethics 29 (January 2019)translates into inequality in income in general.” 73
Without a school diploma, impaired individuals do nothave options in terms of a meaningful career or
profession. This dire situation condemns people into thepoverty trap. While normal persons can climb higher
into the social hierarchy based on their meritorious
achievements, persons with disability find it hard toprovide for their own needs.
Given the above background, we will look into threeareas of policy concern – health care, work policy, andfiscal matters. In this context, the situation in thePhilippines will be the focus. The action of persons ofauthority is instrumental in terms of the delivery ofservices, especially those that are meant to improve thegeneral welfare of persons with impairment. To highlightthe problem, we will also provide a picture of thesituation that people are in and the manner by whichsocial and government institutions respond to theirneeds. In this way, we can have a broader sense of the
problem and thereby, honestly propose concrete
solutions.
First, equitable health care is important. Medical
professionals assume that people with cognitive
disability have no quality of life. 74 Persons with
impairment have to compete with the general public inview of the limited budget allocated to basic health careby the government. Thus, poor health outcomes are
simply a direct result of the lack of resources andindirectly, of bad policies that prioritize the earning of
profits by private hospitals. Private hospitals seldom
allocate investments on developmental disabilities.
Nicholas Lennox et al. reveal that, “for some with adisability, such as individuals with Autism Spectrum
Disorder, waiting for a consultation can cause extreme
distress and may result in unpredictable behavior.”75
Inequities in health care are “exacerbated and, attimes, even caused by the poor system responses to theirhealth needs.” 76 Government policy making in thePhilippines follow the top-down approach. Since theimplementation of many programs is centralized, thisclearly precludes participation at the grassroots level. In
this respect, there appears to be no collective sense of
responsibility. Many laws have not been effectivelytranslated into measures that will empower the people
in the margins of Philippine society. In addition, laws arecharacteristically silent about the specific case and statusof persons with cognitive or functional disabilities in the
country. This often complicates the problem andreinforces the stigma of parents and families.
Second, work policy is an area of particularconcern. According to Josef Yap, et al. the labor
department “has been mandated to formulate policies,
procedures, and programs designed to benefit

73 Soya Mori and Tatsufumi Yamagata, “Measurements toAssess Progress in Rights and Livelihood of Persons with
Disabilities,” Discussion Paper no. 218, Institute of Developing
Economies (2008): 5.
74 Ibid., 115.
75 Lennox, Nicholas; McPherson, Lyn; Van Dooren, Kate. “Caring
for Persons with Intellectual and Developmental Disabilities.”
Journal of Religion and Society 12 (2015), 113.
76 Lennox, et al, “Caring for Persons with Intellectual andDevelopmental Disabilities,” 113.

17

disadvantaged groups and communities.”77 The role ofthe labor secretary is not limited to looking after thebasic welfare of workers. He also has a big duty toincrease employment opportunities in a country that hasover forty-five million people in its workforce. Given thishuge responsibility, some sectors in the labor industry
are naturally left behind. Due to the economic divide inthecountry,labor
discrimination
remains.
Consequentially, the over-all picture is that the work
environment is not conducive to persons with disability.
Thus, the various issues that concern persons with
impairment, including their employment prospects, areput at the sidelines. There is no clear vision and planningon the part of policy makers in terms of the integrationof persons with autism in greater society. The problem isthat some of our state policies often look at human lives
only in terms of one’s productive capacity, thus limiting
the meaning of life into the economic or the productive
life. State investment is centered on the economic. This is
the nature and character of a world that has been
defined by a new global order solely anchored on profit
making. In fact, meaningful work is not available topeople with special needs.
Third, fiscal policy on fund allocation for persons
with disability needs to be improved. For example, “it isincredible to consider the imbalance between the sheer
size of the developing world population, how little is
known about intellectual disability, and disability ingeneral.”78 A study by the Asian Institute of Management(AIM) reveals that “the number of persons withdisabilities reached by government are estimated to be
only 14% of the population of persons withdisabilities…and that 84% of poor municipalities [in thePhilippines] have no SPED Centers (primary level) while
91% of poor municipalities have no SPED schools(secondary level).”79
If the government must distribute resources basedon differentiated schemes, then it must prioritize theneeds of those who are truly disadvantaged by theirsituation. A baseline level of capability will not beenough. A true consensus for that particular type ofthreshold can be good only for those who are within thenormal range, or for those individuals who can
independently manage their situations in life, but not for
persons who will require great care for the rest of theirlives. If the state desires to designate just outcomes foreveryone, then people must secure firstly the care about
the well-being of persons with disabilities and pay
attention to what the meaning of this care might require.

77 Yap, Josef; Reyes, Celia; Albert, Jose Ramon; Tabuga, Aubrey.

“Preliminary Results of the Survey on PWDs Conducted in
Selected Metro Manila Cities.” Discussion Paper Series No.
2009-25, PIDS, 8.
78 Glenn T. Fujiura, Hong-Jae Park, and Violet RutkowskiKmitta. “Disability statistics in the developing world: A
reflection on the meanings in our numbers.” Journal of Applied
Research in Intellectual Disabilities 18(4): 295.
79 Asian Institute of Management. “Philippine Coalition on UN
CRPD on Government spending for Persons with Disabilities.”
http://development.aim.edu/blog/2014/09/67-philippinecoalition-on-un-crpd-on-government-spending-for-personswith-disabilities. (Accessed December 29, 2018).

18

Eubios Journal of Asian and International Bioethics 29 (January 2019)Conclusion
Practical ethics can expose the indifference ofsociety to the plight of the mentally impaired. As such,some things can be done from a practical end. While thismight require enormous moral courage on the part ofindividuals and our basic institutions, it matters torecognize firstly that a problem exists and that the samecan be addressed in a concrete way. To be responsive tothe needs of persons with cognitive disability, society
should possess the fundamental sense of justice that ismeant to value the dignity of each person. The respect
for the equal moral worth of persons is reflective of therole of justice in society.
National policy must secure the rights andentitlements of individuals with disability. The principleof merit does not guarantee the equal access to every
good or the opportunities for human well-being. There isalso a severe implication to health care on the part ofpersons with autism if the law and policy do not provide
for a sense of prioritization given their very difficult
situation. Young is correct in saying that rights are notgoods that people possess. Rather, as moral entitlements,rights also involve just systems and structures that
ensure their meaningful enjoyment of the former.
To ensure that we empower everyone in society,especially the disadvantaged, we have to level theplaying field by making things easily accessible to people.
This will require ending those norms that impede thegrowth of individuals as persons endowed with dignity.
Indeed, Shamsul Haque observes that forms of“subjugation in the cultural-intellectual realm may
perpetuate and expand the same in both the naturalphysiological realm and politico-economic sphere.”80 In
truth, the post-factum (after-the-fact) approach of thegovernment, which only considers the topmost surfaceof the problem, has not really addressed the deep-seatedbias against persons with mental handicap.
References

Barry, Brian. Culture and Equality. Cambridge, Massachusetts:
Harvard University Press, 2001.
Brolan, Claire; Gomez, Miriam; Lennox, Nicholas; Ware, Robert.
“Cross-cultural Understanding of Health Assessments for
People with Intellectual Disability: an Australian resource in
the Philippines.” Health, Culture and Society 8:2 (2015): 1-11.
Fujiura, Glenn; Park, Hong-Jae; Rutkowski-Kmitta, Violet.
“Disability statistics in the developing world: A reflection on
the meanings in our numbers.” Journal of Applied Research inIntellectual Disabilities 18(4): 295-304.
Haque, M. Shamsul. Restructuring Development Theories andPolicies, New York: SUNY Press, 1999.
Kittay, Eva Feder. “When Caring is Just and Justice is Caring:
Justice and Mental Retardation.” Public Culture 13:3 (2001):
557-579.
Lennox, Nicholas; McPherson, Lyn; Van Dooren, Kate. “Caring
for Persons with Intellectual and Developmental Disabilities.”
Journal of Religion and Society 12 (2015): 110-121.
Mori, Soya and Yamagata, Tatsufumi. “Measurements to Assess
Progress in Rights and Livelihood of Persons with
Disabilities,” Discussion Paper no. 218, Institute of Developing
Economies (2008): 1-28.
Nussbaum, Martha. Frontiers of Justice. Cambridge, Mass.:
Harvard University Press, 2006.
80 Ibid., 180.

Rawls, John. A Theory of Justice. Revised edition. Cambridge,
Massachusetts: Harvard University Press, 1999.
Smith, Stephen. Ending Global Poverty, New York: Palgrave
Macmillan, 2005.
Young, Iris Marion. Justice and the Politics of Difference.
Princeton, N.J.: Princeton University Press, 1990.
Young, Iris Marion. Inclusion and Democracy. Oxford: Oxford
University Press, 2000.
Young, Iris Marion. “Structural Injustice and the Politics ofDifference.” Multiculturalism and Political Theory. Edited by
Anthony Simon Laden and David Owen. Cambridge,
Massachusetts: Harvard University Press, 2007.
Young, Iris Marion. “The Five Faces of Oppression.” Social
Ethics: Morality and Social Policy. Edited by Thomas Mappes
and Jane Zembaty. New York: McGraw-Hill, 2002.
Yap, Josef; Reyes, Celia; Albert, Jose Ramon; Tabuga, Aubrey.
“Preliminary Results of the Survey on PWDs Conducted in
Selected Metro Manila Cities.” Discussion Paper Series No.
2009-25, PIDS: 1-109.

Water Keepers, Fluoridation andthe Rule of Experts:
Bioethical implications of Disciplinary
Science- Daniel Mishori, Ph.D.
Department of Environmental Studies, Porter School of theEnvironment and Earth Sciences, Faculty of Exact Sciences, Tel
Aviv University, Israel
https://www.facebook.com/d.mishorihttps://environment.tau.ac.il/FirmnessBook
https://www.facebook.com/Firmness.Firmeza
https://www.youtube.com/channel/UClwZfAuz_end8taotbQfIQ/
Email: d.mishori@gmail.com

Abstract
In 2014 water-fluoridation was abolished in Israel; in2016 the Ministry of Health attempted to reintroduce
fluoridation. The Supreme Court of Justice delayed thedecision until November 2018 on technical grounds, andrefrained from discussing claims regarding violation of
medical ethics and human rights (e.g., enforcing
fluoridation which causes replacing the original
molecular structure of teeth enamel, hydroxyapatite,with the "stronger" fluorapatite).
Before fluoridation was resumed, a new
decentralized NGO, the Water Keepers of Israel, met with
Ministry of Health (MoH) officials and submitted a letterwith 66 questions demanding explanation of the zigzag
in Israel's health and environmental policy, exposing
inadequate data and research in fluoridation "science",
entangled with contradictions and conceptual confusions.
The fact that a contradictory theory became publichealth policy, backed by the United States Centers of
Disease Control (CDC), American Medical Association(AMA), and WHO, exposes the dangers of disciplinaryscience, in which "experts", prone to group-thinking,become practically immune to cross-disciplinary
criticism. In disciplinary science, logical and empiricalcriteria are replaced by "consensus", created politicallyby professional organizations and regulatory agencies.
Updated findings, submitted to MoH, contain refutationof the fluoridation theory and expose unethical conduct

Eubios Journal of Asian and International Bioethics 29 (January 2019)at the MoH, the "experts" and professional healthorganizations. Besides violations of medical ethics(informed consent; nonmaleficence), the experts
discredited criticism by portraying fluoridation-sceptics
as misinformed, unscientific, irrational, emotional or
hysteric; the experts employed Fake News tactics ("safeand effective"), regardless of existing or missing data;
The same unethical treatment is given presently tovaccine-'hesitancy" by the MoH and WHO.
Such aggressive unethical forms of dispute imperils
communication, and discourages (practically excluding)experts from other disciplines and non-academics fromparticipating in scientific debates. The greatest failure ison the part of the Academia and Science community atlarge, who left "controversial" topics of public concern to
sub-disciplinary "experts" who control semi-feudal
branches of the Tree of Knowledge, incapable of crossdisciplinary communication and rational decisionmaking: a new Tower of Babylon. The "Babylonian"disciplinary science, as exemplified by fluoridation
theory, is hopelessly subdivided, incapable ofinterdisciplinary communication or admitting errors,
ecologically uninformed (e.g., aloof to the precautionary
principle), politically and disciplinary biased, unethicaland inherently conservative (e.g., the slow acceptance of
cannabis or Yoga as natural therapies).
The papers suggests "biohacking" as an open-source
alternative (with empowering individual hacking ethics),
basedon
criticalthinking,
subjective
selfexperimentation, embodiment, and objective scientificknowledge and know-how, to ensure democratic
communication and public-participation in science,
medicine and health.
Introduction: Irrationality of disciplinary science
Public policy in developed countries is typically basedon belief in the rationality of contemporary science,
academia and certified experts. Modern science isstructured as contemporary academia, presuming thatthe “Tree of Knowledge” is divided into various branches(e.g., life sciences, or the humanities), subdivided into
sub-disciplines (e.g., molecular biology or philosophy),and further subdivided into fields of expertise (e.g.,
remote sensing or animal ethics).
The growth of knowledge is supposedly based on
infinite entrenchment into subdivisions of academic
disciplines, which only experts (i.e., academic professors
or their certified students) can master. The corollaries ofthis belief are numerous, including the protocols by
which academic promotion committees operate. 81 In
short, promotion committees evaluates professors’ meritprimarily based on supposedly-“objective” criteria, e.g.,number of publications and their “impact factor” (journal
ranking, number of citations, etc.).
The outcome of institutionalizing infinitelysubdivided disciplinary-science is excessive power given
to “experts” in their semi-feudal sub-disciplines. Theseexperts then may become professors, tutoring the next
generation of experts; the editors and “peer” reviewersof academic journals; they sit on promotion committees;
they become deans and presidents of academic
81 Mishori, D. (2018). Firmness in Truth, Tel Aviv University.
[Hebrew] https://bit.ly/2LPGvrj

19

departments and institutions. Their reputation, as well as
the reputation of professional organizations (ADA, WHO)
oppresses and suppresses critical thinking andrefutation: logical and empirical challenges toestablished dogmas in science.82
The high walls between disciplines and within subdisciplines are generally regarded as a reasonable priceto pay for seemingly-infinite growth of scientificknowledge (as supposedly manifested by the rapid
growing number of scientific publications). Many
acknowledge that contemporary science does notencourage interdisciplinary research, or crossdisciplinary communication. However, the grave ethical,
epistemological and methodological implications of
disciplinary-science commonly evade scholars’ attention.
Such implications include replacing “narrow”
concepts of rationality, based on empirical and logicalcriteria, with “broad” concept of rationality: 83 theconsensus of the so-called scientific community—usuallyin the form of small community of like-minded experts in
sub-discipline, whose authority is respected prima-facie
by the greater community of scientists.
The reality is subdivided-science and academia,
prone to manipulations by research funds (corporate or
public), based on judgement of experts—which
commonly answer only to their (small number of) peers,which are prone to group-thinking (the “ratchet effect”),
andcognitive
dissonances(afterprescribing
fluorides/vaccines for decades, we couldn’t be wrong).
In medicine, expert opinion is supported byprofessional institutions (e.g., the AMA, CDC, or theWHO), which supposedly guarantee present-day-Truth,
often implying that the probability of errors (inconsensus-based science) is insignificant, and therefore
immaterial in public policy, which ought to respect therecommendations of experts, and their backing in
professional and regulatory institutions and agencies
which manufacture “consensus”.
Thus, experts and professional institutions usurped
the power to establish “truth”, within their sub-divided
fields of expertise. With “Truth”, came the power toestablish “Good” in public policy, in ways whichsometimes contradict accepted morals, professional
ethics and medical ethics in particular.
Water fluoridation serves as a frightening example ofsuch a process, by which disciplinary science becomes
dangerous; experts were able to persuade politicians andthe wider public to “enrich” water with toxic waste fromchemical industries, while “experts” from other domainsof subdivided-disciplinary-science refrained fromintervening in the controversy: total failure ofcontemporary academia and science.
Moreover, fluoridation became the exclusive domainof public dentistry and public health experts, despite thefact that Water and Water Ethics are topics which exceed
the narrow perspective of the prevalence of tooth caries
in children.

82 Dascal,

M. (2001). Reputation and refutation: Negotiating
merit. In: E. Weigand & M. Dascal (eds.), Negotiation and Powerin Dialogic Interaction. John Benjamins Publishing: 3-18.
83 Brown, H. (1988). Rationality. Rutledge.

