Eubios Journal of Asian andInternational Bioethics
EJAIB Vol 17(6) November 2007

ISSN 1173-2571

Copyright ©2007 Eubios Ethics Institute (All rights reserved, for commercial reproductions).
31 Colwyn Street, Christchurch 8005, New Zealand
c/o Darryl Macer, RUSHSAP, UNESCO Bangkok, 920 Sukhumvit Rd, Prakanong, Bangkok 10110, THAILAND

Eubios Ethics Institute World Wide Web: eubios.info/index.htm
Official Journal of the Asian Bioethics Association (ABA)
Preliminary Call for Papers:

Contents

page

Editorial:
161
Arsenic Contamination in Ground Water in Bangladesh:
Nature of Awareness in an Arsenic-prone Area
162
- Wardatul Akmam, Sk. Muaj Hurayra Marshad &Md. Fakrul Islam
BioCosmological Approach in World Bioethics
167- Konstantin S. Khroutski
Bioethics Education: A response to Viveka
171- K. K. Verma & Rashmi Saxena
Teaching Thanatology: A Qualitative and Quantitative
Study
172
- N. Yasemin Oguz, M. Volkan Kavas & Murat Aksu
Adequacy of informed consent in researchcarried out in Brazil
177- José Roberto Goldim, Joaquim Clotet &Jorge Pinto Ribeiro
Embracing personal and community empowerment:
genetic information policy making in Israel
181- Liza Ireni-Saban
Neanderthal Range Extended
184- K. K. Verma & Rashmi Saxena
Perceptions of Issues in Biotechnology Managementin Thailand
185- Siriyupa Roongrerngsuke and Sarote Phornprapha
Invitation to Join Working Groups on Ethics ofEnergy Technologies in Asia and the Pacific190
Asian Bioethics Association (ABA)
191
Conferences
191
Ordering Information
192
Send papers to the editor in electronic form if possible.
Please use reference style used in News section, do not use
automatic footnotes or endnotes. Papers are peer reviewed.
The papers do not represent the views of Eubios Ethics
Institute, or the editor or editorial board, which upholds theprinciples of freedom of expression.
Editorial address:
Prof. Darryl Macer, RUSHSAP, UNESCO Bangkok,
920 Sukhumvit Rd, Prakanong, Bangkok 10110, THAILAND
Fax: Int+66-2-664-3772
Email: d.macer@unescobkk.org

Deadline for the January 2008 issue is 1 December, 2007.

The Ninth Asian Bioethics Conference of the Asian
Bioethics Association in Yogyakarta, Indonesia, 3-7
November 2008 Bioethics in Asia: healthy andproductive life in harmony with nature
Research findings, discussion papers, and other contributions
dealing with topics in bioethics and related disciplines arewelcomed. Papers are invited on, but not limited to, the following
themes:
Asian Bioethics
Bioethics EducationCan virtues be taught?
Cross-cultural Bioethics
Islamic Bioethics
Environmental Ethics

Biomedical and Biosciences Ethics
Ethical Issues in Disaster Research and ManagementEthnic Conflicts and Peaceful Co-existence
Ethical Issues in Biomedical ResearchEthical Issues on Organ Transplantation
Ethics and Intellectual Property

Public Health Ethics
Science and SocietyTechnology and Culture
Neuroethics
Ethics of Emerging Technologies / Nanoethics
Preliminary deadline for receipt of abstracts for papers (200 wordsmax)* and proposed sessions (with lists of speakers and titles) is 31
January
2008,
toEmail:
nazif.amruhydari@yahoo.com,
amru96@cbn.net.id
The specific objectives of the ABC9 are:♦ to identify issues in the enforcement of law, rules andguidelines and other regulatory means of ‘good research practice’ ofbasic and applied researches leading to quality health care involving
human subjects in accordance with the universally acceptedbioethical norms;♦ to interpret and apply the precautionary approach; where there
are threats of serious or irreversible damage, lack of full scientificcertainty shall not be used as a reason for postponing cost-effective
measures to prevent environmental degradation; and♦ to recognize and duly support the vital role in environmental
management and development of local communities because of
their knowledge and traditional practices.
This event will be organized by the ABA and Indonesian
National Bioethics Commission, with the cooperation of UNESCO,
WHO, and FAO. The local cooperating bodies and agencies will
include industries, universities, and NGOs.
The updated information will be placed on the website:www.kbnindonesia.org*Persons who wish to apply for limited scholarship support should
also submit a letter of explanation and resume. The conference will
also make judgments for the best student presentations.

162

Eubios Journal of Asian and International Bioethics 17 (November 2007)

Arsenic Contamination in
Ground Water in
Bangladesh: Nature of
Awareness in an Arsenicprone Area
- Wardatul Akmam, Ph.D.
Associate Professor, Department of Sociology,
University of Rajshahi, Rajshahi, Bangladesh
E-mail: akmamprottoya@hotmail.com- Sk. Muaj Hurayra Marshad
MSS in Sociology, Department of Sociology,
University of Rajshahi, Rajshahi, Bangladesh
E-mail: mhmarshad@yahoo.com- Md. Fakrul Islam, Ph.D.
Associate Professor, Department of Social Work,
University of Rajshahi, Rajshahi, Bangladesh
E-mail: hiraharati@yahoo.com
Abstract
Since 1993, a significant proportion of tube wells (theprincipal source of ‘safe’ water) have been discovered to be
spewing water containing arsenic at a much greater level thanis permissible (Bangladesh standard: 0.05mg/litre). According
to Dhaka Community Hospital, this has put more than 80
million people at risk of various types of physical and mental
diseases, including cancer of the skin and internal organs,gangrene, seizure, convulsions and mental retardation. Given
this alarming situation, it is indispensable to make people
aware of the imminent danger. Awareness campaigns havebeen undertaken and implemented by the government andother NGOs. This paper assesses awareness level of thepeople of a village named Khajadanga, situated in an arsenicprone area. In this study, awareness has been defined as
knowledge of (a) the dangers of drinking arsenic
contaminated water, (b) the available alternative options ofsafe water from which people can choose the one suitable forthemselves, (c) what to do if there is an arsenicosis patient in
the household, and actual use of that knowledge throughusing water from safe water sources for drinking and cooking.
The findings show that awareness level of the people in the
study area was far from satisfactory.
Key words: Tube well, Arsenic contamination, Awarenesslevel.
Introduction
By the early 1990s, most people in Bangladesh (90%)
became used to drinking water from tube wells, which was
supported and encouraged by the government and worldorganizations to keep them safe from waterborne diseases
like diarrhea and cholera, as tube well water was thought tobe pathogen-free (Akmam and Higano 2007). However, whenthese tube wells were installed, they were not tested forarsenic or other harmful elements. Thus it was neither known
to the authorities, nor to the users that the water that they
were drinking and using for cooking contained arsenic at amuch greater level than was permissible. The permissiblelevel of arsenic in drinking water in Bangladesh is
0.05mg/litre, although the WHO standard is 0.01mg/litre. In
1993, after diagnosing melanosis and keratosis (skin lesions
and warts resulting from over-ingestion of arsenic) patients, it
was discovered in Chapai Nawabganj district that tube wells
were producing arsenic contaminated water (Ahmed 2003).

Arsenic is a carcinogenic and toxic but odorless and tastelesssemi-metal element that belongs to the nitrogen family (HVR
Arsenic Project 2000). Out 64 of districts in Bangladesh, 53
have been found to have the problem of arsenic
contamination in varying degrees (DPHE and BGS 2000).
According to Dhaka Community Hospital, arsenic
contamination in ground water has put more than 80 million
people at risk of various types of physical and mental
diseases, including gangrene and cancer of the skin andinternal organs, which lead to a relatively slow but painful
death, making it the ‘greatest mass poisoning in history’ (DCH
2002, Smith 2000). Women and children are particularly
vulnerable to arsenic toxicity. Pregnant women with highamounts of arsenic in their bodies are likely to pass it on totheir babies. Growing children with skin lesions are likely toeventually develop cancer (Zuberi 2003). There is no specifictreatment for arsenicosis, but safe water, nutritious food andmulti-vitamins could help to make the skin lesions fade away,
if diagnosed early (DCH and JU 2000). The alternative
sources of drinking and cooking water available in
Bangladesh include (1) rainwater harvesting, (2) dug/ring well,(3) deep tube well, (4) pond sand filters, and (5) arsenic
removal filters (household and community type) (Ahmed
2002). Production of toxic sludge is a risk that is associatedwith filtering. However, recently SONO Filter has been
declared by the US Environmental Protection Agency as safe
from any environmental hazard. Not all of the alternative
options may be feasible or suitable for all areas. Thus
selection of cost –effective alternative options must be madefor specific areas.
Given the alarming situation, it is indispensable to makethe people aware of the danger that they are in and they mustbe persuaded to make changes in habits regarding drinking
water, if necessary. In order to disseminate informationneeded for the masses to address the problem, a national
communication strategy had been adopted. This strategy was
based on social marketing technique (UNICEF 1999). Social
marketing involves designing, implementing and controlling of
programs that seek to proliferate the acceptability of a certainsocial idea, and or practice among targeted groups (Kotler
1975). More simply put, it is a strategy to change behaviour,
utilizing advances in marketing skills and communication
technology through action framework and integrated planning(Kotler and Roberto 1989). The first phase of the mitigation
efforts carried out in a limited number of areas included
meetings with community leaders, radio/TV commercial,
dramas and workshops for health workers, distribution ofleaflets, posters etc. (BAMWSP 2002). NGOs and the local
governments were involved in various stages of the
programme. All tube wells in the locality were tested and theresidents were informed whether their tube wells were safefor them to drink water from. Next, they were helped tochoose a safe water option. Village meetings, school
meetings, and meetings with elected leaders of local bodies
were used to disseminate the messages of the arsenic
problem to the people. Workshops to train stakeholders werearranged.
Nevertheless the awareness level of those living inarsenic-prone areas is not at all satisfactory. For example, in
Akmam and Islam (2006) it was observed that in spite of
having arsenicosis patients in almost all the households, morethan 46% of the respondents still used arsenic contaminatedwater for drinking and cooking. In the study carried out by
Zakariya (2000), it was found that in an arsenic prone villagethat did not have many arsenicosis patients, awareness level
was relatively low. Although they knew about the dangers ofarsenic they did not bother to drink from safe water sources.
In these villages, age, education and income had more
influence on awareness. Zuberi (2003) in his study on someareas of Northern Bangladesh has shown that in his sevenpoint awareness scale, the highest level his respondents
could reach was 5. The reasons he mentioned for poor

Eubios Journal of Asian and International Bioethics 17 (November 2007)
performance of his respondents included (a) illiteracy, (b) non
suitable communication materials, (c) non-suitable ways ofpresenting information (d) non-availability of suitable
alternative option at a close distance (e) non-acceptability ofprescribed option, and (f) fatalistic beliefs. Hadi (2003) has
shown that age, exposure to awareness campaigns,
educational status, and exposure to media had significant
impact on awareness level. However, he concludes that it isunlikely that only arsenic awareness campaign is going tobring about behavioural change.
Objectives Of The StudyIn this paper, we examine awareness level of the
inhabitants in a village named Khajadanga. Specificobjectives of the study were the following:
1. To depict the overall socio-economic situation of the
respondents;
2. To understand the water-use pattern in the study area;
3. To know about the arsenic-related situation in the study
village;
4. To find out the respondents’ awareness level regarding
arsenic problem;
5. To identify the factors that affect awareness level of the
respondents.
Methodology
A social survey has been used to carry out the present
study. Out of a total of around 1000 households 200 heads ofhouseholds (the respondents of this study) were selected
through simple random sampling. Data were collected by face
to face interviews with respondents, using questionnaires that
contained both open ended and closed ended questions. The
respondents were interviewed in August 2005. Along withheads of households and female heads of households werealso interviewed, as collecting water for the household isculturally thought to be ‘women’s job’ in Bangladesh.
Household was the unit of analysis. The data were processed
manually. Simple statistical methods were used for analysis.

Monthly Income and Occupation
Figure 2 shows occupation and monthly income of the
respondent households. We find that 12% (n=24) of the
respondent households were dependent on selling theirlabour only. All the others were principally or partiallydependent on agriculture. Twenty six percent (n=52) of them
totally depended on agriculture, while 48% (n=96) weredepended on agriculture and some form of services. Among
the respondents 56 (28%) earned only up to 2000 Taka permonth, 51 (25%) earned 2001-4000 Taka, 56 (28%) earned
4001-6000 Taka and 37 (19%) earned more than 6000 Taka
per month.

Monthly Income (in Taka) and Occupation of the
Respondent Households

e
g15
a
t10
n
e5
c
r 0
e
P

Number of Members in Household
Fifty nine percent of the respondent households (n=118)
had 4-7 members. However, a significant number (n=69,35%) of households had more than 7 members. The reason
for this is that in Khajadanga there were relatively more joint
households, consisting of members belonging to three ormore generations.
Members in Household

7%
34%

2-- 3
4--5
38%

6--7
8--10

21%

Figure 1: Number of Members in Household

0--2000
2001--4000
4001--6000>6000

Occupation
Figure 2: Monthly Income and Occupation of the Households
Amount of Cultivable Land
Figure 3 portrays amount of cultivable land owned by the
respondent households. Only 5 (2.5%) of the respondents
had no cultivable land. However, 38% (n=75) had more than 3acres of land.

The Study Locale
The locale of this study, Khajadanga, is located in Tilak
Shalpo Bahirdia Union within Rupsha Upazilla of Khulna
district. This area has been selected for this study as it has
been identified in the screening tests carried out by National
Arsenic Mitigation Information Centre (NAMIC) as one inwhich 77% of the tube wells were contaminated with arsenic.
Socio-Economic Condition of the Respondents
Before going on into the water-related aspects observed
among the respondents, we shall take a glimpse of the overallsocio-economic conditions in the village.

163

Cultivable Land (In Acres)

14%

3%

0
35%

<1
1--3

24%

3--5
24%

5--7

Figure 3: Amount of Cultivable Land
Types of Houses
All the respondents lived in their self-owned houses.
Among the respondents, 46% (n=92) lived in kacha houses(made of straw, bamboo, mud etc.), 52.5% (n=105) lived insemi pucca (houses with cemented floor and corrugated ironroof) and only 1.5% (n=3) lived in fully concrete houses(pucca) houses.

Eubios Journal of Asian and International Bioethics 17 (November 2007)

164

Types of Houses

2%
Kacha
46%

Semi-Pucca

52%

Pucca

Figure 4: Types of Houses
Average Schooling Years of Households
Average schooling years of each household were
calculated by counting the number of years each member ofhousehold (aged 7 years or more) attended schools (andcolleges, universities etc.) and dividing the sum by the
number of members aged 7 years or more. This gives us abetter picture of education of the household as a whole. In
Khajadanga, 26% of the households had an average of only
0-2 years of schooling, 31% had 2-4 years, 29% had 4-6
years and only 14% had 6-8 years of average schooling.

wells had taken place. Heads of households, because of theirreluctance and ignorance did not take initiatives out of theirown accord to have their tube wells tested. Among thosetested, 52 (29%) were safe but 128 (71%) were not. Around
20 arsenicosis patients were identified in Khajadanga. Most ofthem had been taken away from the village to the cities fortreatment. Only two of them could be found during the study
period, a male and a female. The male patient, after being
diagnosed, received treatment at Khulna Medical Hospital. He
was recovering. The female patient tried to keep her diseasea secret in fear of being abandoned by society. However,when her disease was ultimately exposed (Keratosis), shealso sought treatment. She was not ill treated by her family or
her community.
In spite of knowing that the water they were drinking was
not safe, none had switched to a safe water source. The
reasons they pointed out were that (1) they were habituatedto drink this water and did not feel it necessary to change that
habit (21%), (2) the source of safe water was too far away(22%), and (3) materials/instruments that could make theirwater arsenic-safe were not available (21%). Thirty six
percent of the respondents mentioned all of the three reasonsfor their drinking unsafe water (see Figure 7).
Reasons for Drinking Unsafe Water

Ave rage Schooling ye ars of House holds

21%

Habit

36%

14%

26%

0--2
2--4
4--6

29%

Figure 7: Reasons for drinking unsafe water

Figure 5: Average Schooling Years of Households
Water-Use In Khajadanga
In Khajadanga, every household used tube well-water for
drinking; however, as this water contains too much iron andhas a negative effect on taste and colour of food, they all
used surface water (from ponds) for cooking. The female
heads of households were asked about the distance which
they had to walk to procure their drinking water (from tube
wells). Their answers are shown in Figure 6. Sixty five percent(n=130) of the households had a tube well within their own
home compounds. Thirty nine (20%) had to walk for up to 5
minutes to bring water, and 31 (16%) had to walk for up to 10
minutes.
Distance of Current Water Source from Home
Time required
5--10 mins.
0--5 mins.
0 minute
20

40

60

21%

Long
distance
Unvailability

6--8

31%

0

22%

80

Percentage
Figure 6: Distance of Current Water Source from Home

Arsenic-Related Situation in Khajadanga
Among the respondents in Khajadanga, 180 (90%) had
their tube wells tested for arsenic, but 20 (10%) had not.
These households were left out when the screening of tube

Awareness of Arsenic
Concise Oxford Dictionary defines awareness as“knowledge or perception of a situation or fact.” In thisparticular research, the term refers to knowledge of a situation
along with rational changes in behaviour required to showinternalization of the knowledge or information. Awareness ofarsenic refers to knowledge of the target group on arsenic, its
toxicity, mitigation, along with effective efforts to procure
drinking and cooking water from safe sources.
Arsenic Awareness Scale
For this research, a nine-point awareness scale had beendeveloped on the basis of the respondents’ knowledge of thearsenic problem and the actions taken by them in response to
their acquired knowledge e.g.,
1.
Knowledge that tube well water can be contaminatedwith high levels of arsenic, for which each tube well has to betested. If a tested tube well is painted red, it should be
avoided and water should be collected from one that ispainted green;2.
Knowledge that arsenic is a tasteless, colourlesspoison that causes various symptoms and diseases including
weakness, melanosis, keratosis, gangrene, mental illness andcancer of the skin, liver, kidney and other internal organs;3.
Knowledge that arsenicosis passes on from mother tothe baby to be born, and that growing children are mostsusceptible to arsenic toxicity;4.
Knowledge that toxicity of arsenic does not reduceeven after boiling. So, both drinking and cooking water should
be procured from arsenic free sources;5.
Knowledge of the alternative safe water options andabout the procedure of their use;
6.
Knowledge that arsenicosis is neither contagious; nor
is it a curse of God; if someone is suspected of having

Eubios Journal of Asian and International Bioethics 17 (November 2007)
arsenicosis, he/she must be taken to the hospital fortreatment.
7.
Knowledge that there is no specific treatment forarsenicosis; drinking from safe water sources is the first step
towards cure.
8.
To make sure that the tube well from which one
procures water is tested; if found not safe, water must be
procured from safe water sources.
9.
To make others conscious about arsenic toxicity and toencourage and help them to drink from safe water sources.

Source of Arsenic Information
Fr./Neigh
TV/Radio/NGO

9%

32%

19%

10%

NGO
DPHE

10%

20%

TV/Ra/NGO/Fr./Neig
TV/Radio

Figure 8: Source of Arsenic Information
The arsenic-awareness level of the respondents is shownin Figure 9. We find that the highest level that the
respondents could reach was only 5 (11%, n=22). Although
they all heard the word ‘arsenic’, and most of them had theirtube wells tested, many did not know what arsenic was. Thus
we find that 38% (n=76) percent of the respondents had
acquired the lowest level of awareness. Twenty percent(n=40) acquired level 2, 26% (n=13) acquired level 3 and 36%(n=36) acquired the awareness level of 4. Hence we see thatthe level of arsenic-awareness of the respondents is a far cry
from being satisfactory.

Arsenic-Awareness Level
Level 1

11%

Level 238%

18%

Level 3
Level 4

13%

Level 520%

Figure 9: Arsenic Awareness Level among the Respondents
Willingness to pay per month, willingness to donate permonth, willingness to walk to bring safe water, and their
willingness to give voluntary labour for the purpose of getting
safe water are somewhat related to the respondents’awareness level of arsenic. Figure 10 shows us thewillingness of the respondents to pay a certain amount ofmoney per month to get safe water. It must be said thatpeople in rural Bangladesh are not used to paying for water.
Once they had their tube wells installed, they had to spend
very little for maintenance. They thought it was duty of thegovernment to provide them with safe water free of cost.
However, after knowing that drinking water from contaminatedtube wells is a health hazard, most of them agreed to pay acertain amount money to get safe water. Among the
respondents, 23 (12%) were not willing to pay at all. In spiteof their poverty, 125 (63%) were willing to pay up to 50 Taka,
28 (14%) were willing to pay 50--100, and 24 (12%) werewilling to pay up to 200 Taka per month.

Willingness to Pay per MonthAmount willing topay (Taka)

Respondents who succeeded in fulfilling all the ninefactors were considered fully arsenic-aware persons. Alongwith the awareness campaign that is continuing in the media(radio, T.V.), billboards, school textbooks, newspapers etc.,
the DPHE (Khulna district) and an NGO named ADAMS also
carried out some awareness raising programmes. The DPHE
and ADAMS were engaged in the screening program to
identify tube wells that were arsenic-affected (spewing waterwith arsenic 0.05mg/liter or more). They painted the spouts ofsafe tube wells green and the contaminated ones red andadvised villagers to stop drinking water from tube wells thatwere painted red and share water of the green painted tube
wells. However, they did not inform the villagers about thedeadliness of arsenic and its multifaceted health-effects. Nor
did they provide information on the alternative safe water
options, let alone make these available to them. Hence we
see that the awareness campaigns to which the respondents
were exposed were by no means sufficient for them to attaina high level of arsenic-awareness.
Before going on to awareness level of the respondents,
we must know about sources of arsenic information acquiredby the respondents. We find that the sources of information
were mainly friends, neighbours, DPHE officials, NGO
workers, radio and television. It must also be mentioned thatthese villagers could watch only BTV, the government
channel. Satellite TV channels were still out of reach in rural
areas.

165

101--200
50--100
0--50
Not at all
0

20

40

60

80

Pe rce ntage

Figure 10: Willingness to Pay per Month
Respondents were also asked about the amount they
were willing to donate for the purpose of establishing safe
water sources in the village. Their responses are shown in
Figure 11. Twelve (6%) of the respondents were not willing to
donate at all; maximum number of respondents were willing to
donate up to 500 Taka (n=127, 64%). Figure 12 shows theamount of voluntary labour (hours/week) that the respondents
were willing to give for the establishment and maintenance ofsafe water sources. It shows that most of them (n=111, 56%)
were willing to give 5—7 hours of labour per week. However,20 (10%) were not willing to give labour at all. The reason
could be their age and ill-health.

Eubios Journal of Asian and International Bioethics 17 (November 2007)

166

schooling years’, rather than education level of the
respondent. It often occurs that schooling years completed bya certain head of household is low. However, hisson/daughter may acquire higher educational level anddisseminate information on arsenic contamination to thewhole family.

