D

Philosophy Study, ISSN 2159-5313
May 2012, Vol. 2, No. 5, 362-369

DAVID

PUBLISHING

Cross-Cultural Bioethics at an International University in Japan
Nader Ghotbi

Darryl Macer

Ritsumeikan Asia Pacific University

United Nations University-IAS

Ritsumeikan Asia Pacific University (APU) in Beppu city, Japan has a large body of students from well over 90
countries, especially from the Asia Pacific region, including Japanese, Korean, Chinese, Thai, Vietnamese, andIndonesian students. To improve analytical thinking skills among college students, a course on “bioethics” wasintroduced and offered in two consecutive semesters to undergraduate students for which 245 students registered ateach semester. The course was taught in the form of 14 lecture and discussion sessions, each for 95 minutes basedon the content of A Cross-Cultural Introduction to Bioethics (2006) edited by Darryl Macer, and reviewed a wide
variety of ethical and bioethical issues. In the next semester, the students received a similar teaching content thatwas rearranged to reflect the 15 universal principles of bioethics and human rights covered in the Bioethics Core
Curriculum (2008). Case studies were also added to each unit of the Core Curriculum with the support of the
UNESCO’s Asia Pacific Regional Office, Bangkok (Case Studies for Bioethics 2010). To evaluate the results ofteaching and to compare the achieved objectives between the two groups of students, a short questionnaire wasgiven to all students who finished the course and took up the final written examination. In the whole, 454 students(225 in group 1 and 229 in group 2) completed the course and took the final examination and 427 (218 in group 1
and 209 in group 2) responded to the questionnaire which inquired into their interest in the discussion of bioethicalissues: why they believed they were important, and what they had learned through them. The results of thequestionnaire have been examined and compared to evaluate the success of “bioethics” in stimulating the interestand thinking ability of the students and enriching their experience of a cross-cultural discussion over bioethicalissues using universal principles as general guidance. The result of this examination was so impressive that from2011 bioethics has been formalized into the reformed curriculum of our international school.
Keywords: Asia Pacific region, bioethics curriculum, case study, cross-cultural, Japan, teaching

1. Introduction
Ritsumeikan Asia Pacific University (APU) is located in Beppu city, Kyushu, Japan with close to 6,000
students, about half of them are non-Japanese. There are more than 90 nationalities among the student body but
the majority come from the Asia Pacific region, especially from Korea, China, Thailand, Vietnam, Indonesia,
Taiwan, Bangladesh, Myanmar, Mongolia, Malaysia, Cambodia, etc.. The undergraduate program includes two
main colleges, one on management and the other on social sciences including environment and development,
tourism, international relations and peace studies, and society, culture and media. All undergraduate students
need to pass a certain number of common courses which include bioscience. From fall 2009, the syllabus of thisNader Ghotbi, MD, Ph.D., Professor of Bioethics, Ritsumeikan Asia Pacific University, Japan; main research field: Bioethics
with a special interest in Environmental Ethics, Ethics in Education, and Ethics in Islam.
Darryl Macer, Ph.D., Visiting Senior Research fellow, United Nations University-Institute of Advanced Studies; AffiliatedProfessor of Philosophy at Kumamoto University, Japan; main research field: Bioethics.