20

Eubios Journal of Asian and International Bioethics 29 (January 2019)

The fluoridation controversy
Fluorine is the 13th most abundant element in earth's
crust, found (as Fluoride) at low concentrations in most
fresh and salt water. Fluorides are corrosive, and areused in aluminium smelting, steel-making, and variety ofother applications. Fluorides are highly toxic—Fluorosisis the only disease named after a toxic substance:“ …there are a number of adverse effects that chronic
ingestion [of fluorides] at high doses can have on humanhealth, including dental fluorosis, skeletal fluorosis,
increased rates of bone fractures, decreased birth rates,
increased rates of urolithiasis (kidney stones), impaired
thyroid function, and lower intelligence in children.
Chronic occupational exposure to fluoride dust and gas is
associated with higher rates of bladder cancer and varietyof respiratory ailments.”84
While in Belgium and Denmark (until the 1930s),
fluorides were researched as sources of occupationaland environmental exposures,85 in USA a relation was
found between high natural doses of fluorides in water,
dental fluorosis, and reduction in caries:“At the beginning of the 20th century, dentist Frederick
McKay noticed brown staining of the teeth … The brown
teeth, originally known as “Colorado Brown Stain” andlater termed “mottled enamel”, were more resistant tocaries... In 1931, H.V. Churchill, a chemist working for an
aluminum manufacturer (ALCOA), analyzed the water…and found high levels of fluoride (between 2 and 13 ppm)
and the name of the occurrence was changed again to“dental fluorosis”.”86“The head of the Dental Hygiene Unit at the US
National Institute of Health, H. Trendley Dean, conducted
his famous study and in 1942 published the connection
between fluoride concentration in water and prevalence ofdental caries. He determined that concentrations offluoride at one ppm reduced caries while fluorosis was
minimal. The first artificial fluoridation was carried out in
1945, in Grand Rapids, Michigan…” (ibid)This is the official story, by the head of dentistry
services at MoH; in many respects, it is true, but terribly
incomplete. First, pathological phenomena wereidentified, dental fluorosis, due to high concentrations of“natural” fluorides in water. Instead of learning to avoid
such substances, dentists hypothesized that “optimal”
dosage of fluorides minimize dental carries (supposedlypositive effect), with only “minimal” (negative) side
effects of fluorosis.
Then, unethical mass experiments in humans wereconducted in a few small towns, examining prevalence ofcarries and dental fluorosis in children. In 1950, before
safety could be established by long-term research, major
health organizations began to promote CWF(Community Water Fluoridation) as “safe and effective”
in reducing carries, especially with children.
The theory states that children in particular are
beneficiaries of fluoridation; since the 1940s, most

84 Ozsvath, D. L. (2009). Fluoride and environmental health: areview. ReviewsinEnvironmental
ScienceandBio/Technology, 8(1), 59-79.
85 Bryson, C. (2004). The fluoride deception. Seven stories press.
86 In: Zusman, S. P. (2012). Water fluoridation in Israel: ethicaland legal aspects. Public Health Reviews, 34(1), 6, p. 2.

research regarding efficacy of fluoridation was done on
children, usually 12 years old.
Water fluoridation in Israel“In 1980, WHO assigned a technical expert as aconsultant to the Israeli Ministry of Health in theengineering aspects of fluoridation. Two visits were madeand the technical problems were discussed. The consultant
was later appointed as Chief Fluoridation Engineer in the
Ministry…”.87
Water fluoridation was promoted in Israel by publichealth and dentistry experts, with little public awarenessor participation, with active support by WHO; The first
fluoridation plant was opened in Jerusalem (1981), andby 2002, 50% of domestic water were fluoridated.
In 1998, a law requiring water suppliers to fluoride
every community with more than 5,000 inhabitants was
passed in the Knesset. Resistance emerged, andsubsequently two appeals were submitted to theSupreme Court of Justice—by an environmental NGO,and by the mayor of Herzliya; the appeals were rejected
in 2002, due to a policy held by the Court since 1979,
that when experts disagree, the Court always takes theside of the government.
In 2014, the new Minister of Health, Yael German (theformer mayor of Herzliya), accepted recommendations
by experts’ committee on water (from 2007), and ended
water fluoridation. The Ministry of Health website said:“With the abolition of the obligation of fluoridation, Israel
will join the vast majority of countries in the world where
there is no obligation to fluoridate, and according toWorld Health Organization data, there is a decline incaries in countries that have not fluoridated drinking
water. In Holland, Sweden and the Czech Republic, there is
prohibition to fluoride...”The medical “experts” were outraged; an appeal to reimplement fluoridation was submitted to the Supreme
Court of Justice in 2015. The MoH defended the new nonfluoridation policy arguing that caries dropped also in
non-fluoridated countries (e.g., Europe), and thatfluoridation has negative side effects.
Then, the former minister of health (Y. Liztman)
returned to office, and was persuaded to re-implement
fluoridation, approved by an Israeli parliamentarycommittee (16.3.16); two appeals were submitted to theSupreme Court of Justice, one of which by the former
Ministress of Health.88
The court suspended the implementation offluoridation until rejecting the appeals on 13 November
2018, despite a “significant flaw”: the MoH did notconsult properly an advisory committee. The Court’s
decision completely ignored arguments that fluoridation
violates various laws (hazardous waste; the water law),human rights (Basic Law: Human Dignity and Liberty;
Patient's Rights Law), environmental ethics (The
Precautionary principle), bioethics and medical ethics.

87 Zusman, S. P. (2012). Water fluoridation in Israel: ethical andlegal aspects. Public Health Reviews, 34(1), 6.
88 Proper disclosure: the author of this paper co-authored (probono) an expert opinion for this appeal; he currently heads(pro-bono) the "professional team", Water Keepers of Israel.

Eubios Journal of Asian and International Bioethics 29 (January 2019)
The water Keepers
On 20.11.18, one week after the Court’s decision, agroup of environmental social and health activists
managed to secure a 1.5 hour meeting with five officials
at the MoH, including the acting head of public healthservices and head of dentistry services. It was agreed
that a “meeting summery” including questions will besent to the MoH.
The “Water Keepers of Israel”89—a heterogeneousgroup of individuals from all backgrounds and social
sectors (religious and secular, Jewish, Settlers andArabs)—secured another meeting, with the acting
Minister of Health (3.12.18), arguing that the Court’s
decision gave the MoH an opportunity to reconsider
fluoridation.
On 18.12.18, the Water Keepers’ “professional team”
sent a 34 page “meeting summary” with 66 questions,based on a thorough open-source research andinvestigation, aided by numerous academics andactivists—some of which well-informed academicallyand professionally re fluorides and water, with decadesof individual and collective experience.
The letter exposed the lack of research, and cracks influoridation theory, which upon attentive observation
reveal ridiculous idea: that oral health depends onchanging the molecular composition of teeth, in order tomake them “stronger”; it turned out that fluoridation
theory is based on contradictions, conceptual confusions,
inadequate research and habitual disregard ofuncomfortable facts;
Fluoridation is backed politically by healthorganizations which for decades unethically portray
fluoridation-sceptics as hysteric, emotional irrational
people failing to understand science, thus suppressing
criticism—the essence of rational science.
The theory of water fluoridation
The theory of water fluoridation is simple andsimplistic. Fluoridationists assume that the only
difference between poison and harmless substances (ormedicines) is dose.
Fluoridationists learned this maxim from the 16th
century alchemist and astrologist Paracelsus (14931541), who stated “sola dosis facit venenum” (only thedose makes the poison); in certain dosage, poisonsbecome medical drugs.
However, this claim is true only of certain elements(water and apples, for example), not for toxic hazardous
substances, which accumulate over time in biologicalsystems (e.g., aluminum, fluorides, mercury, lead, dioxins,etc.), posing risks of long-term non-acute exposures.
Paracelsus wasn’t aware of this distinction, revealed
by environmentalists in the 1960s. The “experts”
commonly ignore this distinction, and regard Paracelsus’
maxim an Axiom in fluoridation “science”, and therefore
regularly confuse two types of poison: (a) depending on
dosage (Paracelsus); and (b) systemic accumulation of
hazardous substances, toxic in miniscule quantities(environmental exposure);
Fluoridationists assume that side effects fromfluorides are minimal, unavoidable and therefore
tolerable due (1) to Paracelsus Axiom; (2) insufficient
89 https://www.waterkeepers.co.il/

21

research regarding long-term exposure to fluorides; and(3) deficient cost-benefit analyses—which assume no
calculable health or environmental risks or externalities
from fluorides or water-fluoridation.
The benefit of supposedly-reducing caries becomesby definition "Good", and thus fluorides weretransformed from "Bad" (toxic substance) to “Good” (attherecommended-optimal
dosage).
Therefore,
fluoridationists were unable to apply the precautionary
principle90.
Proponets of the precautionary approach recognize
limitations of conventional scientific methods (which
tend to emphasis independent effects, not synergies andinteractions), whereas "scientific conservatism is often
interpreted as favoring the promoters of a potentiallyharmful technology or activity".91
Science always involves value judgments that requirepolitical decisions—since scientific data is nearly always
limited by uncertainty. Therefore, “…scientists must makeassumptions, choices, and inferences based on professional
judgment and standard practices, …may make scientificresults appear to be more certain and less value laden
than is warranted.”(ibid)
The precautionary principle recommends that policy
decisions should err on the side of caution with respecttopublichealthandthe environment—anincomprehensible course of action for those who
believes risk is only a matter of dosage.
Contradictions
As we have seen, in the 1930s and 1940s (prior to theenvironmental turn in science) a direct ratio was
discovered between fluorides in drinking-water andoccurrence of dental fluorosis; there was also a decreasein caries, supposedly in reverse ratio to the amount offluorides.
To these facts fluoridationists added the “Paracelsus
Axiom” that at certain dosage negative effects "almost"
totally disappear and mostly "good" effects remain. Thisis a contradiction: the idea of a direct ratio between
fluorides and fluorosis is inconsistent with the idea of an“optimal” fluorosis-free dosage. In fact, there is adramatic increase in dental fluorosis in children in the
USA since the 1930s:“Exposure to multiple sources of fluoride may explain
the increase in enamel fluorosis from the 1930s to the
1980s. The exposure to fluoride from sources such as
dietary supplements has decreased since the 1980s
because of reductions in the recommended dosage, butthese changes occurred too late to have an effect on the
study cohort.”92

90 Jackson, W., & Steingraber, S. (1999). Protecting public healthand the environment: implementing the precautionary principle.
Island Press.; O'Riordan, T. (2013). Interpreting the
precautionary principle. Routledge.
91 Kriebel, D., Tickner, J., et al (2001). The precautionary
principle in environmental science. Environmental healthperspectives, 109(9), 871-876.
92 BELTRÁN-AGUILAR, E. D., GRIFFIN, S. O., & LOCKWOOD, S. A.
(2002). Prevalence and trends in enamel fluorosis in the UnitedStates from the 1930s to the 1980s. The Journal of the American
Dental Association, 133(2), 157-165.

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Eubios Journal of Asian and International Bioethics 29 (January 2019)

Even the CDC has updated his recommendations, andnow suggests restricting babies’ and young children’
exposure to fluorides: “Because most infant formulas
contain low levels of fluoride, regularly mixing powderedor liquid infant formula concentrate with fluoridated
water may increase the chance of a child developing thefaint white markings of mild fluorosis”93.
The CDC’s “solution”:” if your child is only consuming
infant formula mixed with fluoridated water, there may be
an increased chance for mild dental fluorosis. To lessen
this chance, parents can use low-fluoride bottled watersome of the time to mix infant formula.”(ibid)
In fact (another contradiction), in 2015 the CDC
lowered his recommended “optimal” dosage of fluorides:“This recommended level updates and replaces thepreviously recommended range of 0.7 to 1.2 milligrams
per liter”.94
A few remarks: first, (1) the original (Dean’s 1945)“optimal” dosage was 1 ppm and above, hence, adverse
effects forces to lower recommended level of fluorides,
thus undermining the very idea of “optimal” dosage(fluorosis-free), which is probably nothing but ascientific myth.
Second (2), another contradiction involves the intake
of fluorides, which is considered risky with toothpastes(especially for young) and safe in CWF.
Third (3), the CDC claims that “dental fluorosis… is the
only unwanted health effect of community water
fluoridation”, which is plain sophistry, since fluorides
have many “unwanted health effect”, but fluoridationists
insist that CWF, in optimal dosage, causes only dental
fluorosis, which they define as “faint white spots on teeth
that usually only a dental professional would notice”. Thisabsurd definition is strongly linked with other flows offluoridation theory, namely, how do fluorides “work”?
How fluorides supposedly-improve oral health?
According to Scientific American, “Researchers believe
there are several mechanisms by which fluoride achieves
its anticaries (cavity-preventing) effect. It reduces thesolubility of enamel in acid by converting hydroxyapatite
into less soluble fluorapatite; it may exert an influence
directly on dental plaque, reducing the ability of plaqueorganisms to produce acid; and it promotes theremineralization of tooth enamel in areas that have been
decalcified by acids.
…The fluoride is carried to developing tooth buds,
where the interaction with the developing crystals
initiates the replacement of hydroxyapatite (the tooth
enamel's normal crystalline composition) withfluorapatite (a related crystal which incorporates
fluoride). Fluorapatite is more resistant to decay than ishydroxyapatite.”95
Hence, “oral health” is secured, according to fluoride
dentistry, by replacing the original “normal” molecular
structure of tooth enamel, hydroxyapatite, created by
God and/or the Evolution, with fluorapatite, which is93
https://www.cdc.gov/fluoridation/faqs/infantformula.html
94https://www.cdc.gov/fluoridation/faqs/public-servicerecommendations.html
95 https://www.scientificamerican.com/article/how-does-thefluoride-in/

supposedly “stronger” and “more resistant” to decay;
this very same process is also termed “remineralization”.
Hence, fluorapatite-enamel is abnormal enamel, and thus
unhealthy, whether-or-not less-or-more prone to caries.
This is a transhumanist theory, disguised as Public
Health measure. Our own body cannot handle modern
diet (sugar)—dentists suggest changing our molecularcomposition, with the courtesy of the chemical industry.
The other way fluorides supposedly “work” is“directly on dental plaque”, as an enzymatic toxin,
poisonous to the same biological (mitochondrial)mechanisms operating in every living (and human) cells,
while according to the European SCHER report, no livingorganism uses fluorides: “Fluoride is not an essential
element for human growth and development, and for mostorganisms in the environment. “(p. 4)96
So, we have a toxic substance, which replaces theoriginal enamel molecules; this replacement is
considered “good”, because it initially (seemingly)
reduces prevalence of caries in children, thereby
distorting the definition of Fluorosis.
Dentists consider the molecular change in enamel
from hydroxyapatite to fluorapatite as “good” (notfluorosis), unless stains are visible, and then “dental
fluorosis” becomes only a cosmetic problem. The
transhumanist theory of fluorapatite, linked with
“Paracelsus’ Axiom” of optimal dosage, stands on a third
cripple leg: epidemiological-clinical research.
Epidemiological and clinical studies in fluorides arehopelessly contaminated by fluorides due to: (a) the
widespread use of fluoridated toothpastes; (b) fluoride“dietary” supplements; and (c) the "halo" effect.97
Toothpastes with fluorides assume the same theory
as water fluoridation with minor changes: (a) the
substance used is sodium fluoride (found in low
concentrations in groundwater) and not fluorosilisic acid(in CWF); (b) swallowing the toothpastes is notrecommended (problem with children); (c) It is assumed
that the "positive" effect of the toothpastes is topological(external), rather than systemic (internal ingestion, as in“dietary” supplements and fluoridated-water);Previously, fluoridationists believed that the benefitsof fluorides are primarily systemic (ingested); now
fluorides are believed to “work” only "topically".
Viva Alaska
In 26.12.18, the acting head of Public Health Services(MoH) sent a two pages letter re water-fluoridation toProf. Yael Shemesh, which exposed naked the MoH
position on fluorides. The letter (obviously written by agroup) insisted on conservative attitudes to fluorides assafe and effective, stating the experts didn’t change theirminds for 28 years (!);

Scientific Committee on Health and Environmental Risks(SCHER): Critical review of any new evidence on the hazard
profile, health effects, and human exposure to fluoride and thefluoridating
agentsofdrinking
water(2010).
https://ec.europa.eu/health/scientific_committees/environme
ntal_risks/docs/scher_o_122.pdf
97 Levy, S. M., & Guha-Chowdhury, N. (1999). Total fluoride
intakeandimplications
for
dietary
fluoride
supplementation. Journal of public health dentistry, 59(4), 211223.
96

Eubios Journal of Asian and International Bioethics 29 (January 2019)
The letter states that responsibility for changes inpolicy re water-fluoridation belongs exclusively to thepolitical echelon, implying that some policy decisions(and public health measures, or MoH statements) are“political” rather than “professional”;
In 2016, however, the Minister of Health, the Head of
the parliamentary committee, and other Members ofKnesset, all stated to the protocol they trust the experts
and follow their recommendations; i.e., no one takes
responsibility.
The letter cites a single updated paper from Alaska,98“Consequences of community water fluoridation
cessation”, which supposedly proves the experts’position. This paper exposes typical flaws of Fluoridation
Theory: it researched only children and adolescents (in avery atypical community); examined only dental
insurance claims re caries; disregarded fluorosis or othernegative externalities; presumed “Paracelsus Axiom”, etc.
This paper concluded the odds of children oradolescents to undergo dental caries procedure in 2003
were 25.2% less than in 2012—seeming proof of theefficacy of fluoridation (less than half tooth difference
per child). However, greatest effect was observed atunder seven-years-old age group (51% less), while withadolescence there were no significant differences:“As no significant difference in the mean number of caries
procedures was observed between the 7- to 12- and 13- to
18-year-old age groups, we suggest that these individuals
may have a residual protective effect from optimal CWF
exposure during childhood and early adolescence.”
Hence, the paper “explains away” difficulties in the
results. The reason thereof are the overt presumptionsof this research:“Previous research indicates that without the presence of
optimal levels of fluoride in drinking water …teeth may
form with weaker enamel and lack the ability toremineralize early signs of decay. Therefore, we expected
to observe a general increase in dental caries-related
procedures and treatment costs across age groups because
fluoride acts primarily topically. Additionally, we expected
to observe more significant impacts among patients withthe lowest exposure to optimal CWF.”The Alaska paper is based on a doctoral thesis99
which fallaciously defines fluorosis (the general
phenomenon) in terms of dental fluorosis (the case),based on definitions by the ADA: “Fluorosis: Dental
fluorosis, streaking or discoloration of tooth enamel, canoccur during tooth development (0-5 years) if
consumption of fluoride is above optimal limits (ADA,
2005). Classification can be ranked from very mild tosevere” (ADA, 2005).
This definition presumes uncritically Paracelsus’
Axiom (“optimal” limits). However, during 70 years offluoridation, science didn’t reach an “optimal” dose (i.e.,
reduction of caries, without a corresponding increase in

98 Meyer, J., Margaritis, V., & Mendelsohn, A. (2018).
Consequences of community water fluoridation cessation for
Medicaid-eligible children and adolescents in Juneau,
Alaska. BMC oral health, 18(1), 215.
99 Meyer, J. (2017). Consequences of Community Water
Fluoridation Cessation for Medicaid Eligible Children andAdolescents. Walden University.