80
60
40
20
0

Relations hip be tw ee n Incom e and Aw areness Le vel

Not at all

0--500500--1000

1000-2000

35
30

Am ount (Taka)

Figure 11: Willingness to Donate for the Establishment of
Safe Water Source

Percentage

Percentage

Willingnes s to Donate for Es tablishm ent of Safe
Sater Source

25

>6000

20

4001--6000

15

2001--4000

10

0--2000

50Willingness to Give Voluntary Labour(Hours/Week)
4%

10%

0

2

3

4

5

Aw are ne ss Leve l

Not at all

12%1

1--3 hours

Figure 13: Correlation between Income and ArsenicAwareness Level

3--5 hours

55%

19%

5--7hours

Re lations hip betw ee n Average Schooling Years
and Aw are ness Le vel

7--10 hours

40

Female heads of each of the respondent households wereasked about the distance they were willing to walk to procure
safe drinking water. As we see in Figure 6, 65% of the
respondent households had tube wells within their homecompound. Thus it is not unnatural that almost 25% (n=49,
24.5%) of the respondent women would say that they were
not at all willing to walk to get safe water (see Figure 13).
Moreover, in rural areas, having to go out of the house to
procure water is a symbol of loss of social status. A significant
proportion of the households however, (n=65, 33%) said thatthey were willing to walk for up to 10 minutes. As alternative
to current tube well water, the respondents would prefer(84%) filtering of tube well water and tap water at home(18%).

30

Willingness to Walk (In Minutes)

Minutes

11--20
6--10
1--5
Not at all
0

10

20

30

40

Percentage

Figure 13: Willingness to Walk (in Minutes)
Factors Affecting Level of Arsenic-AwarenessWe tried to find out the factors that were related to thelevel of arsenic-awareness acquired by the respondents. In
Figures 14 and 15 we see how income and average schoolingyears of household were positively correlated to arsenicawareness level of respondents (coefficients r=0.869 and
r=0.798 respectively). This means that the higher the monthly
income, and average schooling years of household the higher
probability there is that the awareness level would be
relatively high. In this study we used the variable ‘average

Percentage

Figure 12: Willingness to give Voluntary Labour

6--8
4--6

20

2--4

10

0--2

0
0

1

2

3

4

5

Aw arene ss Level

Figure 14: Correlation between Average Schooling Years
and Arsenic-Awareness Level
Conclusion
In this paper, we have principally focused on the nature ofawareness campaigns and the awareness level attained byinhabitants in an arsenic-prone village named Khajadanga.
We observed that the awareness campaigns to which the
respondents were exposed were not at all sufficient orsuitable for them to grasp the message of danger andrespond accordingly. Hence the highest level of awarenessacquired by the respondents could reach the level of only fiveon a nine point scale.
The target of all awarenessprogrammes involves some kind of behavioural change. Thisbehavioural change occurs through a certain communication
process along with some supporting conditions. The
communication process consists of:a. Informingb. Instructing
c. Persuading
While informing has a short-range learning goal,
instructing involves a long-range learning goal, which is
supposed to stimulate the receiver toward some additional
activities. In case of persuasion, the receiver is expected to“yield to the point of view advocated by the persuader”(Schramm 1971, p. 44). The first two processes involve
clearing of four hurdles (Schramm 1971):
Attention: The message we are trying to convey must be able
to attract the attention of those who are targeted;
Acceptance: After gaining attention, the message has to be
accepted. Acceptance depends on the face value of theEubios Journal of Asian and International Bioethics 17 (November 2007)
message and on the credibility of the person/source who isconveying the message;
Interpretation: The targeted person, after accepting amessage will interpret it on the basis of his/her stored up
experience and built-in values; andStoring: The interpreted message will thereafter be stored for
future use.
In the process of persuasion, the receiver is required toyield the message or point of view advocated by the
persuader and act in the direction he/she is persuaded. In thisprocess, the credibility of the persuader is very crucial. Oftena threat over which the receiver has no defense (but not somuch as to arouse panic), guilt appeal, or even ridicule canhelp in yielding desired change in behavior. In Bangladesh, astrategic extension campaign on rat control used this tactic(by distributing posters that show trapped men in cages andrats laughing at them from outside), and was highly effective(Adhikarya 1989). Cross-pressure on a specific target can bebuilt by convincing him/her that the two or more
persons/groups he/she trusts opine in the opposite direction
to his/her opinion, therefore, he/she should also change
his/her opinion. This is called “strain toward consistency”(Schramm 1971). This tactic is also worth trying. However, wemust ensure that the target group has access to acceptablesafe water sources at close distance from which they canprocure necessary amounts of water for drinking and cooking.
References
Adhikarya, Ronny (1989) “Strategic Extension Campaigns on Rat
Control in
Bangladesh” In Public Communication Campaign
Second edition, Rice, R.E.
Atkin, C.A. (eds.), Beverly
Hills; London; New Delhi: Sage Publications pp. 230232.
Ahmed, K. M. 2003 “Arsenic contamination in groundwater and areview of the situationinBangladesh”
in
Groundwater
Resources and Development in Bangladesh: Background to theArsenic Crisis, Agricultural Potential and the Environment Rahman,
A.A. and Ravenscroft, P. (eds.) Dhaka, UPL Pp.395-464.
Akmam, W. and Higano, Y. (2007) “Supplying Safe Water in
Bangladesh: A Policy
Model based on Multi-objective Mixed
Integer Programming” Papers in Regional
Science Vol. 86,
No. 1. Pp. 57-75.
Akmam, W. and Islam, Md. Fakrul (2006) “Taranagar From 2000 To
2005: Changes in Arsenic-Related Situation in A Badly Affected
Village in Meherpur, Bangladesh”
paper presented at theAnnual Conference of the Japan Section of the Regional Science
Association, Chiba, 7—9 October.
BAMWSP (2002) Home page of Bangladesh Arsenic Mitigation andWater Supply
Project viewed on March 3 , 2002 <http://www.BAMWSP.org.>.
Chowdhury, Mufad Ahmed (2002). “Impact of Arsenic on the Rural
Poor in Bangladesh”
in Ahmed, M.F., Tanveer, S.A.,
Badruzzaman, A.B.M. (eds.)Bangladesh
Environment 2002
Vol 1 Dhaka, Bangladesh Poribesh Andolon, Pp. 154-160.
Department of Public Health Engineering (DPHE), Government of thePeople’s Republicof Bangladesh and British Geological
Survey (BGS), UK (2000). GroundwaterStudies of Arsenic
Contamination in Bangladesh: Final Report Summary viewed
on
June
25,
2000
<
http://www.bgs.ac.uk/arsenic/Bangladesh/home.html>
Dhaka Community Hospital (DCH) and School of Environmental
Studies, Jadavpur
University(SOES,
JU)(2000)
Groundwater Arsenic Contamination in
Bangladesh:(A)
Summary of 239 days Field Survey from
August1995
toFebruary, 2000; (B) Twenty seven Days Detailed Field
Survey Information from
April
1999
to
February
2000.
Unpublished survey report procured from Dr. Dipankar
Chakraborty, Head of SOES, JU.
Hadi, A. 2003 “Fighting Arsenic at the Grassroots: Experience of
BRAC’s Community
Awareness Initiative in Bangladesh.
Health Policy and Planning Vol.18, No. 1 Pp. 93-100.
HVR Arsenic Project (2000) "What is Arsenic?" viewed on May 23,
2000< http://www.hvr.se/nov97/arsenic.html. [23.>Jakariya, Md. (2000) The Use of Alternative Safe Water Options to
Mitigate the Arsenic
Problem in Bangladesh: A Community
Perspective. M.Sc. thesis, Department ofGeography,
University of Cambridge, U.K.

167

Kotler, P. and Roberto E. L. (1989). Social Marketing: Strategies for
Changing Public Behavior. New York; London: The Free Press.
Kotler, P. (1975) Marketing for Nonprofit Organizations. Englewood
Cliffs; N. J.:
Prentice Hall.
Schramm, W. (1971) “The Nature of Communication between
Humans” in The Process and Effects of Mass Communication(Revised edition), Schramm, W. and Roberts, D.F. (eds.), Urbana;
Chicago; London, Illinois Press, Pp. 3-51.
Smith, A.H., Elena O. Lingas, E.O. and Rahman, M. (2000) "The
Bangladesh well water
arsenic calamity" an article accepted for
publication in WHO Bulletin collected throughpersonal
communication with Dr. Allan Smith.
UNICEF, Bangladesh (1999). “Arsenic Mitigation in Bangladesh,Media Brief” viewed
on
Feb.
15,
2001
at
<http://www.unicef.org/arsenic/>.
Zuberi, Muhammad Iqbal (2003) Arsenic mitigation through AMPChristian Aid Support:
Awareness,
Communication
andScaling-up: an assessment report commissioned
by AMPChristian Aid (UK).

BioCosmological Approachin World Bioethics- Konstantin S. Khroutski, Ph.D.
Dotsent, Institute of Medical Education,
Novgorod State University after Yaroslav-the-Wise,
Novgorod Velikiy, Russia
E-mail: hrucki@mail.ru"For, truth is rightly named the daughter of time, not of
authority. It is not wonderful, therefore, if the bonds of
antiquity, authority, and unanimity, have so enchained thepower of man, that he is unable (as if bewitched) to become
familiar with things themselves."- Francis Bacon (From his “Aphorisms on the Interpretation of
Nature and the Empire of Man”
What is “Cosmos”?
During my presentation of BioCosmological conception,at the Fifth Asian Bioethics Conference (ABC5 in Tsukuba,2004), Prof. Sang-yong Song inquired of the author about themeaning of the terms in use: “cosmos”, “cosmic”, “cosmist”. It
must be admitted that it was not a simple task, particularly
taking into account the expectation of colleagues to hear ashort and clear reply. Another case of this mysterious attitude
was in the XXth conference of European Society for
Philosophy of Medicine and Health Care in Helsinki (August,2006) where my presentation on BioCosmology was put into
the session, entitled “Medicine, religion and metaphysics”.
Indeed, we might discern at present at least four main
meanings of the term “cosmos”:(1) In its primary philosophical sense, a cosmos is anorderly or harmonious whole (eventually, as it is perceived bya man). It originates from a Greek term κόσμος meaning“order, orderly arrangement” and is the antithetical concept ofchaos. Pythagoras is said to have been the first philosopher
to apply the term cosmos to the Universe. Significantly, in theoriginal (mythological-religious, Eastern philosophical) use thewords “absolute”, “cosmos”, “nature” and “universe” were(and are) employed synonymously to include all that exists.
(2) Cosmos – systematic harmonious whole (but distinct
to Absolute) held to arise by and persist through the directintervention of a concrete divine or mystical power. This
relation to “cosmos” leads to the existing range of religious
and esoteric cosmologies.
(3) An astronomic (astrophysical) standpoint that is
dominating nowadays: cosmos is the universe as a whole,considered as complex, well-ordered, and unified system. In
cosmic space, as distinct from the Earth, scientists study

168

Eubios Journal of Asian and International Bioethics 17 (November 2007)

celestial objects (such as galaxies, stars, planets, comets,etc.) and phenomena that originate outside the Earth's
atmosphere (such as auroras and cosmic backgroundradiation). “Physical cosmos” is an object for modern physicaland metaphysical cosmologies. An evident paradox, herein, isthat in scientific relation Cosmos is contrasted to the planet
Earth, while Earth is ever the integrated and universal part of
Cosmos.
(4) Cosmos is a harmonious world of human experience– a subjective harmony within the surrounding world.
"Humanistic cosmos" is rooted in the philosophical tradition ofancient Greece, but now it is based on new ontologicalfoundations. Humanistic approach, aiming at the harmony inmutual relations of a subject (human being and his society)with the world around (“the nearest cosmos”), as well as
harmonization of the subjective experience of a human (ofhumankind's historical experience on the whole) – is realized
chiefly in the area of philosophical anthropology, modern
vitalistic conceptions, including “new age” theories,
fundamental ecological approaches, including systems
ecology and deep ecology (with Lovelock's Gaia theory), thedoctrine of Noosphere by Vernadsky (and its precursors andfollowers: Bergson, Morgan, Teilhard de Shardin, Steiner,
Wilber), as well as the so-called “postneoclassic” science, inthe forms of synergetics, conceptions of co-evolution or
universal evolutionism (in relation to cosmist issues), that aredeveloped mainly among modern Russian philosophers andscientists(Timofeev-Resovsky,
Moiseev,
Styopin,
Kurdyumov, Knyazeva, Kazyutinsky, Ermolaeva, Liseev).
(Note: the type of "..."-brackets or writing with a capitalletter is used for the designation of my own terms, metaphors,
expressions, etc., whereas “...”-type – for citing and the use ofgenerally accepted words).
From the position of original (BioCosmological)
exploration, which main distinction is its foundation on the aposteriori universal truths (characterized below), author
considers it relevant to add one more (fifth – Cosmist,
realistic) definition: Cosmos is everything that really exists
and is the target of our experience – feeling, perceiving,consideration, reasoning, supposition, etc.). For example,
ABC8 was a true cosmic event.
Every life process (a human’s ontogenesis) is the direct
subject of BioCosmology
Indeed, the planet Earth itself and the entire evolutionary
process of the life on Earth (briefly, Evolutionary Process or
EvoProcess), naturally including every self-dependent life
process (biological, personalist, sociological, ecological), –are unconditionally the product and the integrated part of
Cosmos, subordinated to the common (universal) Cosmic
laws; hence, every life process or event really is the direct
subject of BioCosmology (wherein "Bio-" is Greek. “Bios” –Life), including equally the development of ABA or the
ontogenesis of a human being (person).
The natural sciences reality of cosmic origin of
Evolutionary Process (and hence of every current life
process, be it biological, personalist or sociological) is
simultaneously the Universal objective law of the life on Earth.
This law (of Cosmic origination of every life process) does notdepend upon any of the existing idealistic (i.e. a priori – notvalidated by natural sciences data) assumptions of origin and(macro)evolution of the life on Earth, like creationism,
panspermia, biogenesis and abiogenesis, chemosynthesis,etc.), – at any rate the life on Earth has emerged and beendeveloped always from cosmic matter and energy.
Consequently, the life on Earth (EvoProcess, every humanontogenesis, every social history) always is a cosmic
phenomenon (process) – this is an objective (naturalistic) fact,a posteriori truth.

Objective laws of Earth’s (Cosmic) life
What are then the objective laws of Earth’s (Cosmic) life
– its rational true fundamental principles? We might advance
five fundamental a posteriori (naturalistic) – BioCosmological– principles (truths, laws):
1. Fundamental cosmism (naturalism) – undoubtedly
planet Earth is the product of Cosmic evolution and a part ofreal Cosmos, hence all life processes (including the
ontogenesis of a person) have the Cosmic origin (areoriginated from Cosmic energy and matter);
2. Fundamental universalism, first of all the structural(morphological)-functional universalism – a natural sciences
truth at least since the discovery of the structure of DNA by
Watson and Crick, inasmuch as this discovery has proved,
first of all, the unity (identity) of basic physical-chemicalelements (of proteins, first of all) that constitute any biologicalorganism on Earth, as well as, secondly, has revealed thepsychosomatic unity of any conscious organism (the genetictransmission of psychological character by DNA molecules);3. Fundamental self-(macro)evolutionism – every subjectof life is the self-(macro)evolutionary process (including theentire biological evolution and social history) and every
subject’s ontogenesis is the self-dependent emergent
evolution;
4. Fundamental macro-evolutionary cyclic recurrence oflife processes (a kind of triadicity), which essence is thatdiametrically opposed (in relation to the entire life activity of a
subject), but successive cycles-stages (like Day–Night–
NewDay, or Systole–Diastole–NewSystole, in essence –Thesis–AntiThesis–SynThesis)
effectively
realizetheontogenesis of every living subject (biological, personalist,
sociological, ecological), overruling in evolution each other byturns.
5. Fundamental evolutionary anthropologism – precisely
BioCosmological ‘universal personalist law of evolution’:Since the evolutionary biological emergence of Homo
Sapiens, human freedom is a fundamental assumption of allsocieties and a central experience of all people during theentire social history and every personalist evolution.
All these universal laws, to be underlined once again, areevident a posteriori truths corroborated (and not disproved) by
natural (social) sciences data.
Crucial principles and notions of BioCosmology
In this fundamental light, what are the crucial
BioCosmological conceptions? Herein, the first four chief
BioCosmological notions are adduced:(1)
EvoProcess(Evolutionary
Process)–a
BioCosmological cornerstone – is the one common wholecosmic evolutionary process of the life on Earth (CEPLE).
First of all, CEPLE is a real phenomenon of reality and(meta)naturalistic truth, demonstrated by natural sciences.
The conception of EvoProcess is proposed to have the same
significance (for the exploration of all forms of life) as thenotions of gravity or electromagnetism (for physics) or affinity(for chemistry), etc. EvoProcess is supposed as primary andultimate substance of all life processes on Earth and,simultaneously, as a scientifically evident phenomenon,
therefore this notion integrates a posteriori and a priori
thinking. This is crucially important that EvoProcess is not abelief (conviction, credence, dogma, faith, etc.), but primarilya real phenomenon demonstrable by natural sciences.
(2) Subject – a universalizing notion that means every
living organism and its/her/his ontogenesis – from a moleculeto HumanKind (person, society) and EvoProcess itself.
(3) HumanKind – likewise serves as universal equivalent:
It stresses that human creative (active-evolutionary) vigor isthe leading factor at present of the entire EvoProcess(CEPLE) of the life on Earth, therefore any conscious "humankind" subject (as a person, society, civilisation, mankind) is
HumanKind as well.

Eubios Journal of Asian and International Bioethics 17 (November 2007)
Basic (Cosmist) Functionality (BCF)(4) Basic (Cosmist) Functionality (BCF). EvoProcess, as
we understand it, allows the universal functionalist reductionof all living subjects. Every living subject on Earth is ultimately
the inherent function of EvoProcess – of the all-embracing
self-evolving organism of Earth's life. Hence, every living
subject on Earth has its/her/his basic (ultimate, cosmist)
functionality (BCF). This means that all subjects of life are
intrinsically dedicated for the realization and execution
ultimately of its/her/his foreordained basic certain function (butwhich has manifold forms of expression), which is practicableduring a subject’s (person’s, first of all) entire wholesome
ontogenesis (at its mature stages).
During the entire life of a subject, as BioCosmology
claims, its/her/his basic functionality hierarchically organizes(for example) human’s biological and social needs in one
inherent integral order. This order, in principle, repeats thehierarchy of the main stages of biological and social evolution
on Earth. Hence, biological and social needs (and therealized physiological, biosocial and psychological systems of
their satisfaction) may be considered as tools for a BCF to
implement its self-unfolding and ultimate self-actualization.
So to speak, "we eat to live, but do not live – to eat". As it
naturally should be, all biological and social needs of humans
co-operate on the achievement of the ultimate end of her or
his specific functionalist contribution to EvoProcess’s
wellness. This achievement is mainly possible at the mature
creative levels of social stability (where the possibilities forfree creative activity occur), the culminating stage of man’swholesome ontogenesis.
Cosmos (universe) – uni-versus – “turned to one”
It is important to note that “Cosmos” is synonymic to theterms “Nature” and “Universe”, while the etymology of thelatter is from uni- + versus, which means “turned into one”.
Significantly, the conception of EvoProcess just serves
for universal consideration of world as whole, being a basis
for the reduction (to a "Basic Cosmist Functionality" – a"functional organ" – of universal participation of a subject oflife in the Cosmist world). It is important that in this quality (ofthe universal basis for the reduction of the life activity of a
subject of life, especially of a HumanKind) it is not farther thanquarks (fundamental particles that are explored in modern
physics) or genes (morphological units of heredity) or anindividual her/himself (which is a common morphological orindividualistic reduction, i.e. methodological reductionism).
Therefore, subject (in BioCosmology) always means an
integrated functionalist subject, which forever autonomously
integrates and hierarchically co-subordinate other subjects oflife (to be the functional whole) and, simultaneously, is always
functionally integrated by the higher organized subject(organism) that makes good use of the effects of the subject’s(person’s) inherent functioning, which stem from its/her/his
primary intentional (functionalist) activity (the effects of which
are demonstrable for the selection by a higher organizedsubject).
In that way, every subject is a "functional organ", and theconception of “functional organ” (and, further, “dominanta”) isa long ago established scientific approach, primarily due tothe works of Russian scientist and philosopher Aleksey
Ukhtomsky. Later on his ideas were substantially developedby academicians Petr Anokhin, Aleksandr Ugolev, Pavel
Simonov and other.
Herein the scheme is adduced that presents thefigurative image of integrated scientific knowledge:

169

Designations:
M/I – the Morphological-functional or Individualist approach: It
reduces everything to "a morpho-" – any objective form or
structure, or to the subject of a human being – the individual.
F/C – the Functionalist (Cosmist evolutionary) approach, which
reduces everything to the "functionalist organ" and every subject
to its/her/his Basic Cosmist Functionality.
Eq – "equator" of the modern objects of scientific researches: a
HumanKindor
humanorganism,animals,
plants,microorganisms and their social organizations, as well as theirconstituting cells, tissues, organs and their system organizations.
In the current time, all actual objects of scientific research arechiefly subordinated to the (M/I) pole, leaving indifferently the(F/C) pole – of the one common universal sphere of rational
exploration of all phenomena and processes of the life on Earth.
Consonanceof
BioCosmology
with
Eastern“fundamental naturalism”
Substantially, BioCosmological concept is concordant
with the conception of “fundamental naturalism” (per se,"fundamental cosmism"), Prof. Hyakudai Sakamoto used in
his presentation of the “Globalization of Bioethics – from the
Asian perspective” (at the ABC5 and, previously, in Kiev,
2001). Professor Sakamoto establishes that a new global
bioethics should be “holistic” in contrast to European“individualistic” bioethics, and that it requires “some sort ofcommunitarian way of thinking of a non-western or Asiantype.” His cornerstone position is as following: “We should
now establish a new humanism without human-centrism, a
new methodology to complement this new humanism, andalso cultivate new sciences and technologies to control
human evolution, adopting the Asian ethos and wisdom to
avoid the European excessive inclination to the manifold
natural-artificial dualism”.
Virtually, Hyakudai Sakamoto has introduced a new
emergent (epistematic, non-western) type of bioethicalthinking and a new type of naturalism (based on “Asianethos”, but not on common Western rational fundamental
world-viewing principles) – in the form of his biopolitical“bargain consensus” conception and the “Social Tuning
Technology”, aimed at the resolution of conflicts of any typeand realisation of the harmony in (future) global bioethics.