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subject was changed to bioethics, and two rounds of bioethics courses were completed in the following
semesters to evaluate the potential educational impact on analytical thinking skills of the students. The idea
behind this proposed change was the anecdotal observation of many teachers that the majority of students do
not use or develop strong thinking skills, particularly regarding philosophical issues; in the context of education
at our school, bioethics was seen as a potential conveyer of important issues to be discussed at the classroom toimprove the depth and breadth of thinking abilities and decision-making skills among the student body. Many
authors have referred to the common post-modernism way of thinking among the young generation (Bryant, laVelle, and Searle 2005) and the observations of teachers on college freshmen confirm the view, particularly
among the majority of Asian students, that there are hardly any universal truths, and that truth is relative andwhat works for any individual matters the most (relativism). Lazy thinking has been reported by teachers as a
typical pedagogical issue to commonly deal with education at college (Halpern 2002).
It was hypothesized that the discussion of cross-cultural bioethical issues and the introduction of universal
principles to support the decision-making process under varying circumstances could help break this cycle. But
a critical question that remained unanswered was whether it would be well received by the student body. The
discussions which followed between the bioethics teachers at Ritsumeikan APU and the director of the
UNESCO’s bioethics program in the regional office in Bangkok led to the implementation of this study.
I provided the teaching, with support by the UNESCO Regional Office in Bangkok. After an extensive
search for an appropriate textbook on the internet, A Cross-Cultural Introduction to Bioethics edited by Darryl
Macer (2006) was selected for the following reasons:(1) It includes an introductory chapter to explain the basics of ethics and the associated fundamental
concepts, thus is easy to understand at the undergraduate level.
(2) It includes various domains of environmental ethics, ecotourism, genetics and genetic engineering,
medical ethics, reproductive technologies, neuroscience, and social ethics including peace, child labor, andhuman rights; thus it provides opportunities for discussions under various subjects that may be of interest todifferent students.
(3) It is available for free and can be accessed in an electronic format as well; thus access was ensured foreach and every student.
(4) The cross-cultural emphasis and style of the book provide the framework needed for discussions of thebioethical issues among students from different socio-cultural backgrounds.
Bioethics Core Curriculum was also provided by the UNESCO regional office for the Asia and the Pacificalong with Case Studies for Bioethics. They were all integrated into a common tool to stimulate thinking anddiscussions in the classroom. Evaluation forms were provided by UNESCO and were filled in by the students
throughout the course lectures and at a later date submitted to the UNESCO office in Bangkok for analysis, theresults of which have been presented before (Quek, Ghotbi, and Macer 2010, 125). However, the current paper
examines and compares the results of another survey that used a separate questionnaire to inquire into theteaching impact of bioethics on the students who enrolled at the “bioethics” course, in two consecutive
semesters, before and after the implementation of the “Core Curriculum” and the accompanying “CaseStudies.”This questionnaire includes the following three open-ended questions:(1) What was the most interesting topic among bioethical issues you have studied?

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CROSS-CULTURAL BIOETHICS AT AN INTERNATIONAL UNIVERSITY IN JAPAN(2) Why do you think it was an important topic to study?
(3) What did you learn by studying it?
The purpose of this questionnaire is:(1) To identify bioethical issues which are especially attractive to undergraduate non-medical students andthat may be used to convey the universal principles laid in the “Universal Declaration on Bioethics and Human
Rights.”(2) To check if the students realize the significance of the bioethical issues they have studied, and if deeply
consider and think over the issues discussed at the classroom.
(3) To look for any indications of strength versus weakness in achievements between the two groups ofstudents before and after implementing of the “Core Curriculum” structure.

2. Methodology and Subjects
This study was performed on a cross-sectional basis using a questionnaire survey form that was distributed
to two groups of students at the final day of the course on bioethics. The two groups received a similar
coverage of bioethical issues through lectures and group discussions; however, the second group of students
received the rearranged content with inclusion of the universal principles of bioethics (UNESCO) and clear
usage of “Case Studies” for each and every principle that was discussed at the classroom. Short videos andgroup discussions of the topics were used for both groups. The responses of the students to the questionnaire
regarding the bioethical topics of their interest were examined and a comparison was made between the twogroups to look for indications regarding the use of the universal principles in the “Core Curriculum” and theenriched case study discussions. The first group consisted of 225 students, 218 of them responded, and thesecond group consisted of 229 students, 209 responded to the questionnaire. The three measures that wereselected for this study and compared between the two groups included a description of the bioethical topic ofinterest, the reason of interest, and what was learned through the course. The data were extracted from thequestionnaires into Excel sheets and examined using the Excel’s built in statistical tools.

3. Discussion
A common concern among our teaching faculty is the lack of strong thinking ability among college
students. To be more specific, we may refer to a lack of or relative weakness in using sound and valid
arguments and reasoning to support one’s position regarding issues such as the environment, business andeconomics, lifestyle choices, and so on. Philosophers may ascribe such concerns to broader post-modernism
tendencies that have influenced our young generation of college students in a more implicit manner. Academic
psychologists may ascribe them to a less matured way of thinking among the younger generation that they call“quasi-reflective” which in principle means all judgments are assumed to be mainly subjective with anybody
having a right to one’s own opinion and own interpretation of what the evidence says or means; academic
psychologists have thus commonly prescribed the teaching of “critical thinking” skills as a potential remedy.
Most teachers are not so optimistic about their lasting impact. On the other hand, UNESCO has been advocating
the teaching of philosophy at all levels of education. UNESCO’s statement on their strategy on philosophy (2005)
emphasizes the development of “… intellectual tools to analyze and understand key concepts such as justice,dignity and freedom by building capacities for independent thought and judgment, by enhancing the critical skills
to understand and question the world and its challenges, and by fostering reflection on values and principles …”