23

dental fluorosis—the only fluorosis surveyed in
dentistry).
Also uncritically, the thesis contains a long passage
regarding “Antifluoridation Propaganda”: “Since the1950s, CWF has come under attack by small groups ofindividuals who employ tactics designed to encourage
distrust towards scientists and governments who promote
CWF for improving oral health” (Freeze & Lehr, 2009)
The source quoted is biased by its very subtitle: “howa modest public health measure became America’s
longest running political melodrama”, 100 and uses
expressions such as “pseudo-science”, “junk science” and“Fluorophobia” to describe fluoridation-sceptics; such
portrayal is typical to the debate-ethics offluoridationists since the 1950s, including in Israel: “itwas recognized that the fluoridation plan might be
opposed by some. The main reason for this is the basic
mistrust that some sections of the public have in anythingthat is done by the government. Paternalism andbeneficence by the government were seen as infringement
and are not much appreciated in an atmosphereemphasizing freedom and the right of the individual todetermine his or her destiny as he or she thinks fit.”“…Confrontations
in
the
media
with
antifluoridationists were avoided. It was considered
preferable to refuse to comment on a newspaper article on
the grounds that public interest dies down quickly if there
is no response.
…The anti-fluoridation lobby was addressed politely as
being well meaning but sadly misinformed as discourtesy
and verbal violence often gives rise to hysteria rather thanintelligent discussion.”
Thus portrayed for decades, as misinformed hysteric,their criticism ignored, little wonder some antifluoridationists began to “mistrust” the governments andscientific experts.
More contradictions and flaws in fluoridation-theory
Besides the fallacious definition of Poison, and of
Fluorosis, fluoridationists contradicts themselves when
they employ Paracelsus’ Axiom, since their theory
depends on “optimal” dosage, while they cannot control
individual intake, from multiple sources of fluorides(including food and beverages).
Moreover, dosage is uncontrollable due to the "haloeffect”, absurdly depicted as a “positive” effects offluoridation: “What is the “Halo Effect”? The “halo effect”
is the effect of water fluoridation upon residents oflocalities where drinking water is not fluoridated.
Residents of these areas who consume products producedin fluoridated areas (e.g. milk, vegetables, fruits, bottled
beverages, meat, pastry) are exposed to the positive effectof fluoridation in spite of the fact that the water supplied
to them is not fluoridated”.101

100 Freeze, R. A., &, Lehr, J .H. (2009). The fluoride wars: how amodest public health measure became America’s longest running
political melodrama. Hoboken, N.J: J. Wiley & Sons.100
101

https://www.health.gov.il/English/Topics/Dental_Health/info
rmation/Pages/fluorides.aspx

24

Eubios Journal of Asian and International Bioethics 29 (January 2019)

The ‘halo effect’, environmental pollution portrayed
as a “public good”,seemingly explains unimpressive 102
results of fluoridation in Israel:“It seems that the decline in 12-13 years was bigger in the
non-fluoridated area then in the fluoridated one, and thedifference between the two is smaller. Is fluoridation
losing its effect? I don’t think so.
First of all, in all areas fluoridated toothpaste is in use,
hence the decline in the non-fluoridated area.
Furthermore, 50 percent of the country was fluoridated in
2002 in several distinct areas, not in one, geographicallycontiguous area. Every fluoridated area has a ‘halo effect’on the areas around it that were not fluoridated, but were
influenced secondarily by the fluoridated area. The
children may study in the adjacent town, visit friends orfamily and are exposed to fluoridated water too. Some of
the food industry is located in fluoridated areas and theirproducts are consumed in non-fluoridated areas. As aresult, there is fluoride found in at least part of the nonfluoridated areas. We expect that in the next national
survey we will find a still lesser difference between the
fluoridated areas and the non-fluoridated “islands” thatwill remain. So, fluoridation is working.” (Zusman, ibid).
Just as in the Alaska study, actual results ofFluoridation are explained away, often assuming
benefits from other sources of fluorides; likewise,
fluorosis is never blamed on water fluoridation, but onother sources of fluorides; this is an irrefutable theory
which fails to meet Popper’s refutability criteria of
science.103
Moreover, efficacy of fluorides is demonstrated
mainly in children, often 12 years old, thus long-term
effects are rarely studied; In Israel, since 1955, almost all
studies examined children, usually 12 years old (theglobal standard of "fluoridation" science); no potential
health risk were investigated, since it was presumed thatin "optimal" dosage fluorides are harmless.”
The person quoted above is the head of dentistry
services at the MoH, who stated on few occasions,
including parliamentary hearings, that people "do notneed fluoride to prevent caries; [if] you will not eat sugar,
you will not have caries". Nevertheless, he always
concludes: "Fluoridation of drinking water is the mostefficient, egalitarian and cheapest method to prevent
tooth decay"—the power of scientific conformity andconservatism.
Kings of the swamp
The number of "experts" in every sub-discipline issmall. Hence, in Israel, the same Professor was formerly
the Dean of the Faculty of Dentistry at Hadassah(Hebrew University); set in various professional
committees which recommended fluoridation; was arecipient of research funds by Colgate-Palmolive; andheaded an "independent committee" (MoH) which
decided (with other MoH experts) on a small one-year
research of 12-years-old in 5 schools, instead of a longterm research; the research was carried out by hiscolleague from the same department of Public Dentistryin Hadassah. The small (Hadassah 2012) research found
102 https://ilikemyteeth.org/halo-effect-public-good /103 Popper, K. (1934/2005). The logic of scientific discovery.
Routledge.

increase in dental fluorosis, but the researchersconcluded: “Water fluoridation was associated with mild
fluorosis symptoms, similar to findings worldwide. Thesefindings should not be viewed as cause for concern.”
These conclusions were adopted by the head of the"independent committee" on fluorides, relaying on the“scientific” consensus. This same professor latter coauthored (with the Hadassah’ researcher) an academic
paper in Hebrew on their Fluoridation campaign (“TheWar against the War against Fluoridation”, 2014; in asingle title twice "war" and twice "against"—primeexample of "positive" thinking), and later appealed to theSupreme Court of Justice to renew fluoridation (2015).
To the handful of dentistry-experts who joined ahandful of public-health experts. All other healthprofessionals, members of the advisory committee onwater (MoH), and the Israeli Academia at large (by notintervening), implicitly support any decision the experts
make regarding fluoridation.
Intellectual dishonesty
At the meeting of the Parliamentary Committee(16.3.16), the former Minister of Health and otherparticipants blamed the experts for misleading Membersof Knesset, by stating inaccurate facts (e.g., that there
isn't any controversy about fluoridation). Further
examination show that pro-fluoridation experts,
believing that science was on their side, were taught by
their American predecessors to regard anyone who
doubted fluoridation as misinformed, motivated by"religious" or "philosophical" creeds; criticisms werethus regarded as expressions of hopelessly misinformed
misunderstandings—even when they came from aretired MoH water/fluoridation engineer. Presently,
vaccine-sceptics are treated the same.
Therefore, "Fake News" tactics and strategies weredeveloped to “handle” anti-fluoridation advocacy:
ignoring, distracting, using partial information (in order
not to give unnecessary ammunition to skeptics),
refraining from research which might reveal
uncomfortable facts, etc. Such tactics portray science andmedicine as supposedly comprehensible only to experts,
their professional organizations and regulatory agencies;
This is the Rule of Experts, instead of the rule of thepeople, making science and medicine inherently
undemocratic, uncritical, unethical, unscientific and thus
dangerous.
Freedom-of-choice-based considerations, democracy
and human rights, were treated as nonprofessional
issues that are not of interest to amoral experts.
Inadequacy of professional ethics
The following quotes are taken from an expert inprofessional ethics in Israel. According to Asa Kasher,“Medical ethics require the physician to do his best to
realize the purpose of the medical activity using themethods of the profession.
The preoccupation with morality is different from thepractice of [professional] ethics... Medical ethics includes
morality, because the doctor is a person and the patient isEubios Journal of Asian and International Bioethics 29 (January 2019)a person - but it is broader because medical ethics has
aspects that are not derived from morality.”104
The "broader" aspects not "derived" from morality inprofessional ethics includes the professional-scientificpart, an amoral component, which is "broader" thanmorality, The professional-scientific part enables expert
to establish Truth, and thus the Good, irrespective of"narrow" morality. Moreover, they are required to
employ "the methods of the profession". Hence, narrowprofessional ethics is incapable of coping with challenges
such as water fluoridation (or vaccination-safty), whichuses established method of given professions in
subdivided disciplinary-science.
Vaccinations105
The WHO recently demonstrated chilling example ofsuch "ethics" by portraying vaccine hesitancy as one of"ten threats to global health in 2019"106:“Vaccine hesitancy – the reluctance or refusal to vaccinate
despite the availability of vaccines – threatens to reverse
progress made in tackling vaccine-preventable diseases.
Vaccination is one of the most cost-effective ways of
avoiding disease – it currently prevents 2-3 million deaths
a year, and a further 1.5 million could be avoided if global
coverage of vaccinations improved. Measles, for example,
has seen a 30% increase in cases globally. The reasons forthis rise are complex, and not all of these cases are due tovaccine hesitancy. However, some countries that wereclose to eliminating the disease have seen a resurgence.
The reasons why people choose not to vaccinate arecomplex; a vaccines advisory group to WHO identifiedcomplacency, inconvenience in accessing vaccines, andlack of confidence are key reasons underlying hesitancy.”
I find this statement frightening because:(1) It ignores (and thus, denies) the safetycontroversy re vaccines;(2) It portray "hesitancy" as a problem of"inconvenience" and "lack of confidence" (same as influoridation);(3) It implicitly incite against vaccine-sceptics byinsinuating that they are the culprits for outbreaks of
Measles and possibly other vaccine-preventable diseases,
despite the fact that side-effects of Measles (liveattenuated virus) vaccines is infection, a fact nevercommunicated to the public;(4) If the WHO is wrong about fluoridation, it could
be inaccurate also re vaccinations; the seeming-certaintyof WHO rhetoric is therefore clearly biased andunscientific;
Therefore:(5) The semi-Papal infallibility attributed to WHO
recommendations, based on non-transparent internal
expert committees, such as "vaccines advisory group toWHO" (SAGE), should be replaced with open-source
interdisciplinary forum, unbiased by disciplinaryconservatism and conflicts of interests.
104 Asa Kasher (2018). When the academy escapes ethics.
Shiloah, 73-102. [Hebrew]
105 Proper disclosure: the author's daughters received
childhood vaccinations according to MoH recommendations.
106
Tenthreats
toglobalhealthin2019.
https://www.who.int/emergencies/ten-threats-to-globalhealth-in-2019

25

Presently, SAGE nominate only an "expert" withnarrow qualifications, 107 excluding most scientificdisciplines, including the humanities, social sciences orbioethics.108 The same attitude in Israel towards vaccine"opponents" or "refusers" has already resulted:(a) in a recent bill (December 2018), backed by the
MoH public health services (same department
responsible for fluoridation), enabling private
kindergartens to refuse admission of un-vaccinatedchildren;(b) The Association of Pediatrics in Israel called for
restricting entry into kindergartens, unless children
present updated vaccination record;(c) Hundreds of kindergartens already joined"Mehusgan", voluntary private initiative of doctors andparents preventing un-vaccinated-children admission,arguing that "maximum immunization coverage allows
us to protect not only our children, but also theimmunosuppressed, elderly, pregnant women and more",disregarding the potential infection by vaccinatedchildren—the result of biased health communication byhealth authorities.109(d) Physicians who openly discussed vaccines' sideeffects and risks were summoned (January 2019) to the
Public Health Fraud/Misrepresentation Committee(MoH) for hearing (inquisition). In one case, a physician
was accused of an internet publication which…shows that in the framework of your activity as aphysician, you offer recommendations that are contrary
to the vaccination briefing, and even rejection of
vaccines, in a manner that is contrary to professionalguidelines in Israel and abroad and may even lead to the
avoidance of vaccination [by] children and adults and, asa result, endanger them and their environment.
Your activity as aforesaid is done by way of linking
and creating reliance on your license and your practicein medicine, and may constitute disciplinary offenses
under the provisions of the Physicians Ordinance [NewVersion]Hence, physicians' livelihood (license) is threatenedby the inquisition of MoH, relying on "professional
ethics" mandating doctors to work strictly according to
official guidelines—dissents are punishable ethicaloffences.
The onslaught on vaccine hesitancy violates basic
medical ethics, as well as basic human rights, including
freedom of conscience, and is reminiscent of another era
in which religious inquisition was able to summon people
for interrogation on their religious or scientific beliefs(Galileo, for instance).
Medical ethics, especially public health, urgently
needs revisions.
107 https://www.who.int/immunization/policy/sage/SAGE_wo

rking_group_MR_call_nominations_Jan_2019.pdf?ua=1
108108 Expertise needed in the Working Group: Measles andrubella Epidemiology, Public health expertise, Infectious
diseases,
Paediatrics,
Immunization
programme
planning/management, implementation and monitoring,
Vaccine safety, Health economics in the immunization/vaccinesarea, Expertise in disease modelling.
109 Gesser-Edelsburg, A., & Shir-Raz, Y. (2018). Communicatingrisk for issues that involve ‘uncertainty bias’: what can the
Israeli case of water fluoridation teach us?. Journal of Risk
Research, 21(4), 395-416.

26

Eubios Journal of Asian and International Bioethics 29 (January 2019)

The new Tower of Babylon
The 70 years fluoridation dispute demonstrates thedangers of 21st century’ science; hopelessly subdivided,
disciplinary science becomes a semi-feudal system,
where power and authority are given to experts andprofessional and regulatory consensus-manufacturing
agencies, prone to influences by private-sector researchfunds.
“Science” becomes a system of separate subdisciplines, which rarely communicate, and may even be
hostile to cross-disciplinary communication andcriticism, as in the case of Fluoridation (and vaccines);
thus emerges a new Tower of “scientific” Babylon.
As we have seen, the “experts” were convinced “Truth”
was on their side, and thus were able to determine“Good”, disregarding ethical precepts in medical ethics
such as “informed consent” (Fluoridation was enforced,
despite years of controversy), or “primum non nocere”("first, to do no harm"), despite recurring fluorosis
effects.
Fluoridation is an act of extreme Medicalization, i.e.,
usurpation of social power by medical profession. In thiscase, medicalization of water and the environment atlarge (everything affected by water, including recycledwater agriculture).

their overall health mainly by following professionalguidelines and treatment recommendations, often in theform of pharmaceuticals or invasive surgicalinterventions.
"Biohacking" works differently. Connecting to(software) hacker culture and hacker ethic (in the senseof finding new/better ways to do things), biohacking
combines systems-thinking, Do-it-yourself biology,
traditional research methods and self-experimentation.
Biohackers desire to become best version of themselves,and seek to discover new and old ways to become
healthy, using nutrition, frequencies, measuringbiomarkers, researching corporeal possibilities (e.g.,
Yoga or Tai Chi)112. Biohackers use activists' open-source
web culture to disseminate knowledge as a commons,and to question conservatism, scientific authority andconventional beliefs.
Typical biohackers focus attention on posture,nutrition, rewilding (with nature), natural sunlight andthe outdoor, etc. Focused on halting fluoridation, theWater Keepers operate according to various biohacking
principles, with multiple individual variations, including
the decision whether or not to consider an activity (orthe activist' identity) "biohacking" as few of the originalactivists see themselves.