170

Eubios Journal of Asian and International Bioethics 17 (November 2007)

Asian naturalism vs Western naturalism
So, we might discern Asian naturalism in contrast toWestern naturalism and propose the trend of a "Third"
naturalism. For instance, Prof. Sakamoto’s naturalism isbasically distinct from the common modern (global, Western)naturalism.
i. First of all, from the objective point of view, “Asian”
naturalism is realistic (inasmuch as it treats man and nature
as one whole, this is a real truth – natural sciences fact), but
irrational (rationally unfounded – not reducible to any
fundamental rational reason and, thus, existing in Cosmos but
missing in Earth's rational life – ACosmist in essence). (Note:
My term "ACosmism" has its definite meaning and differs fromthe accepted ones, like “acosmism” in Hegelian philosophy, or“acosmism” in Hinduism, etc.).
ii. On the contrary, (post)modern Western bioethics isrational, but unrealistic, inasmuch as it is based on thecommon (for modern Western philosophy and science)
rational fundamental world-viewing principles, but which have
“dualistic” and “natural-artificial” essence – of basic
AntiCosmism (dualism of Man and Nature) and absolute
anthropocentrism (human being is the ultimate creation of theworld and, thus, the supreme ultimate epistemic certainty is aperson’s subjective knowledge about her/himself).
BioCosmology – as a trend of the "Third" evolutionary
way in the world bioethicsiii. The proposed BioCosmology might be treated as theform of a "Third" naturalism and Third evolutionary way incontemporary bioethics (and, in the metaphor, mentioned
above, – a NewDay, in relation to the Eastern Day andWestern Night, which all are the necessary cycles and always
existing processes, of revolving experience, of the one whole
EvoProcess).
BioCosmology is a rational and realistic trend oftheoretical and practical activity, inasmuch as it is based
substantially on a posteriori fundamentals, i.e. its fundamentala priori notions reflect the real (natural) matter of fact, as it isdemonstrated by natural sciences.
In contradistinction, the contemporary Western worldviewing is based on a priori (speculative, abstract)fundamental principles, like British empiricism, Continental(French) rationalism, German idealism, including Kantian (andhis followers) transcendentalism, American pragmatism, etc.
This is, so to say, naturally (realizing a natural Night-cycle ofworld development) a not natural relation (in the form ofartificial man-world dualism) to the all-including process(EvoProcess) of the life on Earth, really a “manifold naturalartificial dualism” (Sakamoto, 2004).
Three basic questions
A. Do we need the First (Eastern or Asian) way ofbioethical (and biopolitical) development? Yes, absolutely, wereally face a lot of conflicts and problems in various spheresof world development that we need to resolve without delay.
B. Do we need the Second – current dominating(Western) – way of bioethical development? Yes, this is
likewise our absolute need, inasmuch as we constantly haveto cope with the task of crucial importance – protection of therights of a person and society by neutralizing (minimizing) the
possible harmful influences of present-day technologies withincontemporary civilizational practice (biomedical, first of all) on
regional and global level. (Many of the topical bioethicalproblems were put on the agenda and tackled during theABC8).
C. Do we need a Third (Cosmist, "of Real Cosmism")
evolutionary way in the world bioethics? Yes, likewise, this isan absolute need, inasmuch as we have a lot of global
paradoxes (crises) that might not be solved in neither First(Eastern, of Acosmism) or Second (Western, of AntiCosmism)
trends of bioethical activity.

The paradoxes (crises) of the present day
What are the evident paradoxes of up-to-dateness (firstly,on the example of contemporary Russia)? They are:1) The loss of a “motivational basis” to procreation andthe directivity on a family with one child in favor of hedonistic
models in realizing her or his vital energy (in current Russia
we have arrived at the catastrophic surplus of deaths overbirths – one new-born accounts for two deaths; the objective
prognoses of demographers show that already in 50–80 years
Russia will meet demographic collapse and disappear fromthe world scene).
2) The "social hypersexuality" as a feature (norm) ofsocial life (at least in present Russia), simultaneously with thedecrease of births and inability to realize birth control –uncontrollable growth of a sensuality and pornography in
mass-media,
aggressive
feminism,
expansionofhomosexuality.
3) The increase of depressions concurrently with drug
addiction (alcoholism, first of all) – accordantly with the growthof wealth of a democratic society.
4) The super-popularity of sporting shows (and supersuccess of sports industry), alongside (comparatively) withinsolubility of many bioethical problems, as well as
inaccessibility and inadequacy of (open to general use)qualitative health care, education, conditions of physicalculture for the masses, etc.
5) The current leading role of the philosophy of
postmodernism that affirms basic (a priori) pluralism (in the aposteriori universal world) – randomness of creativity.
6) The so-called "anthropological evolutionary paradox",
in relation to personality: a person is a uterine element of theone common whole cosmic evolutionary process of the life on
Earth (that is a natural sciences truth); however we deny thesearch for universal evolutionary knowledge and rely on theplural (different and often incompatible) sources of knowledge
in defining human’s nature: biological, sociological,
psychological, etc.
7) The global biomedical paradox: The inability, in the hitech age, to obtain the etiological – curing, remedial (radical)– approaches against chronic non-infectious and nontraumatic diseases.
8) The global bioethical paradox: up-to-date bioethics
tackles the problems that are the consequences of
unreasonable activity of modern science and technologies,
while, on the contrary, the present bioethics has no intentions(the aim itself!) to disclose the reason of the existing
civilizational unreasonableness! Actually, modern bioethics
has fundamentally the secondary role (in relation to science)– of “technology assessment” (the term of Prof. Sakamoto,used by him at the ABC5), correcting dangerous (to individual
or community health) errors (the consequences of
unreasonable application of technological innovations), while
the basic role of bioethics (of disclosing and treatment the
primary reason(s) of unreasonable activity of a man andsociety) is missed.
9) The global political paradox: we are witnessing atpresent (from rational humanitarian positions) global
senselessness of foreign policy – i.e. arm-twisting policy of
expansion (military intervention), at that the number of billions(trillions) of dollars already having been spent at the aims ofsenseless (and useless) militarist aggression is ten times
enough to resolve the actual bioethical and cultural(aforementioned) problems.
10) Finally, global civilizational paradox has evidently
intruded on our cultural day-to-day life: Western civilization,although based on rational principles, has arrived at thereality of utmost plural (i.e., irrational – irreducible to acommon rational basis) global cultural world – constituted ofextremely different (frequently opposite) evaluations andreflections (and reactions) to the same issues and problems,arising from the evolution of one common, objectively

Eubios Journal of Asian and International Bioethics 17 (November 2007)
universal world – cosmic evolutionary process of the life on
Earth (EvoProcess).
Conclusion
In conclusion, if the existing challenge for realization andelaboration of the Third evolutionary way in the world
bioethics (philosophy, science, culture, civilization) is anobjective reality, then has not the time come for us(bioethicists) for the "awakening"?
The discussion on BioCosmology is opened in thespecial section of the free bi-lingual E-LOGOS: Electronic
Journal for Philosophy <http://nb.vse.cz/kfil/elogos/> (link to
the “BioCosmology”). The participation of every specialist (inall "bio-" sciences) is most welcome!
The detailed characterization of the Cosmist approach is
given also in my previous publications in the EJAIB: 12(1);12(3); 13(1); 13(3); 14(2); 15(1); as well as in the: Challenges
for Bioethics in Asia. The Proceedings of the Fifth Asian
Bioethics Conference (ABC5), 13–16 February, 2004 in
Tsukuba Science City, Japan / Darryl R.J. Macer, editor,
Christchurch, N.Z.: Eubios Ethics Institute).

Bioethics Education: A
response to Viveka- K. K. Verma, Ph.D.
Retd. Professor of Zoology,
HIG1/327, Housing Board Colony, Borsi, Durg 491001, India
E-mail: kkvermain@yahoo.com- Rashmi Saxena, Ph.D.,
Assistant Professor of Zoology,
Bhupal Nobles’ P. G. College, Udaipur (Raj.) 313001, India
We have gone through Viveka’s philosophical paper onbioethics education with appreciation, and in response would
like to offer some comments.
Place of religion and spirituality in Bioethics Education
As Viveka says, religion and spirituality have an important
place in Bioethics Education. In fact religion and spirituality
are a need of the human species (Verma and Saxena, 2000).
Every human population practices some sort of religion. As
Macer (1994) has pointed out, most people derive guidance inlife from religion rather than from scientific thinking.
Every organized religion has a strong ethical component,
and most of it is an expression of altruism. Altruism in humans
is heritable, and has been evolving with the evolution of theirgroup living or social life (Hauser, 2006; Saxena and Verma,2007). This inherited trait of altruism is fine-tuned and shapedfor behavioral responses during parental (i.e. informal) andinstitutional education, in which an extended period of
psychological immaturity makes a growing up child
impressionable and receptive. Bringing up a child in an
unethical cultural environment may partly or wholly block theexpression of the inherited altruism.
While need for bioethics education is being widely felt,
what should be included in it from religious ethics? This
question is specially difficult to answer in a multi-religious,
secular and democratic country like India. Obviously to suit
this situation a secular bioethics education is needed.
Secular Bioethics Education
While there are several broad principles in common in all
the different organized religions, there are also differences inseveral respects. Viveka (2007) recommends ‘dialogue’ tocome to secular contents of bioethics education. There should

171

be dialogue among leaders of different religious groups, andthe inferences reached should be made available to people
through print and electronic media. The feedback, obtained
this way, should again be considered by the religious leaders,
In bioethics education class-rooms too there should be an
open house environment. Students from different religious
backgrounds may be allowed and encouraged to express
their views, while the teacher is expected to provide guidanceand support through “timely and appropriate interventions”(Viveka, 2007). Throughout this process of dialogue is to be
carried out in an atmosphere of mutual respect, “harmony andtolerance” (Macer, 1994).
Elements of science in Bioethics Education
People, especially students, often face the dilemma ofdeciding what is more correct, science or religion. It should beclearly understood that science and religion represent two
different attitudes of human mind, and are two nonoverlapping areas (Verma, 2006). While science is theattitude of enquiry, religion is a matter of faith. Humans are
inquisitive by nature, and wish to investigate and learn about
all that is in us and around us. At the same time we have tolive by faith, as there are situations, in which we, in spite of all
our intelligence and accumulated knowledge, feel lonely andhelpless. In such situations faith gives us strength, and the
feeling of a superpower guiding and protecting us removes
our feeling of loneliness. Thus science and religion are both
our needs, and should be taken as separate and noncompeting areas.
A prejudice, deeply ingrained in human psyche, is ofracism and racial superiority/inferiority. Often the so-called“geographical races” of humans are looked upon as distinct
species. But then the different ‘races’ have successfullyinterbred producing viable and fertile offspring. In fact much of
the present populations are a result of recent ‘racial’interbreeding. As Bates (1963) has pointed out, in Mexico
60% of population is a result of marriages between American
Red Indians and Europeans, and in Ural most of the
population is a result of ‘hybridization’ between Europeans
and Mongoloids. More such example of ‘racial hybridization’
may be cited. Oliveira and Ferreira (2004) point out thatthrough “extensive genetic studies of several humanpopulations from different continents … it was verified that thehuman diversity was higher inside the ‘racial’ or geographic
groups than among them.”. The so called human ‘races’ do
not qualify for the category ‘species’. They are not
reproductively isolated, and reproductive isolation is anecessary feature of a species, as per its biological definition.
Often in biological literature by ‘races’ is meant‘subspecies’. But the geographical groups of humans, withdeep clines or gradients between them, do not qualify forbeing regarded as subspecies either (Verma and Verma,2005).Oliveira and Ferreira (2004) have been very correctwhen they point out that the racial concept is “imprecise” and“subjective”. ‘Race’ has no taxonomic value.
Then how should we refer to the human geographic
varying groups with wide clines or gradients between them?
Verma and Verma (2005) have suggested a provisional
adjective ‘parapatric’, in view of contiguity of these varying
groups.
In the present context it is important to note that recent
studies on DNA analyses have shown that frequent gene flow
between different regional populations of evolving hominids
has been taking place throughout, even from the Homoerectus stage (Stone et al., 2006; Templeton, 2007). Human
evolution has been trellis like or reticulate due to frequentintermixing of genomes of lineages in different geographicalareas.
One strongly founded notion, often circulated, is that war
is a biological necessity. A war, in biological terms, is anorganized conflict between two groups of individuals

172

Eubios Journal of Asian and International Bioethics 17 (November 2007)

belonging to the same species. War, thus defined, is anextremely rare phenomenon in the animal world (Verma andSaxena, 2000). In addition to humans, wars are known
among harvester ants, living in desert like conditions. These
ants have the habit of storing in their nests grass seeds, when
it is not so dry and there are grasses around. Often
individuals of one colony attack another colony of the same
species to loot the grass seed store. Perhaps war, in bothhumans and harvester ants, has in its root the habit of storage
and accumulating assets.
Many animals show fight with con-specifics for food, mate,or territory, but such instances are not of organized groupconflicts.
Defending one’s territory or the phenomenon called
territoriality, seen in so many animals, is believed to be in theorigin of human wars. While we accept this view, we have torealize that our weapons for offence/defence are now sodeadly and extensively destructive that any large scale andwide spreading war may lead to, if not extinction of the humanspecies, extinction of much of human’s culture and tradition,
accumulated so far, as in a widely destructive war even suchinstitutions as libraries, universities, and museums are notspared.
One way to avoid wars is to opt for a healthy democratic
set-up in country states. As Verma and Saxena (2000) point
out, “A collective leadership, chosen by people, is to bepreferred to monarchy or dictatorship, which involves the riskof a person with psychological repressions, coming up as aleader and behaving as (using expression of Huxley, 1959) “ajealous God” or “an infallible Fuhrer” and creating situations ofwar.” An enlightened voter population ensures choice of rightleaders and a healthy democracy.
Concluding remarks
Even an individual failing to realize the need of tolerance
and mutual appreciation of cultural and religious differences
may lead to “global consequences” (Macer, 1994); hence theurgency of planning and implementation of bioethics
education in all countries. Among other ingredients ofbioethics education, religion, spirituality, and some scientificfacts, which are of general and common interest and which
may remove some prejudices and misconceptions, shouldfind place.
References
Bates, M., 1963, Man in Nature (Indian reprint). Prentice-Hall of India
Pvt. Ltd., New Delhi.
Hauser, M.D., 2006. Moral minds – How Nature Designs Our
Universal Sense of Right and Wrong. Ecco/Harper Collins
Publishers, 2006.
Huxley, Julian, 1959. Man in the Modern World (eighth printing). The
New American Library of the World Literature Inc., New York.
Macer, D., 1994. Bioethics – for the People – by the People. Eubios
Ethics Institute, Christchurch, N.Z..
Oliveira, S.F., and Ferreira, L.B., 2004. Biological views of theinexistence of human races. EJAIB, 14(2): 59 – 61.
Saxena. R., and Verma, K.K., 2007. Morality – innate or acquired.
EJAIB, 17(1): 11 – 14.
Stone, I., Lurquin, P.F., and Cavelli-Sforza, L.L., 2007. Genes,
Culture, and Human Evolution: a synthesis. Blackwell Publishing,
Oxford, U.K..
Templeton, A.R., 2007. Genetics and recent human evolution.
Evolution, 61(7): 1507 – 1509. (online: doi:10.1111/j.15585646.2007.00164x)
Verma, K.K., 2006. Science and religion. EJAIB, 16(5): 152 – 154.
Verma, K.K., and Saxena, R., 2000. Man in Biological Perspective.
Himanshu Publications, Udaipur, India.
Verma, K.K., and Verma, R., 2005. Humans, a species withparapatric populations (?). EJAIB, 15(2): 40 – 41.
Viveka, Daphne, 2007. Towards a philosophical framework forbioethics education – the role of religion and spirituality. EJAIB,
17(4): 98 – 104.

Teaching Thanatology: A
Qualitative and Quantitative
Study- N. Yasemin Oguz, M.D. PhD.
Professor of Bioethics (Chair, Bioethics Unit, Turkish
Philosophical Association). Ankara University School of
Medicine, Department of Medical Ethics,
Morfoloji Kampusu 2. kat, Sihhiye-06100, Ankara, Turkey
E- mail: oguzx001@yahoo.com- M. Volkan Kavas, M.D.
Teaching assistant of bioethics,
Ankara University School of Medicine,
Department of Medical Ethics, Ankara, Turkey- Murat Aksu, M.D.
Lecturer of Medical Ethics,
Gaziosmanpasa University School of Medicine,
Department of Medical Ethics, Tokat, Turkey.
Abstract
Objective: To compare the efficacy of two teaching methods
for thanatology education.
Design: 60 students were randomized in three groups. After“focus group sessions” with the participants, a validated
attitude scale was applied to all. Group I continued with theregular program of the School of Medicine, without any
interventions. Group II had seminar studies once every monthfor six months, each lasting 1.5 hours. Group III established adrama team under the direction of one of the researchers andmade rehearsals with the aim of putting a play on the stage
whose main theme is the relationships between the dying
patients and their relatives. Six months later, the same
attitude scale was applied once more in order to assess thedifference between the efficacy of teaching methods.
Results: There was a significant difference in each groupbetween pre-test and post-test. Only Group II (the seminargroup) showed significant decrease in their scores andbecame less thanatophobic.
Conclusion: Students’ attitudes towards death and dying
patients can be changed through education. According to ourfindings, seminar sessions and small group discussions are
the most effective method for this education. Thanatology
education through drama sessions needs further research.
Our initial hypothesis was that about the drama techniquewould be more efficient in thanatology education, but our
results did not support this hypothesis. On the contrary,
although it was not statistically significant, post-test scores ofGroup III were indicating that they became morethanatophobic.
Key Words: Medical education, thanatology, teaching
methods, drama.
Practice Points:¾ Attitudes towards death and dying patients can changeby education.
¾ Medical students feel the need of thanatology education
and ask for it.
¾ Seminar sessions are the most effective method forteaching thanatology.
¾ Though more effective, drama techniques have pitfalls inthanatology education.
Introduction
Over the past few decades, end-of-life (EOL) care issues
have been a topic of hot debates especially in the AngloSaxon literature. Among the most discussed issues regardingEubios Journal of Asian and International Bioethics 17 (November 2007)
EOL care is the integration of thanatology education into the
medical curricula. (Bishop 2000, Magnani 2002, Wear 2002,
Whitcomb 2002, Wood 2002).
Many authors in the field point out that current medical
education lacks a comprehensive thanatology teachingsystem that would provide medical students with relevant
knowledge about EOL care and help them gain necessary
skills (Magnani 2002, Wear 2002, Whitcomb 2002). When theattitudes of residents and attending physicians towards deathand dying are analyzed, it was shown in various studies thatmost of the physicians and residents have trouble when they
have to deal with dying patients. They express that they do
not feel comfortable when they find themselves incircumstances such as breaking bad news to patients andtheir families, discussing with them their treatment options,pain and symptom assessment and management of aterminally ill. (Bradley 2002, Carver 1999, Merill 2000, Wear
2002)
In modern western medical education, some institutions
already began to insert or integrate and implement
thanatology education curriculum into their current education
programs. (Magnani 2002, Wood 2002) Researchers debate
which teaching methodology would best coincide with thegoals of such an education and some even offered structured
programs composed of subsequent methods.
In Ankara University School of Medicine, where we
conducted this study, there used to be no structured
education program on EOL care only until very recently. Afterthe conclusion of our study, some programs were offered to
be integrated into the undergraduate medical curriculum. By
the time we were writing this paper, only two very new
additions in the curriculum were noticeable. One of them is aproblem-based problem solving workshop of 2 hours on“breaking bad news” in the third grade and the other is a 2hour “communication with dying patients” session with fourth
grade medical students under the supervision of an oncologist
and clinical psychologist. (Ankara University School of
Medicine 2005).
With this study, we aim to provide some data about theefficacy of some of the teaching methods by which thethanatology education can be given.
Materials and Method:In our study, we developed and conducted two different
thanatology programs. One of these programs consisted ofseminar sessions and in the other we used drama methods.
We compared the efficacy of these two methods and also
compared them with a control group. We tried to figure out
which method would be more suitable in reaching the goals of
the given education; namely, the relevant attitude of not“escaping” from death and dying patient [thanatophobia]. Withthe term “thanatophobia” we mean discomfort in addressing
patients who are going to die very probably because of thedisease they have and difficulty in communicating with theirrelatives. Whatever the reason might be (for instance; fear ofdeath, fear of one’s own death, anxiety for not being able tosave one’s life (fear of unsuccessfulness), hardness indealing with loss situations), the term refers to the“abstaining” behavior which becomes visible in one-to-one
relationships in daily practice.
We examined three groups each containing a minimum of
16 participants. The participants were randomized among
volunteer students at the Ankara University School of
Medicine. The participants consented to the study
beforehand. The Research Ethics Committee at the Ankara
University School of Medicine approved the research study.
We classified the volunteer students according to theirsemesters and tried to include more or less the same numberof the students from each semester in each group. We
conducted the research study upon 60 participants. There
were 16 participants in Group I, while there were 26

173

participants in Group II and 18 participants in Group III. We
asked the participants their age, gender, level of education(semesters) and experience with a dying person before. We
started the research study by conducting “focus groupsessions” in order to assess the applicability of the attitude
scale to this particular group and comment on the results.
(See Appendix 1) Seven focus groups were conducted. Then
we applied the “Approach to Death and Dying Patient andEuthanasia Attitude Scale” to all the participants and received
the pre-test scores. This scale scores the attitude ofphysicians’ towards death and dying patients, andeuthanasia. The test scores were found to be strongly related
to the level of competence and empathy, and the sense ofanxiety in physicians when confronted with dying patients. As
the main objective of the education was to decrease
thanatophobia in students when confronted with dying
patients, we thought that this attitude scale is an appropriate
tool for assessment. The validity and reliability tests of thisscale had been completed by Senol et al. (Senol 1996) (SeeAppendix 2)
The first group (Group I) did not take any specificeducation on EOL care or thanatology and continued theregular medical curriculum (control group). We followed thisgroup’s attendance to classes in order to make sure that theirattendance rates are within the faculty limits. With Group II,
we organized seminar studies for six months once every
month each lasting 1.5 hours. In these seminars, we gave thestudents a structured education on the issues of death anddying patient as well as the concepts regarding to the end oflife. This group’s attendance to seminar sessions was also
followed to make sure that their attendance rates are within
the faculty limits. Group III established a drama team under
the direction of one of the researchers and made rehearsals
with the aim of putting the play named “The Shadow Box” byMichael Cristofer on the stage. (Cristofer 1977) The main
theme of this play is strongly attached to the issues of deathand the relationships between the dying patients and theirrelatives. In the play, the members of three very different
families face the fact that one member of each family is in thelast stages of a terminal illness. To Group III we did not apply
any other additional education, but we used a number ofdrama techniques for empathizing dying patients. The
attendants needed to vividly imagine, analyze and recreate
the situations, relationships and conditions in which thecharacters in the play find themselves suddenly andexperience how they might feel and how they chose to goover their dilemmas.
We started the study in November 2002 and concluded
the seminar sessions and drama work by the end of May
2003. In June 2003, we applied the attitude scale once again
to all groups. The qualitative part of the study, which was
based on focus group sessions and the quantitative part,which was based on the points derived from attitude scale,were evaluated both together and separately. In thisevaluation process, we both compared all the groups among
each other and examined each group regarding the innerchanges it showed from the beginning to the end of the study.
Nominal variables were assessed by Chi-square test.
Comparison between pre-test and post-test was evaluated byWilcoxon-Signed Ranks test. Differences among three groups
for thanatophobia were evaluated by Kruskal-Wallis varianceanalysis. (Conover 1980)

Eubios Journal of Asian and International Bioethics 17 (November 2007)

174

Table 1: Results of Wilcoxon-Signed Ranks Test

Group IGroup IIGroup III

Pre-Test—
X ± SD Median (Min-Max)
20.2 ± 2.7 20 (17-25)
21 ± 2.7 21.5 (15-27)
20.8 ± 3.2 19.5 (16-28)