CROSS-CULTURAL BIOETHICS AT AN INTERNATIONAL UNIVERSITY IN JAPAN365(UNESCO 2006). We share this view and also believe that to strengthen these skills we need the right medium forthoughtful discussions. The teaching of bioethics shows a lot of prospect as it brings elements from society,culture, and religion to the applications of new science and technology at an age where almost anything is
pictured as possible pending on one’s school of “moral” thinking. The multicultural environment at our campus
provides good opportunities for a cross-cultural dialogue over ethical and bioethical issues under the “bioethics”
course; the inclusion of social ethics in its syllabus and the use of real-life “Case Studies” are further potential
advantages. One important aspect is the concept of using “universally applicable principles” to support group
discussions and decision-making. The universal principles of bioethics and human rights (UNESCO) include
human dignity and human rights, benefit and harm, autonomy and individual responsibility, consent, persons
without the capacity to consent, respect for human vulnerability and personal integrity, privacy andconfidentiality, equality, justice and equity, non-discrimination and non-stigmatization, respect for cultural
diversity and pluralism, solidarity and cooperation, social responsibility and health, and sharing of benefits. For
example, under “consent” the disclosure of a cancer diagnosis to patients is discussed using a case study; many
students state their different “opinions” regarding whether the patients must be informed of his cancer diagnosis
or not; the teacher asked the students to offer arguments and reasons to support their view, and to use the learned“principles” when needed; a student who disagrees with disclosure cited the “harm” done to the mental state of
the patient; other students mentioned the “benefits” of letting the patient know about the prognosis and point to
the “autonomy” of the patient in making some important choices including clinical decisions; the teacher
concluded the arguments by mentioning the necessity of having an “informed consent” for the various treatmentsthat the patient may receive, and then generalized the concept of consent to broader social issues and asked thestudents to “think” about more general instances and matters that a person must be asked for consent.
The next step was to measure the degree of acceptance by the student body and also the effectiveness ofthe bioethics course in stimulating thoughts and discussions over the moral dilemmas. Many issues fromenvironmental ethics, medical ethics, ethics of biotechnology as well as social ethics were included in thesyllabus and accordingly pursued at the classroom. Our hypothesis was that students who were positive about
the teaching of “bioethics” at APU would select a topic of interest and also explain why they were interested
and what they had learned. In fact, the majority of students in both groups, 218 out of 225 (96.80%) in group 1
and 209 out of 229 in group 2 (92.10%) who attended the final examination, responded to this questionnaire.
Only three students in the first group and four students in the second group did not explain any reason for theirinterest and what they had learned from the course of bioethics. Therefore, we believe that the majority (422
out of 490, about 86%) of APU students were probably satisfied with inclusion of “bioethics” in their
university’s curriculum, with no statistically significant difference between the two groups. This result
confirmed the subjective observation of the teacher that bioethical issues had stimulated thinking, motivated thestudents to participate in cross-cultural discussions with their peers, and were satisfying as a course subject.
Next, we attempted to find the most attractive topics to convey bioethical concepts at the undergraduatelevel of a non-medical university. Among the many topics that were used to teach the bioethical concepts andthe “Core Curriculum” principles, some of them had been very attractive to many students from both groups(Table 1). They included, in descending order: HIV/AIDS, brain death, euthanasia, animal rights, genetics (basics
of DNA, genes and chromosomes), human rights, assisted reproduction, abortion, child labor, cloning, genetic
engineering, medical ethics (patients’ rights and informed consent), nanotechnology, and energy resources/crisis.

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CROSS-CULTURAL BIOETHICS AT AN INTERNATIONAL UNIVERSITY IN JAPAN

Table 1The Most Attractive Topics to Teach Bioethics to Undergraduate Students at APUGroup 1 (218)Group 2 (209)Groups 1 & 2 (358)HIV/AIDS (20)

Euthanasia (17)HIV/AIDS (36)

Genetics (19)HIV/AIDS (16)Brain death (29)

Animal rights (19)Brain death (16)

Euthanasia (27)Brain death (13)Human rights (15)Animal rights (27)Genetically modified food (12)Abortion (15)Genetics (25)

Ecotourism (11)

Cloning (10)