Bioethics, medicine, health and Biohacking
In the Book of Genesis, the Tree of Knowledge(Hebrew: Daat) enabled knowing right from wrong(distinguishing Good from Bad). Current disciplinaryscience portrays itself as inherently amoral, as if ethics is
adjunct to real "hard" science, concerning only objective
facts. The fluoridation dispute should serve as a warning
sign, that true knowledge is inseparable from research
ethics, bioethics and democracy.
Bioethics in the sense of Van Rensselaer Potter(1970) is “a new discipline that combines biologicalknowledge with a knowledge of human value systems inan open-ended biocybernetic system of self-assessment”.
Deeply influenced by ecocentric perspectives110 (e.g., theLand Ethic and Deep Ecology), Potter argued: “We must
develop the science of survival, and it must start with a
new kind of ethics—bioethics. The new ethics might becalled interdisciplinary ethics, defining "interdisciplinary"
in a special way to include both the sciences and thehumanities (p.130); …new wisdom that will provide the"knowledge of how to use knowledge" for [hu]man's
survival [since] …human ethics cannot be separated froma realistic understanding of ecology in the broadest sense(p. 127).”111
Water-fluoridation cannot be described as reflecting"a realistic understanding of ecology in the broadest
sense"; Biohacking, on the other hand, could be
integrated into Potter's bioethics. Water-fluoridation istypical of the way modern medicine makes its patients
passive: people don't even have to brush their teeth,water will take care of cavities. In contemporary
medicine, patients are passively being diagnosed andtreated by professionals and experts, contributing toConclusions
Water-fluoridation is an ecological crime without
responsibility: the government trusts the experts, whoassign responsibility to the political echelon. Academia
has largely ignored the issue, as lying in the domain of
public health and dentistry. The ecological crime wasdemonstrated in Israel when in June 2017 massive spillof 100,000 cubic meters of acid contaminants flooded
the Ashalim Stream in the Judean Desert (Dead Sea),
after a reservoir (evaporation pond) collapsed. The spillcontained a mixture of phosphoric, sulfuric, andfluosilicic acids—the same substance used in waterfluoridation—"that surged through a dry riverbed insouthern Israel …left a wake of ecological destruction
more than 20 km (12 miles) long". Such substances
cannot possibly contribute to overall public health.
Such occurrences prove that modern society is inurgent need of a bioethics, conforming to Potter's vision.
Water fluoridation proves that health must be biohacked,
at least partially; the emergence of medical cannabis andcannabis culture is another form of popular biohacking
movement changing paradigm in Israel, facing
opposition from conservative medicine—the same"conservative" experts believing water fluoridation isgood, and pharmaceuticals are better than natural plants(Cannabis).
Water-fluoridation proves that unethical sciencecannot be true. Ethical science is non-coercive, open for
debate, acknowledging the probability of errors andrefutations, ready to change if new data emerge, does not
violates basic human rights or medical ethics. Dentistry
and public health experts should reconsider their
outdated views on fluoridation, with the best intention of

110 Potter, V. R. (1988). Global bioethics: building on the Leopold
legacy. MSU Press, 2012.
111 Potter,
V. R. (1970). Bioethics, the science ofsurvival. Perspectives in biology and medicine, 14(1), 127-153.

112 Mishori D. (2018). Firmness (Firmeza): Meditations on First

Philosophy and Environmental Ethics.
[Hebrew]

Graff

Publishing.

Eubios Journal of Asian and International Bioethics 29 (January 2019)learning from past errors, and to implement new
insights in the emerging vaccination-safety controversy.

Ethical Information Foresights: A
Journey Across Uncharted
Conflictology- Manuel Lozano Rodríguez, MBGPH
Barcelona, Spain; PhD student, AUSN
Email: perennidad@gmail.com
1. Context of Ethical Information and Bioethics
We face not only stress but moral conflicts whenworking on data: sensitiveness, timing, privacy, etc.
Some contents show off an extensive literature, forexample, the users’ data in the social media (Chen andShi 2009). Other sensitive topics like the polluting
compounds that many firms produces, sinks into thesecrecy and lack of data (Lyndon 2011). In Bioethics, theprivacy of subjects after the CRISPR experiments is on
fire (Brokowski and Adli 2019). As we can see, theethical information concerns grows as the technology
does. Otherwise, some worries, just like the Year 2000
bug in computers, have dissipated (Eschrich 1998;
Tewksbury et alt. 2004). The Information andCommunication Technologies never has had the current
weight in Bioethics. The “love of life” (Macer 1998) is
producing zillions lines of code. How our current
healthcare systems would work without? And our cities?
It’s natural to be concerned about a tech-ridden society’s
future but…
Why should we worry about ICTs misuses that might
not happen?
We live in the dawn of autonomous information
systems. There is the clear and distinct possibility of theAIs surpassing the human inventive after a spiral of selfimprovement. The most people alive likely we’ll see thishistorical singularity. But, regardless of foresights, it’s amatter of today.
The most of us, and more every day, live in cities
where some degree of smart metamorphosis has started.
We are newcomers inside information bubbles. The
amount of AI devices grows before our eyes; hangs fromthe walls of our town like Internet of Things; sticks on us
like wearables; sneaks below our Internet searches
where provides us with a semantic experience and,lately, has materialized in the polemic robots.
2. Information Ethics
The Information Systems are involved in the main
disciplines that are changing our world: biotechnologies,
nanotechnologies, cognitive sciences... Thus, are involved
in almost any transcendental ethical decisions we canfigure out. Sadly, our moral awareness and ethicalperceptions are somewhat vitiated. It’s due to theinequality in the access and analysis of the unmatched
information we enjoy (and suffer) today. This unbalance
extends to the production of contents and Artificial
Intelligence agents.
Considering how much our social interaction are
mediated by computerized Information Systems these27

digital breakthroughs, their vertigo and immediateness,
are and will be the spirit of our time. The past Zeitgeist
relied in the industrialization of information. This
ironclad bureaucracy was as a mean of control, of
keeping up the visceral and Nietzschean will of power(Giacalone and Jurkiewicz 2003, 338–39). The dominant
agents of this successful industrialization perhaps looked
the cyberspace as fishing in a barrel. But soon thesaturation of information became obvious. Instead of
having a stronger lock, the speed in retrieving or
attaining became the new Zeitgeist.
To sum up in a Luciano Floridi quote: “We need aphilosophy of information as a philosophy of our time forour time.” (Floridi 2014, ix)
We are getting caught amidst cozy autonomous
technology. It’s a postmodern force able to shape oursociety through its agents. For intelligent agent we’ll takethe Russell and Norvig classic definition: “anything thatcan be viewed as perceiving its environment throughsensors and acting upon that environment througheffectors.” (Russell and Norvig 1995, 31) Those agentsare carelessly being masqueraded as human ones and,on the other hand, they are also relied upon tocoordinate even military actions (Miller et alt. 2015;Roderick 2007).
Our identities and sense of belonging will change after
being agentized (Vlahos 1998). The one to the digital
sphere will be the greatest human migration since our
species traveled out from Africa. How our generation
will deal with the old analogical identities? Will start apeaceful war when the Cave of Bits entrance get sealed
behind us?
We should worry about the future of Information
Ethics because we won’t realize when is too late. Now,
we can face the main question, “What is Ethical
Information?”
3. Ethical Information means true communication.
The ethical information is a piece of justice built fromhonest data. It’s any set of transparent facts thatempowers. So, it’s a shelter both from sly policies andhate speech.
By the same token, a moral obligation of any Ethical
Information maker or developer (dev) is being aware of
the digital divide issue. This is a social gap in the accesstomodernInformation
andCommunication
Technologies, especially when it comes to the digital
literacy, the autonomy in the use of technologies as
Internet browsers, social media, smartphones, etc.
As the UNESCO warned: “The Digital Divide (DD) is thesource of most of the ethical problems emerging fromthe evolution of the information society” (Floridi 2001).
The main prerequisite for Ethical Information is toobserve the principle of non-maleficence. Let’s go
deep into the many plausible injustices...
How to spot and to prevent abuses related with
Information Systems?
The information management comes from a long
institutional tradition of unpunished abuse. Sadly,
acquiring autonomous and systematic features has notbeen a remedy. Otherwise, the information technologies
have also granted us plenty of practical and beneficial
uses that makes up some misuses.
Besides nerdie gifts, we shouldn’t ignore a world

28

Eubios Journal of Asian and International Bioethics 29 (January 2019)cleaved by a decision-making gap. So, it would be naive
to paint with the same brush the Ethics in and out of the
Directors Board. The organizations have also a moral life.
It’s not expressed like the human one, but through itsvery own ecology. These special organizational settings
are very important in a ubiquitous concept ofInformation. They can lead to social changes in the same
fashion than social media (Lin and Sun 2017).
Thankfully, having an Ethical code contribute to theimage of success in the marketer’s eyes (Vitell et alt.
2003). An ethically aware information system consumer
should consider it.
In addition to this, in the last 20 years, has become
evident what managerial changes the globalization andInternet require. The nowadays management must to beframed in moral values (Sora and Natale 1997). To
thrive, a manager must to shift and align with
Information
Technologies
through
leadership
improvement (Rose et alt. 2016). Sadly, the failure ratein the tide of Information Systems projects points to acareless leadership. One that evidences a short-sighted
symbolic achievement unable to extend away from thedesktop (Jiang et alt. 2001).
The executives’ ethics could be an unexpected asset inprogress and sustainable prosperity. But only whenmore attention is paid to their values, underlying
worldviews and sense of responsibility (Esfahani et alt.
2015; Spangenberg 2016).
The AI tycoons’ messianic overtones are a source ofbias and infoxication (Lozano 2018, 28–29). If the future
AI is sadistic, funny, blue, murky, chauvinist,
warmongering, transcendent, voyeur or simply buggy it
is, as I said, a matter of today. Today is when the embryoof the tomorrow’s AI is being developed. Now we canand we must choose if this AI will be built over an Ethical
Information or not.
Using the information to play with the beliefs on
inevitability gives the power to avoid politicalresponsibilities. These are transferred from political to
public and private domains. The pliers we should fear
are not in the end of a robotic arm. Better if we mind
about the pinch in our conscience coming from thescreens. To date, the Ethical Information is not a
nuisance for a bossy AI, but for a bossy use of the AI.
4. How to avoid harm from the Information Systems?
We should know how to differentiate what issenseless for us from what is susceptible to be false.
Then, speaking from heart about it. We must to learn
how to negotiate our right to communicate and dissent.
We must to do it before our age of information becomesmisunderstood. Now, let’s know…What brings the
Ethical Information to the society?
Here I’m acting partly as a forecaster, some kind ofwater diviner of the next generation of troubles in the
Information Society. Nevertheless, we all must to have a
say in the incoming changes. We cannot remain neutral
to the new technologies and its gurus as it wouldn’t has
any societal outcomes. That’s what the Ethical
Information Systems are about!
The Information Society technologies must to be
ethically assessed ex ovo in the same way that thecorrectness of algebra is considered. The prosumers andrecipients of the new Information Systems consequences

and features should be empowered to deal with its:
• social impact• means of diffusion• control and ownership• public institutions lobbying• sensitive clients (e.g. army parties)• privacy issues and monetizing of users• sensitiveness towards the most vulnerable people
During the next years, our pool of knowledge about thematter, the brain and the society will boom thanks to theconvergence of nanotechnology and Information
Systems. But beware!
The data seems a bottomless pit full of gifts but themost of this pit is today private. Such as the devices to
produce information are. The smarter our global village
become, the less our our identities will be. Nevertheless,such is true as humanity has a History, toying withidentity of others will have consequences. Deciding
massively for an entire nation, community or collective,
will also lead to violence: asymmetric conflict, terrorism,
guerrilla... to pick a name. More even in a world where
the disadvantaged countries has togetherness rather
than true unity. Every time a technology allows
deindividualization, an open wound for unethicalbehavior appears.
A lasting prosperity can be attained. We can keepaway from the risk of reifying ourselves amidst
Orwellian abuses. Amidst political malpractices
springing out from the bottom of a smart-city envelope.
Better if we trust in a universal basic income replacing
the rule of markets by a post-democracy, one supported
by open-source tools. Does it seems Utopian? Internet
itself is the Tim Berners-Lee’s open-source!
We shouldn’t focus only in innovating when it comesto bring social justice, but also in ex-novating: getting ridof the worn and useless...
5. What brings Ethical Information to a society?
Constructive controversy.
Saying this, may you were wondering…How to foster
the Ethical Information everywhere? To foster the
ethical information we must to set a difference. It can bedone through a conflictology of the incoming Ethical
Information and can be summed up in a few initiatives
and considerations (Lozano 2018, 101–2).
1. To rally representatives from minorities,
supranational institutions as well as academic andreligious figures in the redaction of “A Harmless Faith in
the Human Being Manifesto”. A declaration where clearly
exposing and developing the trust in the equity of any
well-informed person to contribute to the common good.
2. By the same token, we should consider the muffledpolitical voice of billion people in the world through a
global organism ready to disclose, gather and weight theideas of those who are invisible.
3. Giving to the media similar status and responsibilities
that given to courts or similar institutions. Preserving
the independence of the watchdog journalism in a city
shouldn’t be less important than budgeting the district
attorney office. Otherwise, we won’t transcend theoverdose of quick facticity we are exposed from the earlychildhood.
4. Find a middle ground with hackers andEubios Journal of Asian and International Bioethics 29 (January 2019)
whistleblowers, regulating it to favor the common good
rather than pursuing any hackactivist regardless of her
purpose and contribution.
5. Surrogate the publicity within and between children
contents in any media, including the Web, for freetransformational learning opportunities. For example,
events and programs to raise awareness on ecologicaland social issues.
6. We should focus the education in the practical use of
History and Philosophy through present day cases androle-play activities.
7. To consider thoroughly the ethical dimension of social
exclusion and the role of information systems. Whenneeded, determining legal responsibilities for thetrivialization or apology of any kind of marginalizationor poverty anywhere. It would include as hate crime thebelittling of a community based on its digital or
technological divide.
8. By law, a consideration and analysis of the potential
Information and Communication Technology issues onvulnerable communities should be compulsory. For
example, a form to be included in the design and during
the implementation phases of any Information Systems.
9. To prevent a Digital Age characterized by inequality
and the major powers involved in failed states
showdowns, the international norms related to ICT
should be extensive and accountable, especially whenrelatives to smart-cities. We need a cosmopolitan
governance in a world where the developing countries
wields the greater demographic growth and their cities
are surging more often. Neither shouldn’t we forget thatthe greatest cities before the AI singularity likely will bein Africa.
10. To establish, if any, an UN international bioethics
sub-committee to deal with:• the anthropomorphization of technologicalproducts and,• the humanization of the human–machine
relationship.
It should include the transhumanism as the most radicalcase. A special informed consent to sign before any
enhancement surgery or additional plug-in should be
redacted.
Rather than a recommendation, this is a last advice.
No matter how the things change in the next 30 years,
we must to preserve the chances of turning back to the
Earth. The communities that incorporated rhythms anddances to their communal activities 30,000 years ago
kept on amidst climate changes, the others didn’t. I
believe that, as happened before, we only will be able topreserve our human identity in the same extent that we
can safeguard the moral right to return to innocence.
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Buddhist Perspectives upon
Disease and Human Gene Editing- Chutatip Umavijani
Thammasat University; AUSN Professor of Philosophy &Humanities;
Email: chujid2@gmail.com

Humans and nature are interrelated andinterdependent. We are a part of nature and change is afactor inherent in nature. Human morality effects theprocess of change. The moral deterioration ofhumankind accelerated the process of change and isrelated also to human well being and happiness.
Suttas show a close relationship of humans andnature, the cause and effect. The Cakkavattisihanada
Sutta: pattern of mutual interaction between man andnature. When man is full ofgreed: famine is the outcome,when man is ignorance: epidemic is the result, when
hatred is the driving force: violence is the outcome.
There is hope for the future: when man realizes theresult of moral decline changes take place, then thequality of man and nature improve.
There is interdependence of humans and nature, as
stated in Lily de Silva, (1987) “The Buddhist Attitude
Towards Nature” : ‘Man then live in harmony with nature,utilizing its resources for the satisfaction ofhis basic needs,
such as bee collects pollen from the flower, not harming
the natural world in which he lives.’
Karma is one’s action ofthe past that effect upon thepresent and the future. We are the total of the our own
karma, of our thoughts and deeds. So we all areresponsible of our own mind and action.
The law that shows the cause of one thing leads toanother. Like a drop of water into the lake, leads tocircles of water and spreads over all.
Samsara is the endless cycle of rebirth, after one’s
death there will be a new birth, a new existence depends
upon the state of mind of the person.
Meaning means every single step we make will effectman and nature, at all times, both present and future.
The law of dependent origination is a key principleof Buddhist teaching: that all phenomena arise independence upon other phenomena: “if this exist, that...”and the root of all is ignorance.
The law of causality says nothing exists on its own, but
always has come from earlier circumstance. Everythingis always a consequence of something before, that is theorigin of everything is not unique, it is dependent on aparticular set of circumstances having happened. It isrelated to cause and effect, everything is related andinterconnected to everything else.The Buddha saw theinterdependence of all life, and the cause and effectofactions which determine the future.
The five precepts and the law of cause and Effect arestated below. Why and How: Buddhist view on life, tolive a moral life according to the Dhamma : 5 basic laws
for humans to live peacefully in the society.

1.

not to kill or refrain from harming living
creatures; one will not get sick, healthy life canbe attained and have a long life.
2. refrain from not taking what has been given or
steeling; one will be able to live without being
punished by law.
3. refrain from sexual immorality; one will have apeaceful family life.
4. refrain from speaking falsely; one will live in atruthful society, nofalse information or
misunderstanding in the society.
5. refrain from taking intoxicants; one can live alife full of conscious at all times and not doing
any harm for oneself or others.
Scientists believe in the better state of human being,by trying to control everything, including nature.
Humans are the center of the world not as part of natureor the universe. In agriculture: to increase products anddecrease insects; these processes disrupt the whole
structure of natural surrounding. In medicine we try todevelop new genetic cures for cancer and manage theinherited genetic disease (animals and human are being
treated as a guinea pigs.)
Genome editing is one of a group of technologies thatgive scientist the ability to change an organism’s DNA.
These technologies allow genetic material to be added,
removed or altered at particular locations in the genome.
Several approaches to genome edition have beendeveloped. CRISPR/Cas9 is cheap and efficient. Can beapplied directly in embryo, reduces the time required
based on the use of embryonic stem cells. (2017)
In my opinion, human embryos are human beings. In a
paper from European Molecular Biology Organization:
EMBO Reports 2009 Apr: 10(4):301-306. by Robert P.
George and Patrick Lee - “human embryos are indeed
human beings and, as such, deserve a level of respectthat is incompatible with treating them as disposable
research material”.
Buddhist’s attitudes upon human embryo are basedon compassion to all is important principle in our action.
The unborn baby or embryo has the same status as anadult. The creation of life needs two elements: 1. thespiritual (nama) and 2. the physical (rupa) are
interdependent and cannot survive without one another.
The condition of the parents state of mind or
consciousness effect upon the embryo.If the father is in
the state of awareness or being conscious at the momentof conception the embryo is fully received theintelligence from the father, and if the mother is fully
aware at the moment, the embryo is fully enriched bybeauty and health. So the state of mind of the parent arevery important.
Buddhism condemns any use of human or non-humansentient life by geneticists or others. That we should nottreat other beings as an objects or tools against theirown wishes or aspirations, such as pigs, rats, and manyother kinds of animal or even human being are used forexperimentations.
First precept of the Buddha: not to harm and respect
all life. Human embryos have to be respected, cannot be
used as a means to an end, as they have life, feelings andwanting to survive without getting hurt.