Table 2: Δ Analysis with Multiple Comparison Test
Groups
1–2
1–3
2–3

Δ
p=0.009
p=0.581p= 0.001

difference exists
no difference
difference exists

Results
The participants came from different years ranging fromstth
1 to 6 grades. Each group consisted of participants withvarious ages coming from different semesters. 23% of theparticipants (14/60) declared that they had experience
regarding death or a dying person at least once before theyjoined the study. There was no statistically significant
difference between groups regarding semester levels(p=0.342), age (which showed a range of 16–27 years, but
most of the students were between 18–23 years of age),gender (p=0.260), and experience of death or a dying person
among participants in the past (p=0.517). All these analyses
showed that there was no significant difference between
groups in the beginning of the study for pre-test; so, they werecomparable.
Focus Group Sessions
Appendix 1 shows the topics discussed in focus groups. In
all focus groups only a few concepts were commonly
discussed. These are “loss/to lose”, “preparation for/gettingused to death”, “cancer”, “pain”, “to chose/to accept death”
and “getting insensitive”. Only in one session, (I-B)“euthanasia” was widely talked about, probably with thebiased direction of the moderator. In this session, theparticipants stressed the approach to death and dying patient
only from this one limited point of view. In another session (IIB), the main theme was “conceptualizing death” in medicine.
The participants, without stepping out of their physician
identity, tried to question how they can act when they confront
death. Some participants emphasized that their current
medical education was not sufficient to provide them withadequate knowledge, attitudes, and skills towards death anddying patients.
In focus group sessions some ideas which were shared byalmost all of the participants, emerged. Most of theparticipants seemed confused about what “death” can do withmedicine. At the beginning of the sessions, they usuallytended to view “death” as a situation which has nothing to dowith medicine. Medicine would do anything to prevent death;but when it arrives there are other professionals to take careof the situation.
“…if there is something I can do, I never hesitate to do it evenfor a tiny moment… but if it is beyond what I can do, then, I
don’t know, I would avoid facing it, I think. Because… I
mean… in the end at that point it is also beyond the bordersof medicine. At that point I have no active work there.” (Group
I-A, Participant No.5)“It sounds more like unsuccessfulness to me… In the end you
do something, you try, but consequently the patient is lost.
This is unsuccessfulness in some way.” (Group I-B,
Participant No.2)
In these sessions, most of the participants expressed theiranxiety and fear about “death.” They told that they usually felt

Post-Test—
X ± SD Median (Min-Max)
20.2 ± 2.9 20 (16-25)
18.4 ± 2.9 19 (12-26)
21.3 ± 4.0 21.5 (12-29)

P
0.823<0.001
0.429

helpless while communicating with a dying patient or foundthemselves in situations related to death in some ways. Onlysome of the participants had a direct experience with death.
The latter expressed relatively less anxiety. They argued thatexperience helped them learn how to deal with “death” andmade them think more about it, which eventually provide themwith a broader look. Some of the participants shared theirobservations upon the clinicians facing death in their daily
practice. The common idea was that even the experienced
ones tend to avoid facing a dying patient.
One of the most controversial points in the sessions was
informing the dying patient about her/his prognosis. Someargued that the patient should be informed correctly andcompletely about her/his possible future, while some strongly
disagreed with this idea defending that such an attitude would
devastate the person. Some expressed that this issue should
be a bedside decision, which can be made by taking different
situations into consideration in daily practice.
Many participants pointed out the role of medical
education regarding “death”. Most of the participants
expressed that medical education should include some issues
about “death” and “dying patient”. They argued that this would
increase awareness and lessens the feeling of helplessness.
They evaluated their current education as unsatisfactory.
“One of my friends’ mother was diagnosed with terminal
breast cancer. (…) Because that the tumor had metastasis inbrain, her condition got worse. My friend told me that thedoctor had told her that her mother was in terminal phase.
When she asked me what the terminal phase meant, I wasreally bothered while explaining it to her. (…) Actually I
wanted to escape from there.” (Group II-C, Participant No.3)“To be honest I think that the medical education does notteach us much about death. In my opinion, there is a disease;
there are its causes, its etiology, in the end its treatment, its
prognosis. I mean it is being instructed to us like that, butwhat is behind the curtains is actually very different. (…) I
mean... to people upon how to deal with death or how they
can communicate with a dying patient not much is given.
Moreover, nothing is given and maybe because we see death
everyday we become insensitive.” (Group II-B, Participant
No.7)“I think the education of medical faculty does not add much tothis issue. On the contrary, when I see the approaches of
those who already had the education, I think most of the time,
I say to myself ‘I should not behave like this.’ (…) I see thatsome people had already lost their sensitivity and I ask myself
if after many years I will be like that.” (Group II-B, Participant
No.5)“Towards the end of the first month during my internship welost a patient in the intensive care unit. I was following him.
(…) And when we lost that patient, there was a huge
difference between what I felt and what the specialist
physician felt. Then we went to inform the patient’s family
together; when his family heard the situation, that time, there
was a great difference between what his family felt, and we
felt.” (Group III-A, Participant No.8)
Derived from these focus group sessions, as a last word,
it can be said that almost all the participants pointed out theirunease about death and related issues. Some obviously
never thought of the issue or even did not think that it wasworth discussing before the sessions, since they probablyEubios Journal of Asian and International Bioethics 17 (November 2007)
viewed it as a subject irrelevant to contemporary medicine.
However, this attitude can be interpreted as a sign of thegeneral attitude of physicians. Some others, who are themajority, pointed out that their current education lacks asystematic program regarding death and dying patient. Yet
most of the participants seemed willing to be informed andadopt appropriate attitudes towards death and dying patient.
Some argued that even in these focus group sessions, theyrealized that this issue should be one of the main topics in the
medical curriculum. Finally, the focus group discussions
indicated that the attitude scale was applicable to thisparticular group, because it consisted of the main argumentsthat came up in the group sessions.
The “Approach to Death and Dying Patient andEuthanasia Attitude Scale”
We assessed whether there was a difference in eachgroup between pre-test and post-test. By this analysis, wefound out that only Group II showed significant decrease in
their scores, while there was no significant difference forGroup I and Group III. (Table 1) As the higher test scoresindicate abstaining from the dying patients, only theparticipants of Group II (the seminar group) happened tochange their abstaining attitude towards dying patientssignificantly and became less thanatophobic.
Change from pre-test to post-test between groups (Δ) was
assessed by using Kruskal-Wallis test. There was significant
difference between groups (p=0.003). Afterwards we applied
multiple comparison test and found out that Group II is theone that caused the difference between groups. (Table 2)
Discussion
Thanatology education is an essential part of medical
education as well as the end-of-life care education. It is also
the most neglected part of the medical curriculum in Turkey, if
it exists at all. In accordance with the increasing attention
directed to the end-of-life issues, there have been a numberof studies conducted on thanatology, especially on theperception of death amongst health care professionals andattitudes towards death and dying patients. The results ofthese studies showed that it is necessary to include
thanatology education in the curriculum of medicine. As death
is a very difficult subject to teach, because of the emotionalburden it carries, a new task emerged. What is the best
method of teaching thanatology? There are few studies on
this subject, but many studies are going on.
In Turkey, the studies on the attitudes towards death anddying patients have been conducted since the 1990s. There
are studies on the different health care professional groups
and on the students of health sciences. These studies
showed that the lack of thanatology education causes
enormous anxiety for health care professionals whenconfronted with the death process and it also diminishes thequality of care at the end of life (Abaan 1996, Atac 1996,
Deger 1994, Gunduz 1996, Klagsbrun 1988, Oz 1999, Ozaltin
1997, Uysal 1994). Our study is the first study in Turkey which
has been conducted for assessing the difference between theefficacies of different educational techniques for thanatology
education. After the studies on attitudes towards death anddying patients, we thought that this study would be thesecond step of introducing a thanatology course to the
medical curriculum.
As an attitude scale on death and dying validated for
Turkish medical students was lacking, we had to use“Approach to Death and Dying Patient and Euthanasia
Attitude Scale.” This scale was created for physicians andthere was also a modified form available for nurses. We
foresaw two negative consequences caused by using a near
relevant scale. First of all, our respondents had to assume
some situations as they were not practicing physicians yet,and this may have had an effect on their answers. We

175

expected the students to imagine vividly that they are within
particular clinical conditions of medical practice which are
mentioned in the scale. However, we did not have therelevant measures to assess how much they could achievethis. Secondly, the euthanasia part of the scale may have acontaminating effect on the answers of the respondents to therest of the scale. The focus group sessions showed us thatthe students had distinguished euthanasia debate fromattitudes towards death and dying patients. Besides, the term
euthanasia is not defined precisely. It might have referred todifferent meanings and perceptions for different people. For
instance; sometimes it means an active act of killing, butsometimes it is the term for withholding futile treatments.
Nevertheless, before the study, we emphasized the general
conceptual meaning clearly, which is “letting the person die
upon her/his will, if she/he has a terminal illness”. This
expression leaves no room for confusion. Still it remained
unclear whether it was perceived in the same way by all thestudents, as we do not have any measures to assess it.
Although attitudes toward euthanasia might not be a goodmeasure of thanatophobia, since only 1/3 items in the scale
address euthanasia, we thought that euthanasia sentences
will not create serious bias.
The pre-test scores of the three groups indicated that
there were no statistically significant difference between
Group I (control group), II (seminar group) and III (drama
group). During the focus group sessions, the participants
mainly expressed their concerns about managing dying
patient when they had to. They emphasized that they were
not comfortable with the concept and as they have notreceived adequate education on the subject, they were afraidof making mistakes. They pointed out that becoming
insensitive and establishing distant relationships with dying
patients were two commonly used strategies. These concernsand solutions are in accordance with the existing literature on
thanatophobia (Abaan 1996, Atac 1996, Deger 1994, Gunduz
1996, Klagsbrun 1988, Merill 2000, Oz 1999, Ozaltin 1997,
Uysal 1994). One of the main arguments, which was common
almost in all focus group discussions, was the emphasis put
on “doing something.” It became quite clear that theparticipants felt more comfortable when they literally “could dosomething.” Being an observer or assuming a passive role
seemed to be intolerable.
Some of the participants argued that “death” was not aconcept directly related to medicine, because it was a point
beyond medicine. According to them, death is one of theconsequences after medicine has done as much as it can.
But for the majority of the participants, death indicated thefailure of medicine and themselves as professionals. This
result is also similar to that of the present literature (Abaan
1996, Atac 1996, Bradley 2002, Carver 1999, Deger 1994,
Gunduz 1996, Klagsbrun 1988, Oz 1999, Ozaltin 1997, Senol
1996, Uysal 1994).
The participants put an emphasis on the communication
skills and pointed out that it was not just the fear of death, but
the necessity of communicating about death that put pressure
on them. According to them, thanatology education could not
be complete without education on communication skills. They
told that even the limited time they spent talking on the issue
at the focus group sessions was of help. It became quite
obvious during the sessions that the participants were very
critical about the attitudes they have observed in the clinics.
They said they had found it hard to identify with the medical
faculty, because the faculty’s attitudes towards dying patientswere generally very distant. However, the participants
expressed that the clinicians were excusable for theirattitudes, as they had to deal with death everyday. Some ofthe students even said that they were looking forward to
become as insensitive as their clinical instructors in order tobe liberated from the fear and the anxiety. We may say that

176

Eubios Journal of Asian and International Bioethics 17 (November 2007)

the students view this desensitization as a part of theirprofessional maturation.
The scores we obtained after the educational
interventions indicated statistically significant differences.
Group II (the seminar group) received a better score than theother two groups. There can be a number of reasons for thisresult. Firstly, the structure of the seminar can have an effect,
as it consisted of both experts and family members of dying
patients. In one of these discussions, the participants
discussed for one hour upon a suicide case that had
happened in the same institution short ago. Secondly, theseminar sessions and small group discussions are routine
educational methods for the medical school, so the students
were familiar with these methods, where teaching throughdrama was completely alien to them. There were no special
topics on the attitudes towards death and dying patient at theAnkara University School of Medicine by the time weconducted this study. And thirdly, the participants of seminargroup had enough time to think over and to observe theirenvironment in the light of what they had been taught.
One interesting finding that is not in accordance with theexisting literature and our initial hypothesis is the changes inthe scores in Group III (the drama group). Though it is notstatistically significant, there is a difference between the preand post-test scores of Group III, which indicates that after
the education the group developed a more abstaining attitude
towards death and dying patient. We think that this result iscaused by the content of some of our drama sessions.
Staging a play about death and dying patients and theirrelatives, we thought, would make students gain insight tovery difficult human conditions accompanying the state of
terminal illness. In this study, actors tried to step out of theirindividual borders and understand how the dying person or
her/his relatives feel by identifying with the characters of theplay. Through deep dramaturgic analyses of the text, we tried
to reach the essence of people’s behaviors and feelings
underneath these behaviors. Our hypothesis was that thisstudy would help the students be more empathetic towards
their future dying patients, firstly by facing “death” as aconcept and dealing with it intensely during the drama study
in particular ways; namely reflection, imagination and acting .
However, while working with this group, we were often faced
the difficulty of separating the emergence of the emotions
towards one’s own death from the emotions towards thedeath of dying patient. We realized that it was very
complicated to work on the emotions towards one’s own
death. On the other hand, it was almost impossible to hinder
its emergence, since identifying with the character is implicitin the drama’s nature. In our study, the main characters were
either dying patients or their close relatives. Thus, identifying
with the characters fell quite far from wearing the shoes of aphysician who confronts death in his/her practice. We thinkthat the drama method we used was the cause of thisabnormal result. Other drama techniques must be studied
before any final objection towards using drama techniques inthanatology education. Further research using drama
techniques should focus on the various unexpected problems
that emerge in different ways during the drama activities. We
suggest researchers who are willing to work on the efficacy ofdrama techniques in education to read our experience in its
limits and take the points mentioned above into consideration.
There are some limitations that should be mentioned forthis study. First of all, we randomized the students who
volunteered to participate in this study. They might beinterested in the subject or at least sensitive about end of life
issues before they participated in this research. This may limit
the applicability of the results to the rest of the medical
students. Secondly, the performance of Group III (the drama
group) can be affected by the text that was chosen. “TheShadow Box” consists of many cultural readings that are
unfamiliar for our students. This cultural gap could cause
alienation to the text and determine the result. Also at somepoint, the students of Group III completely focused on thestage performance, and this anxiety might override the maingoal, namely identifying with the dying patient and her
relatives.
For the last word, all the points made above show that theissue of death remains to be a taboo in the medical
education. What gives hope is that the students are eager tolearn more about death and its management in medicine, andthey want to adopt appropriate attitudes towards it. A relevant
and efficient systematic education can guide them in adopting
more humane attitude towards death and the dying patient.
References
Abaan, S. (1996). Otanazi ve saglik ekibi. (Euthanasia and the healthcare team). 3P-Psychiatry Psychology Psychopharmacology, 4(3Supplement), 27-34. (in Turkish).
Ankara University School of Medicine Students Directory for 20052006 Academic Year-A (2005). (2005-2006 Ogretim Yili Ogrenci
Kilavuzu-A). (Ankara, Ankara Üniversitesi Basimevi). (In Turkish)Atac, A. & Erdem, L. (1996). Otanazi ile ilgili anket calismasi (Asurvey about euthanasia). Turkiye Klinikleri Journal of Medical
Ethics, 4(2), 79-81. (in Turkish).
Bishop, M. C., Gores, F. A., Stempel, J., Torrington, P., Tynan, C.,
Jaskar, D. & Garewal, H. S. (2000). A collaborative end-of-lie carecurriculum. American Journal of Hospice & Palliative Care, 17(2),137-140.
Bradley, E. H., Cramer, L. D., Bogardus, S. T., Kasl, S. V., JohnsonHurzeler, R. & Horwitz, S. M. (2002) Physicians’ ratings of theirknowledge, attitudes, and end-of-life-care practices. Academic
Medicine, 77(4), 305-311.
Carver, A. C., Vickrey, B. G., Bernat, J. L., Keran, C., Ringel, S. P. &Foley, K. M. (1999). End-of-life care. A survey of US neurologists’attitudes, behavior, and knowledge. Neurology, 53, 284-293.
Conover, W. J. (1980). Some methods based on ranks, In: PracticalndNonparametric Statistics (2 Edn.) (New York, John Wiley &Sons), 229-239.
Cristofer, M. (1977). The Shadow Box. (New York, Samuel French,Inc.).
Deger, M. (1994). Otanazi konusunda yaptigimiz bir anket calismasi(A questionnaire-based study on euthanasia). Dirim, 1-3, 32-38. (inTurkish).
Gunduz, T., Oner, S., Cinar, T. & Din H. (1996). Hekimler
euthanasia’yi savunuyorlar mi? (Do the physicians defend
euthanasia?). Bulletin of Forensic Medicine, 1(2), 82-88. (inTurkish).
Klagsbrun, S. C., Goldberg, I. K., Rawnsley, M. M., Kutscher, A. H.,
Marcus, E. R. & Siegel, M. E. (1988) Psychiatric Aspects ofTerminal Illness. (Philadelphia, The Charles Press Publishers).
Magnani, J. W., Minor, M. A. & Aldrich, J. M. (2002). Care at the endof life: A novel curriculum module Implemented by medical
students. Academic Medicine, 77(4), 292-298.
Merill, J. M., Dale, A. & Thornby, J. I. (2000). Thanatophobia andopiophobia of hospice nurses compared with that of othercaregivers. American Journal of Hospice and Palliative Care, 17(1),15-23.
Oz, F. (1999). Hemsire ve hekimlerin otanazi ile ilgili tutum ve
gorusleri (Attitudes and opinions of nurses and physicians about
euthanasia). Clinical Sciences and Physician, 5(4), 450-459. (inTurkish).
Ozaltin, G. & Isil, O. (1997). Onlisans hemsire ogrencilerin olume
iliskin yaklasimlarinin incelenmesi. (An investigation of nursing
students’ approaches to death). Turkiye Klinikleri Journal of
Medical Ethics, 5(1), 10-15. (in Turkish).
Senol, S., Ozguven, H. D., Dag, I. & Oguz, Y. (1996). Hekimler icin
Otanazi, Olum ve Olumcul Hastaya Iliskin Tutum Olcegi (OTO)’nin
faktor yapısı ve ic tutarlılıgı (Factoral analysis and internalconsistency of the Attitude Scale on Euthanasia, Death and Dying
Patient (OTO) for Physicians). 3P-Psychiatry Psychology
Psychopharmacology, 4(3), 185-190. (in Turkish).
Uysal, H., Bahsi, Y. Z. & Gonulal, B. (1994). Kalici bitkisel durumdaki
hastaya yaklasim (Medical approach to a patient in a persistantvegetative state). Turkish Medical Journal, 1(1), 59-62. (in Turkish).
Wear, D. (2002). “Face-to-face with It”: Medical students’ narratives
about their end-of-life education. Academic Medicine, 77(4), 271277.
Whitcomb, M. E. (2002). Meeting the challenge to improve end-of-lifecare education. Academic Medicine, 77(4), 269-270.
Wood, E. B., Meekin, S. A., Fins, J. J. & Fleischman, A. R. (2002).
Enhancing palliative care education in medical school curricula:Eubios Journal of Asian and International Bioethics 17 (November 2007)
Implementation of the Palliative Education Assessment Tool.
Academic Medicine, 77(4), 285-291.

Acknowledgement
The authors wish to thank Suat Gurcan for his support intranslating Michael Cristofer’s “The Shadow Box”, Atilla Elhanfor his contribution to the statistical analysis of the data, Murat
Civaner for his enlightening comments during the writing
process. Also, we thank all the students who participated inthis study.
Appendix 1: Focus Group Sessions Interview Guide
The moderator will introduce himself/herself and theobserver to the participants. He/she will ask for permission to
use the voice recording device and he/she will explain theobjective of the session. After mentioning that the session
should last one hour, the participants should introduce
themselves. The moderator will open the discussion. The
observer will note down the seat numbers and identity
information of the participants. He/she will write down short
informative/indicative notes about the session by using thesigns (O=observer) for himself/herself, (M=moderator) for themoderator.
The main topics of the discussion:a. What do you feel about the death?
b. What is your most basic feeling or attitude defining yourapproach to a dying patient?
c. How is death conceptualized in medical profession?
d. What kind of attitudes does your current medical
education help you acquire regarding death and dying
patient?
e. In what ways can the knowledge of approaches towards
death affect your daily professional life?
Appendix 2: Response questions
The following options existed. To each there were four
options: Totally agree. Partially agree, partially disagree,
totally disagree.
During clinical treatment, it may be decided thatcardiopulmonary resuscitation and other intensive life
sustaining treatments are not indicated anymore for aterminally ill patient.
Decisions, as described above, are ethically right.
When a patient of mine dies, I wonder if something could
have been done to save her.
I think it is essential that a dying patient be told of thepositive and negative aspects of his progress.
I have a clear definition of “euthanasia” in my mind.
In my opinion, euthanasia is a moral equivalent to suicide
or homicide.
Telling a person he is going to die is difficult to me.
I find it more difficult to deal with the family of a dying
patient than the families of my other patients
In my opinion, keeping a patient alive when we cannot
improve his quality of life, causes suffering.
I believe physicians refer terminal patients to otherphysicians more often than non-terminal patients.
A patient’s death does not depress me when I know there
was nothing I could do to save him.
In my opinion, euthanasia contradicts the basic philosophyof medicine, which is summarized as “one should showrespect to human life under any circumstances.”
In my opinion terminal patients don’t want to talk about
death.
In my opinion, principles for applying euthanasia should beestablished and it should be decriminalized.
In my opinion, most of the dying patients are afraid ofdeath.
In my opinion, if physicians perform euthanasia, this willcause distrust towards them in the long run.

177

In my opinion, most of the dying patients have painful
deaths.
I might perform euthanasia if one of my patient’s requests
it.
I would want euthanasia to be performed on a relative ofmine, if he has an irreversible terminal illness.
I do not think about death very much.
In my opinion, terminally ill patients consider death as acomfort.
I would perform euthanasia if a committee makes thedecision to authorize it.
I try to avoid telling a patient directly that he is dying.
Treating a dying patient is one of the most unpleasantaspects of my profession..
In my opinion, most of the dying patients have a quiet andpeaceful death.
I could approve of euthanasia, if it is decided andperformed by a committee.
Whenever possible I avoid a person who is dying from anirreversible condition.
I feel as comfortable with a dying patient as I do with anyother patients.
I would want euthanasia to be performed on me, if I had
an irreversible terminal illness.
In my opinion, most of the dying patients talk openly about
dying.
In my opinion, her family is the best support for theterminal patient and they should be always with her.

Adequacy of informed
consent in research carriedout in Brazil- José Roberto Goldim, MsC, PhD
Bioethics and Science Ethics Research Laboratory
Hospital de Clinicas de Porto Alegre
Rua Ramiro Barcelos, 2350
Porto Alegre, RS – Brazil 90035-903
E-mail: jgoldim@hcpa.ufrgs.br- Joaquim Clotet, PhD- Jorge Pinto Ribeiro, MD, PhD
Hospital de Clínicas de Porto Alegre/Universidade Federal do
Rio Grande do Sul, Brazil.
Abstract
This cross-sectional study aimed to assess the adequacyof the informed consent process in six research projects
carried out at HCPA. The 59 participants were interviewed; all
had signed informed consent forms. Most patients werefemales (relative frequency of 71%); and the mean age was
50.17±15.24. Informed consent adequacy was assessed
through the amount of information received and degree ofdifficulty in understanding the form. Having received previous
explanations was reported by 53%, and having had doubts
cleared up, by 24%. Comprehension of what was being
proposed was reported by 56%, but the text was considered
accessible by only 25%. In conclusion, the use of informed
consent in research projects should be considered seriously,
and Ethics Committees should review all the stages involved.
Aspects such as comprehension of information, clearing up of
doubts, and access to the investigator should always be
guaranteed to participants.
Key words: informed consent, research, Ethics Committees,
ethics.