Human rights (21)Assisted reproduction (11)Child labor (9)Genetically modified food (19)Genetic engineering (10)Nanotechnology (8)Assisted reproduction (19)

Euthanasia (10)Medical ethics (8)Child labor (18)Energy resources/crisis (10)Assisted reproduction (8)Abortion (18)Child labor (9)Animal rights (8)Cloning (17)Medical ethics (8)Genetically modified food (7)Medical ethics (16)Nanotechnology (7)Cosmetic surgery (7)Genetic engineering (16)Environmental problems (7)Cancer (7)Nanotechnology (15)

Cloning (7)Genetic engineering (6)Energy resources/crisis (15)

Human rights (6)Genetics (6)Ecotourism (14)Abortion (3)Environmental problems (5)Environmental problems (12)Energy resources/crisis (5)Cosmetic surgery (7)Ecotourism (3)Cancer (7)Other topics (36)Other topics (33)

It was interesting to see HIV/AIDs at the top of the list. Most students who selected HIV/AIDS explainedthat they found it a very important issue in everyday life and could directly affect them. Brain death andeuthanasia had also aroused strong feelings in the sense of a challenge in decision-making which would require
a deliberate consideration of various alternatives and the consequences for the individual, one’s close family
and friends, and the broader community and society.
However, there were certain topics that showed quite a different level of interest between the two groups.
“Abortion” was such a topic (3 students in the first group versus 15 in the second group). The main reason forthis difference could be the use of a “case study” on abortion for the second class where students were asked to
discuss the various choices and their opinion. Ecotourism was another such topic (11 in the first group versus 3
in the second group); it was taught with a case study to the first group but not the second group. We believethese examples show the impact of case studies in attracting the attention of students to thinking aboutbioethical issues. Instead of giving a lecture to describe the issues in bioethics, the presentation of case studies
on the basis of real-life decision-making challenges causes the students to enter a dialogue; the purpose of the
discussion is to make sense of the case and converge towards a solution by paying attention to the universal
principles that were relevant to the case. This method reduces passivity in the lecture room and helps thestudents actively integrate knowledge, values, and constraints into their statements. The teacher should avoid
providing answers to a case but act as a moderator for the ensuing dialogue; otherwise, further case studies may
not lead to active class discussions.
“Human rights” was another topic with a significant difference between the two groups (6 students in theCROSS-CULTURAL BIOETHICS AT AN INTERNATIONAL UNIVERSITY IN JAPAN367

first group versus 15 in the second group). Here the main reason could be the structural emphasis of the “Core
Curriculum” on human rights which was used to teach the second group of students, while the first group wastaught about human rights as part of the lectures on social ethics.
The topic of “medical ethics” showed a puzzling situation; the number of interested students remained thesame (8 in both groups) although many case studies were added for the second group. It appears that using thecase studies on medical ethics for this group of non-medical students had not resolved the complexity of
medical decision-making and many students preferred other issues. The teacher also agreed that many students
had problems understanding the medical terminology and using the associated information in the case studies todevelop an understanding of the underlying bioethical concept.
When students were asked why they were interested in the topic they had selected, the most common
reasons (Table 2) were the challenge to balance benefits versus risks, the controversy over the use of newtechnology, their interest in the potential benefits of technology, having had a personal experience of the sameproblem, relation to daily life issues, exposure through media, and lastly potential harms of technology.
Table 2The Reasons Given by APU Students for Selecting the Topic of Their Interest in Bioethics
Group 1
Benefits vs. risks of new technologies (15)Controversy over the use of new technologies (12)Potential benefits of new technologies (10)Media exposure (10)Related to daily life issues (8)Personal experience of the issue (5)Potential harms (4)Other reasonsGroup 2
Potential benefits of new technologies (15)Controversy over the use of new technologies (15)
Benefits vs. risks of new technologies (15)Personal experience of the issue (14)Related to daily life issues (8)Media exposure (6)Potential harms (3)Other reasons