Eubios Journal of Asian and International Bioethics 29 (January 2019)
There are doubts in genome editing, as stated by
Ellen jorgensen: CRISPR: DNA cutting and replacing. She
raises auestions and doubts: 1) We do not know thatmuch about cells and virus to put into CRISPR yet. 2)
The experiments on CRISPR still have a long way to go,
and people miss took for something easy and cheap.
There are many scientists being supported by many
companies expecting results that can change the newstate of mankind. (Are we being driven by desire andprofit, for fame and fortune?) 3) We should be very
careful of the experiment both the outcome and theeffect upon the planet.
Do we have the right to control evolution oforganism in our environment and our own organism?
Buddhism stresses the importance of knowledge toreplace ignorance. The knowledge means to understandnature, not to control it. To understand nature andrealize three characteristics of all things throughmeditation ( the changeable of all things, the suffering,and the no-self ) these knowledge came from within,when one’s mind is still with the present then able torealize reality of all things.
If one can develop the inner self peacefully throughmeditation, then sickness or any disease cannot harmone; as he or she can accept death as it comes without
any stress as it is a fact of life. Death is just a passing
state of life. Which means we try not to change theenvironment, but to know the inner self and understandwhat life is, then we will live fully in harmony withnature, not to change nature but to live accordingly withnature with peace of mind. We have no right to control
nature but accept it.
In closing let me quote,
Limit of man
Tell me where my limit lies,
So I may go up to it and knock just so gently to show I
am human.
Montri Umavijani, As Old as the World
We should understand our own limitations, and livewith it.

31

named “THOTH”. It was forbidden knowledge by highsociety in ancient Egypt. The seven laws are:
1. Mind
All is mind; and everything is energy. The universe ismental. Sometimes dreams can be the foundation ofsomething that we want to make happen. The universe iswithin our mind “We are what we thought” How can wemaster our Mind? Mind is moves in waves. It responds toour thoughts, sensations, and encounters. It peaks andebbs in a series of highs and lows. It can come fromintuition, old patterns, or even from misinterpretation. It
can also come as a truth, which requires the light ofawareness.
We also have to exercise our mind. From my 2017
research with 240 people from 9 countries, over half
said that they meditate or pray everyday. I think this is
one way to train our mind.113
Also nowadays we have many courses about mind
that you can learn by yourself on social media. This isvery important to live in a complex world, like this era.
2. Correspondence
As above, so below; as below, so above. This principle
states that there is a harmony, agreement andcorrespondence between these planes, delineated as The
Great Physical-Mental-Spiritual Plane –This is reflecting
congruent quality.
3. Vibration
Nothing is stationary, and everything vibrates; giving
off light or sound. This principle explains that thedifferences between different manifestations of Matter,
Energy, Mind, and even Spirit, are the result of only
different "vibrations".
A popular modern celebrity, Oprah Winfrey, talks
about vibration. She interviewed Esther Hicks on the
topic - Are We Ready for the Word "Vibration"?...They
talk about when you are appreciating, or when you are
loving, or when you are acknowledging the value ofsomething, you are in that moment, a vibration. Match tothe source that is truly you.

The Power of Life: Ethics and theSeven Universal Truths- Ananya Tritipthumrongchok, Ph.D., MSc, MBGPH
Vice-President of the Asian Bioethics Association,
Thailand; AUSN Professor of Fortune Telling andLeadership Development
Email: ananya@eubios.info
Seven Universal laws
There are many forms of wisdom that humansocieties have used in the past. Are there governing rulesof life that make us happier? More successful? What are
guiding principles of bioethics? I want to consider theuse of the 7 Universal Laws approach in bioethics. We
need the power of life and this is linked to the love of life.
More than a thousand years ago in Egypt, people
found a secret buried in a tomb, called the 7 Universal
laws. It was inside the Emerald Table of Atlantis, and

4. Polarity
The idea that everything is dual, everything has twopoles, and everything has its opposite. All manifested
things have two sides, two aspects, or two poles.
Everything "is" and "isn't" at the same time; thus
extremes meet. We can compare this to the famous
Chinese philsophy of Ying & Yang
113 Ananya Tritipthumrongchok, 2018. Enhancement of Mental

Health through Fortune Telling, PhD Dissertation, AUSN.

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Eubios Journal of Asian and International Bioethics 29 (January 2019)

The movie the Singularity Principle (2013) is a feature
length science-fiction film about the consequences ofrenegade experiments into Parallel Universes. It’s soamazing and interesting. They do an experiment thatcreates a portal between parallel universes and learn
how to reproduce and control the physical processes.
5. Rhythm
All is ebb and flow; as demonstrated by action andreaction, a swing backward and forward. This principle
explains that there is rhythm between every pair of
opposites.
6. Cause and EffectNothing happens by chance, everything happens
according to the law. There is a cause for every effect,
and an effect for every cause. “What goes around comesaround.” Should we treat disease? There is a tradition oftreating the sick with compassion and medical treatment,so the principle of Cause and Effect does not mean that
we should not apply medical treatment. This will include
genetic therapy.
If we believe in karma, should we edit the genes ofsomeone conceived with a genetic disease? I did
research in 2018 on attitudes in Thailand and thePhilippines – and people did not link genetic disease andkarma. When we asked about “When a baby is born witha disease or disability, what do you think is the cause?”
50% said it is because of genetic disease; while 17%
said it was random; 14%, said it was something bad themother did; 14% said it was because of karma, and 7%
something bad on the father’s side.

I have friend who lives in South Africa, she is German
and uses holistic healing to treat people, doing balancing
when clients have symptoms. Also using Hypnosis toheal a mind when they get stress and depression. It
works quite well because some clients come back to visit
her and she still get more client from referrals. Theircommunity is called Centre of Universal Mind that looks
like church, having a mind training course every week.
We also have to explore how to challenge theboundaries of current science, for example, Dr. Emoto
did an experiment saying water is more than simply aphysical substance. He reported positive changes towater crystals can be achieved through prayer, music, orby attaching written words to a container of water. The
research indicates that human vibrational energy,
thoughts, words, ideas, and music affect the molecular
structure of water. He is a Japanese author andentrepreneur, best known for is claims that humanconsciousness has an effect on the molecular structure ofwater. We should explore new ideas in science throughresearch. It is interesting if it is verified because watercomprises over 80% of a mature human body and covers
that same amount of our planet.
Conclusion
We are born in the world because of some reason. We
are born to learn, to give, to take and realize to present
then everything will be manifested. We are a gift of God
and we can make life better and happier. Nothing is
impossible, everything is related to our Mind, Physical,
Mental, and Spiritual that we call the “Law of Universe.”

Legal & Ethical Issues in Modern
Medical Research and Procedures:
Cultural, Religious & Political
Considerations. Israeli Society as
an Example

7. Generation
Generation is manifested in everything; andeverything animate or inanimate, is both masculine andfeminine (Physical, Mental, and Spiritual).
These
represent different aspects on different planes. It is also
stated that everything and everyone contains these twoelements.
How do we apply these truths?
We have different laws in different cultures even withstrong influence from Buddhism. In the case of Thai
society, a woman can not be a monk, only a man can be.
But in other countries including China, South Korea and
Sri Lanka, Buddhists allow woman to be a monk.
Theravada Buddhism is the religion of 70% of the
population of Sri Lanka, as in Thailand, yet they havedifferent rules to Thailand.

- Tamar Gidron, J.D.
Research fund, Zefat Academic College, Israel.
Law School, Head of Zefat Bioethics Center, Zefat
Academic College, Israel
Email: tgidron@netvision.net.il
Introduction
Biomedical technology is rapidly pioneering new
research and methods that are eventually going to makea huge change in almost every aspect of human life. At atime when a professional term like CRISP-Cas 9114 is
being used familiarly by laymen; and a Chinese doctor
announced that he has just successfully gene-edited twinbabies, Lulu and Nana115, it is high time for lawmakers to114

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4089965/;https://www.researchgate.net/publication/315926787_Geno
me_Editing_with_CrisprCas9_Systems_Basic_Research_and_Clinical_Applications
115 https://www.indiatoday.in/science/story/first-geneticallymodified-babies-china-he-jiankui-1396429-2018-11-26;
https://www.zdnet.com/article/meet-lulu-and-nana-the-Eubios Journal of Asian and International Bioethics 29 (January 2019)
step in. While we already have a handful of bothinternational treaties and national laws that regulate key
dilemmas that the new technologies produce, these legal
tools, although essential and valuable, lag behind. In fact,technology always precedes the law. The law reacts totechnology. It regulates knowledge and restricts its use.
The ongoing race between the right to privacy andmodern technology can serve as a good example. In fact,
He’s 116 groundbreaking and controversial statement
about Lulu and Nana’s birth, serves as a perfect reminderthat the new eugenics and human gene editing should becontrolled regulated and managed by strict oversightand supervision.
This note’s purpose is to highlight – in a nut-shellone of the most problematic hurdles that lawmakers
around the globe face in this quest of the law to tametechnology. While technology is global, the law is mostly
local. Technology has almost no boundaries- CRISPRCase9 is used in most modern states likewise-the law has
to take into account political, social, religious andcultural considerations. Even in this relatively new fieldof genetic testing and manipulation, we already witness
vast differences between national laws andregulations.117
The formal and informal discourse between global
modern medical technologies, and local, cultural, socialand religious norms and values, is illustrated in this noteby various examples taken from Israel’s multicultural,
diverse society.
Israel as an illustration of a multicultural society
While in a crossroads between old and new, between
longstanding traditions, religions and cultures, modern
knowledge, and changing norms and values, lawmakers
and policymakers have to be thoughtful and sensitive. All
the more so when it comes to complicated multilayered
societies such as the Israeli society. Here, extra caution isessential.
Here are some basic data118. The whole of Israeli
Jewish population is 6,668.000, 74.3% of the Israeli
population. 75% of the Israeli Jews were born in Israel.
17% in Europe and America, 8% in Asia and Africa. 35%
are religious/orthodox.
The whole of Israeli Arab population is 1,878,000,
29% of the Israeli population (including 400,000 in East
Jerusalem). 83% of the Israeli Arabs are Muslims. 8.4%
are Christian Arabs; Druze 1.7% (140,000). Others
include: 4% Circes, Russians, Baha’i, Ahmadiyya.
Within each of the groups, one can trace additional
layers of culture, background and roots, yet the format ofthis note dictates generalization. It is thus interesting to
see the dominant trends and the relativity in acceptanceof new technologies and medicine in a multifacetedworlds-first-reported-gene-edited-children/
https://www.zdnet.com/article/meet-lulu-and-nana-theworlds-first-reported-gene-edited-children/
116 https://www.technologyreview.com/s/612997/the-crisprtwins-had-their-brains-altered/
117 https://www.cnbc.com/2018/11/26/chinese-crispr-babygene-editing-criminally-reckless-bio-ethicist.html;
https://futurism.com/scientists-condemn-crispr-babyexperiment
118
The
Israelicenterfor
Statistics.
Jan.2019
https://www.maariv.co.il/news/israel/Article-659897

33

community such as the Israeli one.
In the following sections, I shall present a few
examples of the ethical and legal dilemmas in cases thatinvolve ethics, law, modern medicine and cultural/religion values and beliefs.
Politics and law set aside and give way tohumanitarian and ethical practiceFor 6 years, 2012-2018 Israeli hospitals in thenorthern part of Israel have been treating Syrian men,
women and children in what is now known as “operation
good neighbor”. 119“Some 1,000 children have been treatedin Israel since the operation began, including 687 in 2017
alone. About a dozen babies have been born in Israel to
Syrian Women” 120 The patients suffer from
Tuberculosis/Hepatitis B, C, many were diabetics, andmany suffered from limb amputations, burns andblindness. The ethical issues were serious: how do you
communicate? What language? How do you get consent
to medical treatment- let alone an informed one? How doyou supply medical care with no medical records andhow do you overcome patients’ trauma without family
support? Moreover, when finally it is time to discharge
patients, where do you send them and how do you makesure they will get the proper conditions needed?
Yet above all these medical and ethical issues, there isalways the crucial, sometime cruel, dilemma of thestandard of care provided in these cases. International
humanitarian law provides for a standard procedure:
preserve life and alleviate suffering. In the case of thewounded Syrian person, for example, whose leg wasseverely damaged, it meant amputation, relatively swift
recovery and a journey back home. His hospital bed wasneeded for other Syrians. However, that was not what
happened in reality. All the Syrians patients, bothmilitary and civilians, were treated according to theIsraeli legal standards, the best possible medical carewhatever the cost and extra care was taken to make surethey go home in good shape and with enough medical
supplies. The decision to apply the more sophisticated –and costly- standard of care shows that notwithstanding
political and financial issues, highest ethical values
prevailed.
Ethical and religion-based values lead to a change inlaw- the wrongful life case.
The problem of the “wrongful life” cause of action has
attracted a heated debate over the last few decades inmany legal systems. Legal, ethical, religious and social
values play very important roles here. “Wrongful life
claim” is a claim brought by a child that but for anegligent – usually genetic- medical examination thatfailed to detect his physical faults while he was still a
fetus, he would not have been borne. In such cases, theSalman Zarka,Morshid
Farhat & Tamar Gidron
Humanitarian medical aid to the Syrian people: Ethicalimplications and dilemmas, Bioethics 33 (2) 302-308 (2019)120https://www.jpost.com/Magazine/Operation-GoodNeighbor-540359
https://www.haaretz.com/israel-news/.premium-withborder-now-closed-wounded-syrians-face-uncertain-future-inisrael-1.6479187
https://www.cdc.gov/immigrantrefugeehealth/pdf/syrianhealth-profile.pdf
119

34

Eubios Journal of Asian and International Bioethics 29 (January 2019)negligence is not the cause of the defect. The negligenceis the cause of pregnancy or the cause of keeping the
pregnancy. Had the parents known of their child’s poor
prospects to have a normal life due to some, usually
genetic, defect, they would have aborted him. In suchclaim, the child is really saying, “I am better dead thanalive”.
In 1986, the Israeli Supreme Court allowed the“wrongful life” claim to proceed121 following a heated
and bitter debate in which moral and ethical issues wereapplied. Comparative law and Jewish law were deeply
employed. The doctor who misdiagnosed a Huntington
disease was found liable to both the child and theparents. The secondary problem of the amount ofdamages- how much should the negligent doctor pay forthe miserable life has not been cleared during the years
that followed. For 34 years, Israeli tort law allowed suchcases to proceed, along with claims brought by thegrieving parents for their personal and financial loss.
Eventually, in 2012, the decision was changed122. The
Supreme Court decided that “wrongful life” cases would
no longer be recognized. Instead, the parents will beentitled to most of the damages the child could haveclaimed. The decision was based mostly on ethical values
and religious beliefs. The notion that life can be a“damage” was too unbearable to Jewish beliefs. In
addition, the slippery slope that the 1986 decision
opened, lead to unethical and unreasonable situations
and decisions. The prospect of a society in which too
short or too tall children, red haired youngsters andbabies having only 9 fingers instead of ten can sue andsay that they’d rather not been born 123 , wasfrightening124. Some very important parts of the decisionof the Supreme Court are socio-ethical texts.
Acceptance and use of modern medical technologies
by orthodox religious societies.
Israel is a pro-natalist society. Reproductive
technologies are funded by the state and encouraged.
Even orthodox Jews and religious Arabs and Druze are
receptive to in-vitro fertilization (IVF) and preimplementation Genetic Diagnosis (PGD). The first
Israeli IVF baby was born in 1986 and has just recently(2019) given birth to healthy twins. The IVF unit at the
Galilee Medical Center that was launched in 2013 hasrecently celebrated 100 successful pregnancies in 4
years. At least 50% of the pregnancies are Arabs andDruze. Out of the 50% Jewish pregnancies, thepercentage of orthodox couples is notable. On thecelebration at the Galilee Medical Center, the Jewish
Minister of Health and the spiritual leader ofthe Druze community in Israel, Sheikh Moafaq Tarif, bothvery religious persons, sat side by side at the front row
121 C.A 518/82 Zeitsov v. Katz (1986)

122 C.A 1326/07 Hamer et al. v. Prof. Amit et al., (2009); See

also,
Sagit
Mor,
http://law.haifa.ac.il/images/Publications/Sagit_Mor__The_Dialectics_of_WL_and_WB_-_Print.pdf
123 Nili Karako-Eyal, “A Critical Disability Theory Analysis ofWrongful Life/Birth Actions in Israel”, International Journal ofPrivate Law, Vol. 6, No. 3, 2013.
124 On the other hand, orthodox Jews oppose abortions
whatever the cause.