178

Eubios Journal of Asian and International Bioethics 17 (November 2007)

Introduction
The informed consent process involves a relationshipbetween the investigator and the participant that is permeatedby mutual respect, dialogue, patience, and persistence.
Beauchamp and Faden (1) established a broad approachto the informed consent process. According to the authors,
this process is composed of three stages, and involves sevendifferent elements, involving I - Pre-conditions (Ability tounderstand and decide, and voluntariness); II - Elements of
the information (risks and benefits; the most adequate option;and comprehension); III - Consent elements (option out of atleast two alternatives, and authorization).
Several studies have been carried out in different
countries about the process of obtaining informed consent inhealth institutions, not considering the impact of theevaluation carried out by the Ethics Committees.
One study carried out in the United States analyzed thewritten documents used as the source of information for theobtainment of informed consent in the area of radiology. The
study showed that the texts were too complex for the averagepatient to understand (2). A recent study showed that
educational intervention made a difference in comprehension
about research risk (3).
In another study, performed in four Veterans
Administration hospitals in the United States, 28% of thepatients interviewed declared that they were not aware thatthey were participating in research projects, although all ofthem had signed specific consent forms prior to the beginningof investigation (4).
In Chile, an assessment was made of 44 research
projects submitted to the Ethics Committee of the Medical
School at the Pontificia Universidad Católica de Chile during a
two-year period. The most frequent problem in theevaluations was absence or inadequacy of the informed
consent form (5).
Between 1986 and 1997, a study assessed the use of
informed consent in more than 1,348 research projects
carried out at Hospital de Clínicas de Porto Alegre (HCPA),
Brazil (5). Only 18% of the informed consent forms used in
the projects were considered approvable without any repairs.
Up to 1993, the most frequent problem at HCPA was theabsence of informed consent in most projects; after this date,problems were more related to inadequate information and/or
inaccurate writing of the document. It is important to mention
that the Ethics Committee of the institution started to work
regularly in 1993; before this date, the projects underwent
only a methodological evaluation (6).
Up to the present moment, only a few studies about
practical aspects related to the process of obtaining informed
consent in Brazil have been published. The objective of thepresent work was to assess the adequacy of the informed
consent form used in six health-related research projects
carried out at a general hospital in terms of information andconsent components. This assessment was accomplishedthrough interviews with the patients.
Methods
Fifty-nine patients taking part in six different research
projects at HCPA in the areas of cardiology (n=13),
endocrinology (n=14), medical genetics (n=13), gynecology(n=8), and rheumatology (n=11) were interviewed. All thepatients had signed informed consent forms. This was across-sectional study (patients were interviewed only once).
The selection of projects was done randomly among all
the research projects being carried out in the outpatient clinicsof the hospital. Six projects were drawn from the ones that
had already been approved by the Scientific Commission andby the Ethics Committee. Projects involving patients withpsychiatric or neurological diagnoses were excluded from ourstudy.

Most of the 59 individuals studied were females (relative
frequency of 71%). In all projects, except for the one on
endocrinology, the number of female participants was higher
than the number of males. Ages ranged from 25 to 74 years,
with an average of 50.17±15.24 years.
The adequacy of the informed consent was assessed
according to the amount of information received and thedegree of difficulty in understanding the informed consent
form. The difficulty in understanding the informed consent
forms was assessed by the Flesch-Kincaid and Fleschreadability indices. The results obtained with the formulaestimate the years of education needed for the adequate
comprehension of the text. The most effective values ofFlesch-Kincaid’s readability index are the ones requiring 6 to
10 years of education. The calculation of the Flesch-Kincaid
and Flesch indices was carried out using the Grammatik IV
software (7).
The information received and remembered by theparticipant was assessed with the use of a list for theverification of specific procedures, risks and benefits for eachof the projects included in the study. Procedure was defined
as any intervention carried out with a research-related aim,such as data collection through an interview, collection of
biological material, physical and laboratory tests, use ofdrugs, and use of placebo. Risk was defined as any probabledamage or discomfort resulting from the procedures.
Probable benefits to participants ranged from increased
information about their state of health or diagnostic
characterization to the possibility of alteration in the prognosis
due to the use of drugs. Data collected from different projects
were standardized so as to allow comparison, in spite of theirpeculiarities.
The data obtained and/or calculated were analyzed using
descriptive and inferential statistics. When data were
quantitative and susceptible of being compared to othergroups, the ANOVA variance analysis was used. Qualitative
data were analyzed using the chi-square test. These analyses
were carried out using the EPI-Info software 6.04.
The assessment of multiple interactions between thevariables studied was performed through the correspondence
analysis (8) which was obtained with the SAS system. The
significance level was established at 5%.
The present study assessed only the actual process ofobtaining informed consent, and no risks were involved,
because only one interview was performed, and theassessment instrument presented no risk of privacy invasion.
For these reasons, we asked the Ethics Research Committee
at HCPA to be excused from using a written informed consent
form, according to item IV.3.f of Resolution 196/96.
Results and Discussion
Values obtained with the Flesch-Kinkaid index in theinformed consent forms of the six projects ranged from 12 to
18 years of education, with an average of 14.67±2.16 years.
The sample’s education level varied from illiteracy up tocollege education. When compared to data about the Rio
Grande do Sul population, the education level presented by
the sample was slightly higher. This variable was directly andpositively associated only with the remembrance ofprocedures and benefits: the higher the level of education, thehigher the remembrance of procedures and benefits. The
opposite was not observed: a lower level of education did not
make the remembrance more difficult. Luna had alreadyemphasized, in 1995, that illiteracy does not make a person
become unable to give informed consent. (9).
Viegas, in 1998, carried out a qualitative study in a sampleof six HCPA patients taking part in research projects in thearea of oncology.(10) The experiences of these patients inrelation to their participation in the projects were analyzed.
The author observed that all the participants agreed or
refused to participate in the study before reading the informed
consent form, based only on previously received information.

Eubios Journal of Asian and International Bioethics 17 (November 2007)179

Previous explanations

Accessible text

Answering doubtsComprehension

Education
+/+

+/+

+/+

+/+

+/+
-/+

-/-

-/-

Remembrance of

+/+

+/+

-/-

-/-

-/+

Remembrance

Remembra

Note: (+) represents an assertion, amplification, or a high value; (-) represents a denial, reduction, or a low value
Figure 1. Explanatory model for the informed consent process, based on the Correspondence Analysis.
All six individuals emphasized the importance of
information disclosure and clearing up of doubts (10). So,
education is not a limiting factor, but a facilitator of theinformed consent process.
In our sample of 59 patients, 53% stated that they hadreceived previous explanations. This information alone
already indicates inadequate use of informed consent, sincealmost half of the participants did not remember having
received any information before filling out the informed
consent form. Another possible interpretation for this result isthat informed consent was obtained as an event, and not as aprocess: the person’s authorization was requested based only
on the data presented in the forms.
Receiving previous information or not was the variable
that presented the highest explanatory power (highest inertia
in the correspondence analysis) when associated withobtainment of informed consent. This was the only aspect
directly related (either positively or negatively) with all theother variables of the informed consent process, that is,procedures, benefits, and risks. Patients who had received
previous explanations were more able to remember theprocedures, benefits, and risks involved in the research
project. The opposite was also observed: patients who had
not received explanations had more difficulty in remembering
this information. These associations manifest the paramountimportance of this stage in the informed consent process.
Having received answers to doubts was referred by 24%of the patients, but it is not easy to interpret thecomplementary value of this result. The fact that 76% of thepatients did not receive answers to their doubts may be seen
as a deficiency in the informed consent process, or it may be
due to the absence of questions on the patient’s part, either
because he/she did not want to ask questions or because
he/she did not feel comfortable in doing so. This issue is notwell understood yet. Answers to doubts made theremembrance of procedures easier and the remembrance ofbenefits more difficult. This apparent contradiction may be
explained by the difference in the added value of thisinformation. Procedures are concrete actions, which occur if
the patient agrees to participate in the research project, so
clearing up a doubt related to the procedure reinforces thecertainty of its occurrence. Benefits, on the other hand, are aprobability. When a doubt related to a certain benefit iscleared up, this may calm the person and even be decisive inthe process of making decisions. If the benefit does not occur,
this remembrance may be lost.
Comprehension of what was being proposed in the
research project was reported by 56% of the patients. Data
regarding this characteristic allowed us to assert that in 44%of the sample, the informed consent was considered morally
contestable. According to the results, non-comprehension
made the remembrance of procedures more difficult and theremembrance of benefits easier. These people authorized
their inclusion in the research project without an exact notionof what would be done, perhaps focused only on thepossibility of obtaining some benefit out of the experience.
A similar situation was observed in 1975, in a study
involving the informed consent given by 41 volunteers in nonclinical research projects.(11) In this sample, 14 people gaveconsent without having been adequately informed and without
having understood exactly what would be done during the
research project. It is worth noting that in the study performed
in 1975, only five people, all with medical education,adequately understood what was being proposed in theforms. This professional selection shows that the information
was not accessible to most participants in the North American
project; it reinforces what had been previously discussed
regarding the fact that investigators write according to theirpattern of reading.
The text of the informed consent forms was considered
accessible by only 25.4% of the participants. This
characteristic was associated only with the remembrance of180

Eubios Journal of Asian and International Bioethics 17 (November 2007)

procedures. Coherently, texts considered accessible madethe remembrance of procedures easier, while thoseconsidered non-accessible made it more difficult. This value
was numerically similar to the number of participants that had
an education level compatible with readability indices.
Participants with at least high school education constituted
29% of the sample. There was, however, no significant
correlation between readability and education level. Similarly,
differences between the Flesch-Kincaid and Flesch indices forgroups that considered the text accessible and nonaccessible were not significant. These results confirm thosealready observed when education level was assessed.
The analysis of the results obtained with the threeelements of the informed consent - procedures, risks, andbenefits - also presented some associations that deserve to
be analyzed.
Remembrance of procedures was the main element of theinformed consent, according to the correspondence analysis.
They were remembered in 48% of the cases, which meansthat 53% of the patients either did not remember what had
been proposed and performed with them, or, perhaps, did notconsider such situations as being related to the research. The
remembrance or not of procedures had no relationship withthe time elapsed between the obtainment of the consent andthe present data collection. Having received previous
explanations and answers to doubts, having considered thetext accessible and having an education level superior toelementary school were facilitators for the remembrance ofprocedures. Not having received previous information, nothaving understood it, or not having understood what was
being proposed, made remembrance become more difficult.
Benefits were remembered in 48% of the cases. Having
an education level above elementary school and having
received previous explanations contributed to thisremembrance. The absence of previous explanations, on theother hand, made the remembrance more difficult. There
were two inverse associations: the non-comprehension of
information made the remembrance of benefits easier, andthe absence of doubts on the patient’s part was associatedwith difficulty in remembering benefits. Although apparently
contradictory, both inversions have the same explanation.
The non-comprehension may be the result of a non-clarified
doubt, which generates insecurity and uncertainty.
Remembering benefits may be one way of dealing with thisinsecurity, even if the benefits are not adequately understood.
Complementarily, those who had their doubts clarified and felt
more secure were not even able to remember the benefits
reported. It is important to emphasize that the participants
who did not seek answers for their doubts may haveexperienced an embarrassing situation, caused by theestablishment of a dependence relationship with theinvestigator.
Remembrance of risks had a considerably lower index
than the other aspects, since only 22% of the patients
reported it. This means that 88% of the participants did notremember the risks they had taken when authorizing their
inclusion in the research project. An important aspect is that
only the risks indicated in the informed consent form signedby all subjects were taken into consideration. Only one
association was observed between remembrance of risks andanother variable: having received previous explanations madeit easier to remember risks; the absence of previous
explanations made it more difficult. The low rate ofremembrance of risks may be a sign that the patient isdenying the negative aspects associated with the research
project in which he/she agreed to participate.
The results obtained with the remembrance ofprocedures, benefits, and risks showed that the participants
selectively differentiate between these data during theobtainment of informed consent. People preferentiallyremember what will actually be carried out or what benefits
the research can bring to them. Since risks have a negative

character and are only probabilities, they are remembered ina lower incidence. None of these characteristics - procedures,
benefits, or risks - had an association with the time elapsed
between the obtainment of informed consent and the datacollection.
The low remembrance of risks may be at least partiallyexplained by the studies carried out by Hofstede, who used
another trans-cultural variable: the form by which society
deals with conflicts and uncertainties (12). This characteristic
may clarify the discussion about the lower remembrance ofrisks. The Brazilian population was classified into the group ofcountries that most avoid situations involving uncertainties.
This way, information about a risk associated with theresearch project may generate such anxiety that the risk isdenied or forgotten. Procedures, on the other hand, constitutea certainty; as they had already been performed when thepresent data collection started, they were more easily
remembered. Benefits represent favorable information, which
was probably decisive for the people to authorize their
inclusion in the project. Even constituting a probability or an
uncertainty, benefits do not generate insecurity; on thecontrary, they make people hope that they are really going tohappen.
These results show that it is really necessary that the useof the informed consent in research projects be the object ofdeep reflections in all instances involved. It is of paramountimportance that the informed consent form not be used as ameans of responsibility exemption by investigators, research
institutes, and sponsors. Ethics Committees play an importantrole in reviewing all the stages involved in the informed
consent process, and not only the text adequacy of the form,
as is usual in Brazil. The access to and comprehension of
information, the clearing up of patients’ doubts, the familiarity
with and access to an investigator who is able to clear up
potential doubts are conditions that should be formallyguaranteed to candidates to participate in research projects.
References
1 Beauchamp TL, Faden R. Meaning and elements of informed
consent. In: Reich W, ed. Encyclopedia of bioethics. New York:McMillan, 1995:1238-41.
2 Hopper KD, Tem H, Ave TR, Hartzel J. Informed consent forms forclinical and research imaging procedures: how much do patients
understand?
AmericanJournalof
Roentgenology
1995;164(2):493-6.
3 Woloshin S, Schwartz LM, Welch HG. The Effectiveness of a
Primer to Help People Understand Risk: Two Randomized Trials
in Distinct Populations. Ann Intern Med 2007; 146: 256-265
4 Riecken HW, Ravich R. Informed consent to biomedical research in
Veterans Administration hospitals. JAMA 1982;248(3):344-8.
5 Lavados M, Salas SP. Ethical problems in the biomedical research
projects presented to the Ethical Committee of the Escuela deMedicina de la Pontifícia Universidad Católica de Chile. Revista
Médica de Chile 1997;125(9):1011-8.
6 Raymundo MM, Matte U, Goldim JR. Consentimento informado eavaliação de projetos de pesquisa no período de 1996 a 1997.
Revista HCPA 1998;18(supl):30-1.
7 Grammatik IV. San Francisco: Reference Software, 1990.
8
Micheloud
FX.
Correspondence
analysis.
URL:
http://www.micheloud.com/FXM/COR/E/
9 Luna F. Paternalism and the argument from illiteracy. Bioethics
1995;9(3/4):283-90.
10 Viegas MAV. O processo de consentimento informado em estudosclínicos em oncologia: percepções dos pacientes [[thesis]]. Porto
Alegre: Curso de Pós-Graduação em Psicologia/Pontifícia
Universidade Católica do Rio Grande do Sul, 1998.
11 Garnham JC. Some observations on informed consent in nontherapeutic research. Journal of Medical Ethics 1975;1(3):138-45.
12 Hofstede G. Culture and organizations. New York: McGraw-Hill,
1997.

Eubios Journal of Asian and International Bioethics 17 (November 2007)

Embracing personal andcommunity empowerment:
genetic information policy
making in Israel- Liza Ireni-Saban, Ph.D
Political Science, Tel Aviv University
Naftali Building, Ramat Aviv, Tel Aviv, Israel
E-mail: sabn@bezeqint.net
Introduction
Thirty years ago, researchers from an American groupcollected blood and DNA samples from Indian Amazon tribes
and sold it to scientists around the world for $85 a sample. In
1996, another team came to collect more blood samples inexchange to medicine. Recently, Karitiana and other Amazon
tribes have decided to demand compensation and to stop the
distribution of their blood and DNA by American privatecompanies (Rohter, 2007). Similarly, during the 1990s,
researchers from the U.S. National Institutes of Healthindicated that Ashkenazi Jews had an extremely strong
history of breast cancer. This was the first genetic mutation
positively associated with cancer risk in a particular ethnic
group. Some leaders within Ashkenazi Jewish community
have expressed concerns that these research findings linking
a racial or ethnic population to a disease or disorder might
stigmatize the group involved or the Jewish community(Hodge and Harris, 2001).
The participation of individuals and social or ethnic groups
in genetic research raises some concerns, such as
discrimination, stigmatization, and breaches of privacy. Thus,
this article offers to view regulatory guidelines that apply
specifically to genetic testing and data handling including
privacy and confidentiality of genetic test results, research
profits and benefits sharing, and avoidance of the misuse ofgenetic technologies and information in employment or
insurance as an appropriate response to specific publicconcerns.
This paper suggests that the key strategic concept guiding
such regulations is empowerment (Zimmerman andRappaport, 1988). Empowerment aims at the improvement of
individual and collective skills to regain control over living andworking conditions and their impact on well-being (Henderson
and Thomas, 1987). In public policy studies, empowerment
refers to a constant process of enabling individuals andgroups to enhance their individual and collective skills and to
take part in collective action (Rochefort and Cobb, 1994). It issuggested that in the case of genetic information,
empowerment is manifest in the dilemma between one’s
interest in protecting sensitive personal information and thegeneral will to obtain this information, for instance, in order toundertake research for the benefit of the society as a whole(Rochefort and Cobb, 1994; Gottweis, 2005).
Indeed, regulation of the use of genetic information needs
to assess the basic questions concerning the relations
between state and society. The questions here became more
complicated during recent decades due to the shifting role ofthe state. These changes are often explained by the growing
influence of international actors, private actors, and civilsociety actors (Coleman and Skogstad, 1990; Atkinson and
Coleman,1989).
The present paper aims to analyze how the state's
relationship with non-governmental actors influencesindividual and community empowerment in the field of genetic
information regulation. This paper suggests that legal
protection for individuals and communities should follow thesocial nature of genetic information. Moreover, growing

181

empowerment can result in a policy network exemplified by
the state as a dominant actor whereby the state consciously
tries to exclude organized interests from policy-making. As
such, it should be emphasized that states should enact laws
to protect individuals and ethnic communities from genetic
discrimination instead of self-imposed regulation in theinsurance market.
This article is divided into two sections. The first section
briefly outlines the nature and implications of genetic
information, the second will examine the relationship between
state and non-governmental actors in designing genetic
information regulation in Israel.
Genetic Information vs. Medical Information
Mapping and identifying human genes enables obtaining
information concerning each person. Genetic information has
been seen to be different from other kinds of information
concerning our health and lives in general, in that genetic
information has a probabilistic character in which health risks
can be accurately predicted by genetic test (Beskow et al.,
2001; Issa, 2002). Moreover, medical information isconsidered to be uniquely personal while genetic information
is usually – by its very nature – a social (family) concern.
Genetic information can reveal information not only on aparticular, unique individual, but about those who are
genetically related to him or her, such as members of aparticular family (parents, children, siblings), or an even larger
ethnic or racial population. In the context of political and legal
decision-making, this paper will briefly outline three main
aspects which guide the ethical grounds behind the legislation
calling for special regulation where genetic information isconcerned: genetic privacy protection, sharing in research
profits and advantages, and avoiding misuse of genetic
information by private sectors.
Genetic Information and Privacy Protection
The use of genetic information invokes policy debate overthe ethical grounds behind the special legislation for genetic
information. Some believe that parts of existing medical
information privacy laws could be interpreted to include
genetic information privacy (Lemmens, 1999). They claim thatthe same argumentation that is relevant to the use of genetic
information is, in many ways, relevant also to other kinds ofhealth information which reveals illness or probabilities ofparticular health conditions for people. Others claim that theuse of genetic information challenges a number of existing
legal tools such as intellectual property, privacy, and informed
consent in private-funding research (Wolf, 1995). As such,they suggest that as part of the disclosure for consent,
individuals must be informed of possible future uses of thespecimen, whether identifiers will be retained, and, if so,whether the individual will be re-contacted. However, in
multiplex genetic testing for more than one condition, there isno possible way to re-contact participants and obtain informed
consent from them for each test (Reches, 2003).
Genetic Information and Research Benefits Sharing
With the rapid development of high-throughput
technologies allowing for the screening of very large numbersof samples, and with growing recognition of the important role
genetic variation can play, there has been a tendency to try to
generate large national population collections in various
countries (Iceland, Estonia, Latvia, Sweden and the UK, forexample), or to investigate sub-populations with defined
characteristics (in Italy and Finland, for instance). These
collections, considered as national research resources, areusually supported with private funds in combination withpublic funding, although they are occasionally supported withprivate funds alone. Thus collections which are partly held by
the private sector could be set up on a commercial basis,