It appears that most students had a positive view about learning bioethics because it was not about
accepting certain facts that were dictated to them, but instead trying and thinking to understand the different
options or choices, the diversity of values and the difficulties associated with making the best possible
decisions while facing some uncertainties about the future. However, many students were more excited about
the new technologies they learned about and their potential benefits, as opposed to the few students who
considered the risks and harms of new technologies a pressing issue. It is reasonable to say that for many
students “bioethics” has exposed them for the first time to new sciences and technologies such as
nanotechnology, genetic engineering, etc.. Also, some students could relate to bioethical issues through theirpersonal life experiences and the issues they had seen in everyday life and in different media such as
newspapers and TV programs.
Comparing the data in Table 2 for reasons given by the two groups of students for selecting a topic ofinterest does not show any statistically significant differences. Apparently the teaching of bioethics according to
the “Core Curriculum” did not change their reasons of interest in the bioethical issues they selected. However,
it is possible that the “Case Studies” presented to group 2 helped, with a better understanding of the controversy
and the sense of dilemma over benefits versus risks in decision-making over bioethical issues.
The most common answers to the question of what the students had learned by passing the course were(Table 3): the topics of their interest, bioethics, bioscience, appreciating life, human rights, problem solving

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CROSS-CULTURAL BIOETHICS AT AN INTERNATIONAL UNIVERSITY IN JAPANskills, better decision-making in difficult situations, and diversity of choices/views/values.
Table 3APU Students’ Answers to What They Had Learned about Bioethical Issues from the CourseGroup 1
The topics they selected (29)
Bioscience (19)Bioethics (16)Appreciating life (10)Decision-making (6)Problem-solving (5)Diversity of choices/views/values (3)Human rights (2)Ethics (3)No answer (11)OtherGroup 2The topics they selected (31)
Bioethics (25)
Bioscience (21)Appreciating life (16)
Human rights (12)Improved thinking (7)Ethics (7)Diversity of choices/views/values (7)Problem-solving (6)Benefit vs. risk analysis (5)Decision-making (4)No answer (10)
Other

It is interesting to note that many students had enjoyed learning bioethics as a novel and interesting course
subject. However, it is also noted that many students appreciated the learning of bioethical concepts joint withthe scientific information that conveyed them (such as in nanotechnology and genetic engineering). Anotherinteresting finding is that many students viewed bioethics as beneficial for understanding and appreciating
diversity and helpful to solve difficult problems or make difficult decisions. This was especially stated by thesecond group who were exposed to the “Case Studies” at the start of every lecture. Most interestingly, students
in group 2 demonstrated a higher ability to explain what they had learned, with both a richer selection of ideas
and greater number at each category. It appears that the use of the “Core Curriculum” clarified the learning
objectives better and directed the students to a clear sense of how bioethics could assist them in decision-making.
These results compare well with the strong positive results that Donnie J. Self et al. have reported on thepositive influence of their discussions of medical ethics cases on the students’ ability of moral reasoning (Self,
Baldwin, and Olivarez 1993). They also recommend using evaluation methods to measure the effectiveness ofsuch teaching, which we also agree and have followed with so far.

4. Conclusion and Recommendations
In this study, the teaching of bioethics at the undergraduate level was examined in aninternational/multicultural background at a social science/business management school in Japan. Generally, thestudents who took the bioethics subject had a positive view towards the teaching of bioethics in the context of
ethical issues in life sciences and technologies as well as social ethics, especially as related to human rights.
Many students were attracted to bioethical issues in the sense of the benefits, or the controversy over the
benefits versus possible harms of new sciences/technologies, and the knowledge they gained about newsciences/technologies. We believe this finding supports the view that the teaching of bioethics should be
integrated into the teaching of science/technology, similar to the way in which medical ethics is integrated into
the teaching of medicine in medical schools.
Also, the results of our study suggest that students appreciate and enjoy bioethics more significantly when

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case studies are used. Non-medical students do not have many opportunities to experience bioethical dilemmas
in their studies, therefore, when the case studies are more realistic and more related to actual life circumstances,
students show more interest in learning the underlying bioethical principles and how to use them as a general
guide in decision-making.
The teaching of bioethics according to the UNESCO’s “Core Curriculum” can help students associate thelearning objectives with human rights in general and the “Universal Declaration of Bioethics and Human
Rights” in particular, but it is an added challenging task for the teachers because the bioethical principles within
the declaration do not necessarily follow a convenient pedagogical order for teaching purposes. Thus, it will
require tailor-made teaching support and teaching-aid material including selected case studies for non-medical
undergraduate students.
It was based on the findings of this study that a recommendation was made to the academic affairs of
Ritsumeikan APU regarding adoption of “bioethics” in the new curriculum reform of the school; the reform has
been implemented since the spring semester of 2011. Therefore, a follow-up of the results of this reform for the
possible attainment of its main goals including the strengthening of a more philosophical, analytical, and/or
critical thinking skills will be in order.

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