and gave their blessing to the Head of the Center, Dr.
Barhum.
The legal issue of ownership in frozen pre-embryos
was one of the most significant decisions of the Israeli
Supreme Court in the last few decades. A divorced
couple were fighting over their pre-embryos. The man,
who had remarried and had a child with his new wife,
objected to being the father of the pre-embryo. His wife
won at the Supreme Court. The Court favored thewoman’s right to be a genetic parent and allowed thefrozen embryos to be implanted in a surrogate (thewoman who was the genetic mother had underwent ahysterectomy while they were still married). 125“Embryos
represent the very existence of potential life,” said the
Court, voicing the Jewish well-established value ofsacred human life.
Post humous conception dilemmas have also
produced yet another interesting case at the Supreme
Court. Here, a widow of a deceased Israeli soldier, who
first consented to posthumous conception, changed her
mind and refused to go along with the initial plan. The
dead soldier’s parents asked the court to allow them to
use their son’s sperm for another woman. The Court
declined. Although Israeli law presumes consent for
posthumous sperm procurement and conception126, andalthough the deceased had signed a written consent, thewidow is the one- the court said- to have the final
decision. Parents will be able to apply only in special
circumstances.127
Israeli law also allows sperm separation and sex
selection of pre-embryo by PGD, mainly for medical
reasons. Although forbidden by some orthodox Jews,
Arabs and Druze, the procedure is still relatively
widespread amongst all of Israeli society. Yet it isinteresting to note that according to the statistics
published by the Israeli Committee for sex selection128
there is a sharp distinction between Jews, where numberof male and female preferences is equal (50%-50%) andArabs- 100% male.
Patient Autonomy- a unique feature of Israeli law
The legal regime which governs protection ofpatient’s autonomy, reflects the balance between
personal human rights on the one hand and otherinterests- personal and public- on the other hand, thateach society choses to adopt as an ethical and legal
compass in safeguarding human dignity and freedom.
The Israeli patient’s autonomy law clearly reflects anunprecedented and exceptional choice.
In a seminal case in the 1990s,129 the Israeli Supreme
Court created a unique head of injury within theframework of the general tort of negligence -an injury to
personal autonomy. Thus, when a patient is able to prove
125 ACH 2401/95 Nachmani v Nachmani(1996)

126 https://www.health.gov.il/hozer/mk20_2007.pdf

C.A
7141-15
Plonitv.
Ploni(2016)
https://hartman.org.il/Blogs_View.asp?Article_Id=2332&Cat_I
d=275&Cat_Type=Blogs
127

128

https://www.health.gov.il/Services/Citizen_Services/Pages/gender.aspx
129 CA 2781/93 Miassa Ali Daaka v. 1. Carmel Hospital, Haifa 2.
Health Fund of General Association of Workers in Israel(1999)

35

Eubios Journal of Asian and International Bioethics 29 (January 2019)that the consent given in a certain set of circumstances
does not qualify as an informed consent, the right tocompensation arises. The patient needs not even provethat had the doctor performed the duty to fully explain
all the pros and cons of the medical treatment, he or she
would not have agreed to the treatment. In other words,
the right to compensation is not dependent upon proofof causation. The fact that the information does not meetthe standard of the reasonable patient in a similar
situation and does not fulfill reasonable expectations issufficient to justify liability in tort.
The new head of injury soon became the mostsignificant feature of Israeli medical law. It fitted
perfectly with Israeli notions of patient centered
medicine. Ethical notions heightened the benchmark andthe law soon followed. This, in turn, opened the gate foryet an additional Israeli legal distinctive development:
liability for breach of consumer autonomy via classactions. The first defendants were monopolies like Bezek(communication)130 and Tnuva (dairy)131 and soon after,a stream of medical consumer class action followed. The
cause of action was premised on the Consumer
Protection Act 1981 combined with the Class Actions Act
2006. The dominant feature of most of the cases was theclaim that consumer autonomy was breached by
misleading and wanting information. Autonomy becamevery expensive,132 and Israel, despite its small size, has
become one of the world’s leading class action breeding
grounds.”133
Lately, due to some evolving new trends in Israeli
legal arena, this phenomenon came – at least
temporarily- to a halt. The main example of these new
trends is the well-known case of the Eltroxin – a Thyroid
drug used by over 300,000 Israelis. Here, the (then)District Court justice, Prof. Groskopf, now sitting in theSupreme Court, decided that only those patients who
suffered physical damages such as pain and suffering
because of the change in the ingredients of the drug, areentitled to compensation from Perrigo, the drug
manufacturer. ‘Pure’ breach of autonomy does not
suffice. 134
This decision, no doubt, calls for a re-assessment of
the legal opposing considerations in the realm ofautonomy protection at large and medical autonomy inparticular in Israeli private law.

Genetic-Engineering/Genetics by design/ Cloning
Modifying the human germ line has profound
implications and must be approached with extraordinarycare.135 Yet, human germ line editing offers ‘bright future’
if done carefully136. It is then quite clear why 29 of the 47
member states of the Council of Europe human-rights
organization, have ratified the 1997 Oveido
Convention, which prohibits genetic modification of
reproductive "germ line" cells. Moreover, reports by the
U.S. National Academies of Sciences, Engineering andMedicine in 2017 and the U.K.’s Nuffield Council on
Bioethics in 2018 concluded that human trials of editing
germ line cells should be used only to fill unmet medical
needs and benefit those whose genes are altered.137
Israeli law, which came into force in 2016, prohibits
human cloning and gene-therapy until 2020, when theissue will again be open for debate.138 From a religious
point of view, again, Jews, Christians, Muslims and Druze
all believe that: “Thou shall not play God”. In addition,according to Judaism, “mixtures” (Kil’Ayim) are strictly
prohibited. Nevertheless, human gene engineering
receives a moderate approach. 139
It is, accordingly, interesting to note, even by contrast,that genetically engineered crops in agriculture are notbanned. Moreover, at least one of Israel’s mostprominent Rabbi, who is also an expert in Bioethics, Rabi
Yuval Sherlo, is even ready to allow Orthodox Jews to eat
genetically cloned pig, including when eaten with dairy
products.140 This, however, is still subject to a heateddebate,141 yet whatever the conclusion, it is maybe best
to conclude with the following:“Jewish bioethics emerges from the practicalapplication of Jewish law to ethical questions incontemporary medicine. A central tenet of Jewish law,which takes precedence over virtually all other religious
commandments, is that a human life has infinite value.
The duty to help heal the sick and prevent disease is sooverriding that the Mishnah, the oral law, says: 'He whosaves one life, it is as if he saved the whole world.' This
moral imperative to restore health and prevent disease is
therefore a fundamental starting point in Jewish
bioethics… One of the biggest ethical concerns aroundgenome editing is that it will be exploited for unnecessary
human enhancement through so-called 'designer babies'.
The morality of enhancement, and determining when anintervention crosses the line from being therapeutic to
135 https://www.scientificamerican.com/author/e-paul-zehr/
136 E. Paul Zehr | Scientific American | January 24, 2019

130 S.C.A

5712/01 Bezeq , Israeli Communication Co. v.
Barazani (2003)
131 C. A. 10085/08 Tenuva Central Coop for the Mktg of Agr Prod
In Israel Ltd v. estate of Rabi (deceased)( 2011): (Tenuva (II))
132 CA1338/97 Tnuva Cooperative Center for the Marketing ofAgricultural Produce in Israel Ltd. v. Tawfik Rabi & Ors., (2014)133 http://www.meitar.co.il/files/pdf/ftd-1809-peleg-gilon.pdf
134 A few months ago, in 29/11/2018, the case was settled for
47 million NIS. One of the main reasons for the decision to
exclude breach of autonomy that stands in contradiction withprior decisions in this case, was an important paper publishedby one of Israel’s leading expert in tort law, Supreme Judge
Amit, who called for a re-assessment of the whole regime ofpatient autonomy at large and in class actions in particular:
Izhal Amit, “The new wild horse of patient autonomy” in Justice
Shtrasberg-Cohen Book, 2018.

137https://journals.sagepub.com/doi/abs/10.1177/1073110518822001?
journalCode=lmec
138 Prohibition of Genetic Interfeering

2016(Human Cloning) Law

https://www.kipa.co.il/%D7%A9%D7%90%D7%9C%D7%90%D7%AA%D7%94%D7%A8%D7%91/%D7%A9%D7%99%D7%91%D7%95%
D7%98-%D7%92%D7%A0%D7%98%D7%99%D7%95%D7%94%D7%A9%D7%91%D7%97%D7%AA%D7%91%D7%A0%D7%99-%D7%90%D7%93%D7%9D%D7%A2%D7%9C-%D7%99%D7%93%D7%99%D7%94%D7%A0%D7%93%D7%A1%D7%94-%D7%92/
140 http://www.israelnationalnews.com/News/News.aspx/243481
141
https://www.theyeshivaworld.com/news/israelnews/1500262/tzohar-rabbi-is-incorrect-lab-grown-pig-meat-is-notkosher.html; http://thejewishvoice.com/2018/03/26/nothing-koshercloned-pig/
139

Eubios Journal of Asian and International Bioethics 29 (January 2019)

Introduction
Half a century ago the best-selling environmental book
was The Population Bomb by Paul Ehrlich. [1] The humanpopulation then was half what it is it now. Actually therate of growth continued to rise for at least two decades
and only recently has the rate stabilised. [2] Nowadays
the issue of ever increasing human population and its
burgeoning impact on other pressing global concerns
appears to get less attention than finding technical or
economic remedies for environmental challenges. For
example, in a recent interview with the Dame Georgina
142 https://www.bionews.org.uk/page_95782

41
25

25
5

3
-1
08

03

-0

7

2
-2

20

00

7

98

4

19

19

93

-9

2
-9
19

88

-8

7

2

20

6

83

Abstract
The human population is still rising at nearly an
exponential rate. The consequence of this has impacts on
the environment and sustainability. Some policies tocontrol population growth infringe on human rights asthey are coercive. By not acting then the CatastrophianAge cannot be prevented. This paper outlines somegeological features of what rock strata would like fromthat age. The author then illustrates how using nudges
from behavioural economics could be the way forward to
avoid the onset of this age. This does not rely solely on
governmental policies but involves non-governmentalorganisations and suggests the role social media
providers could have, as part of their social
responsibility, to nudge users to reach millions ofteenagers worldwide.
Key words: Catastrophian Age, nudge, behavioural
economics, population growth, human rights, social
media

50
40
30
20
10
0

2

- Alex Waller, PhD
Khao Yai International School, UK/Thailand; AUSN Visiting
Professor of Science Education and Environmental Ethics
Email: arwaller1@hotmail.com

19

Preventing the CatastrophianAge: Mechanisms to negate theneed of lifeboats-8

Conclusion
Biotechnology’s worst foe is illiteracy. It’s mostcomplicated challenge is containing and resolving doubts,
fear and prejudice. Culture, religion, even history, should
be taken into account when laws and regulations are
created. Ethical considerations should govern science. A
better and healthier future is within reach if science ismanaged sensibly and sensitively.

Mace, the head of the Biodiversity and Environmental
Research Centre at University College London noreference was made to human overpopulation when
discussing the worldwide biodiversity crisis. This is
despite the fact that the highest density of biodiversity isfound in some regions where human population growth
rates remain high and therefore the biodiversity in thoseareas is potentially under greater threat. Yet she clearly
did state that the development of society andenvironmental sustainability are inseparable. [3] In asimilar way the World Energy Outlook 2018 makes noreference to the pressure of populations growing at a
rate of 82 million per year on future supplies, technology
shares in the energy economy or policies, yet it
announces that in 2017 for the first time less than one
billion people had access to electricity. [4] An absence of
proof is no proof at all. Yet the number of publishedarticles referring to “overpopulation” in the journal
Environment and Population peaked in the 1990s and has
dropped dramatically since then as shown in Figure 1.
In 2017 Robert Greene asked: “Why are we spending
billions on energy retrofit programs, climate change
research, environmental consultants, and conservation,
when we are spending next to nothing to slow down
population growth? We're putting a lot of resources into
energy efficiency, but all that goes to vain when we ignore
rapid population growth." [5]78

non-therapeutic, is subjective and open to differences insocial and cultural norms. However, from a Jewish
bioethical perspective, the argument for permitting
genome editing rests on the moral imperative to restore
health and prevent disease. Once an intervention is nolonger therapeutic this moral imperative is removed, andwith it the possibility of outweighing the ethical and safetyconcerns….
…… From a Jewish bioethical perspective, the enormous
potential of genome editing as a therapeutic tool provides
strong support for the moral imperative to continue
research.”142

19

36

Figure 1: The number of articles referring tooverpopulation in Population and Environment 1978 –2013
Catastrophian Age
Diamond (2005) describes at least six factors resulting
from or related to population growth that initiated,compounded and catalysed the collapse of former
societies such as the Roman empire or the Mayan
civilization. These are, in no particular order; soil
depletion or soil quality reduction, habitat loss such as
deforestation, over hunting or over fishing, water
management issues, the effects of alien species andincreased consumption per capita. [7] Since Crutzen andStoermer (2000) defined and popularised the term
“Anthropocene” as being the period during whichhumans have noticeably impacted the patterns ofgeological erosion and atmospheric chemistry. [8] This
paper suggests that this could end with a subunit of time;
namely the Catastrophian Age. Alternatively, this age
could be the start of longer and subsequently barren,with sedimentary rock strata devoid of fossils anddecreased
rates
ofcarbonatedeposition,
Catastrophocene Epoch. Either way the Catastrophian
Age would be seen in the soil layers of the (hopefully
distant) future or subsequent rock stratum as a narrow
band with deposits that will show the remain of
megacities from around the world and the latest point atEubios Journal of Asian and International Bioethics 29 (January 2019)
which plastics (except for microplastics) are to be foundin environmental debris. There would be a different
demographic distribution in the age of human skeletonsand a peak in human populations, earlier geological ages
will indicate increased longevity and exponential
populations in the middle to late Anthropocene. Younger
deposits above the Catastrophian stratum may not becompletely bare from fossils but the recorded
biodiversity (especially that of vertebrate species) would
be dramatically reduced compared to those of the early
Anthropocene, the latter would also have relatively
thicker strata as they were laid down over acomparatively longer time period. An extended list of
events that would occur in the Catastrophian Age will belikely to include disease pandemic or syndemic, resource
depletion, energy consumption, soil or water and air
pollution, in addition to climate change induced
disasters. Collectively these stressors will haveenvironmental, economic and political consequencesthat will impact on individual and societal wellbeing.
This would result in dramatic population decline andsocietal breakdown. The 1972 report by the Club ofRome, The Limits to Growth, predicted that thisCatastrophian Age would be reached within one hundredyears. We are fast approaching the midway point in that“century”. How prescient many of their forecasts are
unfolding to be, as our population has already doubled
since that time. Ury (2011) says that these effects will
have greatest significance for societies in megacities withdisastrous inequalities and urban slums. [9]Kidner (2001) puts it like this. “For caged animals,
almost any behaviour except withdrawn passivity and a
resigned acceptance of the invisible bars that constrain
our natural predispositions will appear as, and often will
actually be, antisocial or destructive.” [10]He continued by quoting from Lasch (1979),“Outwardly bland, submissive, and sociable, they may
seethe with inner anger for which a dense, overpopulated,bureaucratic society can devise few legitimate outlets.” [11]His conclusion is a call for long-term population
reduction. Similarly neo-malthusian and neo_darwinianarguments are voiced by characters in novels by such as
writers such as Morgan (2013, 2019).143
Population Policies
The insights revealed in the IPAT (impact = population
x affluence x technology) formula developed by Ehrlichand others has influenced sustained efforts to seek
technological solutions such as the recent expansion in
research, development and adoption of renewableenergy technologies to address climate change and / orcarbon fuel resource depletion. Yet, not surprisingly,
there has been less focus on addressing either affluence
or population levels. Indeed, to some extent, a measureaffluence associated with economic development,
became more acceptable as a right. The WCED (1987)
Brundtland Report Our Common Future famously definedsustainable development, but in practice since thenemphasis has been an entitlement to develop withlimited stress put on the “sustainably” proviso. The 3R
mantra reduce, reuse, recycle gained worldwide
momentum as landfill waste piled up and technologies
143 Terry Morgan has written a number of novels that havethemes surrounding the issue of population growth such as
Prisoners of Conscience and Circumstance (2019) and The
Malthus Pandemic (2013). For more information please visit
www.tjmbooks.com