182

Eubios Journal of Asian and International Bioethics 17 (November 2007)

using tissue collected from hospitals or extra tissue takenfrom a medical research trial, processed for research, andsold to pharmaceutical, diagnostic, or biotechnology
industries. Therefore, ownership of the data becomes asignificant question that needs to be addressed by bothresearchers and communities. It is argued that the concept ofownership (e.g., of research results or human tissue) needs to
be clarified, and that ownership of data should be defined toinclude the communities providing the data, as well as theresearchers studying the data.
Genetic Information and Discrimination
Expansion of the range of genetic tests and other genetic
information available to physicians, insurance companies,
employers, and the general public could lead to genetic
discrimination based solely on the nature of an individual’s
genotype. The practice of genetic discrimination has thepotential to create a new group of disadvantaged people who
would need the same protections now accorded those
suffering from racial and sex discrimination (Billings et al.,
1992; Natowicz et al., 1992; Alper et al., 1994).
The tragedies of race and sex discrimination illustrate thedangers of basing employment decisions on inborn
characteristics. Like these, discrimination on the basis ofgenetics ignores the present abilities and health status ofworkers and substitutes questionable stereotypes about
future performance. Less absenteeism, reduced life andhealth insurance costs, and longer returns on investments in
employee training all reduce the costs of labor. Insurancecompanies also face strong economic incentives to identify
individuals perceived to be at increased risk for ill health in the
future in order to raise the premium.1 Despite, the extensionof using the self-regulation model by the private sector, somestates in the U.S.A., such as Texas, Georgia, Virginia, andNew Jersey, have enacted laws which prohibit the use ofgenetic information by employers and insurance companies.2
In the future, the extent to which government will be able
to influence the distribution of goods and services will dependon achieving coordination and control among these disparate
actors. (Orenlicher, 1995; Brownsword et al., 1998; O’Neill,
1998; Hall and Rich, 2000; Murray et al., 2001; Annas, 2002)
Coordination of multiple actors becomes an importantprecondition for the increasing capability of government toperform an active role in designing genetic testing policy.
Therefore, this paper claims that a state’s relationship with
non-governmental actors provides a fertile field for analysts
who wish to investigate the structure and decision modes ofgovernments, the interaction between government andgroups, the types of policies which result from suchinteractions, and their impact on non-discriminatory genetic
policy.
The Israeli Genetic Information Policy Making
The unique characteristics of the genetic information
presented above will be strengthened if it can be supported
by empirical data. In this section, we will examine how statecivil society relations affects policy outcomes, namely
providing support for individuals’ and communities’
empowerment or leading individuals and communities tobecome more vulnerable to potential risks from the use ofgenetic technology.
Israel was faster than other states to respond to theconcerns about commercial use of genetic information. In
fact, the special nature of DNA and genetic information withrespect to individual rights has been recognized in the law on
http://www.managed
care/mag.com/archives/9701/9701/genetics.shtml
Date
last
accessed: 27 March 2006.
2
I refer to Information Nondiscrimination Act of 2003:
http://www.gene-watch.org/programs/privacy/genetic-discposition.htm Date last accessed: 27 March 2006.
1

genetic information, adopted in Israel in 2000.3 The Genetic
Information Law 5761-2000 and other existing ethicalguidelines cover most issues of informed consent,
confidentiality, and rules of accession relating to either
identified or non-identified DNA samples or genetic
information in the usual individual or family-based, small
scale, collections. The law indicated a communitarian
approach in addressing the issues of genetic testing, which
set boundaries within which personal autonomy was to be
exercised. The specific responsibilities and goals set out inthe new legislation provided inter-relationships of individual
values, rights, and needs with communal values, civic duties,
and responsibility and public welfare.4
In 2000, the Genetic Information Law was enacted in
Israel. The law as a government regulation initiative contains
protection from genetic discrimination in insurance and inapplying for employment (see esp. sections 23 and 24).
However, genetic information policy-making did not end in
preliminary legislation. Other ethical and legal aspects of theuse of genetic information were being further considered by
the Knesset Committee of Scientific and Technology
Research and Development. One of the Committee’s
challenging regulatory issues was the management of DNA
sample collections from Ashkenazi Jews by the Israelicommercial company IDgene Pharmaceuticals Ltd. IDgene isa privately owned population genomics company focused on
identifying the genetic basis of common diseases.
The commercial interest of IDgene in the use of genetic
information raised public concerns over the regulation of large
population-based genetic studies. During 2001, this issue wasreviewed in two reports: One was issued by the Bioethics
Advisory Committee of the National Academy of Sciences,headed by Prof. Michael Ravel and the second was issued by
the Ethics Bureau of the Medical Association, headed by Prof.
Avinoam Reches. (Reches, 2003) Mostof therecommendations specified in these reports are similar,
especially in their call for the establishment of new statutory
authority, which will assure quality control of both thecollections and the ethical management of genetic databases.
Such authority will be implemented to evaluate and monitor
the current use of existing biobanks throughout the state andconstitute a biobank of its own. The report of the Israel
Academy Bioethics Committee emphasized the concern ofgroups’ genetic discrimination in research: “Genetic profilingof a collectivity that can be defined by ethnic or national
origins could lead to risks of stigmatization of all those who
belong to the collective. Worse, this could lead todiscrimination in various forms – moral, physical or
economic.” 5 The deliberations of the Ethics Bureau of theMedical Association were aimed at defining a broader set ofprinciples, dealing in balancing the privacy of genetic
information and the benefit of research to improve publichealth of ethnic communities and society as a whole. Prof.
Kasher, one of the members of the Israel Academy Bioethics
Committee, suggested considering the community from which
the samples are collected as the owner of such information.
According to Kasher, “…it is actually the community property.”
The description of the Israeli network in genetic
information policy-making enables us to specify the influenceof state regulation on individuals’ and communities’
empowerment. A practical investigation of the Israeli policy
can be found in the responses of an Arab Bedouin community
Passed by the Knesset on 16 Kislev 5761 (December 13, 2000); billand explanatory memorandum published in Hatsaot Chok 2786, 11
Tevet 5759 (December 30, 1998), p. 290. Kovetz HaTakanot 5741,
p. 292.
4
Knesset protocol no. 71, Science and Technology Committee
meeting (19 November 2001); Knesset protocol no.1041, Research
and Technology Development Committee meeting (8 November2004).
5
http://www.academy.ac.il/bioethics/hebrew/report2/report2-h.html
Date last accessed: 20 November 2006.
3

Eubios Journal of Asian and International Bioethics 17 (November 2007)
in Israel to a genetic counseling program for spouse selection.
While health professionals designed the program to fit local
norms such as consanguinity, matchmaking, and the Muslim
ban on abortion, for the Bedouin, it also meant the
medicalization of marriage arrangements and family planning.
Research has shown that during the last decade, the Bedouin
infant mortality rate was 15.3% of 1,000 new births compared
to 3.3% in the Jewish community. In 1994, Soroka Hospital incollaboration with the Institute of Genetics at Ben-Gurion
University of the Negev and Ministry of Health, decided to
implement a Premarital Carrier Screening program of couples
at risk. (BGU, 2000) In 2002, inborn defect was the explaining
cause of 36% of infant mortality. Another community-based
premarital program that uses carrier matching is Dor
Yeshorim, a program developed by the ultra-orthodox
Ashkenazi Jewish community. The Tay-Sachs genetic
screening program was established to follow the ultraorthodox Ashkenazi Jewish community's law under whichbirth control and abortion are forbidden and engagements are
pre-arranged through matchmaking procedures. The program
tests young adults for disease carrier testing before they
begin matchmaking procedure so the engagement can becancelled at the earliest possible stage. The success of Dor
Yeshorim screening program derives from the strong supportof the religious leaders of the Jewish community, theconfidentiality of the storage data and the availability ofshared biomedical information with community members.
According to Raz, "The compliance rate with Dor Yeshorim isover 90 percent; in recent years hardly any children affectedwith Tay-Sachs or cystic fibrosis have been born in thiscommunity to couples who married during the last decade."(Raz, 2005: 18) Although, The Bedouin program was drawn
upon Dor Yeshorim model, with which professionals at the
local medical center were quite familiar, the genetic screening
program for the Bedouin community did not requirecommunity involvement in all aspects of this research,
including follow–up with the results (Raz, 2003). Whenobtaining community empowerment, special attention must be
given to preliminary research to identify potential issues andproblems that may cause turmoil in the community.
Researchers also should strive to select community partners(leaders, organizations) knowledgeably and carefully toensure that these individuals can adequately represent themultiple and diverse views within a community. These
regulatory mechanisms are crucial to obtaining community
empowerment in participation in genetic screening programsand to promote general welfare instead of narrow privateinterests.
Conclusion
This paper has indicated that the possibility of individualand community empowerment depends on the extended roleof governmental actors in genetic information policy making.
The Israeli case of genetic information policy-making
demonstrates that the existence of state's autonomy in which
jurisdictions found that the benefits of a comprehensive,
coherent, and principled regime would displace the perceived
need (as well as the political pressure) to treat genetic
information distinctly from other types of data. Indeed, civil
servants are liable to include provisions of accountability andresponsibility in policy-making. These provisions might
include entailing "collective" termination to privacy rights andinformed consent due to the fact that the collection and theuse of genetic information do not concern only thoseindividuals from whom samples are collected; requiring
researchers, in their research grant proposals, to justify theirselection and definition of communities; demonstratesensitivity for the larger ethical, legal, and social implicationsof their research; anticipate potential group harms; specify
actions to educate and inform the community about the
research and to obtain consensus for the study; indicate ways

183

to communicate research results back to the community forthe benefit of the society as a whole. In the context ofindividuals and community empowerment, it urges the need tocreate a distinct corpus of rules specific to genetic
information. For that, this policy has the obvious advantagesof providing additional and more tailored protections specificto this type of information, while also addressing some of thefamilial and communal interests in that information.
It is argued that in the future, National Bioethics Advisorycommittees will take a leading role in shaping genetic
information regulation. The fact that these committees’
members are coming from different disciplines – ethics, law,science, religion, etc. – promotes dialogue with the public
about the ethical, legal, and social implications of genetics
research. Indeed, growing public involvement in the meetingsand deliberations of the National Bioethics Advisory
Commission and the broad dissemination of theCommission's reports to researchers and the public isessential for justifying public participation in research on the
one hand and commercial investment on the other, for thesake of society’s welfare as a whole.
References
Alper, J.S., Geller, L.N., Barash, C.I., Billings, P.R., Laden, V. andNatowica, M.R. (1994) ‘Genetic Discrimination and Screening for
Hemochromatosis’, Journal of Public Health Policy 15(3): 345–58.
Annas, G.J. (2002) ‘The Limits of State Law to Protect Genetic
Information’, New England Journal of Medicine 345: 385–8.
Atkinson, M.M. and Coleman, W.D. (1989) ‘Strong States and Weak
States: Sectoral Policy Networks in Advanced Capitalist
Economies’, British Journal of Political Science 19: 47–67.
BGU Faculty of Health Sciences. (2000) The Negev Statistical Annual
Review, Beer-Sheva: Ben-Gurion University of the Negev.
Beskow, L.M., Burke, W., Merz, J.F., Barr, P.A., Terry, S.,
Penchaszadeh, V.B., Gostin, L.O., Gwinn, M. and Khoury, M.J.
(2001) ‘Informed consent for population-based Research involving
Genetics’, Journal of American Medical Association 286, 2315–21.
Billings, P., Kohn, M.A., de Cuevas, M., Beckwith, J., Alper, J.S. andNatowicz, M.R. (1992) ‘Discrimination as a Consequence ofGenetic Testing’, American Journal of Human Genetics 50: 476–82.
Broide, E., Zeigler, M., Eckstein, J. and Bach, G. (1993) ‘Screening
for carriers of Tay-Sachs disease in the ultraorthodox Ashkenazi
Jewish community in Israel’, American Journal of Medical Genetics
47: 213–215
Brownsword, R., Cornish, W.R. and Llewelyn, M. (1998) (Eds.), Law
and Human Genetics. Oxford: Hart Publishing.
Coleman, W.D. and Skogstad, G. (1990) ‘Policy Communities andPolicy Networks: A Structural Approach’, in W.D. Coleman and G.
Skogstad (eds.), Policy Communities and Public Policy in Canada,
New York: Oxford University Press.
Hall, M.A. and Rich, S.S. (2000) ‘Laws Restricting Health Insurers’
Use of Genetic Information: Impact on Genetic Discrimination’,
American Journal of Human Genetics 66: 293–307.
Gottweis, H (2005), ‘Governing Genomics in the 21st Century:
Between Risk and Uncertainty’, New Genetics and Society, 24,
175-194.
Hodge, J.G. and Harris, M.E. (2001) ‘International Genetics Researchand Issues of Group Privacy’, Journal of Biolaw and BusinessSpecial supp: 15–21.
Issa, A.M. (2002) ‘Ethical Perspectives on Pharmacogenomic
Profiling in the Drug Development Process’, Nature Reviews 1:
300–8.
Lemke, T. (2005) ‘Beyond Genetic Discrimination: Problems andPerspectives of a Contested Notion’, Genomics, Society and Policy
1(3): 22.
Lemmens, T. (1999) ‘Private Parties, Public Policy?’ in A.K. Tompson
and R.F. Chadwick (eds.), Genetic Information, New York: Klewer
Academic Publishers, pp. 31–40.
Moran, M. (2000) ‘Understanding the Welfare State: The Case of
Health Care’, British Journal of Politics and International Relations
2: 135–60.
Murray, W.D., Wimbush, J.C. and Dalton, D.R. (2001) ‘Genetic
Screening in the Workplace: Legislative and Ethical Implications’,
Journal of Business Ethics 29(4): 365–78.

184

Eubios Journal of Asian and International Bioethics 17 (November 2007)

Natowicz, M.R., Alper, J.K. and Alper, J.S. (1992) ‘Genetic
Discrimination and the Law’, American Journal of Human Genetics
50: 465–75.
Nelkin, D. and Tancredi, L. (1989) Dangerous Diagnostics: The Social
Power of Biological Information, Chicago: The University of Chicago
Press.
O`Neill, O. (1998) Genetics, Insurance and Discrimination,
Manchester: Manchester Statistical Society.
Orentlicher, D. (1995) ‘Genetic Screening by Employers’, Journal of
the American Medical Association 263: 1008.
Rappaport, J. (1987) ‘Terms of Empowerment/Exemplars ofPrevention: Toward a Theory of Community Psychology’, American
Journal of Community Psychology 15: 121–44.
Raz, A. E. (2003). ‘'Aysha': Genetics Education and Community
Engagement in a Consanguineous Arab-Bedouin Population in
Israel’, Health 7(4): 439–61.
Raz, A.E. (2005) The Gene and the Genie: Tradition, Medicalization
and Genetic Counseling in a Bedouin Community in Israel. Durham,
NC: Carolina Academic Press.
Reches, A. (2003) ‘Recommendation and guidelines in Large
Population-based research Report’, Chamber of Ethics, 8: 1-45
Rochefort, D. and Cobb, R.W. (1994) ‘Problem Definition: an
emerging Perspective’, in D. Rochefort and R.W. Cobb (eds.), The
Politics of Problem Definition: Shaping the Policy Agenda,
Lawrence, KS: University Press of Kansas, pp. 1–31.
Rohter Larry, 'In the Amazon, giving blood but getting nothing' New
York Times, 27.6.2007
Sagi, M. (1998). ‘Ethical aspects of genetic screening in Israel’,
Science in Context 11(3–4): 419–429.
Thompson, A.K. and Uhlemann T. (1999) ‘Genetic Engineering andGerman Health Insurances’, in A.K. Thompson and R.F. Chadwick(eds.), Genetic Information, New York: Kluwer Academic, pp. 71–8.
Wolf, S. (1995) ‘Beyond Genetic Discrimination: Towards the Broader
Harm of Geneticism’, Journal of Law, Medicine and Ethics 23: 345–
53.
Zimmerman, M. and Rappaport, J. (1988) ‘Citizen Participation,
Perceived Control, and Psychological Empowerment’, American
Journal of Community Psychology 16: 725–50.

Neanderthal Range Extended- K. K. Verma, Ph.D.
Retd. Professor of Zoology, HIG1/327, Housing Board
Colony, Borsi, Durg (C.G.), 491001, India
Email: kkvermain@yahoo.com- Rashmi Saxena, Ph.D.
Assistant Professor of Zoology, “Sopan”, 71 Madhav Vihar,
near Govt. Senior Secondary School, Shobhagpura, Udaipur(Raj.), 313001, India
Email: ks_pim@yahoo.co.in
In an earlier communication (Verma and Saxena, 2007),
on fate of Neanderthals, it has been said that Neanderthals
lived in Europe and south-west Asia. That was the knowledge
then. Now the range of distribution of this species of Homo is
known to be considerably more extensive (Krause et al.,2007).
Before the work of Krause et al. (2007) there were someindications of Neanderthals in more eastern parts of Asia. In
the Teshik-Tash Cave in Uzbekistan some hominid bones
and artifacts were found; the latter included Mousterian tools,
which are associated with Neanderthals. In the Okladnikov
Cave in the Altai Mountains in South Siberia some hominid
teeth were found, which looked neanderthaline. But thesefinds were not conclusive evidences in favour of Neanderthal
existence in those parts in the past.
In the Krause’s team was included S. Paabo, who had
experience of sequencing and analyzing Neanderthal DNA
from European sites (Wade, 2007). Taking advantage of his
experience Krause’s team planned to identify Neanderthal mtDNA in the DNA samples extracted from bony remains fromthe Teshik-Tash and the Okladnikov Caves. Krause et al.,through DNA sequencing data, inferred “that the DNA
sequences from these fossils fall within the European
Neanderthal mt-DNA variation. Thus, the geographic range of
Neanderthals is likely to have extended at least 2000 km
further to the east than commonly assumed”.
Krause et al. (2007) have estimated the date of an adult14
and a subadult humerus bones by the C technique as nearly
35,000 years old.
In an e-mail letter to Wade (2007) Paabo has said, “We
now know that they (Neanderthals) are (‘were’ would havebeen better) on the doorstep of Mongolia and even China…”.
Neanderthal features started appearing in evolving
hominids in Europe about 400,000 years back. The
Neanderthals first appeared in western Asia 150,000 years
ago. As noted above, the Neanderthal presence in moreeastern Asia has been estimated to have been about 35,000
years back. These time estimations suggest eastward
migration of Neanderthals after their European origin.
After their movement out of Africa the modern humans
were in the Indian subcontinent about 65,000 years back(Verma, 2006). Hence 35,000 years ago presence ofmoderns in more eastern parts of Asia is quite expected. Infact the museum bony remains from the Uzbekistan andSiberian caves, used by Krause and his team for DNA
extraction, were badly contaminated with modern humanDNA. Krause et al. (2007) say, “The high ratio of modern
human DNA to Neanderthal DNA for the subadult Okladnikov
and the Teshik Tash specimens are in agreement withprevious observations that modern human mtDNA occurs inmost fossil bones.”. These facts suggest coexistence ofmoderns and Neanderthals over a long period (more than
10,000 years in Europe, Verma and Saxena, 2007) in a large
geographic range (extending from Gibraltar to the Altai
Mountains in south Siberia). This further increases thepossibility of some interbreeding between moderns andNeanderthals and assimilation of Neanderthal contribution in
the modern human’s genome (vide Verma and Saxena,2007).
References
Krause, J., Orlando, L., Serre. D., Viola, B., Prufer, K., Richards,
M.P., Hublin, J.-J., Hanni, C., Derrevianko, A.P., and Paabo, S.,
2007. Neanderthals in central Asia and Siberia. Nature AOP(Advanced online Publications) (doi: 10.1038/nature06193).
Verma, K.K., 2006. Arrival and dispersal of the modern man (Homosapiens) in the Indian subcontinent. Bionotes, 8(1): 6 – 7.
Verma, K.K., and Saxena, R., 2007. What happened to
Neanderthals? EJAIB, 17(5): 133 – 135.
Wade, N., 2007. Fossil DNA expands Neanderthal range. The New
York Times, October 2, 2007.

Eubios Journal of Asian and International Bioethics 17 (November 2007)

Perceptions of Issues in
Biotechnology Managementin Thailand- Siriyupa Roongrerngsuke, Ph.D.*- Sarote Phornprapha*Associate Professor, Executive Director
Head of Human Resource Program,
Sasin Graduate Institute of Business Administration,
Chulalongkorn University,
Sasa Patasala Bldg. Soi Chulalongkorn 12(2),Phyathai Road, Pathumwan, Bangkok 10330, Thailand
E-mail: siriyupa.roongrerngsuke@sasin.edu
Introduction
Over the past century, biotechnology has created great
promise and new opportunities for the human community as awhole.
Despite the advantages, biotechnology raises
important ethical issues emerging from the manner in which
the technology is developed, designed, and implemented
worldwide.
In terms of management, the most important question
may be – are managers in biotechnology business specificallyand properly educated and prepared to deal with all of theabove questions? (Hoyte and Weiskel, 2004). In the case of
a developing country such as Thailand, there has been no
curriculum of graduate study of biotechnology management
offered by any university when this project started in 2005.
To establish good governance in biotechnology
management in Thailand, this research study, as part of the
EU-Lemlife Project, was funded by the European Union todevelop a curriculum for Biotechnology Management course,
the first curriculum to be offered in Thailand at the graduatelevel.
To design a curriculum to develop Thai managers’
knowledge and skills to manage biotechnology business at
the local and international arenas, the curriculum shouldreflect both local and international concerns. The study wasthus divided into 5 parts:
Part I:
Presentation of background information on
biotechnology in Thailand, concept of corporate governance,
ethical issues in biotechnology companies, and stakeholder
concept in biotechnology business.
Part II: Presentation of topics to be included in the draft ofcurriculum of biotechnology management. The draft of thecurriculum was the outcome of the integration of reviews of
the concepts listed in Part I, together with the information
obtained from the survey of biotechnology management
curricula offered by a number of leading universities.
Part III: Data Collection from interviews with experts,
executives, and managers from leading biotechnology
companies,andmanagers
fromnon-biotechnology
companies regarding the topics to be covered in the
curriculum. Opinions from the public were also surveyed toprovide a broader picture for the curriculum development.
Part IV: Presentation of results.
Part V: Conclusion and recommendations
Biotechnology in Thailand (1983-2007)
Before the economic crisis in 1997, the Thai government
aimed to push Thailand to be named one of the Asian Newly
Industrialized Countries (NICs) with an average economic
growth rate at 8-9 percent during 1993-1995. In 1983, theThai Govenrment established the National Center for Genetic
Engineering and Biotechnology (BIOTEC) under the Ministry
for Science, Technology and Energy. Nevertheless, whencompared with India and China, biotechnology in Thailand
has progressed at a lesser extent despite the fact that

185

Thailand has abundance of unique genetic resources ofplants, animals and micro-organisms (Tanticharoen et al.
2003).
After the economic crisis, efforts have been made byboth the government and private sectors to revive theeconomy via the development of science and technology. In
2001, the total of the Government’s R&D expenditures
provided to the universities in Thailand amounted toapproximately C$40.6 million. The expenditure on R&D wasallocated mainly on development of agriculture, forestry andfishing, with lesser amounts on promotion of industrial
development, environment, and healthcare (Agri-Food Trade
Service: Market Information Southeast Asia, 2002).
At present, Thailand has a number of agencies that workin the field of biotechnology: the National Science andTechnology Development Agency (NSTDA, established in1991), the Thailand Institute of Scientific and TechnologicalResearch (TISTR), the National Research Fund, the National
Research Council of Thailand, together with many of the
major universities such as Chulalongkorn, Mahidol, Kasetsart,
Chiangmai, etc. (Business-in-Asia.com, 2005).
In 2002, the biotechnology industry in Thailand wasconsidered very much in its infancy since only a few products
were commercialized and the technology used by the private
sector was mainly imported (Agri–Food Trade Service: Market
Information Southeast Asia, 2002).
To strengthen biotechnology as a key driver for national
development, the Thaksin Shinawatra Government launched
an initiative to formulate Thailand’s National Biotechnology
Policy Framework. Therefore, the National Economic andSocial Development Board (NESDB), in collaboration with
BIOTEC, and the NSTDA prepared the National
Biotechnology Policy Framework, an eight-year road map(2004-2011) which was endorsed by the National
Biotechnology Policy Committee in 2003.
The policy
framework aims to achieve the following goals by the year2011:
1. Development of new bio-business.
2. Biotechnology promotes Thailand as Kitchen of theWorld
3. Thailand represents Healthy Community and Healthcare
Center of Asia.
4 Utilization of biotechnology to conserve the environment
and to produce clean energy.
5. Biotechnology as the key factor for self-sufficienteconomy6. Development of qualified human resource system.
The Government could not stay long enough to realize
the policy framework set to be achieved by 2011 as the Royal
Thai Army staged a pronunciamiento against the government
on 19 September, 2006. The interim Government was thenformulated mainly to set up the election by the end of 2007.
Under the new Government, the status of these goals is notclear.
Nevertheless, U-sarat Bunnag (2007) views that theoverall picture of biotechnology in Thailand 2007 is not sopoor. The agricultural biotechnology sector now employs
various technologies ranging from industrial fermentation andmarker assisted selective breeding technology, torecombinant DNA techniques.
In the medical biotechnology sector, it seems that
Thailand is becoming well known for being a regional hub forhealthcare with more than 1 million foreigners coming lastyear to use its health facilities and services. Now, this sector’s
focus is to create leverage on biodiversity, Thailand’s
strength, to discover bioactive substances from natural
products and micro-organisms to develop new drugs.
For food biotechnology, this sector provides many
untapped opportunities for investment. It was forecasted thatthe processed food sector will grow at a satisfactory level this
year.