37

along with developing infrastructures have maderecycling economically viable and competitive. However,it was not until our TV screens and social media threads
were blasted with emotive images of turtle nostrils
speared by non-degradable drinking straws andpicturesque ocean scenes spoiled by plastic trash islands
that a fourth R for Refuse (the verb) was considered.
Sustainability is gaining track as a new environmental
ethic, but is this regarded as a tough absolutist maxim tolive by or a conscience absolving indulgence of a growing
middle class in affluent countries. There may well belittle ethical objection to a reduction in affluence in somesocieties, the resistance to implement policies has roots
in socio-political relations. Cripps (2015) provides a clear
argument it must be taken as given that if we aim toallow for development in the less developed countries
then the environmental impact of that cannot be ignored.
This raises the more morally challenging questions
surrounding population control, but that does not mean
we should shy away from them. Consideration from anenvironmental ethical perspective gives new insights.
Before the end of the last century and into the first
decade of this century thinkers, such as Haila (2004),
were highlighting flaws in Ehrlich’s arguments thatsequentially linked biodiversity loss to humanpopulation growth. However, Haila did not say that
population levels would not impact on biodiversity, butthat if it is seen as the primary driver then pragmatic
solutions to solve the biodiversity crisis will not work,
short of surgery on the tumour that is causing the disease. [12] Lawton (2007) put the largely limited wide scaleconservation successes down to policy failures listing
eleven reasons mostly related to socioeconomic factors
and political processes. [13] This illustrates that morethan mere scientific knowledge is needed to make anabout turn to see human population numbers decline letalone stabilize.
Coole (2018) summarizes four arguments for
population stabilization being developmental, existential,
environmental and economic. [14] The first relates to
how the pattern that countries which maintain highrates mirror slower development, but can be seen
merely as a viscous circle. Secondly she referssociological and psychological consequences of highdensity living. The environmental problems of
biodiversity loss, pollution, loss of wilderness, ecosystemservices and so forth are manifold. The economic
arguments are made more powerful as ourinterdependence within the biosphere is more
understood, external costs of ecosystem are accounted
for and the financial impact of climate change extreme
events and climate change become increasingly
apparent.
Cripps classifies population control policies into three
categories. Firstly, directly coercive approaches that may
include forced surgery to prevent conception, birth oreven infanticide violate human rights. Incentive changing
policies which maybe softly done through education or
positive financial incentives or through moredeterminedly through fines or restricting tax benefits of
having additional children. Thirdly by providing
contraception, family planning education andemployment opportunities population stabilization
could be achieved whilst ensuring justice for women. [15]Coercive strategies such as the one child policy inChina and forced sterilization of certain women and over
six million poor men in India [16] do not endear liberal
thinkers and have possibly given greater voice to38

Eubios Journal of Asian and International Bioethics 29 (January 2019)

arguments against central government control in neoliberal democratic societies that in recent decades havepromoted individual rights. Hardin (1974) used a thought
experiment analogy of who to allocate limited spaces toin a lifeboat in a sea of floundering swimmers. [17] Did all
have an equal right to occupancy? By extension this was
proposed to justify securing aid to only countries thatagreed to implement population control policies asproviding aid alone would be likely to result inmaintaining high fertility rates. According to Bagini and
Fosl (2007), in the minds of many people, acts ofomission are equally morally wrong as acts ofcommission. [18] Denying aid for those in desperate need
met with criticisms of being racist, sexist as effectively
leaving no choice for women and increasing the sufferingof the most vulnerable. Coercive population control
strategies were not limited to less developed countries
alone. The 2018 film Amá depicts the impact of the USA
War on Poverty policy on native Americans in the 1960s.
[19]
Human Rights
Ethical arguments in favour of population control canbe framed in consequentialist terms based on the workof Mill. He referred to a variety of non-invasive laws thatwould contribute towards decreasing the rate of
population growth such as the age of marriage,
employment for women and universal access to
education. As children are future citizens they are not a
private “good” but either a potential resource or burden
thus society has a right to intervene in unregulated
reproductive rates if there is a risk to the greater good ofsociety at large. The question that arises is where is theboundary between policies that interfere with or limit
certain freedoms but allow informed personal choiceand coercive approaches that are likely todisproportionally affect already disadvantaged groups.
Bioethical principles identified in the Universal
Declaration on Bioethics and Human Rights (UDBHR) that
relate to arguments surrounding population control
include at least: human dignity and human rights,
autonomy and individual responsibility, social
responsibility and health, sharing of benefits equitably
and with respect for cultural diversity, protecting future
generations, the biosphere and biodiversity. Do any ofthese specifically address limiting population growth oris the cumulative effect of the UDBHR to enshrine therights to reproduce and good health? Surely policies
implementing the precautionary principle to ensure, atleast, a plateau in the human population are ofparamount importance prior to establishing other rights
if we are seriously aiming to account for future
generations as the UDBHR and Brundtland Reportrequire. There seems little merit in insisting upon
maintaining rights such an entitlement to have a child at
any cost if there is not, in all probability, going to be anenvironment or society that can support that child (orthe generations to follow) to live a life that is worth
living. I have not heard of a right to choose to havegametes genetically manipulated to deliberately have achild with a disability. Would that not be unjust for thechild and possible a “economic burden” on society?
Maintaining the right to have an unlimited number ofchildren could be justifiably met with similar objectionsat least.
Coole refers to arguments against fertility andmigration control from ecofeminist perspectives thatclaim that these sorts of population policies are masking

neocolonialist or patriarchal groups wanting to maintaindomination over certain social, ethnic or gender groups.
She also notes the neo-Kantian objection of GarciaMoreno and Claro (1994) to using women’s bodies as ameans to justify and end: “Women’s health and rights, notmacrodemographic objectives, are of paramount concern.”[20]
Macer (2010) reports that although bioethics has
assisted the development democracy in some countries
such as Japan, and that empirical evidence shows that
democracy is possible in different cultures he alsosuggests that a neo-Confusion ethos in some East Asian
countries may be the basis for institutional paternalistic
attitudes which are in conflict with civil rights. [21] If thisobservation is accepted then it may be assumed that
there will be less resistance to policy making bodies,
committees or government departments who propose
ideas that in western states would be met with suchstrong opposition that they would not “off the ground”.
Imagine a one child policy being suggested by a westernpolitical party fifty years ago. They would have been very
unlikely to get more than a few votes of public support.
However, China was able to roll out that policy, which
although would still be unpopular in the west, that now
provides a compelling source of data to inform current
debate and future policies other countries. In theepilogue of The Rise and Fall of the Third Chimpanzee
Diamond (1991) relates with cautious optimism that it
was in Indonesia, where democratic rule was notestablished in a western sense, that leaders took hold of
the vision for conservation of biodiversity. [22] A systemof nature reserves was established that covered a fifth ofwhat is now known as West Papua. Holmes Rolston(2003) argues that there is a case for putting animal
rights over human rights as we are the most destructiveof species. He cites the shooting of poachers in Zimbabwe,
where the right to life for endangered species takes
precedence over those of men for food (or money to buyfood), as one such example of this in action. [23] However,there is little evidence if the basis for this policy isactually founded on biocentric ethical principles or
enforcement convenience for an authoritarian
government. Political expediency often reflects bias,
bringing mistrust and ultimately policy failure.
Infringing
humanrightsandmaintaining
undemocratic power structures can inhibit people forvoluntary participation in schemes that would benefit
them and ultimately their nation at large. The following
story from a participant in a programme funded by theBill and Melinda Gates Foundation exemplifies this.
“When Silper Agandi, a cleaner at the Tupange-supported
Migosi Health Center in Kisumu, Kenya, was invited to a
training on family planning, she was sure there had beensome mistake. "Those things are always for the nurses anddoctors only--why would they ever want a sweeper to go tothat class?" she asked herself. But the 32-year-old mother ofseven is exactly the kind of woman the program hopes toreach. "We learned so much about family planning in thoseclasses." [24]Two advantages of non-governmental organisations insustainability projects is that they may more beperceived as having less of a hidden agenda byparticipants and therefore gain trust more easily. They
are also more financially independent, and some that are
run not-for-profit gain further credence for this. ThereEubios Journal of Asian and International Bioethics 29 (January 2019)
have been other independent organisations144 such as
the UK’s Royal Commission on Protecting theEnvironment, which according to Lawton was “working
to change the framework of the debate and seeking
ultimately to alter belief systems and deeply entrenchedvalues”. He identified that many of the factors thathindered the development of policies that wereconducive to sustainable use of the environment wererooted in politics at one level or another. [13] The Royal
Commission was closed due to budget cuts in 2011.
Behavioural Economics
The example from the Bill and Melinda Gates
Foundation quoted above illustrates the potential impact
of voluntary schemes and opportunities for nongovernmental initiatives over politically motivatedpolicy interventions. Corfee-Merlot et al (2007) note that
increasingly non-state actors actively promote andsupport sustainability and environmental issues. [25]
UNFPA, for example, accepts the responsibility to
educate, provide family planning facilities and safe
contraceptives strategy. [26] Social networks and social
media have been shown to influence behaviours andhave economic consequences. Bailey et al (2018) for
example show these networks influence investments in
the housing market and speculate at how networks must
contribute to behaviours across a number of settings. [27]Social networks are increasingly developed throughonline media, yet in many cultures traditional networks
can be sources to allow attitudes and behaviours toripple through society in similar ways to the economic
ripple effect of house prices in areas surrounding or
proximate to affluent conurbations. Shah, Sellman andMadon (2016) are conducting randomized trials on theimpact of adolescent girls attending youth clubs where
they are educated and rewarded for maintaining good
reproductive health. They already have seen that thiseconomic incentive has positive behavioural results andare now extending this to soccer clubs for adolescentboys. [28] The behavioural economics approach of
nudging people to refrain from impulsive behaviour has
already been shown to promote good health practicesuch as vaccinations, dietary improvements and cancer
screening. [29] Nudging has become a buzzword. Hertwig
and Grüne-Yanoff (2017) show that “boosting”
behavioural choices is less even better as it relies lessfrequently on financial incentives. [30] David Halpern of
the Behavioural Insights Team (BIT) gives several
examples of how behaviour has been nudged in a desired
direction without coercion, for example: “In India it has
been found that if you give workers their money in two
tranches they are more likely to save. It’s even more
effective if you give them the envelopes with pictures of
their kids on it, or if they have to tear that picture inorder to get the money.” These maybe individually
incremental changes but lead to noticeable or evensubstantial collective societal changes. [31]In relation to energy policy Evensen and Stedman(2017) postulate: ”…cruciallyforpolicyandcommunication – if perceptions of what is true (beliefs)
precede feelings (attitudes), additional information could
144 A comprehensive list of these may be found at The
Overpopulation Project website. This provides links to, somedetails and aims of over thirty organisations at national andinternational level, including UNFPA, Population Media Center,
Population Matters, Worldwatch, World Population Balance,
and the Center for Biological Diversity.

39

shape views… …yet, if attitudes precede beliefs, theusefulness of communication, either for influencing beliefs
or simply making the public more informed, is far lessclear”. [6]By this reasoning it would appear that the barrier todeveloping effective population stabilization policies isthat attitudes seem to precede perceptions of the realityof the situation. Therefore, it is imperative to initiate achange in such attitudes. Behavioural economics theory
provides some insights to achieve this.
The key for success of nudges and boosts is to target
the fast automatic neural response pathways governing
actions when people are driven by emotional cues
resulting in impulsive behaviour. [32] The BIT have four
key principles, namely “Make it Easy”, “Make it Attractive”,“Make it Social” and “Make it Timely”. [33] Chhabra et al(2015) make five recommendations to increase theuptake of family planning facilities in Uganda. These
include: lottery prizes, positive automated hotline
messages similar to those that have been shown toincrease voting, [34] call centre training guidelines, bringa friend e vouchers and sms reminders. [35] These are
aimed to reduce: hassle factors, cost concerns and fears
of breaking social norms. This goes a long way towards
changing attitudes as recommended by Evensen andStedman. The fear of breaking of social norms isparticularly important for teenagers in projects likethose of Shah et al mentioned above. The success ofinnovative projects in Africa where fertility rates arehighest and the unmet need of family planning provision
for teenage and youth is highest is of paramountimportance. Cottingham, Germain and Hunt (2012)highlighted how neglecting to provide accessible andrelevant health including sexual health facilities tomillions of unmarried male and female youth in Africa
and South America was a breach of human rights. [36]The use of behavioural economic theory and nudges bysocial media providers could be a mechanism to accessyouth, provide information and timely reminders
regarding family planning through non-coercive
strategies to enable choice and maintaining dignity.
Most attention and debate regarding population
stabilization surrounds issues arising from population
growth such as the right to life and fertility rates. At theother end of the human life cycle are similar questions of
the right to die with dignity. The Netherlands was thefirst country to legalize assisted suicide. There are a few
others where, under certain circumstances, this may notlead to prosecution, and in a small number of countries
such as the UK it has been debated in government.
Rachels makes the case that there is no ethical difference
from active and passive euthanasia and that actively
assisting someone, who is in great suffering, to die with
dignity is honouring their freedom to choose how andwhen to die. [37] There are active campaigners for thisdie with dignity both at national and international level,
including Dignitas, EXIT International and Dignity in
Dying; indeed thirty-eight such groups are under theumbrella of the World Federation of Right to Die
Societies. Not surprisingly there are many religious andlegal arguments strongly voiced against this too. A full
discussion of the rights and wrongs of euthanasia isbeyond the scope of this paper, but questions relating tosufficient health care for an aging population and ethicalconsideration of the indirect environmental cost to
extending longevity should provide the opportunity to
re-engage in this debate.

40

Eubios Journal of Asian and International Bioethics 29 (January 2019)Conclusion
This paper outlines some of the reasons for moreindirect engagement through choice enablingmechanisms to limit further population growth as ofnow. This includes a short review of some ethicallyunacceptable coercive and other incentive based policies
that have been employed to date. The use of behavioural
economic theory has potential to change young people’s
perception of family planning and make contraceptives
more accessible for them. The possibility of controlling
population size by limiting lifespan is not considered, but
the author does propose that as the growing population
places and ever larger burden on the environment thenit is timely to look at these arguments through anenvironmental ethics lens. Cripps discounts thepossibility of population reduction by limiting lifespan,
yet she does advocate making hard choices now to avoid
tragic consequences for global justice later. If this is sothen surely neglecting to take action now is no better
than enforcing policies that will impinge on liberties for
future generations. Ehrlich and Ehrlich (2013) express
their faith in the capacity of humanity to prevent a
collapse of civilization if we have the determination to
pay the price now for the benefits of a largely unknown
future people. [38] Maybe absolute freedom, rights andjustice are illusions that we have indulged in for longenough, we need to face up to the situation and take harddecisions to prevent the appearance of the CatastrophianAge. Lovelock (2008) puts it this way: “In humancivilization, the planet has a precious resource. We are notmerely a disease; we are, through our intelligence andcommunication, the planetary equivalent of a nervous
system. We should be the heart and mind of the Earth notits malady. Perhaps the greatest value of the Gaia concept
lies in its metaphor of a living Earth, which reminds usthat we are part of it and that our contract with Gaia is
not about human rights alone, but includes humanobligations.” [39]Acknowledgments
The author would like express gratitude to Mr Terry
Morgan CBiol MRSB for numerous discussions regarding
human population growth and for the commitment hehas shown by raising awareness of this issue through his
literary works. Also to participants at the 7th AUSNChulalongkorn Bioethics Workshop in Bangkok for their
feedback and discussion contributions, particularly toProf Kala Perkins for providing relevant information
regarding The World Population Project.
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8. Crutzen, P.J. and Stoermer, E.F. (2000) The “Anthropocene”
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12. Haila, Y. (2004) “Making the Biodiversity Crisis Tractable: A
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Philosophy and Biodiversity. Pp 54-83 Cambridge University
Press: Cambridge, UK.
13. Lawton, J.H. (2007) “Ecology, politics and policy.” Journal ofApplied Ecology 44, 465–474 [accessed online 14/1/19 athttps://besjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/j.13
65-2664.2007.01315.x]
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pp 14-56 Polity Press: Cambridge, UK.
15. Cripps, E. (2015) “Climate Change, Population, and Justice:
Hard Choices to Avoid Tragic Choices.” Global Justice: Theory
Practice Rhetoric 8: 2 pp 1 – 22 [Accessed online 12/1/19 athttps://www.theglobaljusticenetwork.org/index.php/gjn/article/do
wnload/96/71]
16. Gupta, J. (2019) “The Puzzle of the Global Commons or The
Tragedy of Inequality: Revisiting Hardin.” Environment: Scienceand Policy for Sustainable Development. 61:1 (16-25) [Accessed
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17. Hardin, G. (1974) “Lifeboat Ethics: the Case Against Helping
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18. Baggini, J. and Fosl, P.S. (2007) The Ethics Toolkit: A
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21. Macer, D.R.J. (2010) “Bioethics in the Transformation of
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22. Diamond, J. (1991) The Rise and Fall of the Third Chimpanzee.
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23. Holmes Rolston III (2003) Feeding People versus Saving
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Oxford, UK; Victoria, Australia and Berlin.
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athttps://www.gatesfoundation.org/What-We-Do/GlobalDevelopment/How-have-contraceptives-changed-your-life]
25. Corfee-Merlot, J., Maslin, M. and Burgess, J. (2007) “Global
Warming in the public sphere.” Philosophical Transactions of theRoyal Society A 365: 2741-2776 [Accessed online 22/1/19 athttps://royalsocietypublishing.org/doi/full/10.1098/rsta.2007.208
4]
26. UNFPA “About Us” [Accessed online 22/1/19 athttps://www.unfpa.org/about-us]
27. Bailey, M., Cao, R., Kuchler, T. and Stroebel, J. “The Economic
Effects of Social Networks: Evidence from the Housing Market.”
Journal of Political Economy 126(6): 2224 – 2276 Accessed
online18/1/19at
http://pages.stern.nyu.edu/~jstroebe/PDF/BCKS_Networks.pdf
28. Shah, M., Sellman, A. and Madon, T. (2016) “Behavioural
Economics and Reproductive Health Decision-Making.”
Behaviouraleconomics.com [Accessed online 24/1/19 athttps://www.behavioraleconomics.com/behavioral-economicsand-reproductive-health-decision-making/]
29. Matjasko, M. L., Cawley, J. H., Baker-Goering, M. M. andYokum, D. V. “Applying Behavioral Economics to Public HealthEubios Journal of Asian and International Bioethics 29 (January 2019)
Policy: Illustrative Examples and Promising Directions.”
American Journal of Preventative Medicine 2016 May ; 50(5Suppl 1): S13–S19. doi:10.1016/j.amepre.2016.02.007. [Accessed
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30. Hertwig, R., & Grüne-Yanoff, T. (2017). Nudging and Boosting:Steering or Empowering Good Decisions. Perspectives on
Psychological Science 12(6): 973 – 986. [Accessed online 22/1/19
athttps://journals.sagepub.com/doi/abs/10.1177/17456916177024
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31. Quinn, B. (2018) “The ‘nudge unit’: the experts that became aprime UK export.” The Guardian Saturday 10 November 2018
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32. Marteau, T.M. (2017) Sustainable Human Behaviour:targeting non-conscious and conscious processes for effective
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[Accessed
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33. Service, O., Hallsworth, M., Halpern, D., Algate, F., Gallagher,R., Nguyen, S., Ruda, S., Sanders, M., Pelenur, M., Gyani, A.,
Harper, H., Reinhard J. and Kirkman, E. (2015) EAST: Four simple
ways to apply behavioural insights.”[ Accessed online
24/1/19athttps://www.behaviouralinsights.co.uk/wpcontent/uploads/2015/07/BIT-Publication-EAST_FA_WEB.pdf]
34. Chhabra, E., Conrad, S., Cruzalegui, I., Metz, R., Shrestha, U.
and Thapa, B. (2015) “Uganda” Part 1 pp 3-27 in Wright, J. andTantia, P. Applying Behavioral Science To Family Planning And
Reproductive Health Challenges In Sub-Saharan AfricaI
Princeton
University[Accessed
online24/1/19at
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as42%20Workshop%20Report_updated%20Feb.pdf]
35. Gerber, A. and Rogers, T. (2009) “Descriptive Social Morms
and Motivation to Vote: Everybody’s Voting and So Should You.”The Journal of Politics 71(1): 178-191.
36. Cottingham, J., Germain, A. and Hunt, P. (2012) “Use ofhuman rights to meet the unmet need for family planning.”
Lancet380: 172-180 [Accessed online 25/1/19 athttps://www.thelancet.com/journals/lancet/article/PIIS01406736(12)60732-6/fulltext]
37. Rachels, J. “Active and Passive Euthanasia.” Ch 49 pp 292 298 in Cahn, S. M. and Eckert, M. (Eds.) (2006) Philosophical
Horizons: Introductory Readings. Thomson Wadworth:Singapore, London, Toronto and Madrid.
38. Ehrlich, P.R. and Ehrlich, A.H. (2013) “Can a collapse of global
civilization be avoided? Proceedings of
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39. Lovelock, J. (2008) “A geophysiologist’s thoughts on
geoengineering.” Philosophical Transactions of the Royal SocietyA
366: 3883-3890[Accessed
online21/1/19athttps://royalsocietypublishing.org/doi/pdf/10.1098/rsta.2008.013
5]Further Abstracts from the Seventh AUSNChulalongkorn Bioethic Workshop(not included in the previous Papers)
Playing God with humans- Prof. John Weckert, PhD.,
Professor Emeritus, Charles Sturt University, Sydney, Australia;
AUSN Visiting Professor of Applied Ethics and Ethics of Science& Technology
Email: JWeckert@csu.edu.au

To be accused of playing God is to be accused of doing
something morally wrong. The wrongness might derivefrom harms caused but might rather come from the factthat something is being done that has no business to bedone by humans.
We play God, it has been said, when we go “beyond
our rightful place” and in a place that is “rightfully
beyond human interference.”

41

Playing God has a distinctively religious ring but thesecular version is now common. Here nature plays therole of God. Instead of claiming that some things are in
the province of God and not humans, some things shouldbe left to nature. If humans attempt to do them, it is insome sense unnatural. It must be noted that this
discussion is very much from the Western perspective
where a sharp distinction is often drawn between bothhumans and God and humans and nature.
The claim then is that playing God is interfering withnature or modifying nature. Two issues immediately
arise: why should we not interfere with or modify nature
and what is nature anyway? Playing God, it will beargued, is expanding the sphere over which we havecontrol, to the extent that we no longer have theknowledge or capacity to competently make decisions inthat expanded sphere.
In this talk we will focus on just one aspect of Playing
God or modifying nature, that is, modifying humanbeings through genetic engineering. It will be argued
that while this is not necessarily wrong in all contexts,
extreme care must be taken.
Reflections on Gene Editing and Transhumanism- Prof. Nilza Maria Diniz,
Universidade Estadual de Londrina – State University ofLondrina-PR, Brazil; AUSN Visiting Professor of Genetics andBioethics
Email: nzdiniz@gmail.com

According to Porter (2017) Transhumanism is a“technoprogressive” socio-political and intellectual
movement that advocates for the use of technology inorder to transform the human organism radically, withthe ultimate goal of becoming “posthuman.” To this end,transhumanists focus on and encourage the use of new
and emerging technologies, such as genetic engineeringand brain-machine interfaces. The use of CRISPR-cas9,
the most precise and cheap way of changing genome, so
called gene editing, can accelerate the process ofreaching the posthuman like.
Friedrich Nietzsche
thoughts about Übermensch (which Aydin translates as“overhuman”) was mentioned at the first article ofgenetic engineering Times in the years 1970`s andreferences for several philosopher. Habermas has
characterizedtranshumanists
as“self-styled
Nietzscheans” (Habermas, 2003, 22). Bostromsees only
“some surface level similarities with the Nietzscheanvision” (Bostrom, 2005, 4), whereas Max More agrees
with Stefan Sorgner in seeing “fundamental similarities”(More 2010, 1) between Nietzsche’s conception
the Übermensch. As affirmed by Porter, In 2015 Chinesescientists used CRISPR to modify human embryos for the
first time, and in October 2016 Chinese oncologists
injected a person with cells containing CRISPR-edited
genes for the first time, in an attempt to combat thepatient’s aggressive lung cancer (Cryanoski, 2016, 1). As aresult of such advances, in 2015 a group of leading
biologists called for a global moratorium on the use of
CRISPR to make heritable changes in a person’s genome(Wade, 2015, 1). The discussion about the changes onhuman nature need to be discussed and we are going to42

Eubios Journal of Asian and International Bioethics 29 (January 2019)present the views abouttranshumanist approaches.

conservatives

andReferences

Cryanoski D. 2016. CRISPR gene-editing tested in a person for
the first time. Nature 539:479.
Habermas J. 2003. The Future of Human Nature. Cambridge, UK:
Polity Press.
Porter A. 2017. The Journal of Medicine and Philosophy: A
Forum for Bioethics and Philosophy of Medicine, Volume 42,
Issue
3,
1
June
2017,
237–
260, https://doi.org/10.1093/jmp/jhx001
Wade N. 2015, March 19. Scientists seek ban on method ofeditingthehuman
genome.The
New
York
Times . http://www.nytimes.com/2015/03/20/science/biol
ogists-call-for-halt-to-gene-editing-technique-inhumans.html (accessed November 14, 2016).

The ART of Birthing Life in Integrity: From Bioethics to
Politics with Assisted Reproductive Technologies- Prof. Deborah Kala Perkins,
Loyola Marymount University, Graduate Theological Union,
USA
Email: starbirthlife@gmail.com

Our new biotechnological capabilities have brought
us to the frontier of the meaning and integrity of birthand personhood. Questions of legal and biologicalparenthood, best interests of the birthing agents anddangers of exploitation interface with the international
dynamics of surrogacy, autonomy and responsibility.
Commercial surrogacy has now been banned in all but a
few nations, after questions of identity, statehood, andtrafficking in human reproduction interfaced withquestions of multiple biological parenthood and thehealth and wellbeing of the child. We have cloned miceand sheep successfully, generated “artificial” embryosfrom pluripotent mouse cells, and are experimenting
with artificial wombs. We have begun experimenting
with human gene modification using CRISPER. We arebeing called upon to develop a new moral spectrum toprotect the dignity and autonomy of life. Ethical and legal
challenges continuing to arise, with attempts tosafeguard against commodification and exploitation ofhuman beings. Egg preservation through freezingpresents diverse social, cultural and legal considerations.
This presentation explores several of these bioethical,
political, social and legal dilemmas with reference tospecific cases with their ethical and moral challenges.
Information Ethics: What is the Point?
- John Weckert, Ph.D.
Professor Emeritus, Charles Sturt University, Sydney,
Australia; AUSN Visiting Professor of Applied Ethics and Ethics
of Science and Technology
Email: JWeckert@csu.edu.au

There is a general enthusiasm for new technology andespecially it seems, for new information technologies.
Given this, is there any point in talking, thinking andwriting about the philosophy and ethics of information
technology? After all, few people apart fromphilosophers seem interested in it and research anddevelopment continue apace regardless, with little
serious questioning. Books on the philosophy and ethics
of information technology abound but it is unclear if they
have much effect. Perhaps that is inevitable because thatis just the way that people are, unthinking technophiles.
Developing and using new technologies is fun regardlessof whether they are useful or needed. Needs can becreated or they arise once the technology is available.
Think of mobile phones. We got on quite well without
them but once they were available and became common,
there was a need to have one or be rather isolated frommuch of the community. New technologies are promoted
though not just because they are fun but because they
are good for efficiency and productivity. They make us
more efficient producers and our society more affluent.
The more affluent it is the happier we will all be,supposedly. Technological progress therefore is seen as
inevitable or good or both. Is it inevitable and is it good?
If so, the study of the ethics of information technology
might just be an interesting but pointless intellectual
exercise. This talk will explore some of the issues thatarise from common views of this technology and its
ethics.
Maritime – Love For Life: Comparative study on the
behavior and perspectives in life of different seafarers
before and after boarding the vessel- Keith Aiken M. Pajarillo,
MAAP, the Philippines
Email: keithaikenp@gmail.com
BACKGROUND: Seafaring requires strong mental,
physical and emotional capabilities as they start to get
out of their comfort zone and live on their second homes
which are their respective vessels.
AIM: To explore and assess different seafarers on how
they working on board the vessel changed theirperspective in life and on how they take care, cope up
and adapt with different circumstances in life where theywould be able to give enough love and care for their own
lives.
METHODS: Conduct an interview and open forum withdifferent seafarers where they will be able to express
their own experiences freely in order to squeeze out thenecessary information that will be essential in thisresearch.
IMPORTANCE OF THE STUDY: As we value and giveimportance to life, investing time and effort in topic likethis will give us better insights and information on how
can we take good care of ourselves, how we value our life,
how we live our life to the fullest and on how can weapply and share the learning experiences that we gather
to different people so that we can be able to make an
impact on their lives that might trigger to spreading
essential perspectives to different people, specificallypeople who will be working on maritime related
profession. Further studies are necessary to describe andelaborate more the changes in the lives of seafarer andon how they perceive and view their lives before andafter boarding the vessel.

Eubios Journal of Asian and International Bioethics 29 (January 2019)
Effects of working with the LGBT community on working
ethics onboard a Ship
- Aldrin M. Ulep,
MAAP, the Philippines
Email:The 21st Century has been moving towards achieving
gender equality and equal chances in landing jobs inmany field of work. Many countries have also legalized
marriage among the members of the LGBT community
thus eliminate norms discriminating LGBT on many
professional jobs. In the maritime industry, the LGBT
community has been gradually accepted due to the
exeptional working ethics and of these people. They arehave great communiting skills which make work
onboard a multinational working environment easier.
There are concerns however like the increasing numberof sexually transmitted diseases among the LGBT's andacceptance of the working environment especially tothose who are officers. Actions toward avoiding the risksof sexually transmitted have been widely promoted andawareness of avoiding these diseases have been
increasing in the past decade. Events such as the WorldAIDS and HIV Day are made to increase awareness andinform people of the effects of these diseases especiallyto health and psychological behavior. Moreover, social
norms that dictates hierarchy in working environmenthas been changing over the past decade. More and more
LGBT's are being promoted to higher ranks in themaritime industry. This research will evaluate the effectsof having LGBT officers in the working ethics of people
working in a vessel. Also, this will identify how thesepeople affects the efficiency and coordination of crew
onboard a ship. Finally, this research will determine
factors that affect ethical behavior among the crew
towards working with the LGBT community.
Ethical Challenges of Medical Assistance at Sea- CEO Angelo D. Fajardo,
MAAP, the Philippines
Email:
A lot of accidents, illnesses and injuries occur on
board seafaring vessels. During this times, lacking
medical professionals or paramedic personnel onboard,
it is usually the vessel’s 2nd mate and captain that is incharge for the Medical care of the ship’s crew. The
delegated officer asks for medical advice through the useof telecommunications equipment. Although thesituation is quite different for Passenger ships thatusually has Medical Personnel on board. On ship’s
without medical facilities, the ship’s captain and 2nd matehas full responsibility of the medical care and decisions
for the welfare of the seafarers onboard but the full
responsibility of the diagnosis and prescription is to thedoctor on-call or the Medical assistance service provided.
This presents legal and ethical issues between DoctorPatient relationships that is quite different to the usuallyexperienced Doctor-Patient relationship on shore. The
Privacy of the patient’s medical record and status should
be protected. This presentation wishes to address thisissues and provide possible solutions to improve theDoctor-Patient relationship of seafarer’s on board.

43

Filipino Awareness in Choosing Treatment for Depression- Christian Gilbert S. Esteban,
MAAP, the Philippines
Email:
It has been a practice in the international stage that
we can choose the treatment that we want regarding ourconditions, however, in the Philippine context, only a few
member of the society have awareness towards thecapacity to choose the treatment. Many agree upon thefirst statements of doctors or consultants without anyother second opinion. Filipinos will only do so if they feelthat the medication, if continued, will have an effect on
the social, physical or mental health of the individual. In
my side, awareness and transparency towards thedifferent options for treatment is vital in process ofhealing of an individual. An individual will have an
increase in morale by being satisfied with the respective
choice. Individuals may feel uncomfortable anddiscontent if the choice was of the doctor only. This aims
to assess awareness of Filipinos in choosing a treatment
for their respective conditions in order to improve thehealing process since emotional state is connected to
how fast a recovery can be and how effective a treatment
will last.
The Impact of the Mangrove Forest Management to theCommunity: The Environmental Awareness and Socio –Economic Assessments- Junel Kristian M. Semaña,
MAAP, the Philippines
Email: semana.junel@gmail.com
Mangrove forests are found in the tropical andsubtropical part of the world. It produces wide range of
ecosystem products and merchandises that include
shelter for marine species, fuel wood, food and ligneous,climate parameters and cultural services (UNEP 2014).
They are the most productive ecosystems compared toother ecosystems that can contribute from 10 to 15%
coastal sediment carbon storage (Alongi 2014).
Concurrent with the coastline wetlands, they isolate andaccumulate carbon at a rate of twice to four times
greater than that of mature tropical forests.
(www.habitat.noaa.gov). However, in the Philippines,
mangroves have declined significantly by 75% over the
past 80 years due to a range of anthropogenic pressures(King et. al.). It only shows that majority of the Filipino
are not aware on the importance of mangrove to theenvironment and to the society,
The proponents of the study together with otherorganizations conducted every year mangrove planting
and orientation to the communities within the province.
Aside from mangrove planting, part of the program is toconduct orientation within the communities nearby thearea. All high school students and locals are invited toparticipate and listen to the resource speakers on theimportance of mangrove planting. Likewise, different
activities were prepared for the one – day activity suchas poster making contest, slogan contest, and debate.
With the help and assistance of the different groups andorganizations, the group were able to raise funds for the
conduct of the said activities.
With all the benefits and advantages of the mangrove
forest management, there are still communities in the44

Eubios Journal of Asian and International Bioethics 29 (January 2019)area that is need to be considered. The said communities
may be affected by the forest management in different
ways. The most visible factors are the environmental andsocio – economic aspects. In the implementation ofmangrove forest management, the said two (2) major
factors must be considered. It is therefore the goal of the
proponents to determine the impact of mangrove forest
management to the community in terms ofenvironmental awareness and socio – economic aspects.

Editorial address, and all correspondence to:Prof. Darryl Macer, Ph.D., Hon.D.
President,
American University of Sovereign Nations (AUSN)
https://ausovereignnations.org
Email: darryl@eubios.info
EJAIB adopts and complies with the Committee on
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
For forthcoming conferences see:www.eubios.info Email to Darryl@eubios.info.

EJAIB Editor: Darryl Macer
Associate Editor
Nader Ghotbi (Ritsumeikan
University (APU))

Asia

Pacific

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),
Jing-Bao Nie (China, New Zealand), Pinit Ratanakul(Thailand), Qiu Ren Zong (China), Hyakudai Sakamoto(Japan), Sang-yong 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 by William Lesser, May 1991, 150pp.
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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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Challenges for Bioethics from Asia Ed: Darryl R.J. Macer
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Getting Along: The Wild, Wacky World of Human Relationship, Laura R. Ramnarace 2017
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Education, Happiness, Mindfulness and Colonization: Reflections from Time with San Carlos Apache Nation
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Philosophy and Practice of Bioethics across and between Cultures. Takao Takahashi, Nader Ghotbi,& Darryl R.J. Macer, ISBN 978-0-908897-33-9 2019 268pp. (B4)
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