186

Eubios Journal of Asian and International Bioethics 17 (November 2007)

Although biotechnology is well developed in most
universities and research institutes in Thailand, there isinadequate number of personnel in biotechnology.
Seventeen universities in Thailand could accept only up to
600 biotechnology students annually (Tanticharoen et al.,2003). In 2007, among 70 universities in Thailand, 20 offer
biotechnology science. However, none of them offer a Master
Degree in Biotechnology Management (Ministry of University
Affairs, 2007).
Corporate
GovernanceandEthicalIssuesin
Biotechnology Companies
The field of biotechnology is advancing so rapidly it
poses challenging problems not just only for the lawmakers,
consumers, and government, but also for corporations since
this area obviously faces a lack of informed public debate andconsensus on key questions. Under such circumstance, evenwell-intentioned corporations may find themselves lacking themoral standard essential for responsible corporate citizenship(MacDonald, 2002).
From the point of view of Pradhan (2003), ‘good
governance’ must have the following characteristics:- Decision makers are held accountable through voice of
stakeholders- Policy making and implementation processes aretransparent and efficient- Decisions are contestable- Rules and regulations are predictable.
Oman (1999) proposed that corporate governance isperceived as a system by which business corporations are
directed and controlled via organization structure that
identifies the distribution of rights and possibilities among
different participants in the corporation, such as, the board,
managers, shareholders and other stakeholders, and spells
out the rules and procedures for making decisions on
corporate affairs. By doing this, company can achieve its
established objectives and can monitor its performance.
From another perspective, Mathiesen (2002) argued that
corporate governance is “a field in economics thatinvestigates how to secure/motivate efficient management ofcorporations by the use of incentive mechanisms, such as
contracts, organizational designs and legislation. This is often
limited to the question of improving financial performance, forexample, how the corporate owners can secure/motivate thatthe corporate managers will deliver a competitive rate of
return.”Regarding how biotechnology firms deal with ethicalissues, Kato and Macer (2003) conducted a survey of 559
biotechnology companies in the USA, UK, France, Canada,
and Germany to investigate how they respond to bioethicalissues. Their survey revealed that in companies involved inbiotechnology, bioethical problems did occur. However, they
responded to the issues differently and their practices forhandling such issues were quite diverse. For instance, only
11 per cent of companies reported that they had codes of
ethics, then, another 11 per cent responded that they had apolicy or policy statement on ethical issues, and 5 per centinformed that they had general codes of conduct notespecially about bioethics.
Given the different types and levels of companies’
approaches in dealing with ethical issues, it can be seen thateven biotechnology companies in the developed countries
lack standards in managing ethical issues.
The Stakeholder Concept in Biotechnology
Chris MacDonald (2004) claimed that the stakeholder
concept was one of the most attractive conceptual devices inbusiness ethics. Accordingly it has been seized upon by
theorists in business ethics as a way of explaining the ideathat businesses have obligations to a broad range of parties,
beyond the stockholders to whom corporate executives weretraditionally thought to be beholden (Goodpaster, 1991).

For Freeman (2001), stakeholders simply refer to thosegroups who have a stake in or claim on the firm including
suppliers, customers, employees, stockholders, and the firm’s
local community. The stakeholder concept gives due credit to
the fact that the motives of agents in business are relatively
complicated and the conflict between those varied motives
has been a central issue in the business ethics literature.
Therefore, the process defined as “stakeholder analysis” “canprovide biotechnology companies with a lens through which to
pay attention to the full range of interested parties”(MacDonald, 2004).
A simplified stakeholder analysis process was developedby Weiss (2003) for a biotech firm as follows:
Phase I: Descriptive Analysis. This involves the listing ofparties having a stake in the issue which might include
employees, stockholders, providers of biological resources,
local communities, competitors, firms in related fields,
government agencies, and university-based researchers, andothers. Then, the assessment of each stakeholder’s interest
should be conducted.
Phase II: Normative Analysis. This includes an assessmentof the types and levels of obligation that the firm has to eachstakeholder. This phase is aimed to accurately locate the firm
as enmeshed in a continuum of ethically relationships.
In conclusion, the aim of stakeholder analysis is tounderstand the awareness, knowledge, perceptions, interests,
and expectations that shape debates among stakeholders on
biotechnology in order that firms can better develop
management strategies and practices in handling newtechnologies.
Topics/Issues in Biotechnology Management
In addition to reviews of concepts of corporate
governance, biotechnology business ethics, and stakeholder
analysis for the biotechnology industry, the researchers havereviewed a number of biotechnology management curricula
offered by some leading universities (see Appendix 1: List of
Selected Universities that offer Biotechnology Management
Course). Then, a number of studies and articles on
management knowledge, skills, and issues related to effective
biotechnology management were also reviewed.
From the sources of information mentioned above, it
seemed that the most frequent topics appeared in the
curricula surveyed and the academicians’ concerns include:
1. Fundamental knowledge of principles of management
andstrategic management for biotechnology
industry (Burgelman et al, 2003; Christensen, 1999;
Dodgson, 2000; Roberts, 1995).
2. Fundamental
knowledge
inbiotechnology
industry(Raeburn 2000; Grace, 1997; Oliver, 2000)
3. Understanding entrepreneurial mindset in startup andlarge companies. (Meyer et al., 1986; Roberts, 1991
4. Finance: financing for biotechnology business, grant
proposal strategies and management (Blandford,
1991; Hale, 1994; Ries and Leukefeld, 1998).
5. Marketing: market analysis, marketing strategies forbiotechnology products (Moore, 1991; Wansink andKim, 2001; Zimmerman et al., 1994).
6. Regulatory issues in biotechnology industry such as
clinical trial process for both devices and drugs, FDA
approvals, etc.
7. Intellectual property and commercialization (Besend andRaskind, 1991; Reitzig, 2004)
8. Product development and transition to business units(Cooper et al., 1999; Wheelwright and Clark, 1992)
9. Bioethics and legal issues. (Bulger et al., 1993; Colley etal., 2003.)
10. Stakeholder analysis and corporate governance (Aerni,
2001; Macdonald, 2004; Monks and Minow, 2001,
Wallace and Zinkin, 2005).

Eubios Journal of Asian and International Bioethics 17 (November 2007)
Research Methodology
Based on the topics listed in the previous part, a draft fora curriculum of the course “Principles of Management in
Biotechnology” was developed for comments by experts,
managers in biotechnology industry, and managers in nonbiotechnology industry.
At the outset, the researchers planned to collect data via
interviews and questionnaire. However, when we pilot tested
our questionnaire, we found that respondents who were not in
the field of biotechnology did not understand the term
“biotechnology” and had very little knowledge about it.
Therefore, we selected personal interview and focus-groupinterview as major tools to collect the data because they could
provide richer information and unclear questions could beclarified during the interview.
Populations:Group 1: Experts
Personal interviews were conducted with 5 experts(academicians and researchers) in biotechnology.
Group 2:Top Management and Middle Managers of
Biotechnology Companies
Twenty-one top managers from 14 biotechnology
companies were interviewed. Among the 14 companies, 2
companies were from agricultural industry, 3 companies fromfood industry, 4 companies from healthcare industry, and 2
from pharmaceutical industry.
Then, focus-group interviews were conducted with 42 middle
managers from those 14 biotechnology companies mentioned
above (3 managers for each company).
Group 3: Twenty-five middle managers from 12 nonbiotechnology companies were asked for comments on thedraft of the curriculum and on other issues of concerns
regarding the management of biotechnology industry on
focus-group interviews.
Group 4: Fifty people from Bangkok metropolitan area
representing “the public” were asked for a short interview(about 5-10 minutes) to survey general awareness andperceptions of biotechnology. These people were not asked
to review the draft of the curriculum. The interviewees
included passers-by and/or shoppers from 4 shopping centers
in Siam Square area, Thonburi area, Srinakarindra area, andRama III area).
Overall results
Most interviewees agreed that the development ofbiotechnology management course should include thefollowing topics:
Rank no. 1: Marketing of biotechnology invention
Rank no. 2:
Corporate governance for biotechnology
business (bioethics and legal issues)
Rank no. 3: Managing conflicts of interests and safetyissues in biotechnology companies
Rank no. 4:
Fundamentals of management, strategic
management, entrepreneurship in biotechnology
industry
Rank no. 5: Financial management and grant management
Rank no. 6: Management for invention and innovation
Rank no. 7: Intellectual property of biotechnology products
Rank no. 8: Creating and managing human resource inbiotechnology business
The above ranking shows the perception of theimportance of each topic as perceived by all respondents.
Each respondent was allowed to select more than one topic
perceived as important.
The marketing of biotechnology invention was regarded
by most respondents as the most important area to be offeredin the curriculum. This may be resulted from the concern
about their quality of life that might be at risk by consuming
the products they were not well informed about, e.g. GMOs

187

(such as soybean), agricultural product adulteration (such asrice). Their concern maybe emerged from their ignorance
about biotechnology, its products, benefits, and risks.
The detailed results from each group’s interviews are
discussed below.
Results from Group 1
Overall, this group perceived biotechnology as criticalmechanism to drive national development and growth if usedproperly and ethically. They expressed their concern about
the level of public awareness and understanding of
biotechnology which seemed so minimal and superficial.
“When people don’t know biotechnology and are noteducated about it, it is very easy for some NGOs to run any
propaganda against GMOs, or other biomedical research by
painting biotechnology to look like a monster that will takeaway people’s lives quietly!,” said one of the experts. Anotherexpert shared his view that, “Although the former Government
had laid out the policy framework for biotechnology
development, they did not do a good job to educate the public
about biotechnology. I think the government themselves do
not quite understand it (biotechnology) as well. Someministers think that it sounds modern to include biotech intheir policy!”
The experts perceived that good management or good
governance in the fast-growing biotechnology industry is verymuch in need because “The technology changes so fast andthere are a lot of problems regarding biosafety guidelines forlaboratory work and for field work such as the issue of therelease of genetically improved organisms (GIOs) into theenvironment.”
Another issue about the field testing of transgenic plantsin Thailand was mentioned by an expert that, “Generally,
Thailand, like other developing countries, lacks the standard
infrastructures for most operational steps regarding the fieldtesting procedures. Although NBC (the National Biosafety
Committee) had developed Biosafety Guidelines, but they are
just only guidelines not law. If scientists or companies do notfollow the guidelines, there are no penalties.
So thedevelopment of business ethics and social responsibilities inbiotechnology management program is really important.”
Another feedback was about the need to develop
management skills in innovation management, financial
management, and entrepreneurial skills in scientists who
were promoted to take management role.
With regard to intellectual property, the experts said that
now Thai scientists better realized about this issue than adecade ago. “But it’s still a good idea to include this topic in
the curriculum,” concluded an expert.
Results from Group 2
About one-third of the managers interviewed had theirdegree in business administration and according to them,“Biotechnology is just another kind of business. So the
management concepts we learned from school can beapplied in managing this business. With some more study
about the biotechnology industry in terms of legal issues, andoperations guidelines, we can manage it.”
Regarding the topic of human resource management, themajority of the managers agreed that the most important
problem confronting their companies was the inadequate poolof qualified personnel in biotechnology and the retention ofthese people.
Another important issue mentioned was about the
intellectual property of biotechnology products. More thanhalf of them similarly said that the field of biotechnology is
new but it grows very fast, therefore the intellectual property
law found a hard time to catch up with technologies.
For top management, more than half of them commented
that advertisement and marketing was important because
certain biotechnology products or service could be perceived

188

Eubios Journal of Asian and International Bioethics 17 (November 2007)

and/or received differently in different society. “Now it is notclear how society will deal with the growing ability of
researchers to manipulate genomes. What kind of marketingstrategy should be used to ethically promote genetics
services available in hospital in the future?,” said a private
hospital administrator.
Another important issue identified by these managers is
the intellectual property of biotechnology products. More thanhalf of them similarly said that the field of biotechnology is
new but it grows very fast, therefore the intellectual property
law found a hard time to catch up with technologies.
The last issue addressed by top management was about
the management of new products or innovation inbiotechnology. They realized that only good ideas or evendiscoveries of new products were not sufficient to createbusiness. Scientists must be trained to be market-oriented,
customer-oriented, cost-efficiency oriented, and fast enoughto be the first to launch the product.
Results from Group 3
About 90% of managers from non-biotechnology
companies were not familiar with the term “biotechnology,”
and were not certain about what the term really meant. Mostof the managers interviewed had at least a Bachelor Degreeand some of them hold Master Degree. These people
admitted that they knew very little about biotechnology
products and/or inventions. All of them heard about GMOs
and animal cloning from newspaper and from some TV
programs but did not paid much attention to such information
since biotechnology sounds not related to their daily life.
However, when the interviewees were provided withsome introductory information from the researchers, they thenrealized how close biotechnology was to their life. They
became more involved in giving comments. Their priority
concern was about bioethics, biosafety, and how their rights
as consumers should be protected. According to them,marketing management of biotechnology played a critical rolein introducing/communicating the products to the consumers.
They voiced their opinion that, “We understand thatbiotechnology yields both benefits, and also, risks. We hopethat the government will do a better job in educating the public
about biotechnology and we expect the business sector tohave social responsibilities in providing accurate information
to the consumers via advertisement, product labeling, anddon’t just providing only the good side of their merchandises
or services.”
Another comment was about the term “biotechnology”
itself.” Many said that, “I just don’t get it, I just know that it is asort of technology. Can anyone come up with a simpler termthat people walking down the street can understand?”
Although the marketing issue attracted much attention
from these managers, they insisted that the curriculum should
include fundamentals of management, finance, innovation
management, and knowledge of intellectual property. Withreference to intellectual property, a few managers commented
that, “Thailand had bad reputation about copyright as we liketo sell fake brand name merchandises. And when we caninvent something new, we are so naïve and slow in getting apatent. We have to improve on this. Developed countries likethe US, Japan, have more experience than Thailand aboutprotecting their intellectual property and they are very fast in
doing this. So we got to be careful about this matter or we willlose our competitiveness.”
Results from Group 4
The public were not asked to review the draft of thecurriculum but
they were interviewed to assess theirawareness and understanding of biotechnology in general.
Among 50 people interviewed, 78% said that they had neverheard of the term “biotechnology”, 11% heard of the term
“biotechnology” but did not understand the meaning, and therest 11% heard of the term and understood the meaning andimportance of biotechnology.
Although about two-third of this group never heard of theterm “biotechnology,” however, when asked about GMOs,
81% heard about this term because they heard the discussion
about GM-crops such as soybean and papaya. And even
they heard about GMOs, they did not clearly understand what
the term GMOs meant, they just understood that GM-crops
were different from normal (natural) crops but they did notknow what the differences were.
From the interviews, the researchers felt that there was ahigh level of anxiety about biosafety.
Some of the
respondents said that, “We don’t know if the ‘Somtam’ (Thaipapaya salad) we have everyday is cooked from geneticallyengineered papaya or not. We don’t know if the geneticallyengineered papaya will cause any sickness in our body in thelong run or not.” They requested that the genetically modified(GM)food should be clearly labeled as “GM-food” so theywould be able to decide to consume or not.
The public also requested that the Government shouldtake more pro-active effort to inform and educate the publicmore frequently about biotechnology by using simpler terms
and examples. “The Government should do more PR about
the concept via radio program or television just like the way
they did the PR for election or about measures to prevent thebird-flu or dengue fever,” one interviewee suggested.
Despite the limited knowledge on biotechnology, themajority of the public agreed that a good curriculum
specifically designed for biotechnology management iscertainly needed.
Conclusion
Most interviewees agreed that a curriculum forbiotechnology management curriculum is necessary for
Thailand to speed its process of economic growth throughgood governance of the technology which takes all
stakeholders’ concerns into consideration.
Marketing issues, biosafety, and bioethics received mostof the attention from the interviewees because they were
worried about the risks and their quality of life. The
researchers also learned that the less people know aboutbiotechnology, the more they are anxious or afraid of it.
Although this research surveyed only a small number ofsamples, the results signifies an important issue about the lowlevel of public awareness and understanding of biotechnologythat might have some impact on the speed of development of
this technology and the speed of national development byusing this technology.
Recommendations
Based on the research findings, the Biotechnology
Management curriculum for Thailand should reflect the needsof 2 groups of people: the scientists who lack management
skills but are promoted to take managerial role and the
managers who were trained in management but lack theknowledge in biotechnology industry.
In addition, thecurriculum should involve other ethics-laden topics which may
concern both groups, e.g. general business social ethics andresponsibilities, ethics for biotechnology industry in particular,
ethics in marketing, managing (and educating) stakeholders,etc.
Successful development and utilization of biotechnology
depends on several factors including clear government policy
and up-to-date law, research funding from both government
and private sectors, responsible and knowledgeable
researchers, effective and ethical business, and, mostimportantly, well informed public.
The development and successful implementation of
biotechnology management program can hardly be realized if
the public, one of the stakeholders, are not sufficiently
educated about technology. If the public or the consumers do
not understand the benefits and risks of biotechnology, theyEubios Journal of Asian and International Bioethics 17 (November 2007)
will not know their rights. And when the public do not know
their rights (to be protected), they can hardly justify or control
other major stakeholders --the Government and the business.
A good curriculum can develop qualified graduates, butcannot guarantee effective and ethical managers. Effective
and ethical managers are the consequences of several
variables including good family, good school, goodorganization culture and management, good and smart
government, good laws, and well-informed citizen to watch
the business. Therefore, the public must be adequately
educated about biotechnology so they will become more
active citizen and consumers. Unreasonable fears and myths
about biotechnology will be eradicated. More demands ofbiotechnology products and services will naturally increase
and it will then spur the inventions from the business andresearchers.
References
Aerni, P. 2001. “Assessing Stakeholder Attitudes to Agricultural
Biotechnology in Developing Countries,” Biotechnology andDevelopment Monitor, 47, pp. 2-7.
Agri-Food Trade Service: Market Information Southeast Asia, “The
Biotechnology Sector in Thailand,” (July 2002), Canada,available online at http://ats-sea.agr.gc.ca/ asean/ e3337.htm.
Besen, S. M. and Raskind, L. J. 1991. “Introduction to the Law andEconomics of Intellectual Property,” Journal of Economic
Perspectives, 5 (1), (Winter), pp. 3-27.
Blandford, D. 1991. “Automating Grants Management and Review,”
SRA Journal, 23 (1), pp. 5-12.
Bulger, R. E. et al. 1993. The Ethical Dimensions of the Biological
Sciences, New York: Cambridge University Press.
Bunnag, U. 2007. “Biotechnology in Thailand,” Thailand Investment
Review, 17 (4), (April), pp. 5-6, available online at
http://www.boi.go.th/english/download/
publication_investment/73/April_07.pdf.
Burgelman, M. et al. 2003. Strategic Management of Technology andthInnovation, 4 Edition, New York: McGraw-Hill.
Business-in-Asia.com, 2005. “Overview of Thailand’s Biotech Efforts,”
Biotechnology Industry in Thailand, available online at
http://www.business-in-asia.net/biotech_programs.html.
Christensen, C. M. 1999. Innovation and the General Manager,
Toronto: McGraw-Hill.
Colley, Jr. John L. et al. 2003. Corporate Governance, The McGrawHill Executive MBA Series.
Cooper, R. G., Edgett, S. J., and Kleinschmidt, E. J. 1999. “New
Product Portfolio Management: Practices and Performance,”
Journal of Product Innovation Management, 16, pp. 333-51.
Dodgson, M. 2000. The Management of Technological Innovation: An
International and Strategic Approach, New York: Oxford
University Press.
Freeman, R. E. 2001. “A Stakeholder Theory of the Modern
Corporation,” In Beauchamp T. L. and Bowie N. E. (eds), EthicalthTheory and Business, 6 Edition, Prentice-Hall, p. 56.
Goodpaster, K. E. 1991. “Business Ethics and Stakeholder Analysis,”
Business Ethics Quarterly, 1 (1), pp. 53-72.
Grace, E. 1997. Biotechnology Unzipped: Promises and Realities,
Washington, D.C.: Joseph Henry Press.
Hale, C. 1994. Grants Management Handbook, Tempe, Arizona:
Maricopa County Community College District, Office of Grants
Development and Management.
Hoyte, J. and Weiskel, T. C. “Biotechnology and Environmental
Justice,” Working Group on Environmental Justice, available
online at http://EcoJustice.Net/ Biotechnology
Kato, M. and Darryl M. 2003. “How Biotechnology Companies
Respond to Bioethical Issues,” Journal of Commercial
Biotechnology, 1 (2), pp. 153-62.
MacDonald, C. 2002. “Corporate Governance and Biotech-Ethics,”thPaper presented at the Canadian Bioethics Society 14 Annual
Conference –October 17-20, 2002, available online at
http://www.biotechethics.ca/papers/ cbs2002-abst.htm
MacDonald, C. 2004. “The Stakeholder Concept in Biotechnology,”
Department of Philosophy, Saint Mary’s University, available
online at http://www.bioethics.ca/papers/stakeholder.html
Maidigue, M. A. and Zirger, B. J. 1985. “The New Product Learning
Cycle,” Research Policy, 14, pp. 299-313.

189

Mathiesen, H. 2002. “What is Corporate Governance?,” available
online at http://www.encycogov.com/WhatIsGorpGov.asp
nd
Monks, Robert A. G. and Minow, N. 2001. Corporate Governance, 2Edition, Great Britain: Blackwell Business.
Moore, G. 1991. Crossing the Chasm, New York: Harper Collins.
Oliver, R. W. 2000. The Coming Biotech Age: the Business of
Biomaterials, New York: McGraw-Hill.
Oman, C. P. 2001. “Corporate Governance and National
Development,” OECD Development Center, Technical Papers
No. 180, (September).
Pradhan, S. 2003. “Good Governance and Private Sector-Lead
Growth for Sustainable Development: Challenges andPerspectives,” A Paper presented at Madagascar Government
Learning Retreat, (June 14).
Raeburn, P. et al. 2000. “After Taco Bell: Can Biotech Learn Its
Lesson?,” Commentary, Business Week, (November 6).
Reitzig, M. 2004. “Strategic Management of Intellectual Property,”
MIT Sloan Management Review, 45 (3), pp. 35-40.
Ries, J. B. and Leukefeld, C. G. 1998. The Research Funding
Guidebook: Getting It, Managing It, and Renewing It, Thousand
Oaks, CA: Sage Publications.
Roberts, E. B. 1991. Entrepreneurs in High Technology: Lessons
from MIT and Beyond, New York: Oxford University Press.
Roberts, E. B. 1995. “Benchmarking the Strategic Management ofTechnology-I,” Research Technology Management, 38 (1), (JanFeb), pp. 44-56.
Tanticharoen, M. et al. 2003. “Recent Major Developments ofBiotechnology in Thailand,” A Paper Distributed at theConsultative Meeting of Asia Cooperation Dialogue in
Biotechnology, October 6-7, New Delhi, India.
Wallace, P. and Zinkin, J. 2005. Mastering Business in Asia:
Corporate Governance, Singapore: John Wiley & Sons (Asia)
Pte Ltd.
Wansink, B. and Kim, J. 2001. “The Consumer Marketing of
Biotechnology,” Journal of Commercial Biotechnology, 7 (3), pp.
249-59.
Weiss, J. W. 2003. Business Ethics: A Stakeholder and IssuesrdManagement Approach, 3 Edition, South Western, Thomson
Learning, Mason, OH.
Wheelwright, S. C. and Clark, K. B. 1992a. “Creating Project Plans to
Focus Product Development,” Harvard Business Review, (MarApr), pp. 70-82.
Zimmerman, L. et al. 1994. “Consumer Knowledge and Concern
about Biotechnology and Food Safety,” Food Technology, 48(11), November, pp. 71-7.

Appendix 1: List of Selected Universities that offer
Biotechnology Management Course
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Biomolecular Science Center, University of Central Florida
Biotechnology and Health Industry Management, Graduate
School, Penn State Great Valley
Biotechnology Graduate Programs, McGill University
Biotechnology Management Program, Southern Illinois
University Edwardsville
Biotechnology Program, College of Life Science, Peking
University
Biotechnology Program, Faculty of Sciences, The University ofHong Kong
Biotechnology
Project
Management,
Massachusetts
Biotechnology Council (MBC)
Business & Management, University of California Extension,
Santa Cruz
Center for Biotechnology Management, Kellogg School ofManagement at Northwestern University
Chemistry and Biotechnology Department, Graduate Courses,
The University of Tokyo
Decision Sciences Department, NUS Business School, National
University of Singapore
Department of Biomedical Engineering, Rensselaer Polytechnic
Institute
Department of Biotechnology, School of Bioscience andBiotechnology, Tokyo Institute of Technology
Department of Food Technology, Faculty of Science,
Chulalongkorn University, Thailand
Graduate Programs in Biotechnology, University of Maryland,
Baltimore County
Institute of Biotechnology, Technische Universität Berlin,
Germany

190
•
•
•
•
•
•
•
•
•
•
•
•

Eubios Journal of Asian and International Bioethics 17 (November 2007)

Management of Biotechnology, University of California, Davis
Graduate School of Management
Master of Biotechnology, The Wharton School of the Universityof Pennsylvania
Master of Science in Biotechnology Program, University of
Wisconsin
Modern Biotechnology Management, AIT Extension, Asian
Institute of Technology, Thailand
Molecular Biotechnology, Faculty of Science, The Chinese
University of Hong Kong
School of Biotechnology, Madurai Kamaraj University
School of Business, McMaster University
School of Management, University at Buffalo, The State
University of New YorkTechnology and the Bio-environment, University of Maryland
University College Europe
The Business of Biotechnology, Haas School of Business, The
University of California at Berkeley
The Institute for Biotechnology and Life Science Technologies,
Cornell University
The School of Agricultural Biotechnology, Seoul National
University

Invitation to Join Working Groups on

Ethics of Energy Technologies
in Asia and the Pacific
UNESCO Bangkok, on behalf of project partners (including the
Ministry for Science and technology and the Ministry of Energy, ofThailand), invites interested individuals and organizations to participate inworking groups for the Ethics of Energy Technologies in Asia and thePacific project.
About the project
Energy is intimately related to our environment and use of its
resources, as well as to almost every sphere of economic activity. As policy
makers around the world grapple with climate change, choices about energy
generation and consumption will have a significant impact on levels ofgreenhouse gas emissions and on environmental health, as well as people’sability to access energy to heat and cool their homes, travel, work and enjoy
leisure time.
This project is not intended to duplicate the numerous meetings being
held on energy and environment, but to open up ethical and value questions
that have often been neglected. It aims to depoliticize discussions onenvironmental ethics to produce substantive cross-cultural andmultidisciplinary outputs that will be relevant for long-term policy making.
The Asia Pacific region is experiencing the fastest annual growth inenergy demand in the world and meeting this demand over the next two
decades will be a tremendous challenge. As oil prices continue to climb,
countries face increasing pressure to articulate their energy policies andachieve energy security. The ethics of all energy choices, including fossil
fuels, biofuels, nuclear energy, fuel cells, renewables, etc., need beconsidered holistically. How will energy production affect the environmentand other living organisms? How will rising energy prices affect the poor?
What are our ethical obligations for consultation with local people? What are
our ethical obligations to future generations and what vision for the future do
we hold? Do environmental values held in Asian philosophical and religious
traditions affect the sustainability of our relationships with our environment?
The project was launched in September 2007 with a three day
conference at the Imperial Tara Hotel, Bangkok. Hosted by UNESCO
Bangkok in collaboration with the Ministry of Science and Technology andthe Ministry of Energy, Thailand, it was attended by a hundred people fromabout 20 countries, from many sectors and backgrounds, with a range ofviews on these issues.
About the working groups
Following on from the conference fourteen provisional working groups
have been formed on the following topics (more details below):•
Universalism and environmental values•
Ethical worldviews of nature•
Visions and hopes of the future•
Representation and who decides•
Community engagement•
Stakeholder responsibilities•
Energy equity and human security••

Cost-benefit analysis and economic constructions
Adoption & development of energy technologies (state of the art
review)•
Ethical frameworks for research agendas and policy•
Educational frameworks for environmental ethics•
Nuclear dialogues•
Energy flow, environment, and ethical implications of meatproduction•
Water ethics and water resource management
The aim of the working groups is to develop dialogue around theseparticular issues with a focus on environmental ethics and human security.
Each group will produce a report that can be used by policy makers,
scientists and researchers to consider the ethical dimensions of energy
policy.
Who are we looking for?
We are looking for people interested in participating in the working
groups with a diverse range of experience in energy and environmental
ethics, from fields including but not limited to engineering, government,
institutional advisory bodies, civil society organizations, energy-relatedindustries, education, and academia. The people participate as individuals in
the highest standards of intellectual vigor and integrity, and the reports will
be subject to peer review, and will not represent the views of partnerorganizations.
We are also looking for organizations with an interest in this project tohelp support the process of deliberation, consultations and dialogue.
Working group members are not paid for their time although there may
be funds available through UNESCO Bangkok and project partners forphysical and virtual meetings and other resources.
Want to know more?
For further information on the project please contact Dr. Darryl Macer,
Regional Unit in Social and Human Sciences in Asia and the Pacific(RUSHSAP) at UNESCO Bangkok on +66(0) 2391 0577, extension 147 or
email d.macer@unescobkk.org.
There is a yahoo group, unesco_eet@yahoogroups.com

Description of Working Groups
Universalism and environmental values
Environmental values in the Asia Pacific region are drawn from adiversity of rich philosophical and religious heritages. To what extent cancommon ground be found within a United Nations system that seeks to
implement universal rights and dialogue among different values? Is it
appropriate to seek universal or pluralist environmental values? Is there sucha thing as an ‘Asian environmental ethos’ that might be the foundation forbuilding and promoting a more sustainable economic growth?
Ethical worldviews of nature
Are there worldviews inherent in philosophical and religious traditionsof the Asia Pacific that shape ethical relationships with the natural world?
Are these anthropocentric, biocentric, ecocentric or cosmocentric
worldviews? How do our worldviews allocate value and meaning to people,
plants, animals and the biosphere? What are the relationships between suchworldviews and actual decisions made by policymakers or the daily lives ofthe people they represent?
Visions and hopes of the future
What is the most appropriate timescale to consider problems ofenvironmental ethics – years, decades, centuries, or generations? Is there acommon vision of where we would like society to go beyond MDGs? Howto balance economic growth, quality of life, and other future aspirations in aholistic vision?
Representation and who decides
What are the rights of nation states to decide on energy technologies fortheir people, when such decisions may pose an environmental or security
risk to neighboring countries, to the region or to all countries? What arerights of provinces, communities and ethnic groups with regards to energy
infrastructure in their geographic area?
Community engagement
How can we engage communities in the decision-making process? Are
communities being given a chance to articulate their environmental values?
Do communities have adequate access to information about energy
technologies and their risks and benefits? What is the role of education inassisting communities to make decisions about their future? Are women andyoung people being engaged? What are the appropriate stages of an energy
project for community consultation? Is there a trade-off between adequate
consultation time and expedient implementation of a project? How can wedevelop the ‘not in my backyard’ view when it comes to large-scale energy

Eubios Journal of Asian and International Bioethics 17 (November 2007)
infrastructure? How can community engagement reflect the emerging
paradigm shift from principles of paternalism through those of informed
consent to informed choice?
Stakeholder responsibilities
What are stakeholders’ responsibilities towards the environment and to
future generations? Is a rights’ based framework really appropriate forenvironmental ethics, when an emphasis on responsibilities may be more
important? When regional or global consensus cannot be reached, docountries have a responsibility to do what is ‘ethically correct’, even if noone else will? The group will articulate the responsibilities of scientists,
policy makers (funding and regulation), the public (including consumers andnon-consumers of different products), investors, companies, institutions,particular interest groups (e.g. geographically close to a power plant,
occupational groups, faith groups), and other living organisms, as examples
in a cross-cultural perspective.
Energy equity and human security
While energy generation supports economic growth and a higher
standard of living, it also has financial and environmental costs. How do wereconcile the disproportionate consumption of energy by developed
countries with increasing demand for energy in developing countries, andparticularly across the Asia Pacific region? Is it appropriate for rich countries
to encourage less developed countries to limit their energy consumption andshun luxury lifestyles? Is there a way for developing countries to access thetechnology and expertise that permits more efficient energy generation in thedeveloped world? At the social level, should governments provide
concessions to make energy more affordable and accessible for lowerincome people? Do government subsidies for energy run the risk ofsubsidizing inefficient use of energy?
Cost-benefit analysis and economic constructions
How can environmental and cultural values best be incorporated into
cost-benefit analyses for energy projects? What are the real costs of ‘cheap
energy’? What are the costs of any form of energy if we consider theopportunity costs of infrastructure construction or land surface area, and totalenergy costs over the lifecycle of a product, including waste, disposal andsecurity?
Adoption & development of energy technologies (state of the art review)
This review of energy alternatives for local and national scale projects
will focus on the ethical implications inherent in different research options
for energy production and delivery. It will include development ofinnovation in new science and translational research, diffusion oftechnology, and energy diversity. It will also consider global networking and
IT. It will analyze points of different alternatives.
Ethical frameworks for research agendas and policy
What criteria do policymakers use in deciding to adopt energy
technologies, and how are ethical considerations taken into account? Howshould policy makers identify and employ the precautionary principle? How
can they ensure appropriate gender-sensitive aspects in policy formulationfrom planning through implementation and impact assessment, emphasizingthat women in a society are assets (UNEP) in environmental and energy
management?
This group will examine the different understanding of ethicalframeworks by looking at critical ethical issues including: codes of ethics forresearchers, societal values, rights of all participants (stakeholders), rights ofindigenous peoples, religious values, legal issues and take account of theconclusions of the specialized working groups above. After a review of allpolicies it will analyze the ethical frameworks inherent in the documents todraw up a model ethical framework.
Educational frameworks for environmental ethics
This working group will link to ongoing efforts to develop and test
environmental ethics education materials and strategies with pilot trials. The
topics link to the coverage of all the above working groups.
Nuclear dialogues
This group will look at the particular sensitivities of the nuclear energy
debates from an ethical perspective.
Energy flow, environment, and ethical implications of meat production
Meat, as a food, is a form of energy for humans, but in order to produce
enough meat to satisfy global demand huge reserves of energy are requiredin the form of feed, fertilizers, pharmaceutical production, transport andrefrigeration. This group will examine the consumption of energy,
particularly fossil fuels, in the meat production industry, and ethicalimplications for humans and the environment.

191

Water ethics and water resource management
The ethical issues associated with water resource management,
including its uses in energy and other domains are a priority area in many
countries. There are also issues over equity of access, ways to conserve
water, and privatization of what many consider to be a common resource.

Erratum: Gabriela Marodin, Diana Monti Atik, Danielle
Beheregaray Schulz, José Roberto Goldim, Risk Information
Assessment in Pharmacological Projects, EJAIB 17 (July
2007), p. 109-112. The editor regrets that the captions for
Figure 1 and Figure 2 on pages 110-111 were switched, andshould be reversed. The on-line pdf version was corrected.

News in Bioethics & Biotechnology
http://eubios.info/NBB.htm
International Bioethics Education Project News
<http://groups.yahoo.com/group/Bioethicseducation/>)

IAB Genetics & Bioethics Network: On-line
The complete address list is updated on the Internet. Send allchanges to Darryl Macer.

UNESCO Asia-Pacific School of Ethics
http://www.unescobkk.org/index.php?id=4913
EJAIB Editor: Darryl Macer
Associate Editors
Jayapaul Azariah (All India Bioethics Association, India),
Masahiro Morioka (Osaka Prefectural University, Japan).
Managing Editor: Nobuko Yasuhara Macer
Editorial Board: Akira Akabayashi (Japan), Sahin Aksoy (Turkey),
Angeles Tan Alora (Philippines), Atsushi Asai (Japan), Alireza
Bagheri (Iran), Gerhold Becker (Germany), Hasna Begum(Bangladesh), Minakshi Bhardwaj (UK), Christian Byk (IALES;
France), Ken Daniels (New Zealand), Leonardo de Castro (ThePhilippines), Ole Doering (Germany), Norio Fujiki (MURS Japan),
Tran Han Giang (Vietnam), Thomas Gionis (USA), Dena Hsin
(Taiwan), Rihito Kimura (Japan), Abby Lippman (Canada),
Margaret Lock (Canada), H. Ahmad Ludjito (Indonesia), V.
Manickavel (Nepal), Anwar Nasim (Pakistan), Mary Ann Chen Ng,(Philippines), Jing-Bao Nie (China, New Zealand), Pinit Ratanakul(Thailand), Qiu Ren Zong (China), Hyakudai Sakamoto (Japan),
Sang-yong Song (Korea); Noritoshi Tanida (Japan), A.K. Tharien(India), Yanguang Wang (China), Daniel Wikler (USA), Michael
Yesley (USA), Jeong Ro Yoon (South Korea).

Asian Bioethics Association (ABA)
The website for ABA is <eubios.info/ABA.htm>

ConferencesA
bioethics
conference
calendarwebsitehttp://www.who.int/ethics/events/en/
For a list of some ethics meetings in Asia and Pacific:

is:http://www.unescobkk.org/index.php?id=current_and_future_events

UNESCO-University of Kumamoto Joint Bioethics
Roundtable: Self-Determination in Asia
15-16 December, 2007 University of Kumamoto, Japan
Contact: Dr. Darryl Macer, Prof. Takao Takahashi
Ninth Asian Bioethics Conference (ABC9): Healthy andProductive Life in Harmony with Nature, 3-7 November,
2008, Jogyakarta, Indonesia. Hosts: Indonesian National
Bioethics Commission.

Eubios Journal of Asian and International Bioethics 17 (November 2007)

192

ASIAN BIOETHICS ASSOCIATION MEMBERSHIP 2008<http://eubios.info/ABA.htm>
and ASSOCIATE MEMBERSHIP IN EUBIOS ETHICS INSTITUTE 2008____ I wish to pay my annual membership fees of Asian Bioethics Association (ABA),

and receive the 2008 issues of Eubios Journal of Asian and International Bioethics(EJAIB) (The Official Journal).
____ Regular Price: US$50 Euro 40 UK£30 NZ$60 A$60 C$60 ¥5000 (=Credit card price NZ$90)____ I wish to make a reduced contribution of____ I wish to register as a member of Asian Bioethics Association, but am not in the position to
pay a fee. I understand that I should be satisfied with Internet access to Eubios Journal of Asianand International Bioethics (EJAIB) <http://eubios.info/EJAIB.htm>.

____ I wish to apply to become an associate member of Eubios Ethics Institute for the year 2008.
This includes the 2008 issues of EJAIB, and a 10% discount on book and CD sales at this time. It is
no additional charge for members of Asian Bioethics Association. For other persons the price is:____ Regular Price: US$40 Euro 35 UK£20 NZ$50 A$50 C$50 ¥4000 Overseas price NZ$70____ Exchange subscription with journal, newsletter, etc. (Name____________________ )____ I agree / ____ do not agree to my name being listed on the Eubios www site for the: ABA and/or

Genetics and Bioethics Network (circle one or both) (send also tel/fax/Email):
Yes ___ Signature:
List Interests to be included in network list on <http://eubios.info/GBNads.htm>

I order the following Eubios Ethics Institute books

Post or Fax or send an Email with your address* (or include current address label)
to: Prof. Darryl Macer,
Eubios Ethics Institute, 31 Colwyn Street, Christchurch 8005, New ZealandFax: Int+66-2-664-3772
Email: asianbioethics@yahoo.co.nz

Please find my cheque for:Note: Cheques in local currency are accepted from accounts with major banks in Australia, Canada, EU, New
Zealand, USA, U.K. (The currency has to be the same as the address of the bank, and the cheque made out to"Eubios Ethics Institute"). Other currencies use a bank or post draft in NZ$ for the Overseas price. In Japan use
postal transfer to the "Eubios Ethics Institute" account 00340-9-32465.

Or authorize a one time credit card payment as below:
Please charge my VISA / MASTERCARD card (circle) for NZ$**
Account #Signature

Expiry Date
Name:

*Mailing address:

Email:Fax:** Other Eubios books / CD may be ordered with 25% discount at the time of renewing the subscription.

Fax to: Prof. Darryl Macer, Fax Int+66-2-664-3772 (or send by Email or post)

Eubios Journal of Asian and International Bioethics 17 (November 2007)
How to order books or journal or the CD!
Cheques in local currency are accepted from accounts withmajor banks in Australia, Canada, New Zealand, USA,
U.K. (The currency has to be the same as the address of thebank, and the cheque made out to "Eubios Ethics Institute").

193

Please use the renewal form enclosed and prices are
below: Other currencies (use a bank or post draft) andcredit cards use NZ$ for the Overseas price.
In Japan use postal transfer to the "Eubios Ethics Institute"account 00340-9-32465.

Eubios Ethics Institute Publications (Books sent by SAL post, Journal by Airmail - Price included)
Eubios Journal of Asian and International Bioethics
Other countries/credit card
Price:

US$35 Euro 35 UK£20 NZ$40 A$40 C$40 ¥3000

NZ$60

Shaping Genes: Ethics, Law and Science of Using Genetic Technology in Medicine and Agriculture
by Darryl Macer, Oct. 1990, 421pp.
Cost: US$20 UK£10 NZ$30 A$25 C$22 ¥2500 Others or credit card NZ$30
Equitable Patent Protection in the Developing World
by William Lesser, May 1991, 150pp.
Cost: US$15 UK£8 NZ$20 A$20 C$17 ¥1500
NZ$25
Attitudes to Genetic Engineering: Japanese and International Comparisons (Bilingual)by Darryl Macer, May 1992 330pp.
Cost: US$30 UK£15 NZ$35 A$30 C$30 ¥3000
NZ$40
Human Genome Research & Society
Eds: Norio Fujiki & Darryl R.J. Macer July 1992 ISBN 0-908897-03-0 (English),
230pp. ISBN 0-908897-04-9 (Japanese), 240pp. Cost: US$20 UK£10 NZ$30 A$25 C$22 ¥2000

NZ$30

Intractable Neurological Disorders, Human Genome Research and Society Eds: N. Fujiki & D. Macer
Feb. 1994 ISBN 0-908897-06-5 (English), 320pp. ISBN 0-908897-07-3 (Japanese), 340pp.
Cost: US$25 UK£12 NZ$30 A$30 C$27 ¥3000

NZ$40

Bioethics for the People by the People
by Darryl Macer,... May 1994 ISBN 0-908897-05-7, 460pp. Cost: US$30 UK£15 NZ$35 A$35 C$32 ¥3000 NZ$50
Bioethics in High Schools in Australia, Japan and New Zealand,
March 1996, ISBN 0-908897-08-1, 200pp.(A4)by D. Macer, Y. Asada, M. Tsuzuki, S. Akiyama, & N.Y. Macer
Cost: US$25 UK£15 NZ$30 A$30 C$30 ¥2000

NZ$40

Protection of the Human Genome and Scientific Responsibility (Bilingual)
Editors: Michio Okamoto, Norio Fujiki & D.R.J. Macer,
April 1996, ISBN 0-908897-09-X, 210pp.
Cost: US$25 UK£15 NZ$30 A$30 C$30 ¥2500

NZ$35

Bioethics in India (includes 115 papers from Jan.1997 conference)
Eds: Jayapaul Azariah, Hilda Azariah & Darryl R.J. Macer
June 1998 ISBN 0-908897-10-3, 403 pp.
Cost: US$30 UK£18 NZ$34 A$36 C$36 ¥3000
NZ$45(Printed in India)
Bioethics is Love of Life: An alternative textbook
by Darryl Macer, July 1998 ISBN 0-908897-13-8, 152pp. Cost: US$26 UK£14 NZ$34 A$34 C$32 ¥3000
NZ$40
Bioethics in Asia (includes 118 papers from Nov.1997 conferences, ABC’97 Kobe and Fukui Satellite)
Cost: US$36 UK£20 NZ$40 A$38 C$40 ¥3000
NZ$50
Eds: Norio Fujiki & Darryl R.J. Macer
June 1998 ISBN 0-908897-12-X, 478 pp. October 1999 ISBN 0-908897-14-6 (Japanese), 320pp.
Ethical Challenges as we approach the end of the Human Genome Project
Editor: Darryl Macer, April 2000 ISBN 0-908897-15-4, 124pp. Cost: US$20 UK£12 NZ$30 A$30 C$30 ¥2500 NZ$35
Bioethics Education in Japanese High Schools (in Japanese only)
Editor: Darryl MacerApril 2000 ISBN 0-908897-16-2, 112pp. Cost: US$20 UK£12 NZ$30 A$30 C$30 ¥1000 NZ$35
Bioethics and the Impact of Human Genome Research in the 21st Century
Eds: Norio Fujiki, Masakatsu Sudo, & Darryl R.J. Macer March 2001 (English and Japanese bilingual, 350pp).
Cost: US$30 UK£20 NZ$40 A$38 C$40 ¥3000

Bioethics in Asia in the 21st Century
Eds: Song Sang-yong, Koo Young-Mo & Darryl R.J. Macer
August 2003 ISBN 0-908897-19-7, 450pp. Cost: US$35 Euro35 UK£20 NZ$40 A$38 C$40 ¥3000
Challenges for Bioethics from Asia
Ed: Darryl R.J. Macer
November 2004 ISBN 0-908897-22-7 656 pp. Cost: US$35 Euro35 UK£20 NZ$40 A$38 C$40 ¥3000
A Cross Cultural Introduction to Bioethics 2006, 300pp. (A4)
Editor: Darryl Macer

The Eubios CD-ROM

Cost: US$35 Euro35 UK£20 NZ$40 A$38 C$40 ¥3000
all journals + all books ++ (English version) US$190

NZ$50
NZ$50
NZ$50
NZ$50
NZ$400Please send a copy of the whole page.

Please find my cheque for:I wish to receive a free copy (only for developing countries)

Please charge my VISA / MASTERCARD card for NZ$

Account #Signature
Date (D/M/Y)

Expiry Date
Want to join the IAB Bioethics andGenetics Network(Yes/No)

Mailing address:
Email:
Fax:
Research Interests (for Network):
You can Fax this order page to Int+66-2-664-3772 (AND Email to: asianbioethics@yahoo.co.nz)